Palliative procedures used for malignant mesothelioma

Surgery to remove the cancer is not always an option for patients with malignant mesothelioma. In that case, less invasive procedures can be used to control some of the symptoms caused by mesothelioma, especially those due to built up fluid.

Removal of fluid

Procedures such as thoracentesis, paracentesis, and pericardiocentesis can be used to remove fluid that has built up and is causing symptoms. In these procedures, a doctor uses a long, hollow needle to remove the fluid. These procedures are described in the section, “How is malignant mesothelioma diagnosed?” The major drawback to these techniques is that the fluid often builds up again, so they may need to be repeated.

Pleurodesis

This procedure may be done to try to prevent 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 placed into the chest so that the fluid can drain out. Then the doctor uses the tube to put a substance into the chest, such as talc mixed in a fluid (talc slurry), the antibiotic doxycycline, or the chemotherapy drug bleomycin. This inflames the linings of the lung (visceral pleura) and chest wall (parietal pleural) so that they stick together, sealing the space and preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might accumulate. Pleurodesis can also be done at the time of thoracoscopy, either using the drugs doxycycline or bleomycin, or by blowing talc powder into the chest cavity. 

 

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 fluid in the chest move into the abdomen, where it is more likely to be absorbed by the body. 

The shunt is a long, thin, flexible tube with a small pump in the middle. In the operating room, the doctor inserts one end of the shunt into the chest cavity and the other end into the peritoneum. (The pump is placed just under the skin over the ribs.) Once the shunt is in place, the patient uses the pump several times a day to move the fluid from the chest to the abdomen. This approach may be used if pleurodesis or other techniques are not effective.

Catheter placement

This is another approach sometimes used to control fluid buildup . One end of the catheter (a thin, flexible tube) is placed in the chest or abdomen 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 allow the fluid to drain out on a regular basis.