Breathlessness

Shortness of breath, also called breathlessness or dyspnoea, is the most common symptom of pleural mesothelioma. This is often caused by a build-up of fluid in the pleural cavity known as a pleural effusion. The fluid can put pressure on the lung, making it harder to breathe.

In the earlier stages of pleural mesothelioma, controlling this fluid build-up will improve breathlessness. The level of improvement will depend on the health of your lungs before diagnosis, and how well they function after surgery. You may also feel breathless because of the cancer itself not allowing the lung to work properly (trapped lung).

Other problems such as infection or a low level of red blood cells (anaemia) can also cause breathlessness.

Although living with breathlessness can be difficult, there are ways to reduce its impact on your life and manage the condition at home.

Learn more about:

• Ways to drain fluid around the lungs
• Ways to control fluid around the lungs
• Improving breathlessness at home

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Ways to drain fluid around the lungs 

Fluid build-up around the lungs may be drained before mesothelioma is diagnosed or at the same time as the biopsy.

Pleural tap 

Also known as pleurocentesis or thoracentesis, a pleural tap drains fluid from around the lungs. Your doctor will numb the area with a local anaesthetic and insert a needle between your ribs into the pleural cavity. An ultrasound scan may guide the needle to the fluid. The needle is connected to a bag for the fluid to drain into. This may take about 30–60 minutes. You usually don’t have to stay overnight after a pleural tap.

Ways to control fluid around the lungs

Talc pleurodesis 

To prevent fluid building up again in the lining of the lungs, you may have a talc pleurodesis. Pleurodesis means closing the pleural cavity.

Sterile talcum powder (talc slurry) is inserted into the pleural cavity, and the talc slurry causes an inflammation that helps fuse the two layers of the pleura together and closes the space. A talc pleurodesis is best done during VATS by a cardiothoracic surgeon, but is sometimes done by a respiratory physician.

After a talc pleurodesis, some people experience a burning pain in the chest for 24–48 hours. This pain can be eased with medicine and you will be able to have physiotherapy to improve lung expansion.

VATS with pleurectomy decortication 

When fluid is drained and talc pleurodesis is done during VATS, part or all of the outer layer of the pleura (parietal pleura) is removed. This is known as pleurectomy decortication or PD.

This may be done when the parietal pleura, which lines the chest wall, has become thick and inelastic.

Open surgery (thoracotomy) with pleurectomy decortication 

Even after VATS and talc pleurodesis, the fluid may build-up around the lungs again, causing breathlessness. The surgeon may suggest more extensive surgery called thoracotomy with pleurectomy decortication (PD). This surgery may also be recommended as a first option if the cancer has grown in a way that makes it difficult to perform VATS successfully.

A thoracotomy helps to prevent fluid building up again in most cases. It also makes it easier for the lungs to expand and to transfer oxygen to the blood.

Pain can last longer than after VATS, but the improvement in symptoms may make open surgery a worthwhile option if VATS has been unsuccessful or isn’t possible.

Indwelling pleural catheter

Some people cannot have VATS or open surgery, either because they are too unwell or because the cancer has grown in a way that makes the surgery too difficult. Instead, you may be offered an indwelling pleural catheter (also known as a drain) to remove the fluid and improve your breathing. This can also be used if the pleural fluid builds up again after pleurodesis.

Under local anaesthetic, the specialist inserts a thin tube (the catheter) through the chest wall into the pleural cavity. You can manage the drain at home with the help of a community nurse, family member or friend. When the fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a bottle.

Sometimes with an indwelling pleural catheter, the pleural cavity may close up over time and stop producing fluid. If this occurs, the drain will be removed.