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Mesothelioma Treatment Options
Conventional Therapies
Conventional mesothelioma therapies include surgery, radiation and
chemotherapy. You should keep in mind that if you choose one course of
action for mesothelioma treatment, you may preclude other courses. All
of your options should be considered as soon as possible.
Surgery
Depending on the stage of a mesothelioma, surgery may be used to
remove the cancer and some of the surrounding tissue. Often, however,
an operation is not appropriate and the patient may have only
minimally invasive procedures to relieve symptoms. A thoracentesis,
where fluid in the chest is removed by placing a needle into the chest
cavity, may be done to make a patient more comfortable. Sometimes talc
or an antibiotic may be injected into the chest cavity to try to
prevent the fluid from returning. These techniques are successful in
controlling the fluid, at least temporarily, in as many as 90% of
patients. Because pleural fluid can compress the lung and cause
shortness of breath, these procedures can help patients breathe more
easily, however, they do not cure the cancer. In the case of
peritoneal mesothelioma, a needle may be inserted into the abdomen to
drain the fluid. Similarly, a needle inserted into the pericardium
(sac around the heart) can drain pericardial fluid and help relieve
circulatory problems. However, draining this fluid may result in
complications. Sometimes the cancer cells spread along the needle
path, and a tumor nodule may form under the skin of that area.
Surgery for mesothelioma may be performed for one of two reasons: for
palliation (to relieve pain and discomfort caused by the tumor), or to
cure. Palliative surgery is typically done in cases where the tumor
has already spread beyond the mesothelium and is difficult to
completely remove, or in cases where the patient is too ill to
tolerate a more extensive operation. Curative surgery is offered when
the patient is in otherwise good health and the tumor is thought to be
localized and can be completely removed. Unfortunately, microscopic
spread of cancer cells into the chest wall and diaphragm are common
even when such spread cannot be detected by routine tests. Therefore,
given the extent of these operations and their very limited success,
the exact role of surgery in treating mesothelioma is often debated.
There are two types of operations that may be offered to patients with
pleural mesothelioma: pleurectomy/decortication and extrapleural
pneumonectomy. Pleurectomy/decortication is usually a palliative
(relieves symptoms without curing the cancer) operation in cases where
the entire tumor cannot be removed. It involves removal of the pleura,
where the majority of the tumor is located. It is effective in
controlling effusions (fluid accumulation) and decreasing the pain
caused by the cancer.
Extrapleural pneumonectomy is a far more extensive operation and most
often used in cases of localized mesothelioma. The operation is
technically difficult and performed only by surgeons in large
specialized medical centers. It involves removing the pleura,
diaphragm, pericardium, and the whole lung on the side of the tumor.
The patient must be in overall good health with no other serious
illnesses in order to tolerate the large operation. This operation is
intended to remove all or most of the cancer and some surrounding
tissues as well.
Surgical treatment of peritoneal mesothelioma is often performed
either to help relieve symptoms or to attempt to remove the tumor from
the wall of the abdomen and other digestive organs. As with pleural
mesothelioma, these tumors are often too extensive to remove
completely. Similar operations can be performed to remove a
mesothelioma from the pericardium (the sac around the heart).
Radiation Therapy
Radiation therapy uses high-energy x-rays to kill cancer cells.
External beam radiation therapy uses radiation delivered from outside
the body that is focused on the cancer. This type of radiation therapy
is often used to treat mesothelioma. These treatments are much like
getting a diagnostic x-ray except for a longer time. Brachytherapy
involves radioactive material being placed directly into the chest or
the abdomen at the site of the mesothelioma. Radiation therapy is
sometimes used as the main treatment of mesothelioma in some patients,
especially those whose general health is too poor to undergo surgery.
Adjuvant radiation therapy can be used in addition to surgery to kill
small deposits of cancer that cannot be seen and removed during
surgery. Palliative radiation therapy can also be used to ease
symptoms of mesothelioma such as shortness of breath, pain, bleeding,
and difficulty swallowing.
Side effects of radiation therapy may include fatigue and mild skin
changes that resemble a sunburn. Often these side effects are
temporary. Radiation may also make the side effects of chemotherapy
worse. Chest radiation therapy may cause lung damage and lead to
difficulty breathing and shortness of breath. Abdominal radiation
therapy may cause nausea, vomiting and diarrhea. If you are having any
of these side effects of radiation therapy, talk with your doctor
since there are ways to help control these symptoms.
Chemotherapy
Chemotherapy is the use of drugs for treating cancer. The drugs can be
swallowed in pill form or they can be injected by a needle into a vein
or muscle. Chemotherapy is systemic therapy. This means that the drug
enters the bloodstream and circulates throughout the body (through the
whole system) to reach and destroy the cancer cells.
In treating mesothelioma, these drugs may also be given intrapleurally
(directly into the chest cavity), or intraperitoneally (into the
abdominal cavity). Depending on the type and stage of mesothelioma,
chemotherapy may be given as the primary (main) treatment or as an
adjuvant (addition) to surgery.
Several anticancer drugs have been used to treat mesothelioma. The
drug most effective when given alone is doxorubicin (Adriamycin).
Other drugs that may be given alone include cisplatin and
methotrexate. These anticancer drugs are often given in combination to
try to increase their effectiveness. Combinations of drugs used in the
treatment of mesothelioma include methotrexate and vincristine;
cisplatin, vinblastine and mitomycin; cisplatin and doxorubicin; and
doxorubicin, cyclophosphamide (or ifosfamide) and cisplatin. Other
drugs such as paclitaxel and irinotecan are currently being studied to
determine their effectiveness in treating mesothelioma.
