Surgical evaluation and removal of mediastinal masses
Mediastinal masses are a group of benign (noncancerous) and malignant (cancerous) tumours that develop in the anterior, middle and posterior mediastinum such as tumours from the:
- Lymph nodes
- Connective tissue
- Germ cells
Mediastinal tumours are rare, but they are commonly diagnosed in people who are 30 – 50 years of age, even though they may develop at any age and may develop in any tissue. The location of the mediastinal tumours varies according to the person’s age. In children, mediastinal tumours mostly develop in the posterior or back mediastinum and normally develop in the nerves. These tumours may not be cancerous. In adults, mediastinal tumours develop in the anterior or front mediastinum and may be malignant (cancerous) lymphomas or thymomas.
How are mediastinal tumours diagnosed?
In most cases, people who have mediastinal tumours experience no symptoms, but these tumours are discovered when a chest X-ray or CAT scan is done for other medical reasons. When these tumours do cause symptoms, one may experience symptoms such as:
- Persistent cough
- Shortness of breath or wheezing
- Fever of night sweats
- Difficulty in swallowing
- Unexplained weight loss
Dr Dongo may recommend the following tests to diagnose you:
- Needle biopsy
This is a procedure done under sterile conditions, local anaesthesia and CT guidance. During the procedure, a biopsy needle is passed through an incision in the skin into the suspected tumour, and it is aspirated.
During this procedure, the surgeon will make a small incision in your breast bone and use a mediastinoscope to take samples of the tumour. This is often done for tumours in the middle mediastinum.
This is a procedure where a bronchoscope will be inserted into your nose to examine your bronchi. Brushes or needles may then be attached to the bronchoscope and used to collect tissue samples from the lungs or bronchi.
How are mediastinal tumours removed?
Mediastinal tumour treatment depends entirely on the type of tumour and the location of the tumour. Dr Dongo may recommend the following surgical procedures to treat mediastinal tumours:
During this procedure, the surgeon will make a large incision in the centre of the chest. He will then separate the breastbone to gain access to the mediastinum and the tumours. The surgeon will then resect the tumours and stitch close the incisions.
During this procedure, an incision will be made in your shoulder, between your ribs. The surgeon will then separate the muscles to access the mediastinum and the tumour. He will then resect the tumours and close the incision with sutures or staples.
- Video-assisted thoracic surgery
During this procedure, small incisions will be made in your chest, and a fibre-optic camera will be passed through the incisions. The surgeon will also pass surgical instruments through the incisions and resect the tumours with visual guidance from the camera.