The Blog

“Remove the Tumor, Save the Lung and Treat Meso as a Chronic Illness”

Dr. Robert Cameron is a cardiothoracic surgeon and surgical oncologist who specializes in the treatment of malignant pleural mesothelioma. He is the director of the mesothelioma program at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) and the chief of thoracic surgery at the West Los Angeles Veterans’ Administration Medical Center.

Dr. Cameron has been treating mesothelioma patients for over 20 years. He is the innovator of the lung-sparing Pleurectomy/Decortication surgical procedure for mesothelioma and has performed the procedure on over 300 patients to date. He has also published many articles and is a frequent lecturer on the surgical and multi-modal management of pleural mesothelioma.

Treating Mesothelioma Like Other Chronic Diseases

“Despite all of the advances in modern medicine, there are a number of diseases or illnesses which doctors simply can’t cure. Diabetes and high blood pressure are good examples. But through treatments which control these conditions, patients are able to live with them for extremely long periods of time.

Mesothelioma is another disease for which there is currently no ‘cure’. No surgery, drug or other treatment can completely remove or destroy all of the mesothelioma cancer cells. Until a ‘cure’ can be found, it is our approach at UCLA to control mesothelioma and provide the patient with the best possible quality of life.

We attempt to do this through multi-modal treatment beginning with the lung-sparing Pleurectomy/Decortication (“P/D”) surgery, followed by radiation and then a long-term maintenance therapy utilizing immunotherapy and a combination of other conventional and experimental treatments designed to stop the recurrence of the tumor.

Mesothelioma is Much Different Than Other Cancers

“Most other cancers grow as a nodule or a lump in an organ. This often allows a surgeon to remove the disease entirely by getting around the tumor with enough extra normal tissue to get what is called a margin.

Mesothelioma is much different. It is a sheet of cancer cells which virtually cover every organ and surface inside the chest. This prevents a surgeon from being able to remove the disease entirely. There simply isn’t enough normal tissue surrounding the tumor to allow the surgeon to get a margin without interfering with major organs like the heart, lungs, major blood vessels, diaphragm and ribs.

Therefore, whether performing a P/D or Extrapleural Pneumonectomy (“EPP”), the goal of the surgery is to remove all visible tumor. Neither procedure is capable of removing all of the cancer cells.”

P/D, not EPP, is the Preferred Surgical Treatment for Pleural Mesothelioma

“EPP is a very radical procedure in which a surgeon goes into the chest through a large incision and virtually cuts out the lung and strips the tumor off of all the surfaces. The lung is an innocent bystander underneath the tumor, but is removed along with the tumor in order to theoretically get better clearance.

P/D involves opening the chest and removing all visible tumor. Instead of removing the lung, you carefully separate the tumor from the healthy lung. This can be done very completely so it provides just as much tumor clearance as taking out the lung in an EPP. It does so with much less sacrifice of lung function and risk of having surgical complications that result in bad outcomes and even death.

Another advantage of P/D over EPP is that P/D allows you to limit the operation site to the areas of tumor. An EPP often expands the surgery into new places where there is no tumor. This can cause the tumor to spread. In P/D, we leave barriers in the form of the diaphragm, pericardium and chest wall, between tumors and other areas to reduce the risk of spreading.

My philosophy has always been: ‘do no harm.’ Taking out a lung does harm and there is absolutely no benefit to the patient. Doing a bigger operation makes no sense from an oncology standpoint, because a surgeon cannot rid a mesothelioma patient of every last cancer cell and cure them – that won’t happen. Once you accept that, then you can understand why P/D is the best surgical option with the least side effects, the least chance of dying and a better chance of getting as much tumor clearance as possible.”

The Role of Post-Surgery Radiation and Maintenance Therapies

“Once the visible tumor has been removed, our attention turns to the cancer cells which inevitably remain at the surgery site. The patient undergoes a series of radiation treatments, each of which takes less than 15 minutes to complete. The goal of the radiation is to kill as many cancer cells as possible to prevent the reorganization of cancer cells and recurrence of a tumor.

The radiation oncologists at UCLA are very experienced in treating patients who have undergone a P/D where special care must be taken to focus the radiation on the sites of the cancer cells so that no damage is done to the healthy lung.

Following radiation, our patients begin long-term maintenance therapy with daily self-administered injections of an immunotherapy agent which is designed to stimulate the body’s own immune system to prevent the remaining cells from developing into a tumor.

Our patients are then monitored closely with regular CT scans and follow-up visits every three to six months. At the first sign of tumor recurrence, we are able to utilize one of a number of treatments, such as radiation, chemotherapy and cryoablation to attack it. As more treatments are developed in the future, we will be able to add these to our arsenal of maintenance therapies.”

Interested in Learning More?

If you have been diagnosed with malignant pleural mesothelioma and would like to learn more about Dr. Cameron’s approach to treating the disease, you may contact his office at (310) 470-8980.

Dr. Cameron sees patients in consultation at his Los Angeles, California clinic located at:

10780 Santa Monica Boulevard Suite 100 Los Angeles, California 90025-7613

If you are traveling from out of town and would like assistance with travel arrangements, contact the Pacific Meso Center at (310) 478-4678 or info@pacificmesocenter.org.