Chest Wall Infections | Cedars-Sinai

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Overview

The chest wall, sometimes called the thoracic wall, protects the heart, liver, lungs and other vital organs. The wall is made up of the ribs, the sternum and cartilage. Together these pieces form a protective cavity within the abdomen.

The chest wall can become infected by bacteria or viruses. In rare cases, fungal infections can also happen. Infections of the chest wall can often lead to inflammation and pain in the affected area.

Types of chest wall infections include:

• Pleurisy — infection of the thin membranes (pleura) of the chest wall
• Costochondritis — inflammation of the cartilage that connects the upper ribs to the sternum
• Empyema — fluid that builds up between the pleura and the inner lining of the chest wall

Symptoms

The most common symptom related to a chest wall infection is chest pain. This is often due to the inflammation caused by the infection and may become more severe with activity. Other common symptoms include:

• Tenderness
• Swelling
• Difficulty taking a deep breath
• Pain in the shoulders or back
• Headaches
• Joint pain
• Dry cough
• Fever

Causes and Risk Factors

Chest wall infections can occur in both men and women, and in patients of any age. The condition is caused by a bacteria or virus, and in rare cases, a fungus, that has invaded the affected area.

Patients with a compromised immune system are at an increased risk of developing a chest wall infection. Common conditions that may increase a patient’s risk include:

Diagnosis

Diagnosis of a chest wall infection usually starts with a physical exam and a review of the patient’s medical history and symptoms.

Imaging diagnostic tests such as a chest x-rays look at the soft tissue and bones in the body to find out if there is inflammation in the chest wall. These images can also help diagnose other related conditions, such as pneumonia.

Blood tests may be done to find out if a bacterial or viral infection is causing the condition.

Other tests such as a bronchoscopy may be used to look at the tissue within the chest wall or at the airway to study inflammation or other signs of infection.

Treatment

Treatment for chest wall infections will often focus on fighting the infection that is causing the symptoms. Antibiotic medications to help fight the infection and reduce inflammation often are prescribed.

Many anti-inflammatory medications such as ibuprofen are available over the counter without a prescription and can provide relief for many patients who are experiencing pain due to inflammation.

Prescription painkillers may be provided to help reduce severe pain. Other prescription medications that can help control pain include antidepressants and anti-seizure drugs.

In-office or at home physical therapy exercises also may be prescribed as treatment. Stretching exercises that focus on the chest muscles can help with pain and tightness related to inflammation.

The multidisciplinary team at the Advanced Lung Disease Program can determine the best treatment option for each patient.

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Tietze Syndrome – NORD (National Organization for Rare Disorders)

TEXTBOOKS
Tanner J. Chest Wall Pain. In: Oxford Textbook of Musculoskeletal Medicine, 2nd edition. Hutson M, Ward A, editors. 2016 Oxford University Press. Oxford, UK. pp. 319-321.

Imamura M, Imamura ST. Tietze syndrome. In: Essentials of Physical Medicine and Rehabilitation. Musculoskeletal Disorders, Pain, and Rehabilitation, 3rd edition. Frontera WR, Silver JK, Rizzo Jr. TD, editors. 2015 Elsevier Saunders, Philadelphia, PA. pp. 582-587.

Brummett CM, Cohen SP. Managing Pain: Essentials of Diagnosis and Treatment. Oxford University Press. New York, NY; 2013:370-371.

JOURNAL ARTICLES
Kaplan T, Gunal N, Gulbahar G, et al. Painful chest wall swellings: Tietze syndrome or chest wall tumor? Thorac Cardiovasc Surg. 2015;[Epub ahead of print]. http://www.ncbi.nlm.nih.gov/pubmed/25742551

McConaghy JR, Oza RS. Outpatient diagnosis of acute chest pain in adults. Am Fam Physician. 2013;87:177-182. http://www.ncbi.nlm.nih.gov/pubmed/23418761

Gijsbers E, Knaap SFC. Clinical presentation and chiropractic treatment of Tietze syndrome: a 34-year-old female with left-sided chest pain. J Chiropr Med. 2011;10:60-63. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110396/

Brunse MH, Stochkendahl MJ, Vach W, et al. Examination of musculoskeletal chest pain – an inter-observer realiability study. Man Ther. 2010;15:167-172. https://www.ncbi.nlm.nih.gov/pubmed/19962338

Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am. 2010;94:259-273. http://www.ncbi.nlm.nih.gov/pubmed/20380955

Proulx AM, Zyrd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009;15:617-620. http://www.ncbi.nlm.nih.gov/pubmed/19817327

Fioravanti A, Tofi C, Volterrani L, Marcolongo R. Malignant lymphoma presenting as Tietze’s syndrome. Arthritis Rheum. 2002;47:229-230. http://www.ncbi.nlm.nih.gov/pubmed/12115149

Thongngarm T, Lemos LB, Lawhon N, Harisdangkul V, et al. Malignant tumor with chest wall pain mimicking Tietze’s syndrome. Clin Rheumatol. 2001;20:276-78. http://www.ncbi.nlm.nih.gov/pubmed/11529637

Kamel M, Kotob H. Ultrasonographic assessment of local steroid injection in Tietze’s syndrome. Br J Rheumatol. 1997;36:547-50. http://www.ncbi.nlm.nih.gov/pubmed/9189056

Costochondritis: Causes, symptoms, and treatment

The ribs are connected to the breastbone by tough, protective tissue called cartilage. When this cartilage becomes inflamed, the condition is known as costochondritis or chest wall pain.

While this condition is usually temporary, it can be alarming, as the pain can become so significant it mimics a heart attack.

Doctors may also refer to costochondritis as costosternal syndrome or costosternal chondrodynia. The condition will usually resolve on its own with home treatments.

Fast facts on costochondritis

• In many cases, doctors do not know what causes costochondritis.
• Pain in the chest and breastbone area is the chief symptom of costochondritis.
• The pain may be so severe that the person feels they are having a heart attack.
• Treatment includes anti-inflammatory medications.

Share on PinterestUsually costochondritis will resolve itself with home treatment, and is a temporary condition.

Though causes are often unknown, in some instances, the condition can be the result of one or more of the following:

• history of an illness that causes a lot of coughing
• heavy lifting or strenuous exercise, involving the upper extremities and chest wall
• carrying heavy bags, such as a heavy backpack on one side or the other
• having large breasts
• history of chest injuries or chest infections
• undergoing surgery that affects the chest wall, such as cardiac bypass

Doctors call costochondritis that has no known causes idiopathic costochondritis.

Chest discomfort and pain may be stabbing, burning, or aching in nature. The ribs most affected are the second to fifth ones.

The condition most commonly affects those older than age 40, according to an article in the journal American Family Physician. An estimated 13-36 percent of those who seek emergency medical attention for chest pain are experiencing costochondritis.

The following activities usually worsened the pain associated with costochondritis:

• significant amount of coughing
• strenuous exercise
• physical activity using the upper arms, such as lifting boxes

The pain associated with costochondritis usually occurs on the left side of the body but can affect both sides.

Tietze syndrome

There is a variation of costochondritis called Tietze syndrome. This condition causes pain associated with costochondritis, as well as swelling of the rib cartilage.

The swelling of Tietze syndrome affects at least one of the upper four ribs, usually the second or third ribs. While the pain associated with costochondritis may subside with time, some people with Tietze syndrome will still experience the swelling.

Although doctors have not defined how prevalent this condition is, they do consider it to be a rare disorder. Other than pain and discomfort, it does not cause any long-term harmful effects.

Share on PinterestThe symptoms of costochondritis can be worsened by certain activities, such as lifting heavy objects, or strenuous coughing.

Doctors usually treat costochondritis conservatively. Resting and avoiding strenuous exercise that affects the chest wall can help. So can over-the-counter pain relievers, such as ibuprofen or acetaminophen.

Children under age 18 should not take aspirin due to the increased risk for Reye’s syndrome.

In rare instances, a doctor may recommend injections of lidocaine or corticosteroids to reduce pain and inflammation. Other treatments that may help to relieve chest pain include:

• Applying moist heat by way of warm compresses.
• Taking cough suppressants to ease coughing and reduce pressure to the cartilage.
• Physical therapy to ease tension in the chest wall.

If these treatments do not reduce a person’s incidence of costochondritis, they should seek a follow-up with their doctor.

If a person is having chest pain, they should not try to determine for themselves if it is a heart-related issue or costochondritis. Instead, they should seek immediate medical attention.

If a younger person who is not at risk of heart attack experiences these symptoms, they should seek emergency attention if their chest pain is sharp and does not improve with rest.

If someone has gone to a doctor for their symptoms and has been diagnosed with costochondritis, there are still some instances when a person should seek immediate medical attention again. These include:

• feeling faint, dizzy, or lightheaded
• feeling as if the heart is beating irregularly or too fast
• pain that worsens over time or cannot be relieved by pain medicine
• having a shortness of breath
• a fever that is higher than 100.4 °F in an adult
• coughing up dark-colored sputum or blood

If the chest pain is radiating to the arms, neck, shoulder, jaw, or back, a person should seek immediate medical attention.

