Chest Wall Infections | Cedars-Sinai

ABOUT

DIAGNOSIS

TREATMENT

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:

• Pneumonia
• Bronchitis
• Tuberculosis
• Asthma
• Emphysema
• Trauma or injury to the chest

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.

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Chest Wall Lumps | Rib Injury Clinic

Chest wall injuries, inflammatory or infective conditions and even cancerous or non-cancerous growths can lead to the development of a chest wall lump. The chest wall is made up of bone (sternum, ribs and thoracic spine), cartilage and other ‘soft tissues’ including muscles, tendons, ligaments, fascia (membranes), blood vessels, nerves, lymph vessels and nodes. Any of these can lead to the development of a chest wall lump. In addition, underlying organs such as the lung, the lining of the lung (the pleura) or conditions in the cavity of the chest (the pleural cavity) can also lead to chest wall lumps. NOTE: The Rib Injury Clinic does NOT treat Breast Lumps.

The chest wall can be divided into three layers:

1. Superficial layer: Skin and subcutaneous fat
2. Intermediate layer: Shoulder girdle and pectoralis muscles
3. Deep layer: Bony chest including sternum, ribs, thoracic spine and Pleural lining including the intercostal space, fascia, and pleural

Chest wall lumps can come from any of these layers and their components including the blood vessels and nerves that course through them.

Symptoms

Depends on what the chest wall lump is caused by, but along with the lump or deformity there may be associated pain, swelling, inflammation (redness), discharge, clicking or altered sensation. If large they can cause a restriction of certain movements. The lump may develop quickly such as an abscess, or slowly or become noticeable with significant weight loss or with certain activities for example a lung hernia.

Congenital and Developmental Abnormalities

Chest wall asymmetry (variation between one side and another) is common and often presents in childhood as a lump in the anterior chest wall. It may be related to scoliosis (curvature of the spine) presenting with a lump on the chest on the opposite side to the curvature along with uneven shoulders and/or hips. Pectus deformities – pectus excavatum and particularly pectus carinatum can present with a ‘lump’ in the anterior chest wall.

Pectus carinatum in a 14 year old boy. It developed during a rapid growth spurt over a year

Pectus Carinatum Bracing treatment – pectusclinic.com Find out more

Pectus deformities can be present at birth or within the first year, but often only become noticeable during puberty. Associated musculoskeletal abnormalities such as Marfan syndrome, Ehlers-Danlos and Poland Syndrome are common but other associated conditions include Congenital heart disease, osteogenesis imperfecta, muscular dystrophy, Pierre Robin Syndrome, Turner Syndrome, and prune belly Syndrome.

Rib Abnormalities and anatomical variations of ribs can cause an ‘apparent’ chest wall lump. One of the more common variants is Prominent Convexity of the anterior rib/s presenting at a young age. It’s important to differentiate this from a pectus carinatum deformity.

Other types of rib abnormalities presenting with an apparent chest wall lump include rib Segmentation and Fusion Anomalies leading to abnormally shaped ribs for example bifid rib, fusion or bridging between ribs or smaller (hypoplastic) or missing ribs (absent) as in Poland’s Syndrome.

Young man with Poland’s syndrome. Note missing right pectoralis muscle and upper ribs at front (red ring). When he breathes in, due to missing upper anterior ribs, chest wall draws inwards (left image, red arrow) and then when he breathes out, lung bulges outwards (right image, blue arrow)

Supernumerary or extra ribs can also be seen, the most common is cervical ribs, arising from the 7th cervical vertebrae, on one or both sides. It does not present with a chest wall lump but can cause temporary loss of feeling, weakness or tingling in the affected arm and fingers.

Benign Chest Wall lumps

Various benign (non-cancerous) conditions or growths can cause a chest wall lump to develop. They can be divided into benign soft tissue tumours and bony benign tumours of the chest wall.

