Mesothelioma Lung Cancer Treatment Overview
While the information in this article is deemed to be accurate, it is in no way intended as a substitute for medical care or as medical counsel. If you have a known risk for mesothelioma, have had prolonged contact with asbestos, or suspect you have symptoms suggesting mesothelioma, please contact your physician immediately.
INTRODUCTION
Malignant mesothelioma is a rarely-seen cancer most frequently affecting the pleura (the lining of the lungs) or the peritoneum (the lining of the abdominal cavity). This type of cancer is almost never found except in people exposed to asbestos over a long period of time. Something about the presence of inhaled asbestos causes changes in the genetic code of mesothelial cells, which line the cavities in the body. Researchers are trying to find out why these changes occur, hoping to discover improved methods for treatment and prevention. Not all people exposed to asbestos will develop mesothelioma.
At this time, mesothelioma patients do not have a good prognosis. Due to the disease's rapid progression affecting vital organs, most people diagnosed with mesothelioma will live only four to eighteen months after diagnosis. The one-year survival rate is less than 30 percent. As with other cancers, those patients diagnosed very early in the disease progression and who are in good health otherwise have the best outlook. Early detection increases the likelihood for surgical removal of the tumor, which, if successful, is the patient's best chance for survival. Doctors and scientists are working hard to find new therapies that will offer patients extended years and more comfort.
TREATMENT
Most all cancer treatments use one or a combination of three tactics: surgery, radiation, and chemotherapy. Depending on the location, spread, and stage of the cancer, these three tactics have varying levels of success. Treating malignant mesothelioma has proven to be frustratingly difficult for doctors, patients, and patients' families. Often, the treatment methodologies are too poorly tolerated, ineffective against this type of cancer, or not appropriate given mesothelioma's rapid spread. As a result, treatments for mesothelioma are frequently palliative rather than curative. This means that procedures are often performed to ease pain and discomfort for a patient, and are not done to bring about a cure. Many treatments may improve quality of life or extend a patient's. In rare circumstances, if the disease is found early enough, a patient may be offered the hope of a cure.
SURGERYSurgery is often a first-line defense against many cancers. In an ideal situation, a surgeon can remove the cancerous cells and any adjacent tissue that may become affected. Since malignant mesothelioma strikes people in their older years, patients' overall health is often too poor for surgery. Even in cases in which a patient could tolerate surgery, the rapid spreading of mesothelioma and the sensitive areas affected by the cancer often make surgery an inappropriate choice. Surgery performed on mesothelioma patients frequently has comfort, or in some cases the extension of the life span, rather than treatment as its goal.
Although rare, situations do occur in which the mesothelioma merits what is hoped to be a curative surgery. This happens most often when the cancer has been diagnosed very early and has not spread. This type of operation, called an extrapleural pneumonectomy, is a very specialized, very extensive operation, performed at a specialty cancer center. In this procedure, a team of surgeons removes the entire lung on the affected side and the pleura lining the chest wall, pericardium (the lining around the heart), and the diaphragm. If surgery is not considered a viable option, chemotherapy and/or radiation may be an option.
CHEMOTHERAPY
Chemotherapy offers a drug-based treatment for cancers. In this method, drugs enter the bloodstream and travel through the whole body to attack the cancer cells. With mesothelioma treatments, these drugs are sometimes given intrapleurally (directly into the pleura) or intraperitoneally (directly into the abdomen) though pill-based drugs and intramuscular drugs are available as well. When surgical removal of a cancerous mass is impossible, chemotherapy can provide relief for malignant mesothelioma patients.
