The P/D surgery procedure involves taking out the lining of the chest so that the cancer cannot spread around the body. The mesothelium, which is affected by this cancer, and is being treated or replaced through this method, is the membrane that creates the lining of numerous body cavities and organs. This membrane is removed in a P/D surgery to stop the abnormality of the mesothelium, from increasing at a faster rate, to prevent the dividing of the mesothelium invading and damaging tissues and organs around it, for instance the tissues of the heart, to avoid a life-threatening situation for the patient.
The first phase of the operation is to use an anaesthetic to make the patient unconscious before the surgery. Then the surgeon collapses the affected lung, this is done so that no air can move in or out of the body, to make it easier for the surgeon to operate on the lung. After that, the operation takes place, and the surgeon takes out the rib cage to operate on the affected area. The surgeon then removes the surrounding tumour, sparing the unaffected lung, and treats the mesothelium after the surgery as a chronic illness thereafter. After the surgery, radiotherapy is performed on the patient to kill off any cancerous cells left in the area, and to control the growth of cells in the affected area. The therapy involves ionizing radiation being injected into your body, the radiation damages the DNA of the affected tissue, as the cells that have become cancerous may have turned off their function to repair their DNA, and thus the cell can be killed. The surgery takes a few hours, and then the patient would have to stay a minimum of 12 days after the operation.
Fig.3 graph to show the median survival time of a patient after the surgery has been performed four different years used for each surgery.
Before the surgery is done, there are things the patients have to take in preparations. No drugs are needed to be taken, but a healthy lifestyle should be followed for the lung to be able to cope with the surgery, and therefore minimise the number of complications that could arise during or after the surgery.
Evaluation: Potentially Curative Surgery
The surgery has a higher success rate than EPP, and the median survival rate between the years 1989-1997 was higher compared to the survival rate of EPP between the years 1994-1999, as Fig.3 shows. The figure shows how effective both surgeries have been in the past. It is reliable as it shows the doctors that did the study to find out what the average survival rate of a patient was after they had got the surgery done. However, the source is not very wide as it does not give us the sample space used in each of the studies and the graph is not in much detail, for instance error bars which could help the reader understand it more. Moreover, the mortality of P/D is significantly lower than EPP, because it is a less radical surgery.
One of the procedures of the surgery, the collapsing of the lung, is a significant part of the operation and is an effective procedure during the surgery as it makes the operation much easier for the surgeon, and thus reduces the chance of any complications during the surgery.
The surgery is effective because, it only targets the affected area in the patient, and therefore, this reduces the risk of the patient having any difficulties or problems being caused elsewhere in the body, while the surgery is taking place.
The solution is appropriate for the reason that the tumour can be removed completely to stop it from spreading around the body. This is the case for every other surgery option, however, each surgery has a different purpose, and for instance, one surgery option may just slow down the development of the tumour, as it may be too difficult to remove it completely. However, the P/D surgery removes all the organs to get to the tumour which involves a lot of risk but is very effective. Additionally, the surgery can help the surgeon get a better look at the cancer and help modern medicine and research understand it more to maybe come up with a better surgery or solution. However, the fact that there are deaths during or straight after this surgery, somewhat questions the appropriateness of the solution.
Implications:
Economic – Costs
Even though the NHS pays for all the surgery and medicine costs the patient needs to survive. It costs the NHS more than £1billion on lung related diseases and surgeries, which put pressure on the Government on getting the money for these costs. Furthermore, the patient may have to quit their job because they can simply not work in the environment and therefore this can cause financial problems for the patient and their family. However, the patient may decide that they want to go abroad to get the best treatment possible and the money, the patient spends on physicians and therapies will also be very high, which may not be affordable by most people because of the current recession.
Social – Family and work problems
The life after the operation may not be as simple and normal as before. The recovering patient would have to follow a number of restrictions in order to obtain the full effects of the surgery. This could affect their family life, for instance, the food they can eat at family gatherings or the activities they can do outside of studies/work.
Additionally, the patient possibly will have to keep visiting the hospital for regular check-ups and medicine collections, which may perhaps interfere with their social life. More implications would be; the side effects the patient could have after the surgery, this could result in the patient having and organ failure or they could have mental side effects, such as being depressed or have mood swings.
Impacts on humans:
Benefits
There are many benefits people can have from a P/D surgery. The main one is indeed is that the life span of the Mesothelioma patient will increase; this is averagely about 20-22 months with technology getting better with time from 1996 when the average survival time was about 18-19 months. Moreover, “Dr. Trousse found that the 57 patients who underwent radical Pleurectomy/Decortication had better overall survival at 1 year (83%) and at 2 years (73%) than did patients treated with alternative surgical techniques.” [2] This illustrates that the P/D surgery is the best type of surgery to undergo, because it results in a better survival time, this means the number of months more they will live after the surgery, and thus would be the surgery that is mainly discussed for a Mesothelioma patient to undergo during their treatment. In addition to that, the patient will have a more comfortable life as they would not have as many complications as before, for instance, their breathing difficulties would be reduced drastically.
