Chest wall tumors

诊断

Diagnosing a chest wall tumor usually starts with a review of your health history and a physical exam. Your care team may ask when you first noticed a lump or pain. The care team may ask whether the lump or pain has changed. The team also may ask whether you have had cancer or radiation treatment before.

Imaging tests can show where the tumor started and how large it is. They also can show whether it affects nearby tissues. A biopsy can show the exact type of tumor.

Imaging tests

Imaging tests include:

• Chest X-ray. An X-ray may show a tumor in a rib, the breastbone or another bone in the chest wall.
• CT scan of the lungs or other areas in the chest. A CT scan uses a series of X-rays to make detailed pictures of the part of the body being studied. It can show bone changes and whether a tumor affects structures inside the chest.
• MRI. MRI makes detailed pictures of bone and soft tissues. It can show how far a tumor reaches into nearby muscles, nerves and other tissues.
• PET scan or PET-CT. For some cancerous tumors, this test may help show whether cancer has spread to other parts of the body.

Biopsy

During a biopsy, a member of your care team removes a small sample of tissue. A doctor called a pathologist looks at the sample under a microscope. The pathologist can tell whether the growth is cancer or not. If it is cancer, the pathologist also can identify the type.

If your care team thinks the tumor may be a sarcoma, a biopsy may be needed to confirm the diagnosis. Imaging tests usually are done first to show the location of the tumor. The test results help the healthcare professional decide where to biopsy.

Tests to check for spread

If the tumor is cancerous, you may need more imaging tests to find out whether the cancer has spread. The spread of cancer is called metastasis. The tests depend on the type of tumor. They may include a CT scan of the chest, PET-CT or other imaging tests.

Grades

Some cancerous chest wall tumors are given a grade. The grade tells how different the cancer cells look from healthy cells under a microscope. It also can help your healthcare team estimate how likely the tumor is to grow or spread.

The grading system used depends on the tumor type. Tumors that are high grade usually have a greater chance of spreading than tumors that are lower grade.

治疗

Treatment depends on whether the tumor is noncancerous or cancerous. It also depends on the tumor type, size, location and whether it has grown or spread.

Some chest wall tumors that aren't cancer may not need any treatment. Other tumors may need to be removed if they:

• Cause symptoms.
• Keep growing.
• Can't be clearly identified as noncancerous.

Cancerous chest wall tumors often need care from several specialists. Treatment may include:

• Surgery.
• Chemotherapy.
• Radiation therapy.
• A combination of these treatments.

The type and order of treatment depend on the tumor.

Surgery

Surgery is a main treatment for many cancerous tumors that start in the chest wall. These include many bone and soft tissue sarcomas.

When possible, the surgeon removes the whole tumor and some healthy tissue around it. The healthy tissue around the tumor is called a margin. The goal is to remove the tumor with no cancer cells at the outer edge of this tissue. This is called a negative margin.

Surgery to remove a tumor is called resection. To remove a chest wall tumor, the surgeon may need to take out part of one or more ribs, the breastbone, muscle, or other nearby tissue. If surgery leaves a large opening in the chest wall, chest wall reconstruction may be needed. Surgeons may use mesh, plates or other materials to help support the chest. They also may use tissue from another part of the body to cover the area.

Reconstruction is planned to help protect the organs inside the chest and preserve breathing and movement as much as possible.

Possible complications of chest wall surgery include:

• Pain, numbness or tingling.
• Infection.
• Breathing trouble.
• Bleeding.

Your surgical team can explain the risks based on your surgery.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells or stop them from growing. Whether chemotherapy is used depends on the type of tumor.

Treatment for Ewing sarcoma includes chemotherapy along with surgery, radiation therapy or both.

Osteosarcoma also usually is treated with chemotherapy and surgery.

Chemotherapy often does not work well for many conventional chondrosarcomas.

Sometimes, certain soft tissue sarcomas may be treated with chemotherapy.

