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Tumor mediastinal

Definición

Los tumores mediastinales son masas o neoplasias que se forman en el mediastino, una zona en la mitad del tórax que separa los pulmones.

Causas

El mediastino es la parte del tórax que está entre el esternón y la columna vertebral, y entre los pulmones. Esta zona contiene el corazón, los vasos sanguíneos grandes, la tráquea, el timo, el esófago y tejidos conectivos. El mediastino se divide en tres secciones:

• Anterior (frontal)
• Media
• Posterior (atrás)

Los tumores del mediastino son poco frecuentes.

La ubicación común para los tumores del mediastino depende de la edad de la persona. En los niños, dichos tumores son más comunes en el mediastino posterior. Estos tumores con frecuencia comienzan en los nervios y no son cancerosos (benignos).

La mayoría de estos tumores en los adultos ocurre en el mediastino anterior. Generalmente son linfomas, tumores de las células germinativas o timomas cancerosos (malignos). Estos tumores son más frecuentes en personas de mediana edad y adultos mayores.

Síntomas

Casi la mitad de los tumores mediastinales no presentan síntomas y se detectan en una radiografía del tórax que se realiza por otra razón. Los síntomas que se presentan realmente se deben a presión (compresión) de las estructuras locales y pueden incluir:

• Dolor torácico
• Fiebre y escalofríos
• Tos
• Tos con sangre (hemoptisis)
• Ronquera
• Sudores fríos
• Dificultad para respirar

Pruebas y exámenes

Una historia clínica y el examen físico pueden mostrar:

• Fiebre
• Ruidos respiratorios chillones (estridor)
• Inflamación o sensibilidad de los ganglios linfáticos (linfadenopatía)
• Pérdida involuntaria de peso
• Sibilancias

Los exámenes adicionales que se pueden hacer incluyen:

• Radiografías de tórax
• Biopsia con aguja guiada por tomografía computarizada
• TC del tórax
• Mediastinoscopia con biopsia
• RM del tórax

Tratamiento

El tratamiento para los tumores mediastinales depende del tipo de tumor y de los síntomas:

• Los cánceres del timo se tratan con cirugía. Puede ir seguida de radiación o quimioterapia, dependiendo de la etapa del tumor y del éxito de la cirugía.
• Los tumores de las células germinativas generalmente se tratan con quimioterapia.
• Para los linfomas, el tratamiento preferido es la quimioterapia y posiblemente seguida de radiación.
• La cirugía es el principal tratamiento para los tumores neurogénicos del mediastino posterior.

Expectativas (pronóstico)

El desenlace clínico depende del tipo de tumor. Los diferentes tumores reaccionan de manera distinta a los tratamientos de radio y quimioterapia.

Posibles complicaciones

Entre las complicaciones de los tumores mediastinales están:

• Compresión de la médula espinal
• Diseminación a estructuras circundantes como el corazón, el revestimiento alrededor del corazón (pericardio) y los grandes vasos (la aorta y la vena cava)

La cirugía, la radioterapia y la quimioterapia pueden ocasionar complicaciones serias.

Cuándo contactar a un profesional médico

Comuníquese con el médico si nota síntomas de un tumor mediastinal.

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