Benign tumours of the chest wall

Benign Soft tissue tumours

Lipoma is a benign tumour made of fat tissue. They can be occasionally multiple and are generally soft painless and movable to the touch. They usually occur just under the skin, but occasionally may be deeper. Most are less than 5 cm in size. They can occur on the chest and upper back.

Large Lipoma (red arrow) involving the intermediate chest wall structures and affecting shoulder movements

Fibromas are another type of benign tumours that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchyme tissue including the chest wall. They can be described as hard fibromas; in the skin this is called dermatofibroma (a fibrous nodule of the skin). Keloid scars are a type of hard fibroma. Or soft fibromas or skin tags. There are other types of fibroma depending on their origin, composition and location. Elastofibroma dorsi is a benign soft-tissue tumour with a characteristic location and imaging appearance.

Peripheral Nerve Tumours are growths originating from nerves or the nerve coverings. They can occur anywhere in the body including the chest wall. Schwannomas, also known as neurilemomas or neurinomas, are benign tumours that originate in nerve sheaths and are usually slow growing. Chest wall schwannomas arise from spinal nerve roots and intercostal nerves and typically occur in patients between 20 and 50 years of age. Neurofibromas are slow-growing neoplasms that originate from a nerve, may or may not be encapsulated, and may include components of cystic degeneration and calcification. Neurofibromas develop most commonly in patients between the ages of 20 and 30 years. Along with Ganglioneuroma and Paraganglioma, peripheral nerve tumours tend to be picked up incidental on x-ray or occasionally are associated with altered sensation or pain but rarely cause a chest wall lump as they tend to grow in the chest cavity.

MRI Image of a large Schwannoma in the left upper chest cavity a middle-aged man with left arm and shoulder pain but no no chest wall lump. It was removed surgically

Vascular Chest wall Tumours refer to growths arising from blood vessels and include Cavernous haemangiomas, typically superficial growths consisting of dilated, tortuous, thin-walled vessels. Similar to vascular chest wall tumour, lymphangiomas are benign tumours caused by lymphatic malformations. When superficial they are soft, non-tender masses with a doughy consistency. Cystic lymphangioma of the chest wall is rare.

MRI image of a right swollen pectoralis muscle with an underlying lymphangioma (red arrow). It was surgically removed

Solitary fibrous tumours are rare growths of soft tissue cells that can form nearly anywhere in the body. They most commonly occur in the lining of chest wall (the inner or pleural lining). Most are benign though they can become malignant. They very rarely cause a chest wall lump.

Benign Bony tumours

Fibrous dysplasia is an uncommon bone disorder in which scar-like (fibrous) tissue develops in place of normal bone. This irregular tissue can weaken the affected bone and cause it to deform or fracture. It can affect the ribs and rarely the sternum. It tends to affect a single rib (monostotic) and more severely multiple bones (Polyostotic). The majority of monostotic lesions have no symptoms and its discovered incidentally on x-ray. Symptomatic patients can have pain, possibly secondary to a pathologic fracture, or with an obvious deformity.

An aneurysmal bone cyst is a benign, but expansile tumour like lesion that generally occurs in the long bones including the vertebral column and rarely in the chest wall. A giant cell tumour is a rare, aggressive non-cancerous tumour. It usually develops near a joint at the end of the bone. Most occur in the long bones of the legs and arms. Giant cell tumours most often occur in young adults when skeletal bone growth is complete. It is very rare in the ribs and chest wall. Other types of benign bony tumours that can occasionally affect the chest wall causing a chest wall lump or chest wall symptoms include Chondromyxoid fibromas are a type benign cartilaginous tumours which occasionally occur in the ribs, spine, or scapulae and rarely the sternum; Ossifying Fibromyxoid tumour which rarely affects the chest wall but can lead to a slowly growing painless mass and Enchondromas, a more common benign cartilage tumour found inside bones including rib bones.

An exostosis, also called a bony spur, occurs when a bony growth extends beyond a bone’s usual smooth surface. Exostosis can cause chronic pain or irritation, depending on its size and location. See chest wall pain. Sometimes, cartilage will grow over an area of exostosis, which is called osteochondroma. These are a common benign bony tumour but a rare tumour in the ribs and chest wall.

