Mesothelioma Surgery

In some cases, surgery may be indicated to alleviate symptoms or slow the progression of mesothelioma. Surgery may be performed in tandem with other treatments such as chemotherapy and radiation, also known as “multi-modal therapy.”

Whether a surgery is recommended in your case will depend on factors unique to your situation, including the type and location of the cancer, the “stage” of the cancer, and your overall health. Of course, whether your doctor recommends surgery in your case will depend on factors individual to your case.
Pleural Mesothelioma Surgeries

Thoracentesis

This procedure involves the draining of fluid that may build up (called a “pleural effusion”) in the chest between the lung and the pleura. A tube is placed in the chest in order to drain out the fluid. Thoracentesis is a “palliative” treatment, meaning that its purpose is to help relieve discomfort.

Pleurodesis

Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. Pleurodesis closes the space between the lung and the lung lining, reducing the chance for fluid to accumulate.
There are two approaches to performing a pleurodesis. In the first, a tube that is inserted into the chest drains the excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as sterile talc powder, is injected through the chest tube and into the pleural space. The schlerosing agent is allowed to distribute itself through the pleural space, with the patient being asked to move about in order to facilitate the distribution. Once the agent is distributed, suction is applied to the tube in the chest. Similar to collapsing a plastic bag, the suction brings the two pleural surfaces together, allowing them to “scar” together.

The second method of pleurodesis uses thoracoscopy, whereby a small incision, or a series of small incisions, are made in the skin. A thoracoscope is passed through the incision in order to get a better look at the pleura. The schlerosing agent is then applied to the area.

Pleurectomy/Decortication

Pleurectomy/decortication involves removing the pleura, where most of the tumor is located. This procedure may help control pleural effusions (fluid build-up) and help to decrease the pain caused by the tumor. It is a palliative treatment, meaning that its goal is to help to lessen the discomfort caused by mesothelioma.

Pneumonectomy

A pneumonectomy is the removal of all or part of the lung. Your surgeon will make an incision in the side of the chest. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.

Extrapleural pneumonectomy

This extensive surgery usually involves the removal of the pleura, pericardium, diaphragm, and the whole lung on the side of the cancerous tumor. Your surgeon may decide to remove some of the surrounding tissues, as well.

Peritoneal Mesothelioma Surgeries

Paracentesis

Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Paracentesis (sometimes called an “ascitic tap”) can help take the pressure off the internal organs, and also helps reduce the risk of infection that may be caused by the fluid buildup. This is a “palliative” procedure, meaning that the goal of paracentesis is to help to relieve the discomfort associated with peritoneal mesothelioma.

Peritonectomy

A “peritonectomy” involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease. Your surgeon might recommend that a peritonectomy be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy where the chemotherapy drugs are administered directly into the abdomen during and/or after surgery.

Cytoreductive (or “debulking”) surgery

During cytoreductive or debulking surgery, the surgeon opens the abdominal cavity (a procedure known as a “laparotomy”) to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be quite long in duration because of the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area. Your surgeon might recommend that this surgery be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy administered into the abdominal cavity.

Pericardial Mesothelioma Surgeries

Pericardiocentesis

This is the process for drawing fluid out of the affected area to help to relieve the discomfort associated with pericardial mesothelioma. For this procedure, a needle is inserted into the pericardium (the sac around the heart) to drain the fluid and relieve circulatory problems. The draining of this fluid can be associated with complications, however.

Extrapleural pneumonectomy

An aggressive surgery also used in appropriate situations to treat pleural mesothelioma, an extrapleural pneumonectomy involves removal of the pleura, diaphragm, pericardium, and the entire lung on the side of the tumor.
(source:mesotheliomanews.com)

Pleural Mesothelioma: Diagnosis

Your doctor may perform some of the following procedures to diagnose pleural mesothelioma.

CT scan

This type of X-ray provides a very detailed picture of the size and location of the cancer. The images taken are compiled by a computer to create a more complete image of the disease. The procedure is also called a computerized axial tomography (CAT) scan.

PET scan

A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.