Chemotherapy drugs kill cancer cells but also damage some normal
cells. Therefore, careful attention must be given to avoiding or
minimizing side effects, which depend on the specific drugs, the
amount taken, and the length of treatment. Temporary side effects
might include nausea and vomiting, loss of appetite, loss of hair, and
mouth sores. Because chemotherapy can damage the blood-producing cells
of the bone marrow, patients may have low blood cell counts. This can
result in an increased risk of infection (due to a shortage of white
blood cells), bleeding or bruising after minor cuts or injuries (due
to a shortage of blood platelets), and fatigue or shortness of breath
(due to low red blood cell counts).
Most side effects disappear once treatment is stopped. There are
remedies for many of the temporary side effects of chemotherapy. For
example, antiemetic drugs can be given to prevent or reduce nausea and
vomiting. If you experience any side effects, be sure to talk with
your doctor.
Experimental Therapies
Several forms of mesothelioma treatment such as the drug Alimta, gene
therapy, immunotherapy, photodynamic therapy and multimodality therapy
are still in their experimental stages. We invite you to read the
following articles on experimental therapies for Malignant
Mesothelioma.
Drug Therapy
Alimta, a new type of cancer treatment being developed by Eli Lilly,
is the first treatment to significantly increase the length of
survival and ameliorate the symptoms of the disease. The trial, one of
the largest against the fatal disease, was presented at the annual
meeting of the American Society of Clinical Oncologists.
Gene Therapy
Many strategies of gene therapy are currently under study. Even though
the results in animal experiments have been remarkable they have
remained disappointing in humans. Other agents such as onconase,
thalidomide, lovastatin have been used as single therapy or in
combination with chemotherapy with various results.
Immunotherapy
This therapy involves the removal of patient cells, activation by
exposure to cytokines and reinstillatin into the peritoneum,
accompanied by additional chemotherapy. In the few cases tried this
form of treatment lead to significant shrinkage of the tumor. However
most patients had very early stages of disease, and general
recommendations are therefore difficult to make, prior to further
research.
Photodynamic Therapy
This therapy involves the use of a drug that makes the cancer cells
sensitive to a particular wavelength of light. The drug is
administered before the surgical procedure. The results have been
disappointing, and no survival benefit has been shown in studies so
far.
Multimodality Therapy:
Doctors are always learning more about the best way to treat patients
with mesotheliomas. The roles of surgery, radiation therapy, and
chemotherapy in the treatment of mesothelioma are highly debated.
Treatments which use some combinations of surgery, radiation therapy,
and chemotherapy, called multimodality therapy, are now being studied
and may provide the most promising option for some patients.
Nutrition:
What you eat and
how you treat your body can have a very powerful impact on your health
and quality of life. Following a healthy diet could impact your cancer
survivability. While proper nutrition is not intended as a replacement
for traditional treatments, eating health-giving foods may help
stimulate your immune system, deter cancer growth and lessen the
negative side effects of traditional therapies.
A
healthy diet is always a low fat (not more than 20% of total
calories), right fat, high fiber, mainly vegetarian diet with minimal
refined sugar, white flour, processed foods and additives.
Carbohydrates should be complex and selected from foods with low
glycemic indices. Protein should be mostly from plant, not animal,
sources (e.g. soy). Omega-3 fatty acids in the form of flaxseed, flax
oil or fish oil should be taken daily in adequate amounts. Alcohol,
caffeine, smoking and trans-fats (all foods that contain partially
hydrogenated oils and fats) should be avoided or eliminated.
Fruits,
vegetables, whole grains and legumes all have important nutrients,
particularly substances called phytochemicals which may strengthen or
enhance the body's immune system. Some research has shown that people
who eat a diet free of animal products and one low in most fats have a
significantly lower cancer risk. Such a diet might also inhibit cancer
growth in those individuals already diagnosed with cancer. Cancer
cells exclusively metabolize glucose for their energy, so the
avoidance of sugar and highly refined carbohydrates that easily turn
into sugar is a good idea for any anti-cancer diet
You may wish to
include the following foods in your cancer fighting diet: fruits,
vegetables, whole grains and legumes. Fruits are rich in fiber,
Vitamin C and beta-carotene. Typically, fresh whole fruit has more
fiber and nutrients than fruit juice.
Vegetables contain a host of antioxidant phytochemicals, Vitamin C,
beta-carotene, riboflavin, iron, calcium and fiber. Include dark green
leafy vegetables such as broccoli, collards, kale, mustard and turnip
greens, chicory, spinach and leaf lettuces in your meals daily.
Colorize your diet with red, orange and yellow vegetables like
carrots, squashes, sweet potatoes, pumpkin, tomatoes, peppers. Gourmet
mushrooms like portabella and oyster mushrooms contain specific immune
system nutrients.
Grains include bread, pasta, cereals, corn, millet, barley, bulgur,
buckwheat, grits and tortillas. Grains are rich in fiber, minerals and
B-vitamins, however, processing removes much of a grains nutrient
value. Choose whole grains and avoid refined white four and its
products.
Legumes are another name for beans, peas and lentils. These foods are
good sources of fiber, protein, resistant starches, iron, minerals and
B-vitamins. Beans, when combined with whole grain rice, pasta or
bread, are as complete a protein as meat. Soy beans are complete
protein by themselves.
For more nutritional information, you can view
http://www.cancerproject.org.
In addition to nutritional information, the site contains sample menus
and recipes.
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