Mesothelioma info

Because mesothelioma is most often diagnosed in its later stages, any type of curative surgery for the disease is usually not an option. However, as scientists invent methods that may help detect the disease during its earlier stages, such curative surgeries may become an option sometime in the near future.

For now, surgeries associated with mesothelioma are usually done for palliative purposes; that is, to relieve the unpleasant symptoms of the disease, such as pain, shortness of breath, coughing, and other problems that infringe on the quality of life of most meso patients. In some instances, these procedures may also prolong the life of the patient, even though they offer no cure.

Diagnostic Procedures

As previously mentioned in the “Symptoms” section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Palliative Procedures

Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.

Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung’s expansion is restricted by disease.

Potentially Curative Surgical Options

These procedures are performed with “curative intent”. Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.

A number of surgical procedures have been recommended for mesothelioma patients. Some are quite simple and may be performed more than once, while others are quite drastic and are done as a last resort. Your doctor will determine which procedures may be appropriate for your treatment, usually in order to help you remain more comfortable as your disease runs its course. Here are the most common types of surgery suggested for a mesothelioma victim:

Thoracentesis - This is probably the most frequent surgical procedure performed on mesothelioma patients. Thoracentesis involves the aspiration of fluid from the area around the lungs. The removal of the fluid can make the patient more comfortable and temporarily relieve symptoms of the disease, such as chest pain or shortness of breath. Thoracentesis is generally done on an outpatient basis but may be done in the hospital if the patient is considered high risk or if the procedure is done in conjunction with another procedure. Pericardial and peritoneal mesothelioma can also be addressed with a similar procedure, which drains fluid from either the sac around the abdomen or the heart, depending on the type of mesothelioma.

Pleurodesis - This procedure involves the injection of talc or other chemicals into the chest cavity, which causes scarring and prevents fluid from returning. The American Cancer Society reports that this procedure has about a 90% success rate and that it will eliminate or significantly reduce the build-up of fluid at least temporarily in a majority of patients. Because this is a surgical procedure that requires anesthesia, a short hospital stay is in order.

Pleurectomy - A more complicated surgical procedure, the pleurectomy involves removal of the pleura - the lining of the lung - where the tumor is located. Also a palliative procedure, this surgery can prevent fluid build-up, therefore improving breathing and relieving pain. This procedure is also known as decortication.

Extrapleural Pneumonectomy - By far the most extensive surgical procedure and offered to just a handful of mesothelioma patients, the extrapleural pneumonectomy involves the surgical removal of the pleura lining the chest wall, diaphragm, pericardium, and the whole lung on the side of the tumor. The diaphragm and the pericardium are then reconstructed with prosthetic material. Only individuals who have localized mesothelioma of the epithelioid type are candidates for this surgery, which is usually not performed unless the doctor believes there is some chance for cure. Those for whom the surgery is recommended must be in overall good health and able to withstand a major operation with a long recovery period. Only a handful of doctors perform this surgery so travel to a major medical center may be necessary in order to proceed with an extrapleural pneumonectomy.

Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient=s chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.

• Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others.
• Adequate renal (kidney) and liver function tests; no significant kidney or liver disease.
• Normal cardiac function per electrocardiogram and echocardiography.
• Adequate pulmonary function to tolerate the surgery.
• Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall.

• Age of the patient is taken into consideration, but may not be as important as their overall status.

Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.