What are chest wall tumors. How common are they. What are the symptoms of benign and malignant chest wall tumors. How are chest wall tumors diagnosed. What treatment options are available for chest wall tumors. What questions should patients ask their doctors about chest wall tumors.

Understanding Chest Wall Tumors: Types and Prevalence

Chest wall tumors are abnormal growths that develop in the structures surrounding the lungs, including bones, muscles, and soft tissues. These tumors can be classified as either benign (non-cancerous) or malignant (cancerous), and they may originate in the chest wall itself (primary tumors) or spread from other parts of the body (secondary or metastatic tumors).

Are chest wall tumors common? While cancerous chest wall tumors are relatively rare, benign tumors occur more frequently. The most common benign tumors include osteochondromas and chondromas, while sarcomas are the most prevalent malignant chest wall tumors.

Primary tumors account for less than half of all malignant chest wall tumors. In children, primary tumors are more common, whereas adults are more likely to develop secondary tumors. Regardless of their origin, these tumors typically present as lumps on the chest wall surface or as growths that invade the bone or muscle.

Recognizing the Symptoms of Chest Wall Tumors

The symptoms of chest wall tumors can vary depending on whether they are benign or malignant. Understanding these differences is crucial for early detection and proper medical intervention.

Symptoms of Benign Chest Wall Tumors

• A localized mass
• Swelling
• Chest pain
• Muscle atrophy (breakdown)

Symptoms of Malignant Chest Wall Tumors

• A localized mass
• Swelling
• Chest pain
• Impaired movement or chest expansion

Can chest wall tumors interfere with pulmonary function? Yes, these tumors can potentially affect breathing and lung function, especially if they grow large enough to compress the surrounding tissues or invade the chest cavity.

Causes and Risk Factors for Chest Wall Tumors

While the exact causes of chest wall tumors remain unclear, several factors may contribute to their development. Hereditary factors, diet, and lifestyle choices might play a role in certain tumor types. However, it’s important to note that in many cases, the specific cause of a chest wall tumor cannot be identified.

Do environmental factors influence the development of chest wall tumors? While research is ongoing, some studies suggest that exposure to certain chemicals, radiation, or other environmental toxins may increase the risk of developing certain types of chest wall tumors. However, more research is needed to establish definitive links.

Diagnostic Approaches for Chest Wall Tumors

Accurate diagnosis of chest wall tumors is crucial for determining the appropriate treatment plan. Healthcare providers typically employ a combination of imaging techniques and biopsy procedures to identify and characterize these tumors.

Imaging Techniques

1. X-ray: Initial screening to detect abnormalities
2. CT scan (computed tomography): Provides detailed images of the tumor’s size and location
3. MRI (magnetic resonance imaging): Offers high-resolution images of soft tissues and can help determine the extent of tumor invasion

Biopsy Procedures

After imaging studies, a biopsy is usually performed to confirm the diagnosis and determine whether the tumor is benign or malignant. The two main types of biopsies used for chest wall tumors are:

• Aspiration biopsy: A needle is inserted into the tumor to extract cells for examination
• Open biopsy: A small surgical incision is made to remove a tissue sample when needle biopsy is not feasible

How long does it take to get biopsy results for chest wall tumors? The time frame can vary depending on the complexity of the case and the specific tests required. Generally, results may be available within a few days to a week after the biopsy procedure.

Treatment Options for Chest Wall Tumors

The treatment of chest wall tumors depends on various factors, including the tumor’s type, size, location, and whether it’s benign or malignant. Here are some common treatment approaches:

Surgery

Surgical removal is often the primary treatment for both benign and malignant chest wall tumors. The extent of surgery depends on the tumor’s characteristics and may involve:

• Local excision: Removal of the tumor and a small margin of surrounding healthy tissue
• Wide excision: Removal of the tumor along with a larger margin of healthy tissue
• Chest wall resection and reconstruction: Necessary for larger tumors or those invading deeper structures

Radiation Therapy

Radiation therapy may be used in conjunction with surgery or as a standalone treatment for certain types of chest wall tumors. It can help shrink tumors before surgery or eliminate remaining cancer cells after surgical removal.

Chemotherapy

For malignant chest wall tumors, especially those that have spread or are at high risk of spreading, chemotherapy may be recommended. This systemic treatment can target cancer cells throughout the body.

What is the success rate for chest wall tumor treatments? Success rates vary depending on the tumor type, stage, and chosen treatment approach. For benign tumors, complete removal often results in a cure. For malignant tumors, success rates depend on factors such as the cancer stage, tumor type, and overall patient health.

Recovery and Prognosis After Chest Wall Tumor Treatment

Recovery from chest wall tumor treatment can vary significantly depending on the extent of the procedure and the individual patient’s health status. Here are some key aspects of the recovery process:

Immediate Post-Treatment Period

• Pain management: Patients may experience discomfort, which can be managed with appropriate pain medications
• Wound care: Proper care of surgical incisions is crucial to prevent infection and promote healing
• Respiratory therapy: Breathing exercises may be recommended to maintain lung function and prevent complications

Long-Term Recovery

Long-term recovery may involve:

• Physical therapy: To regain strength and mobility in the chest and arm areas
• Regular follow-up appointments: To monitor for any signs of recurrence or complications
• Lifestyle modifications: Depending on the extent of surgery, some patients may need to adjust their daily activities

How long does it take to fully recover from chest wall tumor surgery? Recovery time varies depending on the extent of the surgery and individual factors. Some patients may return to normal activities within a few weeks, while others may require several months for full recovery.

