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Mesothelioma Treatment

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The most common treatment for mesothelioma involves a combination of surgery, chemotherapy and radiation therapy. Supportive treatments can help relieve symptoms and improve quality of life for many mesothelioma patients. Mesothelioma treatment is getting better every year and patients are living longer as a result. Patients may turn to traditional therapies, like chemotherapy and radiation, as well as clinical trials. Which may lead to a cure in the future.

Treatment helps people live longer with malignant mesothelioma. While a curative treatment outcome is rare, a treatment approach called multimodal therapy can help certain patients live for years with cancer. The multimodal therapy combines treatments to kill cancer cells in multiple ways. Specialists consider it the best treatment for mesothelioma. 

While no cure currently exists, mesothelioma patients can usually improve their prognosis through some form of treatment. Even in cases where improving lifespan is not viable, palliative care and alternative therapies often help reduce pain and suffering from symptoms for many individuals with mesothelioma.

Mesothelioma Treatment

Standard Mesothelioma Treatments

There are several treatment options for patients with mesothelioma, from surgery to chemotherapy. These treatment options are not typically considered a cure for mesothelioma patients. Although patients have reached remission in certain cases. These cases are typically situations where the disease was caught in the earliest stages and treated aggressively by a specialist. Important considerations in determining a mesothelioma treatment plan include the cancer stage, primary site affected and cell type.

Treatment options also depend on whether the cancer is localized to the chest or has spread to the chest wall or diaphragm. Lymph nodes as well as your age and overall health. The three standard therapies used to treat mesothelioma include surgery, chemotherapy, and radiation.

Surgery

Patients whose mesothelioma hasn’t spread too far may be eligible for surgical treatment. This is the best way to remove large portions of affected tissue. For patients with an early-stage mesothelioma diagnosis, surgery can be used to remove all or most of the tumor(s). Depending on the tumor location, surgery may include removing the mesothelial lining. One or more lymph nodes, or part or all of a lung or other organ.

Chemotherapy

Chemotherapy drugs work by attacking fast-growing cells, such as cancer cells. Often used in conjunction with surgery, chemotherapy can kill any remaining mesothelioma cells. That the surgeon was unable to remove physically. The go-to treatment for any type of cancer, chemotherapy is the traditional way to kill off cancer cells in the body. Mesothelioma requires certain chemotherapy solutions to be effective.

Immunotherapy

Drugs that activate the immune system to target and kill mesothelioma cells are known as immunotherapy treatments. This type of treatment is becoming more common.

Radiation therapy

It is noninvasive and beneficial for all stages and types of mesothelioma. It can be used before and after surgery to help shrink tumors and kill remaining cancer cells in a specific area of the body. Through the use of targeted radiation, mesothelioma tumors can often be shrunk. Making them easier to be removed through surgery. Depending on the tumor location, the radiation can be delivered using an external or an internal source.

Multimodal Treatment

Aggressive surgical treatments combined with chemotherapy and radiation have increased the life expectancy of many patients. Multimodal treatment is a combination of several of the above-mentioned treatments. Doctors now accept that the best way to extend survival time is to use multimodal methods like surgery 

Clinical trials

Clinical trials offer patients access to emerging treatments such as immunotherapy treatments, gene therapy and photodynamic therapy. Every treatment for mesothelioma started out in a clinical trial. Trials allow researchers to test new treatments and give patients access to more options.

In many cases, mesothelioma treatment specialists will recommend a multimodal approach. Which uses a combination of these three types of treatment. In various studies, multimodal treatment has been shown to be more effective than any of these individual treatments alone. For example, surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) applied throughout the chest cavity. Has resulted in an increase in the life expectancy of peritoneal mesothelioma patients in recent years. Studies have found the 5-year survival rate to be at least 50% with this treatment.

Types of Treatment

Mesothelioma doctors create a course of treatment based on his or her patient's diagnosis. The doctor considers the patient's cancer stage, cell type, and location of the mesothelioma. These factors play an important role in determining which types of treatment the patient is eligible for. The current types of surgery for pleural mesothelioma include extrapleural pneumonectomy (EPP) and pleurectomy and decortation (P/D). A thoracotomy is the first part of an EPP or P/D surgery. 

