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A mesothelioma patientÃs prognosis can depend upon a number of factors, including the cancerÃs stage, mesothelioma cell type, tumor size, surgical tumor removal options, fluid amount, and age and health of the patient. In early stages, mesothelioma may be operable. However, once the disease has advanced, pain reduction or palliative treatment can be the primary treatment. Determination of the stage of mesothelioma is called staging and can be done through CT scan, MRI, PET, thoracoscopy or surgical biopsy.
Surgery
Surgical options may include: wide local excision, pleurectomy and decortication, extrapleural pneumonectomy or pleurodesis. Adjuvant therapy given after surgery includes radiation and chemotherapy. These different types of surgeries remove varying amounts of tissue, from the cancer and a small amount of healthy tissue, to the covering of the lungs, chest lining, outside lung surface, entire lung, diaphragm and sac around the heart. Pleurodesis involves chemicals or drugs in order to make a scar in the space between the pleura layers. The scarring stops pleural cavity fluid build-up.
Radiation
Radiation therapy involves high-energy x-rays or other radiation to kill cancer cells. In external radiation, a machine located outside the body sends radiation toward the cancer. Internal radiation involves inserting a sealed radioactive substance placed into or near the cancer cells/tumor.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the cancer cell growth. These medications kill cancer cells or stop them from dividing and spreading. Systemic chemotherapy is taken orally or injected into the body. Regional chemotherapy is placed into the spine or an area of the body and is intended to only affect local cancer cells. New types of treatment that are being tested in clinical trials include the following:
Biologic Therapy
Biologic therapy (immunotherapy) focuses on strengthening the immune system to assist the body in fighting the cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodyÃs natural defenses against cancer.
Photodynamic Therapy uses light energy is used to destroy cancer cells.
Gene Therapy focuses on pinpointing and correcting the genetic defect that first allowed the tumor to develop.
Pleural Effusions
A pleural effusion is an accumulation of fluid between the lining of the lung and the chest cavity and is one of the most common signs of mesothelioma. As the volume of fluid increases, shortness of breath, or “dyspnea” and pain may occur. The effusion is treated in order to relieve shortness of breath, prevent recurrence and minimize discomfort. Relief of dyspnea is a major consideration in mesothelioma. For patients who have large pleural effusions, doctors may recommend chest tube drainage and chemical pleurodesis. Chemical pleurodesis is a technique used to produce an adhesion inside the pleural cavity. It is used on patients who have significant relief of symptoms when pleural fluid is drained and show evidence of lung reexpansion. It is performed with a standard tube thoracostomy. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is administered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution which forms a wet slurry that can roll around the pleural cavity.
Clinical Trials
Research on mesothelioma is taking place in various clinical trials around the country. To see a list of available trials, some of which are recruiting participants, please visit:
http://www.clinicaltrials.gov/ct/search?term=%22malignant+mesothelioma%22
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