If there are symptoms in the abdominal area, the doctor may carry out a laparoscopy or laparotomy to examine the area and take tissue samples for testing.
A laparoscopy involves inserting a laparoscope into a small incision in the abdominal wall. The laparoscope has a small camera, like the thoracoscope. Samples can be taken.
If more information is needed, a laparotomy may be requested. The surgeon opens and examines the abdomen. Tissue samples may be removed and sent to the lab.
A pathologist can look at the tissue or fluid samples through a microscope, to see whether there is malignancy, what types of cells are involved, and how advanced the cancer is.
If the surgeon plans to remove all or part of a lung, lung function tests may be carried out to assess how well the lungs are working, before surgery. This will show whether it is safe to carry out surgery.
Staging
Diagnosis will confirm whether cancer is present, and how far it has spread. The stage of the cancer will be assigned between stage 1 and stage 4.
Stage 1 mesothelioma the cancer is still localized inside the lining around the lung. It has not spread. At Stage 4, it has spread to distant organs and around the chest.
Treatment:
Treatment will depend on several factors, including:
the location of the cancer
the stage of the cancer
the patient's general health and age
Mesothelioma is usually spotted after a period of progression and is often aggressive. For this reason, fewer than half of patients will survive for a year after diagnosis.
Highly advanced tumors can no longer be surgically removed. The only remaining option in many cases is to try to control the cancer, slow it down, and maximize comfort for the patient.
Treatment at a late stage can sometimes cause severe side effects, so pain management and optimizing quality of life may be the better option.
The doctor, patient, and family members should discuss the variety of treatment options thoroughly.
Options for treatment
Options include:
Surgery: The surgeon removes the tumors with an invasive procedure. Normally, this is only appropriate during the early stages. Removing all or part of the cancer can slow tumor growth and relieve symptoms. Sometimes, the surgeon will remove the lung and surrounding tissue, followed by radiation therapy.
A pleurectomy or peritonectomy removes the lining around the lungs or abdominal cavity, to relieve symptoms. A tumor that cannot be completely removed may be debulked, or reduced in size. A catheter or tube, may be installed to relieve fluid on the lungs.
Pleurodesis: Drugs such as tetracycline or bleomycin are inserted between to pleura. This inflames the pleura, bringing them back together and blocking potential fluid buildup in the space.
Chemotherapy: If tumors cannot be surgically removed, chemotherapy may be used to shrink them and slow their progress. Neoadjuvant chemotherapy may be applied before surgery to make it easier to remove a tumor. Adjuvant chemotherapy is used after surgery to prevent recurrence.
Radiation therapy: This may be used to reduce the severity of symptoms in those with pleural mesothelioma. It is sometimes used to prevent metastasis after a biopsy or surgery.
Cancer cells may be left behind after surgery and continue to recur Chemotherapy or radiation therapy can sometimes reduce this risk.
Outlook:
In general, the prognosis for patients with mesothelioma is not encouraging. Malignant mesothelioma is an extremely aggressive type of cancer. It also has a long latency period, so that diagnosis often occurs when the cancer is already advanced.
The patient needs to consider that there are exceptions, and ongoing research into new treatments and possibilities for symptom management is being made.
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