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Mesothelioma Treatment: Talc Pleurodesis

Pleurodesis is a mesothelioma treatment aimed at stopping fluid build-up in the lungs, therefore easing shortness of breath.

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What’s the problem?

A medical procedure routinely used for the treatment of recurrent pleural effusion (excess fluid that surrounds the lungs), pleurodesis is performed by the addition of a number of chemicals and agents into the pleural cavity, which first causes inflammation (pleuritis), and then causes the pleurae to stick together. Talc is the most frequently used agent because it has been shown to result in fewer complications while delivering a high rate of success (90-96%).

Pleurodesis Options

There are two options in performing pleurodesis:

  • If the doctor believes that a patient does not fall into the high risk category, pleurodesis may be performed outside an operating room during hospitalization. A sedative and general anesthetic will be given to the patient and a chest tube will be inserted to drain any existing fluid. Depending on the extent of the fluid, this process may take a few days. When all the fluid is removed, the talc or doxycycline will be inserted through the chest tube and clamped to avoid leakage. A suction device is then used to bring the two lung surfaces together. The biggest disadvantage of a non-surgical pleurodesis is that the chest tube may be in place for several days, which is quite uncomfortable, prompting the need for painkillers.
  • If your doctor chooses to perform pleurodesis in the operating room, you will be given a general anesthetic. A thoracic surgeon (a doctor who specializes in diseases of the chest) will make an incision in the chest and insert a video-assisted thorascope to assist in viewing the inside of the lung. The video will also help the doctor to insert the chemical agent directly onto the pleural surface. This procedure carries all the risks of any surgery, including allergies to anesthesia, infection, or bleeding.

All these measures are intended for provoking an inflammatory reaction of the parietal and visceral pleural surface that will promote obliteration of the pleural space (namely pleurodesis). This ensures that pleural liquid cannot be repeatedly accumulated. It should be taken into account that before performing pleurodesis, it is required to make total drainage and absolute re-expansion of the lung. You may or may not be a candidate for this procedure. If your lung capacity is already seriously diminished, pleurodesis may not work for you.

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