A diagnosis is always difficult, whether it is pleural mesothelioma or another variety. Because this is such an aggressive malignancy, patients and their families may have a difficult time addressing the issue of treatment. However, because options for mesothelioma patients are steadily increasing, the discussion of treatment with one’s primary oncologist, family members, and loved ones is important. Nearly all mesothelioma patients have treatment options-be they curative or palliative that can extend survival, alleviate pain, and increase quality of life.
Each mesothelioma case is considered individually and there is no singular prescribed roadmap for the management of malignant mesothelioma. What's best for each individual patient will depend on any number of factors. Diagnostic procedures such as x-rays, MRIs, CT scans, and biopsies will be used to determine these factors and these tests will assist your primary care physician and/or oncologist in determining the best treatment for the individual and their particular circumstances.
Mesothelioma Treatment Options
Cancer treatment usually focuses upon destroying malignant cells and preserving healthy ones. This can be accomplished in a number of ways. At the present, patients will typically utilize three primary mechanisms for mesothelioma treatment. Either surgery, radiation, and chemotherapy, or some combination of the three are considered the most effective for the treatment of malignant mesothelioma. What course of treatment is recommended will largely depend on these issues:
- The type of mesothelioma and location of the tumor
- The size of the tumor(s)
- The degree to which the cancer has spread or metastasized
- The staging of the cancer – I, II, III, etc.
- The age of the patient
- The overall physical health of the patient
- American Cancer Society: Detailed Guide: Maligant Mesothelioma Chemotherapy http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_29.asp?rnav=cri
- American Cancer Society: Detailed Guide: Malignant Mesothelioma Radiation Therapy http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
- American Cancer Society: Detailed Guide: Malignant Mesothelioma Surgery http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
- Catalano, A., et al. "Experimental Therapy of Malignant Mesothelioma: New Perspectives from Ant-Angiogenic Treatments" Pub Med. Critical Reviews in Oncology/Hematology. 2004 May;(2):101-9. http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=15157659&dopt=Abstract
Setting up any type of treatment may involve seeing a variety of doctors, including an oncologist (cancer specialist), pulmonologist (lung specialist), or radiologist. Patience is sometimes necessary to determine the exact malignancy variety and location, but knowing these factors will undoubtedly assist the oncologist in prescribing the best possible method of mesothelioma treatment.
Surgery for Mesothelioma Treatment
Surgery can be performed on mesothelioma patients for one of two reasons: in an attempt to cure the disease or for palliative reasons in order to keep the patient more comfortable and improve the quality of life. Because mesothelioma is nearly always diagnosed in its later stages, curative surgery is typically not an option. Once the tumor has metastasized outside the pleural cavity, palliation is typically the only ends for which surgery is utilized.
As tests are developed that may help to diagnose mesothelioma at an earlier stage, surgery may become more of an option in the future. At that point, doctors may be able to attempt to remove the cancer and some of the surrounding tissue in an attempt to stabilize the disease.
More often, however, surgery is used as a palliative measure. For example, doctors may opt for a surgery called a pleurodesis, which involves injecting talc into the lungs to prevent fluid from returning. A thoracentesis, a surgical procedure that removes fluid from the lungs by means of a thin needle, may also be recommended.
In severe cases, a pleurectomy may be recommended for palliative purposes. This involves removing the pleura - the lining of the lung - and can control fluid build-up and lessen pain and breathing difficulties.Advancements in Mesothelioma Surgery
In recent years, doctors have made progress at some of the leading cancer medical centers with extensive surgeries that have prolonged survival rate in those diagnosed with early stage disease. Among the more exciting of these treatments is what is known as extrapleural pneumonectomy. This procedure, which requires the expertise of a leading mesothelioma surgeon, involves the surgical resection of the entire affected lung, pleurectomy, removal of the pericardium (a membrane which surrounds the heart), and the diaphragm. During the course of surgery, intra-operative chemotherapy agent (i.e. cisplatin or GEMzar) will be applied directly to the affected area to eliminate any remaining malignant cells. Following the application of chemotherapy, the diaphragm and pericardium are reconstructed with prosthetic material.
Radiation Therapy for Mesothelioma Treatment
If a patient’s health is too fragile for surgery or chemotherapy, radiation is often recommended. Radiation is associated with the fewest side effects and is typically more to tolerable than chemotherapy for mesothelioma treatment. There are a few different methodologies of radiation therapy available to mesothelioma patients. Radiation is often used in conjunction with another type of treatment such as an in complementary capacity to an existing chemotherapy regimen.