Side effects of chemotherapy treatment depend on the specific medicines used. Some chemotherapy treatments can lower blood cell counts and increase the risk of infection. Your cancer care team can explain which side effects are possible with the medicines in your treatment plan.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. Radiation therapy may be the main treatment when surgery cannot remove the tumor safely. The treatment also may be used before or after surgery for some sarcomas.

Side effects of radiation therapy depend on the area treated and the radiation dose.

Radiation therapy can affect the skin and nearby healthy tissues. Your radiation oncology team carefully plans your treatment. The plan helps reduce the chance that radiation will affect nearby organs.

Targeted therapy or immunotherapy

These treatments may be choices for some advanced sarcomas. Your care team looks at the type of tumor and certain cell features before deciding if these treatments may help you. These treatments are not used for every chest wall tumor.

Follow-up after treatment

After treatment for a cancerous chest wall tumor, you need regular health checkups and imaging tests. These visits help your care team see if the cancer has come back in the chest wall or spread to another part of the body. How often you need follow-up appointments and which imaging tests you need depend on your tumor type, grade, stage and treatments received.

Prognosis

There is no single survival rate for chest wall tumors. Each type has a different outlook, also called prognosis.

The prognosis for cancerous chest wall tumors can depend on:

• The exact type of tumor.
• The tumor grade and size.
• Whether the cancer has spread.
• Whether the tumor can be completely removed.
• How the tumor responds to treatment.

General survival statistics for bone cancer or soft tissue sarcoma may not describe what to expect with a specific chest wall tumor. Your care team uses information about your tumor type, stage and how well the tumor responds to treatment to talk with you about your individual outlook.

妥善处理与支持

A chest wall tumor diagnosis can bring uncertainty. Your treatment may involve several specialists or a major operation. Learning more about your condition can help you understand your choices.

• Learn about your tumor. Ask your care team to explain the exact tumor type and what the diagnosis means for your treatment choices.
• Prepare for appointments. Write down your questions. Consider bringing someone with you who can help take notes and remember information.
• Ask about support. If you want to connect with others who have a similar diagnosis, ask your care team about support groups or other resources.

准备您的预约

If you have a chest wall lump or other symptoms of a chest wall tumor, make an appointment with your healthcare professional. If imaging suggests a sarcoma, you may be sent to a sarcoma specialty team. The team may include surgeons, medical oncologists, radiation oncologists, radiologists and pathologists.

Appointments can be brief. Because there's often a lot to talk about, it can help to be prepared for your appointment. Here's some information to help you get ready.

What you can do

When you make your appointment, ask if you need to do anything in advance. For example, you may be told not to eat or drink for a while before some tests.

Other things you can do to prepare:

• Write down when you first noticed the lump, swelling or pain and how it has changed.
• Make a list of all the medicines, vitamins and supplements you take. Include the doses.
• Get your medical records. Bring information about cancers you had in the past and any treatments, such as radiation therapy or surgeries.
• If imaging has been done elsewhere, ask whether the images and reports can be sent to the specialty team.
• Consider asking someone to go with you to help you remember what your care team says.

Questions to ask

Also write down questions to ask your healthcare team. For chest wall tumors, some basic questions include:

• What type of chest wall tumor do I have?
• Is it noncancerous or cancerous?
• Do I need a biopsy?
• Has the tumor spread?
• Do I need treatment?
• What are my treatment choices?
• If I need surgery, how much of my chest wall will be removed?
• Will I need chest wall reconstruction?
• Will I need chemotherapy or radiation therapy?
• I have other health conditions. How can I best manage them together?
• How will treatment affect breathing, movement and daily activities?
• What follow-up will I need after treatment?

What to expect from your doctor

Your healthcare team usually asks many questions, such as:

• When did you first notice the lump or pain?
• Has the lump grown or changed?
• Do you have pain?
• Does anything make the pain better or worse?
• Have you been treated for cancer before?
• Have you ever had radiation therapy?
• Does anyone in your family have a history of sarcoma or an inherited cancer syndrome?