Mesothelioma Treatment

As an individual what will be your treatment options?

When choosing the best treatment option or which is right for you depends on many factors like generally your health condition, age, your cell type (which find out the aggressiveness of cancer), stage of cancer and what is your will. You will have a MDT (multidisciplinary team) of doctors to help you in choosing you the right treatment option for you. These team members comprise a medical oncologist, cardiothoracic surgeon, a pain management specialist, a radiation oncologist and a palliative care specialist, who will study and discuss your case and recommend you the best treatment approach. 

Before making any final decision for your treatment first discuss with your multidisciplinary team of doctors. Although there are so many treatment options for mesothelioma, you should discuss each option with your doctor. You should be well informed about each option which may includes treatment side effects, risk factors, prognosis and quality of life.

Surgery

 

There are two surgical procedures for mesothelioma, pleurectomy/decortication and extrapleural pneumonectomy. These surgeries require highly expertise, as not every thoracic surgeon has expertise in these types of surgeries.  Eventually, the intention or aim of these surgeries is to eliminate the disease with keeping in mind that there must be some remaining of the disease is left. Therefore, for the removal of remaining of the disease can be done by adjuvant therapy. Chemotherapy and Radiotherapy are the most common types of adjuvant therapy.

Pleurectomy/decortication

Pleurectomy/decortication involves the removal of lining of lungs (pleura), it has nothing to do with the eviscerating the lung. You can say that this type of approach is less radical but in few cases the diaphragm and pericardium are removed, but it depends on the extent of tumor. A patient who cannot bear the extrapleural pneumonectomy(EPP) approach and also the recovery time is far quicker than other procedures are the advantages of this approach. Now when we consider about the disadvantages the first thing should comes in our mind that since, from this procedure the tumor is not completely removed so there may be a chance of recurrence of the disease, and inability to use high amount of adjuvant radiation because of possible damage to the lung.

Extrapleural pneumonectomy (EPP)

This procedure involves the eviscerating of lung, the pericardium (lining of heart), pleura (lining of lung) and part of the diaphragm. A Gortex-like material is used during surgery to reconstruct the diaphragm and pericardium. For this surgery only those patients are eligible who are at a certain stage of cancer and can demonstrate sufficient cardiac and pulmonary function so that they can bear the procedure.

Chemotherapy

 

Anti cancer drugs are used in chemotherapy which helps in stopping the cells of cancer to multiply. Combination of drugs can be used in some cases to boost the effectiveness. Mainly chemotherapy is used to forcefully shrink the size of the tumor and to relieve from the symptoms like pain and breathlessness. Chemotherapy may be supervised as an oral medication, using injection into muscle or vein or may be directly into peritoneal (lining of the abdominal cavity) or pleura. Chemotherapy drugs for mesothelioma may include

•  Gemcitabine
•  Navelbine
•  Paclitaxel
•  Cisplatin
•  Carboplatin
•  Doxorubicin
•  Onconase
•  Cyclophosphamide
•  Pemetrexed

Radiotherapy

 

In radiotherapy high energy x-rays are used to shrink tumors and kill cancer cells. It may be used with the combination of surgery to eliminate the remaining of the disease through which the disease can reoccur and also to treat the pain cause by tumor.  

Clinical Trials

 

The basic idea of the clinical trials is to find a better and new treatment for the disease by involving the patients. There are different objectives of different clinical trials which may comprise comparing a variety of ways to treat a disease or the testing of so many different techniques for cancer prevention, testing of new drugs. There are three phases in clinical trials, which are discussed below:

Phase I Trials

This is the initial phase of clinical trials. In which testing of drugs takes place in the laboratory, that what is the effect of these drugs on cancer cells? In this phase there are few participants are enrolled and are only available at restricted cancer facilities. The objective of this phase is to obtain the utmost tolerated dosage of the drug without getting any severe side effects when treated to humans. If the drug is confirmed to have an effect on cancer at a safe level of dosage, then in Phase II the drug will be tested.

Phase II Trials

In this phase the testing of the safety of drugs carry on, not only that it started to look more precisely at their effectiveness on cancer cells. These trials accommodate more participants than the previous phase and are available at more cancer facilities. Randomly participants are chosen by a computer, rather than by a doctor.

Phase III Trials

In this phase, the comparison between the new procedures or drugs with the existing standard of treatment is being done. Lots of participants are enrolled in this phase. They received a standard treatment or a new treatment. The main objective of this phase trial is to find out that if the cancer slowed or reduced by the drugs. It also determines how the drug is affecting the patient’s quality of life and how long the patient will be stable without the development of the disease?

Palliative Care

 

Palliative care is a procedure that enhances the quality of life of not only the patients but also their families facing the problems related with this life-threatening disease. Palliative care can be given along with the other treatments like surgery or chemotherapy or can be used to control the symptoms in those patients who are not going through or doesn’t want an aggressive treatment. 

There are some patients who are not willing to endure an aggressive treatment, may be because of their age or disease has developed to the point where palliative care is a better option.

At early stage of mesothelioma diagnosis there are two symptoms which are very common can be dealt by palliation:

•         Wound Seeding
•         Pleural effusion

Other symptoms which can also handled by palliative care are:

•         Depression and anxiety
•         Pain
•         Skin problems
•         Dry mouth
•         Loss of appetite
•        Fatigue
•         Breathlessness
•         Gastrointestinal problems

Hospice Care

 

If the palliative measures are taken, it is also referred as hospice care. The training is given for the workers of hospice are same as that of any medical specialty. Hospice care is given to patients as well as to their families too.

The idea of hospice is that it a care for the person which handles his emotional, physical, social and spiritual necessities. Hospice care may include:

•   Symptom relief
•   Pain control
•   Physical therapy
•   Nursing care
•   Mourning services
•   Counseling for the patients and their families

Hospice care provides a good alternative treatment, which helps a person and his family in difficult times who is diagnosed by mesothelioma and make him feel that he is not alone.

A loved one who is diagnosed by mesothelioma creates difficult times not only for him but for everyone who are related to him!