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is the most common question asked by cancer patients. Choose food and nutritional supplements which reduces adverse interactions with your cancer treatment and support them.

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Symptoms, Treatment and Diet for Thymic Carcinoma

Feb 24, 2021

Highlights

When it comes to managing cancers such as thymic carcinoma, a rare cancer that develops on the surface of thymus, following a diet containing the right foods and supplements customized for the specific cancer treatment and other health conditions and symptoms of the patient becomes important. Intake of folic acid and Vitamin B12 may help in managing toxicity in thymic carcinoma patients treated with Pemetrexed. Also, a thymic carcinoma patient associated with hypercalcemia (abnormally high levels of calcium) should avoid taking Vitamin D and calcium supplements. While the intake of salicylic acid rich foods such as eggplant, okra and sweet potato may be beneficial for thymic carcinoma patients, eating foods such as corn, rhubarb, radish, savory and common pea may not help. Also, thymic carcinoma patients should avoid taking supplements which contain linoleic acid as part of the diet, including bitter melon, soybean, mint and fenugreek, as these may interact with some of the commonly used chemotherapies for thymic carcinoma.



What is Thymic Carcinoma?

Thymus is a gland which is located between our lungs, behind the breast bone. It is a part of the lymph system and makes white blood cells or lymphocytes that can protect the body against infections.

Thymic Carcinoma is a rare aggressive cancer that develops in the outer surface (epithelial cells) of the thymus. It accounts for 20% of all tumors in the thymus. In thymic carcinoma, the cancer cells grow very quickly and look different compared to normal thymus cells. Usually, when patients are diagnosed with this cancer, they often present with advanced disease which has already spread to other areas, thus making it difficult to treat. It has a poorer prognosis than thymoma, another type of cancer that develops in the outer surface of the thymus.

Symptoms, Treatment and Diet for Thymic Carcinoma , a rare thymus Cancer

The incidence of thymic carcinoma is very low, with only 7 people per 10 million people diagnosed per year. It has a five year survival rate of 30–50% (Yu Yang et al, BMC Cancer., 2017) This cancer is commonly found in the Asians, followed by African Americans, and least common in Whites.

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Symptoms of Thymic Carcinoma

In the early stages, thymic carcinoma may not cause signs or symptoms. However, as the disease progresses, it may start showing symptoms. Following are some of the signs and symptoms that may be caused by thymic carcinoma. 

  • Chest Pain
  • Persistent cough
  • Trouble breathing
  • Swallowing difficulties
  • Neck, Arm or facial swelling
  • Dysphonia or hoarseness in voice

Though many of these symptoms may also be caused by various other health conditions, consult your doctor if you experience these symptoms to rule out the possible chances of thymic carcinoma.

Treatment Options for Thymic Carcinoma

The treatment for thymic carcinoma may be decided based on different factors including the stage and extent of spread of the cancer, cancer characteristics, patient’s general health and medical history, whether the cancer can be removed completely by surgery and whether the cancer was just diagnosed or had come back. The treatment options for thymic carcinoma include:

  • Surgery with or without radiotherapy
  • Radiation therapy
  • Chemotherapy
  • Chemotherapy with radiation therapy
  • Chemotherapy with or without surgery and/or radiation therapy
  • Targeted therapy

Foods and Supplements Associated with Thymic Carcinoma

When it comes to managing any cancer including Thymic Carcinoma, following a personalized diet including the right foods and supplements and a healthy lifestyle becomes crucial. Below are some examples of foods/supplements associated with the thymus cancer- Thymic Carcinoma.

Intake of Salicylic Acid Rich Foods may be beneficial

Salicylic acid is a key bioactive found in different foods such as okra, eggplant and sweet potato. It has the potential to inhibit the activity of kinases called Cyclin-dependent kinases or CDKs which are usually overexpressed in different cancers and promote cancer cell proliferation (Rakesh Dachineni et al, Int J Oncol., 2017).  Studies have highlighted that thymic carcinomas may respond to the inhibitors of these CDKs. (Scott W Aesif et al, J Thorac Oncol., 2017) 

Hence, including salicylic acid rich foods such as okra, eggplant and sweet potato as part of the diet may be beneficial for Thymic Carcinoma Patients.

Intake of Foods and Supplements rich in Linoleic Acid may not be beneficial

Linoleic acid is a key bioactive ingredient of foods such as savory, common pea, corn, rhubarb, and radish. 

