Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer that affects the pleura, the thin membrane lining the lungs and chest cavity. It’s an exceedingly rare disease, especially as its main cause, asbestos, is being phased out in Singapore. Despite its rate of occurrence, it’s a fatal disease due to poor prognosis and challenging treatment. Importantly, early-stage diagnosis can significantly improve outcomes, with surgery playing a crucial role in malignant pleural mesothelioma treatment strategies.
Surgical Intervention as a Treatment for MPM
For patients diagnosed with early-stage malignant pleural mesothelioma, surgery often serves as a primary treatment option. Surgical interventions in MPM typically have two main goals:
- Curative Intent: Simply put, these surgeries aim to remove as much of the cancer as possible. Often combined with chemotherapy and/or radiotherapy, curative surgeries offer the best chance for long-term survival in eligible patients. However, this goal varies depending on the state of the disease and the condition of the patient.
- Palliative Care: When curative surgery is not feasible, palliative procedures focus on reducing symptoms and improving quality of life. These interventions can help manage pain, breathlessness, and other complications associated with MPM, giving patients the chance to share time with their loved ones.
Types of Surgery for Malignant Pleural Mesothelioma
There are two primary types of surgery for malignant pleural mesothelioma. A thoracic surgeon will know best which surgery makes the most sense for you, factoring in the state of your MPM and other conditions that affect the viability of surgery.
Extrapleural Pneumonectomy
Extrapleural Pneumonectomy (EPP) is an extensive surgical procedure that involves removing the diseased lung, the pleura (lining of the chest wall), part of the diaphragm, and sometimes the pericardium (lining around the heart). This aggressive approach aims to remove as much cancerous tissue as possible.
- Benefits: EPP offers the most comprehensive removal of visible tumour tissue, potentially improving survival rates for patients.
- Risks and Challenges: EPP is highly invasive and carries significant risks, including complications associated with living with a single lung. Recovery can be lengthy and challenging as the patient will need to relearn how to navigate their days with a reduced breath capacity.
- Suitability: EPP is typically considered for patients with cancer confined to one side of the chest who are in good overall health and have strong lung function. This makes the recovery process easier as their body may be in a better position to withstand the changes that result from living with a single lung.
Pleurectomy and Decortication
Pleurectomy and decortication is a less invasive procedure that removes only the pleura (lining the chest cavity and the lung) while preserving the lung. This approach has gained favour in recent years as the standard surgical approach for early-stage MPM.
- Benefits: Pleurectomy and decortication are less invasive than EPP and preserve lung function, potentially leading to better quality of life post-surgery.
- Risks and Challenges: Pleurectomy and decortication is a less intense procedure than EPP. It does pose similar risks during surgery, and also requires a long recovery, though both are less severe than the risks involved with EPP.
- Suitability: Pleurectomy and decortication are ideal for patients with earlier-stage disease for whom removing the entire lung is not feasible or desirable.
Factors Influencing Surgical Decision-Making
Several factors influence the choice between extrapleural pneumonectomy, pleurectomy and decortication, or other treatment approaches for malignant pleural mesothelioma.
The extent and stage of the cancer play a crucial role, particularly whether it is confined to one side of the chest and has not spread extensively. This determines whether EPP is even possible, as if the cancer has spread across, removing one lung may not be helpful. The patient’s overall health and lung function are also critical considerations, as they determine the individual’s ability to withstand major surgery. The lungs are a sensitive organ and as such, thoracic surgeons have to be cautious about the patient’s ability to withstand a major change to their respiratory system.
Additionally, the potential for combination treatments is evaluated, considering the possibility of surgery followed by chemotherapy or radiotherapy. Quality of life considerations are equally important, with medical teams weighing the potential benefits of more aggressive surgery against the impact on post-operative quality of life. These factors are carefully assessed to determine each patient’s most appropriate treatment strategy.
Multidisciplinary Approach to Treatment
Effective treatment of malignant pleural mesothelioma requires a multidisciplinary approach. Patients benefit most when their care is managed by a team of mesothelioma specialists, including thoracic surgeons, oncologists and radiologists. This team can provide comprehensive evaluation and create customised treatment plans based on the individual patient’s condition, stage of cancer and treatment goals.
Early diagnosis is crucial for improving outcomes in MPM. Patients diagnosed with, or suspected of having, MPM should consult with experienced mesothelioma specialists to explore their treatment options. This is especially so for people who work with asbestos. Almost a 100 people in Singapore between 1984 and 2019 contracted malignant pleural mesothelioma from an occupational hazard.
If you’ve been recently diagnosed with early-stage malignant pleural mesothelioma, schedule a consultation with Neumark Lung & Chest Surgery Centre today.
