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Mesothelioma Treatment
MESOTHELIOMA
TREATMENT OPTIONS
While there is currently no known
cure for malignant mesothelioma, treatments are available with
the most common being surgery, chemotherapy and radiation
therapy.
Your doctor will recommend one treatment or a combination of
therapies that are best for your situation. The course of
treatment will depend on a number of factors including the
location of the disease, the stage
of the disease, your age, overall health and your
preferences.
The information provided throughout this website is for your
information only, and should NOT take the place of a full medical
diagnosis.
Traditional Treatment Options
There are three traditional kinds of treatment for patients
with malignant mesothelioma:
Doctors will often use two or
more of these treatment courses jointly to provide the maximum
likelihood of success. This “multi-modal” approach holds
the most promise for survival of malignant mesothelioma
patients. Trimodality therapy, in which all three of these
modalities are used, is considered the most effective, and
aggressive, approach.
Surgery
There are several types of surgeries used to treat
mesothelioma and the disease type and stage will determine the
type of surgery. Mesothelioma tumors are usually large and
difficult to completely remove, so surgery is usually combined
with other cancer treatments to ensure the best results in
destroying the tumor.
There are generally two types of surgical methods for the
treatment of mesothelioma: Palliative Procedures and
Potentially Curative Procedures.
- Palliative Procedures
are those which treat the symptoms of mesothelioma,
providing relief for the patient, without aggressively
treating the disease itself.
Chest Tube Drainage and Pleurodesis
The goal of chemical pleurodesis is to cause an irritation
between the two layers covering the lung. This irritation
causes an obliteration of the space between the layers
where the fluid accumulated, and prevents further fluid to
be able to accumulate there. There are a variety of
agents, which can be used including talc and bleomycin. As
the pleural space is closed, fluid drains out of the chest
cavity using a chest tube.
Pleuroperitoneal Shunt
Pleuroperitoneal shunting has been used in patients who
have failed chemical pleurodesis, chemotherapy, or
radiation therapy. Pleuroperitoneal shunting can provide
effective palliation in patients with a trapped lung or
others who have failed treatment.
-
Potentially
Curative Options are medical procedures that attempt
to remove all gross disease with 'curative intent'.
Residual microscopic disease cells are then removed
through Adjuvant
therapy.
Pleurectomy/Decortication
A Pleurectomy/Decortication is a surgical procedure
where the pleura, the membrane lining the lungs and chest
cavity, is removed, without removing the entire lung. This
treatment option is usually performed on patients in the early
staging of mesothelioma.
Extra-Pleural Pneumonectomy (EPP)
EPP is the removal of the pleura, diaphragm,
pericardium, and the whole lung involved with the tumor.
EPP is considered a radical therapy and is not frequently
performed by most surgeons, patients are referred to
centers specializing in these treatments.
Both the above 'potentially curative' procedures are
typically used in combination with other treatment options
(multi-modal therapy).
Chemotherapy
Chemotherapy uses drugs to kill cancer cells and may be
used as the primary treatment to mesothelioma, or it may be
used as part of a multi-modal approach. Chemotherapy is
referred to as systemic treatment because the drug is
introduced into the patient’s bloodstream and travels
throughout the body killing cancer cells. The drugs may be in
pill form, or injected into the body through a needle.
In addition to killing cancer cells, chemotherapy drugs work
to restrict the uncontrolled spread of abnormal cancer cells -
preventing them from dividing and multiplying.
Chemotherapy is not considered a 'curative' approach for the
treatment of mesothelioma and instead focuses on shrinking
existing tumors (usually prior to surgery - neoadjuvant
therapy), controlling the spread of the cancerous cells, and
removing residual cancer cells following surgery (adjuvant
therapy).
To effectively treat mesothelioma, more than one drug may be
used in chemotherapy. Depending on the drugs, the amount taken
and the treatment period, there may be side effects.
Historically, doxorubicin has been the most widely used single
chemotherapy drug. Other newer drugs, including gemcitabine,
cisplatin, carboplatin, epirubicin, cyclophosphamide,
ifosfamide, vinorelbine, paclitaxel, and methotrexate, now are
often preferred and are usually given in different
combinations.
Radiation
Therapy
Radiation therapy uses high-energy x-rays help to destroy
cancer cells and shrink tumors. The radiation may come from
outside the body from a machine (external radiation) or from
radioactive materials placed directly in or around cancer
cells through thin plastic tubes (internal or implant
radiation).
In pleural mesothelioma, it is difficult to irradiate tumor
tissue successfully without injuring nearby organs like the
lungs, heart, and liver. However, radiation therapy can be
very effective in relieving pain in certain situations.
Factors which can impact the use of radiation treatment
include the volume of the tumor and how near it is to vital
organs.
Non-Traditional
Treatments
Photodynamic Therapy
Photodynamic therapy destroys cancer cells by using the
energy from light and may also be effective when combined with
surgery. Although this treatment is in the experimental stage
for mesothelioma, it has shown promising results in treating
other cancers. In the procedure, the patient receives a
photosensitizer (a drug which makes cells sensitive to
specific wavelengths of light) which collects in cancerous
cells but not in healthy cells. Once the cells have been
sensitized, fiber optic cables are placed in the body (usually
through open-chest surgery) so that the correct frequency of
light can be focused on the tumor. This causes the
photosensitizer drug to produce a toxic oxygen molecule which
kills the cancer cell.