Share on PinterestSome conditions may seem similar to costochondritis, including an injured shoulder or neck, or arthritis of the surrounding joints.

Doctors often diagnose costochondritis by ruling out other potential causes of the chest pain and discomfort connected with the condition. For example, if a person is older than 35, a doctor may first want to rule out coronary artery disease (CAD), as a potential cause.

Individuals who are at risk of CAD, such as those with a family history, those who are obese, or those with a history of smoking, should usually have an electrocardiogram (ECG or EKG) and chest X-ray to check for CAD.

Other medical conditions that may closely resemble costochondritis include:

• arthritis of the shoulder or nearby joints
• chest wall infections or cancer
• fibromyalgia, a condition that causes nerve pain
• slipping rib syndrome, when there is too much mobility in the cartilage supporting the ribs
• injuries to the shoulder or neck that causes pain to refer or travel to the chest wall

A physical examination to detect tenderness of the cartilage to the touch may also be performed. If a person is having a heart attack or has another type of heart condition, the cartilage in the chest is not usually sensitive to the touch.

A doctor will also listen to the heart and lungs, as well as examine the skin for any signs of infection. An X-ray or other imaging studies will not show signs of costochondritis.

Doctors can usually diagnose a child, adolescent, or young adult by asking questions about their medical history and by conducting a physical exam. The doctor will often check for tenderness in the chest cartilage, as part of this.

According to American Family Physician, costochondritis can last anywhere from a few weeks to months. It may also recur if it has been caused by physical exercise or strain.

The condition does not usually last longer than one year. However, adolescents with costochondritis can sometimes have a longer period of symptoms.

What it is, causes, diagnosis, and treatment

Tietze syndrome is a rare inflammatory condition that causes swelling of the cartilage that attaches the upper ribs to the breastbone or sternum. The primary symptom is chest pain.

In this article, we outline the symptoms and causes of Tietze syndrome (TS) and provide information on how doctors diagnose and treat the condition. We also describe the outlook for people living with TS.

It is important to note that this condition is different than Tietz syndrome, the hallmarks of which include profound hearing loss, white hair, and very pale skin at birth.

TS symptoms are the result of inflammation and swelling in the cartilage that connects the upper four ribs to the sternum. Doctors refer to this area as the “costochondral joint.”

The main symptom of TS is a sharp, dull, or aching pain in the chest. As TS usually affects only one rib, the pain typically occurs on just one side of the chest. If the condition affects multiple ribs, a person may experience pain on both sides of the chest.

In some cases, chest pain may radiate to the neck, shoulders, and arms. These areas may appear red or discolored and feel warm to the touch.

TS pain may range from mild to severe, and it may come on gradually or suddenly. The pain may worsen during the following activities:

• breathing deeply
• coughing
• sneezing
• exercising
• performing quick movements, such as reaching across the chest or opening a door

TS symptoms may follow a relapsing-remitting pattern, meaning that a person will have alternating periods of experiencing symptoms and being symptom-free.

Symptoms typically appear before a person reaches the age of 40 years.

Scientists have yet to identify the exact cause of TS. However, some researchers believe that small injuries, or microtraumas, to the chest wall may play a role in the development of the condition.

Microtraumas within the chest wall may occur as a result of the following:

• a sports injury
• a car accident
• a fall
• viral or bacterial infections
• frequent coughing
• frequent vomiting
• surgery to the thoracic area, which is the area between the sternum and the bottom of the rib cage

The diagnostic procedure for TS involves ruling out other possible causes of chest pain.

A doctor will ask about a person’s symptoms and medical history before performing a thorough physical examination of the chest.

They may also order one of the following diagnostic tests to help rule out possible heart-related or lung-related causes of chest pain:

An MRI scan can be useful to confirm a diagnosis of TS. If TS is present, the scan should show thickening and enlargement of the affected rib cartilage.

TS pain sometimes resolves without the need for medical treatment. In other cases, a person with TS may experience persistent or relapsing pain.

If TS pain does not subside, a doctor may recommend the following:

Some people may experience severe or persistent TS pain that does not respond to the above treatments. In such cases, a doctor may recommend injecting the affected area with corticosteroids and lidocaine to reduce the inflammation and numb the pain.

In some cases, doctors may recommend physical therapy. A physical therapist may suggest stretches and exercises that the person can do to help manage their TS symptoms.

However, some people may need to avoid exercise and physical activity during treatment. A person should ask their doctor for advice on which treatment approach will be best for them.

TS is not an autoimmune disease. Instead, it is likely to be due to the development of microtraumas inside the chest wall.

However, having an autoimmune condition could theoretically contribute to TS. An autoimmune condition could predispose a person to certain viral or bacterial infections. Some infections could increase the likelihood of persistent coughing or vomiting, both of which are known risk factors for TS.

TS shares similarities with other disorders of the ribs and chest, including costochondritis and intercostal neuralgia.

Costochondritis

Costochondritis is another condition that causes an aching pain in the cartilage that connects the ribs to the sternum. As with TS, the pain may radiate to surrounding areas.

The main difference between TS and costochondritis is that TS causes characteristic swelling and inflammation in the affected rib cartilage, whereas costochondritis does not.

Other differences between the two conditions include:

• Prevalence: Costochondritis is much more common than TS.
• Age group: Costochondritis tends to affect people over the age of 40 years, whereas TS tends to affect people younger than this.
• Costochondral joints: Costochondritis typically affects the second, third, fourth, or fifth rib, whereas TS tends to affect only the second or third rib.

Intercostal neuralgia

Intercostal neuralgia is the medical term for nerve pain that originates in the spaces between the ribs.

Symptoms include a sharp, stabbing, or tingling pain around the ribs and possible left-sided back pain. Chest and back pain may worsen during the following activities:

• breathing deeply
• laughing
• coughing

Intercostal neuralgia may occur as a result of a viral infection or following an accident or surgery that damages the intercostal nerves.

The general outlook for people with TS is good. The condition itself is rare, and most people who have it experience mild or short-term symptoms. A 2018 study notes that with standard treatment, the symptoms of TS last an average of 1–2 weeks.

People who experience severe or relapsing-remitting symptoms may require long-term treatment.

TS is benign, and the life expectancy for people with the condition is normal.

Tietze syndrome is a rare inflammatory condition that involves inflammation of the cartilage between the ribs and sternum. The characteristic symptom is chest pain, which may radiate to the neck, shoulders, and arms.

It can take time to receive a diagnosis of TS because doctors will need to rule out more serious causes of chest pain.

Most cases of TS are mild and go away on their own within a couple of weeks. However, a doctor may recommend medical treatments to alleviate severe or persistent TS pain. Overall, the outlook for people with TS is good.

Symptoms, Causes, Tests and Treatment

Overview

Normal pleura in lung compared to inflamed pleura in lung (pleurisy)

What is pleurisy?

The pleura is the thin membrane that lines the outside of the lungs and the inside of the chest cavity. Pleurisy is an inflammation (swelling or irritation) of these two layers of tissue.

The pleural space is a thin area between the chest lining and the membrane that lines the lungs. Fluid lubricates the layers of the pleura so they slide smoothly alongside each other when you breathe. When the membranes become inflamed, they rub painfully against each other instead.

Pleurisy can cause sharp or stabbing chest pain and shortness of breath. It is also called pleuritis.

Who is affected by pleurisy?

Pleurisy can affect people with certain underlying medical conditions, such as infections or autoimmune diseases. Pleurisy occurs in people of all ages, but it develops most often in people over age 65. These people are more likely to develop chest infections.

People of Mediterranean descent have a higher risk for pleurisy due to a hereditary condition called familial Mediterranean fever. With familial Mediterranean fever, a genetic mutation (change) causes inflammation in the chest and abdomen.

Symptoms and Causes

What causes pleurisy?

Doctors do not always know what causes pleurisy. Infections usually cause the disorder. These infections can be viral (caused by a virus), such as influenza, or bacterial (caused by bacteria), such as pneumonia. While infections can cause pleurisy, pleurisy itself is not contagious.

Other conditions that can cause pleurisy include:

• Asbestosis (lung disease caused by the inhalation of asbestos).
• Autoimmune disorders such as lupus and rheumatoid arthritis.
• Blood clot in the lung (pulmonary embolism).
• Chest surgery or trauma.
• Inflammatory bowel disease.
• Reactions to medicines including hydralazine (treats high blood pressure), isoniazid (treats tuberculosis), and procainamide (treats abnormal heart rhythms).
• Tumors caused by cancers of the respiratory system such as lung cancer.

What are the symptoms of pleurisy?

Most people with pleurisy experience sharp or stabbing chest pain, also known as pleuritic pain. This pain often worsens when you cough or breathe in deeply. Sometimes the pain can spread to the shoulder or back.

Pain similar to pleuritic pain can also be a symptom of emergency medical conditions such as a heart attack or pulmonary embolism (blood clot in the lung). If you experience sharp chest pain, it is important to seek immediate medical attention to rule out these life-threatening conditions.

Other signs and symptoms of pleurisy can include:

• Cough.
• Fatigue (extreme tiredness).
• Fever.
• Shortness of breath.
• Unexplained weight loss.

