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One of the many possible treatment options for pleural mesothelioma is called a thoracentesis. This is an outpatient invasive procedure that involves the insertion of a thin needle or tube into the side, between the ribs to withdraw fluid from the pleural space. Fluid tends to build up there in patients, especially those with advanced mesothelioma.
A thoracentesis is not a treatment that slows the progression of mesothelioma, or any other type of cancer that causes fluid buildup. What it does that is useful is removes the fluid from between the layers of the pleura that can cause pain and discomfort. It is a relatively simple procedure, but it is also only temporary. The fluid will come back for most patients. Still, it is a lower-risk way to provide patients with symptom relief and a better quality of life.
Pleural effusion is the buildup of fluid between the two layers of pleural tissue, the part of the mesothelium that surrounds the lungs and that is affected in pleural mesothelioma. There are many different conditions that can cause pleural effusion and sometimes the underlying cause can’t be found. Some of the most common causes are pulmonary embolism, cirrhosis, congestive heart failure, pneumonia, and cancer.
Mesothelioma is a cause of pleural effusion, but many people with this type of cancer will not experience it until the disease is advanced. Pleural effusion causes some of the characteristic symptoms of pleural mesothelioma: shortness of breath, pain with breathing, chest pains, and a cough. Treating the pleural effusion with a procedure like a thoracentesis will not treat the cancer, but it can help relieve symptoms for patients who are suffering.
Diagnosing the Underlying Condition
If you go to your doctor with symptoms of pleural effusion, you will need to be diagnosed, first to determine if you do have fluid buildup in the pleural cavity and then to find out what the underlying causes is. A chest X-ray is likely to be the first diagnostic procedure. This image of the chest can confirm that there is fluid in the pleura and can also help your doctor diagnose conditions like pneumonia.
Other imaging tests may be needed, such as CT scans or MRIs, followed by biopsies to determine if the cause of the pleural effusion is a malignancy. The thoracentesis procedure that you may then undergo to drain the fluid can also be diagnostic. Your doctor may remove some of the fluid and send it to a pathology lab for testing. With this the experts can determine if there are cancerous cells present or if there is another issue, such as an infection.
What to Expect with Thoracentesis
The surgical procedure used to drain fluid from the pleural cavity is a relatively simple one. You will either be seated or will lie down. Your skin will be sterilized and you will get an injection of a local anesthetic to numb the area. Your doctor will then insert a thin needle between your ribs and will use a tube or a syringe to draw out the fluid from the pleural space. In some cases the doctor may use the image from a CT scan or ultrasound to guide the insertion of the needle.
After the thoracentesis procedure is complete, your doctor may have you have another X-ray. This is done to check for any signs of problems, such as a collapsed portion of the lung and to make sure all the fluid was removed. The actual procedure only takes about ten minutes, but you may be asked to stay in the doctor’s office for a few hours to be monitored for any possible complications and for the X-ray.
Who Can Benefit from Thoracentesis
For anyone with pleural effusion, regardless of the cause, a thoracentesis can be used to provide relief from the symptoms that the fluid causes. After a thoracentesis you should find it easier to breathe and have less pain. For patients with mesothelioma, the procedure is often done as part of palliative care. Patients in the advanced stages of the disease commonly suffer from the symptoms of pleural effusion and a thoracentesis is a relatively simple, low-risk, and painless way to mitigate those symptoms.
When Thoracentesis Isn’t Enough
For some patients, a thoracentesis is not enough to relieve the symptoms of pleural effusion for very long. In many cases, especially when the underlying cause of the effusion is a progressive disease like mesothelioma, the fluid will refill the pleural cavity not long after the procedure to drain it. There are other more invasive and more permanent solutions to pleural effusion.
These include pleurodesis, a procedure that drains and then seals the pleural space to prevent future fluid buildup, or insertion of a semi-permanent indwelling catheter into the chest cavity for patients to drain the fluid on their own at home. Not all patients are good candidates for these more involved procedures. It depends on the nature of their disease and the estimate of how effective the procedures will be. With that said, they can be used at all points of the disease course, but their effectiveness may decrease as the mesothelioma progresses.
Complications and Recovery
A thoracentesis is generally a low-risk procedure. It only requires local anesthesia and a few hours of recovery time. Complications are rare, but may include such minor issues as bleeding, pain, minor internal bleeding, an infection, and a cough. More seriously, but also rare, the procedure may cause respiratory distress, damage to organs or the diaphragm, a buildup of pus or blood in the pleural space, a more severe infection, and seeding of a tumor along the injection site.
This also carries the risk of injury to the lung itself, causing the lung to collapse, or a pneumothorax. One study found that the risk of this could be reduced when the procedure was guided by an ultrasound image of the patient’s chest. The post-procedure X-ray and monitoring are used to ensure the patient has not suffered any complications or that if there are complications, they can be addressed right away. If this occurs, treatment is dependent on the severity which can include monitoring or insertion of a temporary chest tube until the lung is able to stay sealed itself.
For a patient living with mesothelioma, the symptoms of pleural effusion can lead to pain and discomfort, as well as a diminished quality of life. It is an important part of treatment because it is a simple way to bring symptom relief and to help patients breathe better and enjoy a greater quality of life. However, thoracentesis will not help to cure mesothelioma. If you are suffering with pleural effusion symptoms, talk to your doctor and find out if you are a good candidate for thoracentesis or other procedures.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.