Malignant chest wall tumours

The most common malignant tumours affecting the chest wall are called metastasis, cancers that arose elsewhere, such as the lung, colon or breast and have spread to either the soft tissues or especially the bony skeletal of the chest wall. Bony metastasis can lead to pain and deformity as well as risk of rib or even sternal fracture (pathological fracture).

A locally invasive breast cancer that has spread into chest wall that was removed ‘en-bloc’ (all together) with the left breast and part of the chest wall and then reconstructed

Secondary (metastasis) cancer to the 7th right rib causing pain on moving the shoulder (red rings) on chest CT (left) and PET (right). The original cancer was from the thyroid. The rib and cancer were surgically removed

Malignant tumours of the chest wall

Most of these malignant soft tissue and bony tumours can affect any part of the body including the chest wall though most are rare in this part of the body. They form a group of cancers called Sarcomas, a broad group of cancers that arise from connective tissue cells that include bone, cartilage, fat, muscle and blood vessels.

Malignant Soft tissue tumours

Sarcomas include Rhabdomyosarcoma, is an aggressive and highly malignant form of cancer that develops from skeletal muscle cells anywhere in the body. It is generally considered to be a cancer of childhood. Ewing’s sarcoma is a type of cancer that forms in bone or soft tissue. Symptoms may include swelling and pain at the site of the tumour, fever, and a bone fracture. The most common areas where it begins are the legs, pelvis, and chest wall. Leiomyosarcoma is a rare type of cancer that affects smooth muscle tissue. These tumours are most common in the abdomen but can occur anywhere in the body. Angiosarcoma is a rare type of cancer that forms in the lining of the blood vessels and lymph vessels.

Neuroblastoma is a rare type of cancer that mostly affects babies and young children. It develops from specialised nerve cells (neuroblasts) left behind from a baby’s development in the womb. It occurs in the adrenal glands situated above the kidneys, or in the nerve tissue that runs alongside the spinal cord in the neck, chest, tummy or pelvis. Ganglioneuroblastoma is a tumour that also arises from nerve tissues and is regarded as an intermediate tumour, one that is between benign (slow-growing and unlikely to spread) and malignant (fast-growing, aggressive, and likely to spread). Both Malignant Peripheral nerve sheath tumour and Malignant Solitary fibrous tumour arise from the same cells as the benign counterparts but behaviour more aggressively, with local and/or distant spread. Dermatofibrosarcoma is a rare type of cancer, a soft tissue sarcoma that develops in the deep layers of skin. It is sometimes described as having tentacles that can grow into surrounding fat, muscle and even bone. It can present on the torso.

Malignant Bony tumours

Myeloma is a type of cancer that develops from cells in the bone marrow called plasma cells. Bone marrow is the spongy tissue found inside the inner part of some of our large bones. The bone marrow produces different types of blood cells. It often presents in older patients with bone pain often in the back or ribs though a chest wall lump is unusual. Related to myeloma, Solitary bone plasmacytomas is an uncommon plasma cell tumour which is localized to bone. They may involve any bone, but they have a predisposition for the red marrow-containing axial skeleton including ribs and sternum.

Examples of bony sarcomas, Chondrosarcoma is a cancer composed of cells derived from transformed cells that produce cartilage whereas An Osteosarcoma (OS) or Osteogenic sarcoma (OGS) (or simply bone cancer) is a cancerous tumour in a bone.

Infectious causes of chest wall lumps

Infections of the chest wall can often lead to inflammation and pain in the affected area. They are usually caused by bacteria, occasionally viral illness and rarely fungal infection. The infection may arise from the chest wall itself, for example from a skin infection leading to a chest wall abscess. Alternatively, the chest wall infection may come from the inside and be caused by a pneumonia (chest infection) that spreads to the pleural cavity (para-pneumonic effusion) which itself becomes infected (an empyema). Rarely, infection comes from another site such as the underlying bone, such as the ribs or sternum. Bone infection is known as Osteomyelitis.

