Thorax
What is thoracic cancer?
Thoracic cancer refers to a group of malignant tumors that arise inside the chest, between the neck and the abdomen. They comprise mainly tumors developing in the lung and airways, the membrane that lines the chest and the lung (pleura), and some tumors involving organs located in the chest, such as the thymus.
Cancer types
- Pleural tumors: These are tumors that originate in the membrane that lines the lungs and the chest cavity. The most frequent type is mesothelioma, associated with asbestos exposure. There are other types of less common pleural tumors such as solitary fibrous tumors and lymphomas. The pleura can also be affected by other tumors arising in other organs such as breast, lung or gastrointestinal tract.
- Mediastinal tumors: These tumors originate in organs of this anatomic region located between the lungs, the great vessels (aorta, superior vena cava) and the heart. The most frequent mediastinal neoplasms are the ones that affect the thymus, the lymph nodes and those originating in neural elements (neurinomas).
- Lung tumors: These tumors are the most frequent thoracic tumors. They are a primary cause of cancer-related death and are frequently associated with tobacco smoking. There are many subtypes and they are increasingly better categorized at present thanks to the advances in molecular biology.
Cancer symptoms vary across individuals and not everyone exhibits prior symptomatology.
Alarm signals include:
- Persistent or worsening cough.
- Chest pain.
- Shortness of breath.
- Wheezing.
- Coughing up blood.
- Feeling tired all the time.
- Unintended weight loss.
How is diagnosis made?
It begins with a suspicion which can be verified by means of the following:
- Endoscopic studies: Bronchoscopy consists of using a device (tube) to visualize the main airways such as the trachea and bronchi. It offers the possibility of taking biopsies from abnormal areas and even directly treating any lesions causing obstruction or bleeding.
- Imaging studies: An X-ray image can show a nodule or mass. A CT scan can reveal smaller lesions that might not be picked on X-rays, and it is the preferred method for assessing thoracic tumors.
- Sputum cytology: In case of cough with sputum production, studying the sputum under the microscope can reveal the presence of cancerous lung cells.
- Biopsy:A procedure called biopsy can be performed in order to extract a sample of abnormal cells. In needle biopsy, the physician uses X-ray computed tomography imaging to guide the needle through the chest wall and into the lung tissue in order to collect suspicious cells.
There are different ways to treat cancer depending on the type and whether it has spread. Treatment includes:
- Surgery
Some form of surgery is used in the majority of patients with thoracic cancer as part of the treatment. The type of surgical procedure will depend on the intention to treat and the clinical and/or pathological stage of the disease. It is also important to mention that a combination of different surgical procedures can be used.
- Immunotherapy
Immunotherapy is the use of drugs to stimulate the patient’s immune system so that it can recognize and destroy cancer cells more effectively. This therapy can be used to treat some types of thoracic cancer.
- Chemotherapy
The aim is to shrink or eliminate the tumor using drugs administered as tablets or through the intravenous route. Chemotherapy treatment is indicated in some cases, depending on the stage of the disease or the patient’s clinical condition.
- Radiotherapy
Radiotherapy uses high-energy beams (or particles) that destroy or reduce cancer cells. It can be used in combination with other treatments such as hormone therapy or chemotherapy.
Before the surgery: In order to shrink the tumor and facilitate the surgical procedure.
After the surgery: As a means to reduce the probability of the tumor reappearing in the same site or in the adjacent lymph nodes.
As an alternative to surgery in tumors that are confined to the organ or place where they arise.
When cancer has spread to other parts of the body such as the bones or the brain, in order to improve symptoms such as pain or the neurological deficit produced by the tumor in those places.
- Targeted therapies
These are usually oral treatments to specifically block or inhibit a cell pathway that facilitates tumor growth. They are called targeted because they only act on a specific place of the tumor cell, which is why they are more effective and less toxic than chemotherapy. However, they do not work in all types of thoracic tumors.