Chest wall tumors, which are 2 times more common in men than women, are usually malignant. While chest wall tumors can develop without any symptoms, symptoms such as pain, infection or subcutaneous swelling can also be observed. Surgery is the most effective treatment for chest wall tumors, which usually appear with the spread of cancer in other organs.
What is a Chest Wall Tumor?
The chest wall is the structure that provides the shape and durability of the rib cage, which is adjacent to the vertebrae at the back, the ribs on the sides and the muscle layer that closes between the ribs, the sternum bone, popularly known as the sternum bone, the diaphragm muscle below and the clavicle (collarbone) above. Muscle and bone structure in the thorax contributes to respiration with the help of the abdominal muscles. The chest wall contains many different tumors involving the musculoskeletal system and connective tissue, and most of these tumors have a malignant character.
Chest wall tumor classification is done as follows
Chest wall tumors are divided into primary and secondary.
It often occurs secondarily with distant organ metastases (spread from other organs) and regional spread of tumors in neighboring organs such as lung, pleura, mediastinum, and breast.
Sarcomas are most common in malignant tumors originating from the chest wall itself. These tumors can localize to bone, cartilage and soft tissue. Of the chest wall tumors located in the bones and cartilages, 50% are located in the ribs, 30% in the scapula (scapula), 20% in the sternum (sternum bone) and clavicle (collarbone).
What Are the Signs and Symptoms of Chest Wall Tumors?
Chest wall tumors can be asymptomatic or manifest themselves in different ways.
- Pain
- Subcutaneous swellings
- Symptoms such as infection can be seen in chest wall tumors.
While soft tissue-derived chest wall tumors generally grow painlessly, pain may be prominent in bone-derived chest wall tumors. Therefore, painful swellings may be the first sign of a chest wall tumor, and when an abnormal swelling in the body and symptoms of pain that did not exist before are seen, it is necessary to apply to the thoracic surgery department without delay.
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How Are Chest Wall Tumors Diagnosed?
In the diagnosis of the patient group with suspected chest wall tumor, taking a detailed history from the patient and physical examination is the first important technique.
As imaging, it is also important to evaluate the chest X-ray first.
When needed, advanced imaging methods such as Computed Tomography (CT) and Magnetic Resonance (MR) can be applied.
While Magnetic Resonance (MR) can better reveal soft tissue tumors, their relationship with mediastinal organs and great vessels, Computed Tomography (CT) better shows rib structures and intraosseous damage.
PET-CT is one of the advanced imaging methods used for scanning the whole body after a tumor is suspected with Computed Tomography or Magnetic Resonance.
Which imaging method is preferred is decided according to the clinical condition of the patient.
What Is a Chest Wall Tumor?
In most chest wall tumors, surgical excision of the tumor at negative surgical margins (no tumor in the removed tissue margins) is the most effective treatment.
The areas to be surgically removed are determined according to the cell type of the removed tumor and the resemblance of the tumor to a malignant tumor.
Chemotherapy and radiotherapy are used in rapidly differentiated (high grade) tumors. In some cases, if a tumor is suspected to remain in the removed chest wall, chemotherapy is also used to control this area.
Some special methods are performed to close the gap formed after extensive removal chest wall tumor surgeries and to ensure that the patient can breathe comfortably. For this, special materials or patches (grafts) from other parts of the body such as muscle, omentum or skin can be used, and the special materials used generally consist of materials that can be shaped in surgery in accordance with the flexibility of the body. Which material will be used is decided before the surgery according to the patient’s condition.
After some surgeries, organs of the body such as muscle and skin can be used. this planning is done together with other branches such as plastic surgery and orthopedics besides thoracic surgery.
Process After Surgery
After the surgery, drainage tubes are usually placed in the lung cavity, in the surgical areas and under the muscle to drain the fluids produced by the body’s surgical trauma. these tubes should be monitored and removed after providing the necessary evacuation.
Some patients are sent to the inpatient service, while others are kept in intensive care. This period is determined according to the patient’s age, long-term diseases and the effect of the surgery.
Regular lung films and laboratory examinations should be performed in patients staying in the intensive care unit. The followed patients can be referred to the service after staying in the intensive care unit for 5-6 days.
Patients are expected to be observed for an average of 12 hours, to rest, and to return to daily life 1-2 weeks after the operation.
Frequently asked Questions
The duration of chest wall surgeries may vary depending on the type of tumor, the size of the removed part, and additional procedures that may occur in closing the formed cavity. A simple soft tissue excision surgery can be completed in 30 minutes, while surgeries that require large chest wall tumor removal can take 5-6 hours.
After chest wall tumor surgeries, drainage tubes are often placed in the lung cavity, submuscular and subcutaneous surgical areas to drain the post-operative fluids produced by the body, and these are followed up.
Patients can be taken directly to the inpatient service, or they can be followed up in the intensive care unit for a while after the operation, depending on their age, general condition, long-term discomfort, and duration of anesthesia.
After chest wall tumor surgery, the patient should rest for 1-2 weeks, depending on the size of the surgery. By evaluating the general well-being of the patient, he can return to his social and working life after 1-2 weeks.
Chest wall cancers constitute 1-2% of all primary cancers, and 5% of thoracic (related to the chest cavity) cancers.
There is a genetic predisposition in chest wall cancer, especially in sarcoma type, genetic factors have been clearly demonstrated in studies.
Since most of the chest wall tumors are spread from other organs (metastasis) and regional spread of neighboring organs, people with a history of cancer should be more careful about this issue. However, chest wall cancers are 2 times more common in men than women.