Can you get pleurisy more than once?

Yes. You do not become immune to pleurisy by having it and recovering. Also, some of the conditions that can cause pleurisy are chronic—you have them for a long time—so you may continue to be susceptible to inflammation of the pleura.

Diagnosis and Tests

How is pleurisy diagnosed?

Doctors use a medical history and several tests to evaluate for pleurisy. These tests include:

• Biopsy: In some cases, a doctor will take a small sample of lung tissue to determine whether cancer or tuberculosis is present.
• Blood test: Doctors use blood tests to look for signs of infection or autoimmune disorders such as lupus or rheumatoid arthritis.
• Electrocardiogram (EKG or ECG): This test uses small electrodes placed on the chest to measure the heart’s electrical activity. It helps doctors rule out problems or defects of the heart.
• Imaging tests: Imaging tests such as X-rays, CT scans and ultrasounds allow your doctor to see abnormalities in the pleural space, including air, gas or a blood clot.
• Physical exam: Listening to your lungs with a stethoscope allows your doctor to hear a rubbing sound in your lungs that may be a sign of pleurisy.
• Fluid extraction (thoracentesis): A doctor inserts a small needle into the pleural space and removes fluid to look for signs of infection or other causes of pleurisy.

Management and Treatment

What are the treatments for pleurisy?

Pleurisy treatment depends on the underlying condition causing it. In some cases, pleurisy goes away on its own without treatment.

Your treatment options might include:

• Draining the pleural space: Doctors remove air, blood, or fluid from the pleural space. Depending on how much of the substance needs to be drained, doctors use a needle and syringe (thoracentesis) or a chest tube to suction fluid out of the area.
• Medication: Your doctor might prescribe an antibiotic, an antifungal or an antiparasitic to treat an infection. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can relieve the pain associated with pleurisy. Corticosteroids can reduce inflammation, but they can produce many side effects. Your doctor may prescribe bronchodilators to make it easier for you to breathe.
• Radiation treatment or chemotherapy: In some cases, doctors use cancer treatments to shrink tumors that cause pleurisy.

What are the complications associated with pleurisy?

Some people with pleurisy experience complications. They include:

• Hemothorax: Blood builds up in the pleural space.
• Pleural effusion: Too much fluid collects in the pleural space. Pleural effusion can cause difficulty in breathing.
• Severe illness from not treating the infection or condition that caused pleurisy in the first place.

Prevention

How can you prevent pleurisy?

You can’t prevent pleurisy, but you can reduce your risk by promptly treating conditions that may cause it. You should also quit smoking tobacco, using electronic cigarettes, and smoking marijuana. If you don’t smoke, don’t start.

Who is at risk of developing pleurisy?

People of Mediterranean descent have a higher risk for pleurisy due to a hereditary condition called familial Mediterranean fever. People with other underlying conditions that can lead to pleurisy are also at higher risk for the disorder. These conditions include:

• Asbestosis (lung disease caused by inhaling asbestos).
• Autoimmune disorders such as lupus and rheumatoid arthritis.
• Cancers of the respiratory system such as lung cancer, asthma, and COPD.
• Chest surgery or trauma.
• Inflammatory bowel disease.
• Taking certain medications, including hydralazine, isoniazid, and procainamide.

Outlook / Prognosis

What is the prognosis (outlook) for people with pleurisy?

Doctors successfully treat most cases of pleurisy. Most people who receive prompt diagnosis and treatment for the condition causing pleurisy recover fully. People treated with antibiotics for an infection causing pleurisy usually feel better in about a week. Very rarely, people who are not treated may have life-threatening complications. The outlook also depends on the underlying condition that caused the pleurisy.

Living With

When should I see a healthcare provider about pleurisy?

Contact your healthcare provider if you experience unexplained severe chest pain or other symptoms of pleurisy.

What questions should I ask my doctor?

If you have pleurisy, you may want to ask your doctor:

• Why did I develop pleurisy?
• Should I consider genetic testing?
• If medicine caused pleurisy, should I stop or change my medicine?
• Am I at higher risk for other lung conditions?
• What can I do at home to relieve pain?
• What signs of complications should I look out for?
• Am I more likely to get pleurisy again after having it once?

Chest Wall Cancer – Brigham and Women’s Hospital

Comprising less than five percent of all thoracic malignancies, cancers of the chest wall are rare and difficult to treat. Chest wall tumors can develop in the bones, soft tissues and cartilage of the chest cavity, which contains the heart, lungs and other organs. These tumors typically involve invasion or have metastasized from adjacent thoracic tumors, and are malignant in more than half of cases.

The most common chest wall cancer is sarcoma of the chest wall, including:

Other chest wall cancers include metastatic cancer, desmoid tumor and neurogenic tumors.

Tumors in the chest wall typically manifest as painful, quickly growing and easily palpable masses. Surgery is often necessary, and may be followed by plastic surgery reconstruction to recreate a normal appearance.

Physicians and surgeons at the Brigham and Women’s Hospital (BWH) Lung Center provide comprehensive, specialized care for patients with chest wall cancer. As the thoracic surgical and pulmonary medicine specialists for Dana-Farber/Brigham and Women’s Cancer Center, our physicians collaborate with other specialists to provide patients with a highly informed diagnosis and a cohesive treatment plan.

What are the risk factors for chest wall cancer?

While chest wall cancer is rare, factors contributing to an increased risk for chest wall cancer include:

• Advanced age, as certain chest wall cancers are more prevalent among elderly
• Previous radiation to the chest
• Living in certain parts of the world
• History of a previous cancer

What are the symptoms of chest wall cancer?

The most common symptoms of chest wall cancer are:

• Chest pain
• Swelling in the chest
• A mass or lump protruding from the chest
• Muscle atrophy
• Impaired movement

Sometimes chest wall cancer does not exhibit any symptoms. About 20 percent are found incidentally on chest X-rays. For that reason, it is important that you regularly see your physician and alert him or her should you notice any irregularities.

How is chest wall cancer diagnosed?

To diagnose your chest wall cancer, our specialists will carefully review your medical history and conduct a full physical examination. He or she will likely order additional tests, including:

Our thoracic radiologists confine all their work to reading radiographic studies of the chest. They are highly skilled at recognizing chest wall cancers and patterns of spread. Our pathologists are internationally recognized as research leaders in the accurate diagnosis of rare sarcomas. The ability to provide a definitive diagnosis is invaluable to our multi-specialty treatment team.

What are the treatment options for chest wall cancer?

Specialists at Brigham and Women’s Hospital offer both conventional and novel therapies for the treatment of chest wall cancer, personalized to each patient. Depending on your medical history and the stage of the cancer, your treatment may include chemotherapy, radiation therapy and/or surgery.

What are the non-surgical treatment options for chest wall cancer?

Although a traditional surgical approach is still needed for complex chest wall cancers, Brigham and Women’s Hospital has pioneered and refined the most advanced surgical treatments for chest wall cancer, including intraoperative chemotherapy. Surgery for chest wall cancer is typically used in conjunction with a combination of other treatments, including:

• Chemotherapy involves anticancer drugs that aim to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery, although it can be used alone in advanced cases.
• Radiation therapy uses high-energy rays to shrink or kill cancer cells. It is often used alongside chemotherapy before and after surgery.

What is chest wall cancer surgery?

The purpose of surgery is to remove all visible disease. We also strive to preserve function of the chest and arms so patients can continue to enjoy activities important to them, including golf and other sporting activities. Surgical options for chest wall cancer include:

Chest wall resection and reconstruction is the primary surgical option for chest wall tumors. This surgery involves the removal of one or more ribs to extract the tumor, followed by reconstruction to recreate a normal appearance after invasive surgery. This can involve prosthetic materials and/or rotation of muscle flaps.

Video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (small camera) and surgical instruments into small incisions in the chest to remove the tumor.

What can I expect?

A multidisciplinary team will work with you every step of the way, from diagnostics through evaluation, to create a cohesive and comprehensive treatment plan. Our unique approach features same day consultations with multiple specialists and fosters seamless, expert care. Your medical condition will be closely monitored and managed to promote optimal lung functioning and an improved quality of life.

If you require surgery, you will meet with your healthcare team first for pre-operative information and tests. On the day of your surgery, you will receive care from surgeons, anesthesiologists and nurses who specialize in thoracic surgery and interventional pulmonary procedures. After surgery, you will recover in our designated thoracic post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Team-based care

Chest wall cancer patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, medical and radiation oncologists, pulmonologists and imaging experts. This collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any recommended surgery or procedure will be performed by an experienced, board-certified surgeon, in collaboration with the treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with chest wall cancer.

How do I book an appointment or find directions?

What other resources can I read on thoracic cancer?

Learn more about thoracic cancer topics in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Pleurisy | Michigan Medicine

Topic Overview

Is this topic for you?

This topic provides information about pleurisy, which usually results in chest pain. If you have chest pain that concerns you and that your doctor does not know about, see the topic Chest Problems.

What is pleurisy?

