Mediastinum represents an anatomical area that separates vital organs and structures. The tumour frequency is 3-7% in different countries. 30% of all the mediastinal masses are malignant.
The incidence is equal for both men and women and its peak is exactly during the most socially active period from 20 to 40 years old.
Malignant mediastinal mass can be of various origins; starting from the thymus gland cells, connective (fibrosarcoma), fat (liposarcoma), muscle (leiomyosarcoma), lymphoid (lymphosarcoma) tissue, and including the vessels (angiosarcoma).
An exact cause of the tumour remains unknown at the moment.
There are several factors that lead to the changes in the genetic material of the cells and significantly increase the possibility of their malignancy:
The development of mediastinum malformation can be latent for a long time and does not cause any feelings of discomfort for a person. In these cases, the tumour can be detected by chance during diagnostic tests for other diseases.
As the oncologic process progresses and the tumour increases in size, the following symptoms may appear:
Pain develops due to the growth of the tumour in the tissues and neural stem cells of the mediastinum. At the same time, pain sensations can have different intensity. They are located mainly behind the breastbone and can often resemble cardiac angina (compressive pain as a result of insufficient blood supply to the heart muscle).
Compression syndrome occurs when a large tumour compresses the venous stems affecting the blood outflow from the upper or lower half of the trunk, large nerves, which is manifested by the lowering of the eyelids (ptosis), in a hoarse voice (dysphonia). Compression of the large bronchi can be manifested by the broken breathing, cough.
The following phenomena are also possible:
General cancerous intoxication appears on the latter stages of the oncologic process, characterised by severe weakness, decreased appetite or lack of it, increased body temperature, aching joints and muscles.
A doctor will explain the additional diagnostic measures right after the clinical examination (a survey, examination of the patient, palpation of tissues, in particular regional lymph nodes). Additional procedures are necessary to detect the tumour, its exact location, histological origin, size.
Specialists will also perform a test aimed at the detection of metastases with the help of modern diagnostic techniques which include:
To determine the functional status of other organs, clinical, biochemical blood analysis, general urine analysis, laboratory examination of the functional activity of the immune system, electrocardiography, electroencephalography, external respiration function evaluation are additionally assigned by the doctor.
The volume of the diagnostic measures is determined individually for each patient in the European hospitals as tumour location, origin, size significantly differ.
The main treatment of a malignant mediastinal mass is the surgical removal of the malformation through an open access technique or laparoscopic surgery.
If a tumour is small, metastases are absent, radical treatment is performed with complete excision of the malformation and nearby healthy tissues. Unfortunately, many tumours are unresectable, when located close to vital organs, primarily to the heart.
Palliative surgical treatment is performed at the last stages of the disease. It is aimed at the partial removal of the tumour to ease the patient’s condition triggered by the compression of the vessels, nerve stems, and bronchi.
Radical and palliative surgical treatment of the malignant mediastinal mass is often accompanied by radiation therapy or cytostatics (chemotherapy).
The entire situation depends on the histological type of malignant tumour and its location. It is impossible to give certain numbers of the patients survival as malignant mediastinal mass is not a separate disease but a whole group of pathologies.
Nevertheless, judging on the close location of the organs their importance for the body, considerable blood supply, and prognosis is unfavourable. In the absence of proper treatment; the process quickly spreads to distant metastases.
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