Conventional mesothelioma therapies include surgery, radiation and
chemotherapy. You should keep in mind that if you choose one course of
action for mesothelioma treatment, you may preclude other courses. All
of your options should be considered as soon as possible.
Depending on the stage of a
mesothelioma,
surgery may be used to remove the cancer and some of the surrounding
tissue. Often, however, an operation is not appropriate and the patient
may have only minimally invasive procedures to relieve symptoms. A
thoracentesis, where fluid in the chest is removed by placing a needle
into the chest cavity, may be done to make a patient more comfortable.
Sometimes talc or an antibiotic may be injected into the chest cavity to
try to prevent the fluid from returning. These techniques are
successful in controlling the fluid, at least temporarily, in as many as
90% of patients. Because pleural fluid can compress the lung and cause
shortness of breath, these procedures can help patients breathe more
easily, however, they do not cure the cancer. In the case of
peritoneal mesothelioma,
a needle may be inserted into the abdomen to drain the fluid.
Similarly, a needle inserted into the pericardium (sac around the heart)
can drain the fluid caused by
pericardial mesothelioma
and help relieve circulatory problems. However, draining this fluid may
result in complications. Sometimes the cancer cells spread along the
needle path, and a tumor nodule may form under the skin of that area.
Surgery for mesothelioma may be performed for one of two reasons: for
palliation (to relieve pain and discomfort caused by the tumor), or to
cure. Palliative surgery is typically done in cases where the tumor has
already spread beyond the mesothelium and is difficult to completely
remove, or in cases where the patient is too ill to tolerate a more
extensive operation. Curative surgery is offered when the patient is in
otherwise good health and the tumor is thought to be localized and can
be completely removed. Unfortunately, microscopic spread of cancer cells
into the chest wall and diaphragm are common even when such spread
cannot be detected by routine tests. Therefore, given the extent of
these operations and their very limited success, the exact role of
surgery in
treating mesothelioma is often debated.
There are two types of operations that may be offered to patients with
pleural mesothelioma: pleurectomy/decortication and
extrapleural pneumonectomy.
Pleurectomy/decortication is usually a palliative (relieves symptoms
without curing the cancer) operation in cases where the entire tumor
cannot be removed. It involves removal of the pleura, where the majority
of the tumor is located. It is effective in controlling effusions
(fluid accumulation) and decreasing the pain caused by the cancer.
Extrapleural pneumonectomy is a far more extensive operation and most
often used in cases of localized mesothelioma. The operation is
technically difficult and performed only by surgeons in large
specialized medical centers. It involves removing the pleura, diaphragm,
pericardium, and the whole lung on the side of the tumor. The patient
must be in overall good health with no other serious illnesses in order
to tolerate the large operation. This operation is intended to remove
all or most of the cancer and some surrounding tissues as well.
Surgical treatment of peritoneal mesothelioma is often performed
either to help relieve symptoms or to attempt to remove the tumor from
the wall of the abdomen and other digestive organs. As with pleural
mesothelioma, these tumors are often too extensive to remove completely.
Similar operations can be performed to remove a mesothelioma from the
pericardium (the sac around the heart).
Radiation therapy uses high-energy x-rays to kill cancer cells.
External beam radiation therapy uses radiation delivered from outside
the body that is focused on the cancer. This type of radiation therapy
is often used to treat mesothelioma. These treatments are much like
getting a diagnostic x-ray except for a longer time.
Brachytherapy
involves radioactive material being placed directly into the chest or
the abdomen at the site of the mesothelioma. Radiation therapy is
sometimes used as the main treatment of
mesothelioma cancer
in some patients, especially those whose general health is too poor to
undergo surgery. Adjuvant radiation therapy can be used in addition to
surgery to kill small deposits of cancer that cannot be seen and removed
during surgery. Palliative radiation therapy can also be used to ease
symptoms of mesothelioma such as shortness of breath, pain, bleeding,
and difficulty swallowing.
Side effects of radiation therapy may include fatigue and mild skin
changes that resemble a sunburn. Often these side effects are temporary.
Radiation may also make the side effects of chemotherapy worse. Chest
radiation therapy may cause lung damage and lead to difficulty breathing
and shortness of breath. Abdominal radiation therapy may cause nausea,
vomiting and diarrhea. If you are having any of these side effects of
radiation therapy, talk with your doctor since there are ways to help
control these symptoms.
Chemotherapy is the use of drugs for treating cancer. The drugs can
be swallowed in pill form or they can be injected by a needle into a
vein or muscle. Chemotherapy is systemic therapy. This means that the
drug enters the bloodstream and circulates throughout the body (through
the whole system) to reach and destroy the cancer cells.
In treating mesothelioma, these drugs may also be given
intrapleurally (directly into the chest cavity), or intraperitoneally
(into the abdominal cavity). Depending on the type and stage of
mesothelioma, chemotherapy may be given as the primary (main) treatment
or as an adjuvant (addition) to surgery.
Several anticancer drugs have been used to treat mesothelioma. The
drug most effective when given alone is doxorubicin (Adriamycin). Other
drugs that may be given alone include cisplatin and methotrexate. These
anticancer drugs are often given in combination to try to increase their
effectiveness. Combinations of drugs used in the treatment of
mesothelioma include methotrexate and vincristine.
Cisplatin,
Alimta®,
Gemcitabine (Gemzar),
Navelbine (Vinorelbine),
Carboplatin and
Onconase
(Ranpirnase) are also effective chemotherapy drugs. Other drugs such as
paclitaxel and irinotecan are currently being studied to determine
their effectiveness in treating mesothelioma.
Chemotherapy drugs kill cancer cells but also damage some normal
cells. Therefore, careful attention must be given to avoiding or
minimizing side effects, which depend on the specific drugs, the amount
taken, and the length of treatment. Temporary side effects might include
nausea and vomiting, loss of appetite, loss of hair, and mouth sores.
Because chemotherapy can damage the blood-producing cells of the bone
marrow, patients may have low blood cell counts. This can result in an
increased risk of infection (due to a shortage of white blood cells),
bleeding or bruising after minor cuts or injuries (due to a shortage of
blood platelets), and fatigue or shortness of breath (due to low red
blood cell counts).
Most side effects disappear once treatment is stopped. There are
remedies for many of the temporary side effects of chemotherapy. For
example, antiemetic drugs can be given to prevent or reduce nausea and
vomiting. If you experience any side effects, be sure to talk with your
doctor.
Physical Therapy is a complementary therapy that can help
asbestos cancer patients recover from surgery or the side effects of mesothelioma chemotherapy or radiation therapy.
