Palliative Surgery for Mesothelioma Patients

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Mesothelioma, the rare cancer which is linked to asbestos exposure and which is newly diagnosed in up to 3,000 Americans each year, is incurable. By the time this slow-moving cancer is typically discovered, it has usually metastasized to some extent, and so surgical removal of the entire tumor in the hopes of rendering the patient cancer-free is not often an option. There are some surgical procedures, however, which can make the patient more comfortable by alleviating the pain of a tumor or ameliorating the symptoms associated with mesothelioma, such as the fluid buildup which complicates breathing.

One of the major symptoms that accompany the development of late-stage mesothelioma is fluid buildup, otherwise known as pleural effusion. This occurs when excess fluid accumulates in the pleural cavity, and can impair breathing because the expansion of the lungs during inhalation is limited by the fluid. There are two surgical procedures which are employed in cases of pleural effusion:

Thoracentesis is performed by the insertion of either a needle or plastic catheter into the pleural space. The excess fluid is then extracted, after which the patient should find it easier to draw breath. Although some individuals may experience discomfort during the thoracentesis procedure, it is a relatively quick and painless outpatient procedure that can be repeated multiple times. Before the thoracentesis, the doctor may request either x-rays or an ultrasound in order to determine the best location for insertion of the needle or catheter.

Pleurodesis is a process that injects talc, or certain drugs, into the chest cavity. The talc or drugs then create scar tissue, effectively sealing together the outer lining of the lung and the chest wall, in order to eliminate any space in which the pleural fluid could collect. As with thoracentesis, pleurodesis may be repeated, although there is some indication that repetitions of the procedure may actually cause fluid to return to the space. Most patients, however, find that the benefits of pleurodesis outweigh this risk.

Effusion can also take place in other areas of the body, as a symptom of the rarer forms of mesothelioma, peritoneal and pericardial. In peritoneal mesothelioma, fluid may build up in the abdominal area, and can be removed by a procedure called paracentesis. Similarly, fluid that has built up in the pericardium – the membranous sac around the heart – can also be removed via fine needle aspiration.

Palliative surgery may also be an option if the tumor has grown beyond the mesothelium, and causing pain to another area of the body. Oncologists may decide to remove some of the tumor in order to alleviate the pain, with the understanding that they are not attempting to eradicate the cancer from the body altogether. Although this type of surgery does not increase survival time, it can be successful in improving the patient’s quality of life and making them more comfortable. Palliative surgery to remove part of the tumor may also be viable if the patient is too ill for more invasive surgery, such as an extrapleural pneumonectomy.

In addition to these palliative surgery procedures, there are other therapies and treatments that may offer relief from pain and other symptoms for the mesothelioma patient. Traditional methods such as chemotherapy and radiation may be used to shrink the tumors and make the patient more comfortable. Many mesothelioma sufferers also find that they can ease symptoms through holistic approaches such as supplements, acupuncture, massage, hypnosis and other approaches.