Treating Mesothelioma – Surgery - Mesothelioma Biopsy

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Mesothelioma Biopsy and Treatment: What to Expect

Mesothelioma is a rare form of asbestos cancer affecting a patient’s mesothelial cells. These are the cells that cover the surface of the majority of our internal organs. Mesothelioma cancer is found to develop in:

• The pleura or the tissue lining/ covering the lungs and is therefore called Pleural Mesothelioma
• The peritoneum or the tissue lining the abdomen, thus the name Peritoneal Mesothelioma
• The pericardium, or the tissue surrounding the heart, causing Pericardial Mesothelioma

Between these three types of mesothelioma, studies show that there are more cases of pleural mesothelioma than that of peritoneal mesothelioma, and that pericardial mesothelioma is extremely rare.

Getting A Diagnosis

When patients are suspected to be suffering from mesothelioma, a diagnostic procedure called a mesothelioma biopsy is performed to confirm diagnosis. There are multiple ways to obtain a mesothelioma diagnosis:

• The sample of a cancerous mass is obtained
• The fluid surrounding the mesothelioma lung is removed and then examined
• Samples of tissue specimens are taken from the mesothelioma lung.

Because fluid diagnosis can be ambiguous, it is sometimes insufficient to verify if the cell type is sarcomatous, epithelial or mixed. Diagnostic surgery then becomes necessary to obtain a confirmatory diagnosis.

Diagnostic Surgery

Video-assisted thoracic surgery or VATS allows the physician to examine the patient’s pleural space with the use of a camera. At the same time, the physician can extract the necessary amount of specimen samples to be analyzed by the pathologist. The procedure requires small incisions to be made and its invasive nature is often a cause of concern for increase in tumor seeding.

Thoracoscopy is less invasive but is only done when the pleural space has not been destroyed by the tumor. A therapeutic procedure to relieve fluid accumulation can be done simultaneously with thoracoscopy.

Another procedure, laparoscopy, is performed on patients after video images show that the tumor has possibly forayed through the diaphragm.

The peritoneal biopsy procedure requires the surgeon to make a cut through the abdomen. A peritoneoscope is then inserted through the abdominal cavity. Images are then viewed by the surgeon through a video screen and samples are extracted for the pathologist to examine.

When the final diagnosis is positive as malignant mesothelioma, the patient will then undergo treatment. 

Surgical Treatment - Potentially Curative Procedure

This type of procedure is done with the intent to get rid of all gross disease. However, since microscopic disease will likely stay behind, adjuvant therapy will also be performed. This is an additional treatment to the main therapy and is performed to remove any remaining disease.

• Pleurectomy/ Decortication – Usually administered to patients in the early stages of pleural mesothelioma. When the lung has to be removed to eliminate all traces of tumor, it can be done simultaneously through the pneumonectomy procedure.
• Extrapleural Pneumonectomy – This procedure for pleural mesothelioma patients is considered radical, and statistics show that it isn’t successful in prolonging a life longer or achieving a cure, although it may provide relief for many of the symptoms associated with this disease. This surgical treatment is usually integrated with radiation therapy, chemotherapy, photodynamic, gene or immunotherapy.
• Cytoreductive Surgery – The procedure is done with the intent to eliminate the majority of, if not all of, the tumor found in the peritoneal cavity of peritoneal mesothelioma patients. Intra-Peritoneal Hyperthermic Chemotherapy or IPHC is then administered to the abdominal cavity to remove all traces of tumor.

Palliative Surgical Procedure

This type of procedure does not target the disease itself but is only intended for the treatment of mesothelioma symptoms.

Chest Tube Drainage and Pleurodesis – Pleural effusion, or fluid buildup, is often the initial symptom that makes a patient seek medical attention, and this procedure is administered in order to provide relief from the pain that accompanies pleural effusion. Considered the most common palliative treatment, it involves fluid drainage and then closing the pleural space to eliminate the problem.

Pleuroperitoneal Shunt – This procedure involves placing two catheters and a pump chamber into the patient’s body, in order to express excess fluid.

Pleurectomy – When the patient is too ill to undergo undergo more extensive surgery, a pleurectomy—removal of the pleura—is the next option. However, the entire tumor may not be removed completely. A pleurectomy can help control pleural effusion effectively when there is restricted lung expansion because of the cancer.

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