NCCN Guidelines for Patients
Malignant Pleural Mesothelioma, Version 1.2014
Stage I–III epithelioid or mixed mesothelioma
Before surgery to remove the cancer, your surgeon
will perform a surgical exploration. This is a minor
surgery to look inside your chest to see how much the
tumor has grown and spread. Use of a thoracoscope
inserted through one surgical cut is the preferred
method for exploration. A thoracoscope is a thin,
tube-shaped instrument with a light and camera lens
for viewing and tools to remove tissue from the chest.
Surgical exploration allows your doctor to asses if
surgical treatment is possible and a good treatment
option for you.
Primary treatment is the main treatment used to rid
your body of cancer. Surgery is used as a primary
treatment for some mesotheliomas. Surgical
treatment is only recommended if the entire tumor
can be removed. If the whole tumor can’t be removed
by surgery, then you will receive treatment with
chemotherapy. See page 34 for chemotherapy details
and treatment recommendations.
If surgery is possible, your doctor will then decide
which type of surgery is best for you. Surgery should
be performed by a board-certified thoracic surgeon.
A thoracic surgeon is a doctor who’s an expert in
operating on organs inside the chest.
There are two types of surgery for mesothelioma:
ecortication) and EPP
neumonectomy). P/D removes the
tumor and the pleura affected by the tumor. EPP
removes both pleural layers, the lung and diaphragm
on the same side of the chest as the tumor, and often
the pericardium. During both surgeries, lymph node
sampling should be done to assess if the cancer
has spread to the lymph nodes between your lungs.
Lymph node sampling only removes some of the
nodes from a cluster.
There is no well-designed research to show which
surgery is better in which circumstances. Your
doctors will recommend a surgery based on many
factors. They will consider your overall health, ability
to do activities, symptoms, cancer stage, and the
cell subtype of the mesothelioma cell. They will
also consider that the dangers of surgery are more
likely and more serious with EPP than P/D. Ask your
treatment team for a list of all the dangers of the
surgery they recommend.
Adjuvant treatment is given after surgery to treat any
remaining cancer cells.
Adjuvant treatment after
P/D is chemotherapy.
If you had chemotherapy
before P/D, no adjuvant treatment is recommended.
See page 34 for a list of chemotherapy drugs
recommended for mesothelioma.