Mesothelioma Treatments

Mesothelioma Surgery - Pleurodesis

Although mesothelioma can strike anywhere on the lining between the inner wall of the torso (parietal) and that surrounding the internal organs (visceral), it is most commonly found around the lungs, where it is known as pleural mesothelioma (when surrounding the stomach and/or digestive tract, it is called peritoneal; when the heart is involved, it is pericardial).

This is to be expected, as the asbestos fibers most often enter the body through the respiratory system. However, because they are microscopic, these fibers can go anywhere in the body and affect any system. It is not unusual for mesothelioma patients to experience blockages in the lymphatic system, which can cause fluids to built up in the chest. The medical term for this is pleural effusion.

Pleural effusion in mesothelioma patients is considered exudative; its causation is "local" as opposed to being caused by the failure of another organ, such as the heart or liver.

Although this fluid can be removed through the use of a tube inserted into the chest cavity, fluid will continue to collect in this space, necessitating the reinsertion of a tube, or intercostal (between the ribs) drain.

One solution is to eliminate this space between the parietal and visceral linings so that such a build-up cannot occur. The process that is used is called pleurodesis.

The Treatment

The first step is of course to remove all lymphatic fluids that have built up in the space between the parietal and visceral linings (the pleural space or cavity). Once this has been accomplished, the next step is to literally attach the surface of the lung to the pleural lining, sealing up the pleural space.

A pleurodesis procedure can be performed either surgically or chemically. In either case, this treatment is likely to be quite painful, but it ultimately allows the patient to breathe without discomfort. Prior to the treatment, the patient is usually sedated and administered analgesic medication. In the case of surgical pleurodesis, the patient is under general anesthesia.

Surgical Pleurodesis

The surgeon may take one of two approaches. If necessary, s/he literally cuts into the patient's chest; this is called a thoracotomy. In the case of the lungs, this is usually performed from the side, in which case it is called posterolateral.

The other, preferable method is via thoracoscopy. Although this technique has been around for nearly a century (it was first developed in Sweden in 1910), the advent of digital imaging and tiny cameras have made this procedure easier, safer and less invasive than ever. Instead of having to cut open the patient's chest, only a small hole is necessary through which a special surgical instrument can be inserted.

The next part is unpleasant, and involves the irritation of the surfaces of the parietal and visceral linings with the use of a rough pad. This causes inflammation which seals the lung and the pleural lining together as they heal.

During surgical pleurodesis, the surgeon may also remove some of the lung and/or pleural tissue that show indications of metastasis (spread of the malignancy).

Chemical Pleurodesis

This is the least invasive, using video-assisted thorascopy (VATS). It is however no less uncomfortable for the patient. Once the pleural effusion has been drained, a chemical of some type - usually a slurry of talc, but sometimes tetracycline or a form of iodine - is introduced into the pleural cavity through a similar intercostal drain. This chemical agent causes the same kind of irritation and inflammation of the two surfaces, which eliminate the pleural space as they heal and fuse together.

What to Expect During Recovery

The doctor will prescribe some type of analgesic pain reliever; however, the patient should avoid any type of anti-inflammatory medication such as aspirin or ibuprofen, since inflammation of the surfaces is part of the process. One side effect of the pain medication is likely to be constipation, so the patient should plan on increasing the amount of fiber in his/her diet.

Although the first few weeks will involve considerable discomfort - and if the doctor has ordered that a drain tube be worn with a dressing, no small amount of inconvenience - but the result will be the ability of the lungs to expand once more, eliminating painful breathing and coughing.

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