Managing abnormalities of the mediastinum generally requires a multidisciplinary approach. A surgeon, medical oncologist, radiation oncologist, and a pathologist often consult as a team to determine the character of the abnormality and the best way to treat it. At Saint John’s Health Center, we develop comprehensive treatment plans for patients with mediastinal tumors.
Treatment of Benign and Malignant Mediastinal Turmors
The treatment of mediastinal cancers depends on the type of tumor, its location, and how far it’s spread. Treatment can include chemotherapy, radiation therapy, and surgery. Surgical management of mediastinal tumors is typical. These tumors include thymomas, germ cell tumors, cysts, and thyroid abnormalities in the middle portion of the chest. Cystic lesions of the mediastinum are frequently treated surgically as well.
When a mass is detected in the mediastinum, it can generate a lot of anxiety for the patient. However, mediastinal tumors grow slowly and are treatable. They can grow to invade surrounding structures, requiring surgical removal. A more invasive and rare type called thymic carcinoma is more difficult to manage and could require chemotherapy, radiation, as well as surgery.
Most commonly these abnormalities are detected on CT scans or chest x-rays. If only a chest x-ray has been performed, we recommend performing a CT scan with contrast to delineate the anatomy of the abnormality with regards to normal anatomy. There may be times when additional imaging such as an MRI or a PET CT scan may be indicated. Often, one of the most important tests is a biopsy to evaluate the character of the lesion detected on initial imaging. This is particularly the case in patients where there is a high suspicion of a lymphoma. In general, these types of tumors are not treated with surgical therapy, but with a combination of chemotherapy with or without radiation.
Minimally Invasive Robotic Surgery for Mediastinal Tumors
Surgical approaches for Mediastinal disease have dramatically improved in the last 10 years. Specifically robotic approaches for all aspects of mediastinal disease have significantly decreased morbidity and mortality associated with surgery. Minimally invasive approaches generally require smaller incisions and allow patients to return to normal activity within a short amount of time. Frequently, an operation will take only one or two hours in the operating room and an overnight stay in the hospital. Generally, patients can return to their normal function within a week or two. This has dramatically improved the quality of patient tolerance as well as satisfaction with resection for Mediastinal masses. Even larger tumors that would have traditionally required division of the sternum can now be removed using a robotic approach with much less trauma to tissue and the patient.
Compared to open surgery, minimally invasive robotic surgery, such as video-assisted thoracoscopy (VATS) mediastinoscopy, offers patients:
Decreased postoperative pain.
Shorter hospital stays.
More rapid recovery and return to work.
Surgery treats all mediastinal masses, lymphomas, thymomas, and neurogenic tumors.
In lymphomas, surgery can make a diagnosis by mediastinotomy or mediastinoscopy.
Neurogenic tumors of the posterior mediastinum are treated surgically.
Possible complications of minimally robotic invasive surgical treatment include:
Damage to the surrounding structures (heart, pericardium (sac around the heart) or nerves (Phrenic or recurrent laryngeal causing hoarseness).
Chemotherapy for Mediastinal Tumors
Chemotherapy can be treated either by itself or in combination with surgery and radiation. Chemotherapy may require multiple treatments.
Chemotherapy is a treatment that uses drugs to stop the growth of cancer cells, either by stopping them from dividing, or killing the cells.
Lymphomas are usually treated with chemotherapy.
Late stage Thymomas can be treated with adjuvant and or neoadjuvant chemotherapy. Neoadjuvant treatment shrinks the tumors before surgery, and adjuvant treatment after surgery to destroy cancer cells from growing where the tumor was.
Radiation for Mediastinal Tumors
Radiation treatment is a noninvasive approach that can destroy cancer cells.
Radiation can be treated either by itself or in combination with chemotherapy and surgery.
Lymphomas treated with radiation are usually also being treated with chemotherapy.
Late state Thymomas can be treated with adjuvant or neoadjuvant radiation to either shrink the tumors before surgery, or to eradicate any cancer cells left surrounding the area where the tumor was removed.
Radiation typically requires multiple treatments.
Call today to learn more about mediastinal treatment. Our multi-disciplinary team is ready to support you.
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