Mesothelioma Treatments

Malignant mesothelioma is a cancerous tumor of the pleura— the lining of the lung and the chest cavity or cancer of the lining of the abdomen or peritoneum—a thin layer of tissue that lines the abdomen and covers most organs located there malignant mesothelioma is a late onset disease caused by exposure to asbestos fibers.

Asbestos was used in insulation, ceiling and roofing tiles, cement, brake materials, and throughout the ship building industry. Its use was most widespread from the World War II into the late 1970’s. Worldwide, cases of mesothelioma are increasing. Malignant mesothelioma affects men more often than women. Mesothelioma is difficult to diagnose. Even under the microscope, distinguishing between this type of tumor and other conditions and tumors of the pleura is difficult. More than a single specialist may need to be involved in the examination of cells obtained in a biopsy.

Tests performed in order to determine whether mesothelioma is present include:

• Biopsy of lung tissue often called open lung biopsy
• Biopsy of the pleura surrounding the lungs
• Thoracic CT
• Chest x-rays
• Cytology of fluid contained in the pleura, the lining of the lungs

Symptoms of mesothelioma may not be apparent until 20 to 40+ after exposure to mesothelioma-causing asbestos has occurred. Symptoms may include, but are not limited to, the following:

• Coughing
• Pain in the chest cavity
• Pain in the abdomen
• Abdominal bloating
• Fatigue
• Weight loss
• Shortness of breath

Currently, mesothelioma has no cure. By the time symptoms appear and mesothelioma is diagnosed, the disease is often too far advanced for surgery. If untreated, patients typically survive only an average of nine months to twelve months after the disease has been diagnosed. If the cancer is discovered before it has had the chance to spread or metastasize, and if the cancer is aggressively treated, almost half of patients will live two years, and close to 20 percent will live five years. The combination of chemotherapy drugs may help reduce symptoms of mesothelioma but will not cure the cancer.

The first help patients with symptoms of mesothelioma seek will be that of their primary physician. Later a thoracic surgeon may perform diagnostic tests, such as thoracoscopies and plural biopsies. A pathologist will then look at tissue samples in order to diagnose the disease. After diagnosis has been made, the patient will be treated with radiation therapy, chemotherapy, and/or surgery.

While surgery is the best treatment option for patients in the early stages of mesothelioma, surgery is not an option for some. Only those patients able to withstand the surgery itself and only if the cancer is limited to one place in the body will undergo surgery. Depending on the extent of the progression of the disease, a lung may be removed (extrapleural pneumonectomy). In some cases, a part of the diaphragm is removed as well. If the disease is not so advanced, the surgeon may remove a part of the lining of the chest or abdomen and some of the surrounding tissue. These procedures are called pleurectomies and peritonectomies respectively. Surgery is often accompanied by adjuvant radiation followed by chemotherapy.

If surgery is not possible, other less invasive procedures may be performed:

• Thoracentesis—A needle is placed into the chest cavity in order to extract excess fluid in the chest cavity. This procedure is considered palliative and can only improve symptoms of mesothelioma, not cure the disease.
• Sclerotherapy—A procedure which obliterates the pleural space, preventing the accumulation of fluid. This procedure is done in cases in which fluid tends to reaccumulate, causing symptoms.

Radiation therapy makes use of high energy x-rays in order to kill cancer cells. For patients for whom surgery is not an option, radiation therapy may become the primary treatment for malignant mesothelioma. Radiation can also be used to alleviate various symptoms of mesothelioma—problems swallowing, shortness of breath, and thoracic pain, for example. Radiation may also be used as an accompaniment to surgery itself.

Intraoperative photodynamic therapy is a new treatment being studied for treatment of early-stage mesothelioma, which is confined to the chest cavity. Special drugs are used which make the cancer cells more susceptible to being killed through use of a laser. Several days prior to surgery, the drugs are administered to the patient, and then during surgery, the laser light is used to attack the cancer cells.

• Extrapleural pneumonectomy
• Pleurectomy and decortication as palliative therapy in order to relieve symptoms of the disease and thereby improve patients’ quality of life
• Radiation in order to relieve symptoms and improve quality of life
• Clinical trial of new anticancer drugs introduced directly into the chest cavity after surgery has been performed to remove the tumor
• Surgery, chemotherapy, and radiation used in conjunction with one another
• A clinical trial of another new treatment—Patients should check for U.S. clinical trials from the National Cancer Institute’s list of cancer clinical trials now accepting patients with localized malignant mesothelioma.