Symptoms

The most common symptoms are chest wall swelling with localised pain and tenderness, typically persistent, worse on breathing deeply or with certain activities. The pain and swelling may be associated with a fever, ‘flu-like illness’ and chest symptoms such as a cough. Diagnosis is usually clinical along with blood tests and X-rays.

Types of chest wall infections include:

1. Pleurisy — infection or inflammation of the thin membranes (pleura) of the chest wall leading to chest wall pain particularly when breathing in. It may be associated with pleural effusion (collection of fluid) in the chest cavity.
2. Empyema necessitans – Following a pneumonia If the associated fluid (para-pneumonic effusion) in the chest cavity becomes infected it can lead to a empyema (infection of the pleural or chest cavity). Empyema necessitans refers specifically to extension of the empyema into the neighbouring chest wall.
3. Chest wall Abscess – Appears as a hot, swollen and tender lump which can sometimes be associated with overlying skin redness (cellulitis). It can even discharge (burst).
4. Osteomyelitis – Bone infection classically of the upper sternum and the sterno-clavicular joints can lead to swelling and pain. It is a rare of chest wall infection.

Empyema necessitans: Chest CT scan of an elderly lady with underlying health issues with a right sided empyema that is starting to extend into the chest wall (red arrows)

Chest wall infections may be associated with certain types of infection, such as Tuberculosis or be secondary to recent chest or heart surgery or following chest trauma.

Chest CT scan of a chest wall abscess (blue arrows) in middle aged overweight diabetic man. The abscess required an operation called an incision and drainage

Traumatic causes of chest wall lumps

Following chest wall trauma, either immediately, shortly after or many months following the injury a chest wall lump can develop depending on the cause.

Immediately or within a few hours following a chest injury, the chest wall can become bruised and begin to swell. A chest wall Haematoma is caused by a build-up of blood in the soft tissues of the chest wall (superficial) but can be deeper (intermediate) or in the chest cavity itself (deep). This is called a Haemothorax (blood in the chest cavity). The severity and seriousness of a haematoma depends on whether there is still active bleeding, as well as the size and location.

Chest Wall haematoma (red ring) following a surgical procedure.

Rib or sternal fractures if badly displaced can lead to a chest wall lump that may become painful and tender and lead to deformity and a restriction of activities. See Rib and Sternal injuries. Following the original fracture, the bone ends typically begin to heal and lay down bone callus (a connecting bridge a bone fracture made of bone and cartilage cells) followed by remodelling of the bone and healing. If the bone end were badly displaced and/or the patient has impaired healing, the bone (typically the rib but occasionally the sternum) may fail to heal properly. See complications of rib injury.

Following a chest wall injury, due to degeneration or a chronic inflammatory condition such as Osteoarthritis, bony projections (exostosis) or bony spurs (Osteophytes) can develop along bone edges particularly joints and the spine. They are unusual in the skeletal chest wall and rarely cause symptoms but can cause persistent pain and tenderness particularly on certain movements such as twisting. See chest wall pain.

Treatment

Chest wall lumps once diagnosed can be treated either conservatively involving reassurance, rest, restrictions of activities and painkillers, or through some form of intervention including targeted physical therapy, drainage or a variety of surgical options including excision (removal) depending on what the underlying cause is. See Treatments.

symptoms and signs, types, diagnosis and treatment of thoracic cancer

Article content:

• Features of cancer
• Types of disease
• Causes
• First signs and symptoms
• Diagnostics
• Treatment
• Forecasts

Peculiarities of breast cancer

The chest consists of many organs, including bones and soft tissues, as well as lungs and pleura, heart and mediastinal organs (esophagus, trachea, thymus, thoracic lymphatic duct, pericardium), vessels, nerves, lymph nodes. All of them can be affected by malignant tumors. The most common type of malignant lesion of the chest cavity is lung cancer. Other types of tumors are less common and may be primary (occur directly in the chest cavity) or secondary (occur when tumors metastasize). In addition to the organs of the chest cavity, cancerous lesions may occur in the region of the pleura, diaphragm, or sternum, which limit the chest cavity. Source:
V.M. Karpov, A.F. Lazarev
The prevalence of primary multiple malignant neoplasms with lesions of the chest organs //
Russian Journal of Oncology, 2015, No. 5, pp. 53-56.

