treatments for mesothelioma

Treatment of malignant mesothelioma using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation[citation needed]. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed. It is not possible to remove the entire mesothelium without killing the patient.

Radiation
Radiation Oncology/Lung/Mesothelioma
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.

Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[8] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

what is mesothelioma

What is Mesothelioma Cancer?

One rare form of cancer is called Mesothelioma, a malignant tumor in the mesothelial tissues of the lungs and the abdomen, arising from the inhalation of asbestos. Its rarity is one of the reasons why a lot of people are not aware of this kind of fatal disease. In fact, many people die of Mesothelioma undiagnosed. Although there is now a growing awareness of the hazards of asbestos to health, still many have not heard of Mesothelioma and thus, have not understood its nature, cause, signs and treatment. Even some physicians find it hard to detect Mesothelioma because its symptoms are akin to other diseases like lung cancer and pneumonia. Furthermore, it takes decades for a patient who was exposed to asbestos to develop Mesothelioma — fifty years, at most. Being unaware of Mesothelioma poses higher risks since it deters diagnosis and treatment. A person undergoing treatment must know the different stages of the cancer or the extent of the disease. Chances of recovering from Mesothelioma and the kind of treatment depend on the stage of the illness. There are basically two staging systems used for Pleural Mesothelioma (lungs): TNM system and Brighan system. These staging systems are also used in other kinds of cancers; however, the first is commonly used. There is no established method in determining the stage of the Peritoneal Mesothelioma cancer (abdominal) so the TNM system is used. There are three variables in the TNM system: tumor, lymph nodes and metastasis. In the earliest stage of Mesothelioma, stage I, the malignant Mesothelioma cells start to grow and multiply only one layer of the pleura. The pleura is the membrane that encloses the lungs and lines the wall of the chest cavity. However, there are some instances wherein the pericardium (membrane that covers the heart) and diaphragm cover are already affected. In this case, the cancer patient is still in stage I Mesothelioma. In the second stage, the two layers of the pleura are already affected by Mesothelioma. Take note, however, that in this stage, only one side of the body is affected. Normally, the pleura produces only small amount of lubricating fluid that allows easy expanding and contracting of the lungs. The excess fluid is absorbed by the blood and the lymph vessels so there’s a balance between the amount of fluid produced and removed. During the second stage Mesothelioma, fluid starts to build up between the membrane of the lungs and themembrane of the chest wall, resulting to pleural effusion. The increase in the volume of fluid produced causes shortness of breath and chest pain. Other Mesothelioma cancer patients experience dry and persistent cough. Diagnosis of the pleural effusion is achieved through a chest x-ray. Stage III Mesothelioma means that the malignant cells have already spread to the chest wall, esophagus and the lymph nodes on one part of the chest. The patient may suffer severe pain near the parts affected. When not treated immediately or when the Mesothelioma patient doesn’t respond well to medication, the cancer may advance to the fourth stage. The fourth stage Mesothelioma is formidable since at this stage the Mesothelioma cells have penetrated into the bloodstream and other organs in the body like the liver, the bones and the brain. The lymph nodes on the other side of the chest may also be affected by Mesothelioma in stage IV. Brighan staging system, on the other hand, determines whether the Mesothelioma can be surgically removed or not and whether the lymph nodes are affected or not. In stage I Mesothelioma, the lymph nodes are not yet affected and the patient can still recover through surgery. In stage II, surgery can still be executed but some lymph nodes have already been infiltrated by the cancer cells. In stage III, the heart and chest wall are already affected; thus, surgery is no longer advisable. The lymph nodes in this stage, however, may or may not be affected. In the final stage, stage IV Mesothelioma, cancer cells have already gone to the bloodstream and other parts of the body like the heart, brain, bone and liver. In most cases, a patient who has reached stage IV Mesothelioma only has four to twenty-four months to live.