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22

NCCN Guidelines for Patients

®

:

Malignant Pleural Mesothelioma, Version 1.2016

Part 4 is a step-by-step guide through

the treatment options for people with

malignant pleural mesothelioma.

It shares which treatments are

recommended for different stages of

disease. This information is taken from

treatment guidelines written for doctors

by NCCN experts on mesothelioma.

Stage I–III epithelioid or mixed

mesothelioma

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 decide the 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 doctor will watch you

closely during this time. The second option is to

begin treatment with chemotherapy right away. See

page 27 to read about treatment other than surgery.

If your doctors think the cancer can be removed by

surgery, then you will have a few more tests. See

Guide 6.

These tests are used to see how far the

cancer has spread and to assess the health of your

heart and lungs.

PET/CT

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

14) and a PET (

p

ositron

e

mission

t

omography)

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-

f

luoro

d

eoxy

g

lucose). 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 30 for more information about

talc pleurodesis.

Mediastinoscopy

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.

Guide 6. Recommended tests

before surgery

Recommended tests before surgery

PET/CT scan (

p

ositron

e

mission

t

omography/

c

omputed

t

omography)

Mediastinoscopy or EBUS-FNA (

e

ndo

b

ronchial

u

ltra

s

ound–guided

f

ine-

n

eedle

a

spiration)

PFTs

(

p

ulmonary

f

unction

t

ests)

Possible perfusion scanning

Cardiac stress test

4

Treatment guide

Stage I–III epithelioid or mixed mesothelioma