WHAT MESOTHELIOMA IS ALL ABOUT
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mesothelioma,
treatment
Malignant mesothelioma is a rare form of cancer that is diagnosed in approximately 3,000 people each year. The disease usually affects the thin membrane that lines the chest cavity and the lungs. This membrane is called the pleura. It also can affect the lining of the abdominal cavity, called the peritoneum, and, very rarely, it affects the lining around the heart, called the pericardium.
Mesothelioma is a relatively rare cancer, that is usually associated with asbestos. Exposure to asbestos fibers can cause mesothelioma even years later.
Currently, mesothelioma is an active area of lawsuits and litigation. The area of law is not usually medical malpractice, because mesothelioma liability is usually related to the asbestos exposure, involving legal areas such as product liability, wrongful death, or other liability. However, medical malpractice for mesothelioma can occur due to failure to diagnose mesothelioma in its early stages. Such delayed diagnosis of mesothelioma worsens its prognosis. Always seek qualified legal advice about malpractice or other law, as the area is very complex.
Currently, mesothelioma is an active area of lawsuits and litigation. The area of law is not usually medical malpractice, because mesothelioma liability is usually related to the asbestos exposure, involving legal areas such as product liability, wrongful death, or other liability. However, medical malpractice for mesothelioma can occur due to failure to diagnose mesothelioma in its early stages. Such delayed diagnosis of mesothelioma worsens its prognosis. Always seek qualified legal advice about malpractice or other law, as the area is very complex.
Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum). Pleural mesothelioma is the most common form, often presenting with symptoms in the chest area. Peritoneal mesothelioma is much less common. This can effect the organs in the abdomen, and its symptoms are related to this area of the body, that is, abdominal swelling, nausea, vomiting, and bowel obstruction. The rarest form of mesothelioma is pericardial mesothelioma, which involves the sac surrounding the heart.
There are two major cell types of mesothelioma, epithelial and sarcomatoid. Sometimes both of these cell types can be present. The sarcomatoid type is rarer and occurs in only about 15% of cases; it portends a poorer prognosis. In very rare cases, mesothelioma can originate from benign, non-malignant cells. This so-called benign mesothelioma can be cured surgically.
There are two major cell types of mesothelioma, epithelial and sarcomatoid. Sometimes both of these cell types can be present. The sarcomatoid type is rarer and occurs in only about 15% of cases; it portends a poorer prognosis. In very rare cases, mesothelioma can originate from benign, non-malignant cells. This so-called benign mesothelioma can be cured surgically.
SYMPTOMS OF
About 90% of people who are diagnosed with malignant mesothelioma have chest pain or shortness of breath as the first symptoms of the disease. These symptoms can be caused either by the cancer itself, which irritates nerve cells in nearby tissues, or by a collection of fluid between the two layers of the pleura in the chest. This collection of fluid is called a pleural effusion. People with mesothelioma that develops in the abdominal lining can have abdominal pain and swelling caused by an accumulation of fluid in the abdominal cavity. Other possible symptoms include cough, fatigue and unexplained weight loss.
Most people present with complaints of shortness of breath. They also can have complaints of chest pain. Surprisingly, this pain is often not pleuritic; that is, it does not get worse with deep breathing. This is surprising in that the pleura (outer surface of the lung) is often involved in this disease, and most other diseases involving the pleura are often associated with pleuritic pain (pain that worsens with deep breathing). Patients may also be asymptomatic, with the disease discovered by physical exam or an abnormal chest X-ray.
As the disease progresses, shortness of breath increases, and weight loss, decreased appetite, and night sweats can develop. Local invasion by the tumor can result in changing of voice, loss of function of the diaphragm, and symptoms specific to the area and involvement of adjacent structures.
As the disease progresses, shortness of breath increases, and weight loss, decreased appetite, and night sweats can develop. Local invasion by the tumor can result in changing of voice, loss of function of the diaphragm, and symptoms specific to the area and involvement of adjacent structures.