Living with Chest Wall Tumors: Coping Strategies and Support

Dealing with a chest wall tumor diagnosis and treatment can be challenging both physically and emotionally. Here are some strategies to help patients cope:

Emotional Support

• Seek counseling or join support groups to connect with others facing similar challenges
• Practice stress-reduction techniques such as meditation or yoga
• Maintain open communication with family and friends about your needs and feelings

Physical Well-being

• Follow your healthcare provider’s recommendations for physical activity and rehabilitation
• Maintain a balanced diet to support healing and overall health
• Get adequate rest and sleep to aid in recovery

Practical Considerations

• Plan for time off work or school during treatment and recovery
• Arrange for help with daily tasks and childcare if needed
• Explore financial assistance options if treatment costs are a concern

Are there any long-term lifestyle changes required after chest wall tumor treatment? This depends on the individual case. Some patients may need to avoid certain strenuous activities or make modifications to their work environment. Your healthcare provider can offer personalized advice based on your specific situation.

Important Questions to Ask Your Healthcare Provider

When facing a chest wall tumor diagnosis or treatment, it’s crucial to be well-informed. Here are some important questions to ask your healthcare provider:

Regarding Diagnosis and Prognosis

• Where is my chest wall tumor located?
• Is the tumor benign or malignant?
• If malignant, what is the stage of the cancer?
• What is the prognosis for my specific type of tumor?
• How can I obtain a copy of my pathology report?

Treatment-Related Questions

• What are my treatment options?
• Will I need surgery, and if so, what type?
• What are the potential side effects of the recommended treatment?
• How often do you perform the recommended procedure?
• What is the success rate for this specific treatment?
• Are there any clinical trials relevant to my condition?

Recovery and Follow-up

• What restrictions will I have after treatment?
• How long will I need to be off work?
• Will I need to take any long-term medications?
• How often will I need follow-up appointments?
• What signs or symptoms should prompt me to seek immediate medical attention?

How can patients best prepare for their appointments with healthcare providers? It’s helpful to write down your questions in advance, bring a list of your current medications, and consider having a family member or friend accompany you to help take notes and provide support.

Chest wall tumors, while relatively uncommon, can have a significant impact on a person’s health and quality of life. By understanding the types, symptoms, diagnostic procedures, and treatment options available, patients can be better prepared to navigate their healthcare journey. Remember that each case is unique, and working closely with a healthcare team is crucial for developing an individualized treatment plan and achieving the best possible outcomes.

Chest Wall Tumor Symptoms and Treatment

About Chest Wall Tumors

Like any other part of the body, the walls of the chest cavity are susceptible to tumors. A tumor is any type of abnormal growth of cells, whether malignant (cancerous) or benign (non-cancerous). Chest wall tumors can interfere with pulmonary function.

Are Chest Wall Tumors Common?

Cancerous tumors are uncommon. Chest wall tumors, whether malignant (cancerous) or benign (non-cancerous), are classified as primary or secondary (metastatic). The most common benign tumors are osteochondromas and chrondromas. The most common malignant chest wall tumors are sarcomas.

Primary tumors originate in the bone or muscle of the chest wall. Less than half of malignant chest wall tumors are primary. Secondary tumors originate elsewhere in the body and spread (metastasize) to the chest wall. Almost all secondary tumors are malignant. Most chest wall tumors found in children are primary, while most found in adults are secondary. All of these tumors tend to be a lump on the chest wall surface or a growth that invades the bone or muscle.

Symptoms of benign chest wall tumors may include one or more of the following:

• A localized mass
• Swelling
• Chest Pain
• Muscle atrophy (breakdown)

Symptoms of malignant chest wall tumors may include one or more of the following:

• A localized mass
• Swelling
• Chest Pain
• Impaired movement or chest expansion

While hereditary factors, diet and lifestyle choices may play a role in certain tumor types, there are no clear causes of chest wall tumors.

• Imaging:
  • The physician will initially order an x-ray to see if there is an abnormality. If there is an abnormality shown on x-ray, your physician will then do a CT scan (computed tomography) or MRI (magnetic resonance imaging) scan to gain additional information about the chest wall abnormality, such as size and location.
• Biopsy:
  • After this information is collected, a biopsy of the abnormality is done to diagnose what the tumor is and to determine if the tumor is benign or malignant. The most common procedure is an aspiration biopsy, in which a needle is inserted into the tumor and cells are removed for examination. If it is too difficult to reach the tumor with a needle, you may need to undergo an open biopsy, which requires a small surgical incision and may leave a scar.

1. Will my condition ever get better without treatment? Can it get worse?
2. What are my treatment options?
3. Will I need surgery?
4. What are the potential side effects of this treatment?
5. How often do you do the procedure that you’ve recommended for me?
6. What is the success rate for that specific procedure?
7. When should I seek medical attention if I am experiencing symptoms following surgery?
8. Will I have any restrictions after treatment? (activity, driving, etc)
9. Will I have to be out of work? If so, for how long?
10. Will I have to change my diet and/or lifestyle after treatment?
11. Will I have to take any long-term medications?
12. How likely is it that I will need additional treatment later?
13. If I want a second opinion, how would I get one?
14. Where is my chest wall tumor located?
15. Is it cancerous? If yes, what is the survival rate for my particular kind of cancer?
16. How do I get a copy of my pathology report?
17. Are there any clinical trials relevant to my cancer that I can look into?

Submit an online appointment request or call 310-829-8618 if you have any signs or symptoms that concern you.

If you are worried about your hereditary risk of cancer, contact our genetics team.

Lump on Chest Wall | 5 Causes for a Painless Chest Lump

Painless chest wall lump quiz

Take a quiz to find out what’s causing your lump.

Take painless chest wall lump quiz

Other causes

There are many other conditions that can appear as lumps in the chest wall.

