Before your mesothelioma surgery
This page tells you what happens to prepare you before an operation for mesothelioma. There is information about
Before your mesothelioma surgery
Before your surgery you will need to have some tests to stage the disease and make sure you are fit enough to make a good recovery. These will include blood tests, an echocardiogram and a PET-CT scan. You may also have a mediastinoscopy or a test called a pericardioscopy which allows the doctor to see if the mesothelioma has spread into the covering layers of the heart (the pericardium). You may have had some of these tests while your cancer was being diagnosed. If so, you may not need to have them repeated.
When you go into hospital, your surgeon, anaesthetist, physiotherapist and nurse will all come to talk to you. The surgeon will give you a detailed explanation of what to expect. Ask as many questions as you want to. It may help to make a list beforehand.
Your nurse or physiotherapist will teach you breathing and leg exercises. You can help yourself to get over your operation by doing these exercises regularly after your surgery. Breathing exercises will stop you from getting a chest infection. And leg exercises will help to stop clots forming in your legs.
You can view and print the quick guides for all the pages in the Treating mesothelioma section.
You will need to have some tests before your operation to make sure you are fit enough to have it. You may have had some of the tests below while your cancer was being diagnosed. If so, you may not need to have them repeated.
A mediastinoscopy is a test to look inside the centre of the chest. You may have this test to see if pleural mesothelioma has spread into the lymph nodes and elsewhere in the centre of the chest (the mediastinum). This test means an overnight stay in hospital, because you usually have a short general anaesthetic. The doctor makes a cut about an inch long at the base of your neck and puts in a tube with an eyepiece or a small camera so they can see inside. The surgeon will take biopsies of the lymph nodes in the mediastinum too. There is more information about having a mediastinoscopy in the section about diagnosing mesothelioma.
A pericardioscopy allows the doctor to see whether pleural mesothelioma has spread into the covering layers of the heart (the pericardium). You usually need to have a general anaesthetic for this test and so have to stay in hospital for at least one night. Some people have the test with a local anaesthetic and a medicine to make them drowsy (sedation).
The surgeon makes a small cut in the skin over the heart and they put a small tube with a camera and light attached through the cut. The tube contains a small video camera, so that the surgeon can look at the area on a screen. The surgeon can also take tissue biopsy samples, which will be examined under a microscope to see if there are any mesothelioma cells. There is more information about having a pericardioscopy in the section about diagnosing mesothelioma.
Lung tests are very important before surgery for mesothelioma. Your specialist needs to be sure that your lungs are working well enough for you to recover well from your surgery. Lung function tests measure how well your lungs take in oxygen. There are different types of lung function test. The simplest involves you breathing out as hard as you can into a tube attached to a machine. This measures how much air your lungs can take in.
For another type of lung function test, you may have to breathe in a very small amount of radioactive gas. This will not harm you. It just shows up your airways on the scan. The radioactivity involved is very small and goes away within a couple of hours. Lung perfusion tests look at the blood supply to the lungs. This means having a small radioactive injection. Again, this won't harm you. It shows the specialist the blood flowing to your lungs and gives an idea of how important each lung is to your overall breathing capacity. You can have these two tests together - they will take about 20 minutes.
An echocardiogram is a test of your heart using sound waves. It is painless and only takes about half an hour. An echocardiogram shows how strong your heart is, and how well it will cope when you have a lung removed.
Your doctor may ask you to have a test that checks how well your heart and lungs work when you are resting and exercising. This is called cardiopulmonary exercise testing (CPET or CPEX). You wear a mask that measures the levels of particular gases in your breath. Your blood pressure and heart rate will also be monitored. You first rest and then walk on a treadmill or cycle on an exercise bike for as long as you can. A computer monitors your breath gases and how well your heart is working. For two hours before the test you should not eat, smoke, drink caffeine drinks, or have other stimulants. You also need to avoid physical exercise and breathing cold air for two hours beforehand.
Your nurse or physiotherapist will teach you breathing and leg exercises. You should do them as often as you are told you need to. Breathing exercises help to stop you from getting a chest infection. And leg exercises will help to stop blood clots forming in your legs. These are common complications of any major surgery because you are not moving around as much as you normally would be. To help prevent chest infections or blood clots, your nurses will encourage you to get up and about as soon as possible after your operation. Even though this is major surgery, you will only be in bed for a day or two.
Below is a short video showing breathing and circulation exercises after surgery when the wound is on your side. Click on the arrow to watch it.
View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)
When you go into hospital for your operation, your surgeon, anaesthetist, physiotherapist and nurse will all come to talk to you about what will happen. Your surgeon will explain what is going to be done and what to expect when you come round from the anaesthetic. Do ask as many questions as you need to. It may help to make a list of your questions before you go into hospital for your operation. The more you know about what is going to happen, the less frightening it will seem. Don't worry if you think of more questions later. Just speak to your nurses and they, or your doctor, can answer them.
On the day of your operation you will not be able to eat or drink. When you change into your theatre gown, your nurse will help you to put on elastic stockings. These are called TED stockings. They will help to stop you from getting clots in your legs after the surgery. You may have injections of heparin, tinzaparin, or dalteparin before the surgery and for a couple of weeks afterwards. These drugs stop the blood from clotting so easily. You usually have them as a small injection under the skin.
About an hour before your operation is due to start, you will have an injection into a vein or will be given tablets to take. This is your 'pre-medication'. It will make you relaxed and drowsy before you go to the operating theatre.
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