LUNG AND MEDIASTINAL LUNG AND MEDIASTINAL CANCERCANCER
1.1. LUNG CANCERLUNG CANCER2.2. MEDIASTINAL CANCERMEDIASTINAL CANCER
AHMAD RASYIDAHMAD RASYID
Sub Bagian PulmonologiSub Bagian PulmonologiBagian Ilmu Penyakit DalamBagian Ilmu Penyakit DalamRS. Moh.Hoesin / FK UnsriRS. Moh.Hoesin / FK Unsri
1.LUNG CANCER1.LUNG CANCER
HISTOLOGICAL TYPES OF LUNG HISTOLOGICAL TYPES OF LUNG CANCERCANCER
- - SMALL CELL LUNG CANCER (SCLC) : 20% SMALL CELL LUNG CANCER (SCLC) : 20%
(OAT CELL) (OAT CELL)
- NON SMALL CELL LUNG CANCER (NSCLC) :- NON SMALL CELL LUNG CANCER (NSCLC) :
1. Squamous cell carcinoma : 40%1. Squamous cell carcinoma : 40%
2. Adenocarcinoma : 20%2. Adenocarcinoma : 20%
3. Large cell carcinoma : 15%3. Large cell carcinoma : 15%
4. Bronchioalveolar carcinoma : 5%4. Bronchioalveolar carcinoma : 5%
Kanker paru bukan sel kecil
KLASIFIKASI WHO CARCINOMA PARUKLASIFIKASI WHO CARCINOMA PARU ::
1. Ca epidermoid = Ca squamous cell 1. Ca epidermoid = Ca squamous cell = spindel cell = spindel cell
2. Ca sel kecil = Ca small cell 2. Ca sel kecil = Ca small cell
= Oat cell = intermediate cell= Oat cell = intermediate cell
3. Adeno carcinoma3. Adeno carcinoma
4. Ca sel besar = Ca giant cell 4. Ca sel besar = Ca giant cell
=clear cell=clear cell
5. Bronchioalveolar Ca5. Bronchioalveolar Ca
Indonesia (1984-1988) :Indonesia (1984-1988) :
1. Adeno Ca :1. Adeno Ca : 49,1%49,1%
2. Ca epidermoid :2. Ca epidermoid : 40,2%40,2%
3. Ca sel kecil :3. Ca sel kecil : 6,9% 6,9%
4. Ca sel besar :4. Ca sel besar : 3,8% 3,8%
I.I. Ca sel skuamosa=epidermoid CaCa sel skuamosa=epidermoid Ca
– Asal : hiperplasi sel basal epithel Asal : hiperplasi sel basal epithel bronkus bronkus → metaplasi sel squamosa→ metaplasi sel squamosa
– Lokasi : 75-90% : bronkus besar atau Lokasi : 75-90% : bronkus besar atau letaknya di sentral → shg sering letaknya di sentral → shg sering obstruksi bronkusobstruksi bronkus
– Sitologi sputum sangat membantu di Sitologi sputum sangat membantu di samping bronkoskopisamping bronkoskopi
II. II. AdenokarsinomaAdenokarsinoma
– Asal : epithel bronkusAsal : epithel bronkus– Lokasi : umumnya perifer, jarangLokasi : umumnya perifer, jarang
obstruksi bronkus.obstruksi bronkus.– Sering mrp nodule paru soliter, < 4cmSering mrp nodule paru soliter, < 4cm
III. III. Ca sel kecil :Ca sel kecil :
– Ukuran sel 6-8 mikron, banyak Ukuran sel 6-8 mikron, banyak intiinti
– Disebut juga Oat sel, bila tidakDisebut juga Oat sel, bila tidak ditemukan sitoplasmaditemukan sitoplasma– Letak : umumnya sentral, sputumLetak : umumnya sentral, sputum sitologi 90%sitologi 90%– Penyebaran : sangat cepat.Penyebaran : sangat cepat. Saat ter diagnosa, penyebaran sudahSaat ter diagnosa, penyebaran sudah jauhjauh
IV. IV. Ca cell besar :Ca cell besar :
– Asal : epithel bronkus, mikroskopisAsal : epithel bronkus, mikroskopis
mirip dg gambaran Adeno Ca atau mirip dg gambaran Adeno Ca atau
Ca epidermoidCa epidermoid– Letak : 40% sentral, 60% perifer, Letak : 40% sentral, 60% perifer,
