Shortness of breath is a common symptom of pleura mesothelioma. One cause of breathlessness is fluid build-up around the lungs, this is also known as a pleural effusion. As fluid builds up, pressure is put on the lungs making it difficult to take deep breaths.
How are pleural effusions treated?
One way to treat a pleural effusion is a thoracentesis or pleural aspiration. This involves a catheter which is a small tube, being inserted into the chest cavity. The tube is then attached to a bag for the fluid to drain into. Once drained, the fluid can be analysed. Pleural effusions can return after they have been drained and so further procedures may be required.
Another treatment for pleural effusions is a pleurodesis. First the fluid is drained through thoracentesis and then the cavity between the lining of the lungs is filled with talc. This causes irritation and scarring which fuses the two layers together so no further fluid can build up. This is a painful procedure and is not always successful. However, many patients find that in the long-term, it is preferable to multiple thoracentesis procedures.
What is an indwelling pleural catheter?
A further treatment for pleural effusions is an indwelling pleural catheter. This is usually considered for patients with recurring pleural effusions or those whose pleurodesis was not successful. The procedure is similar to a thoracentesis in that a tube is inserted into the chest cavity, however, the catheter has a one-way valve at the end. This allows fluid to come out but stops air from going in. The catheter then allows patients to drain as needed, without having to attend hospital each time.
An indwelling pleural catheter can increase a patient’s quality of life. Patients can drain fluid in accordance with their breathing symptoms and do not have to go back into hospital each time this is needed.
Unfortunately, a new study in Canada has found that there may be serious negatives to having an indwelling pleural catheter if you have pleural mesothelioma. After reviewing 90 cases where mesothelioma patients had indwelling pleural catheters, it found that 24 patients developed catheter trace metastasis. This is when new mesothelioma tumours occur at the insertion site of the catheter.
The study showed that it took, on average, 457 days for the new tumours to develop.
While the study shows that there is a risk of developing tumours at the catheter site, it does not look at the treatment of these, although studies have looked at this in the past, further research is needed.
When discussing treatment options, mesothelioma patients need to take many factors into consideration and this study highlights the need to think of the long-term side-effects of indwelling pleural catheters.
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Source: Hosseini, S, et al, “Catheter tract metastasis in mesothelioma patients with indwelling pleural catheters”, European Respiratory Journal, Vol 52, Issue suppl 62, 2018, http://erj.ersjournals.com/content/52/suppl_62/PA3379