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Mesothelioma Treatment - Surgery - Overview

Surgical procedures involved in the treatment and diagnosis of mesothelioma are divided into three main categories:

• Diagnostic surgery is used to confirm whether or not cancer is present and where it is located. This is typically non-invasive.
• Curative surgery is carried out with the intention of removing as much cancer as possible with hopes of curing the patient. Radiation therapy or chemotherapy is often administered following curative surgery.
• Palliative surgery involves the removal of cancerous tissue and is used to provide symptomatic relief, but does not offer a cure.

Biopsy

A biopsy is a diagnostic surgical procedure in which suspected cancer cells are removed and tested to determine whether they are cancerous. There are three types of biopsy procedures: core biopsy, excisional biopsy, and needle aspiration biopsy. Core biopsy is generally not used to diagnose mesothelioma.

Excisional biopsy involves an operation to determine how far the mesothelioma cancer has spread. Rather than only remove a portion of the suspected cancerous tissue, this biopsy typically removes as much tissue as possible to prevent the spread of asbestos cancer.

Needle aspiration biopsy uses a very long needle to remove a small sample of cells from the area where cancer is suspected. The cells are then tested for the presence of mesothelioma.

Thoracentesis

Thoracentesis is used to diagnose patients who have suspected pleural mesothelioma, and may also be used as a palliative surgical treatment for pleural mesothelioma patients who are suffering from the effects of a buildup of fluid in the lungs.

During a thoracentesis, a very long, hollow needle is inserted into the pleural spaces of the lungs and fluid is removed through the needle. This process is performed under a local anesthetic. If the procedure is used for diagnostic purposes, the doctor may order chest x-rays before the operation to determine the best location from which to extract samples. After the process, the fluid is sent to a laboratory for diagnostic testing.

Pleurodesis

Pleurodesis is a palliative surgical treatment option for those coping with pleural mesothelioma. This procedure is performed in order to prevent a side effect of pleural mesothelioma, called pleural effusion. Pleural effusion is the buildup of fluid in the lungs, which can cause considerable pain and breathing difficulties.

During a pleurodesis, the pleural spaces are first drained of fluid and then treated with a talc-like chemical that causes inflammation. This causes the pleural spaces to "close up," thus preventing further fluid buildup.

Pneumonectomy

A pneumonectomy is the removal of one lung. This procedure may be used for patients with pleural mesothelioma and may be a suitable method of treatment for patients who have mesothelioma in just one of their lungs. Those who have mesothelioma in both lungs, or cancer that has spread to other parts of the body, is usually not a good candidate for a pneumonectomy. Suitable candidates must also be otherwise healthy to prevent the possibility of complications during or after surgery.

Pneumonectomy is performed under general anesthetic and during the procedure the affected lung is completely removed. Following surgery, patients must usually breathe with the assistance of a respirator for several days.

Paracentesis

Paracentesis involves the removal of fluid that has built up in the abdominal cavity of patients with peritoneal mesothelioma. This fluid collection in the peritoneal cavity can cause considerable pain and discomfort due to the pressure the fluid places on internal organs. During a paracentesis procedure, the fluid is removed through a long, hollow needle that is inserted into the abdomen.

Note that Paracentesis is a type of palliative surgery; it provides relief from some of the symptoms of mesothelioma, but it cannot provide a cure.

Thoracotomy

Thoracotomy is a generic term that refers to lung surgery that may be performed on patients with pleural mesothelioma. There are three main types of thoracotomy procedures: wedge resection, lobectomy, and pneumonectomy.

In cases where only small, localized tumors are present, a wedge resection may be performed to remove the tumor, while leaving as much healthy tissue as possible intact. In a lobectomy, one or more of the five lobes of the lungs are removed. The third option is a pneumonectomy, in which an entire lung is removed.

Thoracoscopy

Thoracoscopy is a procedure that may be used as a diagnostic measure for patients suspected of having pleural mesothelioma or another lung disease. During this procedure an incision is made in the chest, and a long, thin tube is inserted into the pleural spaces of the lungs, enabling a doctor or surgeon to examine the pleura. Samples of suspected mesothelioma cancer cells are then removed to be tested for cancerous characteristics.

Sources:

1. Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York. 2005.
2. http://www.cancer.org/downloads/PUB/DOCS/SECTION28/89.pdf
3. http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm
4. http://www.netdoctor.co.uk/health_advice/examinations/biopsy.htm
5. http://www.webmd.com/brain/paracentesis-17042
6. http://www.pulmonologychannel.com/pleuraleffusion/treatment.shtml
7. http://www.impmeso.org/pleurodesis/c28_p24/Mesothelioma_Treatments/Traditional_Treatments/ Mesothelioma_Surgery/Pleural_Mesothelioma/Pleurodesis.html
8. http://cancer.about.com/od/lungcancersurgery/p/pneumonectomy.htm
9. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/23692.html
10. http://www.nlm.nih.gov/medlineplus/ency/article/003420.htm
11. http://www.webmd.com/a-to-z-guides/thoracentesis
12. http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI= /healthatoz/Atoz/ency/thoracoscopy.jsp
13. http://www.healthsquare.com/mc/fgmc1001.htm
14. http://www.webmd.com/lung-cancer/lung-surgery-thoracotomy-for-lung-cancer

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