Thoracentesis is a mesothelioma treatment and diagnostic procedure in which a small needle is inserted into the chest cavity, usually from the back, to drain fluid away from the cavity between the lungs and the chest wall. This chest cavity, referred to as the “pleural space”, is the area in which pleural mesothelioma (cancer in the lungs) can cause excess fluid to accumulate, making it difficult for the patient to breath and causing pain. Mesothelioma thoracentesis is an invasive procedure that requires at least local anesthesia and cooperation from the patient to avoid unintentional injury to the nearby lung. In severe cases of pleural effusion, a condition in which the lining of the lungs (pleura) secretes too much serous fluid, thoracentesis may be replaced with a chest tube procedure.
Thoracentesis and pleurodesis are the two most common treatments for mesothelioma related pleural effusions. Anyone exposed to asbestos can develop pleural effusion as a result of exposure. The primary reason for mesothelioma patients to undergo this type of treatment is to relieve the symptoms of effusion, of which include shortness of breath and chest pain. Mesothelioma thoracentesis may also be used as a diagnostic procedure, yielding fluid that can be laboratory tested for the markers of disease and other abnormalities. It also assists in diagnosing mesothelioma cancer.
Mesothelioma Thoracentesis Procedures
Before deciding to carry out the procedure of thoracentesis, a doctor will conduct a series of tests to determine if a pleural effusion is present. This typically involves a physical examination in which the doctor discovers a distended area around the chest cavity that may indicate some type of fluid buildup. Alternatively, effusion may be discovered by taking pictures of the chest cavity in a person with pleural mesothelioma. (Imagining procedures may also be prescribed to confirm the presence of fluid when distention is discovered during the physical exam.)
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How a Doctor Might Identify a Pleural Effusion |
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| Physical Exam | A doctor may discover distention – swelling around the chest cavity. |
| Chest X-Ray | A chest x-ray provides a clear picture of the pleural cavity, showing fluid in the chest cavity. |
| Ultrasound | Ultrasound provides a close up view of the area where a biopsy needle will be inserted, to help avoid complications. |
| CT Scan | A CT Scan of the chest will show a “sliced” view of the chest, enabling a doctor to find the exact location(s) of fluid accumulation. |
The site for the procedure is primarily determined according to where the fluid has accumulated in the pleural cavity. In most cases, the best site at which to insert the needle is in through the back between the ribs. Before beginning the procedure, the patient is seated and leaned slightly forward onto a padded, chest height table. A nurse cleans the site with an antiseptic and a doctor introduces a local anesthesia so that the patient doesn’t feel any pain during the procedure.
When the anesthesia has had time to effectively numb the area, a long thin needle is inserted through the back, between the ribs, and into the chest cavity. Some patients report a mild sensation of pressure or pain as the needle enters the pleural space. Once in place, a syringe or small tube affixed to a vacuum pouch or bottle is attached to the needle. The vacuum then draws the fluid from the pleural space and into the syringe, pouch, or bottle. When all of the fluid is believed to be removed, the doctor removes the needle and bandages the entry site.
The fluid removed during mesothelioma thoracentesis is then sent to a laboratory for testing. An x-ray follow up is conducted to ensure that there were no complications and that most or all of the fluid was removed successfully.
The complications of mesothelioma thoracentesis are rare, but important to identify if they do occur. Possible complications include:
- Pneumothorax
- Pulmonary Edema
- Infection and Bleeding
- Puncture damage to other nearby organs
Pneumothorax is a term that describes a partial lung collapse due to a punctured lung. When the lung is punctured, air may seep into the pleural space. Air in the pleural space may cause the same effects as fluid accumulation and is usually treated in the same manner. A pulmonary edema occurs when fluid begins to accumulate inside of the lungs. Bleeding can be caused by punctures or ruptured vessels during the procedure. Infection may occur in patients, particularly those with a compromised immune system, such as with pleural mesothelioma.
Mesothelioma Thoracentesis as a Complimentary Therapy
Common symptoms of patients with this asbestos related cancer include shortness of breath and pain under the ribs or under the rib cage. In many cases, the direct cause of both symptoms is pleural effusion in which the formation of fluid in the pleural space causes severe discomfort, at best. A complimentary therapy is a treatment or procedure that treats the symptoms of a disease or condition. Mesothelioma thoracentesis is a complimentary therapy because it is intended to treat an effect of pleural mesothelioma.
Mesothelioma Thoracentesis as a Diagnostic Procedure
As a diagnostic procedure, mesothelioma thoracentesis is used to identify the type of cells present in fluid that has been detected around the lungs. This procedure may occur after an initial diagnosis of mesothelioma to determine the type of cancer cells that are present or as part of a biopsy to provide the initial diagnosis. Staging mesothelioma may also be made easier through thoracentesis fluid testing. In both therapy and diagnostic application, the procedure itself remains the same; a biopsy needle is inserted under the rib and into the area with fluid accumulation.
Alternatives to Mesothelioma Thoracentesis Treatments
Some mesothelioma patients are unable to undergo thoracentesis because of infection or an inability to sit still during the procedure. This can often be the case with mesothelioma patients, who may be afflicted with tremors due to other diseases such as Parkinson’s, stroke, and multiple sclerosis. When simple thoracentesis is ineffective in mesothelioma patients, doctors may resort to tube drainage and pleurodesis. In some cases, a pleurectomy (removing part of the pleura) becomes necessary.
Tube drainage, also known as thoracotomy, is a procedure in which they chest cavity is surgically opened and a large tube is inserted to assist in fluid drainage. Pleurodesis is a common complimentary treatment for those with pleural mesothelioma. During pleurodesis, a doctor injects medicinal drug or a powdery talc-like substance into the pleural cavity to mitigate the accumulation of excess serous fluid seeping from the pleura, the lining of the lungs and chest wall. As a result of pleurodesis, the pleural space is eliminated, leaving the fluid nowhere to go. Alternative treatments to alleviate pain may also be prescribed, including drugs and eastern therapies such as acupuncture.
