Depending on the stage of a mesothelioma, surgery may be used to remove the cancer and some of the surrounding tissue. Often, however, an operation is not appropriate and the patient may have only minimally invasive procedures to relieve symptoms. A thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity, may be done to make a patient more comfortable. Sometimes talc or an antibiotic may be injected into the chest cavity to try to prevent the fluid from returning. These techniques are successful in controlling the fluid, at least temporarily, in as many as 90% of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help patients breathe more easily, however, they do not cure the cancer. In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, a needle inserted into the pericardium (sac around the heart) can drain the fluid caused by pericardial mesothelioma and help relieve circulatory problems. However, draining this fluid may result in complications. Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area.Surgery for mesothelioma may be performed for one of two reasons: for palliation (to relieve pain and discomfort caused by the tumor), or to cure. Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to completely remove, or in cases where the patient is too ill to tolerate a more extensive operation. Curative surgery is offered when the patient is in otherwise good health and the tumor is thought to be localized and can be completely removed. Unfortunately, microscopic spread of cancer cells into the chest wall and diaphragm are common even when such spread cannot be detected by routine tests. Therefore, given the extent of these operations and their very limited success, the exact role of surgery in treating mesothelioma is often debated.
There are two types of operations that may be offered to patients with pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy. Pleurectomy/decortication is usually a palliative (relieves symptoms without curing the cancer) operation in cases where the entire tumor cannot be removed. It involves removal of the pleura, where the majority of the tumor is located. It is effective in controlling effusions (fluid accumulation) and decreasing the pain caused by the cancer.
Extrapleural pneumonectomy is a far more extensive operation and most often used in cases of localized mesothelioma. The operation is technically difficult and performed only by surgeons in large specialized medical centers. It involves removing the pleura, diaphragm, pericardium, and the whole lung on the side of the tumor. The patient must be in overall good health with no other serious illnesses in order to tolerate the large operation. This operation is intended to remove all or most of the cancer and some surrounding tissues as well.
Surgical treatment of peritoneal mesothelioma is often performed either to help relieve symptoms or to attempt to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be performed to remove a mesothelioma from the pericardium (the sac around the heart).
Source:
American Cancer Society - Detailed Guide: Malignant Mesothelioma Surgery http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Surgery_29.asp?rnav=cri
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