Key Takeaways
- Doctors decide whether mesothelioma can be surgically removed by weighing five main factors: cancer stage, tumor location, cell type, the patient’s overall health, and whether surgery offers a meaningful benefit that outweighs its risks.
- Stage alone does not decide eligibility. Some patients with advanced disease may still be evaluated for selected procedures, while some with limited disease may not benefit from an operation.
- For pleural mesothelioma, the main operations are pleurectomy/decortication (P/D), which preserves the lung, and extrapleural pneumonectomy (EPP), which removes it and is reserved for highly selected patients.
- For peritoneal mesothelioma, selected patients may be offered cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC).
- Epithelioid mesothelioma is generally more favorable for surgery, while major surgery is generally not recommended for the sarcomatoid cell type.
- Age alone does not disqualify a patient. Lung function, heart health, physical functioning, and the ability to tolerate additional treatment all factor into the decision.
- If mesothelioma cannot be removed, chemotherapy, immunotherapy, radiation, clinical trials, and symptom-relief procedures may still be options.
Receiving a mesothelioma diagnosis can bring many questions about treatment, recovery, and what comes next. One of the first questions patients may ask is whether surgery can remove the cancer. However, mesothelioma surgery is not an option for everyone. Doctors must carefully evaluate the cancer’s location, how far it has spread, its cell type, and the patient’s overall health before recommending an operation.
Mesothelioma can grow along the lining of the lungs or abdomen, sometimes spreading across nearby tissues rather than forming one distinct tumor. This can make complete surgical removal challenging. Even when surgery is possible, doctors often combine it with other treatments to address cancer cells that may remain.
Understanding how medical teams make this decision can help patients and their families prepare for discussions about their treatment options.
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Cancer Stage and How Far the Disease Has Spread
One of the first factors doctors consider is the stage of mesothelioma. Staging helps the medical team understand the extent of the cancer and whether it may be possible to remove all visible disease.
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Doctors may use imaging tests, biopsies, and other diagnostic procedures to determine whether the cancer has spread beyond its original location. For pleural mesothelioma, which develops in the lining surrounding the lungs, doctors evaluate whether the disease has invaded nearby structures or spread to lymph nodes and distant organs.
Earlier-stage mesothelioma may be more suitable for surgery, but stage alone does not determine eligibility. Some patients with more advanced disease may still be evaluated for selected procedures, while other patients with apparently limited disease may not benefit from an operation.
The key question is whether surgery can reasonably remove the visible cancer while offering a meaningful potential benefit that outweighs the risks.
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The Location of the Tumor
Where mesothelioma develops also influences surgical decisions.
Pleural mesothelioma affects the lining surrounding the lungs. Because this cancer can spread across the pleural surface and into nearby tissues, surgeons must determine how extensively the disease has grown. If the cancer involves critical structures or has spread too widely, removing it surgically may not be practical.
Peritoneal mesothelioma develops in the lining of the abdomen. In selected patients, doctors may consider cytoreductive surgery, which removes as much visible cancer as possible. This procedure may be combined with heated intraperitoneal chemotherapy, commonly called HIPEC, which delivers heated chemotherapy directly into the abdominal cavity during surgery.
The location and distribution of the cancer help determine which procedure, if any, could be appropriate.
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The Type of Mesothelioma Cells
Mesothelioma is classified into different cell types, and these differences can affect treatment recommendations.
The three main cell types are:
- Epithelioid: This is generally associated with a more favorable prognosis than the other major subtypes. Surgery may be considered for carefully selected patients whose disease has not spread extensively.
- Sarcomatoid: This subtype is typically more aggressive, and major surgery to remove the cancer is generally not recommended for patients with this cell type.
- Biphasic: This subtype contains both epithelioid and sarcomatoid cells. Whether surgery is appropriate depends on the characteristics of the tumor and other clinical factors.
Doctors determine the cell type by examining tissue obtained through a biopsy. The results help the medical team understand the cancer’s characteristics and evaluate the potential benefits of different treatments.
