What is Chest Wall Tumors?

The chest wall is the protective barrier around the lungs. It’s encased by the spine and sits above the abdomen, isolated by a muscle called the diaphragm. The chest wall is made up of diverse tissues like cartilage, bone, muscle, fascia, blood vessels, lymph vessels, fat, and skin. Tumors in the chest wall fall into two categories: primary and secondary.

Primary chest wall tumors start within tissues of the chest wall like muscles, fats, blood vessels, nerve wrap, cartilage, or bone. Secondary chest wall tumors, however, could be due to the direct spread of breast cancer or lung cancer, or they could originate from a distant location and spread to the chest wall.

What Causes Chest Wall Tumors?

Chest wall tumors can be caused by multiple factors. These could include the excessive growth and spread of benign (non-cancerous) or malignant (cancerous) cells, infections, or inflammation.

There are several types of primary chest wall tumors, tumors that start in the chest wall itself. These can emerge from the bone, muscle, fat, blood vessels, and the protective coverings of nerves. Moreover, conditions like myositis ossificans, elastofibroma dorsi, and desmoid tumors can also trigger the growth of these tumors.

On the other hand, secondary chest wall tumors are not originally from the chest wall. These are usually advanced stages of cancer that have spread to the chest wall from other body parts.

The exact cause of chest wall tumors is still unknown. Research suggests that factors like genetics, diet, and lifestyle choices might play a role in their development.

Desmoid tumors, which are a type of aggressive fibromatosis, can sometimes develop at the site of a previous chest surgery, known as thoracotomy.

Risk Factors and Frequency for Chest Wall Tumors

Chest wall tumors haven’t been clearly established to affect males or females more. The age when these tumors are found can vary. Younger people usually have smaller, less dangerous tumors. On the other hand, older people often have larger, more aggressive tumors.

These tumors are relatively rare, with a chance of occurrence of less than two percent in people.
These can be original tumors (primary) or spread from other parts of the body (metastatic), with around half being cancerous.
These tumors can show symptoms or be symptomless, with about one in five discovered by accident during a chest x-ray.
They constitute about five percent of all tumors in the chest region.
Types of these tumors include those forming in the cartilage, soft tissues, and bones of the chest cavity. The most common of these are called chondrosarcomas.
Between 50 to 80 percent of these tumors are cancerous. Of these, about 55 percent start from bone or cartilage and 45 percent start from soft tissue.
The overall chance of survival five years after removing these tumors is about 60 percent.
However, these tumors can come back in about half of the patients, reducing the five-year survival rate to 17 percent if they do.

Signs and Symptoms of Chest Wall Tumors

When a patient has a mass in their chest wall, doctors need to thoroughly examine the patient’s medical history and perform a physical examination. Patients with this condition might experience pain, discomfort, swelling, a decrease in their ability to move, presence of a lump, or muscle shrinkage. A physical examination might show noticeable swelling. If the doctor presses the area, they may find that one side of the chest wall is bigger than the other and can describe the feel of the tumor. The patient may also have quieter breath sounds. These symptoms and signs are all due to the tumor’s size and effect, but they do not tell doctors what caused the tumor.

Pain or discomfort
Swelling
Limited movement
A noticeable lump
Muscle atrophy, or shrinkage
Noticeable swelling found in the physical examination
Asymmetry in the chest wall felt upon palpation
Different texture of the tumor felt upon palpation
Reduced breath sounds

Testing for Chest Wall Tumors

After a detailed check-up and discussion of symptoms, doctors often start by taking a chest X-ray. The X-ray gives a quick and simple look at the size and spread of the tumor. This can help doctors see if the tumor is invading the lungs, destroying bone, or confirms whether the tumor originated from bone. However, a type of scan known as a computed tomography (CT scan) is even better at checking these things.

Magnetic resonance imaging (MRI) is another type of imaging technique that provides even more detail than a CT scan. It’s particularly useful for looking at soft tissues. MRIs can help distinguish cancer tumors from regular chest structure and other diseases that might be due to infection or inflammation. They give a full picture of any abnormalities by showing the different parts of complex lesions.

A positron emission tomography scan, often known as a PET scan, is used to understand the stage of the cancer (how far it has advanced), see how the body is responding to treatment, or detect if the disease has returned.

But, it’s vital to note that despite the clarity offered by these scanning techniques, they can’t confirm a definitive diagnosis. For this, a biopsy (a procedure where a small sample of tissue is taken for examination) is necessary. If the lesion is smaller than five centimeters, it’s usually removed for examination (excisional biopsy). But, for lesions larger than five centimeters, a needle aspiration (taking a sample with a needle) or an incisional biopsy (where only a portion of the area is sampled) is performed.

