- Stage II: the
mesothelioma has spread beyond the lining of the
chest wall or involves the esophagus, heart or
pleura on both sides. Mesothelioma may also exist in
the chest’s lymph nodes.
- Stage III: cancer
has spread into the chest wall, penetrated the
diaphragm, and is present in the center of the chest
heart and abdominal lining and into lymph nodes
beyond the chest.
- Stage IV: there is
evidence that mesothelioma has spread through the
bloodstream to distant tissues and organs (distant
metastases)
Treatment
- Draining of fluid in
the chest or abdomen (thoracentesis or paracentesis)
to reduce discomfort. Drugs also may be put into the
chest or abdomen to prevent further collection of
fluid.
- Surgery to relieve
symptoms.
- Radiation therapy to
relieve symptoms.
- Chemotherapy.
- A clinical trial of
surgery, radiation therapy, and chemotherapy
- Chemotherapy given
in the chest or abdomen.
The TNM system (Tumor
lymph Nodes Metastasis) is another, more detailed and
precise staging system developed by the American Joint
Committee on Cancer (AJCC). Minor differences exist
between the AJCC TNM staging system and the Butchart
system; however the Butchart system continues to be
the most commonly used.
[Back to Top]
Traditional
Treatments
While there is
currently no known cure for malignant mesothelioma,
treatments are available with the most common being
surgery, chemotherapy and radiation therapy. Doctors
will often use two or more of these treatment courses
jointly to provide the maximum likelihood of success.
This “multimodal” approach holds the most promise for
survival of malignant mesothelioma patients.
Trimodality therapy, in which all three of these
modalities are used, is considered the most effective
aggressive approach.
Your doctor will
recommend one treatment or a combination of therapies
that are best for your situation. The course of
treatment will depend on a number of factors including
the location of the disease, the stage of the disease,
your age, overall health and your preferences.
Surgery
There are several types
of surgeries used to treat mesothelioma and the
disease type and stage will determine the type of
surgery. Mesothelioma tumors are usually large and
difficult to completely remove, so surgery is usually
combined with other cancer treatments to ensure the
best results in destroying the tumor.
There are two main types of surgical treatment for
pleural mesothelioma: extra-pleural pneumonectomy (EPP)
and pleurectomy/decortication. EPP is the removal of
the pleura, diaphragm, pericardium, and the whole lung
involved with the tumor. Pleurectomy/decortication
removes the pleura without removing the entire lung.
Since EPP and pleurectomy/decortication are not
frequently performed by most surgeons, patients are
referred to centers specializing in these treatments.
Many of these centers also specialize in other forms
of mesothelioma treatment, either alone or in
combination (multi-modal therapy.) Your doctor can
discuss referrals.
Radiation therapy
Radiation therapy uses
high-energy x-rays help to destroy cancer cells and
shrink tumors. The radiation may come from outside the
body from a machine (external radiation) or from
radioactive materials placed directly in or around
cancer cells through thin plastic tubes (internal or
implant radiation). While there may be side effects
from radiation, most of these will go away after a
short while.
In pleural mesothelioma,
it is difficult to irradiate tumor tissue successfully
without injuring nearby organs like the lungs, heart,
and liver. However, radiation therapy can be very
effective in relieving pain in certain situations.
Chemotherapy
Chemotherapy uses drugs
to kill cancer cells. Chemotherapy is referred to as
systemic treatment because the drug is introduced into
the patient’s bloodstream and travels throughout the
body killing cancer cells. The drugs may be in pill
form, or injected into the body through a needle.
Researchers are also studying the effectiveness of
delivering chemotherapy directly into the chest or
abdomen (intrapleural or intraperitoneal delivery).
Chemotherapy may be
given as the primary treatment to mesothelioma, or it
may be used in addition to surgery. To effectively
treat mesothelioma, more than one drug may be used.
Depending on the drugs, the amount taken and the
treatment period, there may be side effects.
Historically, doxorubicin has been the most widely
used single chemotherapy drug. Other newer drugs,
including gemcitabine, cisplatin, carboplatin,
epirubicin, cyclophosphamide, ifosfamide, vinorelbine,
paclitaxel, and methotrexate, now are often preferred
and are usually given in different combinations.
Recently, the
University of Chicago Cancer Research Center released
the results of a yearlong clinical trial of Pemetrexed
Disodium (Alimta). A clinical study has shown positive
results when Alimta was used with vitamins and the
traditional chemotherapy drug, Cisplatin, for treating
malignant pleural mesothelioma. Because of its ability
to reduce tumors, prolong survival and reduce pain,
Alimta is available to some pleural mesothelioma
patients on a “compassionate use” basis. Patients who
have not yet received treatment for mesothelioma may
be eligible to obtain Alimta free of charge prior to
the Food and Drug Administration’s completion of its
formal review of the drug in 2004.
There are several new
experimental treatments that try to enhance the immune
system's ability to combat malignant mesothelioma.
These include gene therapy and the use of cytokine
proteins such as interferons and interleukins. These
treatments are also being tested in combination with
chemotherapy and other treatments.
[Back to Top]
Non-Traditional
Treatments
Photodynamic Therapy
Photodynamic therapy destroys cancer cells by using
the energy from light and may also be effective when
combined with surgery. Although this treatment is in
the experimental stage for mesothelioma, it has shown
promising results in treating other cancers. In the
procedure, the patient receives a photosensitizer (a
drug which makes cells sensitive to specific
wavelengths of light) which collects in cancerous
cells but not in healthy cells. Once the cells have
been sensitized, fiber optic cables are placed in the
body (usually through open-chest surgery) so that the
correct frequency of light can be focused on the tumor.
This causes the photosensitizer drug to produce a
toxic oxygen molecule which kills the cancer cell.
Gene Therapy
This is a new
treatment, currently in clinical trails. This approach
allows treatment to target tumors, rather than
destroying healthy cells which is the negative of
traditional chemotherapy. In gene therapy, cancer is
treated by altering genetic defects that allow a tumor
to develop. A “suicide gene” is inserted directly into
the tumor, making the cells sensitive to a normally
ineffectual drug. The drug is then administered to the
newly sensitive cancer cells and it destroys those
cells while leaving the healthy cells unharmed.
Gene therapy for
mesothelioma is being researched at the University of
Pennsylvania.
Immunotherapy
Immunotherapy (or
biological therapy) treats cancer by using the body’s
own immune system fight cancer cells. Another name
often applies to this therapy, biological response
modifiers (BRMs). Though not yet obtainable, promising
clinical studies are underway for immunotherapy.
In addition to
traditional forms of treatment, some
cancer patients are turning to the alternative
medicine’s healing philosophies and spiritual approach
to living with the disease.
[Back to Top]
