In cancer care, curative surgery is used alone or in combination with other treatments such as radiation therapy and chemotherapy. In this scenario, surgery is part of a plan to completely remove the disease.
There is no definitive cure for mesothelioma, but the goal of aggressive, tumor-removing surgeries is to ensure the person stays in remission, with no evidence of the cancer now or in the future.
Palliative surgery can be an important aspect of managing mesothelioma.
Palliative surgery will not cure mesothelioma or send the cancer into remission. It will make patients feel better. This can help them cope with the physical and emotional challenges of managing an aggressive cancer.
Types of Curative Mesothelioma Surgery
There are two major types of tumor-removing mesothelioma surgeries:
- Extrapleural Pneumonectomy: Surgical removal of the mesothelioma-affected lung, nearby lymph nodes and portions of the diaphragm, the membrane covering the heart (pericardium) and part of the parietal pleura (lining of the lung).
- Pleurectomy and Decortication: Surgical removal of the pleural lung lining and all visible tumors, leaving the affected lung in place.
Of the two, an extrapleural pneumonectomy is the more aggressive procedure. Only the healthiest patients can receive this surgery.
These surgeries may be used in combination with chemotherapy, radiation therapy or heated intraoperative chemotherapy — a procedure in which heated cancer drugs are placed into the chest or abdominal cavity during surgery.
Removing all evidence of the cancer is the goal of these combined, intensive treatment options.
Challenges of Tumor-Removing Surgery for Mesothelioma
The realities of mesothelioma make it more likely patients have advanced disease at the time of diagnosis:
- The disease has few symptoms in the early stages.
- Symptoms are easily mistaken for less serious conditions, delaying diagnosis.
- There are no good screening tests for mesothelioma.
The more advanced a cancer is, the more it has spread beyond the site where the tumor first developed.
Advanced cancer of any type makes it nearly impossible for a surgeon to remove every single cancer cell from the body.
However, palliative surgery can be an important part of mesothelioma care.
Palliative Surgical Procedures for Mesothelioma
The goal of palliative surgery for mesothelioma is to:
- Improve quality of life
- Reduce pain
- Alleviate shortness of breath
- Lessen other distressing symptoms
Palliative surgery will not cure the cancer.
Palliative mesothelioma procedures involve inserting a hollow needle or tube into the body to drain fluid and relieve pressure on vital organs. These procedures are named after the area or cavity in which fluid is drained.
Types of Palliative Mesothelioma Surgeries
- Thoracentesis: Drains fluid from around the lungs
- Paracentesis: Drains excess fluid from the abdomen
- Pericardiocentesis: Drains fluid from the pericardial sac surrounding the heart
- Pleurodesis: Fluid is drained from around the lungs, followed by the additional step of placing a substance (such as talc) into the pleural space to seal it and prevent fluid from accumulating again.
While removing the fluid will not cure the disease, it will make a person feel better immediately. Breathing will become easier. Stomach, chest and back pain may lessen considerably, too.
Clinical Trials and Palliative Surgery
Because there is no cure for mesothelioma, many patients are interested in clinical trials. Clinicaltrials.gov provides a way to search for mesothelioma clinical trials.
Even if a person is willing to enroll in a clinical trial testing an experimental new therapy, this does not mean they want to give up quality of life.
Patients can work with their oncologist to locate a clinical trial that may be a good fit for their situation, and also allow for ongoing palliative care to maximize their well-being.
Combining Palliative Surgery with Other Treatments
Palliative surgeries can be used while a person’s cancer is being treated in other ways.
For example, a person may undergo thoracentesis while continuing to receive chemotherapy.
By combining palliative surgical options with other cancer treatments, a patient can feel better and continue managing their disease with available therapies.
Characteristics of Mesothelioma Can Affect Surgery Goals
Certain characteristics of mesothelioma mean tumor-removing surgery is not a common treatment option.
Mesothelioma often develops with cancerous tissue interlaced throughout healthy tissue. This makes the disease more difficult to target with surgery than other solid tumors.
Palliative surgery, on the other hand, can be an excellent way to help a patient have the best possible quality of life while living with and managing mesothelioma.