Mesothelioma is a disease in which malignant cells in the pleura grow in an uncontrolled fashion with the ability to travel to other parts of the body and disrupt the normal function of the affected organ. It is caused by a genetic mutation in normal cells that turns them into malignant cells and can develop spontaneously or from environmental exposure such as asbestos.
Mesothelioma typically starts in the lining around the lung called the pleura. It initially thickens as it grows over time. As the lining around the lung thickens, patients develop symptoms that may include cough, shortness of breath, hoarseness, weight loss, fatigue, and pain at different parts of the body.
Mesothelioma is diagnosed and treated based on the type of lung cancer. There are two main types of mesothelioma: sarcomatoid and epithelioid.
Saromatoid mesothelioma is typically treated with chemotherapy and radiation therapy. Rarely, surgery is used as part of a treatment regimen.
For epithelioid mesothelioma, surgery plays an important role in the treatment for early stage mesothelioma along with systemic therapy and radiation therapy. However, surgery is rarely used as part of a treatment regimen for more advanced epithelioid mesothelioma.
Once the patient is diagnosed with mesothelioma, he or she undergoes studies to determine the clinical stage of mesothelioma. The following tests provide information on the degree of the spread of cancer. Typically, mesothelioma is found around the lung and spreads to nearby lymph nodes, then to lymph nodes in the middle of the chest, and finally to other organs such as the brain, adrenal gland and bones.
- CT of the chest—This study is performed in radiology. It provides information about the size of the tumor, relationship of the tumor to vital structures, and whether any of the lymph nodes near the tumor or middle of the chest are concerning for the spread of cancer.
- PET-CT—This study is performed in radiology. It provides information about the spread of cancer to lymph nodes and other parts of the body except for the brain.
- MRI of the brain—This study is performed in radiology. It provides information about the spread of cancer to the brain.
- EBUS or Mediastinoscopy—This study is performed to determine whether the tumor has spread to lymph nodes in the middle of the chest.
This provides clinical staging for patients with mesothelioma. For patients with early stage cancer, we perform additional tests to determine if they can safely undergo surgery.
- Cardiac testing—These studies are typically performed by a cardiologist. They are a set of tests to determine if the patient’s heart can safely undergo the stress of surgery.
- Pulmonary function test (PFTs)—This study is performed in a pulmonary lab. It provides information on the patient’s lung function and provides information on the patient’s lungs’ ability to tolerate resection.
- V/Q scan—This test is performed in radiology. It is performed if the PFTs show marginal lung function. It provides more accurate information about the patient’s ability to tolerate lung resection.
- Cardiopulmonary exercise testing (CPET) and maximal oxygen consumption (VO2 max) —These tests are performed in a pulmonary lab. CPET provides information on VO2 max or maximal oxygen consumption. This test is performed if PFTs show marginal lung function. It provides the most accurate information on the patient’s ability to tolerate lung resection.
These studies allow us to advise patients with mesothelioma about the best treatment option for them.
In our practice, we offer pleurectomy and decortication with resection and reconstruction of the diaphragm and pericardium.