Palliative Procedures for Malignant Mesothelioma

Mesotheliomas can often be hard to remove or destroy completely. Still, treatments can often help control it for a time or ease problems it's causing. For instance, some types of surgery or chemotherapy might help keep the cancer in check. Radiation therapy might also be useful to ease chest pain or blockages in the breathing tubes.

Removing fluid

If pleural mesothelioma is causing fluid to build up in the body, it can often cause trouble breathing and other problems. Sometimes procedures can be used to remove the fluid or help keep it from coming back.

Thoracentesis, paracentesis, and pericardiocentesis are procedures that can be used to take out fluid that has built up and is causing symptoms such as trouble breathing. A long, hollow needle is used to remove the fluid. These procedures are described in Tests for Malignant Mesothelioma. The fluid often builds up again, so these procedures might need to be repeated.

Pleurodesis

This procedure may be done to try to keep fluid from building up in the chest. A small cut is made in the skin of the chest wall, and a hollow tube (called a chest tube) is put into the chest so that the fluid can drain out. Then, a talc mixed in a fluid (talc slurry), the antibiotic doxycycline, or the chemotherapy drug bleomycin is put into the chest tube. This irritates the linings of the lung (visceral pleura) and chest wall (parietal pleura) so that they stick together, sealing the space and preventing further fluid build-up. The tube is generally left in for a day or two to drain any new fluid. Pleurodesis can also be done during a thoracoscopy.

Shunt placement

A shunt is a device that allows fluid to move from one part of the body to another. For example, a pleuro-peritoneal shunt lets excess fluid in the chest drain into the abdomen (belly). There, it's more likely to be absorbed by the body. A shunt may be used if pleurodesis or other techniques don't work.

The shunt is a long, thin, flexible tube with a small pump in the middle. In the operating room, the doctor puts one end of the shunt into the chest space and the other end into the abdomen. (The pump part stays just under the skin over the ribs.) Once the shunt is in place, the patient pushes down on the pump several times to move the fluid from the chest to the abdomen. This is usually done a few times each day.

Catheter placement

This is another approach sometimes used to control fluid build-up. One end of the catheter (a thin, flexible tube) is put in the chest (or abdomen for peritoneal mesothelioma) through a small cut in the skin, and the other end is left outside the body. This is done in a doctor’s office or hospital. Once in place, the catheter can be attached to a special bottle or other device to drain fluid out on a regular basis.

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Bibby AC, Tsim S, Kanellakis N, et al. Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment. European Respiratory Review. 2016;25:472-486.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Malignant Pleural Mesothelioma, Version 2.2018 -- February 26, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/mpm.pdf on November 2, 2018.

Last Medical Review: November 16, 2018 Last Revised: November 16, 2018

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