Surgery

There are a variety of surgical procedures to treat mesothelioma.  Your oncologist may recommend one or more of these procedures, depending on the stage of your cancer and your overall health.

If the cancer is in the very early stages and is localized to one part of the chest or abdomen, the doctor may attempt a curative surgery to remove the tumor completely.  However, in the later stages, curative surgery is usually not a feasible option.  Instead, surgery is considered a palliative treatment.

In some cases, the doctor may recommend surgery to remove part of the pleural or peritoneal lining.  For pleural mesothelioma, this procedure is called a pleurectomy/decortication.  Sometimes part of the diaphragm or outer lung is removed as well.  For peritoneal mesothelioma, the doctor may perform a cytoreductive surgery to remove tumor tissue from the abdominal area.

If the disease has spread to the lung, the surgeon doctor may perform an external pneumonectomy to remove the entire lung.  The doctor may also remove the external part of the pericardium around the heart, part of the diaphragm, and part of the pleural lining of the chest.

Both the pleurectomy and external pneumonectomy are extremely serious surgical procedures.  Generally, the thoracic surgeon must permanently remove at least one rib to reach the chest cavity.  The surgery can also put a serious strain on the patient’s heart and other organs.  Not every patient is a good candidate for these procedures.  However, surgery combined with chemotherapy and/or radiation therapy appears to be one of the most effective ways to control mesothelioma at the early stages to alleviate your symptoms and help you live longer.

A less extreme surgical procedure is thoracentesis, which is a procedure to drain fluid from the area around the lungs.  Paracentesis, a similar procedure to remove fluid from the abdomen is used in cases of peritoneal mesothelioma.

Thoracentesis is often done on an outpatient basis.  To remove the excess fluid in the pleura, the doctor inserts a thoracentesis needle into the chest cavity, and then places a catheter inside the needle.  This allows the fluid to drain out through the catheter.  Paracentesis is similar, but the needle is inserted into the abdomen.  Thoracentesis and paracentesis can make the patient more comfortable and temporarily relieve the pain and shortness of breath caused by the accumulation of fluid in the chest.

Thoracentesis may also be combined with pleurodesis, a procedure which administers drugs or chemicals through a tube in the chest to seal off the layers of the pleura.  Pleurodesis causes the layers of the pleura to become inflamed and stick together and prevents fluid from accumulating there.  This helps prevent some of the pain caused by fluid in the chest, and can make it easier to breathe.