Pleural Mesothelioma Treatment

Surgery for Pleural Mesothelioma

For some patients, doctors may recommend surgery to alleviate symptoms and slow the progression of mesothelioma.  Surgery may be performed in tandem with other therapies such as chemotherapy and radiation, which is known as “modality therapy”.  

What follows are descriptions of some types of surgeries used to treat pleural mesothelioma.

Thoracentesis

This procedure involves draining built-up fluid (called a “pleural effusion”) in the chest cavity between the lung and the pleura.  A tube is placed into the chest in order to drain the fluid.  This is a “palliative” treatment, meaning that its goal is to help relieve pain and discomfort caused by the excess fluid.

Pleurodesis

Pleurodesis is a surgical procedure to help control the excessive build-up of fluid between the lung and lung lining.  Pleurodesis closes the space between them, minimizing the chance for fluid to accumulate.

There are two methods for performing a pleurodesis.  In the first, a tube is inserted into the chest to drain excess fluid.  Next, a schlerosing agent (a substance that causes scarring) is injected through the tube and into the pleural space.  To help distribute the schlerosing agent throughout the affected area, the patient may be asked to move around for a short time.  Once the schlerosing agent is distributed, suction is applied to the chest tube.  The suction brings the two surfaces together, allowing them to “scar” together.  

Another method of pleurodesis uses thoracoscopy, in which a small incision is made in the skin.  A thoracoscope is passed through the incision to allow the surgeon to look at the pleura.  The schlerosing agent is then applied to the area.

Pleurectomy/Decortication

Pleurectomy/decortication is a surgical procedure to remove the pleura, where most of the tumor is located.  This procedure may help control pleural effusions (fluid-build-up) as well as help to relieve the pain and discomfort caused by the tumor.  

Pneumonectomy

A pneumonectomy is the removal of all or part of the lung.  To perform the procedure, the surgeon will make an incision in the chest to reveal the lung.  The surgeon can then visually assess the tumor and decide how much of the lung should be removed.

  • Extrapleural pneumonectomy

This extensive surgery involves the removal of the pleura, the pericardium, the diaphragm, and the whole lung on the side of the cancerous tumor.  Some of the surrounding tissue may be removed, as well.  Chemotherapy may be used during the surgery to “bathe” the chest cavity, in an effort to kill any additional cancer cells.

Chemotherapy and related drugs

Chemotherapy involves the use of special drugs that help to destroy cancer cells.  Doctors may prescribe “single agent” chemotherapy (meaning the use of just one chemotherapy drug) or a combination of chemotherapy drugs.  

Chemotherapy is usually given to the patient through an intravenous tube, called an “IV infusion”.  Some types of chemotherapy may be given in pill form.  In some cases, chemotherapy may be given to patients during surgery, administered directly to the affected area and sometimes in heated form.

Besides chemotherapy, doctors may prescribe other drugs to minimize the side effects of chemotherapy and other treatments.  

What follows is a listing of some chemotherapy treatments and related drugs that may be used to treat mesothelioma:

Alimta (Pemetrexed): Alimta is typically used to treat pleural mesothelioma, often in combination with cisplatin, another chemotherapy drug.

Onconase (Ranpiranase): Onconase is a new drug that is showing promise in slowing the growth of mesothelioma tumors.

Navelbine (Vinorelbine): Navelbine is another form of chemotherapy used to shrink mesothelioma tumors.

Carbonplatin (Paraplatin): Carbonplatin is a chemotherapy drug that interferes with the growth of cancer cells.

Taxotere, Taxol: Taxotere and Taxol are drugs that help rid the body of cancer cells when cancer recurs following a previous chemotherapy.  These drugs inhibit the reproduction of cancer cells.

Zofran and anti-nausea drugs: One of the most common side effects of chemotherapy is nausea.  Zofran helps to ease nausea.  Other anti-nausea drugs include Emeset, Oncoden, and Zofron.  They can also help to control nausea after radiation and surgery.

Endostatin: Endostatin is a natural protein that has been shown to “starve” cancerous tumors of blood by inhibiting the growth of blood vessels.  This drug is still in clinical trials.

Radiation

Radiation therapy uses intense X-rays to kill cancer cells.  Although not a cure for mesothelioma, radiation may be used to slow its growth.  Radiation is sometimes the main treatment for patients in fragile health.  It can also be used to destroy small clusters of cancer cells that may have been missed during surgery.

External Beam Radiation is the most common form of radiation therapy and the one most people are familiar with.  It is administered externally, using a machine very similar to an X-ray machine.  The machine directs strong beams of light at the cancerous cells from outside the body, with the goal of killing the tumor underneath.

Internal Radiation (Brachytherapy) involves the placement of radiation sources inside the chest at the site of the area affected by the cancer.  This is a newer form of radiation therapy.