Mesothelioma Treatment Options - Patient Medical Research & Pain Management

1) Keep up an open dialogue with your doctor

It is natural to want to understand as much as possible about a disease and its treatments, particularly when the disease is as rare as malignant mesothelioma. The Internet has opened up a wealth of information on mesothelioma, however, it is still important to keep in mind that your doctor is your FIRST and (hopefully) BEST resource for understanding and dealing with this disease.

This does not mean that you shouldn't explore resources and treatments on your own; a good doctor wants informed patients who are interested in discussing every available option. Only a trained physician, however, can help you understand each treatment and evaluate how it fits in with your particular circumstances, including the stage of your disease.

There are valuable research and support resources available via the Internet which can assist you in your efforts to gain medical knowlege as you begin your interaction with your doctor. To begin, there is an online resource that tutors on how to use the Internet to research a lung cancer diagnosis. This tutorial also cautions you as a researcher to be mindful of the limitations of Internet-based research and to learn how to evaluate the information that you do find. Another useful tool to assist in being an informed patient is The Cancer Patient's Workbook: Everything You Need to Stay Organized and Informed, (DK Books, 2001). This workbook hopes to help the patient better understand their situation so they may deal with and fight their disease from an informed position. This interactive guide helps patients cope and also explains how to receive the best treatment possible.

2) Explore the American Cancer Society's Cancer Resource Center

This community-based organization claims its mission is "eliminating cancer as a major health problem...through research, education, advocacy, and service." As a non-governmental organization, the American Cancer Society is the largest source of private funds earmarked for cancer research. The ACS website is a very good place for you to investigate ongoing research and treatment options, as well as find extensive links to help further direct your medical research.

The American Cancer Society provides a useful fact sheet that describes the asbestos - mesothelioma link. If you suspect that you might have mesothelioma, there are several methods which can help to detect the presence of this disease.

While you may find some answers on this particular site, the ACS advises you to remember that as you cope with cancer and cancer treatment, you need to have honest, open discussions with your doctor. You should feel free to ask any question that's on your mind, no matter how small it might seem.

3) Explore the National Cancer Institute's PDQ

The National Cancer Institute provides a computer service called PDQ to give up-to-date information on cancer issues for patients, their families, doctors, and other healthcare professionals. Detailed information on detection, diagnosis, treatment, support groups, clinical trials and treatments is reviewed and updated each month by oncology experts. Each topic is discussed in two tracks, one for patients and one for healthcare professionals.

You might want to visit the information written for patients first, in order to get a clear understanding of the issues discussed in layman's terms. For more detailed information, you can then explore the physician's track.

By going to NCI's CancerNet, you can research the PDQ informational summaries for malignant mesothelioma; these summaries are written for both patient or professional readers. You will also find a useful overview on researching, treating, and coping with malignant mesothelioma.

You will find links to other treatment specific PDQ pages throughout this website.

4) Explore MEDLINE

Published by the National Library of Medicine, MEDLINE is a comprehensive index of medical citations and abstracts dating back to 1966. In the past, this database was available only to students, doctors or by subscription. However, there are now several Internet resources which offer free MEDLINE access, including PubMed and MedlinePlus. Use of both services is free, although you must initially fill out a member registration form.

An additional benefit of these services is access to full-text versions of many of the articles. PubMed publishes a list of MEDLINE journals with links to publisher web sites at: http://www.ncbi.nlm.nih.gov/PubMed/fulltext.html. Access to these articles may require user registration or a small fee, but recent issues are often available free of charge.

These publications and abstracts are not written for the layperson, so make sure you discuss any literature you read with your doctor before making any decisions about them.

Although MEDLINE is the most comprehensive database of medical literatere, the National Cancer Institute also has a free database of cancer-specific abstracts and literature.

5) Contact the Cancer Information Service

The National Cancer Institute offers an informational and educational service known as the Cancer Information Toll-Free Telephone Service (CIS). Information is available in Spanish and English, and is up-to-date and easy to understand. You can get information about recent scientific advances, cancer programs, prevention, early detection, and other topics.

Contact the CIS, toll-free in the United States and Puerto Rico, at 1-800-4-CANCER (1-800-422-6237), Monday through Friday, 9:00 a.m. to 4:30 p.m., your time.

6) Explore OncoLink

The University of Pennsylvania maintains OncoLink, an outstanding resource on the web for information about all types of cancer and related topics. The homepage is http://www.oncolink.com and has information about clinical trials, symptom management, cancer support services, financial issues, book reviews, and many other topics. OncoLink has mesothelioma patient information found under Patient Statement: Malignant Mesothelioma. For a more personal perspective, there is also an article entitled "Thoughts from a Mesothelioma Patient".

Lastly, for a broad resource on the cancer topic and links to specific web sites, consult the Lung Cancer Resources Directory.

If you have questions, need more information, or experience difficulty accessing these sites, please feel free to contact us and we will do our best to help.

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.