A lump in the chest? Let's learn about Mediastinal Tumor in simple terms

A mediastinal tumor is a lump that forms in the space between your lungs, between your chest and your lungs. You may not have heard of this name before. But it's important to know about it. Sometimes, these lumps can develop without any symptoms. So let's talk about it in a little more detail so that you can understand.

Simply put, what is a mediastinal tumor?

Think about the space inside your chest. The breastbone is in front, the spine is in back, and the lungs are on either side. The space between these organs is what we medically call the mediastinum . This space contains many important organs, including your heart, aorta, esophagus, trachea, thymus gland, and lymph nodes, which are part of your immune system.

So, any mass of cells, that is, a lump, that forms in this area called the mediastinum, we call it a mediastinal tumor. There are two types of these lumps:

• Benign: These are not cancerous. They usually form in one place and do not spread to other parts of the body.
• Malignant: These are cancers. They can spread, damaging surrounding tissue.

What are these types of lumps? Do they differ depending on where they form?

Yes, these lumps are divided into three main parts depending on where they form. That is, according to how the three parts of the mediastinum are formed: the front, middle, and back. Let's see what they are.

Who gets these lumps? How common are they?

Although these types of lumps can develop at any age, they are most often diagnosed in people between the ages of 30 and 50. However, there are slight differences between adults and children.

• Adults: Lumps often develop in the anterior mediastinum. These are more likely to be cancerous conditions such as lymphoma or thymoma.
• Children: Lumps often develop in the posterior mediastinum. These start in the nerves and are usually not cancerous.

This is not a very common condition. It affects less than 1% of the population.

Is this a serious situation? Should I be afraid?

This is a problem that many people have. The important thing to understand here is that even though this lump is not cancerous (benign), it can be serious depending on where it is located .

Imagine, as this lump grows, it can put pressure on organs such as the heart, the thin sac around the heart (pericardium), major blood vessels, and the trachea. Also, a lump that forms in the back can put pressure on the spinal cord. Therefore, if left untreated, serious problems can occur.

What are the symptoms of this?

Surprisingly, about 40% of people with this condition do not experience any symptoms . The lump is often discovered incidentally during a chest X-ray for another reason.

If symptoms occur, it is often because the tumor has grown and is pressing on surrounding organs. Cancerous tumors are more likely to cause symptoms.

These are the symptoms that can be seen in general:

• Hoarseness of voice.
• A low-pitched sound coming from the throat when breathing (stridor).
• Cough, wheezing, or difficulty breathing (dyspnea).
• Coughing up blood (hemoptysis).
• Difficulty swallowing food (dysphagia).
• Fever, chills, or night sweats.
• Chest pain (this is a little less common).
• Being thin for no reason.
• Lymph nodes (glands) are swollen or tender to the touch.
• Eye problems such as drooping eyelids on one side of the face and small black circles on the eyelids.

Why do these lumps form?

It's hard to pinpoint a single reason for this. There could be several factors at play.

• Uncontrolled cell growth: Both cancerous and noncancerous tumors develop when cells divide and grow out of control. Researchers still don't know exactly why this happens.
• As a response to another medical condition: Sometimes, lymph nodes can become swollen and appear lumpy due to an infection or other medical condition in the body.
• Congenital conditions: Some tumors, for example, pericardial cysts and bronchogenic cysts, are abnormal tissue growths that are present from birth.

How does a doctor find this?

Typically, if a lump is found on a chest X-ray, your doctor will order several more tests to learn more about it.

• Chest X-ray: This can primarily be used to check for a lump.
• CT scan (Computed Tomography scan): This can produce much clearer, more detailed images than an X-ray. It can show the size and shape of the tumor, and how it has affected surrounding organs.
• MRI scan (Magnetic Resonance Imaging): Helps to see if the tumor is pushing into surrounding tissues or has spread into them (as in the case of cancer).
• PET scan (Positron Emission Tomography scan): This is very useful in diagnosing some types of cancer, such as lymphoma.
• Blood tests: Blood tests can check for proteins or enzymes (tumor markers) related to certain types of tumors.
• Biopsy: This is the most important test. A small piece of tissue is taken from the lump and examined under a microscope. This test can determine exactly what type of cells the lump is made of and whether it is cancerous. This can be done using methods such as taking a sample with a needle under a CT scan (CT-guided needle biopsy), passing a camera tube down the esophagus (esophagoscopy), or passing a camera down the windpipe (bronchoscopy).

What are the treatments for this?

Treatment depends on the type of lump, its location, its stage if it is cancerous, and the symptoms you are having.

• Surgery: This is the most common treatment. Cancerous tumors, tumors that are pressing on nearby organs, and tumors that are causing symptoms may need to be removed surgically. This can be done through a sternotomy or through several small incisions using a camera (video-assisted thorascopic surgery - VATS).
• Radiation Therapy: This treatment uses high-energy rays to destroy cancer cells. It is sometimes given alone or in conjunction with surgery.
• Chemotherapy: Giving the body drugs that kill cancer cells or shrink tumors.
• Antibiotics: If the lump is caused by an infection (e.g., swollen lymph nodes), it can be treated with antibiotics.
• Watchful Waiting: If the lump is not cancerous and there are no symptoms, your doctor may decide not to treat it and instead perform scans to monitor the lump for any changes.

What will happen next? Can this be prevented?

The outlook depends entirely on the type of lump, whether it is cancerous or not, and your overall health. Therefore, only your doctor can give you the best explanation for the outlook for your condition.

There is no surefire way to prevent these types of lumps from forming. But the best thing you can do is to recognize the condition early . If you have the symptoms we discussed earlier (such as cough, hoarseness, difficulty swallowing) for more than two weeks, be sure to see a doctor for advice.

Things to ask your doctor

If you suspect you have this condition, ask your doctor these questions.

• What type of mediastinal tumor do I have?
• Is this lump cancerous or not?
• Does this definitely need to be treated?
• What treatments do you recommend?
• What are the benefits and risks of those treatments?
• What kind of results can I expect after treatment?
• Should I be concerned about complications from the lump or treatment?