• Dermatologic: Many dermatologic conditions can result in lumps and bumps on the skin throughout the body. For example, cysts are growths that can be filled with fluid, pus, blood or other material. They often feel like small peas under the skin that are painless or smooth to the touch.
• Infections: Some bacterial and viral skin infections can result in sequelae that look like growths. For example, some strains of human papillomavirus (HPV) can result in warts or wart-like growths on the skin.
• Lymphatic: The lymphatic system is an import network of organs, vessels, and glands throughout the body important for immune function. The glands of the system, also called lymph nodes, function to filter and trap viruses, bacteria, and other pathogens before they can spread. There are lymph nodes in the chest wall that can swell with inflammatory conditions and may appear as chest wall lumps.

This list does not constitute medical advice and may not accurately represent what you have.

Wart

Warts, also called common warts or verrucae, are small, rough, rounded growths on the top layer of the skin. They may appear singly or in clusters.

Common warts are caused by the human papilloma virus (HPV) and are contagious through direct contact, especially through a break in the skin. They may spread from one place on the body to another simply through touch.

Anyone can get warts but they are most common in anyone with a weakened immune system, as from illness or chemotherapy. Children and teenagers are also susceptible to warts.

Warts often first appear on the hands and fingers, especially near the nails or after any injury to the skin. This is why biting fingernails is a risk factor for warts.

Warts are benign, meaning they are not cancerous. But they can be unsightly and interfere with normal use of the hands, so treatment is often beneficial.

Diagnosis is made through physical examination. Warts in children sometimes go away without treatment, but otherwise most warts can be easily removed in a doctor’s office.

Skin cyst

A cyst is a small sac or lump, filled with fluid, air, fat, or other material, that begins to grow somewhere in the body for no apparent reason. A skin cyst is one that forms just beneath the skin.

It’s believed that skin cysts form around trapped keratin cells – the cells that form the relatively tough outer layer of the skin.

These cysts are not contagious.

Anyone can get a skin cyst, but they are most common in those who are over age 18, have acne, or have injured the skin.

Symptoms include the appearance of a small, rounded lump under the skin. Cysts are normally painless unless infected, when they will be reddened and sore and contain pus.

Diagnosis is made through physical examination. A small cyst can be left alone, though if it is unsightly or large enough to interfere with movement it can be removed in a simple procedure done in a doctor’s office. An infected cyst must be treated so that the infection does not spread.

Rarity: Common

Top Symptoms: skin-colored armpit bump, marble sized armpit lump, small armpit lump

Symptoms that always occur with skin cyst: skin-colored armpit bump

Urgency: Wait and watch

Male breast cancer

Although breast cancer is much more common in women, men can get it too. It happens most often to men between the ages of 60 and 70.

Diagnosing male breast cancer requires a physician’s clinical exam, a mammogram, and tissue biopsy. It’s treatment involves surgically removing the cancer followed by hormone treatments, chemotherapy, and/or radiation therapy. A doctor’s visit is needed in the next few days!

Lipoma

Lipoma is a word that translates as “fatty tumor,” but a lipoma is not cancer. It is simply a growth of fat between the muscle layer and the skin above it.

The exact cause is not known. The condition does run in families and is associated with other unusual syndromes such as adiposis dolorosa, which is similar. Lipomas most often appear after age 40.

Symptoms include a soft, easily moveable lump beneath the skin, about two inches across. A lipoma is painless unless its growth is irritating the nerves around it. They are most often found on the back, neck, and abdomen, and sometimes the arms and upper legs.

It is a good idea to have any new or unusual growth checked by a medical provider, just to make certain it is benign.

Diagnosis is made through physical examination, biopsy, and imaging such as ultrasound or CT scan.

Most of the time, treatment is not necessary unless the lipoma is unsightly or is interfering with other structures. It can be removed through surgery or liposuction.

Rarity: Uncommon

Top Symptoms: skin-colored groin bump, marble sized groin lump, small groin lump

Symptoms that always occur with lipoma: skin-colored groin bump

Urgency: Wait and watch

Hodgkin’s lymphoma

Hodgkin lymphoma, formerly known as Hodgkin’s lymphoma or Hodgkin’s disease, is cancer of the lymphatic system. It is believed to be caused by a mutation in one of the body’s immune system cells, called a B cell.

Most susceptible are those under age 30 or over age 55, with a family history of the disease, as well as anyone with a history of any illness caused by the Epstein-Barr virus.

Symptoms include swelling of lymph nodes in groin, armpits, and neck; lowered tolerance to drinking alcohol, including pain in lymph nodes afterwards; unintended weight loss; fever; chills; night sweats; and itching.

There are good treatments available for Hodgkin lymphoma, so it is important to see a medical provider about these symptoms as soon as possible.

Diagnosis is made through physical examination; blood tests; imaging such as x-ray, CT scan, or PET scan; and sometimes lymph node biopsy and/or bone marrow sample.

Treatment involves a combination of chemotherapy and radiation therapy. Bone marrow transplant, also called stem cell transplant, can be done in some cases.

Dermatofibroma

A dermatofibroma is a fairly common skin growth that usually appears on the lower legs, but may appear anywhere on the body. These mole-like growths are benign (noncancerous.)

The cause is not known, though a dermatofibroma may appear after a minor injury. The growths are not contagious.

Dermatofibromas are most common in adults and are rarely found in children.

Symptoms include a hard, raised growth that is red, pink, or brown and less than half an inch across. They are usually painless but may be tender or itchy, and may appear alone or in groups.

Any new growth on the skin should be seen by a medical provider, especially if the growth is very dark in color or changes its shape or appearance quickly.

Diagnosis is made through physical examination and sometimes biopsy.

A dermatofibroma does not require treatment unless it is interfering with clothing or is unsightly. They can be surgically removed, though this will leave a scar and the growth may eventually return.

