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Mesothelioma News

Staging mesothelioma is a multi-step process. Most doctors begin by ordering medical scans, followed by blood tests, pleural fluid examination, needle biopsies and, finally, endoscopic examination and tissue sampling.
Docs recommend mediastinoscopy before extensive surgery for mesothelioma
Staging mesothelioma is a multi-step process. Most doctors begin by ordering medical scans, followed by blood tests, pleural fluid examination, needle biopsies and, finally, endoscopic examination and tissue sampling. It is into this final category that the cervical mediastinoscopy (CM) falls. According to a study published in the European Journal of Cardiothoracic Surgery, performing this simple procedure is a solid way to stage the extent of malignant pleural mesothelioma (MPM).

The mediastinum and its sensitive tissues

There is no exact boundary of the mediastinum, but this area of the chest is loosely defined as all of the upper thoracic organs, minus the lungs. This means that the area contains the heart, esophagus, thymus, trachea, aorta and mediastinal lymph nodes.

What makes this region of the chest so important for MPM patients is that, when mesothelioma first begins to spread, the mediastinum is likely to be the first region of the body affected by the disease.

In a CM, doctors make an incision just above the sternum and insert a thin, flexible tube into the mediastinal cavity. This tube contains lights, a camera and instruments that can cut away sample tissue or even remove whole lymph nodes.Using this technique, physicians can better determine the extent to which MPM has spread into the chest.

To put it mildly, a mediastinal metastasis is undesirable. This thoracic region contains vital structures - the heart, esophagus, aorta and pericardium being some of the most important - whose invasion by MPM can spell disaster. Fortunately, a CM can at least help physicians visualize the spread of mesothelioma and then treat it appropriately.

Researchers recommend pre-surgical CM as a matter of course

In the new study, UK scientists from the Leicester's Glenfield Hospital examined the utility of CM in staging MPM prior to surgery. In particular, the team wanted to find out if a CM could improve prognostic staging before two surgeries: the extrapleural pneumonectomy (EPP) and the lung-sparing total pleurectomy with lymphadenectomy.

To do so, researchers examined more than 200 prior cases in which doctors used CM to stage patients' mesothelioma. The team found that CMs typically delivered an accurate prognosis, often detecting metastasis in the mediastinal lymph nodes.

This finding builds on previous investigations performed by many of the same authors, as in a 2004 study (published in the same journal) which concluded that CMs should be used before all EPPs.

In this way, doctors might have a better idea of the extent of a patient's MPM and, thus, of their probable response to radical surgery.
6/4/12

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