Treatment for mesothelioma

Treatment for mesothelioma

Mesothelioma treatment is improving every year and patients are living longer. Patients can turn to traditional therapies, such as chemotherapy and radiation therapy, as well as clinical trials, which can lead to future healing.

 Researchers create, test and refine new treatments every day, giving patients hope to improve their prognosis.

 Treating mesothelioma

  • Surgery: Patients whose mesothelioma has not spread too much may be eligible for surgical treatment. This is the best way to remove large areas of affected tissue.

  • Chemotherapy: Treatment of choice for any type of cancer, chemotherapy is the traditional way of destroying cancer cells in the body. Mesothelioma requires some chemotherapy solutions to be effective.

  • Radiation: Radiation therapy is another traditional treatment for cancer. Radiation therapy is non-invasive and beneficial for all stages and types of mesothelioma.

  • Immunotherapy: Medications that activate the immune system to target and kill mesothelioma cells are called immunotherapy treatments. This type of treatment is becoming more and more common.

  • Multimodal treatment: Multimodal treatment is a combination of several of the treatments mentioned above. Physicians now accept that the best way to prolong survival is to use multimodal methods such as surgery and chemotherapy.

  • Clinical tests: All mesothelioma treatments started in a clinical trial. The trials allow researchers to test new treatments and offer patients more options.

 Types of Treatment

 Mesothelioma doctors create a course of treatment based on the diagnosis of their patient. The doctor considers the cancer stage of the patient, the cell type and the location of the mesothelioma. These factors play an important role in determining the types of treatment to which the patient is eligible.

  • Curative treatment:

 Doctors use curative treatments to remove mesothelioma from the patient’s body. Patients in whom pleural mesothelioma has been diagnosed – and eligible for curative treatment – may undergo one of two standard surgeries for pleural mesothelioma: extrapulmonary pneumonectomy (EPP) or decorticated pleurectomy (P / D). People diagnosed with peritoneal mesothelioma may have cytoreduction, which doctors often associate with hot chemotherapy in a procedure called cytoreduction with HIPEC.

  • Palliative treatment:

Treatment is palliative when a doctor uses it to relieve pain or discomfort caused by mesothelioma symptoms. The most common palliative treatments drain the accumulation of fluid in the chest or abdomen. Patients with pleural mesothelioma receive thoracentesis. Patients with peritoneal mesothelioma receive paracentesis.

  • Multimodal therapy:

 Multimodal therapy is the combination of two or more treatments, usually surgery, chemotherapy or radiation therapy. Using multiple treatments, doctors can attack mesothelioma in several ways. For example, the use of cytoreductive surgery to remove most tumors and heated chemotherapy to destroy the remaining cancer cells. A study conducted by researchers at the Dana Farber Cancer Center – one of the highest-rated cancer centers in the United States – showed that 22% of patients lived at least 5 years after receiving multimodal therapy.

 Surgery for Mesothelioma

 Surgery for patients with pleural mesothelioma

  • Pleurectomy with decortication (P / D):

A decorticated pleurectomy (P / D) is a surgical procedure used by physicians to remove the lining of the lung most affected by tumor growth, as well as any tumor visible on the surface of the lung itself. If mesothelioma has spread beyond the lining of your lungs, your doctor may also remove parts of the diaphragm and pericardium, the protective lining of the heart. The purpose of using a P / D is to relieve the symptoms of mesothelioma without sacrificing the lung. 90% of operated patients experience a reduction in symptoms and retain 100% of their respiratory function.

  • Extra-pleural pneumonectomy (EPP):

Doctors use an extrapleural pneumonectomy (EPP) to remove all the lungs and surrounding tissues affected by mesothelioma. To prevent the return of the disease, it can also remove the diaphragm, the nearby lymph nodes and the wall of the heart.

Surgery for patients with peritoneal mesothelioma

  • Peritonectomy:

 Surgeons use a peritonectomy to remove any part of the peritoneum – the protective membrane of the abdomen – affected by tumor growth. They also remove any visible tumors that may have spread to nearby organs, such as the diaphragm or stomach.

  • Cytoreductive surgery:

 Cytoreductive surgery occurs when a surgeon combines several peritonectomies to eliminate mesothelioma from the abdominal cavity completely. Doctors often associate cytoreductive surgery with heated chemotherapy in a procedure called cytoreduction with HIPEC to maximize its effectiveness.