The severity, rate of growth, and treatment prognosis depend on the specific type of cancer and the affected organ.

Types of oncological diseases of the chest cavity

Malignant neoplasms of the chest cavity are divided into groups:

• Lung cancer . There are several types of malignant lung lesions – non-small cell, accounting for up to 80% of all types of cancer, small cell carcinomas, adenocarcinoma, large cell cancer.
• Cancer of the respiratory tract . It includes carcinoid tumors of the respiratory tract and cystadenoid, mucoepithelioid carcinomas of the bronchi.
• Mediastinal neoplasms . These include malignant lesions of the intrathoracic, extrathoracic lymph nodes, cancer of the esophagus and tumors of the thymus.
• Cardiac and vascular disorders . Primary and metastatic cancers are possible.
• Pleural neoplasms . Pleural mesothelioma and malignant fibrous tumor are especially dangerous.
• Chest wall lesions affecting bones, mesenchymal tissues and cartilage . The most common malignant tumors are multiple myeloma and chondrosarcoma.

Histological examination of lung adenocarcinoma

Causes of breast cancer

The exact cause of different types of breast cancer has not yet been determined. There are a number of factors that increase the risk of tumor lesions of the chest. These include:

• Genetic predisposition. In families where cancer of various localizations is common, the likelihood of tumors of the chest cavity is higher. This is due to the inheritance of defective genes that control cell division.
• Smoking is especially relevant for lung cancer, although it is also detected in non-smokers. Alcohol intake plays a role, especially for esophageal cancer. The combined use of alcohol and smoking increases the risk several times.
• Poor nutrition and deficiency of vitamin A, zinc, molybdenum increases the risk of certain types of cancer. Being overweight and esophageal reflux increase the risk of esophageal cancer.
• Chronic inflammation increases the risk of developing tumors of the chest cavity, including cancer of the heart and blood vessels, lymph nodes, lungs and esophagus.

First signs, symptoms of tumors of the chest cavity

For a long time, cancerous lesions of the chest cavity do not have symptoms. As tumors increase in size, three groups of signs may appear:

• symptoms of compression of neighboring organs, signs of cancer invading tissues and neighboring organs;
• general symptoms of breast cancer;
• specific signs typical for a particular neoplasm.

For example, lesions in the mediastinal region can form a pain syndrome similar to angina pectoris. Pain may radiate to the shoulder, arm or neck, swallowing and breathing may be impaired. Source:
Saynak M, Veeramachaneni NK, Hubbs JL, Okumuş D, Marks LB
Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective // ​​
Balkan Med J. 2017 May 5;34(3):188-199. doi: 10.4274/balkanmedj.2017.0350. Epub 2017 Apr 6.

Among the key signs of tumors of the chest cavity, general symptoms can be distinguished:

• development of shortness of breath on exertion or at rest;
• onset of cough with sputum that may be stained with blood;
• pain during deep inspiration or expiration;
• noises, wheezing when breathing;
• frequent bronchitis, pneumonia;
• violation of the general condition – weight loss, lack of appetite, severe weakness, nausea.

For some types of cancer, specific symptoms are typical – dysphagia (difficulty swallowing), itching, low blood glucose levels.