External beam radiation - the preferred type to treat mesothelioma, this type of radiation comes from a machine outside the body and is aimed toward affected areas. Usually administered 5-days-a-week for up to 5 weeks, this type of radiation is often used for palliative purposes - to lessen breathing difficulties, pain, bleeding, or difficulty swallowing - but has seldom shown true efficacy as a curative mesothelioma treatment. This type of radiation may also be used in addition to surgery.
Brachytherapy - Rarely prescribed for mesothelioma, this kind of radiation places radioactive material directly inside the lung or abdomen.
Chemotherapy for Mesothelioma Treatment
Like radiation, chemotherapy provides no cure for mesothelioma but can be extremely effective in providing relief from the difficult symptoms of the disease. As researchers continue to trial different combinations of chemotherapy drugs, patients will continue to benefit from their findings. The hops is that someday, chemotherapy drugs may go a lot further in prolonging the life of a patient and developing a cure for mesothelioma.
Chemotherapy drugs, in general, are either ingested in pill form or injected into the patient systemically. In the case of mesothelioma patients, the drugs are administered intravenously. Doctors will typically combine two drugs for the best result. One will act as the primary cytotoxin and another will serve as an alkalizing agent to stabilize surrounding healthy cells. At the present the only combination approved by the Food and Drug Administration is Alimta®; (pemetrexed) and Cisplatin®, but other drugs are used in tandem if deemed preferable for a specific patient participating in a clinical trial. In some cases, patients can only tolerate a single drug so only one is used for treatment.
Other drugs are given to the patient to combat the unpleasant side effects of chemo, such as medication to relieve nausea and vomiting or vitamins to replace essential ones lost during chemotherapy. Some patients for one reason or another will make a measured determination that the side effects of chemotherapy are too severe and opt not to receive this treatment.
Clincal Trials for Mesothelioma Treatment
Clinical trials are the study of promising new treatments for a particular disease. These trials are constantly in need of patients who are willing to try these experimental treatments before they are approved by the FDA. Patients should speak to their doctors about current clinical trials available to them and if they might qualify to be a part of a particular study. Those opting to participate in a clinical trial should carefully weigh what advantages and disadvantages, in addition to the goals of the trial before deciding to participate.
Following the backlash of asbestos-related exposures and illnesses, many people were wondering how scientific research was going to proceed. The response has been encouraging, with cancer specialists and other doctors working each day towards a cure for malignant mesothelioma. While a way to completely eliminate the cancer from the body does not presently exist, there are several successful mesothelioma treatment programs as well as clinical trials that are working towards developing a way to eliminate this unfortunate form of cancer.
Treatments for patients of malignant mesothelioma commonly fall in line with treatment of other lung and lung-related cancers. Curative treatments are those which remove the cancer from the body completely. While there are no cures for mesothelioma, any treatment could theoretically be curative, so long as it is successful in completely removing the cancer from the body. While the treatment may be curative, it is important to remember that curative treatments do not rule out the recurrence of the disease.
While curative treatments may not prevent the disease from recurring, it is important to be aware of current initiatives that are working towards a total cure for the disease. There have been instances of unique treatment programs that have prevented the recurrence of the disease for several years. Paul Krauss was diagnosed with mesothelioma in 1997 and given only a few months to live by his physician. Today, Paul Krauss is still alive and active and has dedicated himself towards spreading awareness of the disease and working with others in developing treatment programs that would be as successful as his has been.
Combination treatments, which integrate two or more different treatment options, such as surgery coupled with radiation, or surgery paired with radiation and chemotherapy have been successful in extending life expectancies. Medical researchers believe that when the right combination of therapies is found, prognoses will be far longer than anyone could have imagined when the disease first manifested. Technology has also afforded new possibilities to mesothelioma patients. CT (Computer Topography) scans have been able to map three-dimensional images of the body's internal organs for targeted chemotherapy or radiation therapy to be administered.
Another novel technique is being integrated with surgical resections of mesothelioma tumors. Heated chemotherapeutic agents have shown increased proficiency in the elimination of cancer cells. Side effects of chemotherapy have, in the past, prevented physicians from delivering an optimal dosage of the drug. However, a novel procedure known as intracavity heated chemotherapy treatment has integrated these two concepts into a successful program. Heated chemotherapeutic agent is administered directly to the affected area during the surgical removal, destroying any remaining cancer cells in the area and extending prognoses well beyond typical timeframs.
It is through technology and advancements such as these that cancer specialists and physicians are laying the groundwork for a cure.
Last modified: April 14, 2011.