The Stanford School Of Medicine Approach To Malignant Pleural Mesothelioma Cases

Malignant Pleural Mesothelioma (MPM) is a rare and aggressive form of cancer that is associated with exposure to asbestos in the remote past.

Generally, mesothelioma (sometimes called “meso”, for short) has a long latency period meaning that is usually not diagnosed until 15 to 50 years after the initial asbestos exposure.

The three major subtypes of malignant pleural mesothelioma (MPM) are:

  1. Epithelial MPM is the most common form and makes up about 60% of all cases.
  2. Sarcomatoid MPM comprises about 10% of all cases and these tumors display a somewhat more aggressive behavior.
  3. The remainder of cases are comprised of the Mixed, or Biphasic variant of MPM that contains elements of both Epithelial and Sarcomatoid MPM.

From the Malignant Pleural Mesothelioma page on the Stanford School of Medicine website we get the following information about the staging of mesothelioma diagnoses:

Generally, Stage I MPM represents early disease with low tumor burden, Stage II MPM represents more locally advanced disease with a greater tumor burden, Stage III MPM represents locally advanced disease with significant invasion of surrounding structures or spread to mediastinal lymph nodes, and Stage IV MPM represents a technically unresectable tumor, or spread to the abdomen or other side of the chest.

Next, we get this overview of what is called “The Stanford Approach to Malignant Pleural Mesothelioma”:

Diagnosis:  We routinely perform minimally invasive VATS [(video-assisted thoracic surgery)] procedures to obtain an adequate tissue biopsy for diagnosis. If adequate tissue has already been obtained at another institution, we will arrange review by our Stanford pathology team.

Staging:  Chest CT [(computed tomograpy)] and PET scans [(an imaging technique that highlights tumors)] are utilized to evaluate the distribution of disease, and this is sometimes supplemented with MRI. We recommend and perform cervical mediastinoscopy to evaluate potential spread to mediastinal lymph nodes (N2 disease), and this can often be performed at the same time as the VATS biopsy.

Treatment:  Whenever possible, we believe in a surgery-based multi-modality treatment program for MPM:

  • For Stage I-III disease without the presence of disease in the mediastinal lymph nodes (N2 negative), we recommend surgical resection (either P/D [(Pleurectomy & Decortication)] or EPP [(Extrapleural Pneumonectomy)], depending upon extent of disease and patient health status) and adjuvant (postoperative) chemotherapy and possibly radiation. When the character of the tumor is resectable by P/D, this is our favored approach. However, when significant invasion of the lung is present, EPP is recommended in sufficiently healthy patients.

  • For patients in whom N2 disease is present, our treatment pathway entails preoperative chemotherapy, still possibly followed by surgical resection, and potential adjuvant radiotherapy.

  • For patients with Stage IV disease or those not medically fit for surgery, we generally recommend chemotherapy, with or without state-of-the-art radiotherapy, and aggressive control of symptoms.

As a final note, we point out that at the Stanford School of Medicine you will find a highly regarded surgeon, Bryan Burt, M.D., who has extensive experience with diagnosing and treating mesothelioma.


 Mesothelioma, Asbestos, and Legal Compensation: Basic Facts

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