Other Thoracic Cancers Cancer cell

Cancerous tumors of the chest wall can grow on the muscles, bones, cartilage, blood vessels, connective tissue, nerves, fatty tissue, and skin of the chest.

Cancer of the esophagus (food pipe) and the trachea (windpipe) develops when a cell in these parts of the body becomes abnormal and starts duplicating uncontrollably, eventually forming a mass or tumor. These tumors are malignant and can spread throughout the body.

Malignant pleural effusion: A pleural effusion is a collection of fluid in the chest cavity around the lungs, due to a variety of reasons. A malignant pleural effusion is when fluid collects in the chest due to an underlying cancer. The presence of an effusion represents metastasis of the primary cancer to involve either the lung itself or the pleura, the inner lining of the chest wall and is a poor prognostic sign. This fluid can compress the lung tissue, resulting in shortness of breath that often requires oxygen therapy.

Mesothelioma is a rare type of cancer that occurs in the thin layer of cells lining the body’s internal organs, called the mesothelium. It is caused by asbestos and the inhaling of asbestos fibers, which become embedded in the tissue surrounding the body’s internal organs. Over time, the fibers accumulate and cause scarring, which leads to inflammation and finally, cancer. The most common form of the disease, accounting for about 70 percent of cases, occurs in the lining of the lung, known as the pleura.

Thymoma is a type of cancer that begins in the thymus, a small organ located under the breastbone, that is part of the lymph system and helps white blood cells (protective cells) develop. The cancer cells form tumors on the outside surface of the thymus.

What are the symptoms of cancer? Woman chest pain

Esophageal cancer
Symptoms can include: difficulty swallowing solids or liquids; indigestion; heartburn; vomiting blood; chest pain/discomfort; and regurgitation of food.

Cancer of the trachea
Malignant tumors in this area can cause coughing, coughing up blood, labored breathing, wheezing, and stridor–a high-pitched sound as you draw breath, caused by a tumor blocking the throat or voice box (larynx).

Chest wall tumors
People with chest wall tumors may have a mass, lump or swelling in the chest with or without pain or discomfort.

This disease can be symptom-free. Or you can suffer from a cough that doesn’t go away, chest pain and/or trouble breathing.

Malignant pleural effusion
People with malignant pleural effusion experience shortness of breath.

People usually don’t have symptoms until 20 to 50 years after their first exposure to asbestos. Early symptoms may be mild. But as the cancer spreads, they can become severe and disabling. These can include: persistent cough and chest pain; shortness of breath; night sweats; weight loss yet fluid gain; bowel obstruction; swelling of the feet; chest X-ray showing fluid build-up.

Important: If you have been exposed to asbestos and are experiencing even mild symptoms, please see a doctor immediately. The earlier this cancer is treated, the better the outcome.

What are the risk factors for cancer?

Cancer of the esophagus

  • Age: people who are 55 and older are at greater risk for developing esophageal cancer
  • Sex: men have a three-to-four times higher rate of cancer of the esophagus
  • Gastroesophageal reflex disease (GERD): in which the backflow of stomach acid continually irritates the esophagus
    • Barrett’s esophagus: linked to an even higher risk of cancer than GERD, is a condition in which the chronic irritation of back flowing stomach acid (reflux) produces a series of changes in the cells of the esophagus lining that result in cancer
  • Tobacco of any kind
  • High intake of alcohol
  • Obesity: often obesity is a primary cause of esophageal reflux disease
  • Achalasia: a swallowing disorder in which food and liquids collect in the esophagus, irritating the cells of the lining, finally resulting in abnormal cell changes

Cancer of the trachea
The overwhelming risk factor is smoking of any kind. Other risk factors include exposure to radon and asbestos.

Chest wall tumors
There are no known risk factors associated with this cancer.

There are no known risk factors associated with this cancer.

Asbestos exposure is the main cause of mesothelioma cancer. Whether inhaled or ingested, these fibers can cause inflammation of internal tissue and disrupt organ function, leading to the development of mesothelioma.

What tests can I expect to diagnose cancer?

