In general, surgery is an option that you and your doctor may choose as a method of treatment during your battle with mesothelioma.
Two types of surgery your doctor can perform to reduce the signs and symptoms of mesothelioma are pleurectomy, removal of tissue around your lungs, and a peritonectomy, removal of the tissue of the abdominal cavity.
Debulking, or the removal of as much cancer as possible, is a third type of surgery that may be performed in later stages of cancer combined with chemotherapy and radiation to minimize tumors, or prevent the growth of new cancer cells.
Main Reasons for Surgery
The two main reasons for surgery are palliation, which is making a patient feel morge comfortable and trying to relieve pain and discomfort, and trying to cure a patient.
Palliative care is when a tumor has metastasized or spread beyond the mesothelium and is difficult to remove completely. In addition, if a patient is too ill to undergo the necessary extensive operations to remove tumors, doctors will choose palliative care measures instead, such as the removal of excess fluid.
Thoracentesis, the removal of fluid build-up in your lungs decreasing your ability to breath, is one type of surgery that can be performed. The surgeon will insert a needle into your chest cavity and drain away the excess fluid. During this time your doctor may also choose to inject talc or antibiotic medicine into your chest to prevent the fluid from returning, which is known as pleurodesis.
The fluid can compress your lungs and make it very difficult to breath. Removing this fluid can make your more comfortable, but unfortunately is not a cure for your mesothelioma. This type of needle insertion can be performed in the abdomen for peritoneal mesothelioma to remove excess fluid retention in the abdomen, as well as in the pericardium, the sac around the heart.
This can help to drain the fluid away from the abdomen and the heart and to relieve circulatory problems. However, cancer cells can sometimes metastasize, or spread, along the path that was made by the needle, and new tumors can form.
Your doctor may choose to do neoadjuvant chemotherapy, which is chemotherapy before the surgery, or adjuvant chemotherapy, which is chemotherapy after the surgery, to try to prevent these new cancer cells from growing. Radiation therapy is another form of treatment doctors will use after surgery to prevent the growth of new cancer cells.
This type of therapy is called combination therapy or multimodality treatment and can be used at any stage during your disease either to work on reducing the size of tumors or to make you feel more comfortable as the disease progresses. You and your doctor can discuss the right combination of treatment options for you.
Curative surgeries are for when a patient is in otherwise good overall health and tumors are considered to be localized and thought to be able to be completely removed. In some cases however, the microscopic spread of cancer cells is still possible, and often times undetectable on everyday screenings.
Here again is where your doctor will choose to combine other methods of treatments such as chemotherapy and radiation as an added measure to removal cancer cells. It is a good idea to discuss your concerns about different methods of surgery with your physician.
Surgery Specific to Pleural (Lung) Mesothelioma
One surgery specific to pleural mesothelioma, or mesothelioma that affects the tissue surrounding the lungs is a pleurectomy/decortication. This is a palliative measure where the entire tumor cannot be removed.
This surgery involves the removal of the pleura where the majority of the tumor is located. It is effective in controlling pleural effusions, which are fluid accumulations, and decreasing pain caused by the cancer.
A more extensive surgery that is offered in a more localized case of pleural mesothelioma is an extrapleural pneumonectomy. This surgery needs to be performed by a special surgeon in a very large medical facility that specializes in this type of surgery. It is a requirement that the patient is in otherwise excellent health with no other illnesses for this procedure to occur.
The surgeon will remove the pleura, diaphragm, pericardium, which is the sac around the heart, and the whole lung on the side that has the tumor. The intention is to remove all or most of the cancer and some of the surrounding tissue.
Surgery Specific to Peritoneal (Abdominal) Mesothelioma
Surgeries specific to peritoneal mesothelioma, or the wall of the abdomen, are performed to relieve symptoms or attempt to remove the tumor from the wall or other digestive organs. As with pleural mesothelioma surgeries, often times these tumors are too extensive to remove completely, and doctors will choose more palliative options such as fluid removal.
Surgery Specific to Pericardial (Heart) Mesothelioma
Similar to surgeries specific to peritoneal mesothelioma, pericardial (heart) mesothelioma surgeries are often too complex, because the tumors are too difficult remove completely. Again, in this case doctors will choose more palliative care choices such as fluid removal to make their patients feel more comfortable.
Surgery Specific to Tunica Vaginalis (Testicles) Mesothelioma
Because mesothelioma of the tunica vaginalis, or testicles, is so rare, the information regarding the disease is limited. There have been reports that some males can have an increase quality of life after undergoing a penectomy, removal of the penis, and scrotectomy, removal of the scrotum, which are curative surgical options for men with mesothelioma of the tunica vaginalis.
However, if this is not an option for you, your doctor may consider palliative surgical choices to relieve some of the signs and symptoms of mesothelioma, such as the thoracocentesis to remove fluid around the tunica vaginalis.
Conclusion
Surgery for mesothelioma is just a matter of where your mesothelioma is located – your lungs and your abdomen are the two main locations, with your heart and testicles as secondary locations. You and your doctor will work together to decide what the best surgical choice is right for you.
You can decide between palliative care options with the removal of excess fluid built up around the areas affected by mesothelioma, and the injection of talk and antibiotics to help keep the fluid from returning.
You other choice is more invasive surgical options that can include the removal, if possible of your tumors from your lungs, abdomen and heart, and maybe the removal of some of your organs, depending on your overall health.
All of these choices take careful consideration and need to be discussed with you physician as well as your family. It is a good idea to gather as much information as you can, and make an educated decision about your health.
