Surgery: Physical Removal of the Cancer

Mesothelioma surgery involves the physical removal of the cancer or other operative treatment.

There are several surgeries available for patients, some of which are used palliatively to treat symptoms and others of which are considered radical surgery, such as removal of one of the lungs, with curative intent.

The physician will decide the nature and type of surgery to be performed based on his or her overall treatment strategy and the information determined during the patient’s workup.

The most common radical surgeries for mesothelioma include:

• Extrapleural Pneumonectomy (EPP), during which the surgeon removes the patient’s lung, the affected tissue, and surrounding lymph nodes

• Pleurectomy Decortication (P/D), during which the surgeon removes the pleural tissue lining the lung and chest cavity, as well as the tissue lining the diaphragm and the mediastinum

• Cytoreduction or debulking surgery, during which the surgeon removes any signs of cancer from the peritoneal/abdominal cavity and the patient receives heated interoperative chemotherapy at the same time

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Chemotherapy: Using Drugs to Fight the Cancer

Chemotherapy uses drugs and other chemicals to kill cancer cells.

Treatment with chemotherapy is considered “systemic treatment” because drugs are introduced via the bloodstream and kill cancer cells throughout the body.

The most common chemotherapy drugs for mesothelioma are pemetrexed and a combination of gemcitabine and cisplatin.

However, your doctor may recommend a variety of combinations of other chemotherapy drugs.

Chemotherapy comes with harsh side effects:

• Flu-like symptoms
• Fever
• Fatigue
• Nausea and vomiting
• Constipation
• Poor appetite
• Shortness of breath
• Chest pain
• Taste changes
• Hair loss
• Weakness
• Blood test abnormalities
• Low white blood cell count
• Low red blood cell count

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Radiation Therapy

Radiation therapy uses ionizing radiation to destroy cancer cells and shrink tumors.

Radiation can be used as part of a multimodal treatment protocol, or it can be used in a palliative manner to reduce the pain associated with the disease.

Recent advances in understanding mesothelioma’s complex biology have led to improvements in the effectiveness of the standard therapies.

Those advances are reflected in an increase in median survival times reported by some patients. Much more research needs to be done before the medical community can say it has turned a corner in the treatment of mesothelioma.

Even so, the increase in survival times in patients treated with an effective multimodal protocol points to a new level of hope for mesothelioma patients.

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Palliative Procedures

Since there is no cure for malignant mesothelioma, many of the treatment options are considered palliative, aimed at making the patient more comfortable by easing symptoms.

Palliative procedures your doctor may consider include:

• Pleurodesis, which is used to seal the pleural space so fluid cannot keep building up around the lungs
• Pleurocentesis or thoracentesis, which is used to remove fluid buildup in the chest cavity
• Paracentesis, which is used to remove ascetic fluid from the abdominal cavity
• Pericardiocentesis, which is used to remove fluid buildup from the pericardial sac around the heart

Your doctor will devise a treatment plan based on your general health and the stage of your disease. (Some people are not healthy enough for surgery, for example.)

You should also ask about alternative treatments such as immunotherapy and clinical trials.

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