More ways to research these symptoms: To research other symptoms use the symptom center, or to research causes of more than one symptom in combination, try our multi-symptom search
TREATMENTS:Malignant mesothelioma is difficult to treat. The cancer can spread easily to nearby organs. If the tumor has spread, it is nearly impossible to remove the entire tumor surgically. In addition, it has been difficult to test the effectiveness of different treatments because there are relatively few cases of malignant mesothelioma.
The primary treatment options for malignant mesothelioma are surgery, radiation therapy and chemotherapy.
SurgeryBefore any surgery is considered for the treatment of malignant mesothelioma, your overall health has to be evaluated. Tests are done to make sure the cancer has not spread to distant sites and to evaluate how well your lungs and heart are functioning. Lung tests look for any signs of lung damage from tobacco or from other diseases, including asthma and chronic obstructive pulmonary disease (COPD). These tests determine how risky surgery would be, especially if a lung needs to be removed.
Surgery for malignant mesothelioma can be aimed at long-term control of the cancer (aggressive surgery) or relief of symptoms (palliative procedures).
Aggressive surgery — A procedure called extrapleural pneumonectomy involves removal of the pleura, the lung, the diaphragm and the pericardium. The intent of this very aggressive, complicated surgery is to remove as much of the tumor as possible. Not all centers will do this procedure because it is so complex and because it carries a high risk of death within 30 days after surgery. This procedure typically is done only in younger patients who are in good overall health with stage I disease. Patients are evaluated carefully to determine their ability to tolerate the surgery.
Palliative procedures — When malignant mesothelioma is advanced, palliative procedures can be done to relieve or control symptoms such as breathlessness, which are caused by fluid or by the tumor pressing on the lung or other organs. These procedures do not cure the disease.
A procedure called thoracentesis can be used to treat fluid collection (effusion) in pleural mesothelioma. A needle is inserted into the chest to drain the fluid, relieving breathlessness and pain. Talc may be injected into the pleural space to try to stop fluid from accumulating there. This procedure is called talc pleurodesis. Similar procedures are used to relieve fluid collection (ascites) in peritoneal mesothelioma (paracentesis).
A procedure called pleurectomy and decortication is the surgical removal of the pleura. This procedure can be done to reduce pain caused by the tumor or to prevent the fluid from accumulating. For peritoneal mesothelioma, surgery generally is aimed at relieving symptoms.
Radiation TherapyBecause of the location of malignant mesothelioma, it is extremely difficult to deliver high enough doses of radiation to kill the tumor without damaging the surrounding organs. Lower doses of radiation can help to shrink the tumor, but it is unclear whether this helps people to survive longer than if they were not treated.
Using radiation therapy after surgery has not been shown to improve survival. However, because surgery is very unlikely to remove the entire tumor, radiation commonly is done after surgery in the hopes of killing remaining tumor cells. In addition, radiation therapy can be used to relieve the symptoms of mesothelioma, including chest pain.
ChemotherapyChemotherapy is the use of medications to treat cancer. Chemotherapy cannot cure mesothelioma. Some chemotherapy drugs have a partial effect in some patients. Combination chemotherapy (using more than one drug at the same time) may be given in an attempt to improve the patient's response to the medications. Some combinations have shown promise, and some new medications are being tried.
Like radiation therapy, chemotherapy may be administered after surgery in an attempt to kill cancer cells that could not be removed.
Treatment by StageStage I (localized) mesothelioma — If you want aggressive treatment and are fit enough to have surgery, some centers may do an extrapleural pneumonectomy. Another surgical option is pleurectomy and decortication, which is sometimes done to relieve some of the symptoms of mesothelioma. Both of these procedures may be followed by radiation therapy or chemotherapy. Less than 5% of people with malignant mesothelioma are candidates for aggressive surgery.
Stages II, III and IV (advanced) mesothelioma — Pleurectomy and decortication may be done to relieve symptoms in pleural mesothelioma. Other procedures such as thoracentesis may be done to drain fluid (pleural effusions) and prevent them from recurring. Radiation therapy and/or chemotherapy also may be administered for symptom relief.
Recurrent malignant mesothelioma — There is no standard treatment for recurrent mesothelioma. Generally, treatments are considered that were not used the first time the disease was treated.
