The Thoracic Cavity is a hollow space enclosed by the ribs, spine and sternum. These along with other muscles and tissues form the Chest Wall which protects the vital organs that resides within the thoracic cavity such as the lungs.
The bones that enclose the thoracic cavity are rigid and strong but at the same time flexible to allow movement associated with breathing.
Tumours that form in the chest wall are highly uncommon but when they do occur, can present as a challenging problem to diagnose and manage. The tumour can either be benign (non-cancerous and does not spread to the rest of the body) or malignant (cancerous and will spread to the rest of the body). As both these tumours are very similar, it is very challenging to differentiate between the two. The source of origin of the tumour can also be difficult to pinpoint as there is a wide variety of muscle, bone and tissue within the chest wall that it could have possibly originated from.
Abnormalities in the ribs can also manifest as chest wall tumours, painful fracture, as a bleeding point into the thoracic cavity or just an incidental finding.
The symptoms of tumours in the chest wall or rib abnormalities are as follows:
This is used as the initial tool for screening to determine if there are any abnormalities present in the chest wall and the rib cages.
This is a more in-depth imaging test used to diagnose a chest tumour. It allows the doctor to diagnose the size of the tumour, how active the tumour is and where the point of origin of the tumour is.
This test is used to measure the depth and extent of the tumour, the areas which require surgery along with how the doctor can restore damaged tissues using alternative materials.
The MRI Scan allows the surgeon to diagnose the extent of the tumour growth. As a tumour grows it begins to invade into muscular tissues. It also allows for the amount of nervous system involvement with the tumour to be diagnosed as the tumour may begin to invade the nerves, neurovascular bundle and spinal column.
This is a biological test that allows for the degree of tumour spread to be assessed. It can also assess if there is any disease elsewhere in the body. It can also be used to determine the probability of recurrence.
The most common rib abnormalities are rib fractures with or without Flail Segments. A Flail Segment is the conditions in which a segment of the rib cage breaks in two junctions on the same rib making its part ineffective in respiration and may become detached from the rest of the chest wall.
At ICTS, we combat this problem by fixing pre-contoured rib plates onto the ribs. This helps to provide stability for improved respiratory dynamics.
The benign chest wall tumours are usually treated by surgical resection. Surgical resection is the removal of the targeted tissue. Sometimes when the tumour is large it will require the resection followed by reconstruction of the chest wall.The malignant tumours will require the same procedure. However, they may also require resection of the associated muscles nerves and blood vessels. After surgical resection, they will require reconstruction. Here at our centre, we are pioneers in reconstruction having done the world’s first 3D printed non-metallic implant. After the reconstruction, the patient’s respiratory dynamics should improve more quickly. If the tumour is management patient will require further treatment in the form of radiation therapy and/or chemotherapy.