Chest Wall Diseases
The chest wall is the area that covers the chest cavity. The chest cavity is a cage of bone and muscle that holds the lungs, heart, and other vital organs. Chest wall tumors, whether cancerous (malignant) or non-cancerous (benign), are classified as primary or secondary. Primary tumors originate in the bone or muscle of the chest wall. Secondary tumors originate elsewhere in the body and spread (metastasize) to the chest wall. Only about five percent of chest wall tumors are found to be cancerous. Almost all secondary tumors are cancerous.
The tendency to develop benign tumors can run in families. There are cases of people who experience multiple or recurring benign tumors that eventually develop a malignant tumor; therefore, you always need to remain vigilant.
Individuals with malignant chest wall tumors may experience one or more of the following symptoms:
- Pain or soreness
- Impaired movement or chest expansion
- Protrusion as with a lump
Individuals with benign chest wall tumors may experience one of more of the following symptoms:
- Protrusion as with a lump
- Muscle atrophy
Diagnosing Chest Wall Tumors
An x-ray is usually taken, but x-rays tend to show only that there is an abnormality. A CT Scan (Computed tomography), MRI (Magnetic resonance imaging) or a PET Scan (Positron Emission Tomography) can zero in on the location and size of the tumor, as well as give some information about what type it is.
- CT Scan (Computed Tomography) – This will show your physician a 2 dimensional image of your body, including a view of the lymph nodes. A contrast dye may be used to improve the computer image. If that is the case you may need to avoid eating or drinking for 4 to 6 hours before the test. Be sure to tell your physician if you have any allergies or kidney problems prior to the test being performed.
- MRI (Magnetic Resonance Imaging) – A magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging. You will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than a CT. MRI may not be recommended if you have a pacemaker or other metal implant (due to the magnets).
- PET Scan (Positron Emission Tomography) – a PET Scan detects cellular reactions to sugar. Abnormal cells tend to react and “light up” on the scan, thus helping physicians diagnose a variety of conditions. Radiotracer, is injected into your blood stream. The radiotracer sends three-dimensional images to a computer screen. Patients are generally asked to wear comfortable clothing and refrain from eating for 4 hours before the scan. Tell your physician if you are pregnant or breastfeeding. Patients with diabetes should discuss diet guidelines with their physicians for the hours leading up to the scan.
Once preliminary information is gathered, a biopsy with be conducted. The most common biopsy is an aspiration biopsy – this is where a needle is inserted into the tumor and cells are removed for examination. Where an aspiration biopsy is difficult or impossible to do, an open biopsy will might be done. An open biopsy is a surgical procedure that can leave a small scar. The cells that are collected during a biopsy will be tested to fully diagnose the tumor as benign or cancerous.
Types of Chest Wall Cancers
- Chondrosarcoma – forms in cartilage, and is the most common type of primary chest wall bone cancer. It usually presents as a slowly enlarging painful mass.
- Osteosarcoma – forms in bone, typically during a period of accelerated growth, such as adolescence. It typically presents as a rapidly enlarging painful mass.
- Ewing’s Sarcoma – forms in bone. Most often affects children and young adults. It usually presents as a painful mass with systemic symptoms (fever, malaise).
- Plasmacytoma – arises from plasma cells and is an isolated form of multiple myeloma. Patients often present with pain, but no mass. This is one of the few chest wall tumors in which surgery is not the primary treatment modality.
- Malignant fibrous histiocytoma – is the most common soft tissue sarcoma and often occurs in adults. These usually present as a slowly growing mainless mass.
- Rhabdomyosarcoma – forms in striated muscles. Most often affects children and young adults. These usually present as a rapidly growing painless mass.
Sarcoma is a rare type of cancer. Sarcomas appear in different type of tissue than the more common Carcinomas cancer. Sarcomas grow in connective tissue – cells that connect or support other types of tissue in the body. These tumors are most common in bone, muscles, tendons, cartilage, nerves, fat and blood vessels in your arms and legs, but they can happen anywhere.
There are 50 types of Sarcoma and they can be grouped into two main types: soft tissue and bone Sarcoma, or Osteosarcoma. Approximately 1 in 100 cases of adult cancers is a soft tissue Sarcoma. Osteosarcomas are even rarer than Sarcomas.
Usually the first sign is a painless lump. As the lump gets bigger, it might press on nerves or muscles, making you uncomfortable or making it difficult to breath. There currently are not any tests that can locate these tumors before they cause symptoms that you notice.
Osteosarcoma’s can be detected earlier than Sarcomas. You might feel pain off and on in the affected bone, especially at night. You might experience swelling which usually starts weeks after the initial pain and you might notice that you are limping.
You will need a full exam and tests. A biopsy will be taken from the tumor. Imaging testing will be done such as a CT Scan, an ultrasound, or an MRI. A bone scan might be needed, if it is suspected that you have Osteosarcoma.
Treating Chest Wall Tumors
Malignant chest wall tumors treatment options generally involves some combination of the following:
- Chemotherapy – the use of drugs to kill cancer cells. Chemotherapy may be used before and/or after surgery or alone. Chemotherapy is normally given intravenously in an infusion center, but occasionally by pill form.
- Microwave Ablation – transmits heat from radio waves to kill the cancer cells.
- Radiofrequency Ablation (RFA) – burns the tumor with a high-frequency electric current.
- Tumor Resection (surgery) – removes some or all of the tumor.
If surgery is performed, prosthesis reconstruction or soft tissue replacement can be a recommended follow-up procedure to help restore normalcy to the chest’s structure, appearance, and function.
Chest Wall Deformities
Some cosmetic surgeries are available for conditions such as pectus excavatum and pectus carinatum.
Pectus excavatum is a condition where the breastbone in sunken into the chest. Some people will show a deep dent in their chest. The severity of the dent usually worsens during the growth spurt in adolescence. Heart and lung function may be affected in individuals with severe cases.
Pectus carinatum is a condition where the sternum and ribs are pushed outward away from the body. This condition in children may prevent total expiration of air from the lungs. Because of this, young individuals with pectus carinatum may experience a decrease in stamina.