Deciding the proper course of action against pleural mesothelioma should be a joint effort between patient and physician. The mesothelioma treatment method that is ultimately chosen will depend on how advanced the disease is and on the patient’s overall physical health and personal preferences.
If you or a family member has been diagnosed with mesothelioma, learn as much as you can about cancer treatment options. These include surgery, chemotherapy, radiation, photodynamic therapy, and immunotherapy.
Surgery is an important method of controlling the course of pleural mesothelioma. It may also be combined with chemotherapy, radiation, and other therapies. Types of surgery include palliative, pleurectomy, and extrapleural pneumonectomy.
Palliative surgery is a surgery that provides relief, but not a cure. One type of palliative surgery involves draining accumulated fluid from the chest or abdominal cavity. In “thoracentesis,” a needle is used to remove the fluid from the chest, and often talcum powder or another agent is injected to cause the lung to scar against the chest wall. This helps retard future accumulation of fluid. Because pleural fluid can compress the lung and cause shortness of breath, the procedure helps pleural mesothelioma patients breathe more easily. In the case of peritoneal mesothelioma, a needle is inserted into the abdomen with a similar goal of easing pain.
Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to remove completely, or in cases where the patient is too ill to tolerate a more extensive mesothelioma treatment (American Cancer Society, Cancer Treatment).
In a “pleurectomy,” the chest is opened and the tumor is removed from the surface of the lung. It involves the removal of the pleura where the majority of the tumor is located. Effective in controlling fluid accumulation and decreasing pain in pleural mesothelioma patients, the treatment is palliative if the entire tumor cannot be excised.
The third type of surgery is an extrapleural pneumonectomy. This operation has the best record for removing the maximum number of pleural mesothelioma tumor cells. It removes portions of the lung, the “parietal pleura” (the lining of the lung), the pericardium (the lining of the heart), and the diaphragm.
This is radical surgery that may require a 5-10 day hospital stay. The patient may take up to a year to recover. Risks associated with extrapleural pneumonectomy including hemorrhage, respiratory failure, pneumonia, perforated duodenal ulcer, empyema (accumulation of pus in the chest cavity), upper gastrointestinal bleeding, deep vein thrombosis (blood clotting in the veins of the inner thigh or leg), and death. However, the surgery may improve the chances of survival and the overall quality of life for pleural mesothelioma patients.
Chemotherapy is a traditional pleural mesothelioma treatment that uses anticancer (cytotoxic) medicines, drugs, and chemicals to attempt to kill cancerous cells. The patient may be given these chemotherapeutic agents in pill form or by injection into the vein or muscle. When cancer has spread rapidly, chemotherapy is often used in combination with either surgery or radiation therapy.
Chemotherapy is called a “systemic treatment” because the drug enters the bloodstream, travels through the body, and can kill mesothelioma cancer cells throughout the body. Drugs may be put directly into the chest (intrapleural chemotherapy) or into the abdominal cavity (intraperitoneal chemotherapy).
Chemotherapeutic agents include doxorubicin, cisplatin, methotrexate, pemetrexed, and various drug combinations. Side effects from chemotherapy depend upon the specific drugs, the dosage, and the length of treatment. Temporary side effects include nausea, vomiting, hair loss, and fatigue. The physician may prescribe medication to reduce nausea and vomiting.
Pemetrexed (Alimta®) combined with a standard platinum compound, cisplatin, was approved to treat pleural mesothelioma in 2004. Pemetrexed attacks cancer cells by inhibiting the synthesis of thymidine and purine, enzymes that are necessary for cell growth. Pemetrexed may prolong life and reduce pain, although it cannot cure mesothelioma. Doctors generally use the cisplatin/pemetrexed combination for patients whose mesothelioma is so far advanced that they are not candidates for surgery.
Radiation Therapy (or “radiotherapy”) involves the localized use of high-dose radiation on pleural mesothelioma cancer cells. It works by destroying the mesothelioma cancer cells in the treated area.
The treatment is divided into several sessions (called fractions), usually one session a day for five days with a rest at the weekend. Fractionation ensures that less damage is done to normal cells than to cancer cells. The damage to normal cells is usually temporary but is the reason that radiotherapy has some unwanted side effects such as fatigue and skin changes.
Radiation therapy can both reduce the size of a tumor and relieve symptoms like pain and shortness of breath. However, doctors will limit its use depending on the volume of the tumor and how close it is to other vital organs.
A very experimental treatment, photodynamic therapy (PDT) uses light to kill mesothelioma cancer cells. Initially, the patient receives a photosensitizing agent that collects in the cancerous cells but not in healthy cells. A photosensitizer is a drug that makes the cancer cells vulnerable and sensitive to light of a specific wavelength.
After the cells have been sensitized, fiber optic cables are placed in the body (usually through open-chest surgery) in order to focus light of just the right frequency on the tumor. This causes the photosensitizer to produce a toxic oxygen molecule that kills the cell.
Photodynamic therapy makes the skin and eyes sensitive to light for 6 weeks or more after treatment. Other temporary side effects of PDT include nausea and vomiting (National Cancer Institute, Cancer Facts).
The Food and Drug Administration (FDA) has approved the use of PDT for non-small cell lung cancer and cancer of the esophagus. However, the procedure is still in the early experimental stages as a possible mesothelioma treatment.
Immunotherapy (or biological therapy) attempts to use the body’s own immune defenses against cancerous cells. It includes gene therapy and the use of cytokine proteins such as interferons and interleukins.
Gene therapy is still in the clinical trial phase. Using an “adenovirus” for delivery, a “suicide gene” is inserted directly into the tumor. This gene makes the cells sensitive to otherwise ineffective drugs such as ganciclovir. Treatment with the drug then should destroy only rapidly dividing cells-i.e., the cancer cells-leaving healthy cells unharmed.
Cytokines are proteins that occur naturally in the human body, and which are similar to hormones. The cytokine protein Interleukin-2 (IL2) is capable of stimulating the growth of immune system cells called “T-cells.”
In healthy individuals, T-cells search out malignant or virally infected cells and kill them. Interleukin-2 may be used to increase the number of T-cells to combat cancers. Using IL2 as a treatment for pleural mesothelioma is still in the experimental stages.
Interferons are another cytokine protein that inhibits the growth of malignant cells, as well as enhances the immune system. Like interleukins, interferons are being tested to see if they help increase the body’s response to mesothelioma.
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