Surgery, chemotherapy and radiation are standard for all types of malignant mesothelioma. Treatment is often focused on reducing symptoms (palliative therapy) and giving the patient more time, rather than getting rid of the cancer and going into remission (curative therapy). This is because mortality is high despite treatment; it is often not caught until at an advanced stage; the cancerous cells are often very spread out; and because patients are often too weak for extensive treatment.
Surgery: A palliative and/or curative therapy. It is the only curative therapy, usually used in Stage I (hasn’t spread) in a healthy patient. Used to remove the cancer and possibly nearby tissue or a lung. May also be used palliatively for procedures such as draining accumulated fluid that is causing discomfort.
Chemotherapy: Palliative. Can be taken intravenously or intramuscularly, by mouth as a pill or locally injected into affected area.
Radiation: Palliative. Also used after surgery to avoid spreading mesothelioma to the incision site.
Combination therapy: Using surgery, chemotherapy and radiation, it is the most effective, but the most difficult; and in most cases the cancer will still return at some point.
The treatment for mesothelioma is dependent upon the extent of the disease, the age and medical history of the patient, and the location and type of mesothelioma.
• A surgical procedure called a pneumonectomy can be used for pleural mesothelioma, which involves the removal of the diseased lung. Depending upon the spread of the disease, this may also involve removing parts of the diaphragm, as well as the lung.
• Radiation is a commonly used method for treating mesothelioma and can be used along with surgery or alone if the patient is not well enough for surgery.
• Chemotherapy can be administered orally or as injected medication. However, these drugs can be highly toxic to healthy tissues and the side effects can make the patient extremely ill.
• In advanced stages of the disease, palliative therapies may be the treatment of choice. This may include draining excess fluids and providing comfort measures such as medications to ease the symptoms.
Early symptoms of mesothelioma may mimic those of pneumonia:
• dyspnea
• cough,
• shortness of breath
• chest pain
• hypoxia
Symptoms worsen if fluid builds up in the pleural space causing a pleural effusion. Invasion of adjacent structures or metastasis to other parts of the body can occur, with symptoms depending on the structures or organs affected. Sometimes there are no symptoms and diagnosis occurs as a result of routine physical exams.
Treatment can consist of radiation, surgery, or chemotherapy but results have been disappointing. Clinical trials are underway to study other ways to fight this cancer and interested patients should consult with their doctor about participation in such trials. For now, palliative care with narcotic pain relief and supplemental oxygen for shortness of breath is frequently all that can be done. Fluid build-up is drained via thoracentesis or paracentesis.
There are a variety of different treatment options for Mesothelioma. However, the type of treatment depends on several factors such as the location of the tumor, the stage of the disease, and the patient’s age and current health.
One treatment option is to perform surgery to remove the tumor and the surrounding mesothelial tissue. However, this treatment option should be used only for younger, healthy patients. Another treatment option is to perform radiation therapy, which uses high energy x-rays to destroy the cancer cells in the location of the tumor. Chemotherapy is an option frequently used, which involves using drugs to fight the cancer by injecting them intravenously into a patient’s vein or putting it directly into a patient’s chest or abdomen. Lastly, thoracentesis (draining excess fluid in the lungs) or paracentesis (draining excess fluid in the abdomen) can be used to relieve a patient’s symptoms and control his pain.
The 3 most common treatment options for mesothelioma are surgery, chemotherapy, and radiation therapy:
A pleurectomy/decortication is the surgical removal of a tumor or mass in or around the lung. In some cases, all or part of the lung may have to be removed.
Cytoreductive surgery is the removal of all or nearly all of a tumor located in the peritoneal cavity.
If any residual cancer cells exist after surgery, a follow-up of Intra-Peritoneal Hyperthermic Chemotherapy (IPHC) can be delivered to the abdominal cavity.
Radiotherapy, if indicated, is usually the final stage of treatment. A large dose of radiation is administered to the residual cancerous area to kill any remaining cancerous cells.
