There are a number of different treatments available for malignant mesothelioma, a form of cancer that affects the mesothelium, which is a lining that covers many of the body’s internal organs. Treatment options fall into three main categories: established therapies; experimental treatments; and holistic therapies. Established, or conventional, therapies include chemotherapy, radiation therapy and surgery.
One of the first steps in determining the most appropriate mesothelioma treatment option is “staging” the disease. This process involves ranking the severity of the disease based on issues such as whether the cancer has spread from one side of the chest to the other, whether it has spread to lymph nodes, and whether it has metastasized to other parts of the body. In making treatment recommendations, physicians will assess factors such as the stage of the disease, a patient’s age, general health, gender, and a patient’s wishes. Patients diagnosed with mesothelioma are also strongly encouraged to learn as much as possible about the disease’s progression and available treatment options and to play an active role in decision making about their treatment.
Conventional Therapies Include:
Radiation attacks cancerous cells to keep them from dividing rapidly. It can also be used to reduce symptoms. However, radiation can also kill healthy cells, and so must be directed as accurately as possible at the cancer cells. It is important to note that mesothelioma is commonly resistant to this form of therapy (1). Radiation is often used with chemotherapy drugs and/or surgery.
Radiation therapy can be administered either internally or externally. Internal radiation is delivered into the body and can be either “unsealed” or “sealed.” Unsealed internal radiation is delivered by an injection or by a pill. Sealed internal radiation is implanted in the body using a wire, seed or capsule. External radiation is generated by a linear accelerator, or by a type of machine that uses a radiation source. External radiation is administered as an outpatient procedure, five days a week for several weeks. By contrast, internal radiation therapy involves a three-day to one-week stay in the hospital. Side effects of radiation include shortness of breath, exhaustion, nausea, and reactions such as hair loss in the treated areas (3).
Chemotherapy is a type of treatment that uses drugs to attack cancer cells. There are several categories of chemotherapy. Neo-adjuvant therapy shrinks a tumor before surgery is performed, with the goal of making the surgery less invasive or involved. Adjuvant surgery helps to kill cancer cells that remain after surgery. Chemotherapy drugs can also be used to increase the effects of either radiation or immunotherapy, as well as to destroy cancer that comes back or that has metastasized (spread) to other parts of the body.
Chemotherapy drugs work differently, but they all focus on getting rid of cancer cells and keeping them from spreading further. Two of the most frequently used chemotherapy drugs are gemcitabine and cisplatin. Drugs may be administered individually, or, in pairs (in a method called combination therapy). Common pairings include:
- Raltitrexed and cisplatin
- Methotrexate and vincristine;
- Cisplatin, vinblastine and mitomycin;
- Cisplatin and doxorubicin; and
- Doxorubicin, cyclophosphamide (or ifosfamide), and cisplatin.
Because these drugs are so powerful, they often affect healthy cells in the body as well. Specifically, they affect cells that grow quickly, including hair and cells that are found in the mouth and stomach. This is why hair loss is such a common side effect of chemotherapy. Other side effects include nausea, vomiting and fatigue. Most side effects end once the treatment is over.
Chemotherapy drugs can be administered intravenously (through an injection) or orally (with pills). Chemotherapy drugs can also be administered directly into the chest cavity or the abdominal cavity (the two most common sites of mesothelioma). The length of a chemotherapy course varies and patients can receive chemotherapy at the hospital or at a doctor’s office (2).
Surgery: There are two general approaches to surgery to treat the asbestos cancer mesothelioma: curative surgery, to slow or stop the growth of the disease and to extend a patient’s life; and palliative surgery, which helps to reduce the pain related to a tumor or to symptoms, such as fluid buildup in the pleural cavity or abdominal cavity. Curative surgery is performed when doctors believe there is a likelihood of curing the disease by removing an entire tumor that has not spread aggressively. At its most effective, surgery can lead to a remission, or a period during which a patient is cancer free. One example of curative surgery is pneumonectomy, in which a doctor removes a patient’s lung.
Palliative Surgery is intended to relieve symptoms and to increase a patient’s comfort. This type of surgery will be performed when a tumor has grown beyond the mesothelium and can no longer be fully removed. It will also be done if a patient is too ill for more invasive surgery. One example of palliative surgery is a thoracentsis. In this procedure, a doctor drains fluid from the chest wall to reduce pressure on the lungs and thus make it easier for a patient to breathe.
In addition to these established treatments, there are also a number of experimental therapies, which are still being tested for safety and effectiveness. One example of an experimental therapy is multimodality therapy, which involves using various combinations of surgery, radiation therapy and chemotherapy. The goal of this form of treatment is to achieve the benefits of, and compensate for the weaknesses of, each type of therapy. For example, this approach might involve using multiple chemotherapy drugs, or combining surgery and chemotherapy. New chemotherapy drugs, and combinations of drugs are also being tested in clinical trials. Until the safety and effectiveness of these drugs is officially determined and the drug is approved by the Food and Drug Administration, they will remain “experimental.” A patient can learn about current clinical trials by visiting the National Cancer Institute’s website.
As an individual’s mesothelioma progresses to different stages over time, different types of treatment may be recommended.