Clinical Trials and Future TreatmentsNew treatments for malignant mesothelioma and possible preventive measures, such as a vaccine, are being evaluated in clinical trials, and the future holds some promise. Clinical trials are research studies that evaluate new treatments for safety and effectiveness. There are no guarantees that a new treatment will work, and there are some risks. However, a clinical trial is not started unless the researchers believe the treatment may have some value.
Here are some of the treatments for malignant mesothelioma that are being evaluated:
Combination chemotherapy — Different combinations of chemotherapy drugs have been tried with mixed results.
Intracavitary chemotherapy — Researchers are looking at putting chemotherapy drugs directly into the pleural or peritoneal space because of a possible advantage over traditional chemotherapy. Because the drug is placed directly into the cavity, much greater doses can be given to patients without causing severe side effects. Some studies have shown this therapy to control effusions and reduce tumor size.
Brachytherapy (intracavitary radiation therapy) — In this treatment, a radioactive substance is placed directly into the pleural or peritoneal space.
Multimodality therapy — Multimodality therapy is any combination of surgery, radiation therapy and chemotherapy.
Gene therapy — In this approach, a virus that has been genetically altered is introduced into the tumor. The virus infects the cancerous cells and makes them vulnerable to anticancer drugs.
Immunotherapy — Treatments that stimulate the body's immune system to fight cancer cells are called immunotherapy.
The primary treatment options for malignant mesothelioma are surgery, radiation therapy and chemotherapy.
SurgeryBefore any surgery is considered for the treatment of malignant mesothelioma, your overall health has to be evaluated. Tests are done to make sure the cancer has not spread to distant sites and to evaluate how well your lungs and heart are functioning. Lung tests look for any signs of lung damage from tobacco or from other diseases, including asthma and chronic obstructive pulmonary disease (COPD). These tests determine how risky surgery would be, especially if a lung needs to be removed.
Surgery for malignant mesothelioma can be aimed at long-term control of the cancer (aggressive surgery) or relief of symptoms (palliative procedures).
Aggressive surgery — A procedure called extrapleural pneumonectomy involves removal of the pleura, the lung, the diaphragm and the pericardium. The intent of this very aggressive, complicated surgery is to remove as much of the tumor as possible. Not all centers will do this procedure because it is so complex and because it carries a high risk of death within 30 days after surgery. This procedure typically is done only in younger patients who are in good overall health with stage I disease. Patients are evaluated carefully to determine their ability to tolerate the surgery.
Palliative procedures — When malignant mesothelioma is advanced, palliative procedures can be done to relieve or control symptoms such as breathlessness, which are caused by fluid or by the tumor pressing on the lung or other organs. These procedures do not cure the disease.
A procedure called thoracentesis can be used to treat fluid collection (effusion) in pleural mesothelioma. A needle is inserted into the chest to drain the fluid, relieving breathlessness and pain. Talc may be injected into the pleural space to try to stop fluid from accumulating there. This procedure is called talc pleurodesis. Similar procedures are used to relieve fluid collection (ascites) in peritoneal mesothelioma (paracentesis).
A procedure called pleurectomy and decortication is the surgical removal of the pleura. This procedure can be done to reduce pain caused by the tumor or to prevent the fluid from accumulating. For peritoneal mesothelioma, surgery generally is aimed at relieving symptoms.
Radiation TherapyBecause of the location of malignant mesothelioma, it is extremely difficult to deliver high enough doses of radiation to kill the tumor without damaging the surrounding organs. Lower doses of radiation can help to shrink the tumor, but it is unclear whether this helps people to survive longer than if they were not treated.
Using radiation therapy after surgery has not been shown to improve survival. However, because surgery is very unlikely to remove the entire tumor, radiation commonly is done after surgery in the hopes of killing remaining tumor cells. In addition, radiation therapy can be used to relieve the symptoms of mesothelioma, including chest pain.
ChemotherapyChemotherapy is the use of medications to treat cancer. Chemotherapy cannot cure mesothelioma. Some chemotherapy drugs have a partial effect in some patients. Combination chemotherapy (using more than one drug at the same time) may be given in an attempt to improve the patient's response to the medications. Some combinations have shown promise, and some new medications are being tried.
