Dr. Robert Cameron Meso Myth Buster
- Myth #1 -
A more radical operation obviously provides better results than a less radical surgical procedure
January 3, 2011. Often when confronted with a large obstacle, people naturally chose a "bigger" weapon. In movies and computer games characters are portrayed as being more powerful if they possess a bigger arsenal of guns (or other weapons). In the 1994 movie, The Mask, for instance, when Stanley Ipkiss (Jim Carrey) dons the mysterious mask and is confronted with villains armed with normal handguns, he magically pulls out an entire arsenal of weapons and promptly wins the battle. Mesothelioma is not equivalent to a comedy movie and surgeons (also wearing masks!) cannot just pull out the most radical operation possible and expect to win the day.
The Theodore Roosevelt approach, that is, "speak softly and carry a big stick" (or scalpel), was used for years in other cancers without patient benefit until finally a more rational approach was adopted, albeit reluctantly.
For instance, lung cancer originally was treated with removal of an entire lung no matter the size or extent of the tumor; whereas now removal of only the lobe or segment of the lung containing the tumor has been shown to produce the best results. Similarly, extremity "sarcoma" tumors were initially treated uniformly with amputation of the affected arm or leg, but now few patients with these tumors require this disfiguring type of surgery and instead undergo "limb-sparing" procedures.
Finally and most notably, breast cancer was first treated with "radical" mastectomy (removal of the entire breast and underlying pectoralis muscle). Later it was replaced by the modified radical mastectomy (removal of only the entire breast). Today, breast cancer is successfully treated with simple removal of the tumor (lumpectomy), with some added radiation.
The notion that a small cancer operation could be just as successful as a more radical one was not readily embraced by many surgeons since surgeons were convinced that the more radical operation was the obvious better choice. Yet time and again scientific research has proven surgeons wrong about their "radical" operations.
Why then do surgeons persist in a radical rather than a rational approach to cancers such as malignant pleural mesothelioma? The answer is simple: everyone wants to satisfy our basic desire to "try everything," to "leave no stone unturned," and to "spare no expense." Imagine the remorse if someone died because we didn’t do everything! This need to satisfy treating physicians consciences as well as those of the patient and family all act together to set the stage for this type radical, over-the-top strategy.
Interestingly, this is not the rule with other types of cancer treatment. Radiation, for example, is not used unless there is definite scientific evidence of benefit and chemotherapy isn't given in a "radical" way (i.e., giving 10 different drugs at the same time) because the results have not been shown to be beneficial and the toxicity is too great.
Surgery for MPM, for some reason, is different and has avoided the hurdle of scientific proof of benefit. Instead of carefully and scientifically evaluating possible toxic surgical procedures and subjecting unproven surgeries like EPP (no proven benefit according to the Ontario Oncology Group and the International Association for the Study of Lung Cancer) to rigorous testing, surgeons and patients rush to satisfy their need to “go big” or “try everything.”
Eventually, cooler and more rational intellects will prevail as has always happened in cancer and medicine, and the best possible treatment protocols will be better defined. Until then, the patient should continue to operate under the time-honored warning: "Buyer beware!" January 11, 2011
| Myth #2: | A more radical operation that takes out the pericardium and diaphragm for bigger margins is a better operation. January 11, 2011 |
| Myth #3: | Mesothelioma Tumor in the Lung “Fissures” Cannot Be Removed Without Also Removing the Entire Lung January 27, 2011 |
| Myth #4: | Talc Pleurodesis Prevents Surgeons from Performing a Pleurectomy Operation February 15, 2011 |
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.