ukuran > 4 cmukuran > 4 cm– Penyebaran/pertumbuhan sangatPenyebaran/pertumbuhan sangat
ganas melalui pemb. darah/lympheganas melalui pemb. darah/lymphe
ETHIOLOGI KARSINOMA PARU :ETHIOLOGI KARSINOMA PARU :
– Penyebab pasti tidak diketahuiPenyebab pasti tidak diketahui– Hubungan erat dengan kebiasaanHubungan erat dengan kebiasaan
merokokmerokok– Zat-zat dari pabrik/industri, Zat-zat dari pabrik/industri,
misalnya :misalnya :
nikel, asbestos, arsen, dllnikel, asbestos, arsen, dll– Industri yg menggunakan isotopIndustri yg menggunakan isotop
radioaktif, mis. uraniumradioaktif, mis. uranium
GEJALA KLINIS :GEJALA KLINIS : tergantung dari :tergantung dari :
– Lokasi tumorLokasi tumor– Invasi ke organ sekitarInvasi ke organ sekitar– Ada/tidaknya penyebaran :Ada/tidaknya penyebaran :
lymphogen, hematogenlymphogen, hematogen
Umumnya gejala dibagi :Umumnya gejala dibagi :
– Intra thorakalIntra thorakal : - intra : - intra pulmoner pulmoner
- ekstrapulmonar- ekstrapulmonar
– Ekstra thorakalEkstra thorakal : - non : - non metastasismetastasis
- metastasis- metastasis
I. Intra thorakal intra pulmoner :I. Intra thorakal intra pulmoner :
1. Batuk kering dan lama1. Batuk kering dan lama2. Batuk darah ringan (bercak2. Batuk darah ringan (bercak²)²)
3. Sesak nafas3. Sesak nafas4. Mengi/ wheezing terlokalisir4. Mengi/ wheezing terlokalisir5. Nyeri dada karena invasi ke 5. Nyeri dada karena invasi ke
pleura atau tumor menempati pleura atau tumor menempati daerah sukus superior parudaerah sukus superior paru
II. Intra thorakal extra pulmonal :II. Intra thorakal extra pulmonal : Desakan tumor ke rongga mediastinum, Desakan tumor ke rongga mediastinum,
sehingga menekan/merusak syaraf & organ yg sehingga menekan/merusak syaraf & organ yg ada di dalamnyaada di dalamnya : :
- - N. RekurensN. Rekurens : Parese/paralisis pita suara shg suara serak : Parese/paralisis pita suara shg suara serak - - N. FrenikusN. Frenikus : Parese/paralisis diafragma : Parese/paralisis diafragma - - N. Simpatis servikalisN. Simpatis servikalis : Sindroma Horner ( : Sindroma Horner (ipsilateralipsilateral miosis, ptosis, endopthalmus dan anhidrosis)miosis, ptosis, endopthalmus dan anhidrosis) -- EsofagusEsofagus : disfagia, atau asfiksia bila ada fistula : disfagia, atau asfiksia bila ada fistula bronkoesofagusbronkoesofagus - - V. Cava Superior sindromaV. Cava Superior sindroma : sesak nafas, bullneck dan : sesak nafas, bullneck dan venektasis dinding dada akibat bendungan v. cava venektasis dinding dada akibat bendungan v. cava
superiorsuperior - - Pleksus BrakialisPleksus Brakialis : nyeri pada lengan yang dipersyarafi : nyeri pada lengan yang dipersyarafi n. ulnarisn. ulnaris - - Dinding dadaDinding dada : tumor menempati sulkus superior/apeks : tumor menempati sulkus superior/apeks paru shg terjadi sindroma Pancoast (nyeri dada danparu shg terjadi sindroma Pancoast (nyeri dada dan batuk2 darah)batuk2 darah) - - Jantung – PerikardiumJantung – Perikardium : Pada efusi perikardial dapat : Pada efusi perikardial dapat mengakibatkan tamponade jantung mengakibatkan tamponade jantung