Thoracoscopy

The diagnosis of malignant pleural mesothelioma may involve your doctor looking inside the chest cavity with an instrument called a thoracoscope. For this procedure, an incision is made through the chest wall and the thoracoscope is put into the chest between two ribs. This procedure is usually done in the hospital.

Bronchoscopy

A bronchoscopy involves an examination of the lungs and air passages. The doctor places a lighted tube down the patient’s throat and trachea into the lungs. This procedure is called a bronchoscopy, and the instrument used is called a bronchoscope.

Thoracentesis

Some patients develop fluid in their lungs. This is called a pleural effusion. Your doctor might take a sample of this fluid with a needle injected into the chest and test the fluid for cancer cells. Your doctor may also perform this procedure for draining fluid from the lungs to help relieve pain.

Mediastinoscopy

This is a test that examines the mediastinum. This area is in the center of your chest, between your lungs, and contains the heart, blood vessels and lymph nodes.

Needle Biopsy

For this procedure, the doctor uses a thin needle to take samples of cells for examination under microscope. This test can be uncomfortable but may take only a few minutes. Small pieces of the tissue are taken and then sent to a laboratory for analysis.

The doctor might also use an X-ray, CT scan or fluoroscopy to guide the needle as it is inserted into the tumor. Fluoroscopy is a diagnostic procedure in which X-rays are passed through the body and then projected onto a screen, providing a continuous image of the body’s internal structures.

Wedge Biopsy

For this procedure, a doctor makes an incision through the skin, and a wedge of tissue or tumor is obtained and sent to a laboratory for analysis. A wedge biopsy is often used when other biopsy methods have been unable to confirm a diagnosis.

Cytology and Pathology

Pathology is a study of a disease, which looks at specific cells and types of a disease process to determine the cause. Pathology tests are performed on samples of body fluid or tissue to determine the cell type (cytology) of a specific disease. The process of looking at these samples may include using microscopes, electron microscopes and various stains. This refers to special cell-staining techniques that identify specific types of malignant mesothelioma tumors. Certain types of dyes or coloring are added to the patient’s biopsy samples. Depending on how the tissue responds to the dye, the doctor can make a better estimate about the outcome of the illness. In making the diagnosis, the more information the doctor has about the tumor, the better he or she can recommend appropriate treatment.

After your biopsy, a sample of the tissue or fluid removed may be sent to a hospital laboratory to be analyzed.

* If fluid is removed during a thorancentesis or thorascopy, it is sent to a Cytology lab for analysis. Your doctor will receive a written report of the results. The doctor may receive an oral report from the lab prior to the written results.

* If a tissue biopsy from a bronchoscopy, needle biopsy or thorascopy is done, it is sent to a surgical pathology lab for analysis. The final report will be sent to your doctor.

* Surgical removal of a tumor, pleura or lung is sent to a surgical pathology lab. In the lab the material is analyzed with special stains. The material may be placed under a microscope for magnification and further review to determine the cell type. After analysis is completed, small pieces of any remaining tissue are preserved in paraffin for future us


(source:mesotheliomanews.com)

Cell Types of Mesothelioma

A patient’s doctor or medical records may refer to the “cell type” of the malignant mesothelioma. This refers to the type of tissue where the cancer first developed. For example, “epithelial” malignant mesothelioma refers to cancerous cells that develop in the “epithelium,” which is the membrane lining of the lung, heart, or abdomen. In contrast, “sarcomatous” malignant mesothelioma arises in connective tissue. “Biphasic” refers to malignant mesothelioma that arises in two different cell types. Other cell types of malignant mesothelioma are lymphohistiocytoid and desmoplastic.

(source:mesotheliomanews.com)

Peritoneal Mesothelioma

Peritoneal mesothelioma, also known as cancer of the peritoneum, is a cancer of the abdominal lining.

One way doctors diagnose peritoneal mesothelioma is by looking inside the abdominal cavity with an instrument called a peritoneoscope. In this procedure, a cut is made through the abdomen wall and the peritoneoscope is placed into the abdomen. This test, called a peritoneoscopy, is usually performed in the hospital.