This allows doctors to operate on organs inside the chest. Surgeons may also use a diagnostic procedure called video-assisted thoracoscopic surgery (VATS). Which is inserting a tiny camera through a small cut in the chest to see the lung. VATS allows doctors to see inside the chest and take biopsy samples. The primary surgery for peritoneal mesothelioma is cytoreductive surgery, also known as debulking surgery.

Curative Treatment

Doctors use curative treatments to remove mesothelioma from a patient’s body. Patients diagnosed with pleural mesothelioma—and eligible for curative treatment—may have one of the two standard surgeries for pleural mesothelioma: the extrapleural pneumonectomy (EPP) or the pleurectomy with decortication (P/D). Those diagnosed with peritoneal mesothelioma might undergo cytoreduction. Which doctors often combine with heated chemotherapy in a procedure called cytoreduction with HIPEC. Heated Intraperitoneal Chemotherapy (HIPEC) is the most effective treatment option for peritoneal mesothelioma patients.

In this procedure, heated chemotherapy drugs are delivered directly into the abdominal cavity after cytoreductive surgery to kill remaining cancer cells.
According to a 2013 study at Moffitt Cancer Center in Tampa, Florida. The median survival rate for peritoneal patients who underwent HIPEC and cytoreductive surgery was 41 months. Those who returned for a second procedure survived an average of 80 months. Intraperitoneal chemotherapy may also be administered without surgery and with the chemotherapy at normal room temperature.

Palliative Treatment

A treatment is a palliative when a doctor uses it to relieve pain or discomfort caused by symptoms of mesothelioma treatment. The most common palliative treatments drain fluid buildup in the chest or abdomen. Patients with pleural mesothelioma receive a thoracentesis. Patients with peritoneal mesothelioma patients receive a paracentesis. Palliative care involves any therapy used to relieve symptoms or improve quality of life.

Experimental Mesothelioma Treatments

In addition to more conventional therapies, researchers are constantly looking for new treatments for mesothelioma. Some extremely promising emerging treatments have come out of clinical trials. In some cases extending the lives of mesothelioma patients by months or years. Some of the new mesothelioma treatment options in development include immunotherapy and photodynamic therapy. They are being used in clinical trials and could become standard mesothelioma treatment at some point. New treatment for mesothelioma is thoroughly tested in clinical trials to ensure safety and efficacy.

Immunotherapy

Immunotherapy helps your own immune system fight cancer. The U.S. Food and Drug Administration already approved some checkpoint inhibitors. Such as pembrolizumab (Keytruda) and nivolumab (Opdivo), for the treatment of various cancers. Mesothelioma could be next. By kickstarting or boosting the immune system, it is possible to enhance the body’s own defences against cancer.

Photodynamic Therapy

Through the novel use of light and photosensitizing drugs, researchers have found a way to kill cancer cells with few side effects. This therapy uses light energy to kill cancer cells. Doctors inject a light-sensitive drug into the patient. After a few days, a special light is applied to the area, usually via laser, to activate the drug and kill cancer cells.

Gene Therapy

Since cancer is caused by faults in cell DNA, one new way of fighting cancer is by fixing or overwriting problematic genes.

Clinical Trials and Emerging Treatments

While the treatments above account for the most promising experimental therapies for mesothelioma. Ongoing clinical trials which look for new ways to fight mesothelioma occur in cancer clinics all over the world. These trials may offer opportunities to patients who have not found the effective treatment for their mesothelioma. Many mesothelioma patients are eligible for clinical trials that test emerging treatments. Clinical trials also test new approaches to multimodal therapy and the combination of different chemotherapy drugs.

While the treatments above account for the most promising experimental therapies for mesothelioma treatment. Ongoing clinical trials which look for new ways to fight mesothelioma occur in cancer institutes all over the world. These trials may offer opportunities to patients who have not found the effective treatment for their mesothelioma. If you’re not eligible for traditional treatments, like surgery or chemotherapy. Participating in a clinical trial may give you a chance to improve your prognosis with new treatments. In clinical trials, researchers develop new ways to fight mesothelioma like immunotherapy. A treatment that strengthens your immune system and helps kill mesothelioma cells.

