Mediastinal Cancer - Types, Causes, and Treatment

Introduction

Mediastinum is the space in the chest that holds the heart and certain vital structures. The pleural cavities are the space that holds the lungs. So, the mediastinum is seen as the middle section of the thoracic cavity between the left and right pleural cavities. In Antero-posterior or front-back view, the mediastinum is seen between the sternum and spinal column. So, this area encompasses the heart, trachea (windpipe), esophagus (food pipe), thymus gland, large blood vessels, and connective tissues. Several conditions can affect the mediastinum's vital organs, structures, blood vessels, and tissues, including mild infection to profound tumors.

What Is Mediastinal Cancer?

Mediastinal cancer refers to a wide range of cancers or tumors involving the mediastinum space. So, cancers in the mediastinum can be developed from the structures located anatomically inside the mediastinum or transverse through that space during its development. The cancer can also occur from metastases or malignancies originating anywhere in the body. There is not one mediastinal cancer but many different types of mediastinal cancers.

What Are the Types of Mediastinal Tumors?

There is a range of mediastinal tumors. The classification is based on the site of the tumor concerning the mediastinum. The location can be anterior or front, middle, and posterior or back region.

Anterior Mediastinal Tumors

• Thymic Cysts: Thymic cyst is a benign tumor occurring at the front region of the mediastinum. It requires treatment only if the mass is pressing the surrounding structures.

• Thymoma and Thymic Carcinoma: Thymoma is the most prevalent cancer type of all mediastinal tumors. They begin in the thymus gland and gradually progress to nearby structures. The most aggressive and serious form of thymoma is thymic carcinoma.

• Lymphoma: A malignant form that includes both non-Hodgkin and Hodgkin lymphoma.

• Thyroid Masses: Thyroid masses are referred to as benign growth like goiter.

• Germ Cell Tumor: The germ cell tumor generally develops in the mediastinum more than in the ovaries or testicles. The germ cell tumors are mostly benign form.

Middle Mediastinal Tumors:

• Pericardial Cyst: This benign growth formed like a fluid-filled sac in the surrounding structures of the heart called the pericardium.

• Bronchogenic Cyst: Bronchogenic cyst is a small and benign cyst that presents as a fluid or mucus-filled sac.

• Mediastinal Lymphadenopathy: Mediastinal lymphadenopathy is swollen or inflamed lymph nodes.

• Tracheal Tumors: Tumor growth in the trachea (windpipe) that can be benign or malignant.

• Esophageal Tumors: Tumors growing in the esophagus (food pipe) can be middle mediastinal cancer. It can be benign or malignant.

• Blood Vessel Conditions: Blood vessel conditions like aortic dissection and aortic aneurysm can influence the middle mediastinum region.

Posterior Mediastinal Tumors:

• Mediastinal Lymphadenopathy: Mediastinal lymphadenopathy, known for enlarged lymph nodes, can also occur in the back aspect of the mediastinum.

• Neurogenic Tumors: Neurogenic tumors refer to the tumor developing in the nerve tissue, and these are the most prevalent posterior mediastinal tumors. The neurogenic tumors in the posterior mediastinum region are ganglion cell, paragangliomas, and certain nerve sheath tumors.

• Neurogenic Cyst: A neurogenic cyst is a rare form that develops with distinct tissues.

• Extramedullary Hematopoiesis: The tumor can be developed from bone marrow that sorts with the posterior mediastinal tumor.

• Paravertebral Conditions: This includes conditions like malignant growths, infections, and traumatic conditions occurring in the middle portion of the spine.

• Blood Vessel Conditions: This refers to aortic aneurysms.

What Causes Mediastinal Cancer?

The tumor, growth, or cyst occurring in the mediastinum's front, middle, and back region can be regarded as the mediastinal tumor. In addition, Different causes are attributable to the development of mediastinal cancer.

• The benign and malignant tumors form as a result of abnormal growth and progression of cells. But, there is no appropriate answer for why the cells grow atypically and abnormally.

• In certain cases, mediastinal cancer can be developed in response to any underlying condition or infection. It also can occur as a response to a new inflammation. An example of such development includes mediastinal lymphadenopathy.

• At times, mediastinal cancer can be present right before birth as a congenital condition. This includes pericardial cysts, germ cell tumors, or bronchogenic cysts.

What Are the Signs and Symptoms of Mediastinal Cancer?

The majority of the mediastinal cancer cases do not encounter any symptoms. Cancer or tumor is generally diagnosed with chest radiographic techniques. Nevertheless, several people develop certain signs and symptoms. This is because tumor growth pushes or presses adjacent structures and organs. The most common symptoms of mediastinal cancer include the following.

• Shortness of breath.

• Cancer.

• Night sweats.

• Fever.

• Chills.

• Coughing up blood.

• Weight loss with no absolute reason.

• Swollen or enlarged lymph nodes.

• Hoarseness of voice.

• Respiratory blockage.

How Is Mediastinal Cancer Diagnosed?

The healthcare professionals comprehensively review the signs and symptoms that concern the mediastinum region and growth. Addedly, the medical history of the growth is evaluated and examined. The chest X-ray can detect the presence of a tumor or mass in reaction to the mediastinum. So, the doctors might prescribe additional tests to confirm the diagnosis.

The most common diagnostic aids for mediastinal cancer are listed below.

• Chest X-ray.

• Computed tomography (CT) scan.

• Magnetic resonance imaging (MRI).

• Positron Emission Tomography (PET).

• Biopsy.

• Blood tests.

• Mediastinoscopy in conjugation with biopsy.

How Is Mediastinal Cancer Treated?

The treatment of mediastinal cancer depends upon its type of tumor, extent, stage, and symptoms. The most common treatment options that doctors would recommend for,

• Surgery: The tumors pressing the organs and supporting structures and those causing distressing symptoms are most likely to be removed by surgical procedures. There are minimally invasive surgeries, video-assisted thoracoscopic surgery (VATS), and other sternotomy procedures.

• Radiation Therapy: Radiation therapy works by directing high-energy X-ray beams to the cancer with the means to destroy them. Radiation therapy is usually recommended alone or in conjugation with other treatments like surgery.

• Chemotherapy: Chemotherapy treatment involves chemo drugs to kill and shrink the cancer cells. This is the most prevalent treatment option for cancer.

• Antibiotics: Antibiotics are not preferred in all cases. It is prescribed when the cancer has occurred from any underlying infection. Hence, antibiotics can be given for mediastinal lymphadenopathy.

Conclusion

Mediastinal cancers refer to all kinds of tumors involving the space called mediastinum, so several ranges of mediastinal tumors can be benign or malignant. The prognosis and outlook of mediastinal cancer depend upon the behavior, severity, disposition to invade or spread, and treatment resistance. The treatment depends upon the type of cancer, the sage, and its metastases. The healthcare professions either advise on complete removal of the tumor with minimally invasive procedures or other appropriate options.