Dr K K Pandey
Often people complain of twitching and pain in the chest wall. I am not talking about a lump or tumour in the breast of women here. I am talking about pain in the wall of the chest other than the breast.
This pain can occur in the back portion of the chest wall as well as in the side or front part of the chest. The pain increases when one coughs or sneezes. Sometimes, when you place your hand on the painful area on the chest wall, you may feel the presence of a lump. Even touching or pressing this lump causes pain. Sometimes, the lump on the chest wall is visible when you stand in front of a mirror or at least your family member may notice this lump. Then you become alert.
What is the perception about these chest wall lumps in our country?
In our country, if there is a complaint of pain and twitching in the chest wall, then people take painkillers or apply various kinds of traditional balms and ointments on the area of pain for treatment. To get rid of this pain, they even go to quacks. When they go to the doctor for advice, then it is treated by considering it as neuritis i.e., inflammation of the nerves of the chest or pain caused by inflammation in the muscles of the chest or ribs. Painkillers are given and deep breathing exercises are advised. This continues for months and one day a surprise springs when by rubbing over the painful area of the chest wall, a lump is noticed either by oneself while standing in front of a mirror or by someone else.
If there is no pain in the lump of the chest wall
If there is no pain in the lump in the chest, then in two thirds of the patients, the chances of the lump being cancerous are negligible and only one third of the people may have the possibility of cancer. These lumps mostly emerge from the ribs and from the tissues or muscles located in the chest. If the lump is soft and on pressing if it feels as if it is filled with some thick liquid, then this lump may be due to tubercular infection and may emerge prominently on the chest wall and then also cause severe pain. Some tumours of the rib are congenital or by birth. In the beginning, these tumours are of small size and grow in size very slowly. Sometimes more than one tumour emerges simultaneously in many ribs. These are called Exostosis.
Other painless chest wall tumours
Most of these are lumps emerging from the ribs. These are called ‘Chondroma’ and ‘Osteochondroma’ in medical language. This type of chest wall lump is found more in men than women. These lumps emerge from the ribs or the rib joints. If these chest wall lumps start to pain and hurt sooner or later, then one should realize that the possibility of these lumps turning into cancer has increased. And without delay, try to get these chest wall tumours removed as soon as possible by a Cardiothoracic or Thoracic surgeon i.e.,Chest surgeon. A wise thing to do is to get these rib lumps removed surgically whether they are painful or not. Because it is difficult to tell with clarity of hundred percent from the results of X-ray and biopsy tests whether there is cancer in it or not.
Rib tumours by birth
Some chest wall lumps are present in the ribs from birth. This lump or tumour may be in one rib or in many ribs. These tumours grow slowly. These are called Exostosis. Sometimes these tumours grow so big in size that the chest anatomical structurebecomes shapeless and the person standing in front can see the tumour. Often school children who have this congenital lump or protuberance on the chest wall have to face ridicule from their friends, due to which they suffer from inferiority complex and frustration. Although the chances of these tumours turning into cancer are very low, but to avoid mental frustration in school children, it is better to get the lump removed through surgery in such children.
“Desmoid Tumour”
This chest wall tumour is mostly found between 15 years and 40 years. This protuberance is not found in small children and old people. This tumour is found on the chest and shoulder. Although mostly there is no pain in the desmoid lump, but if this lump starts pressing from all sides the nerves or blood pipes going to the hand and neck, then tingling sensation and pain starts in the hand. In this case, surgery is necessary, to remove the pressure on the nerves or blood pipes. Only then can one get relief from pain. Nowadays, the compression pressure of the tumour is removed from the nerves by wide surgical resection and post operative radiotherapy may or may not be required.This is its modern treatment.
If there is pain in the tumour of the chest wall
If there is pain in the tumour of the chest wall, then the possibility of cancer is two-thirds. Among these cancerous tumours of the chest wall, the tumour called “Malignant Fibrous Histiocytoma” is found the most. This tumour is almost non-existent in children. It mostly occurs between the ages of fifty to seventy.
The second cancerous tumour is called ‘Chondrosarcoma’. It develops in the ribs.Another chest wall tumour that instead of developing from the rib, originates from the muscles inside is called “Rhabdomyosarcoma” in medical language. This tumour occurs in children and young boys. This tumour is usually not seen after the age of forty-five.
What to do?
If you have a lump in your chest wall, do not sit idle. Immediately consult an experienced Thoracic surgeon or cardiothoracic surgeon and start treatment as per their advice. Remember that the treatment of chest wall tumour in most patients is surgery. If the tumour was painless earlier but now pain has started, then assume that cancer has possibly started in it and do not delay the operation at all. Even if there is no pain, get rid of the chest walltumour by undergoing surgery, because one-third of the painless tumours may be cancerous. Always a part up to four centimetres beyond the boundary of the tumour has to be cut out, otherwise the chances of tumour growing again will increase. In summary, early identification and immediate surgery is the key to successful treatment of chest wall tumour.
(The author is Sr. Thoracic & Cardiovascular Surgeon Indraprasthan Apollo Hospital, Sarita Vihar, New Delhi)
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