Mesothelioma Treatment

Surgery for Mesothelioma

Pleurectomy with Decortication (P/D)
A pleurectomy with decortication (P/D) is a surgery doctor use to remove the lining of the lung most affected by tumor growth. And any visible tumors on the surface of the lung itself. If mesothelioma has spread beyond the lining of your lung, your doctor may also remove parts of the diaphragm and pericardium. The protective lining of the heart. For patients with pleural mesothelioma, the surgeon may remove the cancerous lining around the lung. This procedure is called a pleurectomy/decortication. Generally, the tumor cannot be completely removed with a pleurectomy/decortication. A more aggressive surgery for pleural mesothelioma is called an extrapleural pneumonectomy.

The goal of using a P/D is to relieve symptoms of mesothelioma without sacrificing the lung. 90 percent of patients who have the procedure experience a reduction of symptoms, and retain 100 percent of their breathing function.P/D spares the lung and only removes cancerous parts of the pleural lining, the chest wall lining and the diaphragm.

Extrapleural Pneumonectomy (EPP)

Doctors use an extrapleural pneumonectomy (EPP) to remove the entire lung and nearby tissue affected by mesothelioma. To prevent the disease from coming back, he or she may also remove the diaphragm, nearby lymph nodes, and the lining of the heart.EPP removes the cancerous lung and all nearby areas where mesothelioma spreads. This can include nearby lymph nodes, parts of the chest lining, heart lining and diaphragm.

Peritonectomy

urgeons use a peritonectomy to remove any part of the peritoneum — the protective lining of the abdomen — affected by tumor growth. They also remove any visible tumors that may have spread to nearby organs, like the diaphragm or stomach. Patients with peritoneal mesothelioma may often have a surgery called an omentectomy. An omentectomy is the removal of the lining around the abdominal organs. Since patients with peritoneal mesothelioma often have tumors throughout the entire abdomen, it is difficult to remove all of them

Cytoreductive Surgery

Cytoreductive surgery is when a surgeon combines multiple peritonectomies to completely remove mesothelioma from the abdominal cavity. Doctors often combine cytoreductive surgery with heated chemotherapy in a procedure called cytoreduction with HIPEC to maximize its effectiveness. Cytoreductive surgery removes cancerous growths from the lining of the abdomen. Also known as debulking surgery or peritonectomy, this procedure is often followed by heated chemotherapy.

Chemotherapy for Mesothelioma

Chemotherapy is the use of drugs to attack and kill cancer. Its effectiveness depends on your diagnosis, specifically on the cancer stage and location of the mesothelioma. Chemotherapeutic drugs work better when they are combined with other drugs—the most common combination of drugs being Alimta and cisplatin—or surgery. Chemotherapy is the most common type of systemic therapy used for mesothelioma. It usually works by ending the cancer cells’ ability to grow and divide. Systemic therapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give systemic chemotherapy for mesothelioma include an intravenous (IV) tube placed into a vein using a needle. Chemotherapy can also be given directly to the abdomen after surgery for peritoneal mesothelioma, called intraperitoneal chemotherapy.

Pleural mesothelioma

The recommended treatment for patients who haven’t yet received treatment is the combination of pemetrexed (Alimta) and cisplatin (Platinol) or carboplatin (Paraplatin). These medications are given in 4 to 6 treatment cycles that each last 3 weeks. There can be significant side effects with this combination of drugs. Some patients may receive a single drug if there are too many side effects from giving both drugs. Bevacizumab (see Targeted Therapy, below) may be added to chemotherapy for some patients.

Peritoneal mesothelioma

As mentioned in the surgery section (above), chemotherapy is often given directly into the abdomen after surgery. IV chemotherapy is also used. Just as with pleural mesothelioma, the combination of pemetrexed with cisplatin or carboplatin are most often used for mesothelioma treatment.

