There are several items to consider when deciding on your mesothelioma treatment options, including your health and personal preferences, the latest research, and the stage . Additionally, your care and treatment options should be discussed with your medical team as well as your family.
The conventional treatments for mesothelioma are the same as those of other cancers. The primary difference in conventional mesothelioma treatment stems from the type of mesothelioma you have, as well as your symptoms.
Surgery
Surgery may be recommended for pleural mesothelioma for two reasons: to relieve pain and discomfort and to extend survival time. The typical procedures can be similar to other cancer treatments as follows:
Curative
This type of surgery is not to be interpreted as "cure for" the cancer since, at this time, there is no cure for a mesothelioma diagnosis. But, it is a medical term. If you are in good health and the tumor is thought to be localized, then surgery to remove tumors may help. Unfortunately, cancer cells often spread into the chest wall, around the heart and into the diaphragm. Therefore, these procedures are primarily aimed at relieving symptoms and extending your life.
Palliative
The goal of palliative surgery is to relieve the pain and symptoms associated with mesothelioma. This can include a thoracentesis, where fluid is removed from the chest with a needle, and pleurodesis, where drugs are injected into the chest to prevent the fluid from returning.
With peritoneal mesothelioma, a needle is inserted into the abdomen to drain the fluid. Similarly, with pericardium mesothelioma, a needle is inserted into the sac around the heart to drain fluid and increase circulation.
Pleural Mesothelioma Surgery
Pleurectomy / Decortication
This surgery removes the pleura where the majority of the tumor is located, and can control the build up of fluid. This is a palliative procedure.
Extrapleural Pneumonectomy
This surgery is typically recommended for a patient with localized mesothelioma where the surgeon believes a cure is possible. The surgery removes the pleura lining the chest wall, diaphragm, pericardium, and the whole lung on the side of the tumor. The diaphragm and pericardium are reconstructed with prosthetic material. This procedure requires you be in good health with no other serious illnesses.
Peritoneal Mesothelioma Surgery
Surgery is typically performed to help relieve symptoms or remove the tumor from the wall of the abdomen and other digestive organs. Often the tumors are too extensive to completely remove.
Chemotherapy
Chemotherapy is system therapy, meaning the drug enters the bloodstream and circulates throughout the body to destroy cancer cells. In the case of mesothelioma, chemotherapy drugs can be given directly to the affected area, such as the chest cavity (intrapleurally) or the abdominal cavity (intreperitoneally).
Chemotherapy is a palliative treatment for mesothelioma, and may be given as the primary treatment or as a supportive treatment to surgery. Several drugs have been used to treat mesothelioma, including:
- Alimta (pemetrexed) – the preferred drug combination
- Cisplatin and gemcitabine
- Carboplatin and Gemcitabine
- Methotrexate and Vincristine
- Cisplatin, Vinblastine and Vitomycin
- Visplatin and Doxorubicin
- Doxorubicin, Cyclophosphamide (or Ifosfamide), and Cisplatin
Any of the drugs may be given alone for those patients who cannot tolerate two drugs.
A new drug, Raltitrexed, has been shown to help patients taking Cisplatin. In fact, patients taking both drugs lived longer than those who take Cisplatin alone.
Chemotherapy kills cancer cells but damages normal cells in the process. It is important that your doctor carefully monitor your dosages and side effects to minimize the damage. Additionally, chemotherapy can damage blood-producing cells in bone marrow, giving you low blood counts. This can result in any one or all of the following:
- Shortage of white blood cells (increased infections)
- Shortage of blood or platelets (increased bleeding or bruising after minor injuries)
- Low red blood cell counts (causing fatigue or shortness of breath)
While most side effects stop once treatment is completed, there are remedies for the side effects, including medication for nausea and vomiting.
Radiation
Radiation therapy can be used as the main treatment for mesothelioma in those patients whose health is too poor to undergo surgery. This treatment uses high energy x-rays to kill cancer cells. The two main types of radiation are:
External beam radiation therapy – radiation is focused on the cancer and given from outside the body. This is the preferred form of mesothelioma radiation therapy. The treatments are given 5 days a week for 3 to 5 weeks. Unfortunately, these treatments do not help fight mesothelioma since it is resistant to radiotherapy. Additionally, the necessity to treat large parts of the lungs can damage them.
Brachytherapy – radioactive material is placed directly into the site of the mesothelioma (typically the chest or abdomen). However, brachytherapy is not often used for mesothelioma.
Side Effects
Side effects can include fatigue and minor skin changes often resembling a sunburn. Radiation can make the side effects of chemotherapy worse.
Chest radiation therapy may cause lung damage, and cause difficulty breathing. Abdominal radiation therapy may cause nausea, vomiting, and diarrhea. There are treatments for these side effectives, so talk to your doctor if you have them in order to get some relief.