Surgey of Mesothelioma
Surgery for cancer can be aimed either at curing the disease or at giving the patient relief from symptoms. Surgery aimed at a cure is called curative surgery. Surgery aimed at relieving symptoms is called palliative surgery. Different forms of surgery are offered depending on the type of mesothelioma and its stage.
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.
Surgery for Pleural Mesothelioma
If you are in otherwise good health and your pleural mesothelioma is caught in the earliest stage (stage I), you may benefit from an extensive surgery called extrapleural pneumonectomy. This is a difficult operation, but it offers hope of a cure. According the American Cancer Society, the procedure is most often performed on patients with the epithelioid type of mesothelioma tumor. (The cells making up a mesothelioma tumor are either epithelioid, sarcomatoid, or mixed; most mesotheliomas are epitheloid and this type has the best prognosis).
Extrapleural pneumonectomy is only performed at comprehensive cancer centers, by experienced surgeons. It involves removing the pleural lining of the chest wall, diaphragm, pericardium, and the entire lung on the tumor side. Surgeons then reconstruct the diaphragm and pericardium with prosthetic material.
The aim of extrapleural pneumonectomy is to remove all of the cancer or at least as much as possible. Chemotherapy may be used before the surgery to shrink the tumors or afterwards to target any cancer cells that were not removed. Radiation is sometimes used for this purpose.
Another surgical procedure used for pleural mesothelioma is called pleurectomy/decortication. This surgery is usually for palliative proposes. The pleura is removed and this typically removes the majority of the tumor. Pleurectomy/decortication can improve breathing and relieve pain by controlling the buildup of fluid.
Surgery for Peritoneal Mesothelioma and Pericardial Mesothelioma
Surgeons have less experience with peritoneal and pericardial mesothelioma because these conditions are rarer than pleural mesothelioma. Surgery is performed to remove at least part of the tumor in the abdomen in the case of peritoneal mesothelioma. It is seldom possible to remove the entire tumor.
Surgery may also be performed in the case of pericardial mesothelioma in an attempt to remove as much of the tumor as possible. As in pleural mesothelioma, surgery for peritoneal and pericardial mesothelioma is most effective when the disease is in the earliest stage (stage I). Frequently, surgery is aimed a palliative purposes, rather than a cure; removing much of the tumor or tumors can reduce pain and other symptoms.
Surgery can also be performed in the case of the rare mesothelioma of the tunica vaginalis (mesothelioma of the lining around the testicles). This cancer frequently looks like a hernia in the groin. The doctor may operate with the intent to repair a hernia, only to discover a cancerous mass instead. According to the American Cancer Society, surgery for this mesothelioma can relieve pain, but it is seldom curative.
Other Palliative Procedures
Other procedures may be used to relieve the symptoms of mesothelioma. Controlling the fluid buildup caused by mesothelioma helps ease the patient’s pain and makes breathing easier. Different procedures are used depending on the type of mesothelioma.
Two procedures can help control fluid buildup in pleural mesothelioma. During a thoracentesis, a needle is inserted into the chest cavity to remove the fluid. In a procedure called pleurodosis the doctor may inject drugs or talc into the chest cavity to cause scarring, which may prevent the return of fluid. According to the American Cancer Center, as many as 90 percent of patients receive at least temporary relief from pleurodosis; however, the procedure is not a cure for pleural mesothelioma.
Fluid buildup in peritoneal mesothelioma and pericardial mesothelioma may also be relieved in a similar manner. A needle is inserted into the abdomen to remove the fluid caused by peritoneal mesothelioma, a process called paracentesis. Fluid may also be withdrawn by needle from the pericardium (sac surrounding the heart) in the case of pericardial mesothelioma. These procedures are not without risk; it is possible for the cancer cells to grow along the needle track, forming a tumor under the skin. The American Cancer Society urges patients not to let such a possibility deter them from having their fluid removed, since the benefits of pain relief likely outweigh the risks.
