Malignant mesothelioma is a rare type of cancer that starts in the lining of certain parts of the body, usually the lining of the chest and abdomen. The most common type of malignant mesothelioma is pleural mesothelioma. The leading risk factor for malignant mesothelioma (commonly referred to only as mesothelioma) is exposure to high levels of asbestos.
Signs and Symptoms can include:
- Chest pain
- Shortness of breath
- Pleural effusion(s)
- Difficulty swallowing
- Or a patient may be asymptomatic
Once there is concern that a patient may have mesothelioma, there are multiple interventions we offer to either diagnose, stage, and/or resect the cancer.
Diagnostic Interventions include:
Endobronchial ultrasound (EBUS)
An endobronchial ultrasound (EBUS) is a bronchoscopic technique that uses ultrasound to view structures within the airway, lung, and mediastinum. This approach can be used in the diagnosis and staging of lung cancer, in diagnosing mediastinal lymphadenopathy of unclear etiology, in sampling/biopsying certain pulmonary nodules and endobronchial or peribronchial lesions, and in sampling mediastinal masses. We will often perform an EBUS with fine needle aspiration (FNA) in order to sample the tissue in question. The advantage in performing an EBUS versus another form of diagnostic testing is that this procedure is minimally invasive and is usually performed under moderate sedation (not general anesthesia).
Esophageal endoscopic ultrasound (EUS)
An esophageal endoscopic ultrasound is a procedure where the surgeon enters the esophagus with an endoscope to view and/or biopsy esophageal masses, certain lung masses, and abnormal lymph nodes.
A pleural biopsy is performed via a VATS. This may be indicated if a patient has a recurrent pleural effusion, irregular pleural thickening, or if other tests have not given definitive answers.A video assisted surgery is a minimally invasive lung surgery where the surgeon creates multiple small incisions in the chest and uses a video camera that sees into the chest in order to perform the procedure. Performing a VATS procedure will accomplish the same anatomic dissection as an open thoracotomy approach.
Surgical Interventions include:
Radical pleurectomy and decortication with or without Hyperthermic Intraoperative Intrathoracic Chemotherapy
A radical pleurectomy and decortication is a surgery performed via open thoracotomy where the surgeon carefully and meticulously removes the lining of the chest wall (parietal pleura) and the lining of the lung (visceral pleura) on the side of the chest affected by mesothelioma. This typically also involves resection and reconstruction of other potentially affected areas of the chest (the lining of the heart, chest wall and the diaphragm). This operation is performed with a team of surgeons, including our Surgical Oncology associates. Typically at the end of surgical resection, the patient will receive hyperthermic intraoperative intrathoracic chemotherapy to completely eradicate tumor cells and to prevent disease recurrence.
Extra-pleural pneumonectomy essentially involves all the components of radical pleurectomy and decortication (as described above), with the addition of removing the entire lung on the affected side. This is sometimes necessary if the tumor is invading the broncho-vascular structures of the lung.