Why are some patients candidates for surgery while others are not?
Q: Hello Dr. Vogelzang! My father was recently diagnosed with mesothelioma and was told he was not the “right candidate” to undergo surgery. However, my uncle was diagnosed with the same cancer five years ago and his physician performed surgery on him. Why are some patients able to undergo surgery and others are not? Is the decision for a surgical approach usually based on the patient’s age?
A: Mesothelioma is like most common cancers: It starts in one organ and generally stays there unless you can remove it. But if you can’t remove it, mesothelioma can spread through the body, often to the other lung or lymph nodes. I’ve seen it spread to the liver, the brain, and other places after advancing significantly. We’ve looked at the many combinations of treatments, and chemotherapy first followed by surgery is the best option. Only 10-20 percent of patients are candidates for surgery. The majority of patients with advanced mesothelioma have heart disease or lung disease, or the cancer is outside the expected ability of operation. I suggest chemotherapy, and if the response is successful, then we’ll consider surgery. For the young and healthy patient, surgery is the first option.
The question of how old is too old always comes up in oncology. Old is physiologic, not chronologic. You can be 70 and run marathons, or you can be 80 and on the golf course every day, but in general the cut off age is 70. Risks of surgery go up, and we always concern ourselves with potential unexpected complications after surgery. I counsel the very healthy 70-year-olds out doing everyday activities like golfing, swimming, and hiking to consider it. But, if they lose a lung or part of a lung at age 70, it makes life pretty difficult. If a tumor grows through the chest into the muscles or the bones causing severe pain, those patients cannot often be operated on successfully.