mesothelioma pathway by NyaknoabasiItuen


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									                                            MESOTHELIOMA PATHWAY FOR MID-TRENT LUNG CANCER NETWORK
                                                                                       HISTOLOGICAL DIAGNOSIS OF

                                                                         PS 0-1                             PS 2+

                      Epitheliod confirmed & patient would consider surgery
                                                                                                                                             Non-epitheliod cell type
                                                                                                                                              unwilling for surgery
                                   Lung function Echo

                                       Fit for surgery

                                             Staging                                                                         unfit for surgery
                                            CT +/- PET

                       T1-3 N0-1                                       T4 N2
                   tumour resectable                            tumour unresectable

                   Offer MARS

 Accepts MARS                      Rejects MARS

  Staging as per                                                      Pleurodesis
     protocol                                                      MESO-VATS trial
                                       Radical                    VATS pleurectomy /                                Indwelling              palliative                port-site RT
                                     decortication                    decortication                                 drain                 chemotherapy             (if not receiving
No EPP out of trial                No EPP out of trial              Indwelling drain                                                        (? in trial)           chemotherapy)

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