Mesothelioma is a rare type of cancer that develops in the mesothelium, the lining that surrounds and protects the body's internal organs. When the cancer develops in the lining that surrounds the lungs, the pleura, it can cause fluid to build up between the layers of the pleura. Symptoms include: shortness of breath, difficulty breathing, and a racing heart. This is where pleurodesis can help. Pleurodesis is a procedure that helps prevent this fluid buildup, easing the patient's ability to breathe. Choosing the correct mesothelioma treatmentoption is critical.
Pleurodesis is used specifically to treat the symptoms of pleural mesothelioma, which is the type of mesothelioma that forms in the lining surrounding the lungs. Pleural mesothelioma and other cancers that affect the lungs often cause pleural effusion, or a buildup of fluid between the layers of the pleural lining. This fluid places pressure on the lungs so they cannot fully expand. Pleural effusion is usually diagnosed with a chest X-ray.
Pleurodesis is what is known as a "palliative" procedure, that is, a procedure that helps to relieve a patient's symptoms but doesn't deal with the underlying disease. When the fluid buildup causes the patient significant trouble breathing, the doctor may recommend chemical pleurodesis to relieve breathing problems.
Although pleurodesis does not treat or cure mesothelioma, it can be very helpful dealing with patients' symptoms. Not every mesothelioma patient is a candidate for pleurodesis. Talk to your doctor to determine whether or not this procedure will be helpful for you.
The concept of pleurodesis is simple: the physician drains the fluid from between the pleural layers and inserts a chemical irritant into the space. This irritant causes inflammation and scarring, which causes the two layers to stick together. No space remains in which fluid can collect.
The first step in the procedure it to drain the fluid from around the lungs. The doctor administers an anesthetic, then inserts a wide needle into the chest. A drainage tube connects the needle to a collection bag. Fluid drains slowly through this tube.
Once the fluid has completely drained, the treatment agent is inserted between the pleural layers. This is usually sterile talc powder; other chemicals used include Bleomycin, Tetracycline, and Doxycycline. Sometimes the doctor has the patient change positions while the irritant is in place, to help to distribute it evenly between the pleural layers. The chest tube remains in place until fluid drainage decreases, indicating that the pleurodesis procedure was successful. This is usually confirmed with an x-ray.
Pleurodesis can be performed either in or out of the operating room. In the operating room, the patient receives general anesthesia and the surgeon examines the inside of the chest with a thin, lighted tube called a thoracoscope. The thoracoscope can also take tissue samples, if needed, and is used to insert the chemical agent. When pleurodesis is performed as a "bedside" procedure, it is carried out in the hospital using a local anesthetic and a sedative. The physician does not use a thoracoscope in the bedside procedure.
After the Procedure
After the procedure, you are likely to feel sore at the site of the chest tube or when taking a deep breath. Some patients develop a fever. The doctor may prescribe pain medication. You should avoid taking anti-inflammatory medications such as Ibuprofen, which will interfere with the adhesion of the pleural layers. Check with your health team for specific post-procedure instructions.
- Mayo Foundation for Medical Education and Research, Mayo Clinic. http://www.mayoclinic.org/mesothelioma/treatment.html
- International Mesothelioma Program. Dr. David Sugarbaker. Dana Farber Cancer Institute. http://www.impmeso.org/pleurodesis/c28_p24/Mesothelioma_Treatments/Traditional_Treatments/Mesothelioma_Surgery/Pleural_Mesothelioma/Pleurodesis.html
Last modified: February 15, 2010.