Surgery for cancer can be aimed either at curing the disease or at giving the patient relief from symptoms. Surgery aimed at a cure is called curative surgery. Surgery aimed at relieving symptoms is called palliative surgery. Different forms of surgery are offered depending on the type of mesothelioma and its stage.
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.
Surgery for Pleural Mesothelioma
If you are in otherwise good health and your pleural mesothelioma is caught in the earliest stage (stage I), you may benefit from an extensive surgery called extrapleural pneumonectomy. This is a difficult operation, but it offers hope of a cure. According the American Cancer Society, the procedure is most often performed on patients with the epithelioid type of mesothelioma tumor. (The cells making up a mesothelioma tumor are either epithelioid, sarcomatoid, or mixed; most mesotheliomas are epitheloid and this type has the best prognosis).
Extrapleural pneumonectomy is only performed at comprehensive cancer centers, by experienced surgeons. It involves removing the pleural lining of the chest wall, diaphragm, pericardium, and the entire lung on the tumor side. Surgeons then reconstruct the diaphragm and pericardium with prosthetic material.
The aim of extrapleural pneumonectomy is to remove all of the cancer or at least as much as possible. Chemotherapy may be used before the surgery to shrink the tumors or afterwards to target any cancer cells that were not removed. Radiation is sometimes used for this purpose.
Another surgical procedure used for pleural mesothelioma is called pleurectomy/decortication. This surgery is usually for palliative proposes. The pleura is removed and this typically removes the majority of the tumor. Pleurectomy/decortication can improve breathing and relieve pain by controlling the buildup of fluid.
Surgery for Peritoneal Mesothelioma and Pericardial Mesothelioma
Surgeons have less experience with peritoneal and pericardial mesothelioma because these conditions are rarer than pleural mesothelioma. Surgery is performed to remove at least part of the tumor in the abdomen in the case of peritoneal mesothelioma. It is seldom possible to remove the entire tumor.
Surgery may also be performed in the case of pericardial mesothelioma in an attempt to remove as much of the tumor as possible. As in pleural mesothelioma, surgery for peritoneal and pericardial mesothelioma is most effective when the disease is in the earliest stage (stage I). Frequently, surgery is aimed a palliative purposes, rather than a cure; removing much of the tumor or tumors can reduce pain and other symptoms.
Surgery can also be performed in the case of the rare mesothelioma of the tunica vaginalis (mesothelioma of the lining around the testicles). This cancer frequently looks like a hernia in the groin. The doctor may operate with the intent to repair a hernia, only to discover a cancerous mass instead. According to the American Cancer Society, surgery for this mesothelioma can relieve pain, but it is seldom curative.
Other Palliative Procedures
Other procedures may be used to relieve the symptoms of mesothelioma. Controlling the fluid buildup caused by mesothelioma helps ease the patient’s pain and makes breathing easier. Different procedures are used depending on the type of mesothelioma.
Two procedures can help control fluid buildup in pleural mesothelioma. During a thoracentesis, a needle is inserted into the chest cavity to remove the fluid. In a procedure called pleurodosis the doctor may inject drugs or talc into the chest cavity to cause scarring, which may prevent the return of fluid. According to the American Cancer Center, as many as 90 percent of patients receive at least temporary relief from pleurodosis; however, the procedure is not a cure for pleural mesothelioma.
Fluid buildup in peritoneal mesothelioma and pericardial mesothelioma may also be relieved in a similar manner. A needle is inserted into the abdomen to remove the fluid caused by peritoneal mesothelioma, a process called paracentesis. Fluid may also be withdrawn by needle from the pericardium (sac surrounding the heart) in the case of pericardial mesothelioma. These procedures are not without risk; it is possible for the cancer cells to grow along the needle track, forming a tumor under the skin. The American Cancer Society urges patients not to let such a possibility deter them from having their fluid removed, since the benefits of pain relief likely outweigh the risks.