Diagnosis of chest cancer

It is possible to detect breast cancer from the earliest stages. The medical center “SM-Clinic” is equipped with everything necessary for the fastest and most accurate diagnosis, including histological and biochemical studies in its own laboratory. The diagnostic process uses:

• X-ray to detect large tumors, bone and lung lesions. The method helps to determine the affected area for more targeted research.
• MRI or CT diagnostics allows you to determine the exact size of the tumor, the involvement of neighboring structures, blood vessels, bones, cartilage.
• Diagnostic thoracoscopy is indicated for pleural lesions or suspected metastases, complications of lung cancer.
• Bronchoscopy is indicated for examining the bronchial tree, clarifying the location of the tumor, and collecting material for histological examination.
• Various options for sputum examination in order to exclude concomitant pathologies, to identify tumor cells.
• Pleurocentesis and sampling of pleural fluid for examination (sometimes performed for therapeutic purposes).
• Biopsy of tumor sites, affected lymph nodes with determination of the type of cancer and its histochemical characteristics Source:
  M.I. Davydov, D.G. Zaridze
  Screening of malignant tumors //
  N.N. Blokhin”, 2014, v.25, No. 3-4, p.5-16.

Treatment of breast cancer

Based on the diagnosis, the final diagnosis, stage of cancer, its type and specific localization are established. Patient management is developed individually, taking into account age and diagnosis, comorbidities and general condition. Source:
Semenova EA, Nagel R, Berns A
Origins, genetic landscape, and emerging therapies of small cell lung cancer //
Genes Dev. 2015 Jul 15;29(14):1447-62. doi: 10.1101/gad.263145.115.

If possible, surgical removal of the tumor with pre- or post-operative conservative techniques is used. These include:

• Chemotherapy . Before surgery, it helps shrink the tumor so it can be removed more easily. After – to suppress the remaining cancer cells.
• Targeted Therapy targets a specific type of cancer such as small cell lung carcinoma.
• Radiation therapy is indicated to suppress the growth of malignant cells in inoperable forms or to prepare for surgery.

The treatment protocol for each patient is drawn up on the basis of international and domestic clinical recommendations, modern drugs and surgical intervention methods are used that reduce the risk of side effects, have proven effectiveness with the minimum possible effects on the patient’s body.

Chest cancer prognosis

With early detection of lung cancer, about 80% of patients live more than 5 years, with other breast tumors, prognosis depends on the form of cancer and the stage of its detection. The smaller the tumor and damage to surrounding tissues, the higher the chances of favorable outcomes. Source:
V.V. Starinsky, L. M. Alexandrova,
O.P. Gretsova
Lung cancer: epidemiology, prevention //
Medicine in Kuzbass, 2014, p.30-31.

The risk of recurrence in tumors of the chest cavity is low, to prevent recurrence of cancer, doctors conduct long-term follow-up with follow-up examinations.

Sources:

• V.M. Karpov, A.F. Lazarev. The prevalence of primary multiple malignant neoplasms with lesions of the chest organs // Russian Journal of Oncology, 2015, No. 5, pp. 53-56.
• M.I. Davydov, D.G. Zaridze. Screening of malignant tumors. N.N. Blokhin”, 2014, v.25, No. 3-4, p.5-16.
• V.V. Starinsky, L.M. Alexandrova, O.P. Gretsov. Lung cancer: epidemiology, prevention // Medicine in Kuzbass, 2014, pp. 30-31.
• Saynak M, Veeramachaneni NK, Hubbs JL, Okumuş D, Marks LB. Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective // ​​Balkan Med J. 2017 May 5;34(3):188-199. doi: 10.4274/balkanmedj.2017.0350. Epub 2017 Apr 6.
• Semenova EA, Nagel R, Berns A. Origins, genetic landscape, and emerging therapies of small cell lung cancer // Genes Dev. 2015 Jul 15;29(14):1447-62. doi: 10.1101/gad.263145.115.