Cell type is only one part of the decision. Even a patient with epithelioid mesothelioma may not be a suitable surgical candidate if the cancer has spread extensively or the risks of surgery are too high.
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The Patient’s Overall Health and Ability to Recover
Even when a tumor appears surgically removable, doctors must determine whether the patient is healthy enough to tolerate the procedure.
Mesothelioma operations can be complex and may require substantial recovery time. Doctors evaluate several aspects of a patient’s health, including:
- Lung function: Tests help determine whether the patient can safely tolerate an operation involving the tissues around the lungs.
- Heart health: Cardiovascular conditions may increase the risks associated with major surgery.
- Other medical conditions: Conditions affecting the lungs, heart, kidneys, or other organs can influence surgical eligibility.
- Physical functioning: Doctors assess how well the patient manages daily activities and whether they are likely to tolerate treatment and recovery.
- Ability to receive additional treatment: Surgery is often considered as part of a broader treatment plan, so doctors may evaluate whether the patient can also undergo chemotherapy or other recommended therapies.
Age may be considered alongside these factors, but it does not determine eligibility by itself. A patient’s overall condition, medical history, and preferences are important parts of the evaluation.
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Diagnostic Tests and Additional Evaluations
Doctors use several tests to determine whether mesothelioma can be surgically removed. The exact evaluation depends on the suspected cancer location, the patient’s health, and the treatment being considered.
Common assessments include:
- CT scans: These provide detailed images that help doctors evaluate the tumor’s location and possible involvement of nearby structures.
- PET scans: These may help identify areas of suspected cancer activity elsewhere in the body.
- Biopsies: Tissue samples confirm the diagnosis and help identify the mesothelioma subtype.
- Lung function tests: These measure breathing capacity and help determine whether a patient can tolerate certain chest operations.
- Additional staging procedures: Depending on the case, doctors may recommend further tests to evaluate lymph nodes or determine the extent of the disease.
Imaging tests cannot always reveal the full extent of mesothelioma. In some cases, surgeons discover during an operation that the cancer has spread farther than expected. If complete removal is not feasible, the surgical team may change the planned procedure or stop the operation if continuing would not provide sufficient benefit.
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The Potential Benefits and Risks of Surgery
Doctors must weigh the possible benefits of surgery against its risks. The goal may be to remove visible cancer, reduce the amount of disease, or relieve symptoms. However, removing the visible tumor does not guarantee that all cancer cells have been eliminated.
For pleural mesothelioma, one option is pleurectomy/decortication (P/D). This procedure removes the affected pleural lining and visible tumor while preserving the lung. More extensive versions may also involve removing and reconstructing nearby tissues.
Another operation, called extrapleural pneumonectomy (EPP), involves removing the affected lung along with surrounding tissues. Because this procedure is more extensive and carries significant risks, it is reserved for highly selected patients in experienced centers.
For peritoneal mesothelioma, cytoreductive surgery may be combined with HIPEC when appropriate.
Surgery may also be used to relieve symptoms even when removing all the cancer is not possible. For example, certain procedures can help address fluid buildup or discomfort.
Importantly, surgery is not automatically the best option simply because a tumor appears removable. Current treatment guidance emphasizes careful patient selection and multidisciplinary evaluation, particularly for major operations involving pleural mesothelioma.
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Why a Multidisciplinary Team Matters
Mesothelioma treatment decisions often involve several specialists, including thoracic or surgical oncologists, medical oncologists, radiologists, pathologists, and pulmonologists.
Each specialist contributes different information. A radiologist evaluates imaging findings, a pathologist examines the cancer cells, and a surgeon determines whether an operation may be technically feasible. Other specialists assess treatment options and the patient’s ability to tolerate them.
The team considers these findings alongside the patient’s goals and preferences. Depending on the circumstances, the recommended plan may involve surgery, chemotherapy, immunotherapy, radiation therapy, a combination of treatments, or approaches focused on relieving symptoms.