III. Ekstra torakal non metastasis :III. Ekstra torakal non metastasis :
1. Manifestasi neuromuskuler :1. Manifestasi neuromuskuler : - - Gejala berupa neuropati karsinoma : sindroma Gejala berupa neuropati karsinoma : sindroma
berupaberupa miopati, neuropati perifer, degenerasi serebelermiopati, neuropati perifer, degenerasi serebeler subakuta, ensefalomiopati dan mielopati nekrotiksubakuta, ensefalomiopati dan mielopati nekrotik
2. Manifestasi endokrin metabolik :2. Manifestasi endokrin metabolik : - - Hiperparatitiroid dengan hiperkalsimea, sekresi Hiperparatitiroid dengan hiperkalsimea, sekresi insulin dengan hipoglikemi, sindroma Cushing,insulin dengan hipoglikemi, sindroma Cushing, sindroma karsinoid, sekresi berlebihan gonadotropinsindroma karsinoid, sekresi berlebihan gonadotropin disertai ginekomastidisertai ginekomasti
3. Manifestasi jaringan ikat / tulang :3. Manifestasi jaringan ikat / tulang : - - Peningkatan kadar Growth hormon plasma ditandaiPeningkatan kadar Growth hormon plasma ditandai hipertrofi osteoartropati baruhipertrofi osteoartropati baru
4. 4. Kadang2 migratori thrombophlebitis,Kadang2 migratori thrombophlebitis, purpura & anemiapurpura & anemia
IV. Ekstra Thorakal metastasis :IV. Ekstra Thorakal metastasis :
Melalui sirkulasi arterial ke : Melalui sirkulasi arterial ke :
- Hati : - Hati : Nyeri hipokondrial dan ikterikNyeri hipokondrial dan ikterik
- Tulang- Tulang dan paralisis ektermitas bawah dan paralisis ektermitas bawah
- Otak : - Otak : pusing, sakit kepala, bingungpusing, sakit kepala, bingung
- Glandula supra renal- Glandula supra renal
DIAGNOSIS :DIAGNOSIS :
1. Sitologi sputum1. Sitologi sputum : 82,8%: 82,8%
2. Bronkhoskopi2. Bronkhoskopi
- Washing- Washing : 76% : 76%
- Brushing- Brushing : 74% : 74%
- Biopsi- Biopsi : 82% : 82%
- Kombinasi- Kombinasi : 94% : 94%
3. Aspirasi transbronkhial3. Aspirasi transbronkhial : 71% : 71%
4. Aspirasi transthorakal4. Aspirasi transthorakal : 53% : 53%
Lain-lain : - pungsi & biopsi pleuraLain-lain : - pungsi & biopsi pleura
- fluoroskopi, - fluoroskopi,
- tomografi,- tomografi,
- mediastinoskopi, - mediastinoskopi,
- CT scan, MRI,- CT scan, MRI,
- torakoskopi - torakoskopi
Diagnosis kanker paru (rontgen)
Bayangan padat (putih) pada bagian paru yang terkena
Diagnosis kanker paru (CT Scan)
Diagnosis kanker paru (bronkoskopi)
Bronkoskopi
STAGING SYSTEM OF LUNG CANCER :STAGING SYSTEM OF LUNG CANCER :
T : PRIMARY TUMORT : PRIMARY TUMOR
T1 T1 : Tumor 3 cm or less : Tumor 3 cm or less T2T2 : Tumor > 3,0 cm : Tumor > 3,0 cm T3 T3 : Tumor any size, location ≤2 cm : Tumor any size, location ≤2 cm
distal carina, no pleural effusiondistal carina, no pleural effusion T4T4 : Tumor any size, extension into : : Tumor any size, extension into :
- chest wall,- chest wall, - mediastinum,- mediastinum, - diafragma, - diafragma, - pleura, pleural effusion- pleura, pleural effusion
The trachea (wind pipe) – The trachea (wind pipe) – Cont.Cont.