Information verified by an expert

Mikhailov Alexey Gennadievich
operating oncologist, doctor of the highest qualification category, Ph.D.
experience: 22 years

The information in the article is provided for reference purposes and does not replace the advice of a qualified specialist. Do not self-medicate! At the first sign of the disease, you should consult a doctor.

symptoms, prognosis, causes, diagnosis and treatment of bronchial carcinoma

Contents:

• Causes and risk factors for bronchial cancer
• Signs of bronchial carcinoma
• Bronchial cancer classification
  • Histological
  • ICD-10 code
  • Stages
• Diagnosis of bronchial cancer
• Bronchial oncology treatment
• Prognosis in bronchial cancer

Cancer of the bronchi is a malignant tumor that develops on the mucous membrane of the bronchi of large, medium or small caliber. This is a common and dangerous cancer. Together with alveolar cancer, it is in second place in terms of occurrence and in first place in terms of mortality among all malignant neoplasms. Exposure to carcinogens in the air is one of the main causes of bronchial cancer. This effect is gradually increasing, which is why the incidence of bronchial oncology is growing.

It is most often detected after the age of 45, but the disease can also occur in young people. In men, it is detected 6-7 times more often than in women, and this mainly happens after the onset of symptoms, that is, when bronchial cancer has time to develop before the third or fourth stage. Early diagnosis is very important for this disease. Those who smoke, work in hazardous industries or live in areas with polluted air should be regularly examined for prevention.

Causes and risk factors for developing bronchial cancer

Smoking is the main risk factor for bronchial cancer. All smokers are at risk, but it is especially high for those who:

• smoke more than 1 pack of cigarettes a day;
• has been smoking for over 15 years.

Passive smoking also threatens oncology. If a person is often in a place where people smoke, they can get sick, even if they themselves are not a smoker.

Any other carcinogenic effect on the bronchi can also cause oncology:

• inhalation of coal dust, asbestos, chromium, nickel, mustard gas, other carcinogenic substances while working in hazardous industries;
• long-term residence in areas with severely polluted air.

Cancer of the central, main bronchus occurs most often because it is best ventilated and when inhaled carcinogens come into contact with the greatest amount of harmful substances.

Hereditary predisposition influences the probability of getting sick. If there were cases of cancer in the family, you need to carefully monitor the state of health, periodically undergo preventive examinations.

Symptoms of bronchial cancer

In the early stages, bronchial cancer may not have symptoms at all. Therefore, the disease is very dangerous. The neoplasm may have time to develop up to the third or fourth stage before noticeable signs appear. It can be detected at an early stage with the help of x-rays. Those who are at risk should take it regularly. Symptoms also depend on which bronchus is affected, and on the characteristics of the tumor itself.

Common signs of bronchial cancer:

• Cough. At first it can be dry, gradually intensifies, sputum appears, in which blood is found over time. Breathing becomes difficult, wheezing.
• Inflammation of the lung. It develops if the tumor completely clogs the bronchus. The unventilated part of the lung becomes inflamed, coughing, shortness of breath increase, and the temperature rises.
• Pain in the side or front of the chest. They appear if the neoplasm grows into the pleura, and pleurisy develops.
• Malaise. Loss of strength, weakness, decreased performance.
• Superior vena cava syndrome. The face becomes puffy, cyanotic, the veins of the neck swell. The condition is urgent, requiring urgent medical attention. It develops at a late stage, if the outflow of blood from the neck and head is disturbed due to the tumor.

Seek medical attention if breathing becomes difficult, coughing or shortness of breath. This is not always associated with oncology – other respiratory diseases can also manifest themselves in this way. In any case, it is necessary to undergo examination and treatment.

Bronchial cancer classification

There are several classification options.

According to histology

The propensity of a tumor to relapse and metastasize depends on its histological structure. There are four types of neoplasms:

• Squamous cell carcinoma of the bronchi – mainly associated with smoking, common, good chances for recovery at an early stage.
• Adenocarcinoma of the bronchi – to a lesser extent due to smoking, can be diagnosed in non-smokers. Carcinoma often affects the bronchi of medium or small caliber. Because of this, its symptoms appear very late.
• Large cell neoplasm may be poorly or highly differentiated. The degree of aggressiveness depends on this (higher for poorly differentiated tumors).
• Small cell bronchial cancer – develops due to smoking. The tumor is very aggressive and difficult to treat.

