Treatment

Surgery
Mesothelioma can be treated by surgery (removing the cancer cells), radiation therapy (using high-dose X-rays to kill cancer cells), and chemotherapy (using high-dose anti-cancer medication to kill the cancer cells).

The two main surgical procedure options for patients with mesothelioma are: a pleurectomy, in which the surgeon removes part of the lining of the chest or abdomen and some of the tissue around it; and an extrapleural pneumonectomy, in which the entire lung, along with its pleural lining, and the diaphragm (the breathing muscle located below the lungs) are all removed. No study has ever compared the efficacy of these two procedures against one other.

If the cancer has spread too far to be operable, surgery may still be performed to relieve symptoms. This kind of surgery is called palliative because it is not meant as a cure. For instance, fluid in the chest can be relieved by placing a needle in the chest cavity. A similar procedure can be used to remove fluid in the abdomen and heart. Fluid can also be removed in a pleuroscopy, in which the surgeon looks into the pleural cavity through a small hole or holes, and empties the fluid under direct vision. (This procedure also allows directed sampling, or biopsies, of the cancer when a diagnosis is still being sought.) Often, this procedure is completed with a chemical pleurodesis, in which a pleural irritant-most commonly talcum powder-is left in the pleural cavity to minimize the risk of the fluid coming back.

Radiation Radiation therapy can be performed externally or internally. External radiation uses a machine outside the body. Internal radiation, also called brachytherapy, involves the insertion of radioisotopes (materials that produce radiation) through thin plastic tubes directly into the place where cancer cells are found.

Chemotherapy Chemotherapy may be taken in pill form, or given intravenously, or-in clinical trials-put directly into the chest. This last method is called intrapleural chemotherapy.

Follow-Up After Treatment
As part of the Survivorship Program at SCCA, a clinic has been developed for general medical oncology survivors treated with conventional therapy. This clinic is the Medical Oncology Survivorship Team (MOST). For more information about the MOST program, click here.

The Cancer Profiler
For more information about a type and stage of cancer, please try the The Cancer Profiler, a free decision support tool brought to you by the Seattle Cancer Care Alliance (SCCA) and NexCura, Inc. The Cancer Profiler enables cancer patients and their physicians to make better informed treatment decisions using information from evidence-based, peer-reviewed medical literature.

Source

Clinical Trials for Mesothelioma

Clinical Trials

SCCA plays a major role in promoting and participating in local and national clinical trials regarding mesothelioma. Many of the members of the mesothelioma team are playing a larger role in national clinical trials.

Medical researchers have recently discovered that removing the lung and the lining of the lung, followed by high-dose radiation therapy, is producing good survival rates in patients with early stage mesothelioma.

A new form of treatment called intraoperative photodynamic therapy uses special drugs to make cancer cells more sensitive to light. During surgery, a special light is used to shine on the pleura. This treatment is for early stages of mesothelioma in the chest.

Scientists are also investigating new methods of immunotherapy, which means using the body's own immune system to protect itself against disease, as well as new chemotherapy drugs, and combinations of treatments.

Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. Therefore, patients may seek help through a clinical trial. Patients who take place in clinical trials have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risk, researchers take careful steps to protect people who take part.

Clinical trials come in four phases.

• Phase I trials, investigators try to determine the most effective and safe dosage.
• Phase II trials, which involve a larger group of patients, researchers hope to build on what they learned in the first phase by trying to establish response rates and response durations, and by trying to determine what side effects will occur.
• Phase III trials, researchers compare the experimental treatment with the standard treatment.
• Phase IV trials, researchers monitor the effects of long-term usage.

For more information on clinical trials, a patient should talk to his or her doctor.

Source

Tests for mesothelioma

At the GP

Usually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. Your doctor will listen to your chest, to see if there are any signs of fluid collecting.

After your examination, your doctor may need to refer you to hospital for tests and X-rays. You may be referred directly to a specialist. Or your GP may send you to hospital for some tests first.

At the hospital

If you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests to check your general health. Then your tests will be arranged in the out patients department.

If your doctor suspects you may have mesothelioma, you may have quite a few tests. This is because it can be difficult to diagnose. Many of the usual tests used to diagnose lung disease prove negative when used to diagnose mesothelioma. You may have

• X-rays
• CT scan
• Thoracoscopy (and biopsy of the pleura)
• Fluid drainage (thoracocentesis or abdoparacentesis)

Of these tests, X-ray, CT scan and thoracoscopy are the most important for diagnosing mesothelioma. But of course, at this stage, your specialist doesn't know what's wrong. So, as mesothelioma can be difficult to diagnose you may have a range of tests.

