Several Surgical Treatments That Can Relieve Mesothelioma Symptoms

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In many cases, surgery to remove cancerous cells, such as in early stage colon cancer, can greatly improve one's odds of survival. In the case of mesothelioma, a rare cancer that develops in the lining of various organs, surgery is usually used to minimize symptoms rather than cure the disease. 

“For most people with mesothelioma, the care is predominantly palliative,” explains Neil Schachter, MD, medical director of respiratory care and a professor of pulmonary medicine at the Mount Sinai Medical Center in New York City. There is no known cure for mesothelioma, so palliative care — care that focuses on alleviating symptoms instead of curing the disease — is the mainstay of treatment.

Understanding Mesothelioma 
According to Dr. Schachter, mesothelioma is particularly difficult to treat because it differs from other, more common cancers in a number of ways. “The problem with mesothelioma is it’s not one of these cancers that goes all over your body,” he says. “It tends to be localized and grows [only in certain] areas," Schachter adds. As a result, mesothelioma often leads to vague symptoms that can mimic other conditions, making it tougher to diagnose. By the time mesothelioma is actually diagnosed, it becomes that much more challenging to treat.

Surgical Options for Mesothelioma
Mesothelioma typically affects the pleura, the lining of the lungs. When the pleura become irritated, excess fluid can build up in the lungs making it very difficult to breathe. Many palliative procedures for mesothelioma therefore involve surgical procedures to drain and prevent this type of fluid accumulation.

Surgical palliative care options for treating mesothelioma include:

• Chest tube drainage. When excessive fluid builds up around the lungs, a thick catheter or chest tube may be temporarily placed to allow the fluid to drain outside of the body.
• Pleurodesis. After the fluid is successfully drained, surgeons may place special chemicals into the pleural space in a procedure known as pleurodesis. These chemicals usually cause the pleural tissue to become so scarred that no new fluid can accumulate.
• Pleuroperitoneal shunt. Another option for addressing recurrent fluid buildup is to place a permanent catheter that diverts pleural fluid away from the lungs into the peritoneal, or abdominal, cavity.
• Pleurectomy and decortication. These surgeries are more drastic than pleurodesis, Schachter says, but they can be helpful for relieving symptoms if pleurodesis is ineffective. In a pleurectomy, the pleural tissue is separated from the lungs and chest wall and removed. In a decortication, both the pleural tissue and associated scar tissue are removed. “You are basically peeling out all the scar tissue that surrounds the lung,” Schachter explains. This enables patients to breathe more easily.
• Palliative tumor resection. This involves “cutting out as much tumor as you can, but this is the kind of tumor that you can’t just take all out; it will [eventually] grow back,” Schachter says. Even so, removing the tumor and any damaged lung tissue can temporarily alleviate shortness of breath and chest discomfort.

In some cases, an operation called extrapleural pneumonectomy can also be performed. This is considered a very extensive surgery. In addition to removing the pleura and some of the lung, surgeons “also sometimes take part of the diaphragm," explains Schachter. "If you happen to be young and relatively functional, and they find no lymph node involvement, then your prognosis for five-year survival is almost reasonable. But that represents a small percentage of patients. There’s also hope that treating some patients with chemotherapy may shrink some tumors."

Other Palliative Treatments 
Bartolome R. Celli, MD, chief of pulmonary care at St. Elizabeth’s Medical Center in Boston, also says that experimental chemotherapy regimens can relieve discomfort for mesothelioma patients. “In addition, oxygen if necessary, analgesics [pain killers], and opiates [narcotic pain killers] will improve symptoms and quality of life,” Dr. Celli adds. Palliative radiation therapy can be used to control pain as well.

Though there is currently no cure for mesothelioma, researchers are studying novel ways to control the progression of this disease. In the mean time, palliative care therapies aimed at reducing pain and other symptoms are essential for people with mesothelioma.