Know your treatment options for mesothelioma

An average of 3,000 people in the U.S. are diagnosed with mesothelioma each year.  This rare form of cancer is caused by asbestos exposure and may be found in the pleura (the lining of the chest and lung), the peritoneum (abdomen), the pericardium (the cone-shaped sac of membrane that encloses the heart), and the lining of the testes.

Around 60 percent of mesothelioma cases are pleural (start in the chest cavity) and 30 percent are peritoneal (start in the abdomen).  Pericardial, which starts in the lining around the heart, and testicular, which starts in the lining of the testes, are very rare, but still dangerous.  Around 5 percent of mesothelioma cases diagnosed each year are pericardial and 1 percent is testicular.

After exposure to asbestos, it can take anywhere from 15 to 60 years for symptoms to develop.  Because mesothelioma has such a lengthy latency period, it is typically diagnosed in individuals over 50 years of age.  It is more common in men than women, with one woman diagnosed for every four men.

View MRHFM’s What is Mesothelioma infographic to review more statistics about mesothelioma.

Once a patient has been diagnosed with mesothelioma and has been deemed fit for conventional treatment, the oncologist may prescribe a treatment combination consisting of surgery, chemotherapy, and radiation.

When diagnosed at an early stage (Stage I/Localized has the best prognosis), the oncologist will work together with a surgeon to determine which surgical procedure will be most effective in removing the mesothelioma.

Surgical options include:

• Thoracentesis
• Pleurectomy
• Extrapleural Pneumonectomy (EPP)

Thoracentesis, also called “thoracocentesis,” is a procedure that helps treat shortness of breath by removing fluid in the pleural space.  The surgeon will insert a needle, catheter or tube into the chest to drain the fluid.  To prevent fluid from returning, the surgeon may perform a pleurodesis, which involves injecting an irritant such as talc or other substance into the chest.  This creates inflammation and causes the membranes around the lungs to stick together, which eliminates the space between the pleura where fluid may reaccumulate.

If performed in the abdominal cavity, the procedure is called “paracentesis” If the procedure is performed in the sac around the heart, it is called “pericardiocentesis.”

Pleurectomy is surgical removal of part of the pleura, which is sometimes done to prevent further recurrences of spontaneous pneumothorax (a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse) or to remove diseased areas of pleura.

Extrapleural Pneumonectomy (EPP) involves the removal of the diseased lung, part of the pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and the abdomen), and part of the parietal pleura (membrane lining the chest), according to the Division of Adult Cardiothoracic Surgery at the University of California, San Francisco (UCSF).

According to the Division, an extrapleural pneumonectomy is usually performed on patients with early stage localized mesothelioma that has not spread to the lymph nodes or invaded surrounding tissues and organs.  EPP is sometimes performed in conjunction with radiation and/or chemotherapy, before or after the operation.

Chemotherapy drugs are used to kill and inhibit the growth and division of cancer cells.  There are several delivery methods including injection into muscle or a vein or by mouth (called systematic chemotherapy), and delivery directly to into an organ, spinal column, or body cavity (called regional chemotherapy).

Some of the most common types of chemotherapy drugs used to treat mesothelioma include:

• Alimta (generic name Pemetrexed)
• Platinol or Platinol-AQ (generic name Cisplatin)
• Paraplatin (generic name Carboplatin)
• Tomudex (generic name Raltitrexed)
• Onconase (generic name Ranpirnase)
• Gemzar (generic name Gemcitabine)
• Navelbine (generic names Vinorelbine, Vinorelbine Tartrate)

Depending on the treatment path, combination chemotherapy may be administered to mesothelioma patients. This involves the use of more than one chemotherapy drug.  For example, in 2004, the FDA approved Alimta (pemetrexed) in combination with Platinol (cisplatin) for the treatment of pleural mesothelioma.

Common chemotherapy side effects include hair loss, lack of appetite, changes in taste and smell, nausea, vomiting, fatigue, sun sensitivity, dry mouth, burning, tingling or numbing pain in hands and feet, diarrhea, constipation, hormonal disturbances, changes in memory and thinking (called “chemobrain”), and depression.

It is important to note that some people may experience one or several side effects of chemotherapy, while others may experience few, if any.

Radiation involves the use of high-energy x-rays or particles to kill cancer cells.  Two main types of radiation are used to treat mesothelioma including external beam radiation therapy (EBRT) and brachytherapy.

EBRT is the most common type of radiation used for mesothelioma. Used outside the patient’s body to kill cancer cells, this intense form of radiation is painless and it is typically administered five days a week for several weeks.

Brachytherapy is used internally in mesothelioma patients, and involves the placement of radioactive material in the abdomen or chest at the site of the cancer.

Common radiation side effects include fatigue and changes in the skin including blistering, dryness, itching and peeling.  Other side effects depend on the part of the body being treated and may include diarrhea, hair loss, nausea, urinary and bladder changes, mouth problems, swelling, trouble swallowing, and vomiting.

Fortunately, radiation side effects typically disappear within two months after treatment ends.

In many cases, the patient’s treatment team may utilize a number of complementary and alternative treatments to minimize the side effects associated with surgery, chemotherapy, and radiation or to help manage pain and other symptoms associated with mesothelioma.

Please click here to read MRHFM’s recent article about the different types of complementary and alternative treatments for mesothelioma patients.

For more information about mesothelioma, you can request a free copy of 100 Questions & Answers About Mesothelioma here or contact the client services team at MRHFM directly by calling 10866-373-5000.

Sources

100 Questions & Answers About Cancer Symptoms and Cancer Treatment Side Effects
Print. Joanne Frankel Kelvin, RN.

100 Questions & Answers About Mesothelioma
Print. Harvey I. Pass, MD.

Cooper Clinic Pennsylvania
Cooperclinic.com

MedicineNet.com
MedicineNet.com

National Cancer Institute at the National Institutes of Health (NCI NIH)
Cancer.gov