When you have mesothelioma, you may have surgeries to diagnose the disease or to treat it. Surgery is rarely used alone. Doctors often use surgery as part of multimodal therapy that includes chemotherapy and radiation therapy. Not every patient is a good candidate for surgery. However, there are many other mesothelioma treatment options that will be offered to you.
Various Surgical Options
When you are diagnosed with mesothelioma, your doctors will need to know if you are healthy enough to have surgery and if you will be able to recover from it. This involves doing certain tests. Common tests to determine eligibility for surgery include:
- Electrocardiogram (EKG)
- Cardiac stress test
- Pulmonary function tests
If these tests return as normal or near-normal, the doctor will consider doing surgery to help treat the mesothelioma. Surgery can be done before chemotherapy and radiation or after chemotherapy and radiation. If the mesothelioma is localized and of a low stage, surgery might be done with the intention to cure the disease. In this type of surgery, all visible signs of cancer are removed and sometimes the diaphragm and lung are removed as well.
Types of Surgeries
Many people will have diagnostic surgeries that help obtain biopsies that diagnose mesothelioma. Some surgeries used for diagnosis of mesothelioma include:
- Open lung biopsy
- Fine needle biopsy
- Core biopsy
- Excisional biopsy
The type of diagnostic surgery done depends on where the cancer is located and on the skill and preference of the mesothelioma specialist.
- Extrapleural Pneumonectomy (EPP). In this radical surgery, the entire affected lung is removed in an effort to remove the mesothelioma tumors. Parts of the pleural lining of the lungs and diaphragm are removed as well. This is a very invasive surgery that can be risky and take a long time to recover from. Despite this, many people have lived long past their prognosis after receiving an EPP.
- Pleurectomy with Decortication (P/D). In this surgery, the cancer is removed along with the pleural lining but sparing the lung and the diaphragm. This surgery was developed by Dr. Robert Cameron at the UCLA Medical Center. It has been found to be less invasive than the EPP, and people who have this surgery tend to live up to 19 months after having it performed.
- Cytoreduction with HIPEC. The HIPEC procedure is performed on patients with peritoneal mesothelioma. During the surgery, the doctors remove all visible traces of cancer and then put heated chemotherapy medications inside the abdomen in order to kill off any remaining cancer cells. Some people who have had this type of surgery have lived five years or more.
Sometimes surgery is done just to relieve symptoms and not to cure the disease or extend the individual’s lifetime. Types of palliative surgery include the following:
- Pleurodesis. This procedure is done for patients with pleural mesothelioma. It involves inserting a flexible tube into the chest wall so that fluid can drain from around the lung. In some cases, antibiotics (to treat infection), talcum powder (to prevent the buildup of more fluid), or chemotherapy drugs (to kill cancer cells) are given after the fluid has been drained. The chemotherapy drug called bleomycin is sometimes used as part of the pleurodesis procedure.
- Thoracotomy. During this surgery, the chest wall is opened up and part of the lung, cancerous tissue and pleural tissue are removed to reduce the amount of cancer in the chest cavity.
- Paracentesis. This surgery is done for patients with peritoneal mesothelioma. Like pleurodesis, a hollow tube is inserted into the abdominal cavity to remove fluid so patients can feel less pressure and less shortness of breath.
- Segmentectomy. This is also called a wedge resection. During this procedure, cancer that is located in one area of the lung is removed, leaving the rest of the lung intact. It is less invasive to do this type of surgery than it is to remove the entire lung but it does not remove all the cancer. Shortness of breath and chest pain can be relieved after this procedure.
- Lobectomy. In a lobectomy, one or more of the lobes of the lung are removed. It is used when the cancer appears to reside in just one lobe of the lung and is considered less invasive than removing the entire lung.
- Pneumonectomy. In a pneumonectomy, the entire lung is removed. It is the most invasive of palliative surgeries but can help reduce chest pain. Usually, the removal of the lining of the lung (the pleura) is done as well.
- Shunt or catheter placement. During this procedure, a tube is placed in the pleural cavity or in the peritoneal cavity so that fluid can continually drain from the area. This eliminates the need to do repeat surgeries to remove fluid that will continue to build up because of the cancer.
The type of surgeries you have depend on the stage of mesothelioma you have, the cell type you have, and on the preferences of the mesothelioma specialist. Each specialist has his or her own area of expertise and may prefer one type of surgery over another.