Pleurisy is swelling (inflammation) of the thin layers of tissue (pleura) covering the lungs and the chest wall.

The outer layer of the pleura lines the inside of the chest wall, and the inner layer covers the lungs. The tiny space between the two layers is called the pleural cavity. This cavity normally contains a small amount of lubricating fluid that allows the two layers to slide over each other when you breathe.

When the pleura becomes inflamed, the layers rub together, causing chest pain. This is known as pleuritic pain.

Pleurisy is sometimes called pleuritis.

What causes pleurisy?

In young, healthy people, an infection of the lower respiratory system by a virus or bacteria may cause pleurisy. Pleurisy usually lasts a few days to 2 weeks. In very rare cases, the virus or bacteria may spread and cause pleurisy in others.

Other causes of pleurisy include air leaking into the pleural cavity from a hole in a lung (pneumothorax), injury to the chest (such as a broken rib), tuberculosis or other infections, or a tumor in the pleura.

Other conditions may also cause pleurisy. These include rheumatoid arthritis, lupus, sickle cell crisis, pulmonary embolism, or pancreatitis. Pleurisy may also develop as a complication of heart surgery.

What are the symptoms?

The symptoms of pleurisy are chest pain and difficulty breathing. The chest pain usually starts suddenly. People often describe it as a stabbing pain, and it usually gets worse with breathing. The pain:

• May always be present, but it usually gets worse when you breathe in. You may avoid breathing deeply to prevent the pain.
• Usually is on only one side of the chest.
• May extend to a shoulder or the belly.
• Is usually worse when you cough, sneeze, or suddenly move.
• May ease when you hold your breath or press on the painful area.

But this type of chest pain can be caused by conditions that do not affect the pleura, such as chest muscle strain and costochondritis.

If a viral infection is causing your pleurisy, you may or may not have common viral symptoms, such as fever, headache, and muscle aches.

The inflammation of the pleura sometimes causes fluid to build up in the pleural cavity (pleural effusion). You may have less pain after this happens, because the fluid prevents the two layers of the pleura from rubbing together. If there is a large amount of fluid, it may prevent the lung from expanding when you breathe in. This can make it hard to breathe. Other symptoms of pleural effusion include fever, chest pain, and a dry cough.

Pleural effusion
may occur without pleurisy in other conditions, such as heart failure or liver or kidney disease.

How is pleurisy diagnosed?

Many different health problems can lead to pleurisy, so your doctor will look for what is causing your inflammation. He or she will do a physical exam and tests such as a chest X-ray, blood tests, or a CT scan to look for the cause of your symptoms. The conditions that may cause pleuritic chest pain include:

If your doctor thinks your pleurisy may be caused by an autoimmune disease such as lupus or rheumatoid arthritis, he or she may do blood tests.

If you have pleural effusion, your doctor may use a needle to remove some of the fluid from the pleura. This procedure is called thoracentesis. The fluid is then studied, to help your doctor find out the cause of the effusion.

See pictures of pleural effusion and thoracentesis.

How is pleurisy treated?

The treatment for pleurisy depends on the cause. For example, if a bacterial infection is the cause, you will probably need an antibiotic. If a pulmonary embolism is present, you may get medicine to dissolve the clot or to prevent future blood clots (anticoagulants).

For most cases of pain caused by pleurisy, your doctor will suggest that you use aspirin, ibuprofen, or another nonsteroidal anti-inflammatory drug (NSAID). Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome. If you have severe pain, you may need prescription cough or pain medicine. You may also be able to relieve pain by lying on the painful side or pressing a pillow against it.

If you have pleural effusion, you may need to have the fluid drained through a tube that the doctor inserts in your chest.

In some cases of pleural effusion, you may need pleurodesis. During this procedure, a medicine is put into your chest cavity, which triggers an inflammatory reaction over the surface of the lung and inside the chest cavity. This causes the surface of the lung to stick to the surface of the chest cavity, which prevents more fluid from building up or reduces the amount of fluid.

90,000 Chest tumors – treatment in Europe

The mediastinum is a complex anatomical region located in the chest cavity and bounded by the parietal pleura, sternum, vertebral column and diaphragm. The mediastinum is conditionally divided in the frontal plane, passing along the posterior wall of the trachea into the anterior and posterior, and at the level of the tracheal bifurcation – into the upper and lower.
In each of the departments, certain organs and tissues are located, from which tumors can arise.Almost all the lymph nodes and the thymus gland are located in the anterior-upper mediastinum, so tumors from the lymph nodes (lymphomas and lymphosarcomas) and the thymus gland (thymomas) are formed here. In the posterior region, tumors from nerve tissue (neuroma) or cartilaginous (chondroma) are more common. In the antero-lower part of the mediastinum, dermoid and coelomic cysts are more often found, and in the posterior-lower part – chondromas and neurinomas. Mediastinal neoplasms account for 1 to 3% of all human tumors, occur mainly in young and middle age.

Classification of tumors of the mediastinum

Currently, more than 50 morphological varieties of mediastinal neoplasms have been described.

According to the clinical course and histological structure, mediastinal tumors are divided into benign and malignant.

Dermoid and coelomic cysts and teratomas are the most common benign tumors of the mediastinum. The most common malignant neoplasms of the mediastinum include tumors originating from lymphoid tissue – lymphosarcoma, lymphoma, malignant thymoma, chondroma and neuroma.Mediastinal lymphoma occurs in 50% of patients with Hodgkin’s disease (lymphogranulomatosis) and non-Hodgkin’s lymphoma and is located in the anterior mediastinum. In addition, all tumors of the mediastinum are divided into primary (arising in the mediastinal space initially) and secondary (metastases from neoplasms in other organs).

The so-called pseudotumors are also found in the mediastinum – enlarged conglomerates of lymph nodes in Beck’s sarcoidosis and tuberculosis, aneurysms of large vessels, etc.

Symptoms of mediastinal tumors

The clinical symptomatology of neoplasms of the mediastinum is characterized by a long asymptomatic period, gradually giving way to a period of severe symptoms. The duration of the asymptomatic period depends on the size, location, nature, growth rate of the mediastinal tumor, its relationship with other organs. Often asymptomatic mediastinal tumors are found with prophylactic fluorography.

The onset of clinical manifestations of mediastinal tumors is associated with compression by the tumor or its invasion into adjacent organs and tissues.The earliest manifestation of neoplasms of the mediastinum, both benign and malignant, is the appearance of pain in the chest area caused by the involvement of nerve plexuses and trunks in the process, as well as the parietal and visceral pleura rich in nerve endings. Pain is usually of moderate intensity, can radiate to the interscapular region, shoulder girdle, neck. When a tumor of the trachea and bronchi is compressed, shortness of breath, cough, stridor breathing occur, if the recurrent nerve is damaged, hoarseness (dysphonia) occurs, and when the esophagus is compressed, there is difficulty in passing food (dysphagia).With left-sided localization, pain may resemble angina pectoris. With the growth of a tumor or compression of the borderline sympathetic trunk, Horner’s syndrome (ptosis, miosis and enophthalmos) and hyperemia of half of the face on the affected side may develop. Compression and disturbance of blood flow through large venous vessels is manifested primarily by the “superior vena cava syndrome” (SVCS), in which patients are worried about severe headache, tinnitus, shortness of breath, swelling and cyanosis of the face and chest, swelling of the cervical veins.

The appearance of general symptoms of tumor intoxication – weakness, fever, weight loss – indicates a far-reaching malignant process.

Some tumors of the mediastinum show specific symptoms. In malignant lymphomas, itching and night sweats are noted. Fibrosarcomas of the mediastinum can be accompanied by hypoglycemia (a spontaneous decrease in blood glucose levels). Patients with thymoma develop myasthenia gravis.

Neuroblastomas and ganglioneuromas of the mediastinum can produce adrenaline and norepinephrine, which leads to arterial hypertensive crises, as well as vasointenstinal polypeptide causing prolonged diarrhea.

Diagnosis of mediastinal tumors

According to the history, physical examination and clinical manifestations, pulmonologists and thoracic surgeons are not always able to diagnose mediastinal tumors. Therefore, the leading role in identifying neoplasms of the mediastinum belongs to instrumental research methods.

With a comprehensive X-ray examination, it is possible to determine the localization, prevalence of the pathological process, the shape and size of the tumor. If a tumor of the mediastinum is suspected, a multi-position chest x-ray and contrast x-ray of the esophagus must be performed.To clarify the X-ray data, computed tomography of the chest, MRI or MSCT of the lungs are used.

Endoscopic diagnostics for neoplasms of the mediastinum includes the following research methods:

• fiberoptic bronchoscopy,
• video thoracoscopy,
• mediastinoscopy.

With fibrobronchoscopy, it is possible to perform a transtracheal or transbronchial biopsy of a mediastinal tumor.

Samples of pathological tissue for research can also be obtained using transthoracic aspiration or puncture biopsy, carried out under the control of ultrasound or X-ray apparatus. Techniques such as diagnostic thoracoscopy and mediastinoscopy allow biopsy of the tumor focus under visual control and are the preferred methods for obtaining material for morphological examination. In some cases, it becomes necessary to perform a parasternal thoracotomy (mediastinotomy) for revision of the mediastinum and biopsy.