Mesothelioma Treatment

Side Effects

Depending on your tolerance, chemotherapy may affect you severely, mildly, or not at all. Its side effects disappear slowly after treatment and vary according to the type of drug, amount of dose, and length of time it’s given. The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue. The risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhoea. The most common side effects from the drugs used to mesothelioma include damage to the kidneys, numbness and tingling in the fingers or toes. Decreased hearing, rash, a higher risk of infection from a low white blood count, or anaemia. Patients may experience other side effects as well. Patients receiving these types of chemotherapy are given the vitamins B12 and folic acid to lower the risk of these side effects.
Common side effects experienced during chemotherapy are:
  • Hair loss
  • Loss of appetite
  • Nausea
  • Diarrhoea
  • Fatigue 

Radiation Therapy for Mesothelioma

Radiation therapy is the use of high energy rays to kill mesothelioma cells. Doctors may use radiation by itself — as a palliative treatment — or combine it with chemotherapy and/or surgery. With some types of radiation therapy, patients may not experience as many side effects as chemotherapy. Because doctors can target tumors, minimizing damage to healthy cells. Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation, which is radiation given from a machine outside the body.

Three-Dimensional Radiation Treatment (3D-CRT)

Using 3D scans of the tumor, doctors customize the amount and intensity of each radiation dose according to its size and shape. Customizing the amount of radiation helps doctors target tumors more effectively and minimizes damage to healthy, non-cancerous cells surrounding the tumors.

Pleural mesothelioma

It is challenging to treat pleural mesothelioma with radiation therapy because of the risk of damaging the lung. When 1 of the 2 lungs has been surgically removed, radiation therapy is often given to the chest cavity to lower the risk of the mesothelioma returning in the chest. For example, this approach may be used after an extrapleural pneumonectomy (see Surgery, above). For some patients, radiation therapy may be given to a smaller area to help relieve symptoms such as pain (see Getting care for symptoms and side effects, below).

Intensity-Modulated Radiation Therapy (IMRT)

IMRT is an advanced form of 3D-CRT. Doctors use computers to adjust the amount and intensity of a radiation beam as it passes over a tumor. Researchers in a recent study showed that IMRT used after an extrapleural pneumonectomy (EPP) produced a median overall survival rate of just over 2 years. Of these patients, 41 percent survived an additional 3 years after the procedure.

Peritoneal mesothelioma

For patients with peritoneal mesothelioma, radiation therapy to the entire abdomen causes severe side effects and is not done. If a patient has pain in a specific area, radiation therapy may be an option to help relieve pain (see Getting care for symptoms and side effects, below).

Side Effects of Radiation Therapy

Side effects from radiation therapy may include tiredness, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy. Doctors do have to use high doses of radiation to get the same cancer-killing effectiveness as chemotherapeutic drugs. As doctors increase the amount and intensity of radiation, the chances of radiation damaging healthy cells also increase and more side effects can occur.
The side effects of Radiation therapy can occur:
  • Inflammation of the oesophagus
  • Skin redness
  • Fatigue
  • Nausea
  • Hair loss

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment. Your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Bevacizumab is a type of drug called and anti-angiogenic. Anti-angiogenesis is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. 

Immunotherapy

Immunotherapy also called biologic therapy, is designed to boost the body's natural defences to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

For mesothelioma, pembrolizumab (Keytruda) and a combination of ipilimumab (Yervoy) and nivolumab (Opdivo) may be options for patients who have already received chemotherapy. Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Complementary Mesothelioma Treatments

Treatment for mesothelioma is usually provided by a combination of surgery, chemotherapy, and radiation. An emerging mesothelioma treatment such as immunotherapy or gene therapy. However, complementary cancer treatments can provide additional relief from symptoms or help patients during recovery after their primary treatment is delivered. Doctors use palliative treatments to relieve pain caused by symptoms at all stages of mesothelioma. Doctors may use them to complement curative treatments for patients diagnosed with stage 1 or stage 2 mesothelioma. Stage 3 and stage 4 patients receive palliative treatment to reduce pain and increase their quality of life.

Palliative Care

This type of care focuses on relieving the pain and suffering of the patient, rather than trying to eradicate the disease. Palliative care involves any therapy used to relieve symptoms or improve quality of life. If the cancer already has spread significantly, doctors typically recommend palliative treatment options for mesothelioma that can help alleviate pain. Breathing problems and other cancer symptoms that lessen your quality of life.