N : NODAL INVOLVEMENTN : NODAL INVOLVEMENT
N0N0 : No metastasis to regional : No metastasis to regional limonudilimonudi N1 N1 : Metastasis Limfonudi : : Metastasis Limfonudi : - peribronchial,- peribronchial, - ipsilateral hilar region,- ipsilateral hilar region, - both- both N2N2 : Metastasis Limfonudi : : Metastasis Limfonudi : - ipsilateral mediastinal- ipsilateral mediastinal - subcarinal- subcarinal
N3N3 : Metastasis Limfonudi : : Metastasis Limfonudi :
- contralateral mediastinal,- contralateral mediastinal,
- contralateral hilar,- contralateral hilar,
- ipsilateral or contralateral - ipsilateral or contralateral
scalene or supraclavicularscalene or supraclavicular
M : DISTANT METASTASISM : DISTANT METASTASIS
M0M0 : No distant metastasis : No distant metastasis M1 M1 : Distant metastasis present: Distant metastasis present liver, bone, brain, etcliver, bone, brain, etc
STAGE = STADIUM :STAGE = STADIUM : II : T1 N0 M0, or T2 N0 M0: T1 N0 M0, or T2 N0 M0 II II : T1 N1 M0, or T2 N1 M0: T1 N1 M0, or T2 N1 M0 III aIII a : T 1,2,3 N2 M0: T 1,2,3 N2 M0 III bIII b : T4 any N M0, or any T N3 M0: T4 any N M0, or any T N3 M0 IV IV : any T any N M1: any T any N M1
PENATALAKSANAAN :PENATALAKSANAAN :
Terdiri dari :Terdiri dari :
- Operasi- Operasi
- Radioterapi- Radioterapi
- Kemoterapi- Kemoterapi
Pengobatan• Paliatip
• Kuratif
Bedah Radiasi Kemoterapi Imunoterapi
• Tergantung staging dan tipe kanker
OperasiOperasi
Ca epidermoid (NSCLC) Stad. I, II, IIIACa epidermoid (NSCLC) Stad. I, II, IIIA
AdenocarcinomaAdenocarcinoma
Ca Sel besarCa Sel besar
Ca Sel kecil : - ganas, metastasis >Ca Sel kecil : - ganas, metastasis >
- jarang operasi- jarang operasi
- sensitif : sitostatika- sensitif : sitostatika
radioterapiradioterapi
RadiotherapyRadiotherapyDefinitif/kuratifDefinitif/kuratif
PaliatifPaliatif
Umumnya Ca yang terdiagnose Umumnya Ca yang terdiagnose sudah stadium lanjut sudah stadium lanjut → > 75% → > 75% perlu radioterapiperlu radioterapi
Indikasi RadioterapiIndikasi Radioterapi
I. Berdasarkan I. Berdasarkan sifat radioterapisifat radioterapi
I.a Definitif:I.a Definitif:Ca operable, tapi toleransi operasi Ca operable, tapi toleransi operasi sangat rendahsangat rendahTumor primer, KGB hilus, KGB Tumor primer, KGB hilus, KGB mediastinummediastinum
I.b Paliatif:I.b Paliatif:MeningkatkanMeningkatkan kualitas hidupkualitas hidupTumor primer sajaTumor primer saja
KemoterapiKemoterapiPilihan pada yang sudah alami Pilihan pada yang sudah alami metastasismetastasis
Bukan sel kecil : Bukan sel kecil : – Stadium III lanjut atau menyebarStadium III lanjut atau menyebar– Segera/bersama-sama dengan Segera/bersama-sama dengan
radioterapi atau operasiradioterapi atau operasi
Ca sel kecil : terapi utama selain Ca sel kecil : terapi utama selain radioterapiradioterapi
PrognosisPrognosis Tergantung dari :Tergantung dari :
1. Derajat / staging = stadium1. Derajat / staging = stadium
2. Tampilan umum /2. Tampilan umum /
performance statusperformance status
