Treatment

Mediastinal tumor treatment depends on whether or not the tumor is cancerous, its stage, and the patient’s overall health. After taking all of these factors into consideration, the surgeon may recommend:

Surgery and Minimally Invasive Procedures

BMC’s thoracic oncologists can help treat mediastinal tumors through several procedures. The goal of mediastinal surgery is to remove the tumor and spare as much of the healthy tissue as possible.

The surgical techniques to remove mediastinal tumors include:

Surgical Resection

In mediastinal tumor resection, the surgeon removes (resects) some or all of a tumor. There are several types of mediastinal tumor resection, including:

Sternotomy

The surgeon makes an incision in the center of your chest and separates the sternum (breastbone). The surgeon then locates and removes the tumor.

Thoracotomy

Thoracotomy involves the surgeon making an incision in your side, back, or in some cases between your ribs, to gain access to the desired area.

Minimally Invasive Tumor Removal

Video-Assisted Thorascopic Surgery (VATS) is a minimally invasive alternative to open chest surgery that involves less pain and recovery time. After giving you a sedative, the physician will make tiny incisions in your chest and then insert a fiber-optic camera called a thorascope as well as surgical instruments. As the physician moves the thorascope around, images that provide important information are projected on a video monitor. VATS is not appropriate for all patients; you should have a thorough discussion with your provider before making a decision. It is often not recommended in people who have had chest surgery in the past, because remaining scar tissue can make accessing the chest cavity more challenging and thus riskier.

Robotic-Assisted Mediastinal Tumor Resection

The surgeon uses a computer-controlled device that moves, positions, and manipulates surgical tools based on the surgeon's movements. The surgeon sits at a computer console with a monitor and the camera provides a three-dimensional view of the heart that is magnified ten times greater than a person's normal vision. The surgeon's hands control the robotic arms to perform the procedure.

Non-Surgical Cancer Treatments

Surgery or minimally invasive treatments for malignant mediastinal tumors are typically used in combination with other treatments, including:

Chemotherapy

Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, it destroys cancer cells. Chemotherapy is particularly useful for cancers that have metastasized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).

Radiation Therapy

Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT). Radiation may be used as a solitary treatment to cure the tumor or in combination with surgery and/or chemotherapy. The equipment used to deliver the radiation therapy is called a linear accelerator. The linear accelerator has a moveable arm, which enables the radiation to be focused on the part of your body where the cancer is located. Developments in EBRT equipment have enabled physicians to offer conformal radiation. With conformal radiation, computer software uses imaging scans to map the cancer three-dimensionally. The radiation beams are then shaped to conform, or match, the shape of the tumor.

Radiation works by breaking a portion of the DNA of a cancer cell, which prevents it from dividing and growing. Radiation therapy can be systemic, meaning it moves throughout your bloodstream. Systemic therapies are usually given as an injection into a blood vessel or are taken as a pill. Systemic treatments expose your entire body to cancer-fighting medication. Radiation therapy is typically given as a "local" treatment however, meaning it affects only the part of the body that needs therapy.

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