Patients may also ask whether a second opinion from a medical center experienced in treating mesothelioma would be helpful. Because this is a rare and complex cancer, specialized evaluation can help patients better understand the potential benefits and limitations of their options.
What Happens if Mesothelioma Cannot Be Surgically Removed?
When mesothelioma is considered unresectable, meaning surgery cannot reasonably remove all visible disease, treatment options may still be available.
Depending on the cancer’s location and characteristics, doctors may recommend chemotherapy, immunotherapy, radiation therapy, clinical trials, or treatments designed to relieve symptoms and improve quality of life. Procedures to manage fluid buildup may also be considered when needed.
The absence of a surgical option does not mean there is nothing that can be done. The appropriate treatment plan depends on the individual patient’s diagnosis, health, and goals.
Understanding Your Options After a Mesothelioma Diagnosis
Determining whether mesothelioma can be surgically removed requires more than looking at the tumor alone. Doctors consider the cancer’s stage, location, cell type, the patient’s overall health, and whether surgery is likely to provide a meaningful benefit.
Because treatment decisions can be complex, patients should discuss the potential benefits, risks, and alternatives with a qualified mesothelioma treatment team. Asking questions and understanding the reasoning behind a recommendation can help patients and their families make informed decisions about care.
For individuals diagnosed with mesothelioma following asbestos exposure, there may also be legal questions to consider alongside medical treatment. The Halpern Law Firm represents individuals and families affected by mesothelioma and other asbestos-related illnesses. If you have questions about your legal options, you can contact the firm at (800) 505-6000 or fill out our contact form and we will respond right away.
Frequently Asked Questions
What does it mean if mesothelioma is “resectable”?
Resectable means surgeons believe an operation can reasonably remove all visible cancer. Unresectable means surgery cannot remove all visible disease, often because the cancer has spread too widely or involves critical structures. Even resectable mesothelioma is usually treated with surgery combined with other therapies, because removing the visible tumor does not guarantee every cancer cell is gone.
Can you have mesothelioma surgery if you are over 70?
Age is considered, but it does not determine eligibility by itself. Doctors focus on overall health, including lung function, heart health, other medical conditions, and how well a patient manages daily activities. An older patient in good health may be evaluated for surgery, while a younger patient with serious health problems may not be a candidate.
What is the difference between P/D and EPP surgery?
Pleurectomy/decortication (P/D) removes the affected pleural lining and visible tumor while preserving the lung. Extrapleural pneumonectomy (EPP) removes the affected lung along with surrounding tissues. Because EPP is more extensive and carries significant risks, it is reserved for highly selected patients treated at experienced centers.
Is surgery an option for peritoneal mesothelioma?
Yes, for selected patients. Doctors may recommend cytoreductive surgery, which removes as much visible cancer as possible from the abdominal lining. It is often combined with heated intraperitoneal chemotherapy (HIPEC), which delivers heated chemotherapy directly into the abdominal cavity during the operation.
Why is surgery usually not recommended for sarcomatoid mesothelioma?
Sarcomatoid mesothelioma is typically more aggressive than the epithelioid type, and major surgery is generally not expected to provide enough benefit to justify its risks. Patients with this cell type are usually evaluated for other treatments, such as immunotherapy, chemotherapy, or clinical trials. Biphasic mesothelioma, which contains both cell types, is evaluated case by case.
Can doctors change the plan during mesothelioma surgery?
Yes. Imaging cannot always show the full extent of mesothelioma, and surgeons sometimes find during the operation that the cancer has spread farther than expected. If complete removal is not feasible, the surgical team may change the planned procedure or stop the operation if continuing would not provide enough benefit.
Does my treatment choice affect my mesothelioma legal claim?
No. Whether you have surgery, chemotherapy, or another treatment does not determine whether you can file a claim. Your medical records, including biopsy and pathology results, help document your diagnosis. In Pennsylvania, mesothelioma claims generally must be filed within two years of diagnosis, so speaking with an attorney early is important. Call The Halpern Law Firm at 800-505-6000 or request a free case review.
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