Performance Status Performance Status berdasarkan berdasarkan Skala KarnofskySkala Karnofsky
Skala 90-100% : Aktivitas normalSkala 90-100% : Aktivitas normal
Skala 70-80% : Ada keluhan umum, tapiSkala 70-80% : Ada keluhan umum, tapi
cukup aktif mengurus diricukup aktif mengurus diri
sendirisendiri
Skala 50-60% : Umumnya aktif, hanyaSkala 50-60% : Umumnya aktif, hanya
sesekali butuh bantuansesekali butuh bantuan
Skala 30-40% : Tidak aktif, perlu banyak Skala 30-40% : Tidak aktif, perlu banyak bantuan bantuan
Skala 10-20% : Sangat lemah, tidak dapat Skala 10-20% : Sangat lemah, tidak dapat meninggalkan tempat meninggalkan tempat
tidur,tidur,
total perlu bantuan orang.total perlu bantuan orang.
NSCLCNSCLCStage I Stage I : Surgical : Surgical resectionresectionStage II Stage II
Stage IIIa : RadioterapiStage IIIa : Radioterapi
Stage IIIbStage IIIb : Radioterapi dan : Radioterapi dan & Stage IV kemoterapi& Stage IV kemoterapi
Survival times NSCLCSurvival times NSCLCThe five years survival by the stagingThe five years survival by the staging
Squamous cellSquamous cell
Stage I : 55%Stage I : 55%
Stage II : 35%Stage II : 35%
Stage IIIa : 15%Stage IIIa : 15%
Stage IIIb : 0%Stage IIIb : 0%
Stage IV : 0%Stage IV : 0%
AdenocarcinomaAdenocarcinoma
Stage I : 45%Stage I : 45%
Stage II : 23%Stage II : 23%
Stage IIIa : 8%Stage IIIa : 8%
Stage IIIb : 0%Stage IIIb : 0%
Stage IV : 0%Stage IV : 0%
Survival times SCLCSurvival times SCLCLimited disease Limited disease → 15 months→ 15 months
Extensive disease → 8 monthsExtensive disease → 8 months
More than 2 years → 13%More than 2 years → 13%
Mayor causes of deaths → 2-5 yearsMayor causes of deaths → 2-5 years
2. 2. MEDIASTINALMEDIASTINALCANCERCANCER
MEDIASTINAL TUMORSMEDIASTINAL TUMORS
MediastinumMediastinum: Region between the : Region between the pleural sacspleural sacs
Tumors arise from anterior, middle & Tumors arise from anterior, middle & posterior compartmentsposterior compartments
ExtentExtentAnteriorAnterior – between sternum – between sternum anteriorly to pericardium & anteriorly to pericardium & brachiocephalic vessels posteriorlybrachiocephalic vessels posteriorly
MiddleMiddle - between the anterior & - between the anterior & posterior compartmentsposterior compartments
PosteriorPosterior - pericardium & trachea - pericardium & trachea anteriorly, to vertebral column anteriorly, to vertebral column posteriorlyposteriorly
BOUNDARIES OF BOUNDARIES OF MEDIASTINUMMEDIASTINUM
AnteriorAnterior - sternum - sternum
Posterior Posterior - Vertebral Column- Vertebral Column
SuperiorSuperior - Thoracic inlet - Thoracic inlet
InferiorInferior - Diaphragm - Diaphragm
** ** MediastinumMediastinum is connected to is connected to neck & retroperitoneum allowing neck & retroperitoneum allowing spread of air & infectionspread of air & infection
ANTERIOR MEDIASTINUM-ANTERIOR MEDIASTINUM-CONTENTSCONTENTS
ThymusThymus
Anterior mediastinal lymph nodesAnterior mediastinal lymph nodes
