NCCN Guidelines for Patients
Malignant Pleural Mesothelioma, Version 1.2014
Stage I–III epithelioid or mixed mesothelioma
Stage I–III epithelioid or mixed mesothelioma:
Treatment with surgery
Surgery may be a treatment option if you have stage
I–III epithelioid or mixed mesothelioma. Your doctors
will use the tests described in Parts 3 and 4 to assess
if the tumor can be surgically removed. If your doctors
cancer can’t be removed by surgery
then you have two treatment options. One option is
to start observation if you have no symptoms of the
cancer. The second option is to begin treatment with
chemotherapy right away. See page 34 to read about
treatment options other than surgery.
If your doctors think the
cancer can be removed by
, then you will have a few more tests.
These tests are used to see how far the
cancer has spread and to assess the health of your
heart and lungs.
A PET/CT scan is the use of two imaging tests
together to take pictures of the inside of the body.
These two tests are a CT scan (described on page
15) and a PET scan. A PET scan shows how your
cells are using a simple form of sugar. To create
the pictures, a radiotracer first needs to be put into
your body. The radiotracer lets out a small amount
of energy that is seen by the machine that takes the
pictures. For mesothelioma, the radiotracer used
is FDG (18F-
lucose). FDG is made of
fluoride and sugar (glucose). Cancer cells use more
FDG than normal cells, so they show up as bright
spots on the pictures. For this test, you must fast
for 4 hours or more. PET/CT is helpful for finding
mesothelioma that has spread to lymph nodes or
distant sites. This test should be done before talc
pleurodesis. See page 38 for more information about
A mediastinoscopy is a procedure used to perform
a biopsy of the lymph nodes in the area of the chest
between the lungs. This area is called the mediastinum.
For this biopsy, a mediastinoscope is inserted through
a small surgical cut in your neck right above your
sternum. A mediastinoscope is a thin, long, tube-
shaped instrument that has a light and camera for
viewing as well as a tool to remove a tissue sample. A
mediastinoscopy is done while you are under general
anesthesia. This procedure may cause some pain and
swelling and will leave a small scar.
Chart 6. Recommended tests before surgery
Mediastinoscopy or EBUS-FNA (
Pulmonary function tests,
Possible perfusion scanning, and
Cardiac stress test.