Several recent chemotherapeutic advancements are significantly prolonging life and reducing discomfort. A relatively new combination of two specific drugs is now commonly used to fight mesothelioma. These drugs, cisplatin and pemetrexed, now comprise a primary choice for chemotherapeutic treatments for mesothelioma. Other drugs, too, are available for those patients who do not respond well to or tolerate these two (though pemetrexed especially has limited side effects and a good track record of shrinking the tumors). Additionally, new combinations, new administrations, and new drugs themselves are all on the medical horizon for cancer patients. One new drug regimen has recently shown some success by heating the drug up to slightly above body temperature and then "washing" it through the pleura during a surgical procedure in which the lungs are exposed. As with all treatments, chemotherapy stands the most chance of success when the disease is caught early and has not spread beyond its initial (sometimes caused "index") spot.
Side effects of chemotherapy can include nausea, vomiting, fatigue, easy bruising, mouth sores, appetite loss and hair loss, among others. Patients receiving chemotherapy run a higher risk of infection due to the drugs' damaging effect on bone marrow, the substance in the body that produces infection-fighting blood cells. While undergoing chemotherapy, patients may be prescribed additional drugs to alleviate any unpleasant side effects and to restore vitamins and minerals to the body. Most side effects will disappear once treatment is stopped.
RADIATION
Radiation therapy is considered a good treatment option for those mesothelioma patients who cannot tolerate surgery or chemotherapy. With radiation therapy, high levels of energy are sent into the cancerous areas of the body with the intention of killing the cancer cells. Because radiation can also kill or damage healthy cells, it is best used in localized, targeted areas, and not systemically.
Radiation therapy can take two main forms. The first, most commonly given radiation treatment for mesothelioma is external-beam radiation. In this kind of radiation therapy, a high energy x-ray is targeted at the cancerous area. Brachytherapy radiation is a treatment in which radioactive material is placed directly into the cancer site. Radiation therapy can be used to treat uncomfortable or painful symptoms of mesothelioma. New combinations of radiation therapy with chemotherapy and surgery may become a regular practice in the treatment of mesothelioma.
While radiation therapy itself is no more painful than an x-ray, some uncomfortable side effects can occur. These include fatigue, nausea, shortness of breath, or skin changes. As with chemotherapy, doctors can prescribe medications to ease these discomforts.
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)
CAM refers to the treatment of disease that falls outside the realm of medicine. Sometimes these are harmless, even beneficial procedures, such as yoga, prayer or meditation, massage, or exercise. Other times CAM can include herbal concoctions, vitamins, and products labeled "dietary supplements." These in the latter group should be approached with caution and only with the consent of the patient's cancer care team. Whereas most of these remedies are probably innocuous, anecdotes abound in which CAM has caused real harm, and sometimes death. A very real danger of CAM is the possibility of abandoning traditional medical treatment. Doing so may seriously jeopardize a patient's ability to get better, shorten his or her life expectancy, or lead to further discomfort. When faced with a terminal diagnosis, many people look for a "magical" cure, maybe one unknown to scientists and doctors. This is a normal reaction. Unfortunately, there are no known cases of CAM products or procedures curing malignant mesothelioma.
THE FUTURE OF MESOTHELIOMA TREATMENT
Researchers are constantly searching for new treatments for cancer. In the future, perhaps even the near future, immunotherapy, gene therapy and other innovative medical breakthroughs will be available to mesothelioma patients. Multimodality therapy, a combination of surgery, radiation, and chemotherapy, is being studied in clinical trials and labs with some promising results. Gene therapy, in which modified viruses are designed to infect the cancerous mesothelial cells is also showing some promise in clinical trials. Immunotherapy is an up-and-coming treatment designed to give a boost to the patient's own immune system, allowing it to fight the cancer more aggressively.
In order to discover the best methods of using these new therapies, researchers rely heavily on participation in clinical trials. Clinical trials offer benefits to researchers by allowing them to study the effect of a new drug or procedure, but they also offer some hope to patients who are not showing response to the more standard cancer treatments. In these cases, patients entering clinical trials may experience their best chance of recovery or life extension. Many institutions provide information about getting into clinical trials. For clinical trial information:
Many federal research dollars are assigned annually to cancer research projects as scientists aspire to find new solutions to the challenges of treating cancer.
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