Treatment Options for Chest Wall Tumors

Treating tumors in the chest wall can be quite difficult both clinically and surgically. For benign, or non-threatening tumors, surgery to remove the tumor is the usual treatment. However, for malignant or harmful tumors, a team of healthcare professionals is generally needed to manage the treatment and ensure the best possible outcome for the patient.

A key factor in reducing the chance of the tumor coming back is to make sure it’s completely removed during surgery with no remains. Additionally, post-operation, it’s crucial to stabilize the chest wall; this helps prevent any negative effects on the person’s ability to breathe.

Depending on the site and size of the chest wall defect, various muscle flaps can be utilized to cover most of the chest wall defects. A few examples include pectoralis flap, latissimus dorsi flap, and rectus abdominis flap.

However, these surgical procedures come with high risks during, and after the procedure because of the possibility of incomplete removal of the tumor or unsuccessful reconstruction. In some rare cases, there might be a mistake in diagnosing the type of the tumor. Options best for primary tumors and a selection of secondary tumors in the chest wall include surgical removal. These procedures could even completely cure the disease.

In certain situations, a combination of surgery, radiation therapy, and/or chemotherapy may be necessary. However, whether or not these additional treatments are used usually depends on the specific type and nature of the tumor.

When determining the cause of chest wall tumors, there are numerous possibilities. These could include benign (non-cancerous) or malignant (cancerous) growths. Sometimes, these tumors could be an extension of a disease that’s already occurring nearby. Other times, these tumors could be a localized response to inflammation or infection.

To figure out the reason behind chest wall tumors, doctors usually look at a few things. These include how common the type of tumor is, its typical symptoms and appearance, its location on the chest wall and any specific characteristics visible on MRI scans that match up with findings from tissue examinations.

Some of the most common benign or non-cancerous tumors include:

Osteochondromas
Chondromas
Fibrous dysplasia
Desmoid tumors

While, some of the most common malignant or cancerous tumors include:

Soft tissue sarcomas
Chondrosarcomas
Ewing sarcoma

What to expect with Chest Wall Tumors

The outlook for a patient depends completely on the type of tumor they have. If the tumor is not harmful, surgery might be needed if the growth is causing pain, trapping nerves and blood vessels, or leading to concerns about looks. Patients in this category usually have a good chance of recovery after surgery. However, the outlook for patients with harmful tumors is more uncertain. A team of different types of doctors is required to manage these cases, but the prognosis is generally worse for patients with tumors that have spread to other parts of the body.

Possible Complications When Diagnosed with Chest Wall Tumors

Patients who choose not to have surgery or are not suitable for surgery can face a number of serious problems. These can include increased pain and swelling, the trapping of nerves leading to limited blood supply and unusual sensations, and changes to their physical appearance. However, patients who do opt for surgery are also at risk of complications. These could include nerve damage, issues with their blood vessels, and problems with their breathing. After surgery, patients will often need help managing their pain and support for their lung function.

The risk of illness and death is closely connected to how deep and widespread the cancer is, as well as what caused the tumor in the first place. The type of cells in the cancer can also impact outcomes and overall survival; the chances of the cancer coming back can be high if the cancer cells are particularly aggressive.

Common Complications:

Increased pain and swelling
Nerve entrapment leading to limited blood supply and unusual sensations
Physical appearance changes
Nerve damage from surgery
Problems with blood vessels from surgery
Breathing difficulties from surgery

Preventing Chest Wall Tumors

Identifying a chest wall tumor involves several steps. First, doctors will gather a detailed patient history and conduct a physical examination. Chest wall tumors often develop gradually and their symptoms are not always specific. A patient might feel pain and swelling, or notice a visible change in their chest, which usually leads them to consult a doctor. After taking the patient’s history and performing a physical examination, the doctor may recommend further imaging tests, such as a chest X-ray.

If the X-ray raises a concern about a potential chest wall tumor, more detailed imagery, using technologies like a CT scan or an MRI, might be necessary. To confirm the diagnosis, a doctor will take a tissue sample from the area (a procedure known as a biopsy).

The primary treatment is usually surgical removal of the tumor, possibly combined with chemotherapy or radiotherapy, based on individual cases. Successful treatment depends on a team of healthcare professionals working together to ensure a well-rounded and effective treatment plan.