Diagnostic tests for cancer of the esophagus

  • Barium swallow, which involves swallowing a chalky liquid that coats the esophagus and sharpens images on X-rays
  • Chest CT scan, which produces an image of the esophagus and chest to see tumors and look if cancer has spread
  • Esophagogastroduodenoscopy (EGD), in which a fiber optic instrument lets the doctor see the inside of the esophagus and take tissue samples of any abnormal areas
  • Endoscopic ultrasound, which determines the depth of the cancer and whether its spread to other areas in the chest
  • PET scan, which also helps evaluate how far the cancer spread
Chest Xray

Diagnostic tests for cancer of the trachea

  • Laryngoscopy, in which a tube tipped with a camera is used to examine the windpipe
  • Bronchoscopy, which involves sliding a lighted tube into the bronchial tubes to look for abnormal areas and to take tissue samples for a biopsy
  • Biopsy, in which a tissue sample is removed with a bronchoscope for examination under the microscope

Diagnostic tests for chest wall tumors

  • Radiology imaging (for example, a CT, MRI or PET scan)
  • Biopsy, or snipping tissue for analysis
  • Removal of part of the chest wall for testing

Diagnostic tests for thymoma

  • Chest X-ray and imaging scans, such as CT (CAT), MRI and PET

Diagnostic tests for mesothelioma

  • Blood tests for high levels of two particular substances linked to the cancer
  • Fluid and tissue sample tests
  • Biopsy, in which a tissue sample is removed with a bronchoscope for examination
What are my treatment options?

Patients diagnosed with cancer will work with a team of experts from Comprehensive Thoracic Oncology Program at the Continuum Cancer Centers of New York as well as our surgeons to determine the best course of treatment. While minimally invasive techniques are preferred, some patients may require open surgery. Each case is unique and many factors may influence a course of treatment.

Treatment options for cancer of the esophagus
The following approaches are often combined with radiation and/or chemotherapy:

  • Advanced inoperable esophageal cancers can present with obstruction that makes it difficult to swallow food. Esophageal cancers may also lead to fistulous connection between the esophagus and airway, leading to continuous aspiration, mediastinitis and pneumonia. Esophageal stenting dramatically improves the quality of life in selected patients, with restoration of natural alimentation that enables the patients to swallow soft food and liquids. Our advanced airway program is the busiest in Manhattan, and we are frequently referred the most complex cases, with excellent results.

  • Esophagectomy is the surgical removal of all or part of the esophagus and is typically undertaken as a treatment for cancer of the esophagus. For cancers involving the upper region of the esophagus, an esophagectomy may be done to remove the cancerous portion along with nearby lymph nodes and reconnect the remaining esophagus to the stomach, which is brought up into the neck. For cancers of the lower esophagus, it may be necessary to perform an esophagogastrectomy, in which a portion of the stomach is removed as well. The stomach can then be reattached to the remaining portion of the esophagus either in the chest or neck. Chemo and/or radiation therapy is often combined with surgery. We are generally able to utilize minimally invasive techniques (using laparoscopy and a combination of video-assisted thoracoscopic surgery (VATS) and robotic surgery) to perform esophagectomy, avoiding large abdominal or chest incisions. Our outcomes for esophagectomy are one of the best in the country according to the STS database.

Treatment options for cancer of the trachea
Approaches include radiation therapy and/or chemotherapy; surgery using Video Assisted Thoracoscopic Surgery (VATS) combined with the da Vinci robot; or bronchoscopic treatments such as stenting which can restore breathing and slow down the growth of a tumor in patients not candidates for surgical removal of the tumor.

Treatment options for chest wall tumors
Treatment usually involves removing the cancerous parts of the chest, such as particular ribs and muscles. As a second step, plastic surgery is used to rebuild the normal appearance and function of the chest wall.


Treatment options for thymoma
Surgical approaches include a thymectomy, an operation to remove the thymus gland which leads to significant remission of the disease in more than 80% of patients. The location of the thymoma will impact the surgical approach needed to access the diseased area to remove the malignancy, options include a sternotomy (through the breast bone), transcervical (through a small collar or neck incision) and transthoracic (through one or both sides of the chest, using VATS). Endoscopic thymus surgery with the da Vinci robot enables a complete and extended resection of all the thymic tissue in the mediastinum and neck. We are one of only a few centers in the US that can also offer transcervical thymectomy. Due to minimal trauma of both these minimally invasive techniques, patients can return to full activity in a very short time.

Radiation therapy, which uses high-energy rays to kill cancer cells and shrink tumors and chemotherapy, which uses drugs to kill cancer cells, may be used in conjunction with surgery. For advanced thymus tumors that have spread to the lining of the chest wall we can remove the tissue and then treat any microscopic disease with heated chemotherapy (also known as hyperthermia) perfused into the chest at the time of the surgery.

Treatment options for mesothelioma
Treatment options include: surgery to remove cancerous tumors; radiation therapy, which uses high-energy rays to kill cancer cells and shrink tumors; and chemotherapy, which uses drugs to kill cancer cells.

For an Appointment Call
Andrew J. Kaufman, MD
Chief, Department of Thoracic Surgery
Daniel Nicastri
Andrea Wolf

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