People who are diagnosed with mesothelioma have three main conventional treatment options: surgery, chemotherapy, and radiation therapy. For information about other types of typical mesothelioma treatment, please see “Mesothelioma Treatment Options.”
Surgery for Different Purposes
Surgical options for mesothelioma and other cancers are split into three different categories: diagnostic, curative, and palliative surgery.
- Diagnostic surgery is carried out to determine what is causing a patient’s symptoms. In these cases a sample of tissue or fluid is removed from a site and tested for the presence of diagnostic markers, such as cancer cells.
- Curative surgery attempts to remove as much cancer as possible, in an effort to cure the patient permanently. This type of surgery is usually followed up by chemotherapy or radiation therapy to kill residual cancer cells.
- Palliative surgery is carried out when curing a patient is not an option. These procedures are designed to provide symptomatic relief.
Surgical Procedures for Mesothelioma Diagnosis and Treatment
Biopsy: This diagnostic procedure removes suspected cancer cells from a site so they can be tested to determine whether cancer is present. There are three types of biopsy procedures: core biopsy (not usually used to diagnose mesothelioma), excisional biopsy, and needle aspiration biopsy.
In an excisional biopsy the intent is to determine how far the cancer has spread. In some cases, the purpose of the surgery may change during the operation itself, and as much cancerous tissue as possible may be removed before completing the procedure.
Needle aspiration uses a very long needle to remove a small sample of cells and fluid from the area. The cells are then tested for the presence of cancer by looking at the shape of cells, the types of proteins they produce, and other diagnostic indicators.
Paracentesis: This palliative procedure is carried out to remove fluid that has built up in the abdominal cavity of patients with peritoneal mesothelioma. In patients with peritoneal mesothelioma, built-up fluid can cause considerable pain and discomfort because the fluid places pressure on internal organs. During this procedure a very long, hollow needle is inserted into the abdomen to remove the fluid. This procedure can also be diagnostic. In this case, the fluid is removed and tested for the presence of cancer cells.
Pleurodesis: This is another palliative treatment in which symptomatic relief is achieved for people with pleural mesothelioma (which develops in the lining of the lungs). Undergoing this procedure prevents a side effect of pleural mesothelioma, called pleural effusion. Pleural effusion occurs when fluid builds up in the lungs, causing considerable pain and difficulty with breathing.
During a pleurodesis procedure the pleural spaces are drained of fluid, then treated with a chemical that causes inflammation. The inflammation causes the pleural membrane spaces to close up so fluid cannot build up again.
Pneumonectomy: This curative procedure involves the complete removal of one lung. This procedure can be carried out on patients who have pleural mesothelioma in one of their lungs. A patient with mesothelioma in both lungs is not usually a good candidate for a pneumonectomy. Similarly if a patient has mesothelioma in one lung but the cancer has metastasized to other organs, they may not be a suitable candidate. A person who undergoes this procedure must also be otherwise healthy, to reduce the possibility of complications that might endanger their health.
Thoracentesis: This palliative procedure is carried out to remove fluid that has built up in the lungs of patients with pleural mesothelioma. This built-up fluid can cause considerable pain and discomfort because the fluid places pressure on the lungs, and prohibits breathing. During this procedure a very long, hollow needle is inserted to remove the fluid. A thoracentesis may be followed by a pleurodesis to prevent further fluid build-up. In some cases a thoracentesis is also a diagnostic procedure. In this case, the fluid is removed and tested for the presence of cancer cells.
Thoracoscopy: This procedure is a diagnostic surgery used to diagnose pleural mesothelioma and other lung diseases. In this procedure an incision is made in the chest, through which a long thin tube is inserted. This allows doctors to view the interior of the pleural spaces to determine whether disease is present, and perhaps make a preliminary diagnosis. Samples of suspected cancerous tissue are usually removed so diagnostic tests can be carried out to confirm what type of disease is present.
Thoracotomy: This generic term refers to lung surgery in which part of one or both lungs are removed. A thoracotomy may be diagnostic, curative, or palliative depending on the circumstances under which the procedure is performed.
There are three main types of thoracotomy surgery: wedge resection, lobectomy, and pneumonectomy. A wedge resection is carried out when tumors are small and localized, and involves removing a section of tissue that is as small as possible. A lobectomy involves the removal of one of the five lobes of the lungs, while a pneumonectomy involves the removal of one entire lung.