Pleural mesothelioma is a cancer that starts in the sheets of tissue that cover the outside of the lung and the lining of the chest cavity. These sheets of tissue are called the pleura. You can see the pleura in the diagram below.
Mesothelioma can sometimes cause fluid to collect between the 2 layers of the pleura (pleural space). Doctors call this fluid collection a pleural effusion. The fluid can press in on the lung and make it hard to breathe.
How the treatment works
Treatment can stop the fluid from building up and can help relieve symptoms. This treatment is called pleurodesis. It seals the space between the tissues covering the lung by using sterile talc to make them inflamed so they stick together. Then there is no space for the fluid to collect.
You can have this done as an outpatient if you are well enough. But you may have to stay in hospital overnight if there is a lot of fluid to drain off. This can take some time and your nurses will want to keep an eye on you.
This treatment doesn't treat the cancer. But it should be easier for you to breathe afterwards. If it doesn't work completely the first time, you can have it done again.
How you have treatment
There are different ways of having this treatment, depending on whether you need to have fluid drained beforehand.
No fluid to be drained
If you have no fluid to be drained, your doctor may put a tube called a thorascope into your chest until it is between the coverings of the lung (the pleura). They can see through the tube so they know exactly where to put the powder. They put it through the thorascope tube. This way of doing pleurodesis is called video assisted thoracoscopy.
If you need to have fluid drained from between the pleura beforehand, your doctor will first give you a small injection of local anaesthetic.
When the anaesthetic has worked, the doctor puts a wide needle (cannula) into your chest, usually through your side. The tip of the needle goes into the space where the fluid is collecting. Once it is in the right place, the doctor attaches the needle to a drainage tube called a chest drain, that is attached to a collecting bottle or bag.
Your doctor puts a stitch in the skin around the tube to hold it in place. This is called a purse string suture.
As long as the drainage bottle or bag is kept lower than your chest, the fluid drains out automatically. If there is a lot of fluid, this can take several hours. It needs to be done slowly, because draining a large amount of fluid too quickly can make your blood pressure drop suddenly and make you feel faint. Also, if the lung expands too quickly you can feel more breathless.
Putting in sterile talc
Once the fluid has stopped draining, the doctor injects sterile talc powder into the pleural space through the drainage tube. Then they clamp the tube shut and leave it for an hour.
You lie in different positions on your bed to help to spread the powder around the pleural space.
After that, the drain may be attached to suction apparatus. This helps to stick the pleura together. It can be a bit uncomfortable and you might have painkillers to take beforehand. But for most people the soreness is mild and doesn't last long. Do tell your doctor or nurse if it is a problem for you.
After the treatment
After this, your doctor or nurse takes the tube out and pulls the stitch tight to close the small opening in your chest wall. The stitch stays in for about a week.