Listen to a summary on Mesothelioma Treatment.
One of the greatest challenges today is
finding the most effective way of treating mesothelioma, the cancer caused by
asbestos.
While no cure currently exists,
mesothelioma patients can improve their prognosis through various treatments,
including surgery, radiation, chemotherapy, and experimental therapies tested
in clinical trials.
What
mesothelioma treatment options exist?
There are five primary types of
treatment for mesothelioma:
- Surgery Depending on the location and stage of the
cancer, and the health of the patient, tumors may be able to be removed
through surgery.
- Radiation One of the oldest mesothelioma treatments,
radiation techniques can target and shrink tumors to make other treatments
more effective.
- Chemotherapy With
chemotherapy, cancer cells are prevented from growing and multiplying
throughout the body.
- Experimental Treatment Clinical
trials that test newer therapies like immunotherapy and phototherapy can
prove effective if other options are exhausted.
- Palliative Treatment Additional
techniques and therapies can treat the symptoms of mesothelioma to help
ease patient pain and suffering.
History
of Treating Mesothelioma
Despite years of research since mesothelioma was
first identified, it’s still difficult to identify the best approach to
treating the disease, says David Rice, MD, a cardiothoracic surgeon and
nationally known mesothelioma
expert who
practices at the MD Anderson Cancer Center in Houston, TX.
The very rareness of the cancer — only
about 3,000 people a year are diagnosed in the United States—makes it difficult
to run the kind of research
studies needed
to compare treatments and determine the ideal therapy at each stage of the
disease. “There isn’t a lot of evidence-based science in this disease,” Dr.
Rice admits. So when his patients ask him what the best treatment is for the
disease, he tells them what we tell you in this section, adding that “we don’t
have a reliable cure for mesothelioma.”
Thus, a major goal of treatment is to reduce pain and suffering and prolong a
patient’s life as long as possible while providing them with the highest
quality of life possible.
Choosing the right mesothelioma doctor
is an important first step in planning for treatment.
There are a number of mesothelioma doctors practicing in specialized clinics throughout the
country. Each of these cancer specialists has an acute knowledge of the
behavior and pathology of malignant mesothelioma and its treatment. It is
likely that if you are diagnosed with mesothelioma, you will be referred by
your personal physician to a larger scale comprehensive cancer center.
Important considerations in determining
a mesothelioma treatment plan include the cancer stage, primary site affected and cell type. Treatment
options also depend on whether the cancer is localized to the chest or has
spread to the chest wall, diaphragm, or lymph nodes as well as your age and
overall health. Recommended treatment plans will also vary based on available
resources and any ongoing clinical trials at the cancer center where you’re
being treated. Learn more about finding a doctor here.
You should be prepared when you meet with your doctor by being ready to ask
these questions.
Conventional treatments for
mesothelioma involve surgery, chemotherapy, and radiation therapy.
As with most solid tumors, doctors turn
to surgery, radiation and chemotherapy to
manage mesothelioma. When exploring the various treatment options available
with your doctor it is important to be informed about the risk and benefits of
each one before making a final decision.
Surgery
Only about 1 in 5 patients with
metastatic pleural mesothelioma undergo surgery. There are two main surgeries: pleurectomy/decortication,
in which the surgeon tries to remove as much of the tumor from around the lung
as possible, and the more radical extrapleural pneumonectomy,
in which the lung itself is removed.
Much debate exists as to which surgery
is more effective, although studies show that most long-term survivors have
undergone some form of surgery. Studies have found that pneumonectomy followed
by radiation prevents tumor recurrence in the chest in 80 to 85 percent of
patients.
However, it is a long, intensive
operation with a 55 percent complication rate and a 3 percent risk of death,
higher in some institutions. Therefore, this surgery is only performed for
patients with a reasonably good prognosis, when it doesn’t appear that the
cancer has spread outside the chest.
Patients best suited for pneumonectomy
are younger, with the epithelial form of the disease, no obvious lymph node involvement,
and are otherwise healthy enough to withstand the rigor of the procedure.