Questions your doctor may ask about painless chest wall lump

• What color is the bump?
• Is the lump on your chest on the surface of the skin or below the skin?
• What is your body mass?
• Have you been experiencing a deep, aching bone pain that started for no apparent reason?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Tumors of the chest – Istituto Europeo di Oncologia

Tumors of the pleura

Malignant mesothelioma of the pleura

early diagnosis in people not at risk. In the case of people who have been exposed to asbestos for more or less long periods of time, some doctors recommend periodic examinations (X-rays or CT scans) to monitor for any changes in lung structure that may indicate the presence of mesothelioma or lung cancer over time. However, it is not yet clear whether this strategy can lead to early diagnosis.

The best way to prevent mesothelioma is to avoid or at least minimize exposure to asbestos . New laws require checking for asbestos in public buildings such as schools, but older homes may also contain traces of the material. It is important to contact professional technicians who will inspect building materials and remove substandard parts. Do-it-yourself removal should be avoided, as poor performance can risk contamination of other parts of the structure and inhalation of hazardous fibers.

Symptoms of malignant pleural mesothelioma common and less severe diseases. Early signs of pleural mesothelioma may include pain in the lower back or side of the chest, shortness of breath, cough, fever, fatigue, weight loss, difficulty swallowing, and muscle weakness. Abdominal pain, weight loss, nausea and vomiting are the most common symptoms of peritoneal mesothelioma.

Investigations to diagnose malignant pleural mesothelioma

The first step for a proper diagnosis is a visit to your general practitioner or a specialist who takes information about your medical history to determine if you have had exposure to asbestos and evaluate the presence of fluid in the abdominal cavity. cavity or in the cavity around the heart. In cases of suspected mesothelioma, more specific tests will be performed.

• Computed tomography (CT) of the chest with contrast agent is used to determine the presence of a tumor, its exact location and possible spread to other organs, which helps the surgeon choose the type of intervention. Recently, helical CT has been developed, which is faster and provides more detailed images compared to conventional CT.
• Positron emission tomography (PET) is used to identify cells that grow faster and are consistent with cancer cells. The resulting images are not as detailed as CT scans, but they can help doctors understand if mesothelial disorders are really tumors or other types and if the cancer has spread to the lymph nodes or other parts of the body. Currently, there are tools that allow you to perform CT and PET in one examination.
• The biopsy is the most effective tool to confirm the suspicion of mesothelioma. In some cases, fluid samples are obtained from the chest (thoracentesis), abdomen (paracentesis), or the cavity around the heart (pericardiocentesis) using a long, thin needle to check for the presence of cancer cells under a microscope. In other cases, it is necessary to select small portions of mesothelial tissue using a thin needle inserted under the skin or inserting a probe equipped with a video camera through a small incision in the skin. In this way, the doctor can see suspicious areas and take samples, which will then be analyzed under a microscope. To reliably distinguish mesothelioma from other types of tumors, biopsy samples may be subjected to immunohistochemical analysis (to see the proteins present on the cell surface) or genetic analysis (to capture gene expression typical of mesothelioma). Blood tests are not usually used to make a diagnosis, but may be useful in confirming a diagnosis made by other methods or in tracking the evolution of a disease during and after treatment. In particular, levels of osteopontin and soluble mesothelin family proteins (SMRPs), molecules present in high concentrations in mesothelioma, are measured.

Solitary Fibrous Tumor of the Pleura: Symptoms and Diagnostic Tests

This type of pleural tumor generally shows an occult course and is often diagnosed incidentally by simple diagnostic imaging. The larger the mass, the more likely and more severe the symptoms: shortness of breath, chest pain, and cough are three recurrent symptoms in patients with pleural fibrosis. Although less common, patients with this form of pleural cancer may complain of anorexia, chills, fever, hemoptysis, lower extremity edema, paraneoplastic manifestations (osteoarthropathy and hypoglycemia due to excess production of insulin-like growth factor II), syncope, and pleural effusion. In giant forms, hypomobility of the hemithorax affected by the neoplasm occurs.

Fibrous tumor of the pleura is often diagnosed incidentally by a simple radiological examination performed for other reasons. Among the diagnostic strategies aimed at establishing a tumor of the pleura, routine blood tests, epigastric ultrasonography, CT, CT, and magnetic resonance imaging (MRI) are included. Some patients should undergo further evaluation, PET, which is useful for selected subjects with suspected malignant tumor degeneration.

Mediastinal tumors

Thymus tumors

Due to the slow clinical development, the diagnosis of thymoma can often be accidental. At least 30% of patients are asymptomatic at the time of diagnosis. When symptoms are present, often very vague and vague, they are due to local pressure or infiltration of surrounding structures: chest pain, cough, dyspnoea, diaphragmatic dome palsy due to phrenic nerve involvement are the most common, but dysphonia due to infiltration of the laryngeal nerve and signs that can be attributed to the syndrome of the superior vena cava.

Thymomas can be associated with a number of paraneoplastic syndromes: the most common is without a doubt myasthenia gravis which is present in 30-45% of patients, while true erythrocyte aplasia and hypogammaglobe ulinemiya occurs at 2 -5% of cases.

Hypogammaglobulinemia is present in 2-5% of patients with thymoma A. Thymoma A rarely develops distant metastases, but in some cases it can be locally invasive with infiltration of surrounding organs and spread to the parietal pleura and/or pericardium. The degree of local invasiveness is decisive in the choice of treatment.

Chest CT is required to determine the extent of the mass, its relationship to adjacent structures, and possible pleural and/or pericardial effusions; it can also serve as a tool in the diagnosis of small tumors that are not detected by a standard chest x-ray. Surgical biopsy of the lesion not recommended for encapsulated thymus tumors due to risk of dissemination; it is necessary in the case of inoperable tumors or for differential diagnosis with other malignant neoplasms affecting the anterior mediastinum, for the correct choice of treatment.

