While cancer in the lungs has an effect on the lung tissues, malignant pleural mesothelioma is affected in the pleura, a serous membrane that separates the lungs from other body organs in the abdominal area and the chest. Though mesothelioma is not really a lung cancer, it potentially spreads to the lungs once the cancer in the pleura has metastasized. That is the reason why a standard pneumonectomy needs to be performed to remove the cancerous lung. An extrapleural pneumonectomy, on the other hand, is needed for removing the cancerous pleural tissue and the lung nearest to the affected part. The removal of the lung in extrapleural pneumonectomy is done in order to prevent the malignant mesothelioma from spreading.

There is no perfect treatment modality that can cure malignant pleural mesothelioma. The best way for the patient to survive is to use a trimodality treatment where chemotherapy and radiation therapy are performed along with extrapleural pneumonectomy.

The Candidates for Extrapleural Pneumonectomy

Extrapelural pneumonectomy surgery can be given for only few selected patients. Patients who are currently in the early stage of the malignant pleural mesothelioma with respectable cancer formation are the most likely candidates that can undergo extrapleural pneumonectomy surgery.

The most well-known cancer cell subtypes that are linked with malignant mesothelioma are epithelial cancer cells, compared to the other serious subtypes such as desmoplastic and sarcomatous. Moreover, the operative centers want to use extrapleural pneumonectomy procedures that patients with epithelioid cancer contain due to the low post-extrapleural pneumonectomy survival time of the other two.

The Procedure for Extrapleural Pneumonectomy

Because of many preoperative and postoperative treatments, extrapleural pneumonectomy surgeries become very persistent. In order to limit the preoperative pain and discomfort, patients are given general anesthesia. Also, postoperative pain is managed by inserting a thoracic epidural catheter before the operation starts.

The extrapleural penumonectomy surgery starts as it enters the chest and passes by the unobstructed sixth rib where the sixth rib is taken out occasionally. The process of extrapleural dissection begins which the surgeon provides intensive care in order to avoid entering the pleural cavity. Entrance to the pleural cavity may only lead to spillage or malignant cells within the active field. The removal of the pleura or the lining of the lung, the lining of the heart or pericardium, the diaphragm or muscles that aids in breathing, and the appropriate lung depends where the affected part of the chest is located.

Postoperative Care for Extrapleural Pneumonectomy

People’s recovery standard pneumonectomy procedure is similar to the recovery experienced by postoperative care of extrapleural pneumonecotomy patients. Postoperative patients are in danger of developing low blood pressure or hypertension which results from reconstructing the pericardium. Once a patient of postoperative extrapleural pneumonectomy experiences hypotension, follow-up has to be done immediately.

The most vital postoperative concern is managing the patient’s pain. Pain has to be controlled in order for it to lead to the breakdown of the residual lung. This is called the postoperative atelectasis. Pulmonary rehabilitation is used to restore the function of the heart to its normal state. This usually takes place on the second day, preceding extrapleural pneumonectomy.

Moreover, trimondality therapy is the best and most efficient method in order for the first stage malignant pleural mesothelioma victims to survive. Once the therapy is successful, five years to survive is possible for the patients in comparison to the one year span for survival that is common with malignant mesothelioma.

Thoracentesis Procedure

During the thoracentestis treatment, the fluid that is mounted in pleural effusion is reduced through lessening the pressure exerted on the chest wall and the lungs. In order to perform the treatment, inserting a catheter or a syringe in the middle part of the chest wall and the lungs is needed in order to allow aspiration or have the fluid removed.

In the middle of the lung area and the ribs, a needle is usually placed in from the back. The part where the needle will be injected is sterilized and an anesthetizing medication is injected into the little area of the skin. This procedure is not lengthy and moderately painless. It also has less complication. The procedure is often described as pleural fluid aspiration.

Pleural Effusion

The cells that surround the serous membranes’ walls and part the major body organs are the mesothelial cells. They produce little amount of fluid that are used to serve as a lubricant between the different body organs and the chest wall. Once an excessive mounting up of fluid takes place, pleural effusion happens. This is classified into two major kinds: exudates and transudates.

The first type of fluid which is the exudative fluid is cloudy and has various cells and proteins. This fluid is linked with diseases concerning mesothelial cells such as mesothelioma. A transudative fluid, on the other hand, is clear and most common to the processes of mesothelial cells. This fluid builds up not due to the disease in the mesothelial cells but due to the imbalance that is present between the making and elimination of the transudative fluids.

