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After a malignant mesothelioma diagnosis, or when you visit your doctor’s office with potential symptoms of malignant mesothelioma, one of the first steps is often to determine whether you are eligible for a surgical procedure. Surgical procedures tend to fall into two different categories: exploratory surgery to identify areas that are potential abnormalities and to take biopsies, and treatment surgeries in early stages to remove cancerous tissue or tumors. Generally speaking, exploratory surgeries tend to be less invasive than surgeries intended for the treatment, although your health and ability to withstand any type of surgical procedure will be taken into consideration by your health care team.
It is also important to keep in mind that there is no single approach for diagnosing or treating mesothelioma. As such, you should not necessarily expect that a surgical procedure that was appropriate for one mesothelioma patient will be appropriate for you. There are a wide variety of factors that go into the individualized decision about which surgical procedure or procedures a specific patient will have. Those factors certainly include the patient’s health and medical data, as well as details about the patient’s type of cancer and the areas in which it may exist in the body. A health care provider who is determining the best surgical procedure or procedures that are right for you should discuss all relevant factors in order to reach a decision about your diagnosis and treatment schedule moving forward.
What is the general process for determining which surgical procedure you will have in relation to your malignant mesothelioma symptoms or your malignant mesothelioma diagnosis? Consider the following steps, which cover the general process for determining which surgical procedure or procedures a patient will have.
Undergo a Complete Consultation with a Provider
The first step in determining which surgical procedure you will have is typically to undergo a full consultation with a surgeon who specializes in mesothelioma diagnosis and treatment. In an initial consultation with your doctor, you will likely learn that any mesothelioma diagnosis and treatment involving surgery will be particular to the patient’s specific condition and needs. There is never a one-size-fits-all approach when it comes to using surgical procedures or other methods to diagnose and treat malignant mesothelioma.
When you have an initial consultation with your doctor, you will likely learn about surgical methods that could be used in your case. Your doctor will likely inform you about certain exploratory surgeries that can be used in order to diagnose malignant mesothelioma, take biopsies, and identify areas of concern or areas of potential abnormality that may have shown up on other imaging tests like x-rays or CT scans. For example, when it comes to exploratory surgeries, you might learn about a thoracoscopy, which can be used for patients with suspected or known cases of pleural mesothelioma, laparoscopy, or laparotomy for suspected or known cases of pleural mesothelioma.
In terms of surgeries involved in the treatment process, your surgeon should inform you about the two most commonly used surgical procedures for treating pleural mesothelioma: pleurectomy decortication (PD), which involves removing the entire lining of a person’s lung, or extrapleural pneumonectomy (EPP), which involves removal of a person’s lung. Both of these procedures remain somewhat controversial among thoracic surgeons, according to a peer-reviewed study that appeared recently in Translational Lung Cancer Research. These surgical procedures are extremely complicated, and they have varying results. These surgical procedures certainly are not appropriate for all mesothelioma patients. For peritoneal mesothelioma, your surgeon will explain that a debulking procedure would likely be the most common form of surgery to treat peritoneal mesothelioma, and it is often combined with chemotherapy.
Your doctor will also clarify how surgery can be used for mesothelioma patients. In terms of exploratory surgical procedures, you may be eligible for surgery to properly diagnose your malignant mesothelioma and to develop a subsequent treatment plan. In addition, surgery may be used as part of your treatment plan. When doctors say that surgery can also be used as a form of “treatment,” they often mean that surgery can be used to extend a patient’s life, control a patient’s symptoms, or allow a patient to receive other forms of treatment. Many forms of treatment that involve surgical procedures are known as multimodality treatments which involve surgery in addition to other treatments like chemotherapy or radiation. Sometimes surgical procedures are completed in connection with a patient’s eligibility to participate in a clinical trial. You will be able to play a role in the decisions about your course of treatment, and you will need to consent to any surgical procedures before they are scheduled (unless an emergency surgical procedure must be conducted while you are already under anesthesia).
Have Various Tests Completed to Determine Your Eligibility for Surgery
Next, after an initial consultation with a surgeon who handles mesothelioma cases, you will likely be sent for a series of medical tests that will be used to determine whether you are a good candidate for surgery and, if so, what type of surgical procedure or procedures might be most appropriate based on your circumstances. Some of the following tests are likely to be conducted before any decisions are made about what type of surgical procedure or procedures you should have:
- Imaging scans;
- Blood tests;
- Echocardiogram and other cardiac tests; and
- Pulmonary function tests (PFTs).
Your Performance Status and Its Impact on Determining the Surgical Procedure That Is Right for You
In addition to your initial consultation, which may also involve a physical exam, the results of the above tests (which may or may not be used in your case) will become part of your health care provider’s determination of your performance status (PS). Performance status is a score or classification that doctors use for cancer patients to determine their relative health, including their ability to undergo a surgical procedure safely based on their ability to perform activities of daily living (ADL) and their mobility.
Seeking a Second Opinion and Controversial Mesothelioma Surgeries
You should always seek a second opinion. Given that there are often no treatment options for mesothelioma that can provide a cure, a patient will need to rely on a surgeon’s expertise and experience to determine the best surgical procedure or procedures in their case. While exploratory surgical procedures are more common and streamlined, as we have explained above, surgical procedures designed to treat malignant mesothelioma can be significantly more complicated and contentious. To be sure, different surgeons who specialize in treating mesothelioma patients have differing opinions concerning the value of particular surgical procedures like PD or EPP.
Generally speaking, your doctor will weigh the benefits and limitations of a surgical procedure, and will usually make a decision about what they think—based on their experience and medical expertise—to be the best course of action for you. Some surgeons believe EPP surgeries are more beneficial than PD surgeries, while others focus on a PD over an EPP. There are other surgeons, still, who will rarely turn to these surgical procedures because of their potential complications, and the risks they pose to mesothelioma patients. As the recent study in Translational Lung Cancer Research clarifies, many thoracic surgeons consider both PD and EPP surgical procedures to be radical options that can have long-term and life-threatening consequences. Some surgeons believe that the potential benefits almost never outweigh the risks, while other surgeons believe that these surgeries can be beneficial for some patients.
Given that mesothelioma is a relatively rare form of cancer, there have not been a substantial number of studies or significant data gathered to determine clear benefits and limitations of each type of surgery for treating mesothelioma, and whether early mesothelioma can in fact be managed with surgical procedures that may appear extreme. Accordingly, it will be essential to speak with more than one surgeon who specializes in diagnosing and treating mesothelioma, asking difficult questions, and considering options with your loved ones before making a decision about the surgical procedure you will have. You will need to consider the risks associated with various procedures, and take into account your health and the trust you have developed with a particular doctor. While you may need to make a decision relatively soon about the surgery you want to have (and whether you want to have surgery at all), that decision should also be a measured one.
If you want to enter into a clinical trial, you may not be able to make a decision about the specific type of surgery you want to have. Rather, you may be bound by something known as a protocol. A protocol is a term that is used to describe a plan for a clinical trial, and the protocol will dictate what surgical procedures patients must have to participate in, how the patient will report the effects of the trial, and what tests those patients must receive.
While you will ultimately be trusting a surgeon who specializes in treating mesothelioma patients to help you reach the decision that is right for you, it is also critical to continue to play a role in your own treatment plan.