Neuromas

In most cases, they are detected by chance, during chest X-ray. The test used to definitively diagnose this disease is chest CT, to which spinal cord magnetic resonance can be added in cases of suspected extension into the spinal canal.

Tumors of the esophagus

Precautions for the prevention of cancer of the esophagus

Abstinence from alcohol and smoking are the main precautions for preventing the formation of squamous cell carcinoma of the esophagus. As for adenocarcinoma, in most cases it develops from Barrett’s esophagus, so the most effective way to prevent it is to reduce the risk of gastroesophageal reflux . This is achieved by reducing the consumption of coffee, alcohol and cigarettes and avoiding overweight and obesity. Although some antacids may control reflux symptoms no scientific evidence is currently available for their effectiveness in reducing the appearance of Barrett’s esophagus.

Research for early diagnosis of tumors of the esophagus transformation. In patients whose esophageal mucosa has converted to gastric mucosa, endoscopic examination every two or three years is recommended. For patients whose transformed cells show signs of pathology (dysplasia), it is recommended to repeat the endoscopic examination at least twice every six months and then once a year. Finally, if the degree of dysplasia is high (namely, if the cells are highly transformed), endoscopic removal or even surgery is recommended, since this is a precancerous condition with a high risk of malignant transformation.

Esophageal tumor symptoms

Almost always, the initial symptoms of esophageal cancer are progressive weight loss preceded by dysphagia, a difficulty in swallowing that usually comes on gradually, first with solid foods and then with liquids. These symptoms are reported by 90 percent of patients. In addition, tumor growth outside the esophagus can lead to a decrease or change in the tone of the voice, because it affects the nerves that control the emission of sounds, or causes paralysis of the diaphragm or even pain in the chest just behind the breastbone if the area between the heart, lungs, sternum and spine.

In the most advanced stages of the tumor, the ability to eat may be reduced. If the tumor is ulcerated, swallowing may become painful. When the tumor mass prevents the descent of food down the esophagus, episodes of regurgitation may occur. In more common forms, the lymph nodes on the sides of the neck and above the collarbones may swell, or fluid may form in the lining of the lungs (pleural effusion) with shortness of breath (difficulty breathing), or there may even be bone pain or an enlarged liver. The cause of these symptoms is usually associated with the presence of metastases.

Diagnostic tests for tumor of the esophagus

In symptomatic patients, the diagnostic strategy includes X-ray of the esophagus with contrast agent and endoscopic examination of the esophagus ( esophagogastroscopy ), allowing us to see if there is a mass and obtain material for cell examination . The combination of these two procedures increases the diagnostic sensitivity to 99 percent. X-ray examinations are used to exclude the presence of concomitant disease, esophagogastroscopy is the examination of the greatest diagnostic value, since it allows direct visualization of structures and sampling for biopsy.

Endoscopy is another type of examination that allows us to more accurately determine how deep the infiltration of layers in the esophageal wall is and can show lymph nodes with suspected metastatic involvement. When the tumor is localized, CT of the chest and abdomen with contrast agent (cmc) and PET should be performed to complete the diagnostic study to exclude the presence of distant metastases.

Nutritional prophylaxis for tumors of the esophagus

Based on a careful evaluation of the results currently obtained in scientific research, it has become possible to identify specific risk factors and protective nutritional factors for specific types of cancer. The experts classified the results into four levels: “strong evidence”, “probable evidence”, “limited evidence” and the last level, combining those effects for which their relationship with the tumor is “highly unlikely”. The plausible and compelling evidence to support recommendations is:

Risk factors

• alcoholic beverages (strong evidence)
• overweight and obese (strong evidence for adenocarcinoma).

Protective factors

• fruits and vegetables
• foods rich in beta-carotene such as carrots, pumpkins, apricots, spinach, sweet and hot peppers (probable evidence)
• food rich in vitamin C, such as citrus fruit juice and zest, kiwi fruit, strawberries, sweet and hot peppers (probable evidence).

Surgical treatment of tumors of the chest organs invading the superior vena cava and pulmonary trunk

There are not enough reports on the combined surgical treatment of invasive tumors of the mediastinum [2, 3, 9, 11, 13-15, 17, 19, 25, 38] . The need for resection of organs adjacent to the tumor of the mediastinum and great vessels is noted in 18-42.7% of cases [11]. For example, germination of the right atrium with a locally advanced lung tumor occurs in 25%, aorta – in 17% of cases [24, 27, 29, 30, 36]. According to P. Thomas et al. [35], 6% of all cases of right lung cancer were accompanied by invasion of the superior vena cava (SVC). L.Szur and L.L. Bromley out of 2 thousand patients with lung cancer found invasion and obstruction of the SVC in 104 (5.2%). I. Steinberg and C. Dotter estimated the frequency of SVC germination in lung cancer at 10-15%, B. Le Roux – at 4.6%, W. Stanford and D. Doty – at 6-7%, I. Robinson and J Jackson – in 5% [7, 21, 28, 32, 35].

Superior vena cava syndrome (SVCS) is characteristic of lung cancer, mediastinal tumors, lymphoma. The syndrome is caused by compression of the SVC or obstruction of its lumen by a tumor located near the mediastinum and the apex of the lung, its germination into the mediastinum or metastases to regional lymph nodes. According to different authors, SVCS in lung cancer occurs in 48-81% of cases [6, 7, 23, 34, 37, 39].