Enough amount of fluid that the mesothelial cells produce is usually immersed by the blood and the lymph vessels so that the pleural gap is not filled or extended in an entirely balanced system. Congestive heart failure is one of the most common causes of excessive transudative fluid. What happens in congestive heart failure is that the heart no longer pumps blood through the lungs properly. Also, there is no adequate blood flow that can suck in the fluid found in the pleural gap.

Diagnostic Thoracentesis

Moreover, thoracentesis can be carried out as a diagnostic method. This procedure is utilized in the same way as the treatment is utilized but there is less removal of fluid. Usually, the fluid is brought to a pathologist for analysis after it has been removed. Once a pleural effusion is found, diagnostic thoracentesis is executed.

Pleural effusions are symptomatic amounted to abnormalities that are related to mesothelial cells such as mesothelioma. In various cases where cancer is at hand, negative or inconclusive results come out of the examinations of the effusions. There are only fifteen percent of the cases that are cancer-related come out with a definitive diagnosis. Usually, biopsy of pleural material is a must in order to get a specific diagnosis of mesothelioma.

Ever since the early 1940s, chemotherapy has been widely used in curing cancer. But because of scientific improvements and a better understanding of the characteristics of the disease, a continuous research and development of targeted chemotherapy agents are allowed recently. The treatment that chemotherapy provides becomes most useful when the cancer cells are moderately young and there is still no formation of a solid tumor mass.

Many mesothelioma chemotherapy drugs are used in treating the rare type of cancer. However, none of those drugs have been effective in treating the malignant mesothelioma. Similar to standard chemotherapy agents, these drugs are impaired in cell division and initiated programmed cellular death or also called apoptosis. The anti-angiogenesis mesothelioma chemotherapy drugs, for instance, prevents the new blood vessels to form in a process called angiogenesis. These drugs also prevent tumors from creating a trail where nutrients are received and oxygen passes through which are necessary once the tumor has grown and continue to spread.


Cisplatin is one of the most traditional chemotherapy drugs that is used to treat malignant mesothelioma. It is part of the family of three comparable drugs, including Carboplatin and Oxaliplatin. It cross-links DNA in a number of ways which prevents fast division of cells and duplication of DNA that aids in further cell division. Other recent chemotherapy drugs such as Alimta or pemetrexed, Onconase or ranpirnase and Veglin are in conjunction with Cisplatin.

Types of Treatment for Mesothelioma Chemotherapy

The Mestothelioma Chemotherapy treatments are not always geared for the intention to heal. There are more common mesothelioma treatments that are used such as Combined Modality Chemotherapy which is usually partnered with other types of treatment like radiation therapy and surgery. One example that involves different kinds of therapy is the trimodality therapy which contains the use of chemotherapy, radiotherapy, and surgery. Another type of therapy is the intensity modulated radiation therapy or the IMRT which is also a radiotherapy that is more advanced and uses computer-controlled linear accelerators while minimizing the dose to surrounding normal critical structures. The other kind of treatment is called Neoadjuvant chemotherapy which is also called preoperative chemotherapy with the intention to shrink the size of the tumor mass before surgical treatment takes place. Adjuvant chemotherapy is another type of therapy that is also called postoperative chemotherapy. This therapy is utilized after a surgical treatment once a returning risk of cancer is found. Palliative chemotherapy, on the other hand, is a kind of mesothelioma chemotherapy that uses a palliative technique where it emphasizes on curing the symptoms more rather than the whole disease.

The dosage for chemotherapy differs based on the patient’s body surface area or BSA, which determines an approximate body volume. This can give the perfect balance of chemotherapy treatment and at the same time, avoiding the toxic side-effects.

Side Effects of Mesothelioma Chemotherapy

When a person undergoes chemotherapy, there is an expectation of physical and mental exhaustion for patients. Chemical treatments that are constant entail the following side effects: cardiotoxicity, constipation, diarrhea, hair loss, hepatoxicity, increased risk of cardiovascular disease, lowered number of red blood cells or anemia, nausea, nephrotoxicity, ototoxicity, secondary neoplasm, vomiting, and a weakened immune system.

The chemotherapy treatments all depends on the patient and the severity of the condition which can usually be managed on both an in-patient and out-patient basis.