Mesothelioma Treatment

The prognosis of those diagnosed with mesothelioma is poor, with a typical survival period of one to two years after diagnosis.

There are several treatment options available to those with mesothelioma but none are considered a “cure”. Doctors and patients decide together how to proceed with treatment depending largely on the stage of the patient’s mesothelioma. Most cases are identified at an advanced stage because the symptoms are not unique to this illness. Most symptoms are hard to identify as indicators of mesothelioma and diagnosis is often very difficult. In almost all mesothelioma cases more than one type of treatment: surgery, chemotherapy and radiation therapy is used.

Three major treatment options are available to manage this form of cancer though none are considered curative. Patients may undergo surgery, chemotherapy or radiation therapy to treat the symptoms of this disease or a combination of these treatments may be used in an effort to eliminate the disease altogether. The disease is fatal in most cases with a five-year survival rate of only 9%.

Questions to ask your doctor about mesothelioma treatment.

Surgery

Most mesothelioma patients undergo surgery, especially those that are diagnosed at an early stage. In early-stage mesothelioma tumors that have not spread can be removed and radiation therapy or chemotherapy can be administered to further stop the disease from spreading.

However, due to the aggressive nature of this disease most patients cases are advanced when they are diagnosed and no measures have been proven to provide a cure. Advanced cases are not viewed as curable so surgery is used to treat the symptoms and make the patient more comfortable while living with the illness.

The types of surgery typically used in the palliative treatment of mesothelioma are thoracentesis and pleurodesis. A thoracentesis is performed to remove fluid from the pleural lining surrounding the lung. This build up of fluid prevents the lung from contracting fully, which causes the patient to experience chest pain, persistent coughing and shortness of breath. During a thoracentesis a long, hollow needle is inserted into the lining that surrounds the lung. The fluid is removed and the patient will feel some relief. Unfortunately, most patients will have a recurrence of fluid build-up very rapidly making further procedures necessary. When a pleurodesis is performed the same technique is used, however the space where the fluid was removed is then filled with a talc slurry to ensure that fluid build-up does not recur. These procedures are not curative and provide only short-term relief from symptoms for the patient.

The most radical treatment is surgical removal of all diseased tissue. A thoracotomy, an incision in the chest, is usually performed when a patient has tumors that have not spread to other tissue or organs in the body. There are three types of thoracotomy: the wedge resection, lobectomy and pneumonectomy. A wedge resection is used when a patient has small tumors that can be removed while leaving much of the healthy tissue behind. If the tumors have spread to other lobes of the lung a lobectomy is performed. If there is too much diseased tissue to save the lung a pneumonectomy is done to remove the entire lung. This is only possible in cases where the mesothelioma is present in only one lung. The patient must be an otherwise healthy individual and recovery time may be extensive. All of these surgical procedures are commonly followed by several courses of chemotherapy or radiation treatment to help prevent further spread of the disease.

Questions to ask your doctor about mesothelioma surgery

Radiation Treatment

Radiation treatment is almost always used in conjunction with another form of treatment. either surgery or chemotherapy or both. Radiation therapy, or radiotherapy, can be used to treat mesothelioma symptoms or in an effort to cure the disease. The success rate of radiation therapy in curing mesothelioma is poor; however radiation can provide patients with some relief from symptoms.

Unlike tumors in other forms of cancer, mesothelioma grows as a diffuse sheet along the mesothelium. The shape of the tumor makes radiation therapy impractical, especially as it is difficult to administer enough radiation to kill the cancer (over 60 Gy). This high a dosage is considered dangerous for the other organs that inevitably pick up some of the radiation.

Radiotherapy can be administered in one of two ways. It can be delivered from the exterior of the body using a beam of electromagnetic radiation or internally with radioactive particles injected directly into the site to destroy cancer cells (this is called brachytherapy). This therapy is also used to attack remnants of cancer along the pathways of invasive treatments such as thoracentesis or pleurodesis although recent thinking among oncologists is that this propylactic radiation may not pass the cost-benefit test (REF?). Radiation may also assist in shrinking tumors and creating relief from some of the symptoms associated with mesothelioma.

Trials of the complex IMRT (intensity-modulated radiotherapy) have shown promise. This method directs radiation preferentially at the cancerous area.

Chemotherapy

Chemotherapy involved drugs given intravenously or in pill form to kill the malignant cells. Chemotherapy agents can be administered directly into the site of cancer growth or can be injected into the blood stream to travel throughout the body.

Chemotherapy is not usually considered curative when used in mesothelioma cases but is used most often in conjunction with surgery to relieve symptoms. Chemotherapy is sometimes used prior to surgical procedures to shrink the tumor enabling the surgeon to remove the tumor while leaving as much healthy tissue behind as possible. This same treatment can be used after surgery to prevent cancer cells from spreading further. Chemotherapy is also used to slow the growth of tumors within the body, which helps control some of the symptoms such as shortness of breath in pleural mesothelioma and abdominal pain in peritoneal mesothelioma.

Many chemotherapy agents have been employed in the treatment of mesothelioma, and oncologists have a large number of drugs at their disposal. The standard chemotherapy treatment for mesothelioma today is a combination of cisplatin and pemetrexed (brand name Alimta). However, doctors may modify that regiment or substitute other medications as they see fit.

Chemotherapy often evokes images of horrible side effects and painful treatment sessions, however many of the side effects are treatable with medication and most are temporary and will stop when the treatment ends. The majority of chemotherapy patients suffer nausea, vomiting, loss of appetite and fatigue. Others complain of overall achy-ness, fever or chills, tingling in the hands and feet and depression. All side effects of chemotherapy are important and should be shared with a health care professional to ensure they are normal reactions to the type of chemotherapy being administered. Almost all mesothelioma patients will receive some form of chemotherapy treatment and although it is not a cure it may increase the life span of the patients.

Questions to ask your doctor about chemotherapy for mesothelioma.

The following video discusses the types of treatment available to mesothelioma patients and describes the risks associated with each.

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Palliative procedures are designed to treat the symptoms of mesothelioma but have no curative possibility. These processes, used to control symptoms in later stages of mesothelioma, are mostly those that aim to eliminate the fluid build up in and around the lungs, making the patient more comfortable. If the disease has progressed to a point where the lung is being restricted a pleurectomy, surgery to remove some of the diseased tissue may be performed. This will not be a curative measure and is done only to treat the symptom of pleural effusion.

The survival rate for individuals with mesothelioma depends largely on the stage of the disease when it was diagnosed. Unfortunately, the disease is most often discovered long after it initially takes hold in the body and when patients are generally at an advanced age. The overall 5-year survival rate has been shown to be approximately 9% however, there is much research being done on mesothelioma and on cancer treatment in general. Dozens of clinical trials are available to qualifying individuals with mesothelioma and many researchers believe that new treatments will offer hope to patients currently suffering with the disease.

Personalized Mesothelioma Treatment

Each type of mesothelioma treatment poses different risks and produces various side effects. In almost all cases individuals will need more than one form of treatment (combination treatment) and doctors decide on the options with the patient’s approval. Each case is different and therefore treatment time, side effects and results will vary. There is hope for patients as researchers are continuously searching for new and better treatment options.

Medical Care

Online resources people with mesothelioma