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NCCN Guidelines for Patients



Malignant Pleural Mesothelioma, Version 1.2016


Treatment planning

How do doctors plan for treatment?

Based on the tests in Part 3, your

doctors will let you know if you have

mesothelioma. The next phase of care

will include planning your treatment.

How do doctors plan for


The next step of care involves a multidisciplinary

team of experts who have experience treating

mesothelioma. Your treatment team may include

a radiation oncologist, thoracic (chest) surgeon,

medical oncologist, radiologist, and pulmonologist.

Your treatment team will come together and decide

on a treatment plan. This treatment plan will be

based on the extent of cancer in your body and your

other health needs, as well as your personal choices.

A treatment plan is a written course of action that

covers every stage of the treatment process.

Once mesothelioma is confirmed, your doctors will

need to know the stage of the cancer. The cancer

stage is a rating by your doctors of how far the

cancer has grown and spread. The cancer stage

is based on the results of certain tests. It is used

to plan which treatments are best for you. The

recommended tests for cancer staging are:



Chest and abdominal CT scan with contrast



Possible chest MRI (









Possible VATS and/or laparoscopy

Chest and abdominal CT

If you have not already had a chest CT scan, it

should be done along with a CT of your belly area

(abdomen). Contrast should be used if possible.

Contrast is a dye put into your body to make clearer

pictures during imaging tests. These scans can show

your doctors where the tumor is, how big it is, and if it

has spread. See page 14

for CT scan information.


MRI is an imaging test that uses radio waves and

powerful magnets. An MRI scan of your chest is

another way to see if the cancer has spread to your

chest wall, spine, diaphragm, or blood vessels. The

scan may cause your body to feel a bit warm. Like a

CT scan, a contrast dye may be used.

Thoracoscopic biopsy

A thoracoscopic biopsy is a type of biopsy, also

called a VATS (








urgery) biopsy. For this test, at least 1 to 3 small

cuts into your chest are made between your ribs.

A thoracoscope to see inside your chest is inserted

through one cut. A thoracoscope is a thin, tube-

shaped instrument that has a light and camera

lens for viewing. Surgical tools are inserted to

remove samples of the pleura, lymph nodes, or

other tissue. VATS is done while you are under

general anesthesia. This test is recommended if

imaging tests suggest that there is mesothelioma

in the pleura (tissue lining the lungs) on both sides

of your chest or in the peritoneum (tissue lining the



Laparoscopy is a type of surgery used to view the

inside of the abdomen and take biopsy samples

of organs and tissues. For this surgery, a tiny cut

is made in your abdomen. Then, a laparoscope is

inserted through the cut. A laparoscope is a thin,

lighted tube with a lens for viewing and tools to

remove samples of tissue. This surgery is done while

you are under general anesthesia. Laparoscopy

is suggested if imaging tests show there is

mesothelioma in the pleura on both sides of your

chest or in the peritoneum.