Some patients develop excessive fluid in the abdomen. This is called an effusion or ascites. A doctor may take a sample of such fluid to diagnose peritoneal mesothelioma. Fluid in the abdomen might also be drained to relieve symptoms of peritoneal mesothelioma. The procedure for drawing out this fluid is called “paracentesis”.

For more information about the diagnosis of this disease, click here

Symptoms

The symptoms of this cancer may include stomach pain, weight loss, nausea, vomiting, hernia, fluid in the abdominal cavity or a mass in the abdomen.
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Pleural Mesothelioma

Pleural mesothelioma, also known as mesothelioma of the pleura, is a tumor of the lining surrounding the lungs. The pleura is a thin tissue around the lungs and the inside of the chest. In order to protect the lungs, the pleura produces a small amount of fluid which helps cushion the lungs, making the lungs move more smoothly during breathing.

Benign (Non-Cancerous) pleural mesothelioma

Benign pleural mesothelioma is a non-cancerous tumor that has not spread to other organs of the body. If the tumor is large, it may squeeze the lung itself and cause shortness of breath and pain.

Malignant Pleural Mesothelioma

Malignant Pleural mesothelioma is cancerous and can spread to other parts of the body. This rare form of cancer is found in the pleural sac lining of the lung. Exposure to asbestos is considered the primary cause of pleural mesothelioma.

Symptoms

Pleural mesothelioma may include shortness of breath, chest pain, back pain, pain in the rib cage, fluid build-up in the lung lining, hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, paralysis and sensory loss.

(source:mesotheliomanews.com)

Pleural Mesothelioma

Pleural mesothelioma, also known as mesothelioma of the pleura, is a tumor of the lining surrounding the lungs. The pleura is a thin tissue around the lungs and the inside of the chest. In order to protect the lungs, the pleura produces a small amount of fluid which helps cushion the lungs, making the lungs move more smoothly during breathing.

Benign (Non-Cancerous) pleural mesothelioma

Benign pleural mesothelioma is a non-cancerous tumor that has not spread to other organs of the body. If the tumor is large, it may squeeze the lung itself and cause shortness of breath and pain.

Malignant Pleural Mesothelioma

Malignant Pleural mesothelioma is cancerous and can spread to other parts of the body. This rare form of cancer is found in the pleural sac lining of the lung. Exposure to asbestos is considered the primary cause of pleural mesothelioma.

Symptoms

Pleural mesothelioma may include shortness of breath, chest pain, back pain, pain in the rib cage, fluid build-up in the lung lining, hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, paralysis and sensory loss.

(source:mesotheliomanews.com)

Mesothelioma Causes

Asbestos

The major known cause of mesothelioma is exposure to asbestos. A known history of asbestos exposure is present in 70-80% of all cases of mesothelioma. Asbestos likely causes cancer by physically irritating the cells. When asbestos fibers are breathed in, they reach the ends of the small airways and penetrate into the pleura (lining of the lung). These fibers may then injure mesothelial cells of the pleura and eventually cause mesothelioma.

The risk of developing mesothelioma rises with the quantity of asbestos exposure. However, genetic factors also play a role in determining who develops the condition. This is probably the reason why all people exposed to high levels of asbestos do not develop mesothelioma.

Smoking

Although smoking has not been associated with the development of mesothelioma, the combination of smoking and asbestos exposure significantly increases a person's risk of developing pleural mesothelioma.

Other Causes

Mesothelioma also has been linked to the following:

* Radiation: Mesothelioma has been reported to occur in few people following exposure to therapeutic radiation using thorium dioxide (Thorotrast).


* Zeolite: Zeolite is a silicate mineral (chemically related to asbestos) commonly found in the soil of the Anatoli region of Turkey. A few cases of mesothelioma reported from this region may have been caused by zeolite.


* Simian virus 40 (SV40): The role of SV40 in the development of mesothelioma has also been suggested. This virus has been identified in human mesothelioma cells. In studies conducted in animals, it has been shown to induce the development of mesothelioma.

What is Mesothelioma?

Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products. Unlike lung cancer, there is no association between mesothelioma and smoking.

Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss

In severe cases of the disease, the following signs and symptoms may be present:

* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

(source:en.wikipedia.org/wiki/Mesothelioma)