[Information provided by Henry J. Tannous, MD]
Stony Brook Medicine's highly trained physicians and surgeons can help patients navigate the diagnosis and treatment of mediastinal tumors. We offer minimally invasive techniques that include video-assisted and partial sternotomy approaches in state-of-the-art facilities.
Our multidisciplinary thoracic surgery team works closely with other specialties to ensure the best possible patient care. This comprehensive approach is delivered with compassion and a personalized plan to maximize our patients' quality of life.
Our team provides surgical care to patients with lung and mediastinal tumors. With the scope of our practice expanding into open heart operations, we can offer resections of cardiac tumors and complex mediastinal tumors involving the major vessels, a situation that requires a cardiopulmonary bypass. This allows a safer and more aggressive resection in otherwise unresectable tumors.
The mediastum is the term used to describe the area in the chest between the lungs that houses the heart, esophagus, trachea, great vessels, thymus, and lymph nodes. It is separated into three compartments: anterior, middle, and posterior. An anterior compartment mass is the most common, and it could represent a thymoma, a lymphoma, a germ cell tumor, or a thyroid mass.
Mediastinal tumors are benign or cancerous growths
that form in the area of the chest that separates the lungs.
Thymomas are the most common mediastinal tumors. They represent 15-20% of all tumors. They could be associated with myasthenia gravis, a disease of the neuromuscular junctions causing less efficient transmission and, hence, weakness. They grow slowly and invade surrounding structures; consequently, these tumors require surgical removal with a good cure rate. A rarer but more invasive type, thymic carcinoma, is harder to manage and could require chemotherapy or radiation.
Lymphomas are the second most common, and can be found in the anterior or middle mediastinum. The most common types are Hodgkin's and B-cell lymphomas. These cancers are usually diagnosed with a biopsy and treated with chemotherapy and radiation.
Sixty percent of patients with mediastinal masses present with symptoms. These include:
- "Fullness in the chest"
- Shortness of breath
- Substernal pain
- Weight loss
A CT scan of the chest is the most commonly used imaging study to define the mediastinal tumor size and extension. Once the mass is confirmed, a biopsy is usually indicated.
- CT guided biopsy: A needle biopsy is occasionally possible and sufficient to make a diagnosis. In cases of lymphomas or germ cell tumors, the treatment consists of chemo-radiation, and is initiated without further surgical interventions.
- Mediastinoscopy: A cervical mediastinoscopy consists of a small incision made at the base of the neck. It allows the visualization and biopsy of any masses around the airway (via direct vision or with the help of a camera). This procedure also helps staging lung cancers.
- Video-Assisted Thoracoscopic Surgery (VATS): VATS consists of a camera used to project images on a monitor, allowing the visualization of the chest cavity and the resection of the mediastinal or lung tumors. This approach uses small incisions, and provides faster recovery than traditional resections. Learn more.
- Sternotomy / Hemi-Sternotomy: This approach is commonly used in open heart operations. However, it is also very useful to resect a large mediastinal tumor, especially if it is invading vital structures like a major vessel. Rarely, the resection requires placing the patient on cardiopulmonary bypass to allow for a safer resection.
After surgery, patients continue to follow up with our team of oncologists, who provide them with any further treatments and to monitor their case.