Mesothelioma Treatment

A diagnosis of mesothelioma is always difficult, whether it is pleural mesothelioma or another variety. Because this is such an aggressive and stubborn form of cancer, patients and their families may have a difficult time addressing the issue of treatment, but because options for mesothelioma patients are steadily increasing, the discussion of treatment is quite important, even if all hope seems lost.

Each mesothelioma case is considered individually and there is no right or wrong treatment for the disease. What's best for you or your loved one will depend on a number of factors. Diagnostic tools such as x-rays, MRIs, CT scans, and biopsies will be used to determine these factors and these tests will assist the doctor and/or oncologist in determining the best treatment for the patient in question.
What are the Options?

Cancer treatment usually focuses upon destroying malignant cells and preserving healthy ones. This can be accomplished in a number of ways. At present, mesothelioma patients are faced with three major options for treatment of their disease - surgery, radiation, and chemotherapy. What course of treatment is recommended will largely depend on these issues:
The type of mesothelioma and location of the tumor
The size of the tumor(s)
The degree to which the cancer has spread or metastasized
The stage of the cancer - beginning, advanced, etc.
The age of the patient
The overall physical health of the patient

Setting up any type of treatment may involve seeing a variety of doctors, including an oncologist (cancer specialist), pulmonologist (lung specialist), or radiologist. Patience is sometimes necessary, but doctors will no doubt set up treatment as soon as possible after diagnosis.
Surgery

Surgery can be performed on mesothelioma patients for one of two reasons: in an attempt to cure the disease or for palliative reasons in order to keep the patient more comfortable and improve the quality of life. Unfortunately, because mesothelioma is almost always diagnosed in its late stages, curative surgery is not usually an option.

As tests are developed that may help to diagnose mesothelioma at an earlier stage, surgery may become more of an option in the future. At that point, doctors may be able to attempt to remove the cancer and some of the surrounding tissue in an attempt to stabilize the disease.

More often, however, surgery is used as a palliative measure. For example, doctors may opt for a surgery called a pleurodesis, which involves injecting talc into the lungs to prevent fluid from returning. A thoracentesis, a surgical procedure that removes fluid from the lungs by means of a thin needle, may also be recommended.

In severe cases, a pleurectomy may be recommended for palliative purposes. This involves removing the pleura - the lining of the lung - and can control fluid build-up and lessen pain and breathing difficulties.
Radiation Therapy

If a patients health is too fragile for surgery or chemotherapy, radiation is often recommended. Radiation causes the fewest side effects and is usually easier to tolerate than chemo. There are a few different forms of radiation therapy available to meso patients:

External beam radiation - the preferred type to treat mesothelioma, this type of radiation comes from a machine outside the body and is aimed toward affected areas. Usually administered 5-days-a-week for up to 5 weeks, this type of radiation is often used for palliative purposes - to lessen breathing difficulties, pain, bleeding, or difficulty swallowing - but seldom has much of an effect on the mesothelioma tumors. This type of radiation may also be used in addition to surgery.

Brachytherapy - Rarely prescribed for mesothelioma, this kind of radiation places radioactive material directly inside the lung or abdomen.
Chemotherapy

Like radiation, chemotherapy provides no cure for mesothelioma but can go a long way in providing relief from the horrendous symptoms of the disease. As researchers continue to test different combinations of chemotherapy drugs, patients continue to benefit from their findings, and someday, chemo may go a lot further in prolonging the life of a mesothelioma victim.

Chemotherapy is given in pill form or injected. In the case of mesothelioma patients, the drugs are given intrapleurally (into the chest cavity) or intraperitoneally (into the abdominal cavity). Doctors usually combine two drugs for the best result. Currently, the preferred combination is Alimta© (pemetrexed) and Cisplatin, but other drugs are used in tandem if deemed preferable for a specific patient. In some cases, patients can only tolerate a single drug so only one is used for treatment.

Other drugs are given to the patient to combat the unpleasant side effects of chemo, such as medication to relieve nausea and vomiting or vitamins to replace essential ones lost during chemotherapy.

Some patients decide that the side effects of chemotherapy are too severe and opt not to receive this treatment.
Clinical Trials

Clinical trials are the study of promising new treatments for a particular disease. These trials are constantly in need of patients who are willing to try these experimental treatments before they are approved by the FDA. Patients should speak to their doctors about current clinical trials available to them and if they might qualify to be a part of a particular study. Those opting to participate in a clinical trial should carefully weigh the pros and cons before agreeing to participate.
Alternative Therapies

Alternative therapies include potential treatment for a disease or its symptoms that are not part of the conventional treatment generally recommended for patients with the disease. These might include the use of vitamins or herbs or participation in therapies such as acupuncture, massage, or hypnosis.
A Mesothelioma Cure

Following the backlash of asbestos-related exposures and illnesses, many people were wondering how scientific research was going to proceed. The response has been encouraging, with cancer specialists and other doctors working each day towards a cure for malignant mesothelioma. While a way to completely eliminate the cancer from the body does not presently exist, there are several successful mesothelioma treatment programs as well as clinical trials that are working towards developing a way to eliminate this unfortunate form of cancer.

Treatments for patients of malignant mesothelioma commonly fall in line with treatment of other lung and lung-related cancers. Curative treatments are those which remove the cancer from the body completely. While there are no cures for mesothelioma, any treatment could theoretically be curative, so long as it is successful in completely removing the cancer from the body. While the treatment may be curative, it is important to remember that curative treatments do not rule out the recurrence of the disease.

While curative treatments may not prevent the disease from recurring, it is important to be aware of current initiatives that are working towards a total cure for the disease. There have been instances of unique treatment programs that have prevented the recurrence of the disease for several years. Paul Krauss was diagnosed with mesothelioma in 1997 and given only a few months to live by his physician. Today, Paul Krauss is still alive and active and has dedicated himself towards spreading awareness of the disease and working with others in developing treatment programs that would be as successful as his has been.

Combination treatments, which integrate two or more different treatment options, such as surgery coupled with radiation, or surgery paired with radiation and chemotherapy have been successful in extending life expectancies. Researchers believe that when the right combination of therapies is found, prognoses will be far longer than anyone could have imagined when the disease first manifested. Technology has also afforded new possibilities to mesothelioma patients. CT (Computer Topography) scans have been able to map three-dimensional images of the body's internal organs for targeted chemotherapy or radiation therapy to be administered.

Another novel technique is being integrated with surgical resections of mesothelioma tumors. Heated chemotherapeutic agents have shown increased proficiency in the elimination of cancer cells. Side effects of chemotherapy have, in the past, prevented physicians from delivering an optimal dosage of the drug. However, a novel procedure known as intracavity heated chemotherapy treatment has integrated these two concepts into a successful program. Heated chemotherapeutic agent is administered directly to the affected area during the surgical removal, destroying any remaining cancer cells in the area and extending prognoses well beyond typical timeframs.

It is through technology and advancements such as these that cancer specialists and physicians are laying the groundwork for a cure.
References:
American Cancer Society: Detailed Guide: Maligant Mesothelioma Chemotherapy
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Chemotherapy_29.asp?rnav=cri
American Cancer Society: Detailed Guide: Malignant Mesothelioma Radiation Therapy
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
American Cancer Society: Detailed Guide: Malignant Mesothelioma Surgery
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_29.asp?rnav=cri
Catalano, A., et al. "Experimental Therapy of Malignant Mesothelioma: New Perspectives from Ant-Angiogenic Treatments" Pub Med. Critical Reviews in Oncology/Hematology. 2004 May;(2):101-9.