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Conditions and Diseases

Dartmouth-Hitchcock Medical Center (DHMC) thoracic surgeons provide diagnosis and surgical treatment of diseases that occur in the chest including the lungs, esophagus, trachea, chest wall and mediastinum (including the thymus):

Lung cancer

Lung cancer can present without symptoms, and often is detected on a screening CT scan or x-ray. Some people may have a chronic cough, begin to cough up blood (hemoptysis) or experience recurrent pneumonias.

There are two main types of lung cancer based on the kind of cells in which the cancer begins: non-small cell lung cancer, which is more common, and small cell lung cancer.

Non-small cell lung cancer

Non-small cell lung cancer develops in the epithelial cells that line the lungs. There are several types of non-small cell lung cancer, each which grows and spreads in different ways:

  • Adenocarcinoma forms in epithelial cells associated with glands, and begins in the cells that line the alveoli, the tiny air sacs where oxygen and carbon dioxide are exchanged.
  • Squamous cell carcinoma forms in cells that line the lungs, beginning in the bronchial tubes, which lead from the trachea (windpipe) to the lungs.
  • Carcinoid tumors in the lungs are rare and slow-growing cancers. "Typical" carcinoid tumors rarely spread beyond the lungs. "Atypical carcinoids" are very rare and more likely to spread to other organs.

Small cell lung cancer

Small cell lung cancer begins in neuroendocrine cells in lung tissue, and usually spreads to surrounding lymph nodes and other parts of the body.

Esophageal cancer

Most people experience pain and/or difficulty in swallowing as the initial sign of esophageal cancer. The two most common forms of esophageal cancer are squamous cell carcinoma and adenocarcinoma.

  • Adenocarcinoma begins in glandular cells that line the esophagus, usually forming in the lower part of the esophagus near the stomach. Adenocarcinomas are the more common type of esophageal cancer, and are often seen in people with longstanding gastroesophageal reflux disease (GERD) and Barrett's disease.
  • Squamous cell carcinoma begins in the cells that line the esophagus, most often in the upper and middle part of the esophagus.

Tracheal disease

Nonspecific signs of malignant tracheal disease include cough, hemoptysis (coughing blood), and wheezing, and are difficult to distinguish from COPD and benign tracheal disease. It can be treated surgically.

  • Squamous cell carcinoma is a fast-growing tumor that often breaks through the wall of the windpipe.
  • Adenoid cystic carcinoma (ACC) is a slow-growing tumor that usually stays within the windpipe but can eventually close it off completely.

Tracheal stenosis

Surgical options in the treatment of tracheal stenosis include:

  • Tracheal resection and reconstruction, in which the constricted section of the trachea is removed and the remaining upper and lower sections reconnected.
  • Bronchoscopic dilation and spray cryotherapy to open the stenosis, although this is not always a permanent fix.

Tracheal papillomatosis

Adults with recurrent respiratory papillomatosis (RRP) may undergo one or more bronchoscopic treatments with laser and/or spray cryotherapy to control and potentially cure the condition.

Paraesophageal and hiatal hernias

Hiatal hernias occur when parts of the stomach push through the diaphragm and into the chest, and are often seen in patients with GERD. Hiatal hernias are commonly repaired through a surgery that places the stomach back into the abdomen and repairs the diaphragm.

We often use a minimally invasive approach such as robotic-assisted laparoscopy. In cases of large, paraesophageal hernias, surgery to repair the hernia is often paired with anti-reflux surgery (fundoplication).

GERD and Barrett's disease

Gastroesophageal reflux disease (GERD) is a chronic condition in which the contents of the stomach backflow into the esophagus, causing heartburn and regurgitation. Overtime, changes in the esophagus can lead to Barrett's disease and in some cases, esophageal cancer (adenocarcinoma).

Patients with GERD that does not respond to medication may choose to have anti-reflux surgery (fundoplication). This surgery strengthens the valve between the esophagus and stomach to minimize the backup of stomach acid into the esophagus. The procedure is usually done using a minimally invasive or robotic approach through the abdomen or chest.

Barrett's esophagus is a condition in which the normal lining of the esophagus - the tube that carries food from your mouth to your stomach - is replaced with a lining similar to that of the stomach. Although Barrett's esophagus causes no symptoms on its own, it increases a person's chances of getting a rare type of cancer of the esophagus called esophageal adenocarcinoma.

Ablation of Barrett's disease uses a laser or heat to destroy abnormal cells lining the esophagus, which allows the normal lining to regrow. This procedure uses an endoscope, a thin, flexible tube with a tiny video camera and light that is inserted through the mouth and into the esophagus. Sometimes Barrett's disease needs to be treated with anti-reflux procedures.

Mediastinal tumors

The mediastinum is the center part of the chest outside of the lungs, heart and large blood vessels. The mediastinum contains fatty and connective tissue, lymph nodes and the thymus, a small organ that is part of the immune system. Diseases in the mediastinum that may be treated with surgery include:

  • Thymomas form on the outside of the thymus, grow slowly and usually remain localized and thus treatable through surgery.
  • Thymic carcinomas are rare tumors of the thymus that are more likely to spread and recur.
  • Myasthenia gravis is an autoimmune disease that affects the connection between nerves and muscles, and causes weakness in certain muscles especially in the eyes, mouth, throat and limbs. Surgical removal of the thymus can help manage myasthenia gravis symptoms. A minimally invasive approach called RVATS thymectomy helps to minimize complications in these patients, whose weakened muscles can make them more susceptible to complications after surgery.

Pleural diseases

Pleura are thin sheets of tissue (membranes) that line the inside of the chest cavity and outside of the lungs. This creates a potential space between the lung and chest wall where fluid can accumulate due to either benign or malignant cancers such as mesothelioma and metastatic disease.

  • Malignant mesothelioma is a rare disease in which cancer cells form in the pleura, the thin layer of tissue that lines the chest cavity, abdomen and outside of the lungs. This is often caused by asbestos exposure and smoking.
  • Metastatic pleural tumors are cancers that began in other organs in the body and have spread to the pleura.

Traumatic rib fractures

In cases of multiple rib fractures and flail chest, "plating" of the ribs in surgery can help to control pain, support respiratory function, and stabilize the chest wall for faster healing. Rib plating and fixation, and pleural space drainage when necessary, can help to control pain, support respiratory function and stabilize the chest wall for faster healing of complex rib fractures.

Hyperhidrosis

Hyperhidrosis is a condition that causes excessive sweating, usually in the hands, underarms and face, but without the usual triggers such as exercise or stress. A surgical procedure called a sympathotomy can be an option for some patients who suffer from excessive sweating. In a sympathotomy, the sympathetic nerve is cut in particular places to control the sweating reaction in the body. The sympathotomy is conducted via a minimally invasive approach, often as an outpatient procedure.


Page reviewed on: Jun 26, 2015

Page reviewed by: Dr. David J. Finley

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