NCCN Guidelines for Patients
Malignant Pleural Mesothelioma
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Part 5: Treating mesothelioma
Primary treatment is the main treatment used to rid your body of cancer.
Surgery is used as a primary treatment for some mesotheliomas. Surgery
should be performed by a board-certified thoracic surgeon. A thoracic surgeon
is a doctor who’s an expert in operating on organs inside the chest.
Before surgery, your surgeon will perform a surgical exploration. This is a minor
surgery to look inside your chest to see how much the tumor has grown and
spread. Use of a thoracoscope inserted through one surgical cut is the preferred
method for exploration. A thoracoscope is a thin, tube-shaped instrument with
a light, camera lens, and tools on the end for viewing and to remove tissue from
the chest. If the whole tumor can’t be removed, surgery isn’t recommended.
There are two types of surgery for mesothelioma: P/D (
ecortication) or EPP (
neumonectomy). P/D removes the tumor
and the pleura affected by the tumor. EPP removes both pleural layers, the
lung and diaphragm on the same side of the chest as the tumor, and often
the pericardium. During both surgeries, lymph node sampling should be done
to assess if the cancer has spread to the lymph nodes between your lungs.
Lymph node sampling only removes some of the nodes from a cluster.
There is no well-designed research to show which surgery is better in which
circumstances. Your doctors will recommend a surgery based on many factors.
They will consider your overall health, ability to do activities, symptoms,
cancer stage, and the type of mesothelioma cell. They will also consider that
the dangers of surgery are more likely and more serious with EPP than P/D. Ask
your treatment team for a list of all the dangers of the surgery they recommend.
Stage I – III epithelioid or mixed mesothelioma
to identify doctors who are
trained in a specialized field
A rating of
the growth and spread of
A sheet of
muscles below the ribs that
helps a person to breathe
groups of disease-fighting
cells located throughout the
lining around the heart
use of radiation to treat