Surgical treatment of SVCS has been attempted for a long time. Historically, SVC reconstructive surgery in thoracic oncology has been the subject of quite a large number of works [15, 16, 20, 26, 31, 36]. The main deterrent was thromboembolic complications in the postoperative period. The first attempts at venous prosthetics in the experiment were made by C. Gluck in 1898, then by A. Carrel and C. Guthrie in 1906. The first marginal resection of the SVC in a tumor lesion was performed by L. Lome and I. Bush in 1972 g. The first in the USSR prosthetics of the SVC in combination with a combined pneumonectomy for locally advanced cancer (unfortunately, unsuccessful) was performed in 1960 by E. P. Dumpe. In 1983, R. Andersson and W. Li [10] performed the first successful segmental resection of the SVC with reconstruction of the removed segment in a patient with recurrent leiomyosarcoma of the upper anterior mediastinum.

The emergence of modern synthetic prostheses, the development of cardiovascular surgery at the present time allow us to reconsider the attitude to this variant of surgical treatment of locally advanced tumors. If there are indications, the methods of reconstruction of the main venous vessels are determined individually in each specific observation. Ligation of the SVC or innominate vein is, in principle, acceptable, since it does not lead to death, but is undesirable, since after this the phenomena of venous congestion in the long term are compensated slowly and not in full [4]. Some authors [5] consider it necessary to replace the SVC in case of its damage, and revascularization of the subclavian veins in case of damage to the latter – with any technical possibility using reinforced prostheses. The literature describes plasty and autovenous prosthetics of the SVC, innominate veins during the removal of tumors of the chest [1, 11], prosthetics of the SVC with a synthetic prosthesis [7, 10, 11, 15, 22, 35].

K. Suzuki et al. [33] performed 3499 operations for a large (T4) lung cancer during the period from 1980 to 2001, 40 of them underwent resection of the SVC. Lobectomy was performed in 19 cases, pneumonectomy in 21 cases. Resection of the SVC with prosthetics was performed in 11 patients, partial resection of the venous wall – in 29 (of which an autologous pericardial patch was used in 8 people, a direct continuous suture – in 21). Postoperative mortality did not exceed 10%, 5-year survival was 24% (for patients with SVC invasion by metastatic nodes – 6.6% and the tumor itself – 36%) with an average life expectancy of 67 months.

The need for innominate vein plasty occurs in 14.6% of patients with surgical treatment of mediastinal tumors [11]. If there is a trained team of specialists and instrumental support, a combined intervention, possibly even in combination with SVC prosthetics, in such a situation, the mortality rate can be 4. 5% [12, 15] (Fig. 1). Figure 1. Stages of the operation (photographs). a – the tumor was removed along with the SVC wall. On the clamps are the right and left innominate veins, the superior vena cava. Figure 1. Stages of the operation (photos). b – the defect of the superior vena cava was repaired with a synthetic patch.

We give an example of surgical treatment of a patient suffering from a tumor of the mediastinum with invasion of the SVC.

Patient S., 29 years old acad. B.V. Petrovsky on August 28, 2007 with complaints of recurrent vomiting of food eaten, sensation of a foreign body in the throat. During an objective examination, attention was drawn to the swelling of the cervical veins, mainly on the left. He has been complaining of these complaints since April 2007. An outpatient examination on a CT scan on 06.04 in the anterior mediastinum revealed a volumetric formation of irregular shape, 73 × 40 × 110 mm in size, of an inhomogeneous structure with signs of fusion with the left mediastinal leaflet and nearby great vessels. According to the patient, when applying to a number of medical institutions, surgical treatment was denied.

On a chest x-ray in the upper mediastinum at the level of the tracheal bifurcation, a dense shadow measuring 12 × 8 mm with clear, even contours is determined.

Helical CT scan with intravenous contrast enhancement: the left innominate vein is dilated to 35 mm, filled with a contrast agent without obvious signs of thrombotic masses. The expansion and deformation of the distal section of the left internal jugular vein, pronounced tortuosity and expansion of the venous trunks around the innominate vein (pericardial, bronchial, vertebral) are determined. In the anterior mediastinum with a transition to the zone of the vascular bundle of the neck on the left, a tumor conglomerate 65×35×115 mm in size with massive calcified venous malformations is determined. Compression of adjacent arterial vessels (aortic arch, brachiocephalic trunk, left subclavian and common carotid arteries) is not determined. In the lower part of the vascular formation there are zones that are not filled with a contrast agent – thrombosed areas. The shadow of the thymus gland, 45×20 mm in size, is separated from the formation by a fatty layer. Lymph nodes of the mediastinum, aorta, pulmonary trunk are not dilated.

Duplex scanning data: right jugular vein 1.5 cm in diameter, left 2.8 cm. Vertebral plexuses show signs of venous outflow obstruction (mainly on the left). Left subclavian vein 1.0 cm

Taking into account the clinical picture of the disease and the data of instrumental methods of examination, on September 04, according to absolute indications, an operation was performed: removal of the tumor with resection of the left innominate vein [1]. Access from the mastoid process along the anterior surface of the left sternocleidomastoid muscle to the jugular notch of the sternum bluntly and sharply mobilized the upper pole of the formation along the neurovascular bundle of the neck and in the scaling space. The formation of a soft elastic consistency, bleeds profusely during traction. Rapid biopsy: coelomic lymphovenous malformation. Complete longitudinal sternotomy. The tumor circularly covers the left innominate vein, subclavian artery and vein, jugular vein to the angle of the mandible, extends into the dome of the pleura, pericardium and along the cervical spine. The tumor was mobilized with ligation of the semi-azygous vein, resection of the pericardium, the dome of the left mediastinal pleura and the phrenic nerve. An intimate connection of the tumor with the left innominate vein was established. Removal of the tumor with resection of the left innominate vein for 6 cm. Taking into account the pronounced diastasis of the stump of the innominate vein, the left jugular vein was mobilized to the mastoid process of the skull, followed by anastomosis of the latter with the stump of the innominate vein by end-to-end anastomosis (Fig. 2). Figure 2. Scheme venous reconstruction. Due to the presence of powerful venous collaterals, the left subclavian vein was ligated. The duration of the operation is 360 min. Blood loss 1500 ml. The postoperative period proceeded without complications. The patient was discharged on the 10th postoperative day. Violations of the venous outflow from the upper limb no.

