Mesothelioma is an aggressive but rare type of cancer developed by people continuously exposed to asbestos. The natural mineral was widely used in industries like construction, shipbuilding and manufacturing, before being proven toxic. When disturbed, asbestos fibers are released into the air and inhaled or swallowed. Since the human body is unable to properly expel these fibers, asbestos becomes trapped and housed in the mesothelial cells that line some organs, causing the formation of tumors.
In about 70% of patients, mesothelioma occurs in the lining of the lungs, the pleura, and is called pleural mesothelioma. But the disease can also occur in the abdomen, heart and testicles, known as peritoneal, pericardial and testicular mesothelioma, respectively. While there is no cure for mesothelioma, there are treatments that improve survival and help ease the symptoms, which can include chest pain, shortness of breath, reduced chest expansion, faint or harsh breathing sounds, dry cough or wheezing, pleural effusions, coughing up blood, body aches and blood clotting disorders, in the case of pleural mesothelioma.
The Thoracentesis Surgical Procedure
Thoracentesis is one of the surgical treatments for patients with pleural mesothelioma who experience pleural effusions. Pleural effusions are a buildup of fluid in the pleural space due to the disease. Given the fact that it can cause numerous other problems like chest pain and difficulties breathing, it is important to treat it. Thorancentesis was developed in the mid-19th century and it continues to be used today. Before the procedure, a chest x-ray is performed to evaluate the extent of the problem. Patients are seated or lay down during the process and a local anesthesia is administered to numb the surgical site.
The physician inserts a needle between the ribs, while an ultrasound or CT scan may be used to guide the needle. Patients may feel pressure, but there is no pain due to the anesthesia. Then, the excess fluid is drained. A thoracentesis takes about 15 minutes and following the removal of the fluid, the needle is removed and the wound is dressed. The thoracentesis has two purposes: the fluid may be analyzed in a lab to confirm the diagnosis, which makes it a diagnostic procedure, or it can be used to relieve the symptoms of mesothelioma, in which case it is a palliative method.
Benefits and Risks of Thoracentesis
Thoracentesis is known as a palliative therapy — it is not curative, but is designed to relieve symptoms associated with the disease. Despite the fact that it is an effective temporary treatment, there is the risk of reoccurrence of pleural effusions, which is why other methods like pleurodesis can be preferable.
Complications from a thoracentesis are rare, but they can happen. The most severe adverse events include a collapsed lung or pneumothorax, hemothorax or accumulation of blood in the pleural cavity , empyema or accumulation of pus in the pleural cavity, tumor seeding which is the invasion of tumor cells along the thoracentesis needle track, lacerations to spleen or liver, and diaphragm injuries. In addition, there are also other minor complications that can occur, such as bleeding, pain, infection, dry tap, cough, subcutaneous hematoma, subcutaneous seroma, vasovagal syncope, and respiratory distress.