Chest wall tumors

A chest wall tumor is a growth in the tissues that make up the outside of the chest. These tissues include the ribs, breastbone, cartilage, muscles, fat, blood vessels and nerves. The breastbone also is called the sternum.

Chest wall tumors may not be cancerous. That means they are benign. If they are cancerous, they are called malignant.

Some tumors start in the chest wall. These are called primary chest wall tumors. Cancer also can spread to the chest wall from another part of the body or grow into the chest wall from a nearby organ.

Treatment often depends on the type of tumor, where it is, how large it is and whether it has spread.

Types

Chest wall tumors are grouped by the kind of tissue where they begin. They also are grouped by whether they are noncancerous or cancerous. A biopsy is usually needed to find the exact type of tumor. During a biopsy, a small sample of tissue is removed and tested.

Noncancerous chest wall tumors

Noncancerous tumors are benign and do not spread to other parts of the body. An example is a lipoma. But some noncancerous chest wall tumors can grow large and cause pain or damage nearby tissues. Depending on the type, they may start in bone, cartilage, fibrous tissue, fat, blood vessels or nerves. Noncancerous chest wall tumors may still need treatment or close follow-up with your healthcare team.

Cancerous chest wall tumors

Many cancerous chest wall tumors are sarcomas. Sarcomas are cancers that start in bone or connective tissues. Sarcoma types that can affect the chest wall include:

• Chondrosarcoma. This cancer starts in cartilage. Cartilage is a strong, flexible type of connective tissue. Chondrosarcoma is one of the most common cancerous tumors that starts in the chest wall. In the chest wall, it often starts in a rib. Less often, it starts in the breastbone, also called the sternum.
• Ewing sarcoma. This cancer can start in bone or soft tissue. It often affects children, teens and young adults.
• Osteosarcoma. This cancer starts in bone-forming cells. Rarely, it can start in the ribs or other bones of the chest wall.
• Soft tissue sarcoma. Many types of soft tissue sarcoma can start in the muscles, fat, blood vessels, nerves and other soft tissues of the chest wall.

Symptoms depend on the type, size and location of the tumor. Possible symptoms include:

• A lump or growth on the chest wall that may get larger over time.
• Pain or tenderness in the chest wall. Tumors that start in bone or cartilage may be painful.
• Swelling in the chest wall.
• Trouble breathing if a large tumor presses on or affects nearby structures.

When to seek care

Contact your healthcare team if you have a new or growing lump on your chest wall. Also contact your care team if you have swelling or pain in the chest wall that does not go away or gets worse. These symptoms can happen with noncancerous or cancerous tumors. Your care team can decide whether you need tests.

For most chest wall tumors that start in the chest wall, the exact cause is not known. Cancer happens when changes in a cell let it grow and divide in a way that's not usual. (The gene changes and other factors involved can be different for each tumor type.

Some chest wall cancers are types of bone or soft tissue sarcoma. In a small number of people, conditions that are passed down through families or past radiation therapy can raise the chance of getting a sarcoma.

There are many different types of chest wall tumors. There is no single list of risk conditions. Most sarcomas happen in people who have no known risk factor.

Depending on the tumor type, things that may raise the risk of some sarcomas include:

• Age. Ewing sarcoma is more common in children and young adults. Chondrosarcoma is more common in older adults.
• Some cancer syndromes passed down through families. Some inherited conditions can raise the risk of bone or soft tissue sarcomas.
• Radiation therapy in the past. Rarely, a sarcoma can develop years after radiation treatment.

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.

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.

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.

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?