The most common tumors of the mediastinum are thymomas, carcinomas, sarcomas, germline tumors, lymphomas, while in 74% of cases tumors are localized in the anterior mediastinum [11].

In our observation, mediastinal hemangioma debuted as a clinical picture of compression of organs and vessels of the anterior mediastinum, which determined the absolute need for surgery. The long period (about 5 months) from the onset of the clinical picture of the disease to the operation emphasizes the difficulties of diagnosis. Despite the problems described in the literature associated with paralysis of the diaphragm during resection of the phrenic nerve, we did not observe respiratory failure in the patient. Ligation of the subclavian vein in the presence of a long-term compression syndrome was not accompanied by a violation of the venous outflow from the limb due to the compensation of blood flow by powerful collaterals. In order to prevent violations of the outflow from the brain, anastomosis of the stumps of the jugular and innominate veins was used. Compensation of venous outflow from the left upper limb after ligation of the subclavian vein, apparently, was carried out due to collateral circulation.

Surgical treatment of mediastinal masses is accompanied by complications in 17% of cases and death in 6% of cases [11], but guarantees 5-year survival in 42-83% of patients, depending on the histological structure of the tumor [11, 15].

The choice of operative access is carried out individually and depends on the localization of the formation, the organ from which it comes, the presence of invasion of certain anatomical structures. The greatest freedom of action is provided by the median sternotomy [11, 12, 25], used in 45-79% of observations [11, 12]. Prior to mobilization of the mediastinal tumor, an express biopsy and an urgent histological examination should be performed, since a morphological diagnosis can change the course and extent of the operation. During mobilization, the phrenic and vagus nerves should be preserved whenever possible, except in those situations in which these nerve trunks are involved in the tumor infiltrate. Damage to the phrenic nerve leads to paralysis of the corresponding dome of the diaphragm, which is associated with the risk of postoperative respiratory failure. Crossing the vagus nerve is not associated with any serious dangers [12]. According to E. Bacha et al. [11], in surgical treatment 89mediastinal tumors in 42.7% of cases, it was not possible to save the phrenic nerve.

Summarizing the literature data [15, 16, 20, 25, 26, 31, 36] concerning SVC repair/prosthetics in patients with locally advanced tumors, we can focus on the following:

– SVC plasty in patients with cancer of the upper lobe of the right lung is rational from the right-sided thoracotomy access, with mediastinal neoplasms, longitudinal sternotomy is advisable;

– complete clamping of the SVC for a period of 45-60 minutes can be performed only with the help of pharmacological support, clamping for an unforeseen period – with the help of a shunt, IR;

– SVC stenosis by 30% requires only resection of the vessel wall with a primary blind suture, more pronounced stenosis – plasty / prosthetics;

– for prosthetics of the SVC, an “incompressible” PTFE prosthesis 18-20 mm should be used (the use of an autopericardium is promising), only one brachycephalic vein can be restored, the second can be ligated;

– direct anastomoses to the right atrium are best avoided due to the risk of thrombotic complications.

An important issue is the advisability of prescribing anticoagulant therapy in the postoperative period for patients with a prosthetic SVC. Opinions are contradictory. In our opinion, taking into account the low blood flow velocity in the inferior vena cava (IVC), the tactics of anticoagulant therapy in patients with SVC prosthesis should be the same as in aortic valve replacement with the appointment of indirect anticoagulants for life and maintaining the INR at the level of 2.0- 2.5. Refusal to prescribe anticoagulants is possible due to the use of auto- and allo-tissues [19] (pericardium, dura mater, aorta). There are studies devoted to the use of hollow organs (for example, the stomach) to replace the defect of the vena cava [8].

If intervention without CPB for locally advanced tumor of the chest is not possible due to the risk of bleeding and hemodynamic instability, the problem can be successfully solved using CPB [25, 38].

The following example demonstrates the benefit of using CI in thoracic oncology in patients previously considered inoperable.

Patient F., 50 years old, operated on 10.03.11 (Fig. 3) stump of the left pulmonary artery. patient F. e – view of the wound after removal of the preparation. Figure 3. Stages of surgery in patient F. f – removed left lung. with a diagnosis of squamous cell carcinoma of the left upper lobe bronchus with invasion of the trunk of the left pulmonary artery and the left upper lobe vein. Performed extended and combined pneumonectomy on the left with resection of the left pulmonary artery, left upper pulmonary vein and pericardium under EC. Mediastinal lymphadenectomy. IR 117 min. Blood loss 2000 ml.

Full longitudinal median sternotomy. Heparin. The pericardium was opened, taken on a holder. Both pleural cavities were opened. The upper lobe of the left lung is collapsed. In the upper lobe, a dense formation is determined, closely adjacent to the trunk of the pulmonary artery, aortic arch, isthmus of the aorta, with invasion of the intrapericardial section of the left superior pulmonary vein, the left pulmonary artery. Purse-string sutures were placed on the aorta and right atrium. Cannulation of the ascending aorta, SVC, IVC. The beginning of EC according to the scheme: vena cava – aorta, spontaneous cooling. The trunk of the pulmonary artery, the orifice of the left pulmonary artery, and the upper left pulmonary vein were mobilized from the tumor. Clamps were placed on the upper left pulmonary vein, the latter was crossed with continuous suture stitching with Prolene 4/0 thread. Clamps were applied to the left pulmonary artery, the latter was sutured with a continuous twisting suture with a 4/0 Prolene thread immediately at the mouth. The tumor is separated from the descending thoracic aorta in the adventitia of the latter. The left main bronchus was sutured with UKL-40 and crossed. Pneumonectomy. Decreased performance and termination of IR. Hemodynamics is stable. Decannulation. Protamine. Hemostasis. The pericardium is partially sutured with a continuous suture with a polypropylene mesh patch sewn in. A package of lymph nodes was removed in the area of ​​the tracheobronchial angle on the left. TachoComb to the area of ​​lymphadenectomy. Bulau drains were installed in the pericardium, left and right pleural cavities. Hemostasis. Standard wound closure.

