Coding and Treatment for Pleural Mesothelioma

Although it doesn't seem that long ago, my brother Bob was diagnosed with malignant pleural mesothelioma in September 1997. He was only 50 years old. As chronicled by my sister Barb in “A Hole in Many Lives” – Bob’s Story, Bob had been exposed to asbestos while working a summer job approximately 30 years prior to his diagnosis. Two months after being diagnosed, he went on to have surgery to remove his right lung, pericardium and diaphragm. Following the surgery, he began chemotherapy and radiation.
Bob was told he had no more than 18 months to live. He surpassed that.
In September 2003, Bob’s cancer recurred in his abdomen. This time he chose to undergo chemotherapy using cisplatin and Alimta …show more content…
The primary cause is exposure to asbestos. Mesothelioma is a strikingly forceful and fatal disease which has no cure. In fact, the goal of most treatment is to provide the patient with as much comfort as possible.
For the purposes of this article, we will focus on the diagnosis and treatment of pleural mesothelioma.
Diagnosing Mesothelioma
When mesothelioma is suspected, the physician will perform a physical examination and check for any lumps or other unusual signs. He will also perform a biopsy based on the affected body area, which may involve fine needle aspiration, thoracoscopy, laparoscopy, or thoracotomy. Once the tissue is analyzed under a microscope, it will be determined if it is mesothelioma and what types of cells are involved.
To determine the stage and monitor the cancer, imaging tests will be ordered. These may include CT (computerized axial tomography) scans of the abdomen and chest, MRIs (magnetic resonance imaging), and PET scans (positron emission tomography). Blood tests will also be done and may include Mesomark and SOMAmer.
Stages of …show more content…
Some surgeons feel that the patient’s quality of life will be adversely affected with only one lung and prefer the P/D method. Hence, the P/D surgery was developed where only the lining of the affected lung is removed and not the entire lung.
Extrapleural Pneumonectomy (EPP)
The Extrapleural Pneumonectomy surgery was developed by Dr. David Sugarbaker. I actually met Dr. Sugarbaker at Brigham and Women's Hospital in Massachusetts while on a trip with Bob. Bob had originally planned to have Dr. Sugarbaker perform his surgery but then decided instead on Dr. James Mault of Colorado. Our experience with Dr. Mault was very positive.
During an EPP, the entire affected lung is removed, along with the lining of the lung (pleura), lining of the heart (pericardium), and a part of the diaphragm. A patch created by Gore-Tex breathable fabric is then inserted to stabilize the chest wall and fill the cavity.
The main goal of an EPP is to remove all cancerous tissue and reroute all blood vessels to prevent cancer cells from spreading. This can also keep the cancer from returning