X-ray

You will almost certainly be asked to have a chest X-ray or abdominal X-ray. A chest X-ray can show up fluid collecting around the lung. An abdominal X-ray may show up a swelling or fluid in the abdomen (tummy).

CT scan
This is a computerised scan using X-rays. You may be asked to have a CT scan of your chest or abdomen. A CT scan can show abnormal swellings in body organs or lymph nodes. You may be given an injection of dye called ‘contrast’ before the scan. This helps to make the scan clearer to read. There is more about having a CT scan in the CancerHelp UK section about cancer tests.

Thoracoscopy
This is a small operation usually carried out by a specialist surgeon. It is done under a general anaesthetic. A small cut (incision) is made in your chest wall and a thoracoscope (a telescope like instrument with a video camera attached) is inserted through the hole. Using forceps the doctor can take a small sample (biopsy) of the pleura, the tissues which cover the lungs. This is then sent to a laboratory for testing to see if there are any cancer cells. This is sometimes the only certain way of finding out what's wrong because mesothelioma can be so difficult to diagnose. Other tests may not always show mesothelioma or may not be able to show whether the problem is mesothelioma or a different type of lung problem.

Fluid drainage

Many people with pleual mesothelioma have fluid around their lungs (a pleural effusion). People with peritoneal mesothelioma may have fluid in their abdominal cavity (peritoneal effusion). The diagram shows a pleural effusion.



Fluid build up happens because cancer cells are irritating the pleura or peritoneum. Fluid in the plura can make it difficult to breathe. Fluid in the abdomen can make the abdomen feel swollen and tight and uncomfortable. If mesothelioma is the cause of the fluid build up, the fluid may contain cancer cells. To drain the fluid off, a needle is put into the chest or abdominal cavity and the fluid drained through a tube into a bag. A sample of the fluid will be sent to a laboratory for testing to see if contains cancer cells. Your doctor may call this 'thoracocentesis' or pleural aspiration if you are having fluid removed from your chest. If you are having fluid removed from your tummy (abdomen), you may hear your doctor call it an abdoparacentesis or peritoneal aspiration.

Difficulty with diagnosis

Mesothelioma can be difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumour. Sometimes it can be very difficult for a pathologist (doctor who looks at cells under a microscope) to decide if the cells or tissue taken from the lungs (pleura) or the abdomen (peritoneum) are a type of mesothelioma. These cells can often look very similar to other types of cancerous cells. For example, pleural mesothelioma can look like other types of lung cancer and peritoneal mesothelioma can look like some types of ovarian cancer. Also, many of the usual tests doctors use to diagnose lung disease prove negative when they use them to diagnose mesothelioma. For these reasons if your doctor suspects you may have mesothelioma, you may have quite a few tests so they can be sure of a correct diagnosis. In some cases, you may even need to have surgery to find out what's wrong. This surgery is called a surgical biopsy.

Mesothelioma Facts

Mesothelioma is fairly rare. There are an estimated 2,000 to 3,000 new cases of mesothelioma each year in the United States. The incidence of mesotheliomas in the United States increased from 1970 to 1990 and then stabilized. It may now be decreasing. Most of the past increase in cases, as well as the recent decrease in cases, has been in men. The rate, although lower, has been fairly steady for women. In European countries and world wide, the rate of mesotheliomas is still increasing.

Mesothelioma is rare in people under age 55. Its incidence increases with age. Three-fourths of people with mesothelioma are over 65 years old. The disease affects men 5 times more often than women. Mesothelioma is less common in African Americans than in white Americans.

Mesothelioma is a serious disease. By the time the symptoms appear and cancer is diagnosed, the disease is often advanced. The average survival time is about 1 year. The 5-year relative survival rate is around 10%, but this rate has been slowly improving.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Many of these patients live much longer than 5 years after diagnosis, and 5-year rates are used to produce a standard way of discussing prognosis. Five-year relative survival rates do not include patients dying of other diseases and are considered to be a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. That means that relative survival only talks about deaths from mesothelioma. Of course, 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. They may no longer be accurate. Improvements in treatment result in a more favorable outlook for recently diagnosed patients.

• Each year 2,500 to 4,000 patients in the U.S. are diagnosed with mesothelioma and asbestos-related diseases.
  
• Mesothelioma has a long latency (inactive) period of anywhere between 15 – 50 years.
  