Gene Therapy
This is a new treatment, currently in clinical trails.
This approach allows treatment to target tumors, rather than
destroying healthy cells which is the negative of traditional
chemotherapy. In gene therapy, cancer is treated by altering
genetic defects that allow a tumor to develop. A “suicide
gene” is inserted directly into the tumor, making the cells
sensitive to a normally ineffectual drug. The drug is then
administered to the newly sensitive cancer cells and it
destroys those cells while leaving the healthy cells unharmed.
Immunotherapy
Immunotherapy (or biological therapy) treats cancer by
using the body’s own immune system fight cancer cells.
Another name often applies to this therapy, biological
response modifiers (BRMs). Though not yet obtainable,
promising clinical studies are underway for immunotherapy.
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Our Mesothelioma Library and Latest News sections provide
access to many articles, abstracts and information regarding
recent treatment options and experimental therapies. Mesothelioma
Library | Latest
News
MesotheliomaHelp.net provides a thorough listing
of mesothelioma specialists, treatment centers and support
groups, click
here.
If you have been diagnosed with mesothelioma, or are worried
that you might have mesothelioma, you may be eligible for
compensation. Medical treatment is your primary concern,
however, knowing your legal rights can help protect you and
your family. Click
here to learn more about your legal options.
STAGING
Staging is a method of evaluating
the progress of cancer in a patient. It looks at the
mesothelioma and the extent to which it has developed and its
possible spread to other parts of the body. Since pleural
mesothelioma occurs most frequently and has been studied
the most, it is the only mesothelioma for which a staging
classification exists.
Several medical approaches are utilized to determine the
staging of mesothelioma, including x-rays,
CT scans, and MRI scans. The advancement, extent, and
spread of the cancer determines the stage of the mesothelioma,
and determines the treatment and outlook for the patient.
There are three recognized clinical staging systems for
evaluating the spread and extent of pleural mesothelioma: The
Butchart System, TNM Staging, and the Brigham System. The
Butchart System has been the standard staging method for most
cancers, including mesothelioma. The TNM Staging system is
beginning to be used by major cancer centers as a more
accurate method for specifically evaluating mesothelioma. The
Brigham System is one of the latest methods for the staging of
mesothelioma.
Butchart Staging System
The staging system used in the past for mesothelioma is
the Butchart system. This system is based mainly on the extent
of the primary tumor mass, and divides mesotheliomas into
stages I through IV. Many doctors will still use this system.
- Stage I: Mesothelioma
is present within the right or left pleura, and may also
involve the lung, pericardium, or diaphragm (the muscle
separating the chest from the abdomen) on the same side.
-
Stage II:
Mesothelioma invades the chest wall or involves the
esophagus (food passage connecting the throat to the
stomach), heart, or pleura on both sides. The lymph nodes
in the chest may also be involved.
-
Stage III:
Mesothelioma has penetrated through the diaphragm into the
peritoneum (lining of the abdominal cavity). Lymph nodes
beyond those in the chest may also be involved.
-
Stage IV:
There is evidence of distant metastases (spread through
the bloodstream to other organs).
TNM Staging System
Another staging system has recently been developed by the
International Mesothelioma Interest Group and adopted by the
American Joint Committee on Cancer (AJCC). This is a TNM
system, similar to staging systems used for most other
cancers. T stands for tumor (its size and how far it
has spread to nearby organs), N stands for spread to
lymph nodes and M is for metastasis (spread to distant
organs). In TNM staging, information about the tumor, lymph
nodes, and metastasis is combined in a process called stage
grouping to assign a stage described by Roman numerals from I
to IV. Major cancer centers are beginning to use this system
instead of the Butchart staging because it more accurately
depicts the extent of tumor.
- Stage I: Mesothelioma
involves either the right or left pleura lining the chest.
It has only spread to the outer lining of the lung in, at
most, a few small spots. It has not yet spread to the
lymph nodes.
- Stage II:
Mesothelioma involves either the right or left pleura
lining the chest and has spread from the lining of the
chest into 1) the outer lining of the lung or 2) the
diaphragm or 3) into the lung itself.
- Stage III:
Mesothelioma involves either the right or left pleura
lining the chest and has spread into 1) the first layer of
the chest wall, or 2) the fatty part of the mediastinum,
or 3) a single place in the chest wall or 4) the outer
covering layer of the heart or 5) lymph nodes anywhere in
the same side of the chest.
- Stage IV:
Mesothelioma involves either the right or left pleura
lining the chest and has spread 1) into the chest wall,
either muscle or ribs, or 2) through the diaphragm, or 3)
into any organ contained in the mediastinum (esophagus,
trachea, thymus, blood vessels), or 4) into the spine, or
5) across to the pleura on the other side of the chest, or
6) through the heart lining or into the heart itself, or
7) into the brachial plexus (nerves leading to the arm),
or 8) into lymph nodes outside that side of the chest, or
9) spread to other organs through the bloodstream.
The Brigham System
The Brigham System is the latest system and stages
mesothelioma according to resectability (the ability to
surgically remove) and lymph node involvement.
Your doctors may utilize one or
more of the above staging systems to evaluate the extent of
the mesothelioma, and identify appropriate treatment options. Click
Here to learn more about available treatment procedures.
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