If mediastinal lymphoid tumors are suspected, bone marrow puncture is performed to examine the myelogram.

Treatment of mediastinal tumors

The main method of treatment of neoplasms of the mediastinum is their surgical removal. In order to prevent the development of compression syndrome and malignancy, all mediastinal tumors should be removed as soon as possible. In recent years, the techniques of videothoracoscopy and mediastinoscopy have been successfully used.These minimally invasive techniques make it possible not only to visualize and document tumor foci in the mediastinum, but also to remove them using thoracoscopic instruments, while inflicting minimal surgical trauma on the patient. This technique allows for intervention even in patients with low functional reserves and severe concomitant diseases.
Benefits of minimally invasive treatments:

• reduction of blood loss and postoperative pain;

90,031 reduction in the length of stay in the clinic;

• faster return to normal quality of life;
• reduction in the risk of postoperative complications.

Transthoracic ultrasound aspiration of mediastinal neoplasms can be performed in patients with severe general somatic background. In case of a malignant process in the mediastinum, an extended radical removal of the tumor is carried out in compliance with the rules of ablastic and antiblastic surgery, or palliative removal of the tumor for decompression of the mediastinal organs.

The need to use radiation and chemotherapy, both in combination with surgical treatment, and independently, is solved in each specific case of the disease.With advanced stages of a malignant tumor process, as well as with mediastinal lymphomas, conservative treatment methods play a major role.

With timely diagnosis and as early treatment as possible, the prognosis is relatively favorable.

Diagnostics and Treatment of Cancer, Examination, Tests for Cancer Moscow City Oncological Hospital № 62

Thoracic Department provides routine surgical care for cancer patients with chest pathology, including lung cancer, tracheal cancer, bronchial cancer, pleural cancer.During the year in the department, on average 600 patients are examined and treated, of which about 450 receive surgical treatment.

The department’s specialists possess all the modern arsenal of diagnostic manipulations and surgical interventions:

Tracheobronchoplastic operations. Used for benign and malignant tumors of the trachea and large bronchi, cicatricial post-traumatic and post-tuberculosis stenosis of the trachea and large bronchi.Allows to perform radical removal of tumors with maximum preservation of lung tissue and organ function.

Angiobronchoplastic operations. Used for malignant tumors of the lungs and mediastinum with involvement of the great vessels (pulmonary artery, superior and inferior vena cava, aorta, atrium). They make it possible to perform radical surgical interventions in a locally advanced tumor process as an alternative to palliative chemoradiation treatment.

Operations for tumors of the apex of the lung with invasion into the chest wall (Pancost tumor) from the combined cervicotransternal-thoracotomy or posterior approaches. They are used for peripheral cancer of the upper lobe of the lung IIB stage T3N0-1M0 with damage to the 1-3 ribs, benign and malignant tumors of the upper aperture. They give the possibility of radical surgery as a stage of combined treatment after chemotherapy and radiation therapy in the same oncological institution.

Cervico-mediastinal lymphadenectomy from transsternal access. It is used for malignant tumors of the lungs, mediastinum, esophagus, trachea. They make it possible to perform radical operations in the presence of metastases in the lymph nodes of the neck and mediastinum (including bilateral ones) within the framework of combined and complex (chemoradiation) antitumor treatment.

Pneumonectomy with mediastinal lymph node dissection. It is used for lung cancer, inflammatory processes of the lungs (abscesses and gangrene), requiring removal of the lung in order to prevent bronchopleural fistula.It makes it possible to perform radical removal of the lung in conditions unfavorable for the healing of the bronchial stump (post-radiation, inflammatory), allows to reduce the number of purulent bronchopleural complications.

Open anatomical segmental lung resection with mediastinal lymphadenectomy. It is used for stage 1 peripheral lung cancer, lung metastases, benign tumors (root localization), non-tumor processes (tuberculoma, pneumocirrhosis, cysts).It makes it possible to perform radical surgery with maximum preservation of the volume and function of the lung, including in elderly patients with low cardiopulmonary reserves, and is also used as an alternative to surgery in the volume of lobectomy.

Intrathoracic ultrasound examination of pathology of the lungs and mediastinum during videothoracoscopic operations. It is used in the detection of non-visualized foci in the lungs (10-15 mm) and nodular formations in the mediastinum (mediastinal tumors, lymph nodes) during videothoracoscopy for biopsy and histological examination.It allows to reduce the duration of the pathology search procedure, increase its accuracy and reduce the trauma of invasive diagnostics by combining the advantages of videothoracoscopy and intrathoracic ultrasound.

Videothoracoscopic atypical lung resection. It is used for morphological verification of nodules in the lung (sizes from 5 mm to 3 cm) identified by computed tomography of the chest, treatment of solitary and single metastases in the lungs, benign lung tumors and non-tumor pathology (tuberculoma, cyst).Low-traumatic surgery with short rehabilitation periods compared to traditional thoracotomy.

Video-assisted and videothoracoscopic lobectomy with mediastinal lymphadenectomy. It is used for stage 1-2 lung cancer, benign tumors, intrapulmonary sequestration, chronic abscess. It makes it possible to perform a radical operation for the above pathology with a low-traumatic approach with short rehabilitation periods.

Video-assisted and videothoracoscopic anatomical segmentectomy with mediastinal lymphadenectomy. It is used for root localization of benign lung tumors, solitary and single metastases, primary peripheral lung cancer up to 20mm. It makes it possible to perform radical surgery with maximum preservation of lung tissue with a low-traumatic approach with short rehabilitation periods.

Videothoracoscopic combined plasma-talc pleurodesis. It is used for pleurisy of various etiologies (metastatic, recurrent nonspecific), spontaneous recurrent pneumothorax in patients with preserved reserves of the cardiopulmonary system.It makes it possible to improve the patient’s quality of life due to the filling of the pleural cavity as an alternative to multiple pleural punctures.

Videothoracoscopic removal of tumors and cysts of the mediastinum. It is used for malignant and benign neoplasms of the mediastinum. It makes it possible to perform a radical operation for the above pathology with a low-traumatic approach with short rehabilitation periods.

Radiofrequency or microwave thermal ablation of peripheral lung cancer and solitary lung metastases. It is used for stage 1 peripheral lung cancer or solitary metastasis in the lung up to 3 cm in size of subpleural localization in patients with functional contraindications to surgical and radiation treatment. Allows to carry out local antitumor treatment in functionally inoperable patients.

Ambulatory transthoracic needle biopsy of lung and mediastinal tumors under ultrasound + CTG navigation using Fusion technology. It is used for morphological verification of nodular formations of the lung, mediastinum, pleura.Allows for outpatient morphological verification of intraparenchymal nodes in the lung with a decrease in radiation exposure in comparison with a biopsy under X-ray CTG-chest.

Removal of a mediastinal tumor with resection and plasty of the superior vena cava from the transsternal approach. It is used for malignant tumors of the mediastinum with the defeat of the superior vena cava residual tumor of the mediastinum after chemoradiation treatment. Provides the possibility of radical removal of the tumor, as an alternative to palliative chemoradiation treatment.

Patients are accommodated in single, double, triple and quadruple wards. In total, the department has 30 beds. Each ward is equipped with functional beds and consoles for communication of the patient with guard nurses, bathrooms.

Single rooms of superior comfort are equipped with individual bathrooms with shower, TV, refrigerator.

Diagnostics in Oncology | Health Blog

Today, there is an increase in the incidence of cancer worldwide.Along with this, the development of radiological diagnostic methods and their widespread use contribute to the diagnosis of oncological diseases in the early stages. The survival rate for cancer directly depends on the severity of the cancer.

The following basic methods of radiation diagnostics are used in oncology:

• Ultrasound – (a visual technique based on the use of ultrasonic waves to obtain an image)
• on obtaining layer-by-layer images in the transverse plane and their computer reconstruction
• Magnetic resonance imaging (MRI) – a method based on obtaining layer-by-layer images of organs and tissues using the phenomenon of magnetic resonance
• Radionuclide diagnostics or nuclear medicine – a method of radiation diagnostics based on registration of radiation from artificial radiopharmaceuticals introduced into the body
• The development of the stage of the disease determines the treatment and outcome of the underlying disease

The use of radiation diagnostics in oncology is aimed at solving the main problems:

1. Early (preclinical) diagnosis of neoplasms.Recently, radiation diagnostic methods have been effectively used as screening, which allows detecting neoplasms less than 1 cm in size
2. Staging, assessment of localization, prevalence, metastasis, differential diagnosis. At this stage, radiation and radionuclide methods are the most informative, based on which a decision is made on treatment tactics
3. Assessment of treatment results and dynamics of the disease. Antitumor treatment includes radiation therapy, chemotherapy, surgery, both independent methods and their combinations in various sequences.A system of criteria known as RECIST (Response Evaluation Criteria in Solid Tumors) is used to assess the effectiveness of the therapy, as well as to objectively compare the results obtained in various clinics around the world. Using these criteria, the parameters of complete, partial responses, stabilization and progression of the disease are determined. The classification is based on determining the size of the tumor using methods of radiation diagnostics and endoscopic methods. Thus, repeated diagnostics using radiation methods is actively used in the postoperative period and after treatment, i.e.to. gives a clear understanding of the effectiveness of therapy and allows you to plan further tactics of patient management
4. Dynamic observation. Modern algorithms for the treatment of oncological diseases provide for observation and periodic studies using radiological methods to detect relapses

Types of cancer and methods of its diagnosis

Ovarian tumors

Imaging techniques such as magnetic resonance imaging (MRI), which may provide additional information, but are not necessary studies for routine preoperative assessment.In case of questionable ultrasound results, the use of MRI enhances the specificity of the imaging method, thereby reducing the risk of misdiagnosis

CT is not the method of choice for ovarian cancer, but is used when it is impossible to perform MRI, also to assess the damage to the lymph nodes.

