NCCN Guidelines for Patients
Malignant Pleural Mesothelioma, Version 1.2016
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.
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.