Treatment Options Mesothelioma

Malignant mesothelioma is a terminal cancer typically found in the lining of the chest or abdomen. (It can also form in the heart or testicles, but this is much rarer.)

Exposure to asbestos is the only proven cause of mesothelioma, which is why those with a diagnosis should consult with an experienced Boston mesothelioma attorney to discuss options for pursuing financial compensation from entities that may have negligently exposed them to this toxic substance.

Treatment options for mesothelioma will depend greatly on how far the cancer has advanced by the time it is detected. Mesothelioma is not identifiable until decades after exposure to asbestos, making it difficult to diagnose and tough to treat.

Although dependent on a myriad of factors, treatment options may include:

• Surgery
• Radiation
• Chemotherapy
• Immunotherapy
• Multimodal treatment (a combination of two or more of the above)

In some cases, more than one of these treatments may be used. The success of these treatments will impact a patient’s survival rate.

According to the American Cancer Society, the 5-year survival rate – or the percentage of people who live at least 5 years after the cancer is diagnosed – is only between 5 and 10 percent. Median survival times depend on the stage to which the cancer had progressed. Those include:

• Stage I – 21 months
• Stage II – 19 months
• Stage III – 16 months
• Stage IV – 12 months

Although the prognosis is grim, patients are being diagnosed earlier than ever before. With prompt, aggressive treatment, patients may be able to survive for several years.

Those whose cancer can be operated upon tend to have longer survival times than those whose condition has advanced too far for the cancer to be removed. Younger patients too tend to survive longer.

Doctors spearheading mesothelioma treatments will first formulate a treatment plan. This typically involves collaboration among numerous specialists to determine what stage the mesothelioma is at and to ascertain which treatments might be the most effective. Those specialists may include:

• Surgeons
• Medical oncologists
• Radiation oncologists
• Radiologists
• Pathologists

The treatment plan will involve consultation with medical professionals, as well as with the patient to determine his or her wishes. That will be a guiding factor in how doctors proceed.

Treatment plans will be based on one of three guidelines:

• Curative Treatment. These are treatments intended to remove the mesothelioma from the patient’s body, usually through surgery and radiation.
• Palliative Treatment. This is treatment intended primarily to relieve pain or discomfort caused by the symptoms of mesothelioma. This often involves draining fluid buildup in the abdomen or chest of the patient, and providing a series of pain medications.
• Multimodal therapy. This involves some combination of two or more treatments – usually surgery, chemotherapy and radiation. This is known to have one of the best success rates, with the Dana-Farber Cancer Institute reporting a 22 percent 5-year survival rate with this approach.

As the DFCI notes, there is no universally-accepted standard therapy for mesothelioma. The process for each patient may be slightly different. The National Cancer Institute reports factors that will affect the treatment options include:

• Stage of cancer.
• Size of tumor.
• Whether tumor can be removed surgically.
• Amount of fluid in chest or abdomen.
• Patient’s age.
• Activity level of patient.
• Patient’s general health (particularly heart health and lung health).
• Type of mesothelioma cells.
• White blood cell count.
• Whether patient is male or female.
• Whether cancer has just been diagnosed or has recurred.

If surgery is an option, it is typically one of the first approaches taken. The purpose of curative surgery for mesothelioma is to remove all visible traces of the disease, and hopefully extend the life of the patient.

Typically, the surgical options for mesothelioma are:

• Pleurectomy: Removal of the chest lining.
• Extrapleural pneumonectomy (EPP): Removal of portions of the lung affected by the cancer, as well as the lining of the chest.
• Cytoreduction with HIPEC. This would be a removal of the abdominal lining (peritoneum), along with any visible tumors.
• Pericardiectomy. Removal of all or portions of the fibrous tissue surrounding the heart.

Patients with pleural or pericardial mesothelioma will typically be referred to a thoracic surgeon, while those with peritoneal mesothelioma will see a gastrointestinal surgeon.

This type of treatment option for mesothelioma is one of the most aggressive, and it’s usually only pursued in cases where the patient is in good overall health otherwise and the disease is in the early stages.

Surgery can also be palliative in nature, intended to alleviate the patient’s pain, discomfort and other symptoms. This would be primarily for patients whose mesothelioma has metastasized beyond the pleural cavity.

Chemotherapy is a standard treatment for most individuals with a mesothelioma diagnosis, both pleural and peritoneal.

Medical oncologists are the ones who administer this treatment. These drugs can be administered in two ways:

• Systemic. Either injected intravenously or swallowed in a pill.
• Intraoperative. This is when drugs are injected directly at the site of the tumor during or immediately after surgery.

In the past, doctors would use a single chemotherapy treatment for mesothelioma patients. However, that approach proved largely ineffective, with only a 15 percent success rate. Today, doctors typically initiate numerous chemotherapy treatments. Those may include:

• Neoadjuvant Chemotherapy. This is when drugs are administered before surgery to shrink the tumors and make them easier to remove.
• Intraoperative Chemotherapy. This is when chemotherapy drugs are given during surgery, which allows doctors to up the dosage while minimizing the potential side effects.
• Adjuvant Chemotherapy. This is when chemotherapy drugs are administered after surgery to kill microscopic cancer cells that are left over and lower the risk of recurrence.

Chemotherapy cannot cure mesothelioma and it’s often associated with numerous unpleasant side effects. However, it does kill cancer cells, and the goal is to both extend the length and improve the quality of the patient’s life.

The American Cancer Society reports approximately 60 percent of all cancer patients receive some type of radiation therapy.

High-dose radiation can kill cancer cells to a small, localized area. Radiation is not typically effective in cases where the cancer has metastasized to other parts of the body.

There are generally two types of radiation used for mesothelioma patients:

• External beam radiation. This is an outpatient procedure wherein radioactive waves are aimed at the tumor via an x-ray machine.
• Internal radiation. Formally known as brachytherapy, this radiation involves placing a radioactive implant into the cancerous tissue. This is an inpatient procedure, and due to the radioactivity, patient may be limited in the visitors he/ she can have for several days.

Radiation will not cure mesothelioma. However, it is often suggested as a palliative measure to help alleviate some of the pain and suffering and other uncomfortable side effects of the disease. It may also help to reduce the shortness of breath that is so characteristic for mesothelioma patients.

Immunotherapy is an emerging treatment for mesothelioma, meaning it’s not necessarily standard, but it has been employed with some success in some cases. Typically, it’s only an option in clinical trials.

It is a treatment that utilizes the immune system to help fight the disease. A passive immunotherapy approach involves giving patients man-made proteins the body may be lacking, while active immunotherapy involves giving patients drugs to stimulate their existing immune system to work harder.

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