Internal mammary A & VInternal mammary A & V
Pericardial fatPericardial fat
MIDDLE MEDIASTINUM- MIDDLE MEDIASTINUM- CONTENTSCONTENTS
Heart & Pericardium, ascending Heart & Pericardium, ascending aorta & arch of aorta, vena cavae, aorta & arch of aorta, vena cavae, brachiocephalic A &V ,brachiocephalic A &V ,
Phrenic nervePhrenic nerve
Trachea, main stem bronchi & Trachea, main stem bronchi & contiguous lymph nodescontiguous lymph nodes
Pulmonary A & VPulmonary A & V
POSTEIOR MEDIASTINUM-POSTEIOR MEDIASTINUM-CONTENTSCONTENTS
Descending thoracic aortaDescending thoracic aorta
EsophagusEsophagus
Thoracic ductThoracic duct
Azygos & hemiazygos veinAzygos & hemiazygos vein
Posterior group of mediastinal Posterior group of mediastinal nodesnodes
Sympathetic trunk & intercostal Sympathetic trunk & intercostal nervesnerves
CLASSIFICATIONCLASSIFICATION
DevelopmentalDevelopmental
NeoplasticNeoplastic
InfectiousInfectious
TraumaticTraumatic
Cardiovascular disordersCardiovascular disorders
ANTERIOR MEDIASTINAL ANTERIOR MEDIASTINAL MASSESMASSES
ThymomaThymoma
TeratomaTeratoma
ThyromegalyThyromegaly
LymphomaLymphoma
Lipoma, Fibroma - rareLipoma, Fibroma - rare
MIDDLE MEDIASTINAL MIDDLE MEDIASTINAL MASSESMASSES
Aneurysms - aorta, innominate artery, Aneurysms - aorta, innominate artery, enlarged pulmonary arteryenlarged pulmonary artery
Lymphadenopathy secondary to Lymphadenopathy secondary to carcinoma / metastasis / carcinoma / metastasis / granulomatosisgranulomatosis
Cysts - enteric, bronchogenic, Cysts - enteric, bronchogenic, pleuropericardialpleuropericardial
Dilated azygos, hemiazygos veinsDilated azygos, hemiazygos veins
Hernia of Foramen of MorgagniHernia of Foramen of Morgagni
POSTERIOR MEDIASTINAL POSTERIOR MEDIASTINAL MASSESMASSES
Neurogenic tumorsNeurogenic tumors
Meningo-myelocele, meningoceleMeningo-myelocele, meningocele
Esophageal - tumor, cyst, diverticulaEsophageal - tumor, cyst, diverticula
Hiatus herniaHiatus hernia
Hernia of Foramen of BochdalekHernia of Foramen of Bochdalek
Thoracic spine disease,Thoracic spine disease,
Extramedullary hematopoiesisExtramedullary hematopoiesis
POSTERIOR MEDIASTINAL POSTERIOR MEDIASTINAL NEUROGENIC TUMORSNEUROGENIC TUMORS
NeurilemmomaNeurilemmoma
NeurofibromaNeurofibroma
NeurosarcomaNeurosarcoma
GanglioneuromaGanglioneuroma
PhaeochromocytomaPhaeochromocytoma
CLINICAL FEATURESCLINICAL FEATURES
Nospecific-> mass effect on Nospecific-> mass effect on sorrounding structuressorrounding structures
Insidious onset of retrosternal Insidious onset of retrosternal chest pain, dyspnea , dysphagiachest pain, dyspnea , dysphagia
50% are asypmtomatic50% are asypmtomatic
Mass detected on CXRMass detected on CXR
Physical findings depend on nature Physical findings depend on nature & location of mass& location of mass
COMMON SYMPTOM OF MEDIASTINALTUMORCOMMON SYMPTOM OF MEDIASTINALTUMOR