Gene Therapy is a less common approach to treating mesothelioma. This involves injecting therapeutic genes into the tumor cells. This is believed to promote tumor regression, (tumor shrinkage.)
Needle biopsy is one of two definitive ways to confirm a diagnosis of mesothelioma. The procedure is performed, using local anesthesia, to obtain tissue samples for pathologic examination. It is used instead of video assisted thoracoscopy when the patient has contraindications to, or cannot tolerate the general anesthesia needed for thoracoscopy.
In pleural needle biopsy, a large bore needle is inserted into the chest cavity in order to take sample tissue from the pleura, or lining of the lungs. Often, radiographic guidance, such as computerized tomography, assists in assuring proper placement of the needle. Tissue is aspirated into the needle, which is then removed. The tissue is sent to the pathology lab for microscopic examination. Needle biopsy has advantages in that it takes little time, and does not require general anesthesia, but it does not allow the surgeon to view the biopsy area, an advantage in video assisted thoracoscopy.
The chemotherapeutic drugs used in treating mesothelioma are often traditional cancer fighting agents. The classes include alkylating agents, antimetabolites, anthracyclines, and plant alkaloids. Agents in the first three classes damage DNA or RNA, thus preventing cancer cell reproduction. Alkaloids inhibit cell division by interfering with the proteins needed for mitosis. Some of these drugs disrupt cancer cell growth at one specific stage, and some can kill the cells at any stage of the cell cycle.
Specific drugs or combinations of drugs are chosen based on diagnosis of the cancer cell type and staging of the disease. Often, combinations are used in order to fight cancer cells at various stages of cancer cell growth.
One of the most recent advances in treating mesothelioma is the use of the antimetabolite pemetrexed in combination with cisplatin, an alkylating agent. Pemetrexed is the first agent approved by the FDA specifically for treating mesothelioma.
The treatment options for mesothelioma are surgery, chemotherapy, radiation or a combination of all three. Surgical options include pleurectomy with decortication and extrapleural pneumonectomy. Pleurectomy with decortication involves dissection and removal of the parietal pleura with decortication of the visceral pleura. Extrapleural pneumonectomy is indicated in early stages of the disease when the mesothelioma is confined to the chest cavity. It involves dissection of the parietal pleura; division of the pulmonary vessels in addition to en bloc resection of the pleura, lung, pericardial sac as well as the diaphragm. For surgical treatment to be an option the patient must have adequate cardiopulmonary function. Chemotherapy currently used in treatment of mesothelioma is Alimta/Cisplatin and is considered the first line treatment in patients who are not surgical candidates.
There are many types of treatments available for mesothelioma whether they are palliative or curative. Since symptoms do not usually present until twenty to fifty years following exposure to asbestos, patients tend to be in the severe stages following diagnosis. The treatment depends on the location of the cancer, how far the cancer has metastasized, and the patient’s age. The approximate survival rate for people diagnosed with mesothelioma is eight to twelve months. The survival rate may increase for those patients that are diagnosed in the early stages of the disease.
The three types of treatments used for mesothelioma are surgery, chemotherapy, and radiation. Surgery may be used to remove the malignancy. Chemotherapy is introduced to the body by intravenous chemicals in order to destroy the multiplication of malignant cells. Chemotherapy is also often used following the surgical removal of a tumor to make sure that all malignant cells are destroyed. Radiation can be used to help control metastases of the tumor or shrink the size of a tumor prior to surgical excision. Often combinations of the treatments prior mentioned are used together.
The treatment options available for the management of mesothelioma are surgery, chemotherapy, and radiation.
- Surgery is reasonable when the disease is localized or confined within the pleura.
- The two surgical procedures used in the treatment of mesothelioma are pleurectomy with decortication and extrapleural pneumonectomy (thought to be the preferred method in managing early disease)
- Cisplatin is the drug of choice when mesothelioma is treated with chemotherapy.
- Doxirubicin is another agent that can be used when treating mesothelioma with chemotherapy.
- Radiation therapy has more of palliative effect and has no effect on survival.
- Another treatment option that can be used is the combination of surgery, chemotherapy, and radiation therapy.