Symptoms for pleural mesothelioma are typically centered on lung function breathing, with shortness of breath (dyspnea), pleural effusion (fluid build-up), and pain in the chest being the primary indicators. There is no cure for malignant pleural mesothelioma and while scientists and researchers are continually developing new treatments and therapies, in the meantime, advancements in palliative care therapies aim to provide symptom relief.
As previous mentioned, pleural effusion and dyspnea are common symptoms in someone suffering from mesothelioma. Pleural effusion is a fluid build-up in the lining between the outside the lung and inside the ribcage (known as the pleura). When there is too much fluid build-up between the pleura, it can cause chest pain and it difficulty breathing (dyspnea). Since the lungs are under a lot of pressure and are overworking to intake air, this condition can be very painful. Untreated, lung infections are likely. To treat pleural effusion, patients have two main options to consider – indwelling pleural catheter (IPC) and pleurodesis.
The purpose if the IPC is to drain the fluid from the lungs by using a small tube that is specifically designed to do so. This flexible and soft catheter is inserted in the patient’s chest by one end, while the other end remains outside the body for drainage. This procedure is less invasive than pleurodesis, but the procedure itself can be costly as drainages have to be to be repeated for the duration of the disease.
Pleurodesis is a more aggressive procedure but that is because it is meant to stop pleural effusion altogether by “obliterating the pleural space.” This procedure can be done either chemically or surgically. In the surgical procedure, the first step is to drain the fluid around the lungs. After that is completed, the pleural lining is then irritated to produce scar tissue. This scar tissue helps to fuse together the pleural layers, eliminating the space where fluid buildup can occur. In chemical pleurodesis, chemicals such as bleomycin, tetracycline e.g. minocycline, povidone iodine, or talc are inserted into the pleural space. These chemicals cause an irritation just like in the surgical procedure and eventually the space between the layers of the pleura become closed and no more fluid can accumulate. Pleurodesis can be a very painful procedure with longer hospital stays and repeat procedures necessary.
Various studies have been done to establish which procedure is better overall, but a definitive answer has not been found. A recent study based upon the results of a clinical trial published in JAMA found little significance. Patients who underwent IPC had few hospitalization days from beginning of treatment to death, but overall, the findings remained minor. A 2015 study published in the Journal of Thoracic Disease noted similar findings and concluded neither procedure was superior to the other.
Marc Fortin and Alain Tremblay, “Pleural Controversies: Indwelling Pleural Catheter vs. Pleurodesis for Malignant Pleural Effusions,” Journal of Thoracic Disease (June 2015). [Link]
Thomas R. et. al., “Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion: The AMPLE Randomized Clinical Trial,” JAMA (November 21, 2017). [Link]