Mesothelioma is a complicated disease, an aggressive and lethal form of cancer caused by human exposure to asbestos. Specifically, mesothelioma is caused by tiny asbestos fibers that can be inadvertently inhaled or ingested. These tough fibers lodge in the mesothelium, a membrane of thin tissue that protects various organs and surfaces within the body. Eventually they will cause the generation of malignant cells which reproduce quickly and uncontrollably, launching the development of malignant mesothelioma. Because seventy percent of all mesothelioma cases are pleural mesothelioma, most of the efforts at improving treatment are focused on the chest cavity. However there have been some impressive treatments developed for peritoneal mesothelioma in recent years that are worth noting as well.
Variables for Asbestos Treatment
Treatment for mesothelioma is dictated by a number of variables. An oncologist or pulmonary specialist who has diagnosed a patient with mesothelioma designs a program that will be most effective with:
- The location or type of the disease
- The stage of the disease
- The overall health of the patient
Surgery for Asbetsos Cancer
Deciding whether or not to attempt tumor removal is probably the most important decision in devising a treatment plan for mesothelioma surgery. If the disease is diagnosed early enough and if the patient is healthy enough, surgery may be performed in an attempt to remove much or all of the malignant tissue. This is the most aggressive treatment choice, because it is a major effort to halt the growth of the disease by removing damaged tissue and the malignant cells that are causing the damage. Surgery is the first step in attempting to "cure" a case of mesothelioma or asbestos cancer. Surgical options for pleural mesothelioma generally include the pleurectomy/decortication, or removal of pleura, and the extrapleural pneumonectomy which is removal of the pleura and the lung on that side of the body where the disease has developed1.
If the disease has advanced into the lymph nodes, additional tissue resection will be required for those areas as well. A case of mesothelioma asbestos cancer that has moved into the lymph nodes is considered to be in a more advanced stage than a case where the malignant tissue has remained localized.
Nearly all mesothelioma patients are over the age of fifty and many are in their sixties or seventies. People of this age are not always in the best of health; heart problems are often a factor as are respiratory ailments. A lifelong smoker with COPD, for example, is not a good candidate for pleural mesothelioma surgery.
Radiotherapy for Mesothelioma Cancer
Treatment options both for patients who have had surgery and those for which surgery is not an option nearly always includes chemotherapy and radiotherapy. This treatment mode uses radiation to kill cancerous cells; it is perhaps the oldest non-surgical treatment for malignancy in Western medicine. Radiation can be effective in killing cancer cells but it is not a very precise technology, so the radiation beams tend to kill healthy cells adjacent to the malignant cells on which it is targeted.
Because of the limitations for radiation – precision and the depth to which it can be effective – a surgeon performing a resection procedure on a patient may perform a radiation treatment for mesothelioma while the patient is still in surgery and the location of the disease is exposed. However radiation treatments are included in virtually any treatment program for mesothelioma, whether surgery is involved or not. Radiation is used to combat malignant cells and to treat some of the symptoms such as pleural effusion associated with mesothelioma.
Chemotherapy for Mesothelioma
There is a lot going on in mesothelioma chemotherapy research; the various types of chemotherapy have evolved as physicians have learned about the types of malignant cells that are present with mesothelioma. There are multiple variants of cancer cells, all of which have different strengths and weaknesses. There are two types of cells associated with mesothelioma; epithelioid and sarcomatoid: they react to different types of treatments. With increasing frequency, mesothelioma diagnoses are showing cases with both types of cells – a condition called biphasic mesothelioma.
There have been and continue to be clinical trials that combine chemotherapy drugs to find more effective treatments for mesothelioma cancer cells. There are also a few new drugs in the test phase that are specifically designed for mesothelioma cancer cells; the first of these is Alimta, or pemetrexed. The reports on these trials usually consider them a success if the tested treatment modality extends the life of the patient by a period of a few months. That fact illustrates the limits to mesothelioma treatment that chemotherapy alone can provide.
There have been some successes treating peritoneal mesothelioma using surgical removal of as much malignant tissue as possible and combining it with intraperitoneal hyperthemic chemotherapy. This type of post-surgical treatment involves heating and delivering the chemotherapy drugs directly to the diseased area with some form of shunt. Utilization of this technique resulted in a median survival period of nearly three years in one study and over four years in another.
New Approaches to Mesothelioma Treatment
Medical technology is moving just as fast as consumer oriented technology, and the treatment concepts for mesothelioma are no exception. Because mesothelioma is a relatively rare disease compared to other forms of cancer, the therapies being tested are also focused on more common malignancies. But the focus of these mesothelioma treatment concepts is generally seeking new and more productive ways to destroy malignant cells and/or stop their reproduction.
The concepts under study for cancer treatment are startlingly different. In some ways they resemble engineering challenges, looking for the most effective way to cause or bring about a cellular reaction. Among them:
There are also new drugs in development that are targeted at the types of cells found in mesothelioma. Unfortunately, the life expectancy after a mesothelioma diagnosis leaves little room to wait for new developments. However the study and work being put into developing more effective mesothelioma therapy today is going to benefit future mesothelioma victims and individuals with other types of malignancies.
- Surgical Management of Malignant Pleural Mesothelioma, National Guideline Clearinghouse, Department of Health & Human Services, http://www.guideline.gov/summary/summary.aspx?doc_id=8457&mode=menu&ss=15#s23
- Radiation Therapy for Malignant Pleural Mesothelioma, University of Florida Shands Cancer Center, http://www.ufscc.ufl.edu/patient/content.aspx?section=ufscc&id=30346
- Journal of Clinical Oncology, Vogelzang et al, July 2003, http://jco.ascopubs.org/cgi/reprint/21/14/2636
- Center for Surgical Oncology, Washington Cancer Center, Sugarbaker, http://www.surgicaloncology.com/meso.htm
- What's New in Malignant Mesothelioma…Treatment? American Cancer Society, March 2009, http://www.cancer.org/docroot/CRI/content/CRI_2_4_6X_Whats_new_in_malignant_mesothelioma_research_and_treatment_29.asp?sitearea=