Mesothelioma Information

Malignant mesothelioma is a rare type of  cancer that is caused by asbestosthat and has thus far proven to be an incurable.  Traditional treatments including curative mesothelioma surgery, mesothelioma chemotherapy and mesothelioma radiotherapy, have provided sufferers with little save for an occasional brief extension of life.  New treatments including photodynamic therapy (PDT), immunotherapy, gene therapy and intensity modulated radiation therapy (IMRT), are still being developed and have yet to demonstrate an ability to combat the disease any better than traditional treatment modalities.

Without being able to cure the disease, treatment is often reduced to treating the symptoms. Palliative mesothelioma surgery does just that.

 Palliative Mesothelioma Surgery – Procedure Types

Malignant mesothelioma is known to produce a number of symptoms, some of which leave patients in extreme pain. If unable to treat the disease itself, doctors aim to allow mesothelioma sufferers to live out their remaining days in as much comfort as possible. Outside of medicating the patient, there are a variety of palliative mesothelioma surgical procedures that can be performed to limit the effect of disease symptoms; procedures aimed at palliation include:

• Chest tube drainage
• Pleurodesis
• Pleurectomy
• Pleuroperitoneal shunt

Chest Tube Drainage

The buildup of fluid inside the pleural space (between the lungs and the mesothelial tissue casing of the chest cavity) is the most common presenting symptom of pleural mesothelioma. Commonly referred to as pleural effusion, this fluid buildup causes patients a great deal of chronic chest pain. In order to relieve the pain, a hollow bore needle is inserted between the ribs, draining built-up fluid from the pleural space (thoracentesis). Although thoracentesis rids the patient of pleural effusion (and any associated pain), relief is typically temporary. After the initial onset of pleural effusion, patients face an increased risk of future development. Thoracentesis can be continuously used to treat the recurring symptom; however, the more often the treatment is used, the more rapidly effusion will recur.

Pleurodesis

The only way to provide permanent relief from pleural effusion is through the artificial closure of the pleural space (pleurodesis). Pleurodesis can be achieved by chemical or surgical means. Pleurodesis is achieved chemically through the use of a scelrosing agent that causes irritation of the tissue, causing it scar and harden (talc slurries are often used). Pleurodesis is achieved surgically through an incision made in the chest (thoracotomy or thoracoscopy).

Pleurectomy

A pleurectomy is a type of major palliative mesothelioma surgery that is used to treat pleural effusion. If a more extensive surgical procedure is not an option, a pleurectomy can be administered to side-step the process of pleurodesis. A pleurectomy involves the surgical removal of the pleura (mesothelial tissue lining the lungs), effectively removing the pleural space and preventing the possibility of any type of future fluid buildup. Pleurectomies are complex procedures and are rarely performed unless absolutely necessary.

Pleurectomy procedures can also fall into the category of curative surgery when used as a treatment for early stage pleural mesothelioma. If the cancer is diagnosed early enough before metastasizing outside of the pleural cavity, then removal of the pleura could serve as a curative measure (pleurectomy has been unsuccessful in providing curative treatment).

Pleuroperitoneal Shunt

The use of a pleuroperitoneal shunt is another type of palliative surgery that is not frequently used for the treatment of mesothelioma symptoms. A shunt is a type of artificial bridge between two parts of the body. A pleuroperitoneal shunt functions by redirecting fluid from the pleural space to the peritoneal space. In this way, a pleuroperitoneal shunt can prevent the occurrence of pleural effusion. There are a number of concerns associated with the use of pleuroperitoneal shunts, most notably cancer seeding. The spilling of pleural mesothelioma cancer cells could potentially allow for the cancer to metastasize to the peritoneum and the development of peritoneal mesothelioma. It is also possible that shunts can lead to infection or become obstructed, creating a very serious medical situation.