Thymic Cancer Metastasis: Symptoms and Treatment Options

Thymic carcinoma metastasis

Hello Doctor, my family member, a 21-year-old male, experienced lower back pain and underwent an X-ray in early February, which revealed an abnormal enlargement of the thymus.
A biopsy confirmed thymic carcinoma (lymphoepithelial type) with bone metastasis, and he started chemotherapy once a month (chemotherapy drugs: Camptothecin, Carboplatin, and Etoposide).
After three cycles of chemotherapy, a CT scan showed that the tumor had not significantly reduced; the chemotherapy was not very effective, although there was some improvement in the lower back pain from bone metastasis (the pain is no longer intermittent).
However, he still cannot bend over because his red blood cell count has been below 7 after each chemotherapy session, and he experiences severe thigh pain that prevents him from sleeping.
Therefore, we decided to pause chemotherapy for a month, but his condition worsened during this time.
He is now unable to walk, has developed purpura on his thighs, his heart rate fluctuates between 120-140 beats per minute, and his respiratory rate is about 45 breaths per minute.
He is lethargic, his fingers tremble involuntarily, and there are many swollen lymph nodes in his neck.
During a follow-up visit, the doctor advised against continuing treatment at their hospital.
Currently, we are giving him traditional Chinese medicine (Detoxifying and Nourishing Decoction) to boost his red blood cell count, along with recommended stem cell therapy (three days a week).

I would like to ask, for the past month, he has been mostly bedridden, and recently he has been waking up and saying strange things, such as suddenly asking me if there are guests visiting.
This has been happening more frequently, possibly three to four times a night.
Could this be a symptom of brain metastasis, or is it more likely due to prolonged lethargy and being bedridden? Because he does not seem to exhibit other symptoms typically associated with brain metastasis.
Thank you, Doctor.

Ms. Chen, 20~29 year old female. Ask Date: 2016/07/24

Dr. Lai Yicheng reply Oncology

Hello Ms.
Chen, regarding the symptoms of your relative, we are unable to provide an accurate diagnosis without actually observing the symptoms.
Please return to the hospital for a thorough evaluation by a physician.
It is important to seek medical attention as soon as possible for detailed examinations, in order to initiate treatment promptly and avoid any delay in the condition.
This message is from Dr.
Lai Yi-Cheng, Department of Radiation Oncology, Changhua Hospital.

Reply Date: 2016/07/24

More Info

Thymic cancer, particularly lymphoepithelial carcinoma, is a rare and aggressive form of cancer that can lead to significant complications, including metastasis to bones and potentially other organs, including the brain. Your family member's situation is concerning, especially given the symptoms and treatment history you've described.

Understanding Symptoms and Potential Metastasis
The symptoms your family member is experiencing, such as severe back pain, difficulty walking, and changes in mental status (e.g., confusion or unusual speech), warrant careful evaluation. While the back pain may have improved with chemotherapy, the emergence of new symptoms, particularly the cognitive changes, raises the possibility of metastasis to the brain or other complications related to the cancer or its treatment.

1. Cognitive Changes: The episodes of confusion or unusual speech could be indicative of several issues:
- Brain Metastasis: Thymic cancer can metastasize to the brain, leading to neurological symptoms. If cancer cells have spread to the brain, symptoms may include confusion, changes in behavior, headaches, seizures, or other neurological deficits.

- Chemotherapy Effects: Chemotherapy can cause cognitive changes, often referred to as "chemo brain," which can manifest as confusion, memory issues, or difficulty concentrating.

- Metabolic Issues: Low red blood cell counts (anemia) can lead to fatigue, weakness, and cognitive impairment. The heart rate and respiratory rate you mentioned are also concerning and may indicate underlying distress or metabolic imbalance.

2. Physical Symptoms: The inability to walk and the appearance of bruises (purpura) could be related to:
- Anemia: Low red blood cell counts can lead to weakness and increased susceptibility to bruising.

- Bone Metastasis: If the cancer has spread to the bones, it can cause pain and weakness in the affected areas, contributing to mobility issues.

Treatment Options and Considerations
Given the complexity of your family member's condition, it is crucial to consider the following:
1. Oncology Consultation: If the current treatment facility is not providing adequate care or options, seeking a second opinion from a specialized cancer center may be beneficial. They can offer additional insights into treatment options, including targeted therapies or clinical trials that may be available.

2. Palliative Care: Given the severity of symptoms and the impact on quality of life, involving a palliative care team can provide support for symptom management, pain relief, and emotional support for both the patient and family.

3. Monitoring for Neurological Symptoms: If there is a concern for brain metastasis, imaging studies such as an MRI of the brain may be warranted to assess for any lesions or changes that could explain the cognitive symptoms.

4. Supportive Care: While traditional treatments are important, complementary approaches, such as nutritional support, physical therapy, and possibly integrative therapies (like acupuncture or meditation), can help improve quality of life.

5. Stem Cell Therapy: While some patients explore stem cell therapy, it is essential to discuss this with a qualified oncologist to ensure it is appropriate for the specific type of cancer and the patient's overall condition.

Conclusion
In summary, the symptoms your family member is experiencing could be multifactorial, including potential metastasis, treatment side effects, or metabolic issues. It is crucial to have a comprehensive evaluation by healthcare professionals who can assess the situation holistically and provide appropriate interventions. Early detection of any new complications, especially neurological ones, is vital for effective management and improving quality of life. Please ensure that your family member receives the necessary medical attention and support during this challenging time.

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