Undergoing surgery is one of the most effective ways to survive mesothelioma. However, this statement isn’t in question.
The question is whether patients are healthy enough to have surgery, and findings from a new study may provide patients a reliable answer.
A report from the American Association for Thoracic Surgery details how “diffuse chest wall invasion” can determine if pleural mesothelioma patients should have surgery. Specifically, this symptom of pleural mesothelioma can help doctors decide whether they can even remove the cancer without putting the patient at severe risk of death.
If a pleural mesothelioma patient isn’t a surgical candidate, then advancing to nonsurgical treatments (like chemotherapy, radiation or immunotherapy) could save their life.
What Is Diffuse Chest Wall Invasion?
Diffuse chest wall invasion is when the cancer spreads to the tissue, fat, muscles and bones that comprise the chest.
Pleural mesothelioma forms in the pleura, which exists just inside of the chest wall. Mesothelioma tumors often spread inward, towards the lungs, diaphragm and other organs. The disease can also spread outward, towards the skin and all body components along that path. Diffuse chest wall invasion is a common pleural mesothelioma symptom.
The curative surgeries available to pleural mesothelioma patients are extrapleural pneumonectomy and pleurectomy with decortication. The former involves removing at least the affected lung, the lining between the lung cavity and chest wall (the pleura), and part of the diaphragm. The latter spares the lung but removes at least the pleura and part of the diaphragm.
If diffuse chest wall invasion occurs, then neither surgery is an option since removing the chest wall is not possible for many pleural mesothelioma patients. Removing ribs, bones, tissues and muscles would take a severe toll on most people with this cancer.
There just hasn’t been any clear-cut way to determine when diffuse chest wall invasion occurs — until now.
Diffuse Chest Wall Invasion and Pleural Mesothelioma
In the study, 170 pleural mesothelioma patients either completed surgery or attempted to do so. Around 84% (143) had a successful operation. The other 16% (27) had an “unresectable disease,” meaning surgeons couldn’t remove it. The doctors only realized this was the case after they opened the chest wall (a procedure called a “thoracotomy”).
Of the 27 who couldn’t have surgery, most of them (24) had diffuse chest wall invasion. The other three had intrathoracic organ invasion, which means the disease had impacted the patients’ internal organs too much to be removed.
The researchers discovered that diffuse chest wall invasion is associated with “contraction of the ipsilateral hemithorax.” This phrase means half of the patient’s chest region — the same half where the cancer originated — has shrunk.
The research team measured this shrinking through thoracic cage volume, which is a size measurement of the patient’s rib cage. If a patient’s rib cage decreases in volume, then that’s a reliable indicator of cancer spreading to this region and, eventually, the chest wall.
The results showed that a greater than 5% decrease in thoracic cage volume represented “the optimal cutoff” for pleural mesothelioma surgical candidacy. The 5% decrease compares the patients’ cage size to what it would be without the cancer.
“Preoperative identification of (diffuse chest wall invasion) will avoid unnecessary (surgery) and accelerate initiation of nonsurgical therapy in malignant pleural mesothelioma,” the study report reads. “Our data suggest that contraction of thoracic cage volume has merit in predicting malignant pleural mesothelioma unresectability and should be validated in prospective studies.”
How Should You Treat Your Pleural Mesothelioma?
There is no doubt mesothelioma patients should consider having surgery. If you can manually remove the cancer from your body, then your body is one step closer to remission.
However, the two curative pleural mesothelioma surgeries have a risk of death or significant complications arising during operation. Undergoing surgery to remove cancer can take a toll on the body, which must not only survive the procedure but also heal in the weeks and months following.
The problem? Doctors sometimes won’t know if a patient is at any risk until they open the chest wall, which can cause health issues for the patient. Doing so unnecessarily also delays them from receiving other possibly life-extending treatments.
If you were recently diagnosed with pleural mesothelioma and are researching surgical options, please contact our medical staff. Jenna Campagna, our patient advocate and registered nurse, can help you learn whether you are a candidate for pleural mesothelioma surgery. You can reach her via email at firstname.lastname@example.org.
Show Sources & Author
- Preoperative prediction of unresectability in malignant pleural mesothelioma. Journal of Thoracic and Cardiovascular Surgery. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/32087959. Accessed: 02/25/2020.
- The Thoracic Cage. BC Open Textbooks. Retrieved from: https://opentextbc.ca/anatomyandphysiology/chapter/7-4-the-thoracic-cage/. Accessed: 02/25/2020.