Chest Wall Tumors: Diagnosis and Treatment of Chest Wall Tumors in Thoracic Surgery

Chest wall tumors can be classified as benign or malignant. In up to 39% of cases, a chest wall tumor is malignant, while 35% are benign. The remaining 26% are so-called secondary chest wall tumors, meaning they arise from lung metastases (“secondary tumors”) originating from another cancerous site in the body.

The most common benign chest wall tumors include:

• skin tumors,
• fibromas (tumors of connective tissue), lipomas (tumors of fatty tissue),
• neurofibromas (within nerve tissue),
• fibrous dysplasias (in bone tissue), and
• chondromas and osteochondromas (of cartilage tissue).

Malignant chest wall tumors, however, include:

• skin tumors, such as malignant melanoma (“black skin cancer”),
• tumors arising from cartilage tissue—so-called chondrosarcomas,
• soft tissue sarcomas, such as fibrosarcoma, liposarcoma, angiosarcoma, or neurofibrosarcoma, as well as
• bone cancer, including, among others, Ewing’s sarcoma or osteosarcoma.

The most common symptom associated with chest wall tumors is pain in the chest and breast area. Occasionally, a palpable swelling on the chest wall may also be present. However, warmth and redness are described less frequently.

However, chest wall tumors—especially in the early stages—can also be completely asymptomatic. Thoracic wall tumors are often discovered incidentally during routine examinations, such as computed tomography (CT), X-rays, or magnetic resonance imaging (MRI).

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If a chest wall tumor is suspected based on symptoms, a CT scan typically provides the best images. In computed tomography, the chest is imaged in individual slices, which allow for very high depth resolution. This makes it possible to determine the tumor’s location very precisely.

CT is also essential, particularly for planning surgery to remove the chest wall tumor. In some cases, it is necessary to perform an MRI as well to assess whether the chest wall tumor has already invaded neighboring tissues and organs.

Chest wall tumors are usually treated surgically, meaning the tumor tissue is removed as completely as possible. Depending on the tumor’s location, size, and stage, surgery may also be combined with chemotherapy and/or radiation therapy.

As a general rule, chest wall tumors should be removed as extensively as possible to prevent the tumor from returning (recurrence). However, in cases of advanced chest wall tumors, it may be necessary to partially remove the chest wall as well (= partial chest wall resection).

The resulting defect is then closed using a chest wall replacement in that part of the thorax. To do this, thoracic surgeons use bone substitute material as well as synthetic mesh, which seals off the chest cavity and is intended, for example, to protect the lungs. Depending on the extent of the procedure, plastic surgeons are also involved to restore a natural appearance to the surgical area. Overall, the treatment of chest wall tumors is an interdisciplinary endeavor. It involves, for example, thoracic surgeons, neurosurgeons, plastic surgeons, and oncologists.

The prognosis for chest wall tumors depends primarily on the tumor stage and its extent. However, the earlier a tumor is detected, the better the chances of a potential cure.

In addition, the outcome of the surgery also influences the long-term prognosis. Particularly in the case of soft-tissue chest wall tumors, this is ensured by wide surgical margins extending into healthy tissue. This helps prevent recurrences—the return of a tumor.

A 2012 doctoral dissertation also demonstrated that thoracic surgery—particularly chest wall resection and reconstruction—is a safe procedure. Mortality (death rate) and morbidity (burden of disease) are low compared to the severity of the procedure.

What are chest wall tumors?

Chest wall tumors are tumors of the chest wall that can be either primary chest wall tumors or secondary tumors. A chest wall tumor can originate in bone, cartilage, or soft tissue. The most common types include benign tumors, chest wall sarcomas, and malignant tumors originating in adjacent structures.

What symptoms can occur with a chest wall tumor?

One symptom of a chest wall tumor may be a palpable mass in the chest wall area. Depending on the type of tumor, symptoms may include chest wall pain, warmth, redness, or other discomforts. Some chest wall tumors cause virtually no symptoms for a long time and are only detected through imaging tests.

How is a chest wall tumor diagnosed?

CT, MRI, and computed tomography are used for diagnosis to determine the location and extent of the tumor. This allows for a better assessment of whether the chest wall tumor has invaded neighboring structures. In addition, tissue samples help determine the tumor type and guide further treatment planning.

How are chest wall tumors treated?

Treatment of chest wall tumors is usually surgical. The goal is the complete removal of the tumor with a sufficient safety margin from healthy tissue. In cases of sarcomas, chondrosarcomas, or other malignant findings, resection is often performed according to oncological principles. Depending on the findings, chemotherapy may be combined with other treatment modalities.

Is chest wall reconstruction necessary after surgery?

After the removal of large chest wall tumors, chest wall reconstruction is often necessary. In this procedure, missing areas are reconstructed using special materials. In complex cases, treatment is carried out in close collaboration with the plastic surgery department to restore the stability and function of the chest wall.