Neurogenic tumors originate from cells that make up the nervous system. They are the most common tumors of the mediastinum (the region between the lungs). Neurogenic tumors are commonly found in the posterior mediastinum, also known as paravertebral, the back of the spine. In most adults, neurogenic tumors do not cause noticeable symptoms and are usually detected on routine chest X-rays or, incidentally, on an MRI or CT scan done for other reasons. While these tumors are typically benign in adults and can be followed with serial imaging, they may become larger in size, causing problems with the lungs, bones and spinal column. In these cases, the lesions can be treated successfully with surgery. The most common neurogenic tumors are benign schwannomas and neurofibromas.
The Lung Center at Brigham and Women’s Hospital (BWH) uses the most current diagnostic methods and proven treatments for patients with neurogenic tumors of the mediastinum, including minimally invasive surgical techniques aided by video technology. We are the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.
Most adults with neurogenic tumors of the mediastinum do not experience any symptoms. When symptoms do occur, however, they result from compression of the surrounding structures caused by the growing tumor. Symptoms include:
- Breathing problems
- Chest pain or fullness in the chest
- Night sweats
- Unexplained weight loss
- Lymphadenopathy (swollen or tender lymph nodes)
- Change in bowel or bladder habits
- Trouble walking
The Lung Center’s thoracic surgeons are experienced in the most modern, safe and minimally invasive biopsy techniques to identify neurogenic tumors. They will specifically provide the highest quality diagnostic material to establish a definitive diagnosis.
Your BWH thoracic surgeon may conduct the following tests and procedures to diagnose neurogenic tumors:
- Physical exam and Medical history
- Chest X-ray, a type of energy beam that goes through the body and onto film, making a picture of areas inside the body.
- CT scan, a series of detailed pictures inside the body, taken from different angles by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
- Magnetic Resonance Imaging (MRI), a diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. It is particularly useful in imaging the bones of the spine.
- Biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to make a diagnosis. This is often done using CT-scan to guide the biopsy needle into the target lesion.
- Fine needle aspiration (FNA) biopsy: The removal of small pieces of tumor using a thin needle and syringe.
- Excisional biopsy: The removal of an entire lump of tissue.
- Incisional biopsy: The removal of part of a lump or sample of tissue.
- Core biopsy: The removal of tissue using a wide needle.
- Pulmonary Function Tests (PFT) provide measurable feedback about the function of the lungs.
Options vary depending upon the size and location, but most often surgical removal is the recommended treatment for neurogenic tumors.
Although a traditional surgical approach is still needed for many complex thoracic cases, an increasing number of diagnostic and surgical procedures can now be approached through smaller incisions and by using less invasive techniques aided by video technology. These procedures have been found to be accurate, efficient, cost-effective, and safe through years of technological development and experience.
- Video-Assisted Thoracic Surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (a tiny camera) and surgical instruments into incisions in the chest. VATS uses small incisions without any spreading of the ribs. A camera is used to assist the dissection of sensitive blood vessels and mediastinum masses. Less pain and quicker recovery are the goals. The majority of neurogenic tumors can be removed using this technology. Occasionally robotic instruments can assist in this type of surgery.
- Mediastinal tumor resection removes a tumor in the mediastinum.
- Median Sternotomy: The chest cavity is accessed through an incision on the side, back or between the ribs. Although open operations are frequently performed in the community, BWH thoracic surgeons usually do this procedure telescopically or with VATS.
Non-Surgical Cancer Treatments
Surgery for malignant neurogenic mediastinal tumors are typically used in combination with other treatments, including:
- Radiation therapy uses high-energy rays to kill or shrink cancer cells. Radiation is often used in conjunction with chemotherapy before surgery to shrink the tumor or after to treat the margin of the resection bed. The Radiation Oncology service at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) uses the most advanced equipment and techniques to deliver radiation to cancerous areas, while minimizing exposure to normal tissues.
- Chemotherapy Chemotherapy at DF/BWCC uses anticancer drugs to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery or alone in the most advanced cases. When used before surgery, the purpose is to shrink the tumor so it can be surgically removed.
When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. You will receive a thorough diagnostic examination and receive clinically-proven treatment by a board-certified thoracic surgeon with expertise in neurogenic tumors. Sometimes these tumors can enter the spinal cord and a neurosurgeon will join the surgical team. Our goal is to alleviate or eliminate symptoms so patients can confidently resume everyday activities.
Neurogenic tumor patients benefit from the wide range of specialists at The Lung Center. Any surgery recommended will be performed by an experienced, board-certified surgeon, in collaboration with a treatment team including neuro-spine surgeons, oncologists, radiation oncologists, anesthesiologists, radiologists and pathologists, as well as nurses and physician assistants, all of whom specialize in taking care of patients with lymphoma.
Go to our online health library to learn more about thoracic diseases and tests.
Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.
This page was last modified on 6/23/2016