Mesothelioma is a rare type of cancer that most often starts in the covering the lining of lungs (pleural mesothelioma) but can also start in the abdomen (peritoneal mesothelioma).
Treatment and Hope
Treatment options for mesothelioma will depend on:
- The stage of your cancer
- Any other medical conditions you may have
- Your general fitness
Some people with early mesothelioma may have surgery, followed by chemotherapy or radiotherapy or a combination of both.
If you have more advanced mesothelioma, you may have chemotherapy to shrink it and reduce symptoms and tumor size. We know from research that chemotherapy can help you live longer.
Radiotherapy may also shrink the cancer and control symptoms. Or your specialist may suggest surgery to take away some of the tumor and reduce symptom
Doctors and researchers are working to improve mesothelioma treatment all the time. They may offer you treatment as part of a clinical trial. The results of the trials will be used to improve treatment in the future.
Remember these is hope. In some cases tumor size can be shrunk considerably and a non surgical candidate may become a surgical patient and have a better outcome.
Chemotherapy uses anti cancer drugs, which for mesothelioma are usually injected into a vein. In some cases heated chemotherapy baths are done around the affected organs during surgery. Depending on the type of chemotherapy drugs used, you may have treatment weekly, or every 2 to 3 weeks.
Chemotherapy may be used to control symptoms in more advanced mesothelioma which cannot be removed surgically. The treatment may also help to slow down the growth of the cancer.
If you have surgery for early stage mesothelioma, you may have chemotherapy before or afterwards. Chemotherapy before surgery is called neoadjuvant chemotherapy and aims to shrink the tumour and make it easier to remove. Chemotherapy after surgery is called adjuvant chemotherapy and aims to delay the cancer coming back for as long as possible.
Radiotherapy is usually given to reduce the symptoms of stage 2, 3, or 4 mesothelioma. It may also slow down the growth of the tumour. Radiotherapy is sometimes given after fluid has been drained from around your lung. This is to try to stop new growths of mesothelioma developing in the scar on your chest wall.
Surgery can be used to try to completely remove localized mesothelioma. There are 2 main types of operation for this.
These are removing the pleura (pleurectomy) or removing the lung and pleura (extrapleural pneumonectomy).
For people with advanced mesothelioma, the surgery aims to remove as much tumor as possible to relieve symptoms — this is called palliative surgery or debulking.
In some case surgery may be the only therapy with a long term benefit.
Removing the pleura (pleurectomy)
Pleurectomy means removing the pleura from around the lung. The lung is left behind. This type of surgery is also called decortication. The pleural space around the lung is treated so that no further fluid can collect there.
If you have stage 1 mesothelioma, you may have a pleurectomy to remove the cancer. If you have a more advanced stage, pleurectomy can slow the growth of the mesothelioma, and help to relieve symptoms such as pain and fluid collecting around the lung (pleural effusion). Removing as much of the cancer as possible may also help other treatments to work better, for example chemotherapy.
Removing the lung and pleura (extrapleural pneumonectomy)
Extrapleural pneumonectomy (EPP) is extensive surgery, which is only possible for some people with early stage mesothelioma. Pneumonectomy means removing the lung.
Extrapleural means that the pleura, diaphragm, and the covering of the heart (pericardium) are removed as well on the side affected by mesothelioma. It may help some people to live longer when combined with chemotherapy and radiotherapy.
This operation is only possible if you are fit enough and have good heart and lung function. If your heart and lung function is already poor, this operation is not suitable.
Supportive Care (Palliative Care)
Mesothelioma is often diagnosed when it is quite advanced. Some people with very advanced disease may be too ill to cope with treatments such as chemotherapy, radiotherapy or surgery. But they can still have treatment to try to relieve symptoms such as pain, breathing problems and weight loss. Your care will be managed by a palliative care team. This is a team of doctors and nurses who are expert in controlling symptoms of advanced cancer. The team may also include a physiotherapist and a dietician.
If you are having trouble with fluid collecting around your lungs, the fluid may be drained off. This procedure is called a pleural tap or thoracocentesis.
If the fluid comes back you may be offered treatment to try to stop this from happening. Removing the pleura (pleurectomy) is one option and this helps the lung to expand better. Often sterile talc is put in to seal the space and stop the fluid collecting again. This is called pleurodesis and is carried out either through a chest drain or by the doctor putting a tube into the area through a small cut (keyhole) in the chest wall. The keyhole surgery is called a video assisted thoracoscopy.
If the lung cannot expand fully after draining the fluid, your doctor may put in a tube that drains the fluid continuously for a few weeks. This is called an indwelling catheter. You can go home with this tube and it means that you do not have to keep going to the hospital to have the fluid drained off.
New Mesothelioma Medications
ALIMTA (pemetrexed for injections) is a relatively new treatment for malignant pleural mesothelioma. Alimtax ia given with cisplatin, another chemotherapy cancer medication. Alimta is often given when surgery is not an option.
VERASTEM – a new drug currently in Phase 2 clinical trials has produced unique results in the maintenance of malignant pleural mesothelioma. Verastem works by blocking the signaling pathwasys to prevent the metastasis of the cancer stem cells. Verastem acquired the stem cell inhibiting drug (defactnib) VS-6063.
Additional Medical Resources
Contact us for a list of the best mesothelioma Doctors / Hospitals so you can help locate where you should obtain treatment and find out more about who will treat you. Our Patient Match Program connects you with other mesothelioma patients and families who have been through the treatment process. Patients and their care givers often find it comforting and helpful to speak with someone who has already been through the process and can offer advice. Lastly, find out about new Clinical Trials to treat mesothelioma.
Mesocare.com provides critical services, financial assistance, and provides free books to mesothelioma patients and their families. To obtain this information call 1-800-877-6000 or fill out the online form.