The Asbestos Cancer and Mesothelioma Support Center - Mesothelioma Treatments

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The Asbestos Cancer and Mesothelioma Support Center - Mesothelioma Treatments
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One of the first decisions that a person who is diagnosed with mesothelioma will make is what type of treatment to pursue. There are a range of treatment options, which fall into three main categories: established therapies; experimental treatments; and holistic therapies. Physicians will help patients understand the range of options before them, and then select the treatment that is most appropriate. Educational resources such as this one can also help to answer questions.

Among the first steps in determining the most appropriate treatment option is “staging” the disease. This process ranks the severity of the disease based on factors such as how extensive the cancer has spread in the chest, whether it has spread to lymph nodes, and whether it has metastasized to more distant parts of the body. In making treatment recommendations, physicians will weigh factors such as the stage of the disease, a patient’s age, gender and general health, and a patient’s wishes.

Chemotherapy, radiation and surgery are the most established and frequent treatments. Chemotherapy uses drugs that kill cancer cells to treat mesothelioma. There are several approaches to the sequencing of chemotherapy. Neo-adjuvant therapy shrinks a tumor before surgery is performed. Adjuvant surgery helps to get rid of cancer cells that are there after surgery. Chemotherapy drugs can also be used to increase the effects of either radiation or immunotherapy. It can also be used to destroy cancer that comes back or that has metastasized (spread) to other parts of the body.

The names of some of the most commonly used drugs are cisplatin, gemcitabine, alimita, coramsine, and endostatin. Drugs may be administered individually, or, in what is called combination therapy, in pairs. Some common pairings are: methotrexate and vincristine; cisplatin, vinblastine and mitomycin; and doxorubicin, cyclophosphamide (or ifosfamide), and cisplatin.

Chemotherapy drugs function differently, but are all focused on the same goal: destroying cancer cells and keeping them from reproducing. These drugs are often very potent and it is very common for them to affect healthy cells in the body as well. Specifically, they affect cells that grow quickly, including hair and cells that are found in the mouth, stomach and other parts of the digestive system. This is why hair loss is such a common side effect of chemotherapy. Other side effects include nausea. Most side effects end once the treatment is over.

Chemotherapy drugs can be administered intravenously or orally (with pills). The length of a course can also vary. Patients can receive chemotherapy at a doctor’s office or at a hospital (1).

Radiation is often used along with chemotherapy drugs and/or surgery. Radiation attacks cancerous cells and keeps the cells from dividing rapidly. It can also be used as a palliative treatment to reduce symptoms. However, radiation can also kill healthy cells, and so must be directed as precisely as possible. Mesothelioma is often resistant to this form of therapy (2).

There are a number of ways to administer radiation therapy, either internally or externally. Internal radiation is delivered into the body and can be either “unsealed” or “sealed.” Unsealed internal radiation is administered by a pill or by an injection; and sealed internal radiation is implanted in the body in a seed, capsule or wire. External radiation is provided by a linear accelerator, or by a type of machine that has as its radiation source a radioactive substance.

A course of external radiation therapy is administered as an outpatient procedure, five days a week for several weeks. By contrast, internal radiation therapy involves a three day to one week stay in the hospital. Side effects of radiation include exhaustion, nausea, shortness of breath and reactions such as hair loss in the treated areas (3).

Surgery: There are two general surgical approaches: palliative surgery, which helps to alleviate the pain caused by a tumor or by symptoms associated with the disease, such as fluid build up in the chest wall or abdominal cavity; and curative surgery, to slow or stop the growth of the disease and to extend a patient’s life.

Palliative Surgery is performed when a tumor has grown beyond the mesothelium and cannot be fully removed. It will also be done if a patient is too ill for more invasive surgery. The purpose of this type of surgery is to relieve symptoms and to make a patient more comfortable. One example of palliative surgery is a thoracentsis, a procedure in which a doctor drains fluid from the chest wall to reduce pressure on the lungs and make it easier for a patient to breathe.

Curative surgery is performed when doctors believe there is a strong chance of curing the disease by removing an entire tumor that has not spread aggressively. When it is most effective, surgery leads to a remission, or a period during which a patient is cancer free. One example of curative surgery is pneumonectomy, in which a doctor removes a patient’s lung. In some case, part of the diaphragm will also be removed.

In addition to these established treatments, there are also a number of experimental therapies, which are still being tested for safety and effectiveness. A patient can try an experimental treatment by entering a clinical trial. Several types of experimental therapy are briefly described here.

Angiogenesis Therapy cuts off the blood supply to tumors to slow their growth (4). Gene Therapy changes the genetic composition of living cells in order to fight cancer. Immunotherapy attempts to “trick” the body into recognizing that cancer cells are not normal by introducing drugs called biological response modifiers into the body. Multimodality Therapy involves combinations of surgery, radiation therapy and chemotherapy, with a goal of realizing the benefits of, and compensating for the weaknesses of, each type of therapy. For example, this approach might involve using multiple chemotherapy drugs, or combining surgery and radiation.

Some patients also choose to pursue holistic treatments which can boost the immune system and increase relaxation. Examples include dietary changes such as eating fish oil, supplements such as Melatonin, or practicing yoga and breathing techniques.