• Experts predict that mesothelioma diagnoses will continue to increase in the United States for at least another 10 to 20 years.
  
• While many countries have banned certain forms of asbestos, an estimated 5,000 asbestos-containing products exist today.
  
• As many as 8 million people in the U.S. have already been exposed to asbestos and it continues to pose a serious threat to workers in certain occupations.
  
• One study of asbestos insulation workers reported a mesothelioma death rate up to 344 times higher than the general population.
  
• Most mesothelioma victims die within 18 months of diagnosis. Mortality is swift not because the cancer is fast-growing but because it usually is far advanced by the time it is detected.
  
• Poor prognostic variables include: nonepithelial histology, older age (greater than 75 years), pleural primary, chest pain at presentation, poor performance status, and elevated platelet count (greater than 400,000/mcL).
  
• By the year 2030 there are estimates that asbestos will have caused 60,000 instances of mesothelioma and around 250,000 other cancers that result in death.
• Over half a million asbestos and mesothelioma injury claims have been filed to date. Over 50,000 were filed in 1998 alone.
• Every year, more than 10,000 people worldwide (3,000 in the U.S. alone) are diagnosed with mesothelioma or other asbestos-related conditions.
• More than 500,000 asbestos or mesothelioma lawsuits have been filed.
• More than 110,000 schools in the U.S. still contain some form of asbestos.
• 8 million Americans have been exposed to dangerous levels of asbestos.
• Asbestos insulation workers have a mesothelioma death rate 344 times higher than that of the general population.
• More than 7,500 Americans died from mesothelioma between 1999 and 2001.
• The industries with the highest mesothelioma mortality rates are ship building and ship repairing.
• People working around industrial chemicals had the second-highest rate, and those in the construction industry were third.
• 85% of mesothelioma deaths are male; this has more to do with asbestos exposure than with gender.
• There is also a high rate of mesothelioma deaths among schoolteachers, many of whom are female.
• The average age of people diagnosed with mesothelioma is between 50 and 70, but the number of people diagnosed with mesothelioma between the ages of 30 and 40 is increasing.
• Asbestos is used to make more than 5,000 products worldwide.
• Even when mesothelioma treatment is possible, it is very expensive, sometimes costing between $400,000 and $800,000 for oxygen, drugs, pain medicine and other forms of treatment

About Mesothelioma

Mesothelioma is a rare form of cancer that develops in the mesothelial cells. These cells are tissue that surround or line the lungs, heart, and stomach. The mesothelial cells protect these organs by producing a lubricating fluid that allows these organs to move smoothly.

There are 2 types of tumors of the mesothelium, “benign” and “malignant”. A benign tumor is non-cancerous, which means it does not cause any damage or will not harm you. A malignant tumor of the mesothelial cells is called a malignant mesothelioma. Because tumors of the mesothelium are usually cancerous, malignant mesothelioma is usually just called “mesothelioma”.

Malignant mesotheliomas arise from the cells that line the surface of the pleura or the peritoneum. Eighty percent of these tumors are pleural in origin. Malignant mesotheliomas are rare, with an incidence of one to three cases per 1 million persons per year in the general population.

The relationship between asbestos exposure and malignant mesothelioma was established in 1960. The latency period between exposure and tumor development has usually been 30 years or more.

The incidence of malignant mesothelioma has been highest in persons with heavy occupational exposure to asbestos, such as shipyard workers.[14] However, malignant mesothelioma can occur in the absence of any known asbestos exposure. No history of such exposure has been noted in about one-third of cases,[15] and the etiology of these cases is unknown. Cigarette smoking is not considered a risk factor for malignant mesothelioma.[16]

The patient with malignant mesothelioma of the pleura may have symptoms of dyspnea and pleuritic chest pain, with malaise and weight loss. A large pleural effusion is often seen on the radiograph. This effusion is frequently bloody, and the hyaluronic acid level may be elevated. Associated parenchymal fibrosis (asbestosis) is rare in pleural mesothelioma but appears to be more common in, peritoneal mesothelioma.

Malignant mesothelioma can be very difficult to diagnose; open biopsy is usually necessary, because needle biopsy of the pleura often yields an inadequate specimen.

There is no effective treatment for malignant mesothelioma. Surgical resection is not possible. The tumor encases the lung in a bulky, lobulated mass that invades the fissures and, eventually, the diaphragm and the chest wall. Average survival is less than two years. Except in rare cases, chemotherapy and radiation therapy have not been useful.

Source