How do they know Tumor Close To Chest Wall before surgery?

Posted by srobinet @srobinet, Feb 8 9:36pm

My radiologist did not mention this in his report but my oncologist told me that my tumor is close to the chest wall. He said he does not think it's actually in the chest wall. How can they tell for sure before surgery? Would they need to do more tests or do they just go ahead with surgery and access the situation once they get to the tumor?

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dolphina3 | @dolphina3 | Feb 9 7:30am

Hi,

My tumor was 2 inches from my chest wall..My surgeon told me,and after masectomy had to do radiation because of tumor size and close to tumor wall.
They can tell some things from the MRI and cat scan.
Thinking of you and sending hugs.

mcchesney | @kathleen1314 | Feb 9 8:02am

Oncologists use a combination of imaging and, sometimes guided biopsies to determine if a tumor is invading the chest wall before and during surgery.
While a CT scan can show proximity, other tests are often used to confirm the absence of invasion, but frequently the final assessment is completed during the surgery itself. I think that many surgeons know that they will have to make that determination during surgery and will wait because of this on any other tests until surgery.

But...
If a CT scan shows the tumor is close to the chest wall, these presurgery tests may provide more detail:
MRI : Often considered the best tool for visualizing soft-tissue involvement because it provides contrast to determine if the tumor is actually touching or invading the muscle or ribs.
PET/CT Scan: Used to determine if the area of contact is cancerous or just inflammation.
Dynamic Cine-MRI: A specialized MRI that watches the tumor while you breathe to see if it moves freely against the chest wall or if it is fixed to the cell wall, which would indicate invasion. I find this one the most interesting, but have seldom heard of anyone having it.
A guided biopsy can also be used presurgery to determine if the tumor is in the chest wall. Most surgeons seem to prefer to not do this if surgery seems likely, because they will probably have to redo it during surgery anyway.

Surgery options:
1. the surgeon may decide to take a frozen analysis while you are under anesthesia. A pathologist will then analyze and can tell if the chest wall is involved.
2. Manual manipulation.....the surgeon can physically see and even feel whether the turmor is stuck to the chest wall. Think Dr. Pimple Popper, when she uses her fingers to manipulate a mass to make sure that it is not stuck to any muscles etc. Yes, I am a watcher, ha.

mistymar | @mistymar | Feb 9 12:45pm

Even knowing where it was from mammogram, surgeon couldn’t feel my tumor. MRI showed it close to chest wall but not involving chest wall. Did lumpectomy and luckily at a hospital with in surgery path so got clean margins. My problem now is that they can’t get the surgery marker on the mammograms so I get US with each mammogram to evaluate the area. Only other problem was with radiation because it was medial left side so did extra positioning to avoid heart.

srobinet | @srobinet | Feb 11 11:39pm

It seems to make sense that the surgeon just waits until they are doing the Mastectomy surgery to determine if chest wall involved. It concerns me but maybe it's not that close. The tumor is deep and small. The surgeon could not feel it and neither can I. Hoping for the best my surgery is 3/10/26. Thanks for taking the time to reach out.