Like radiation therapy, chemotherapy may be administered after surgery in an attempt to kill cancer cells that could not be removed.
Treatment by StageStage I (localized) mesothelioma — If you want aggressive treatment and are fit enough to have surgery, some centers may do an extrapleural pneumonectomy. Another surgical option is pleurectomy and decortication, which is sometimes done to relieve some of the symptoms of mesothelioma. Both of these procedures may be followed by radiation therapy or chemotherapy. Less than 5% of people with malignant mesothelioma are candidates for aggressive surgery.
Stages II, III and IV (advanced) mesothelioma — Pleurectomy and decortication may be done to relieve symptoms in pleural mesothelioma. Other procedures such as thoracentesis may be done to drain fluid (pleural effusions) and prevent them from recurring. Radiation therapy and/or chemotherapy also may be administered for symptom relief.
Recurrent malignant mesothelioma — There is no standard treatment for recurrent mesothelioma. Generally, treatments are considered that were not used the first time the disease was treated.
Clinical Trials and Future TreatmentsNew treatments for malignant mesothelioma and possible preventive measures, such as a vaccine, are being evaluated in clinical trials, and the future holds some promise. Clinical trials are research studies that evaluate new treatments for safety and effectiveness. There are no guarantees that a new treatment will work, and there are some risks. However, a clinical trial is not started unless the researchers believe the treatment may have some value.
Here are some of the treatments for malignant mesothelioma that are being evaluated:
Combination chemotherapy — Different combinations of chemotherapy drugs have been tried with mixed results.
Intracavitary chemotherapy — Researchers are looking at putting chemotherapy drugs directly into the pleural or peritoneal space because of a possible advantage over traditional chemotherapy. Because the drug is placed directly into the cavity, much greater doses can be given to patients without causing severe side effects. Some studies have shown this therapy to control effusions and reduce tumor size.
Brachytherapy (intracavitary radiation therapy) — In this treatment, a radioactive substance is placed directly into the pleural or peritoneal space.
Multimodality therapy — Multimodality therapy is any combination of surgery, radiation therapy and chemotherapy.
Gene therapy — In this approach, a virus that has been genetically altered is introduced into the tumor. The virus infects the cancerous cells and makes them vulnerable to anticancer drugs.
Immunotherapy — Treatments that stimulate the body's immune system to fight cancer cells are called immunotherapy.
2).There are three traditional kinds of treatment for patients with malignant mesothelioma. Often two or more of these are combined in the course of treatment:
surgery (taking out the cancer),
radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells), and
chemotherapy (using drugs to fight the cancer).
Additional information
Surgery: There are several types of surgery used in treating mesothelioma.
A pleurectomy is the removal of part of the chest or abdomen lining and some of the tissue around it.
Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy.
In an extrapleural pneumonectomy, the lung is removed along with the lining and diaphragm (the muscle that helps you breathe) on the affected side. In this surgery, the lining around the heart is also removed.
Sometimes a pleurectomy/decortication is performed. In this surgery, the lining of the lung is removed along with as much of the tumor as possible.
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be administered by pill, or it may be put into the body by a needle in the vein or muscle.
Chemotherapeutic agents can be administered either systemically (through the bloodstream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.
surgery (taking out the cancer),
radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells), and
chemotherapy (using drugs to fight the cancer).
Additional information
Surgery: There are several types of surgery used in treating mesothelioma.
A pleurectomy is the removal of part of the chest or abdomen lining and some of the tissue around it.
Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy.
In an extrapleural pneumonectomy, the lung is removed along with the lining and diaphragm (the muscle that helps you breathe) on the affected side. In this surgery, the lining around the heart is also removed.
Sometimes a pleurectomy/decortication is performed. In this surgery, the lining of the lung is removed along with as much of the tumor as possible.
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be administered by pill, or it may be put into the body by a needle in the vein or muscle.
Chemotherapeutic agents can be administered either systemically (through the bloodstream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.
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