Treatment of Mesothelioma

Mesothelioma is one of those cancers where the therapy is multimodal. The standard treatment is surgery and followed by a combination chemotherapy regimen of Alimta and cisplatin.

Surgery

Surgery may be diagnostic, palliative, or potentially curative. The types of surgery most commonly used in the treatment of mesothelioma are:

• A pleurectomy or decortication is the removal of the pleura (lining of the lung) without resecting the underlying lung. Instead of resection, the tumor is stripped from the lung, diaphragm, and vessels. In cases of peritoneal mesothelioma, cytoreductive surgery, also called debulking, is used. The surgeon carefully looks for any sign of cancer in the abdominal cavity, and then removes as much of the tumor as possible. This makes it more likely that chemotherapy and/or radiation can kill remaining cells.
• An extrapleural pneumonectomy is a more radical procedure involving the removal of the lung, the lining of the lung (pleura), the pericardium surrounding the heart, and part of the of the diaphragm.

Surgery is looked at as a first line option for eligible mesothelioma patients. Evaluation for these surgeries should be made with input from a physician experienced in these surgical techniques.

Chemotherapy

Chemotherapy is literally "chemical therapy" - chemicals are injected into the body with the hope of destroying the cancer cells. Anticancer, or chemotherapy drugs, work to prevent cancer cells from multiplying.

Most mesothelioma patients undergo some type of chemotherapy. Indeed it is the mainstay of treatment for the majority of patients presenting as inoperable. Several types of chemicals are used, either alone or in combination. Drugs used to treat mesothelioma are given by injection into a vein or muscle (some are administered by pill) and thus go through the entire body. In some cases, specialists can administer the chemotherapy directly into the pleural or peritoneal cavity. By administering chemotherapy directly to the affected area, they hope to target the mesothelioma tumor more effectively. Targeted therapy is a sophisticated twist on chemotherapy that many scientists are pursuing

Although the most obvious use of chemotherapy is to control the cancer by stopping its spread or slowing its growth, other uses include:

• Neoadjuvant chemotherapy for mesothelioma - to shrink tumors prior to other treatments, such as surgery.
• Adjuvant chemotherapy for mesothelioma - to destroy microscopic disease which may remain after surgery.
• Palliative chemotherapy - to relieve symptoms, such as pain.

Chemotherapy drugs may have undesirable side effects. Doctors monitor the effects of these treatments. It is important to discuss with your doctor the chemotherapy options you are offered, including the expectations of success and possible side effects.

Radiation therapy

High-energy x-rays are used to kill cancer cells and shrink tumors. Radiation may be used palliatively to treat pain by shrinking tumors which may pressing on nerve endings or another organ. It may also be used in conjunction with surgery to eliminate microscopic seeding which can cause recurrence of disease.

Radiation therapy is commonly used for treatment of cancer, although it is not often used alone in the treatment of mesothelioma. Many physicians feel that traditional radiation therapy's benefits are outweighed by the damage it causes to healthy lung tissue.