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My Child Has:
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Mediastinal Cysts and Tumors
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Mediastinal cysts and tumors are benign or malignant (cancerous) masses that arise from multiple sites in an area known as the mediastinum, which is the space that separates the lungs. Tumors growing here can be particularly dangerous if they compress any of the vital structures housed in the mediastinum including:
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- the heart and its large vessels
- trachea (windpipe)
- esophagus
- thymus
- lymph nodes
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Mediastinal cysts and tumors can be benign, slow growing causing minimal symptoms or they can be aggressive and invasive, spreading to other organs and tissues, rapidly resulting in death. (A cancer cell that has spread to other organs and tissue is called "metastasis.")
The most common primary (originating in the mediastinum) mediastinal masses include neurogenic tumors (tumors that originate in the nervous system), thymomas (tumors that arise from tissue in the thymus), primary cysts, lymphoma and germ cell tumors. Malignancy seems to be somewhat relative to age. Mediastinal masses found in children who are in their first decade of life are usually benign. Greater proportions of malignant tumors are found in adolescents and adults.
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The symptoms of mediastinal cysts and tumors vary depending on the type of mass and where in the mediastinum it is growing. Some patients experience no symptoms. Generally speaking, patients with these kinds of tumors that do have symptoms may experience the following:
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- chest pain
- fever
- cough
- difficult or labored breathing (dyspnea)
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The symptoms of mediastinal cysts and tumors may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.
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Your child's doctor will want a complete medical history and will perform a physical examination. The tests used to detect these kinds of masses, which are usually a combination of blood tests, imaging tests and biopsy, may vary depending on what type of tumor or cyst is suspected. Your child may undergo a combination of the following tests:
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- complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood. Abnormal cells may indicate cancer. Variation in the normal number, size, and maturity of cells may indicate a problem.
- chest x-ray - a diagnostic test which use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs of the chest onto film. Doctors can use a chest x-ray to detect tumor cells.
- computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- biopsy of the tumor - a surgical procedure in which a sample of tissue is removed from the tumor and examined under a microscope. Biopsies may be necessary to determine whether the tumor is benign or malignant.
- Echocardiography - a procedure used to assess the heart's structures and function. A small probe called a transducer is placed on your child's chest and sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on your child's chest in certain locations and at certain angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce (or "echo") off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into an image of the heart walls and valves.
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Your child's doctor will use these tests to detect the tumor, identify the tumor, differentiate a primary mediastinal mass (a tumor that originates in the mediastinum) from a secondary mass, or mass that originated in another region of the body and spread to the mediastinum. The doctor will also want to evaluate whether the mass is compressing part of the trachea, bronchial tree, or major vessels of the heart, such as the pulmonary artery or superior vena cava. Some primary mediastinal masses produce hormones or antibodies that cause certain syndromes. The doctor will be checking for any of these as well as trying to determine whether or not it will be possible to surgically remove the tumor.
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Specific treatment for mediastinal cysts and tumors will be determined by your child's physician based on:
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- your child's age, overall health, and medical history
- extent of the disease
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
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The treatment of a mediastinal cyst or tumor varies greatly depending on what type of tumor it is and whether it is malignant or benign. Most of these tumors will be surgically removed by a pediatric surgeon. In some cases however, if the tumor is heavily involved with the spinal column for instance, it may not be possible to remove the tumor. If the tumor is malignant, a combination of chemotherapy or radiation may be used.
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Prognosis greatly depends on:
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- the extent of the disease.
- the size and location of the tumor.
- presence or absence of metastasis.
- the tumor's response to therapy.
- the age and overall health of your child.
- your child's tolerance of specific medications, procedures, or therapies.
- new developments in treatment.
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