There are three main modes of treating mesothelioma, these are; Chemotherapy, Surgery and Radiotherapy. Surgical procedures used in treatment of the disease are of three types;-Diagnostic Procedures, Palliative Procedures, Potentially Curative Procedures
Diagnostic Procedures
Diagnostic surgery is a necessary step in confirming and staging mesothelioma.
Thoracoscopy enables a physician to examine the pleural space and to take multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at reducing the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and to see the possibility of removing the tumor surgically. While less invasive than an open biopsy, it can only be performed on patients where tumor has not completely blocked the pleural space.
VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, it could lead to seeding of the tumor {dislodgement of fragments of the tumor by contact}. By using small incisions on the skin, the surgeon can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking {shrinking} procedure necessary can be made at this time.
Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.
Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy{complete removal of pleura on one side} or extrapleural pneumonectomy{complete removal of one lung}.
Palliative Procedures
Palliative surgical procedures are those which treat the symptoms of mesothelioma, without aggressively treating the disease itself.
Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion that causes the layers of the pleura to stick together thus closing the pleura space.
Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.
Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.
Potentially Curative Procedures
These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) in form of chemotherapy and or radiotherapy is given to eliminate any residual disease.
For Pleural Mesothelioma:
-Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
-Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself.
For Peritoneal Mesothelioma:
• Cytoreductive Surgery is aimed at removing all or nearly the entire gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician's preference.
Surgery is usually combined with other types of treatments to achieve maximal result during treatment.
Patients should also educate themselves about mesothelioma and treatment options and reach out to available resources to make coping with a mesothelioma diagnosis easier.
For complete information on mesothelioma, and mesothelioma treatments visit http://www.mesotheliomacorner.blogspot.com
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