Cervical cancer

• Magnetic resonance imaging (MRI) is considered as an additional examination method, which is superior to CT examination in assessing the extent of the tumor, but in assessing lymph node involvement, both methods are equivalent.Magnetic resonance imaging of the pelvis and abdomen is also performed to search for metastases
• Computed tomography can be used to detect metastatic lesions of the chest organs

Endometrial cancer

• If the cervix is ​​involved, contrast-enhanced magnetic resonance imaging (MRI) is recommended
• CT of the chest and abdomen is used to detect metastases

Tumors of the esophagus

To determine the prevalence of the process, search for metastases, as an additional method, CT of the chest and abdominal cavity with contrast is used

Tumors of the stomach

Methods of radiation diagnostics (MRI, CT) are used to search for metastases in the abdominal cavity and retroperitoneal space, in the small pelvis, lungs and brain.For this, it is preferable to do MRI of the abdominal cavity, small pelvis, brain and CT of the lungs

Pancreatic tumors

CT and MRI with contrast are considered the best diagnostic methods.

MRI will provide more accurate information on tumor detection, and CT will more accurately determine invasive growth, which is important for the operative surgical volume.

All organs of the abdominal cavity and retroperitoneal space tend to metastasize to the lungs, brain, small pelvis.

Liver tumors

• MRI with contrast enhancement is considered the optimal method for diagnosing liver masses, and the use of hepatospecific contrast agents has an additional advantage for this pathology
• For adequate tumor staging, CT of the chest and abdominal organs is used

Cancer of the gallbladder and bile ducts

The diagnosis should be based on MRI radiological findings and pathological confirmation of the diagnosis.

Colon cancer

Virtual colonoscopy (a non-invasive method based on radiation diagnostics) is able to accurately visualize the localization of the tumor, which is especially useful in combination with the endoscopic method in planning the volume of surgery

Colorectal cancer

• Magnetic resonance imaging of the rectum can provide comprehensive information to the surgeon regarding the stage of the process, determine the characteristics of the blood supply, help form an understanding of the scope of the operation and surgical access
• Computed tomography, in this case, is performed to detect metastases (abdominal cavity, lungs, head brain)

Colon tumors

• Virtual colonoscopy is used as a screening diagnostic method (non-invasive method based on radiation diagnostics)
• CT is used to search for metastases

Tumors of the lung and mediastinum

• The main diagnostic method is CT of the chest
• Since lung cancer often metastasizes to the abdominal cavity and the brain, it is advisable to perform CT / MRI of the abdominal cavity and MRI of the brain

Kidney tumors

• This disease is diagnosed on CT, the connections with the renal arteries, the degree of invasion into the calyceal system and extraorganic spread and exposure are determined.
• Magnetic resonance imaging is also widely used in this field.Both CT and MRI studies are performed using contrast

Bladder tumors

• MRI of the small pelvis with contrast is performed
• The presence of metastases is examined on CT in the lungs and abdominal cavity

Cancer of the prostate and testicles

• Magnetic resonance imaging of the small pelvis, allows you to assess in detail the structure of the prostate gland, the prevalence of the pathological process, the involvement of the surrounding tissues, lymph nodes in the process
• T.Since prostate cancer often metastasizes to the bone, bone scans are performed in the later stages of the disease

Lymphoproliferal diseases / lymphomas

Radiation diagnostics (computed, magnetic resonance imaging with contrast) reveals the presence of tumor formations in various anatomical areas that are not available to the doctor during an external examination

Brain tumors

• The main diagnostic method is MRI. This type of study is necessary to clarify the localization of the tumor, to determine the degree of prevalence
• MR – tractography can indicate the degree of involvement of the pathways of the brain (tracts)
• Computed tomography is used as an additional method if bone structures are involved in the process.CT is also performed if there are absolute contraindications to MRI examination

Spinal cord tumors

Magnetic resonance imaging is used to determine the localization of the tumor, its level and position (intramedullary or extramedullary tumors, i.e. located in the structure of the spinal cord or outside it). In case of contraindications to MRI, CT scan is performed

Melanoma

Radiation diagnostics is not used to detect melanoma as such, but due to active metastasis, CT and MRI are performed.

Bone tumors

• MRI / CT is used depending on the location. In addition to local information in the area of ​​interest, CT / MRI diagnostics of other areas can reveal the spread of the tumor to other organs, damage to the lymph nodes.
• MRI of soft tissues provides insight into the spread of bone tumors to them.
• Whole body MRI is used to stage and evaluate treatment.

Neoplasms, what to do? – everything about veterinary oncology! / Veterinary clinic ASVET Odintsovo

For owners about animal oncology

The main condition for the effectiveness of the treatment of any disease is early diagnosis, but especially the importance of this provision in oncology should be emphasized.In the late stage, the cure of a malignant tumor is a rare exception.

Among the causes of general mortality in dogs and cats, tumor diseases confidently hold the second place. The 1st and 2nd are occupied by tumors of the skin and mammary glands, respectively. Given the high frequency of detection of cancer in domestic animals, cancer alertness should be shown to both doctors and animal owners.

When a pet owner asks the doctor what caused his pet’s cancer, the question is often abstract.He has no intention of knowing what histones, DNA methylation and stage 3 carcinogenesis are. In fact, the owner implies: why did my animal get sick; you can cure him; what is the prognosis for each treatment method?

Our task is to make this secret understandable.

Why did my animal get sick?

Normal (healthy) cells are self-regulating. Abnormal (diseased cells) activate the p53 suppressor gene, which delays cell division until the abnormalities are corrected.If no correction occurs, p53 induces programmed cell death – apoptosis.

Cancer cells carry mutations and errors in genes, including the p53 gene. They avoid apoptosis and thus acquire “immortality”. After degeneration, unregulated, rapidly dividing cancer cells are characterized by a gradual change in genotype.

Genetic disruptions can be spontaneous or can be caused by viruses, chemicals, parasites, radioactive radiation, light rays, as a result of endocrine / metabolic disturbances, etc.mechanisms.

So, a tumor is a group of cells characterized by continuous growth and reproduction, not controlled by the organism. “Immortality”, constant division and dysregulation of genes provide cancer cells with advantages that benign cells do not.

Benign tumors, unlike malignant ones, do not penetrate beyond the tissues in which they began to develop, or into other parts of the body. In most cases, the prognosis for benign tumors is favorable.However, they can have serious consequences if, for example, they compress vital structures such as blood vessels and nerves.

Malignant tumors are characterized by local invasion into the surrounding tissues, a high growth rate, so they reappear (recur) after surgical removal. Cancer cells can metastasize. Metastasis is the process of spreading tumor cells through the intercellular spaces into the bloodstream and lymph, which makes it possible for new foci of tumor growth to appear in various parts of the body.

Depending on the time of appearance and place of development, there are early and late, regional and distant metastases. The earlier metastases appear, the more malignant the tumor. Distant metastases (not regional lymph nodes, organs) are a factor of poor prognosis.

It is important to note that tumors that develop as benign can become malignant over time. Also, a certain group of diseases is distinguished that have a high risk of transition to a malignant tumor: chronic gastritis, long-term non-healing ulcers of the mucous membranes and skin, glandular degeneration of the endometrium of the uterus, adenofibrous mastopathy, accompanied by a sharp proliferation of the epithelium, etc.

Oncological alertness of the owner

Unfortunately, often animals with oncological diseases come to oncologists at rather advanced stages of the process. This affects the choice of treatment for the animal, the prognosis, as well as the patient’s quality of life. For early diagnosis and complete cure, it is important that the owners themselves have an attentive and responsible attitude to the animal, knowledge of the main signs of possible malignancy of a number of diseases. The overwhelming majority of owners are of the opinion that cancer occurs only in older older animals.This stereotype reduces oncological alertness, leads to late visits to a doctor with an already incurable stage of the disease.

For example, tumors of the mammary gland of dogs account for 25% of all neoplastic diseases in dogs and are the second most common after skin tumors in females. The peak of the disease occurs in the age group 7-10 years. In almost 50% of cases in dogs, the disease is malignant and in 25% of cases it has a poor prognosis. Factors in the development of this pathology are hormonal disorders (absence of childbirth, frequent falsehoods, drug suppression of lactation, cystic degeneration in the ovaries).One of the important criteria for predicting life in breast cancer is the size of the tumor. When the size of the mammary gland tumor is more than 3 cm in cats and more than 5 cm in dogs, the third (out of possible four) stage of the process is set and the animal is recommended not only for surgery, but also chemotherapy. At the fourth stage of the disease, even with ongoing therapy, the average life expectancy is from 1 to 2 months.

