Thymic carcinoma is a rare mediastinal malignant tumor with unknown cause. It is derived from thymic epithelial cells. The most common tissue types are squamous cell carcinoma and undifferentiated carcinoma. Thymic carcinoma exhibits a malignant biological behavior that is significantly different from thymoma in histological behavior. Thymic cancer is more common in adult males, with an average age of 50 years old. 1. Incidence Primary thymic cancer is a relatively rare malignant tumor in clinical practice, accounting for 9.4% to 36.3% of thymic tumors. This disease is more common in adult men, more common between the ages of 40 and 60. Thymic carcinoma Thymic squamous cell carcinoma 2. Main symptoms The clinical manifestations of thymic carcinoma are mainly chest pain, chest tightness, cough and sputum, fatigue, weight loss, etc. It is very similar to thymoma, and some patients may not have any symptoms. A few patients may also have extrathoracic syndrome at the same time. Thymic carcinoma with pleural effusion 3. Preoperative diagnosis Preoperative diagnosis of primary thymic carcinoma mainly relies on chest X-ray and CT. It often appears as a mediastinal mass shadow with uniform density without calcification, severe invasion into surrounding organs, and fat gaps. disappear. However, these signs are still difficult to distinguish from malignant thymoma. The diagnosis of primary thymic cancer relies on pathological examination. According to the WHO thymoma classification, thymic cancer is defined as type C. Its diagnostic criteria are that tumorous epithelial cells have obvious malignant cytological characteristics, which are different from those occurring in other tumors. Cancers of organs are similar. 4. Classification and staging Classification: Thymic cancer can be further divided into squamous cell carcinoma, lymphoepithelioma-like carcinoma, sarcomatoid carcinoma, clear cell carcinoma, undifferentiated carcinoma, etc. The former two are the most common. The staging is based on the Masaoka staging: Stage I means that the tumor capsule is generally intact and there is no microscopic capsular invasion; Stage II means that the tumor invades surrounding adipose tissue or mediastinal pleura with the naked eye, and there is capsular invasion under microscopic examination; Stage III means that the tumor invades adjacent organs (Pericardium, great blood vessels, lungs); Stage IVA means pleural or pericardial dissemination; Stage IVB lymphatic or blood vessel metastasis 5. Surgical resection is the first choice of treatment plan; extended resection can be performed for those with invasion of the pericardium or lungs; and for those with existing In cases of obvious external invasion, palliative resection can reduce the tumor burden, followed by postoperative radiotherapy and chemotherapy. 6. Dr. Xie, what options are available for postoperative chemotherapy for thymic cancer? There are relatively few relevant studies in this area, mainly cisplatin combined with etoposide or cisplatin combined with doxorubicin chemotherapy. CODE protocol (cisplatin 25 mg/m2, vincristine 1 mg/m2, intravenous infusion at 1, 2, 4, and 6 weeks; doxorubicin 40 mg/m2, intravenous infusion at 1, 3, 5, 7, and 9 weeks ; Etoposide 80mg/m2, intravenous infusion at weeks 1, 3, 5, 7, and 9) VIP protocol (etoposide, ifosfamide, cisplatin) 7. Dr. Xie, when does radiotherapy for thymic cancer start? Radiotherapy is generally started 4-6 weeks after surgery. 8. How to follow up and observe postoperative thymic cancer? Chest CT and abdominal B-ultrasound should be reviewed every three months, bone scan and head MRI should be reviewed every year, and if conditions permit, PET/CT should be reviewed every year. 9. What symptoms or examination results indicate the recurrence of thymic cancer? Symptoms such as chest tightness, shortness of breath, chest pain, cough, and sputum production are also found in some patients during routine examinations.