Mesothelioma treatment depends on several factors,
including the stage of mesothelioma, the location of the tumor, and the age and
overall health of the patient.
1. Surgery - Removal of Malignant
Mesothelioma
Surgical removal of the tumor and surrounding tissue may be used depending on how
far the mesothelioma has spread (the stage). The more advanced the stage, the less
likely that surgery will be effective in treating mesothelioma.
Surgery for malignant mesothelioma can be used for long-term control or to cure
the disease (aggressive surgery) or can be used to relieve pain (palliative).
a) Aggressive surgery
Aggressive mesothelioma surgery involves removal of the pleura, lung, diaphragm,
or pericardim. (The type involving removal of the pleura is called extrapleural
pheumonectomy.) The goal is to remove as much of the mesothelioma tumor as possible.
This type of surgery, also called extraplueral pneumonectomy, typically is performed
on younger patients in Stage 1 of mesothelioma.
Because of the complexity and the high risks involved with this type of surgery,
some mesothelioma hospitals do not perform the procedure.
Also, different mesothelioma treatment centers may have different criteria for accepting
patients for surgery. Therefore, it is important to check with a mesothelioma hospital
to see if you meet its criteria.
b) Palliative Surgery
Palliative surgery is typically used in the more advanced stages of mesothelioma.
The goal is to relieve or control symptoms caused by fluid collection or by the
tumor compressing the lung or other organs. It is not intended to cure mesothelioma.
Pleurectomy/decortization is usually a palliative operation. It is used in situations
where the entire tumor cannot be removed. It is effective in controlling the accumulation
of fluid in the lungs (effusion), and the pain caused by mesothelioma.
Thoracentesis is also used to treat effusion in pleural mesothelioma. This treatment
involves inserting a needle into the chest in order to drain the fluid. Thoracentesis
does not involve surgical removal of the mesothelial cells.
2. Radiation
Radiation therapy uses high-energy x-rays to kill mesothelioma cancer cells and
to shrink tumors. There are two types of radiation therapy.
External radiation therapy uses a machine outside the body that beams x-rays
to the location of the mesothelioma.
Brachytherapy involves putting chemicals that produce radiation directly into
the site of the mesothelioma cancer. This is done by inserting a thin plastic tube
into the chest or abdomen.
Because of the location of malignant mesothelioma, it is very difficult to deliver
high-enough doses of radiation to kill the tumor without damaging surrounding organs.
As a result, it is unclear whether radiation therapy is a successful method of treating
mesothelioma. It has, however, been effective in killing remaining tumor cells after
surgery has been performed.
Radiation therapy is also used as a palliative therapy to relieve symptoms of
mesothelioma, such as shortness of breath, chest pain, and internal bleeding.
Radiation therapy has several side effects, such as fatigue, nausea, and vomiting.
Although these side effects are sometimes temporary, you should let your doctor
know, since they often can be controlled.
3. Chemotherapy
Chemotherapy uses drugs to treat mesothelioma cancer. It is administered either
orally (through pills) or by injecting the drugs directly into the veins (intravenously),
the muscles, the chest cavity (intrapleurally), or the abdominal cavity (intraperitoneally).
The goal of mesothelioma chemotherapy is for the drug to enter the bloodstream and
circulate throughout the body in order to destroy the cancer cells.
Several drugs have been used, either individually or in combination with others,
to treat mesothelioma. Some of the single-agent drugs include:
 |
Adriamycin (doxorubicin), which is the most studied
and, currently, the most effective single agent; |
|
|
epirubicin |
|
|
carboplatin |
|
|
detorubicin |
|
|
pirarubucin |
|
|
mitomucin |
|
|
cisplatin. |
Single-agent therapy has been only modestly successful in treating mesothelioma,
with studies showing a response rate in the 10 to 20% range.
Because of the relatively low response rate of single-agent therapy in treating
mesothelioma, combinations of these drugs have been used to increase their effectiveness.
Although some researchers have reported high response rates to these therapies,
these rates have not been consistent, and more research is necessary.
Chemotherapy drugs are generally very toxic. Therefore, a doctor must be very
careful in monitoring the condition of a patient during therapy. Some of the more
common side effects include nausea, vomiting, loss or appetite, hair loss, and fatigue.
Chemotherapy can also result in low blood cell counts, which increases the risk
of infection and bleeding or bruising.
Side effects vary depending on the treatment, and generally disappear after treatment
is completed.
|