ICD-10 code

Bronchial cancer code C34 in the ICD-10 classifier. The classifier specifies the localization of the tumor:

• C34.0 – damage to the main bronchi;
• C34.1 – tumor in the upper segment of the lung;
• C34.2 – neoplasm in the middle segment of the lung;
• C34.3 – cancer in the lower segment of the lung;
• C34.8 – defeat outside of any of the above localizations;
• C34.9 Location unspecified.

Stages

In accordance with the TNM system, the stage of cancer is assessed according to three criteria:

• T – the size of the neoplasm in the largest dimension, its localization;
• N – lymph node involvement
• M – metastasis.

There are four stages in the development of a malignant tumor in the bronchi:

• 1 — tumor up to 5 cm, no lymph nodes affected, no metastases;
• 2 – tumor up to 7 cm, possibly affected lymph nodes closest to it, no metastases;
• 3 – neoplasm up to 7 cm or more, may affect neighboring structures, there is damage to the lymph nodes, no metastases;
• 4 – any characteristics of the tumor, any damage to the lymph nodes, there are metastases.

Histological examination of bronchogenic carcinoma

Diagnosis of bronchial carcinoma

Radiation diagnostics is the main way to detect bronchial cancer. Radiography, CT, MRI show changes in tissues, allow you to assess the size and location of the tumor. They are carried out both prophylactically, for those who are at risk, and for suspected oncology. Radiography is performed in two projections. CT and MRI are used to clearly visualize the tumor.

To confirm the diagnosis, a bronchoscopy is performed – an examination during which you can examine the epithelium, a tumor, as well as perform a biopsy, take samples for cytological and histological analysis.

An ultrasound of the chest is performed to assess the extent of the tumor and to check if it has invaded adjacent structures. In the later stages, the oncologist may order additional tests to assess how widespread the cancerous process is. This can be a bone marrow puncture, a biopsy of the lymph nodes, CT, ultrasound or radiography of individual organs.

Laboratory tests are also performed: clinical, biochemical blood tests, tests for tumor markers, sputum examination.

Bronchial cancer treatment methods

The oncologist determines the treatment tactics taking into account the stage, aggressiveness, prevalence of the oncological process and other parameters. The main methods are surgery, chemotherapy, radiation therapy.

The operation is carried out in such a way as to completely remove the malignant neoplasm, but at the same time preserve healthy tissue as much as possible. The size and location of the tumor affect how the operation will be performed. If possible, only the tumor itself is removed with a small amount of healthy tissue around it. Removal of only a segment or lobe or the entire lung may also be performed. If the lymph nodes are affected, they are also removed.

Surgical treatment is used in the initial and middle stages of the disease.

During radiation therapy, the neoplasm is exposed to aggressive radiation, reducing it. Such treatment may be given before surgery to make the tumor operable, or after it to reduce the risk of recurrence or metastasis. In advanced stages, radiation therapy is used as the main treatment instead of surgery.

Chemotherapy is treatment with drugs that destroy actively developing tumor cells. Chemotherapy may be given before or after surgery. For inoperable cancer, surgery is not performed and instead, chemotherapy is used along with radiation therapy.

Bronchial cancer prognosis

Survival is affected by the stage and type of bronchial cancer. If the tumor is non-small cell, the prognosis for a patient with bronchial cancer is better. According to various estimates, the chances of a cure are 68–92% for the first stage, 53–60% for the second stage, and up to 26% for the third stage. Small cell cancer is more aggressive, which reduces the chances of recovery. For the first stage they are 31%, for the second 19%, for the third only 8%. For any type of tumor in the fourth stage, the prognosis is unfavorable.

For bronchial oncology, it is very important at what stage the treatment is started. The earlier cancer is detected, the sooner the patient begins to receive medical care, the greater the chance of a successful outcome. Therefore, for those who smoke, work in hazardous industries, or are at risk for other reasons, it is important to regularly undergo preventive examinations.

Sources:

1. Aidinov G.T. Multivariate analysis of the structure and contribution of potential risk factors in malignant neoplasms of the trachea, bronchi and lung / G.