Tumors of the chest wall

Primary tumors of the chest wall are uncommon but should be considered in the evaluation of patients with persistent chest wall pain or the presence of a chest wall mass, especially when this is near the costal cartilages. Special radiographic techniques may help to define the diagnostic possibilities and the extent of local involvement. Since at least half of the primary rib tumors and virtually all of the sternal tumors are malignant, these problems demand prompt investigation, accurate tissue diagnosis, and, usually, generous surgical excision. With appropriate attention to skin, soft tissue, and skeletal involvement, resection of major chest wall tumors can be done safely, and there are a variety of reconstructive techniques available to deal with the resulting defects. Radiotherapy has little role in the treatment of chest wall tumors except for the myeloproliferative disorders and possibly some cases of Ewing's sarcoma. Chemotherapy has similarly been ineffective for the cartilaginous tumors but shows some promise in the multidisciplinary approach to osteogenic sarcoma. Surgical resection, however, remains the mainstay for the treatment of most tumors of the chest wall. Even in instances of recurrent disease there are many whose long-term survival has been achieved by multiple operative procedures.