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Cervical Mediastinoscopy

The diagnosis of malignant pleural mesothelioma has always been a difficult one to make. The initial symptoms of pleural effusion, cough, shortness of breath, do not happen to everyone and are symptoms of other very common diseases. Patients are often treated for pneumonia and then the symptoms persist, and they are then worked up further. Often this takes months from the initial symptoms to diagnosis and sometimes the diagnosis is not made until malignant mesothelioma is advanced. When a patient has respiratory symptoms, imaging, chest x-ray or CT scan, has pleural thickening or an effusion, and a history of asbestos exposure, malignant pleural mesothelioma may be suspected. Since the diagnosis is difficult most major mesothelioma centers reconfirm it with a series of tests. In order to confirm the diagnosis and to stage the disease, usually at a mesothelioma center, one of the tests that a patient undergoes is a cervical mediastinoscopy. This test is usually done if surgery is a treatment option. At a major mesothelioma center of excellence, the diagnosis is confirmed, and the stage of the disease must be identified for the proper treatment options to be presented to the patient and family. If surgery is being considered a procedure that is performed is a cervical mediastinoscopy.

Cervical mediastinoscopy is a procedure that is used to diagnose and stage malignant pleural mesothelioma, to see if the disease is in the lymph nodes of the mediastinum, it is also used for any other diseases in the mediastinum area. The mediastinum is a space between the sternum- often referred to as the breast bone- in the middle of the chest, between the two lungs. The mediastinum consists of lymph nodes, heart and its great vessels, the trachea, the thymus gland. Using a long thin flexible instrument that has a camera attached and a light, the doctor who is doing the procedure can see where he is going, avoid the organs that he needs to, and take a sample of the lymph nodes. Direct visualization allows for a better-quality specimen to lead to a definitive diagnosis.

Cervical mediastinoscopy has been the “gold standard” for staging diseases in the mediastinum. It is a procedure that can be performed with few side effects and complications for most people. Staging of malignant pleural mesothelioma involves testing the lymph nodes in the mediastinum. Staging will tell you the extent of the disease.

A cervical mediastinoscopy is often performed under general anesthesia. The patient usually goes home the same day. An incision is made at the bottom of the patient’s neck so that the doctor can visualize the trachea. The incision is small. The mediastinal area is inspected by the MD visually, next he takes samples of the lymph nodes to check if the disease has spread to them. During the procedure the patient is asleep under general anesthesia due to the sensitive area that the doctor is operating on, and to control any pain that might interfere with the procedure. Once the procedure is complete the skin and muscles are closed with sutures. A small dressing is applied to the area. Post-surgery the patient is usually observed for a few hours for any bleeding or hoarseness and usually discharged that same day.

The procedure, cervical mediastinoscopy is usually well tolerated. With any procedure there are risks that must be discussed with the patient before the surgery. The risks that are most often cited with a cervical mediastinoscopy are bleeding, infection, hoarseness which can indicate temporary or permanent paralysis of the laryngeal nerve. Other complications are a pneumothorax which is air trapped in the space between the lung and the lung lining called the pleural space that can cause the lung to collapse. Air can also become trapped under the skin and cause subcutaneous emphysema, which looks like swelling and is crackly to the touch. Another rare complication is a hole or perforation that can develop in the esophagus, trachea, or large blood vessels in the heart. These are very rare complications, but patients must be told of them while the physician is obtaining Informed Consent for the operation.

In a major mesothelioma center of excellence, they estimate that after the results of the cervical mediastinoscopy the surgical plan changes in up to 25% of the patients.

Cervical mediastinoscopy is usually a low risk operation that yields vital information for the patient and the mesothelioma team. Options for surgery, chemotherapy, radiation therapy, clinical trials are often presented based on the results of this procedure.

 

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Did You Know?

  • Mesothelioma Facts
    Mesothelioma Facts
    The highest award of compensatory damages ever upheld on appeal in a mesothelioma case is $30.3 million.
  • Mesothelioma Facts
    Mesothelioma Facts
    The largest punitive damages verdict ever upheld on appeal in a mesothelioma case is $18 million.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are over $30 billion in asbestos trust funds to compensate victims of mesothelioma and other asbestos-related diseases.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are more than 50 bankruptcy trusts accepting claims to compensate victims of mesothelioma and other asbestos-related diseases.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are many “asbestos dockets” that permit living mesothelioma patients to obtain a jury verdict in less than 1 year.
  • Mesothelioma Facts
    Mesothelioma Facts
    In 2015, more than 2000 mesothelioma cases were filed in the United States.
  • Mesothelioma Facts
    Mesothelioma Facts
    In some mesothelioma cases, settlements can be obtained in less than 1 year.
  • Mesothelioma Facts
    Mesothelioma Facts
    Thousands of different companies have been defendants in mesothelioma cases over the past 40 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 77 peritoneal mesothelioma cases, the average life expectancy (median survival period) was 75.7 months, or over 6 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 77 peritoneal mesothelioma patients, 73.8% were living after 3 years, and 65.3% were living after 5 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 77 peritoneal mesothelioma patients, 64% were treated with HIPEC and cytoreductive surgery.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of 303 pleural mesothelioma patients, the average life expectancy (median survival period) was 18.4 months.
  • Mesothelioma Facts
    Mesothelioma Facts
    According to a 2015 study of pleural mesothelioma patients, 73.1% were still living after 1 year, and 22.9% were still living after 3 years.
  • Mesothelioma Facts
    Mesothelioma Facts
    In 2015, the largest number of mesothelioma cases were filed in the following 10 courts: (1) Madison County, IL; (2) Cook County, IL; (3) St. Louis, MO; (4) Los Angeles, CA; (5) New York, NY; (6) Philadelphia, PA; (7) New Castle County, DE; (8) Middlesex County, MA; (9)Middlesex County, NJ; (10) Kanawha County, WV.
  • Mesothelioma Facts
    Mesothelioma Facts
    The states with the largest number of diagnosed mesothelioma cases are: New York, New Jersey, California, Washington, Pennsylvania, Massachusetts, Virginia, Florida, Texas, Illinois, Wisconsin, Michigan and Ohio.
  • Mesothelioma Facts
    Mesothelioma Facts
    There are about 3000 mesothelioma cases diagnosed in the United States each year.
  • Mesothelioma Facts
    Mesothelioma Facts
    About 1 in 100,000 people in the United States will be diagnosed with mesothelioma each year in the United States.
  • Mesothelioma Facts
    Mesothelioma Facts
    More than 80% of all mesothelioma cases occur in the pleura (pleural mesothelioma).
  • Mesothelioma Facts
    Mesothelioma Facts
    Less than 20% of all mesothelioma cases occur in the peritoneum (peritoneal mesothelioma).
  • Mesothelioma Facts
    Mesothelioma Facts
    About 22% of all mesothelioma cases occur in women.
  • Mesothelioma Facts
    Mesothelioma Facts
    A history of asbestos exposure can be found in more than 80% of mesothelioma cases.
  • Mesothelioma Facts
    Mesothelioma Facts
    More than 30% of all mesothelioma patients in the United States were exposed to asbestos in the military.
  • Mesothelioma Facts
    Mesothelioma Facts
    Mesothelioma can be caused by laundering, or other household contact with, work clothing contaminated with asbestos.
  • Mesothelioma Facts
    Mesothelioma Facts
    Mesothelioma can be caused by work with (direct exposure) or around (bystander exposure) asbestos-containing products.
  • Mesothelioma Facts
    Mesothelioma Facts
    The average time between a person’s first exposure to asbestos and the development of mesothelioma (latency period) is more than 40 years.
 

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