Although researchers are continually developing new ways to treat mesothelioma, doctors have depended on some tried and true techniques for decades. Thoracentesis, a technique developed in the mid-19th century, is still widely used today.
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During thoracentesis for pleural mesothelioma patients, doctors remove excess fluid that often accumulates between the lungs and the pleura, a thin membrane that envelops the lungs and aids in breathing. This fluid buildup, known as pleural effusion, is a primary symptom of mesothelioma that can cause a considerable amount of pain and discomfort.
A small amount of fluid in the pleura is normal. But if cancer or another condition causes pleural effusion, doctors can extract the excess fluid with a hollow needle, or cannula. They can then perform a pleural fluid analysis, which may help determine the cause of the effusion (if a diagnosis has not been confirmed). In addition to this diagnostic role, doctors often perform the procedure to alleviate respiratory issues that occur as the fluid accumulates.
Before the procedure, doctors first take a chest X-ray to see the extent of the problem. It also allows them to determine the best location to insert the needle. Other tests may also be performed, including blood tests, a CT scan or ultrasound.
Patients may assume a seated position throughout the procedure, or lie down if necessary. Next, doctors sterilize the skin around the insertion point and provide local anesthesia to numb the area. They then insert the needle between the ribs, sometimes using ultrasound or CT images to guide the needle. Patients may experience a feeling of pressure, but the anesthesia blocks any pain.
Once the needle is inserted, doctors drain the pleural effusion until some or all is removed, depending on the goal. The extracted fluid is usually sent to a lab for analysis. Once the needle is removed and the wound is dressed, doctors often perform another X-ray to confirm enough fluid was removed and to ensure there is no sign of a collapsed lung. The entire process takes about 15 minutes.
For patients with pleural mesothelioma, thoracentesis is primarily a palliative therapy. This means it does not attempt to cure the cancer, but does address its painful symptoms to improve the patient's quality of life. Removing excess pleural fluid can improve shortness of breath, reduce pressure on the chest and lungs, ease pain and provide more space for the lungs to expand during respiration.
This procedure can also serve a diagnostic function. In addition to mesothelioma and other cancers, pleural effusion is a symptom of several other diseases and disorders, including:
Analyzing the levels of protein, glucose, cholesterol, pH and other substances in the extracted pleural fluid can help doctors identify the root cause of the pleural effusion. However, with one study reporting a sensitivity of only 10 percent, thoracentesis is not reliable enough to confirm a mesothelioma diagnosis for patients with the disease. Instead, doctors prefer biopsy, a much more accurate and dependable test involving a tissue sample.
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While complications are rare, they can occur. The most common serious complication of the procedure is a collapsed lung, also known as pneumothorax. This can happen if the doctor accidentally punctures the lung or disrupts an accumulation of air in the pleural cavity.
Complications are more common among certain groups of patients. Patients with a history of lung surgery face greater risks, as do patients with a chronic, irreversible lung disease like asthma or emphysema. Patients with any condition that affects normal blood clotting may also face a higher risk of complications.
One 2010 study identified patients who would benefit most from thoracentesis while experiencing the lowest risk of complications. Out of 446 patients involved in the study, including a number of malignant mesothelioma patients, the incidence of pneumothorax, or a collapsed lung, was significantly lower in patients whose procedure was guided by an ultrasound.
Another factor that increased the risk of complications in participants was the presence of symptoms of their primary disease. Thoracentesis led to complications for only one asymptomatic patient (out of 328 total), yet 15 of 118 symptomatic patients developed complications.
Patients whose pleural fluid analysis revealed exudative (protein-rich) pleural effusions were found to face a higher risk of post-operative complications when compared to patients with transudative (protein-poor) effusions. Of the 208 participants with exudative effusions, 13 experienced one or more complications. The remainder of the patients had transudative effusions, and only three developed side effects from the procedure. Asbestos-related diseases typically cause exudative effusions.Learn more about depression and mesothelioma.
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