Which treatment option will be best for you as an individual, depends on many factors including your age, overall health status, stage of the cancer, cell type (which determines the aggressiveness of the cancer) and most importantly, your personal wishes. To assist you in evaluating these options, you will have a “multidisciplinary team” (MDT) of doctors, who will discuss your case and provide you with their suggested treatment strategy. These team members may include a cardiothoracic surgeon, a medical oncologist, a radiation oncologist, a pain management specialist, and a palliative care specialist. Nurses and other health care workers may also be involved in your care.
Conventional treatment for mesothelioma offers several options, and you should discuss each option thoroughly with your MDT before making a treatment decision. Be sure you are informed as to the risk factors, prognosis with treatment, potential side effects and quality of life each option affords.
There are two surgical approaches to mesothelioma, pleurectomy/ decortication (P/D) and extrapleural pneumonectomy (EPP). These are extremely specialized surgeries, and may not be offered at all facilities. Not all thoracic surgeons have expertise in these types of surgeries. The ultimate goal of these procedures is the removal of all gross disease, with the knowledge that residual microscopic disease will most likely remain. Adjuvant therapy, in which additional forms of treatment are used along with the primary therapy, is typically aimed at the elimination of this residual disease. The most common forms of adjuvant therapy are chemotherapy and/or radiotherapy.
Pleurectomy/decortication is considered the less radical of the two approaches since it involves only the removal of the pleura (lining of the lung) without resecting the underlying lung. In some cases, the pericardium and diaphragm may be removed, dependent on the extent of the tumor. Advantages of this procedure are a generally quicker recovery time, and usefulness for patients who may not be able to tolerate the more radical EPP. Disadvantages include an increased risk for recurrence of the disease because of inability to remove all cancerous tumor, and inability to use high dose adjuvant radiation because of potential damage to the underlying lung.
Extrapleural pneumonectomy is a more radical procedure involving the removal of the lung, the pleura (lining of the lung), the pericardium surrounding the heart and part of the diaphragm. During surgery the pericardium and the diaphragm are reconstructed with a Gortex-like material. Patients may be eligible for this surgery only if they meet certain staging criteria and demonstrate adequate pulmonary and cardiac function to be able to tolerate the procedure.
Chemotherapy involves the use of anti-cancer drugs which work by preventing cancer cells from multiplying. In most cases, combinations of drugs are used in order to increase effectiveness. Chemotherapy may be used aggressively to shrink the tumor, or palliatively to relieve symptoms such as shortness of breath or pain. Administration of chemotherapy may be via injection into a vein or muscle, as an oral medication or may sometimes be administered directly into the pleural or peritoneal cavity. Some of the most commonly used drugs include:
New drugs are constantly being investigated by pharmaceutical companies, so you should always feel free to ask your doctor about the newest and most promising drugs. One such drug, Alimta (pemetrexed) was approved in Europe in September, 2005.
Radiotherapy involves the use of high energy x-rays to kill cancer cells and shrink tumors. It may be used aggressively in conjunction with surgery to help eliminate microscopic seeding which can cause recurrence of disease, or palliatively to treat pain caused by tumors pressing on nerve endings or on another organ. Radiotherapy has also proven effective in preventing tumor seeding at the sites of biopsy or chest tube drainage.
The purpose of clinical trials is to involve patients in finding new and better treatments for their illnesses. Different clinical trials have different goals which may include the testing of new drugs, comparing various ways to treat an illness or the testing of various techniques for cancer prevention. Clinical trials are divided into three phases. Following are short summaries of what each trial phase seeks to accomplish.
Phase I trials are the earliest phase of the clinical trial system. At this point, drugs have only been tested in the laboratory, but have had an effect on destroying cancer cells. These trials enroll only a limited number of participants, and are only available at limited cancer facilities. The goal of Phase I trials is to find the maximum tolerated dosage of the drug without causing serious side effects, which side effects are most common and whether the drug continues to have anti-cancer activity when administered to humans. If the drug is proven to have an effect on cancer at a safe dosage, the drug will then be tested in Phase II trials.
Phase II trials continue to test the safety of drugs or procedures, but also begin to look more closely at their effectiveness for particular types of cancer. These trials accrue somewhat larger numbers of participants, and may be located at more facilities. These trials may be “randomized”, meaning that different groups of participants are chosen by a computer, rather than by a doctor.
Phase III trials compare promising new drugs or procedures with the current standard of treatment. Large numbers of participants from widespread areas are accrued for these trials, and receive either the new treatment or the standard treatment. One of the primary goals of Phase III trials is to determine whether cancer is reduced or slowed by the drugs, how long patients remain stable without progression of disease and how treatment with the drug affects the patient’s quality of life.
If you are interested in participating in a clinical trial for mesothelioma, your doctor should be able to provide you with information on eligibility and availability in your area.
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