Superior vena cava syndromeSuperior vena cava syndrome : cause by : cause by obstruction of superior vena cavaobstruction of superior vena cavaDysphagiaDysphagia : cause by compression of : cause by compression of esophagusesophagusDyspnoe, coughDyspnoe, cough : cause by compression of : cause by compression of tracheobronchial treetracheobronchial treeHoarsenessHoarseness : cause by laryngeal nerve : cause by laryngeal nerve paralysisparalysisHorner’s syndromeHorner’s syndrome (ipsilateral miosis, ptosis,(ipsilateral miosis, ptosis, an/hypohidrosis)an/hypohidrosis) : Cause by compression of : Cause by compression of stellate ganglion/symphatetic pathwaystellate ganglion/symphatetic pathwayWeakness/myasthenia gravisWeakness/myasthenia gravis : cause by : cause by thymomathymomaChest painChest pain : cause by chest wall/neural : cause by chest wall/neural invasioninvasion
NEUROGENIC TUMORSNEUROGENIC TUMORS
Can be ASYPMTOMATICCan be ASYPMTOMATIC
Cord compression, Cord compression,
Chest pain, dyspnea, hoarse Chest pain, dyspnea, hoarse voicevoice
Horner’s syndrome - unusualHorner’s syndrome - unusual
DIAGNOSTIC APPROACHDIAGNOSTIC APPROACHImagingImaging : CT, MRI, Radionuclide : CT, MRI, Radionuclide study,study,
Tissue samplingTissue sampling : Mediastinoscopy, : Mediastinoscopy, Thoracoscopy, Needle aspiration, Thoracoscopy, Needle aspiration, Open BiopsyOpen Biopsy
Barium study for hernia, achalasia, Barium study for hernia, achalasia, diverticuladiverticula
I-131 for intrathoracic goiterI-131 for intrathoracic goiter
DIAGNOSTIC APPROACHDIAGNOSTIC APPROACH
Mediastinoscopy or Mediastinoscopy or anterior mediastinotomy can anterior mediastinotomy can definitively diagnose anterior & definitively diagnose anterior & middle mediastinal massesmiddle mediastinal masses
Video assisted thoracoscopy (VAT) Video assisted thoracoscopy (VAT) plays an important role in diagnosisplays an important role in diagnosis
TREATMENT & TREATMENT & PROGNOSISPROGNOSIS
Dictated by the Dictated by the etio-pathologyetio-pathology of of the massthe mass
TREATMENTTREATMENTResectionResection by Thoracotomy or by Thoracotomy or Video Assisted Video Assisted Thoracoscopic Surgery (VATS)Thoracoscopic Surgery (VATS)
Post-op Post-op radiationradiation for malignant for malignant tumorstumors
REFERENCESREFERENCESFishman’s - Pulmonary Diseases & Disorders, 3rd Fishman’s - Pulmonary Diseases & Disorders, 3rd ed, Ch. 96, Acquired lesions of Mediastinum- ed, Ch. 96, Acquired lesions of Mediastinum- benign & malignant, John R Roberts, Larry R benign & malignant, John R Roberts, Larry R Kaiser, p 1509-1536Kaiser, p 1509-1536
Manual of Clinical Problems in Pulmonary Manual of Clinical Problems in Pulmonary Medicine, 4th ed, 101, Mediastinal masses, Medicine, 4th ed, 101, Mediastinal masses, Stephen P Bradley, p 482-484Stephen P Bradley, p 482-484
Comprehensive Respiratory Medicine, R Albert, Comprehensive Respiratory Medicine, R Albert, S Spiro, J Jett, Sec 18, ch 74. 1-10, Disorders of S Spiro, J Jett, Sec 18, ch 74. 1-10, Disorders of MediastinumMediastinum