Risks
The risks of the P/D vary from a minor problem to life-threatening problems. One risk is that the patient could suffer allergic reactions from the anaesthetic; this will cause complications at some stage in the surgery that could in turn change the outcome of the surgery and make the surgery more difficult because the allergic effects might interfere with the surgery procedure. Furthermore, the patient is put under chemotherapy after the surgery; during this, the patient could have side effects to the therapy which may also affect the recovery of the patient. On the other hand, a major risk would be that after the tumour is treated, the patient’s lung was collapsed and they were put on a breathing machine, anything could malfunction in the machine and thus cause the death of the patient. The main risk evidently is that the patient could die from the surgery, even though the surgery has a very low mortality rate, it is still a possibility.
Alternative Solutions:
Other than radical surgeries, there are a few other treatment options that could help the Mesothelioma patient either considerably or just act as a painkiller treatment to make the patient feel more comfortable.
Palliative Surgery
Palliative surgery is the best treatment (other than chemotherapy) that can be offered to a patient suffering from Mesothelioma, in the UK. These surgeries are for patients whose tumour has gone past the Mesothelium, and consequently, have to get their mesothelium completely removed.
The process of palliative surgery is a surgery which is simpler than a P/D surgery, but has to fix a more complicated situation. During the surgery, the mesothelium and visceral pleura, the thin membrane around the lungs and inner walls of the chest, are taken out and replaced my mesh to work in the same way as the membrane would have worked before the cancer developed. This means that the cancer cells are not able to diffuse through the membrane because the mesh has no channel proteins or holes in the membrane for diffusion to happen.
One sort of palliative surgery is pleurodesis, this type of surgery is used to treat pleural effusion, which is the build-up of fluid around the chest area between the lung and its lining, which is called the pleural area. There are two ways of pleurodesis; one method is to irritate the cancerous cells with surgery, and also remove cells that are suspected to be affected by the cancer.
At the end of the surgery, the patient will feel a relief in their breathing problems, and after recovering fully, they shouldn’t feel much pain, because the fluid in the pleural area is removed, therefore the cancer and tumour has no space to block the respiratory system, which will lessen the patient’s coughing as well.
Chemotherapy (5)
Chemotherapy is the main stream treatment given to patients with any sort of cancer.
The aim of this is to improve the quality of the patient’s life, and is known in some cases to have shrunk the cancer and keep the cancer under control for longer, which could sometimes result in extending the length of life as well.
Chemotherapy for a Mesothelioma patient, would involve them having anti-cancer drugs being injected into their lungs. The drugs stop the cancer cells from growing and damaging other cells and tissues around it. Nevertheless, the drugs do damage normal body cells that are not affected, which could make the patient feel uncomfortable and pain, but this side effect is overcome quite simply as the healthy cells repair themselves quickly.
Although, in Mesothelioma, only an estimated 35% of people who receive chemotherapy actually respond to it, in the UK, chemotherapy is one of the best treatments that can be given to a patient. This displays, that even though it does not help every patient, it has still got a good success rate to extend the life span of a patient, to be one of the best treatments to be offered.
Bibliography
- Name: Cancer Research UK
URL:
Date Accessed: 30/10/2011
Evaluation – I believe that the Cancer Research UK website is a very reliable source, as the purpose of it is to educate and inform people about Mesothelioma. It is one of the UK’s most renowned cancer help and information centre, which has information, experiment, results and data, on all known cancers. Evidence of their validity is shown, as their data – “Between 7 and 8 out of every 10 people diagnosed with Mesothelioma (70 to 80%) say they have been in contact with asbestos.” Is to some extent replicated on as they confirm – “In 2008, the last year for which figures are available, 2,249 individuals in the United Kingdom died of Mesothelioma. Of that number, men accounted for 83 percent of those deaths.” This proves that the source is valid and reliable.
- Name: Doc Guide
URL:
Date Accessed: 03/11/2011
- Name: Kazan Law
URL:
Date Accessed: 31/10/11
-
Dr Lang-Lazdunski. L. (2011, 5 October) Lecture: Lung Cancer: The quest for a curative treatment, Lecture presented at King’s College London
Evaluation – Dr Lang-Lazdunski is a world famous cardiothoracic surgeon, who currently works at Guy’s Hospital in London. I believe that this would make him a reliable source because he has a lot of experience in this field and is an expert in the surgeries for Mesothelioma patients. His intention was to inform and explain his job and this cancer at the lecture, to give us an insight on his medical speciality and this particular cancer. Dr Lang-Lazdunski states “they have a very strong tensile strength, and are resistant to fire, heat, electrical and chemical damage, which consequently is good for many industries” this shows why asbestos is used, and is reflected by information on they state “Its properties of resistance to heat, electricity and sound, make it useful for a variety of purposes...” This verifies that the source is valid and very reliable as his information is similar to another source.
- Name: Resource 4 Mesothelioma
URL:
Date Accessed: 03/11/2011
-
Dr Cameron, RC (2006), “Extrapleural Pneumonectomy is the Preferred Surgical Management in the Multimodality Therapy of Mesothelioma: The Con Argument”, Annals of Surgical Oncology, volume 14, issue 4 -
Date Accessed: 31/10/2011
Image Bibliography
Image: Fig.1
URL:
Date Accessed: 31/10/2011
Image: Fig.2
URL:
Date Accessed: 31/10/2011
Image: Fig.3
URL:
Date Accessed: 31/10/2011
Word Count:
2849