Pleurectomy/decortication has a higher
failure rate, with the tumor recurring in the chest cavity 50 to 80 percent of
the time. However, that rate may change with improved radiotherapy techniques.
The reason for the high recurrence is that it’s difficult to completely remove
the tumor without removing the lung.
However, there is no difference in survival rates between
the two surgeries. Part of the reason is that the cancer has often spread to
other parts of the body by the time it is diagnosed even
if it appears to be confined to the chest.
In the end, part of the debate around
the value of surgery is whether many patients who undergo surgery do better
because the patients offered it are the very patients most likely to do well
regardless of treatment, since surgery tends to be offered far more readily to
younger, fit patients with earlier stage disease. There is no randomized trial
evidence that demonstrates a significant benefit to surgery over non-surgical
management of mesothelioma.
Chemotherapy
Chemotherapy, also known as
systemic therapy, uses oral or infusion-based medications to kill cancer cells
throughout your body. Chemotherapy is used both before and after surgery, as
well as in people who do not undergo surgery. Though not curative, it has a
proven survival benefit. It is also used in the palliative setting to reduce
pain and improve quality of life.
The most commonly used
chemotherapy drugs for mesothelioma are cisplatin combined
with pemetrexed (Alimta) or raltitrexed (Tomudex). Other combinations
include gemcitabine, carboplatin or
oxaliplatin.
If you can’t manage
combination therapy, your doctor may start on just one drug. Sometimes, your
doctor may infuse the medication directly into your chest cavity, a procedure
called pleural chemotherapy, or, abdomen, called intraperitoneal chemotherapy.
You may also get a second course of chemotherapy, called “second-line”
chemotherapy, with pemetrexed or other drugs, raltitrexed plus oxaliplatin, or
the triple drug combination of irinotecan, cisplatin and mitomycin.
Radiation
Radiation can be an
important part of mesothelioma treatment. The problem is that because the
cancer is near the heart and lungs, it’s challenging to provide the kind of
high-dose, intensive therapy needed to shrink the tumor. However, a newer
option, intensity-modulated radiotherapy (IMRT), which can more accurately
target cancer cells and avoid healthy tissue, may provide better results when
performed by experienced clinicians.
Clinical Trials
Investigational therapies
are being explored through clinical and surgical trials at many of the nation’s
top cancer centers. There are more than 50 studies on new therapies for
mesothelioma in the U.S. that are looking for volunteers. Researchers are
investigating new targeted drugs and chemotherapies, as well as new protocols for
giving the medications; immunotherapy, which harnesses the power of the immune
system to fight the disease; phototherapy, in which you are injected with a
drug that bonds to cancer cells and is activated by high-intensity light; genetic therapies; and novel radiotherapy techniques like tomotherapy to treat the
disease. Learn more about participating in a clinical trial here.
Palliative Care
At some point, the
management of the disease will shift from trying to cure the disease to trying
to keep the patient as comfortable as possible for as long as possible. This is
the palliative care stage, when many patients enter a hospice program. Hospice
care can be provided at a designated hospice facility or in the comfort of a
patient’s home by a designated hospice nurse or care provider. The primary goal
at this stage is maximizing patient comfort. Medication to help with pain,
difficulty breathing, and other symptoms that may be experienced is a mainstay.
So is emotional and spiritual support for you and your family.
Alternative Therapies
Alternative therapies for mesothelioma may possibly be helpful to ease side effects of
traditional cancer treatment. Complementary and alternative medicine (CAM)
includes such therapies as massage, acupuncture, and meditation. They may
contribute to your overall management plan, helping you better manage the
stress and anxiety of the disease and conventional treatments.
Costs Associated with
Mesothelioma Treatment
Medical treatment costs can
be significant with a mesothelioma diagnosis. Sometimes insurance companies may
not cover the cost of diagnostic tests, clinical trials or other experimental
therapies. If you or a loved one is diagnosed, you should strongly consider
taking steps to help offset this potential financial burden. Learn more about
the financial assistance that is available to you if you or a loved one
has been diagnosed with mesothelioma and exposed to asbestos.
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