It can be a chest tumour!

A young man had a dry cough for two years, sometimes with a little phlegm. He didn't pay much attention to it because cough medicine from different doctors would give him temporary relief. He also tried homemade remedies which helped a bit. But the cough never completely went away, and he also started feeling short of breath. Finally, after two years, he saw a doctor who ordered a chest x-ray.

The x-ray showed a large tumour in his chest. Further tests revealed it was a type of chest tumour called 'lymphoma'. With the right treatment, the tumour was removed, and the cough and shortness of breath went away too.

Coughing and extreme weakness--Beware

A university professor started coughing at first. Then, he started feeling tired easily and weak in his hands and feet. When he walked, his legs felt like they couldn't move. After a few months, he had trouble holding a pen to write, and he started having trouble breathing.

A chest x-ray showed a tumor called 'Thymoma' between his chest wall and heart. This rare tumor caused a disease called 'myasthenia,' which made him very tired and weak every afternoon. Removing the 'thymoma tumor' helped control the severity of the 'myasthenia' disease. In some patients, removing the tumor can even cure the disease.

After all, what are these chest tumors?

There exists an empty space between the chest wall and the heart. This space is called in medical term as ‘Mediastinum’. Normally in this empty space are situated thymic gland, lymphnodes and other special types of tissue.

When a tumour starts growing in this empty space and assumes a big size, it begins to exert pressure on the surrounding structures existing in the same area. When the wind pipe or its any of its branches is compressed, patient starts complaining of cough. When more area of wind pipe is compressed, the problem of breathlessness and chest pain appears.

What are the types of chest tumour?

The most common tumour that grows in the empty space in the front part of the chest is called 'Thymoma.' It's often linked to a disease called myasthenia. The second most common tumor is caused by large masses of lymph nodes and is called 'Lymphoma.' There are two types: 'Hodgkin's' and 'Non-Hodgkin's.'

The third common tumour found in this space is called 'Germ Cell Tumor' or 'Germinoma,' mostly seen in young people. Sometimes, another tumour called 'Teratoma' can also develop here.

Another tumour called 'Mesothelioma' grows from the inner chest wall. It's usually found in people who have been in contact with a substance called 'asbestos.' Asbestos is used in building materials and fire-resistant products.

How to recognize a chest tumor?
1. If you have persistent problem of dry cough which is unresponsive to all sorts of treatment
2. Complaint of chest pain
3. Onset of breathing difficulty while walking
4. A feeling of heaviness and pressure inside the chest
What to do if you have a suspected chest tumor?

First, it's important to get a chest x-ray done. In today's time, a chest x-ray is the easiest, most helpful, and cheapest test. Many people make the mistake of not getting a chest x-ray and instead do other tests. By the time they finally get the chest x-ray, it might be too late, and the tumor could have grown big.

So, if coughing lasts for more than two weeks, it's important to get a chest x-ray without waiting. If the chest x-ray shows a possible tumor, it's best to see a thoracic surgeon right away. They might suggest getting a multi-slice Contrast CT scan of the chest to accurately see the size and shape of the tumor.

Where to go for treatment in such cases?

If someone has a chest tumour, it's important to go to a hospital where there's a thoracic surgeon available all the time. The hospital should also have CT and MRI machines. A small piece of the tumor is taken out with a needle and syringe for examination. This is called a 'tumor biopsy,' and it's done while looking at images of the tumor on a computer screen using a CT machine. A trained radiologist does this procedure. The hospital should also have the facility to check tumor markers.

Correct treatment is not possible without a proper diagnosis of tumour

If the needle procedure (FNAC) doesn't give a diagnosis, doctors do a special procedure called tru-cut biopsy. They take out a bigger piece of the tumor and check it. If this doesn't work, they try a thracoscopic approach to remove material from the tumor. If that doesn't work either, they try a new technique called 'para sternotomy.' This is where they make a small cut in the skin in front of the tumour and take out a piece for examination. This technique is simple, easy, and gives clear results for diagnosis. That's why it's becoming more popular.

Surgery is not always required in treatment of chest tumour

The right treatment plan can only be decided once the tumor is diagnosed correctly. For 'Thymoma' tumours, surgery is the main solution. For others like lymphoma and 'Germinoma,' most can be treated with medicine. Some tumours need both chemotherapy and radiation therapy. Tubercular tumors usually respond well to anti-tuberculosis medicine. Some may need both surgery and radiation.

In special cases, a large lymphoma may need surgery. So, it's clear how important it is to diagnose tumours correctly for proper treatment. It saves patients from unnecessary surgeries and helps doctors choose the best treatment plan. So, starting treatment for chest tumours should only happen after the right diagnosis. Otherwise, it's like shooting arrows blindly without a target.

How to select a proper hospital for the surgery of chest tumours?

When it comes to surgery for a chest tumor, it's important to choose a hospital where they regularly perform heart and lung surgeries. Make sure there's a thoracic surgeon available 24/7. For major surgeries like this, having enough ventilators for post-operative care is crucial.

Also, having an experienced critical care specialist or intensivist can greatly help in the patient's recovery. Considering all these factors, it's essential to pick the right hospital.

Dr. K.K. Pandey is a Senior Thoracic & CardioVascular Surgeon at Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi.