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
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
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
14) 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
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
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
Guide 6. Recommended tests
Recommended tests before surgery
PET/CT scan (
Mediastinoscopy or EBUS-FNA (
Possible perfusion scanning
Cardiac stress test
Stage I–III epithelioid or mixed mesothelioma