The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient’s age and general health. Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered.
There are a number of treatment options available to mesothelioma patients. Extrapleural pneumonectomy in selected patient with very early stage disease may improve recurrence-free survival, but its impact on overall survival is unknown. Pleurectomy and Decortication can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumors. The use of radiation therapy in pleural mesothelioma has been shown to alleviate pain in the majority of patients treated. Unfortunately, the duration of symptom control is short-lived. Single agent and combimed chemotherapy have reported higher response rates in STAGE II patients, but the toxicity reported is also higher, and there is no evidence that combination treatments result in longer survival or longer control of the symptoms.
There are treatments for all patients with malignant mesothelioma. Three kinds of treatment are used:
- Surgery is a common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen 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. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
- 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, the doctor may drain the fluid out of the body by putting 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. The doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
- Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).
- Intraoperative Photodynamic Therapy is a new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.
Cancer treatments all have side effects. It is hard to kill cancer cells at the same time as keeping all healthy cells safe. Side effects of treatment depend on the type of treatment and the person’s overall health when treatment starts.
Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. Clinical trials, therefore, are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for many patients with malignant mesothelioma.
These new approaches often combine two or more traditional treatments or consist of other promising innovations.
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