Different studies have highlighted that targeting a signalling pathway called the PI3K pathway, which leads to the activation of a kinase called AKT, may be an effective strategy to treat thymic carcinoma (Anna Teresa Alberobello et al, J Thorac Oncol., 2016). However, linoleic acid has the potential to enhance the activation of this kinase, AKT, which is not be favorable for the treatment of thymic carcinoma (Nathalia Serna-Marquez et al, Med Oncol., 2017; Katia Mariniello et al, Nutrition., 2019) 

Hence, it is better to avoid foods rich in linoleic acid such as savory, common pea, corn, rhubarb, and radish if diagnosed with thymic carcinoma. 

Additionally, while taking dietary supplements with highly concentrated bioactives, thymic carcinoma patients should be aware that these bioactives may modulate the activity of the drug metabolizing enzymes – CYPs, which sometimes may end up reducing the therapeutic efficacy or abnormally increasing the drug concentration, thereby resulting in toxicity. Linoleic acid is an inhibitor of the CYP enzyme, CYP3A4 (Hsien-Tsung Yao et al, Life Sci., 2006). Drugs such as Cisplatin, Doxorubicin and Cyclophosphamide which are used for the treatment of thymic carcinoma are substrates of this drug metabolizing enzyme CYP3A4 (Pius S Fasinu et al, Front Oncol., 2019).

Hence, consuming linoleic acid containing supplements by thymic carcinoma patients undergoing treatment with Cisplatin, Doxorubicin and/or Cyclophosphamide can lead to very high increase in the drug concentrations and may lead to toxicity. Dietary supplements of thyme, bitter melon, soybean, mint and fenugreek do contain significant amounts of linoleic acid and hence should be avoided by thymic carcinoma patients.

Intake of Folic Acid And Vitamin B12 may be beneficial for Patients treated with Pemetrexed

In 2018, the Journal of Thoracic Oncology published a phase II clinical study done by the researchers from the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center and Community Health Network in Indiana and University of Washington, Seattle involving 27 thymus cancer patients including 16 diagnosed with thymoma and 11 diagnosed with Thymic Carcinoma. The study was done to evaluate the impact of administering Pemetrexed along with Vitamin B12 and Folic Acid, in previously treated patients with thymoma and Thymic Carcinoma. The study found that out of 26 fully evaluable patients, two patients showed a complete response and three patients, including a Thymic Carcinoma patient, showed a partial response to Pemetrexed taken along with Vitamin B12 and Folic Acid. (Olumide B Gbolahan et al, J Thorac Oncol., 2018)

Folic Acid and Vitamin B12 has been previously shown to reduce Pemetrexed induced toxicity in cancer patients. (K Nakagawa et al, Br J Cancer., 2006; Giorgio V Scagliotti et al, J Clin Oncol., 2003) Hence, the intake of Folic acid and Vitamin B12 supplements may be beneficial for patients with Thymic cancer undergoing Pemetrexed treatment in managing toxicity.

Vitamin D and Calcium Supplements should be avoided by Thymic Carcinoma Patients associated with Hypercalcemia of Malignancy

In 2017, a case report was published which highlighted that a thymic carcinoma patient had a condition called hypercalcemia of malignancy, which means that he had an abnormally high level of calcium in the blood, a condition common in advanced cancer. Elevated 1,25-dihydroxyvitamin D levels were observed in this patient. (Cheng Cheng et al,  Case Rep Endocrinol., 2017) Hypercalcemia can result in the weakness of the bones, create kidney stones, and may interfere with heart and brain functioning. 

Hyperparathyroidism is one of the major causes of hypercalcemia. However, it is also important to note that our body uses vitamin D to promote calcium absorption in the gut. Hence, patients with thymic carcinoma associated with Hypercalcemia of Malignancy should avoid Vitamin D and calcium supplements.

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Conclusion

While undergoing treatment for thymic carcinoma, it is important to take the right foods and supplements. Consuming supplements or foods rich in folic acid and Vitamin B12 may help in managing Pemetrexed-induced toxicity in thymic carcinoma. In case of thymic carcinoma associated with hypercalcemia (abnormally high levels of calcium), Vitamin D and calcium supplements should be avoided. While eating salicylic acid rich foods such as eggplant, okra, and sweet potato may be beneficial for patients with this cancer, eating foods such as corn, rhubarb, radish, savory and common pea may not help. Also, patients should avoid taking supplements such as bitter melon, soybean, mint and fenugreek which contain linoleic acid as part of the diet as these may interact with some of the commonly used chemotherapies for thymic carcinoma.

“What should I eat?” is the most frequently asked question to cancer dieticians and physicians. The right answer depends upon cancer type, underlying genomics, current treatments, any allergies, lifestyle information, and factors like BMI.

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Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.