 Chemotherapy for mesothelioma

 Chemotherapy involves using drugs to attack and kill cancer. Its effectiveness depends on your diagnosis, especially the stage of cancer and the location of mesothelioma. Chemotherapy drugs work best when combined with other medications – the most common drug combination being Alimta and cisplatin – or surgery.

 Doctors use chemotherapy before surgery (neoadjuvant), during surgery (intraoperative) or after surgery (adjuvant).

 There is a difference in administration between systemic chemotherapy and intraoperative chemotherapy:

  • Systemic:

Systemic chemotherapy goes through your bloodstream, attacking all the cancer cells with which it is in contact. Your doctor will give you systemic chemotherapy in tablet form or intravenously.

  • Intraoperative:

The doctor administers the drugs during the surgery. Depending on the procedure, he applies chemotherapy directly to the lungs or the abdominal cavity and usually heats the drugs to increase their effectiveness in the fight against cancer.

 Side effects

Depending on your tolerance, chemotherapy can affect you severely, slightly or not at all. Side effects disappear slowly after treatment and vary depending on the type of medication, the dose and the duration of administration.

 Common side effects seen during chemotherapy are:

  • Hair loss

  • Loss of appetite

  • Nausea

  • Diarrhea

  • Tired

 Radiotherapy for mesothelioma

 Radiation therapy involves using high-energy rays to kill mesothelioma cells. Physicians can use radiation alone – as a palliative treatment – or combine it with chemotherapy and/or surgery. With some types of radiotherapy, patients may not experience as many side effects as chemotherapy because doctors can target tumors, minimizing damage to healthy cells.

 Radiation therapies commonly used in patients with mesothelioma include:

  • Three-dimensional radiation treatment (3D-CRT):

Using 3D tumor analysis, physicians customize the amount and intensity of each dose of radiation based on its size and shape. Customizing the amount of radiation helps doctors target tumors more effectively and minimize damage to healthy, non-cancerous cells surrounding tumors.

  • Intensity-modulated radiotherapy (IMRT)

IMRT is an advanced form of 3D-CRT. Doctors use computers to adjust the amount and intensity of a beam of radiation as it passes over a tumor. Researchers in a recent study have shown that IMRT used after extra-pleural pneumonectomy (EPP) produced a median overall survival rate of just over 2 years. Of these patients, 41% survived an additional three years after the procedure.

 Side effects of radiotherapy

Physicians must use high doses of radiation to achieve the same anti-cancer efficacy as chemotherapeutic drugs. As doctors increase the amount and intensity of radiation, the risk of damaging healthy cells from radiation also increases and other side effects may occur.

 Radiation therapy can have the following side effects:

  • Inflammation of the esophagus

  • Redness of the skin

  • Tired

  • Nausea

  • Hair loss

 Palliative treatments for mesothelioma

 Doctors use palliative treatments to relieve pain caused by symptoms at all stages of mesothelioma. Physicians can use them as a complement to curative treatments for patients diagnosed with stage 1 or 2 mesotheliomas. Stage 3 and 4 patients receive palliative treatment to reduce pain and improve their quality of life.

 Several types of palliative treatments are available for patients with mesothelioma.

  • Thoracentesis:

Thoracentesis involves draining excess fluid from the pleural cavity – the space between the inner and outer walls of the lungs – with a needle. It reduces the pressure caused by too much fluid, which pushes the lungs and makes breathing difficult.

  • Video-Assisted Thoracoscopic (VAT) Talc Pleurodesis:

Assisted by a camera, the doctor drains excess fluid from the pleural cavity and seals it with talcum powder. Talc causes an inflammatory reaction that closes the pleural space. Over time, scar tissue forms and prevents more fluid from accumulating. Doctors use this procedure to reduce chest pain and relieve the pressure caused by accumulations of fluid.

  • Partial pleurectomy:

Doctors use partial pleurectomy to remove the lining of a lung with mesothelioma. Tumor growth hardens the lining of the lung, making breathing difficult. Removing a portion of the hardened liner allows the lung to expand again and facilitate breathing.

  • Paracentesis:

A Paracentesis is drainage of excess fluid from the abdominal cavity. The liquid is drained via a needle. This relieves the pressure caused by the accumulation of liquid in this space. Too much fluid in the abdominal cavity creates pressure on the organs, causing intense pain and discomfort.

New treatments in clinical trials

 If you are not eligible for traditional treatments, such as surgery or chemotherapy, participating in a clinical trial can give you a chance to improve your prognosis with new treatments. In clinical trials, researchers have developed new methods of controlling mesothelioma, such as immunotherapy, a treatment that strengthens your immune system and helps destroy mesothelioma cells.

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