In cats, breast cancer is characterized by an extremely aggressive course, a high degree of malignancy and a poor prognosis.Benign processes can be found in the mammary gland of cats only in 10 – 14% of cases, while malignant tumors are diagnosed in 86 – 90%. The disease affects mainly animals aged 10 – 12 years, however, there are observations of the disease in cats at a young age. Breast tumors are easily diagnosed by the owners themselves. But, unfortunately, often a visit to the clinic occurs even when the tumor grows to a significant size, and this began to bother the cat or dog.

Symptoms in patients with oncology are varied, they depend, first of all, on the localization of the neoplasm.

Skin cancer is the most common cancer in dogs and cats. You can find formations while bathing and stroking your pet. Tumors of the skin and soft tissue appear as thickening on or under the skin. Very often they do not bother animals, and the owners discover them by accident. Some skin tumors look like ordinary dermatitis, and sometimes only the lack of effect of treatment can lead to thoughts of research on oncology.If the tumor has fuzzy boundaries, is motionless relative to the underlying tissues, is characterized by rapid growth, the skin grows (the presence of ulcerations) – this indicates a malignant process and the animal needs a doctor’s consultation.

The presence of a tumor in the animal’s oral cavity is indicated by increased salivation, bad breath, impaired swallowing, weight loss or impaired appetite, as well as enlargement and induration of the mandibular and periopharyngeal lymph nodes, detected by palpation, loss of interest in chewing toys, scratching the mouth with paws …

Signs of a tumor in the nasal cavity – exophthalmos (bulging of the eyeball), asymmetry of the muzzle, sneezing, chronic, refractory, nasal and eye fissure discharge, bleeding, wheezing.

Musculoskeletal tumors account for 3.5 – 5% of all tumors in dogs and cats. Most of them are bone neoplasms, which are divided into: primary (osteosarcoma, chondrosarcoma, fibrosarcoma) and metastatic.

Primary bone tumors are predominantly malignant (98% of the total) and are 5 times more common than metastatic tumors.

Osteosarcoma or osteosarcoma is the most common primary malignant bone tumor in dogs and cats. With osteosarcoma, the limbs are mainly affected. The pain is localized at the site of the tumor, swelling, diffuse edema may appear. In this case, the mobility of the joint may be impaired, a pathological limb fracture may occur in the area of ​​the neoplasm. Bone tumors occur in dogs between the ages of 6 and 7, although they are believed to occur earlier. Developing slowly, sometimes for many years, they do not show themselves in any way.The first clinical signs of a tumor, if it develops in the bones of the limb, is lameness, a clear reluctance of the dog to get up from its place, especially after lying. The impetus for the development of osteosarcoma in animals of large breeds can be the trauma suffered, although today it is not clear whether this is actually so. But there are suggestions that damage can provoke disease. It is believed that malignant bone tumors are diseases of giant and large breeds. Among the patients, St. Bernards, Doberman Pinschers, Irish Setters, Danish Great Danes, German Shepherds, and Golden Retrievers are registered.Nevertheless, according to experts, the size of the animal is a more significant factor in the appearance of osteosarcoma than belonging to a particular breed.

Tumors of the testes account for 15% of all tumors arising in males. The average age of the animals is 7 years. Formations are easy to detect when examining and palpating the scrotum. In most cases, tumors arise in one testis, and about a third of them affect the non-descended testis. In this case, the tumor is located in the inguinal canal or in the abdominal cavity.

Tumors of the vestibule of the vagina – the urogenital canal ending with an external opening – are predominantly sarcomas. The initial stages of their development are asymptomatic. However, many dogs at this time become restless, often urinate. Later, bloody mucus begins to stand out from the genital slit. Sometimes it is brick red or resembles meat slop. Therefore, frequent licking of the external genitalia can be a sign of tumor development in a dog. With its strong increase, the perineum protrudes.A tumor of the vaginal wall (usually benign leiomyoma) occurs mainly in females over 5 years old. Unlike sarcoma, it is a smooth, well-defined muscle knot and does not show bleeding, so that the two diseases can be distinguished. In cases where the neoplasm grows towards the tissues surrounding the vagina, it can be felt through the dog’s perineum. Clinical symptoms will be difficulty in the act of urination, less often, defecation.

Discharge from the prepuce, the skin fold covering the dog’s penis, should also alert the owner, especially if it intensifies and becomes purulent, dirty brown, with an unpleasant odor (which occurs when the tumor decays).

Tumors of internal organs in dogs are difficult to diagnose due to the absence of any specific signs and clinical manifestations that could indicate a tumor lesion of one or another organ. Even when the tumor reaches a significant size and there are changes in the activity of the body, then the symptomatology is very general in nature, which does not allow suspecting a tumor process. Among such common phenomena observed, for example, with tumors of the liver and spleen, include ascites (accumulation of fluid in the abdominal cavity), pallor of the mucous membranes (as an external manifestation of anemia), weakness, refusal to eat, thirst.Ovarian tumors clinically can manifest themselves in estrus disturbance, lengthening of the estrus phase with constant bloody discharge. With tumors of the bladder and kidneys, hematuria (blood in the urine), dysuric phenomena (urinary disorders), weakness, weakness can be noted. When tumors of the stomach develop phenomena associated primarily with obstruction (vomiting eaten, exhaustion, weakness). Tumors of the internal organs lead to a decrease in their function, which will manifest itself with its own symptoms.Yellowness of the skin and mucous membranes, weight loss, digestive problems can appear with liver cancer. A swelling in the intestine can lead to symptoms of obstruction – first of all, frequent, prolonged vomiting, stool disturbances (visible blood in the stool, discoloration, regularity, difficulty in defecating). Coughing, shortness of breath, impaired coordination of movements are also a reason for an immediate visit to a doctor. syncope (short-term fainting), exercise intolerance.

Biochemical products of tumors in advanced stages often cause malaise and anorexia (refusal to eat). At the same time, other substances can mediate chemical signals that mimic wound healing, and catabolic processes will occur in the deceived, emaciated body to provide the tumor with proteins and nutrients. Therefore, the most common cancer conditions are malnutrition and cachexia (wasting).

This is not a complete list of alarming symptoms that can appear both separately and in combination, requiring immediate examination and diagnosis.

Diagnosis is necessary for prognosis and correct treatment

Diagnosis begins with anamnesis. The doctor will ask you to evaluate the dynamics of tumor growth, the duration and sequence of symptoms. Age and breed, sex, type of animal are also taken into account.

Further, for the correct treatment, it is necessary to answer two basic questions:

1. What is it (including diagnosis and grade)?

2. Does the tumor spread (locally, regionally, systemically)?

Answers to these questions will be obtained through the diagnosis and determination of the stage of the neoplasm.

Staging is important for determining the extent of the lesion. It is based on examination of the tumor, local and regional lymph nodes, and distant areas such as the lungs. Areas for research are selected taking into account the known biological characteristics of the tumor.

To determine the type of tumor and its stage:

Minimum diagnostic spectrum:

1. Fine needle aspiration biopsy is a cytological study (at the cellular level).The procedure is fast. Used to give an initial assessment of the tumor and diagnose either inflammation or neoplasia. When the results of only one cytological study are not enough, a biopsy (examination at the tissue level) is performed.

2. Thick-needle biopsy. This type of biopsy allows you to obtain a slightly larger area of ​​tissue. For its implementation, a thick needle equipped with a cutting device is used. The advantage of this type of biopsy is that a larger tissue site for histological examination allows for a more accurate diagnosis.

3. Incisional biopsy. This biopsy technique involves excising a small piece of tumor tissue. It already looks more like surgery. This biopsy is done under local anesthesia. An incisional biopsy is often done when the results of an aspiration biopsy are insufficient.

Tissue biopsy confirms the result of cytology and is the “accepted diagnostic standard” for assessing completeness of removal and staging a tumor to aid in prognosis.

However, damage to the tumor can lead to the fact that cancer cells can be carried into the wound channel, so the puncture or incision site should be located in such a way that it is also removed during excision.

The most common form of biopsy in animals is complete removal of the tumor followed by histological examination.

4. X-ray of the chest and ultrasound of the abdominal cavity to exclude the fact of tumor metastasis.

5. Hematological examinations (blood tests).

If the location of the tumor remains unknown or additional evidence is required

apply:

6. Endoscopic research methods,

7. Magnetic resonance imaging, computed tomography.

8. Laboratory methods include morphological examination of blood, bone marrow.

If there is fluid in the chest and abdominal cavities, they are also subjected to cytological examination.

