Mesothelioma Treatment May Include Surgery to Reduce Pain

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Mesothelioma Treatment

Mesothelioma Treatment: Surgery and Fluid Removal

Your doctor may recommend surgery to remove the main mesothelioma tumor and nearby tissues that contain cancer cells. If extensive surgery is not possible, your doctor can help reduce your pain by using a procedure to drain excess fluid from around your chest or abdomen. You should both discuss the risks and benefits of surgery, as well as other mesothelioma treatment choices. You may want to get several medical opinions before making a decision.

Surgery is usually combined with chemotherapy or radiation. The idea is to reduce or remove the mesothelioma tumor, then attempt to control or halt further tumor growth. We discuss surgery and fluid removal techniques below, as well as how surgery is used in conjunction with other mesothelioma treatments.

Reducing Mesothelioma Pain Through Fluid Removal

In mesothelioma patients, excess fluid may build up around the lungs, causing pain and breathing difficulty. A method called thoracentesis drains this fluid from between the lining of the outside of the lungs or pleura and the chest (Medline Plus, Medical Encyclopedia and University of Maryland Medicine, Thoracentesis). The doctor uses a needle to remove the fluid. Sometimes, talc or another agent is injected to cause the lung to scar against the chest wall. This helps stop future accumulation of fluid. Thoracentesis improves the patient’s breathing, because pleural fluid can compress the lungs.

Similar to thoracentesis, paracentesis is a method that uses a needle to withdraw fluid from the abdominal area. Patients with abdominal or peritoneal mesothelioma may benefit from this procedure. Draining fluid from the abdomen or chest does not remove any portion of the tumor. Thoracentesis and paracentesis are performed to relieve symptoms, not as attempts to cure the patient. These techniques are usually performed when the patient is too weak to undergo major surgery such as a pleurectomy or an extrapleural pneumonectomy.

Side effects are not that common, although sometimes the cancer cells may spread along the needle path, and a tumor nodule may form under the skin of that area. Other problems could include lung collapse due to air leaking through the needle or due to trauma to the underlying lung (Merck Manual, Special Procedures, Thoracentesis).

Pleurectomy

In a pleurectomy, the surgeon opens the patient’s chest and removes the tumor from the surface of the lung. The process involves removal of the pleura where the majority of the tumor is located. A pleurectomy can control fluid accumulation and decrease pain. The treatment is generally considered to be palliative, that is, it decreases pain but is not a cure. In early stages of mesothelioma, when a pleurectomy is combined with other treatments such as radiation and chemotherapy, it may improve the length of survival (see Chest. 1993 Apr; 103 (4 Suppl): 382S–384S; and Chest. 1999, 116: 446S–449S. In one clinical trial at Memorial Sloan–Kettering Cancer Center, for example, the researchers obtained promising results using pleurectomy followed by the chemotherapy drugs cisplatin and mitomycin.

One advantage of a pleurectomy is its low mortality rate compared to more invasive mesothelioma surgery such as an extrapleural pneumonectomy. Also, the operation can be performed in patients with a less favorable heart/lung condition than that required for an extrapleural pneumonectomy. However, a pleurectomy may not be possible if the patient’s pleural space is overrun by extensive tumor growth.

Extrapleural Pneumonectomy

An extrapleural pneumonectomy removes portions of the lung, the parietal pleura (the lining of the lung), the pericardium (the lining of the heart), and the diaphragm. It has the best record for removing the maximum number of tumor cells. This is radical surgery, which is only recommended if you have good enough heart and lung function to withstand its rigors. Usually, the surgery is indicated in the earlier stages of mesothelioma, when the tumor is confined to the chest cavity. An extrapleural pneumonectomy can slow down the progress of mesothelioma and improve the overall quality of life in some patients, allowing better breathing and mobility.

At Brigham and Women’s Hospital in Boston, some patients with mesothelioma are treated with a combination of extrapleural pneumonectomy, radiotherapy, and chemotherapy. Various studies showed patients with an increase in median survival rate of 9 months to a year in some cases. (see J Thorac Cardiovasc Surg 1999, 117: 54–65, Chest. 1999, 116: 450S–454S, and Cancer Control. 1997 Jul, 4(4): 326–334). In Scotland, a recent study of 191 mesothelioma patients treated with extrapleural pneumonectomy and chemotherapy gave promising results. They had a mean survival time of 35 months, compared to a survival time of 9 months for patients treated with palliative or pain–reducing care only.

Still, some physicians feel that performing an extrapleural pneumonectomy does not warrant the risks. These include hemorrhage (internal bleeding), respiratory failure, pneumonia, empyema (accumulation of pus in the chest cavity), deep vein thrombosis (blood clotting in the veins of the inner thigh or leg) and in extreme cases, even death. They point out that only a few patients can benefit from this technically complicated surgery, and may prefer to use pleurectomy or other mesothelioma treatment methods (J Thorac Cardiovasc Surg. 1991 Jul; 102(1): 1-9; and Chest Surg Clin N Am. 1999 May, 9(2):327–38. In some cases, mesothelioma reoccurs even after the extrapleural pneumonectomy, although this is also an issue with a pleurectomy.

Extrapleural pneumonectomy operations are usually done in larger medical centers that have experience with mesothelioma surgery. To get a better idea of what the surgery entails, go to the Brigham and Women’s Hospital web site, where you can view an actual video of an extrapleural pneumonectomy performed by a renowned surgeon, Dr. David J. Sugarbaker. The video also provides more information about mesothelioma surgery at the hospital.