For example, one of the most debilitating symptoms of malignant pleural mesothelioma is the build-up of fluid in the pleural space around the lungs. This collection of fluid makes it very difficult to breathe and also can cause severe pain. It greatly impacts the quality of life for the patient and can make it difficult to do everyday tasks. The best way to relieve this discomfort is to have the fluid removed by means of a pleurocentesis. A thoracentesis is the draining of excess fluid from the pleural cavity — the space between the inner and outer lining of the lungs — with a needle. It reduces pressure caused by too much fluid, which pushes on the lung and makes it difficult to breathe.

Physical Therapy

After the primary treatment, physical therapy is often required to help patients recover from the trauma of the treatment itself. The specific form of physical therapy a patient undergoes will depend on the specific type of treatment they receive, and how their body reacts to it. Common types of physical therapy include cardiovascular training, scar tissue healing, fatigue management, and strength training. While physical therapy will not necessarily help eradicate cancer or prevent recurrence. It can improve a mesothelioma survivor’s quality of life and overall health. Many mesothelioma patients take steps to improve their overall health. Some patients focus on their emotional and mental health by joining a support group.

Alternative Therapies

Many patients have found relief from physical and emotional symptoms through different forms of alternative treatment. Including everything from massage and acupuncture to yoga and art therapy. The important thing is to consult your doctor before trying one of these alternative treatments. To make sure it will not interfere with your primary treatment plan. The fluid is drained via a needle. Complementary and alternative medicine options don’t treat the disease itself but focus on the patient mentally, emotionally and physically. They can be used alongside more traditional approaches to cancer treatment. These types of treatments are not replacements for modern medicine and should not be used in place of a doctor or other medical professional. Patients in many states have access to medical marijuana, which can help control cancer pain.

Mesothelioma Specialists

Doctors who specialize in mesothelioma treatments include oncologists and thoracic surgeons. These doctors know how to treat mesothelioma and they often take leadership roles in mesothelioma clinical trials.

Several other types of doctors play supportive roles in mesothelioma care such as radiologists, palliative medicine doctors, pulmonologists, general practitioners, internal medicine specialists and occupational medicine doctors. Treating mesothelioma requires a multidisciplinary approach to cancer care. Connecting with a specialist who is knowledgeable about mesothelioma is critical. Mesothelioma is rare cancer and there are a limited number of specialists who are qualified to treat patients with it.

Specialists can also offer more aggressive treatments options than a general oncologist. These treatments have the potential to increase life expectancy significantly, and new treatments are always emerging. The doctors above are just a few of the specialists we can connect you with.
Our Doctor Match program involves our team travelling across the nation. Developing relationships with the best mesothelioma specialists and cancer centres. Through these relationships, we connect patients with a specialist uniquely capable of treating a patient, based on their diagnosis.

Oncologist

A small number of oncologists specialize in the diagnosis and treatment of mesothelioma. These oncologists stay up-to-date on all the latest malignant mesothelioma treatment guidelines. Your oncologist will be the primary doctor who oversees your care and any chemotherapy you may receive. Your oncologist will also coordinate with other doctors involved in your treatment such as your radiologist, surgeon and palliative care doctor.

What Is the Average Cost for Mesothelioma Treatment?

The average cost of treatment for malignant pleural mesothelioma is comparable to lung cancer treatment, which costs $60,709 during the initial year after diagnosis, according to recent projections from the National Cancer Institute.

Treatment of malignant mesothelioma can be expensive if you don’t have health insurance or financial resources. Cost is difficult to pinpoint because every case is unique. Chemotherapy costs vary depending on the type of cancer, the drugs used and patient-specific factors. The total cost for pemetrexed (Alimta) plus cisplatin — the most used chemotherapy combination for first-line treatment of mesothelioma — was $40,102. According to a 2013 cost-effectiveness study comparing the drug pair with other chemotherapy regimens.

The estimated monthly cost of radiation therapy is $2,000. The total expense depends on your health coverage and the number of treatments you receive. According to a 2015 study published in the Journal of Oncology Practice. The median cost of a course of radiation therapy for lung cancer patients was $9,000.

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Mesothelioma Master: Mesothelioma Treatment
Mesothelioma Treatment
The most common mesothelioma treatment involves a combination of surgery, chemotherapy and radiation therapy. In cases where standard treatments do not work...
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