If cancer is confirmed

First of all, we must try not to fall into despair and not see cancer as the “last” disease of our time, firmly associated with suffering. Veterinary oncology is developing rapidly. The accumulated knowledge of practicing doctors in this area will allow either to cure the animal completely, or to significantly prolong its life, reducing the intensity of the disease, i.e. improve the condition of the animal by reducing the rate of development of the disease and prolonging the good quality of life.

Treatment options

The goal of all cancer treatment options is to inhibit the division of tumor cells and their irreversible destruction, that is, to suppress the possible recurrence of the disease.

Methods of local (local) exposure: surgery, radiation therapy, cryodestruction, hyperthermia, etc.

Methods of systemic exposure: chemotherapy, immunomodulatory therapy.

Surgery is the most common treatment for cancer in pets and can be very effective if the cancer is localized and enough tissue is removed.Diagnostics in combination with an exhaustive definition of the stage allows you to decide whether to carry out only an operation or the simultaneous use of additional therapy

Chemotherapy is most commonly used to treat systemic rather than local cancer, and can also be used when injected into a cavity or inside damaged tissue (interstitially). Chemotherapy is indicated when it is known that the tumor is sensitive to it, also when the risk of developing systemic cancer is unknown or increased.

Each method has its own advantages and disadvantages. Depending on the location of the tumor and its sensitivity to the chosen method of treatment, one treatment option will be more effective than the other. Sometimes, to achieve the goal, it is necessary to combine several types of treatment, the so-called combination therapy.

Treatment goals

Once the owner is informed of the diagnosis, stage, treatment options, and response to treatment, the owner and veterinarian decide on a treatment goal.

Treatment goals: cure, prolong and improve quality of life, temporarily relieve symptoms and monitor.

Healing therapy has the goal of completely eliminating the disease. It is a radical treatment that maximizes cancer clearance while preserving normal tissue, which involves the use of non-surgical treatments such as chemotherapy and radiation to areas that may contain viable cancer cells.Cure is always the optimal goal, but not always possible due to the diagnosis / stage of the disease, the body’s reserves and the financial capacity of the owner or the limits of risk.

Reducing the intensity of the disease is a treatment aimed at reducing the rate of cancer development, prolonging the high quality of life.

Relief is a treatment aimed at minimizing the suffering of an animal and possibly prolonging life while maintaining its good quality, but the final stage is euthanasia.

Observation is a continuous, targeted examination that is necessary to change or establish a different goal of treatment. During observation, the animal may or may not receive treatment. All treated animals need regular medical supervision, taking into account changes in the course of the disease.

Oncological alertness is the key to successful cancer treatment

Having discovered a tumor in your pet, do not expect that it will disappear by itself.Do not waste such precious time for you and for doctors. In the later stages, the diagnosis of tumor malignancy does not cause difficulties, but the treatment is much more difficult. More often than not, it is for this reason that we are unable to help our patients, and they continue to die of cancer.

Remember that a complete cure is possible only with timely treatment and early diagnosis of tumors.

A specialized veterinary oncologist, Elena Nikolaevna Shvydkina, is attending our clinic.

Reception of an oncologist is conducted at records .

90,000 Malignant tumors

Causes of

Breast cells are characterized by rapid regeneration. A large number of new cells leads to a high risk of mutational changes in them. In addition, in the breast tissue, a very high concentration of female sex hormones and changes in hormonal levels during menopause or for other reasons can become a trigger for the development of pathological processes.

Factors contributing to the development of the disease are:

• early onset of menses or late menopause;

90,031 the presence of gynecological diseases;

• genetic predisposition;
• long-term use of hormonal contraceptives;
• multiple termination of pregnancy and history of miscarriage;
• lack of regular sexual contact;

90,031 absence of children;

90,031 overweight;

90,031 mechanical trauma to the chest;

90,031 smoking;

• alcohol abuse;
• contact with carcinogenic substances;
• high doses of radiation exposure.

Classification of breast cancer

Depending on the size and extent of the tumor, the following stages are distinguished:

I – characterized by the size of the neoplasm, not exceeding 2 centimeters, and the absence of metastases.

II – the tumor grows up to 5 centimeters and affects the surrounding tissues, metastases appear in the axillary lymph nodes.

III – the size of the formation exceeds 5 centimeters, and it affects the muscle tissue, characteristic symptoms appear in the form of discharge from the nipple, swelling and “lemon peel”; multiple metastases spread to the axillary and supraclavicular lymph nodes.

IV – the entire breast is affected, cancer spreads to the skin, affects adjacent anatomical structures, extensive ulcers and metastases to other organs appear, the tumor is motionless and attached to the chest. The stage is terminal.

Symptoms

In the early stages, a malignant neoplasm proceeds without any pronounced signs, and can only be detected during a preventive examination or self-diagnosis. Alarming symptoms are:

• The appearance of palpable lumps in the chest;
• any nipple discharge;
• deformity of the nipple or breast;
• skin flushing;
• formation of ulceration, flaky crusts;
• nipple retraction;
• “lemon peel” effect on the chest.

If any of the above signs appear, you should immediately seek medical help.

Diagnostics

In half of the cases, women discover pathological processes during self-examination, which is recommended to be carried out every month after the end of menstruation. Standing in front of a mirror, you must first carefully examine the chest, paying special attention to changes in shape, swelling, the presence of reddened areas, rashes or ulcerations.Then the woman should carefully feel the breasts, first standing and then lying down. The self-examination ends by squeezing the nipple to check for any discharge.

Hardware diagnostic methods, as mammography, ultrasound, MRI can detect tumors not only in the early stages, but also precancerous conditions. The reliability of mammography is close to 100% and allows you to identify non-palpable formations located in the deep sections.After 30 years, all women are encouraged to undergo mammography annually, since they are at increased risk.

Treatment

Surgery is a radical way to treat breast cancer. The scope of the operation directly depends on the stage of tumor development, its localization and the presence of metastases. With early detection of a malignant process, it is possible to remove only the tumor itself and the surrounding tissues. In other cases, a complete removal of the mammary gland is performed.

Before and after the operation, it is possible to use radiation therapy, the purpose of which is to reduce the size of the tumor before the operation and to destroy any remaining cancer cells in the body.

Drug therapies are also widely used and include chemotherapy and hormone therapy.

Regular mammography and monthly self-examinations are the best way to deal with a serious illness like breast cancer.The chances of a favorable treatment outcome directly depend on the early diagnosis of cancer.

90,000 Neoplasms of the mediastinum | Clinical Hospital No. 122 named after L.G. Sokolov of the Federal Medico-Biological Agency

Mediastinum – the space in the chest between the lungs, which contains the heart, large vessels, trachea, esophagus, thymus (thymus), lymph nodes.

Mediastinal neoplasms (tumors and cysts of the mediastinum) are a group of benign and malignant neoplasms of heterogeneous origin, united by a common localization and similar symptoms.The most common formations of the mediastinum are thymomas, cysts, tumors of neurogenic origin and lymphomas. Sarcoidosis, tuberculosis, and other diseases can cause enlargement of the mediastinal lymph nodes.

Symptoms depend on the location, size and nature of the formation. Often, the disease is asymptomatic, and a neoplasm of the mediastinum is an accidental finding on X-ray examination or computed tomography of the chest. For example, tumors of the thymus, called thymomas, may have no symptoms at all, or a neuromuscular disease called myasthenia gravis may develop.General – non-specific symptoms may appear – weakness, malaise, weight loss, a slight increase in body temperature. There may be chest pain.

There are symptoms associated with squeezing the tumor of adjacent organs. For example, when the superior vena cava is squeezed, puffiness of the face, headache, shortness of breath in a horizontal position appear. Patients cannot perform work associated with forward bends. When the trachea is squeezed, cough, shortness of breath, noisy, shortness of breath are observed; when squeezing the esophagus – difficulty in swallowing.

Computed tomography is performed for all patients with neoplasms of the mediastinum and allows you to accurately determine their size, localization and relationship with other organs and tissues, and hence the possibility of surgical treatment of the formation. Sometimes, to improve the accuracy of the image and assess the relationship with other organs and tissues, the introduction of radiopaque substances is used. Also used are Angio-CT, MRI , Ultrasound .

Sometimes, in order to clarify the nature of the neoplasm and, accordingly, to determine the therapeutic tactics, it is necessary to obtain a piece of tissue for histological examination.We are not in favor of needle biopsy of operable tumors. Such a procedure almost never cancels the need for surgical treatment, and therefore is useless.

On the other hand, in case of non-removable tumors, material should be obtained for histological examination in the least traumatic way:

– needle biopsy of the formation – performed under the control of ultrasound, CT, fluoroscopy.

– diagnostic thoracoscopy.

The main method of treatment of neoplasms of the mediastinum is surgical.The type of surgery depends on the location and size of the tumor. Whenever possible, we perform operations through small incisions (video-assisted or thoracoscopic operations). Such interventions are much less traumatic, and significantly reduce the time of recovery and hospital stay.

The head of our thoracic service, V. G. Pishchik, is a recognized European expert in the treatment of neoplasms of the mediastinum, especially by the thoracoscopic method. This issue is devoted to his doctoral dissertation.Lymphomas and germ cell tumors do not require surgery and respond well to chemotherapy.

Center for Thoracic Surgery

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