Treatments for mesothelioma are greatly varied and determined by physicians after careful consideration of many factors, including how quickly in the course of the mesothelioma’s development a diagnosis is achieved. The size of the mesothelial tumor and whether its surgical removal is possible also influence the physician’s decisions in treatment planning. Other physical problems the patient may have, as well as the patient’s age, will also be considered. Additionally, the malignant mesothelioma will be treated differently from the benign, and a recurring cancer might be approached with a different treatment plan from the cancer that is newly diagnosed.
If a mesothelioma is diagnosed early in the cancer’s progression, the patient is described as being in the early stage of the disease, as opposed to the end stage. Treatment options are generally more favorable when the cancer is caught in its earliest stages, as the cancer is less likely to have spread or metastasized.
Surgery
Surgical removal is frequently the recommended treatment for pleural mesotheliomas, and can be performed in several ways. The surgeon may decide to remove the mass as well as some of the unaffected tissue directly adjacent to it. By including some of the healthy surrounding tissue in the excision, the surgeon further ensures the malignancy’s complete removal. Another surgical option involves the removal of a portion of the lungs’ covering and some of the lungs’ exterior surface. The surgeon may also choose to completely remove one of the lungs and the lining around it; this procedure is called a pneumonectomy. There is also the option of using a chemical scarification procedure which deters the subsequent collection of pleural fluid. For peritoneal mesothelioma, the surgeon may remove part of the abdominal muscle known as the diaphragm in addition to the affected peritoneal area and mass. This procedure may also extend to parts of the lungs and/or pleural mesothelium if such tissues are discovered to be affected by the cancer’s spreading.
Radiation
Another treatment option for mesothelioma may be radiation therapy. This therapeutic treatment uses invisible, high-energy rays to target cancerous cells in a certain area of the body. This is achieved either through external radiation, which is administered with a machine, or through internal radiation from the implantation of small amounts of radioactive materials at the affected site. By destroying the DNA or genetic material of the cancerous cells, radiation strips away the diseased cells’ ability to proliferate, leading to their death.
Radiation therapy is often used in conjunction with surgery and performed after the patient recovers from surgery. This type of treatment combination is referred to as adjuvant therapy, in which a secondary treatment is administered after a primary treatment. Other treatment specific terms that may be used to describe the use of different cancer treatments in conjunction include combination and multimodal. A combination refers to a variety of treatments within the same therapy, while a multimodal treatment is one that incorporates two or more modes of treatment, like surgery and radiation.
In radiation therapy, it is impossible to avoid doing some damage to healthy tissue surrounding the cancerous area, but normal tissue can repair itself in most cases. The treatments are usually delivered over a series of several weeks. Most of the time, this form of radiation therapy is administered on an outpatient basis. There is no pain involved, and the treatments are fairly short in duration.
For internal radiation therapy, the radioactive materials are either inserted, injected, or swallowed, and usually involve the implantation of a radioactive agent in or around the cancerous mass. This form of treatment can be used independently or in conjunction with external radiation therapy, and sometimes requires the patient to be hospitalized. When radiation is delivered by mouth or injected intravenously, it is referred to as a radiopharmaceutical.
Common side effects with radioactive treatments include fatigue and loss of appetite. Skin irritation, hair loss to the treatment area, and localized symptoms based on the radiation site may also be experienced.
The efficacy of radiotherapy has been questioned due to some evidence of the treatment’s potential for apparently causing the very cancerous growth that it was designed to destroy. Additionally, malignant mesothelioma tends to infiltrate surfaces on a more extensive level than can be treated with radiotherapy.
Chemotherapy
Chemotherapy may also be used as a treatment for malignant mesothelioma. This therapy involves powerful drugs that are used to destroy cancerous cells. Chemotherapy can be delivered through an injection, by mouth, or in an intravenous (IV) system. In a process called regional chemotherapy, chemotherapeutic chemicals can also be deposited directly into the affected organ or tissue.
Chemotherapy works by interfering with the replication and division of cancer cells’ DNA. This therapy can shrink, halt, or cure cancers, or in the case of advanced stages of the disease, can provide relief of symptoms.
The many side effects of chemotherapy require that the patient undergo a recovery phase between the cycles of treatment. These side effects are mainly the result of chemotherapy’s attack on healthy cells with similar reproduction rates as cancerous cells, for example, the stomach, intestines, and hair follicles. Nausea and vomiting are common effects, as are hair loss and diarrhea. Weight gain or loss, fatigue, and anemia are also possible results from chemotherapy. Treatment cycles continue until as many cancer cells as possible are destroyed while maintaining enough bodily strength and resilience through intermittent breaks from chemotherapy.
Malignant mesotheliomas have not shown a strong responsive reaction to chemotherapeutic agents, and no standard regimen of chemotherapy is identified as preferable or routine for treating the disease. However, chemotherapy treatments have shown occasionally good responses for mesotheliomas.
While the benefits of radiation and chemotherapy for the patient with malignant mesothelioma have been analyzed and questioned, the limited treatment options for most mesothelioma patients requires their continued use. In addition to these forms of treatment, a surgeon or physician may choose to relieve pain and pressure from the abdomen and/or lungs by using a needle or tube to drain the fluid that has collected in these areas.