The most difficult situation is in the case of a tumor lesion of the pulmonary trunk. A similar condition can occur in a patient suffering from central cancer of the left lung. There are isolated reports in the literature [25, 38] concerning the surgical treatment of such patients.

It is necessary to note the extreme complexity of such operations – any mistakes, both in tactics and in technology, are fatal. In the following example, we want to warn our colleagues against the dangers that warn surgeons who decide to operate on such patients.

Patient B., 54 years old acad. B.V. Petrovsky on January 24, 2011 for locally advanced central cancer of the left lung. From a complete longitudinal sternotomy, access was made to the heart and root of the left lung. A tumor growing from the left main bronchus invades the isthmus of the aorta, the pulmonary trunk is 2 cm above the valve. Clamp on the aorta. Crystalloid cardioplegia solution “Consol” by puncture of the aortic root. Cooling down to 28°C. The tumor was mobilized from the ascending aorta. Stupidly and sharply, with difficulty, the tumor was mobilized from the pulmonary trunk to the bifurcation of the pulmonary artery. Similarly, the tumor was mobilized from the isthmus of the aorta with the intersection of the phrenic and vagus nerves. At the same time, the wall of the aorta was damaged in the area of ​​5 mm. Hemostasis by suturing the aorta with a 4/0 prolene thread without effect. Hemostasis was achieved only with the help of exoprosthesis of the damaged part of the aorta. The left pulmonary artery was sutured with a UO-40 device, additionally ligated on both sides, and divided. In the aortocaval “window” the left main bronchus was sutured with the UO-40 device immediately at the carina, crossed. The left upper and lower pulmonary veins were sutured with UO-40, ligated and transected. Mediastinal lymphadenectomy. The drug has been removed. Warming the patient, removed the clamp from the aorta. When trying to turn off the EC device, right ventricular failure increased. During the revision, the trunk of the pulmonary artery was stenotic by ³ /4 with a stapled seam. Attempts to escape from IR were unsuccessful. Re-calculation of IC, clamp on the aorta, cardioplegia. The pulmonary artery is occluded between vascular clamps. The staple seam has been removed. A patch from the autopericardium was sutured into the defect of the pulmonary trunk with a 5/0 prolene thread, thus eliminating the stenosis of the pulmonary trunk. Removed clamps from the pulmonary trunk, aorta. Cardiac activity recovered on its own. Warming of the patient, decrease in productivity and termination of EC. The revision revealed diffuse bleeding from the tissues of the posterior mediastinum, as well as perspiration of the aortic wall altered by the tumor with blood. Long-term local hemostasis with hemostatic sponges, TachoComba. Hemodynamics was maintained by high doses of cardiotonic drugs, while it remained unstable. Against the background of hypotension, an increase in cardiotonic support, persistent asystole developed. Direct cardiac massage for 40 minutes without effect.

Operation duration 630 min. Blood loss 9000 ml, EC 453 min (174+10+9+21), MI 65+35 min.

Faced with such a significant tumor invasion and intraoperative complications, critically evaluating them, we made the following conclusions.

1. In the presence of tumor invasion of the main vessel, laborious and dangerous mobilization of the tumor from the vessel should be considered impractical due to the possibility of bleeding. In this situation, preference should be given to vessel resection within healthy tissues, followed by its prosthetics/plasty.

2. Mobilization of the main vessels (pulmonary artery, thoracic aorta) should be performed under EC conditions. In the presence of a locally advanced tumor of the chest that invades the great vessels, CPB is required in 70% of cases [25]. At the same time, EC should be used for the smooth work of the surgeon, in particular, to stabilize hemodynamics during tumor mobilization. It can be used as a standard bicaval cannulation with arterial perfusion of the ascending aorta and pharmaco-cold cardiac arrest with perfusion under normothermia / moderate hypothermia, as well as peripheral EC. Alternatively, descending aortic grafting and resection of the pulmonary trunk/SVC can be performed under conditions of hypothermic circulatory arrest.

M. Perrot et al. [18] note the safety of EC in the surgical treatment of patients with large (T4) non-small cell lung cancer with invasion of the main arteries and the left atrium. An interesting recommendation of the authors is to use EC in case of carina lesions and the need for separate ventilation of the lungs as a method that simplifies the work of the surgeon and allows performing full resection within healthy tissues.

3. If resection of the pulmonary trunk is necessary, primary closure of its defect with a patch/prosthesis should be performed in order to ensure adequate outflow from the right ventricle.

4. The bronchus mechanical suture should always be reinforced with a second row of 3/0 absorbable sutures. With a large pericardial defect, it is advisable to cover it with a polypropylene mesh. If the contralateral pleural cavity is opened during surgery, the pleura should be sutured and its cavity drained separately.

5. It is advisable to perform the pneumonectomy stage after CPB, minimizing the CPB time on one lung. The latter position is debatable and has the character of only our judgment. A number of authors [25] do not share the opinion of K. Ulicny et al. [38], who believe that lung resection during CPB may be associated with a higher risk of pulmonary complications and a higher rate of bleeding.

Thus, in the presence of a locally advanced malignant tumor of the chest organs with invasion of the great vessels, the treatment tactics are complex and far from unambiguous, remaining the subject of discussion among specialists.