Mesothelioma Treatment

A treatment program for Mesothelioma revolves around three primary approaches: Surgery, Chemotherapy or Radiation. There is a forth category but it is primarily a combination of Chemotherapy and Radiation and is mentioned as an adjunct to the other two.
*MESOMARK Blood Test
As of January 2007, the FDA has approved the MESOMARK assay to help monitor response to treatment in epithelial and bi-phasic malignant Mesothelioma patients. A specific protein, or biomarker, called Soluble Mesothelin-Related Peptide (SMRP), may be released into the blood by Mesothelioma cancer cells. By measuring the amount of SMRP in a blood sample, doctors can better monitor a patient's progress. Based on the limited amount of data currently available, use of this test may be beneficial, but effectiveness has not been determined at this time. The MESOMARK blood test has NOT yet been approved for the early diagnosis of Mesothelioma.
This test has been approved as a Humanitarian Use Device (HUD), meaning that physicians must follow certain procedures to qualify their patients for testing. Once the physician is certified, informational brochures will be sent to be distributed to each applicable patient.
Those wishing to take part in MESOMARK testing will be asked to provide one or more samples of blood. The blood samples will then be sent to a national reference laboratory for testing. In conjunction with other clinical and laboratory data obtained by your doctor, decisions regarding your treatment and care may be simplified. You may discontinue testing at any time.
The costs associated with the MESOMARK blood test may not be covered under health insurance, therefore, you may be required to pay all or part of the costs out of pocket. It is recommended that you check with your insurance carrier to determine whether coverage is available under your policy.

*Source: Fujirebio Diagnostics, Inc, February 7, 2007

SURGERY
Surgical procedures for the treatment of Mesothelioma can be broken down into three broad categories: Diagnostic Surgical Procedures; Palliative Surgical Procedures; and Potentially Curative Procedures. Each of these three broad groups are the broken down to specific surgical procedures for that group.
Diagnostic Surgical Procedures
A noninvasive diagnosis of Mesothelioma is many times inconclusive. Because of this, diagnostic surgery may be necessary as a next step in confirming that the patient has Mesothelioma.
Mediastinoscopy
Mediastinoscopy (a surgical procedure that allows physicians to view the cavity behind the breastbone that lies between the lungs) uses a mediastinoscope inserted through an incision to detect or stage the Mesothelioma. The purpose of the Mediastinoscopy is to allow the physician to directly see the organs inside the cavity, and to collect tissue samples for study.
Laproscopy
Laproscopy procedure is where small incision is made, through which a viewing tube (laparoscope) is inserted. The viewing tube houses a small camera allows the doctor to examine the abdominal organs on a video monitor. It is sometimes used in Mesothelioma patients when the imaging techniques show that there is a possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential surgery.
Thoracoscopy
This procedure is when an endoscope (a narrow-diameter tube with a viewing mirror or camera attachment) is inserted through a small incision in the chest wall. This enables a physician to look at the pleural cavity and to conduct multiple tissue biopsies under direct vision. In 98% of the cases, Mesothelioma can be definitively diagnosed. Often, treatment to relieve the accumulation of fluid in the chest cavity can be done during the same procedure. The doctor can also gauge the extent of the tumor, and make a determination if further surgical intervention is necessary.
VATS, Or Video-Assisted Thoracic Surgery
VATS is an alternative to thoracoscopy. But because of its more invasive nature, there is the possibility of increasing tumor seeding. By using small incisions, the physician can view the pleural space by camera, and also obtain tissue samples to be analyzed. The extent of the tumor (i.e., pleural involvement, chest wall invasion) may also be determined.
Palliative Surgical Procedures (Relieves the symptoms of Mesothelioma)
Palliative Surgical Procedures treat a symptom of Mesothelioma, without aggressively treating the disease itself.
Chest Tube Drainage and Pleurodesis
This is the most common of palliative treatments. Fluid build-up is often the first symptom which prompts Mesothelioma patients to seek medical attention. Once this fluid build up has occurred, it is often persistent, returning rapidly after initial draining of the fluid. In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other agent which produces an adhesion.
Thoracoscopy and Pleurodesis
This procedure uses a powdered form of talc instead of a talc slurry. Both this and the chest tube drainage will only be effective if there is no tumor encasing the lung restricting its expansion.
Pleuroperitoneal Shunt
A Pleuroperitoneal Shunt has limitations for several reasons. First, it involves the placement of a catheter that runs under the skin from the pleural to the peritoneal cavity. Secondly, obstruction of the catheter and the possibility seeding the tumor into the abdominal cavity is a real concern.
Pleurectomy
Pleurectomy (excision a portion of the pleura) is used where more extensive surgery is not an option. When it is used, it is understood that not all of the visible or gross tumor will be removed. A Pleurectomy is considered the most effective means of controlling fluid build up in cases where the lung's expansion is restricted by the Mesothelioma.

Potentially Curative Procedures

These are procedures that are performed with "curative intent". Their goal is the removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Another form of treatment in addition to the primary therapy is typically aimed at eliminating any residual disease.
For Peritoneal Mesothelioma:
Cytoreductive Surgery (debulking surgery done to remove as much of the tumor as possible) is intended to remove all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, chemotherapy is used.
For Pleural Mesothelioma:
Pleurectomy/Decortication (removal of a portion of the pleura while removing the outer covering of another organ is) is usually performed on patients with early stage disease (Stage I and selected Stage II). It attempts to remove the entire gross tumor. If all of the tumor can not be removed without removing the lung, then the lung may be removed at the same time.

Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If the patient is considering surgery as a treatment option, he/she should speak openly with the doctors about his/her concerns, and be sure all of his/her questions are answered.

CHEMOTHERAPY

Chemotherapy is the treatment of cancer using chemical substances. When cancer occurs, abnormal cells divide uncontrollably. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals in the treatment of cancer. The goal for the use of a certain chemotherapy drug depends on the stage of the cancer at the time of diagnosis and the age and health of the patient. Chemotherapy for Mesothelioma is not considered "curative"; therefore the goal is:

• The control of the cancer by stopping its spread or slowing its growth.
• The shrinking tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
• The destruction of microscopic remnants of the Mesothelioma disease which may remain after surgery. This is called adjuvant chemotherapy.
• The relief of symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.

The most common use for chemotherapy treatment in a Mesothelioma patient is as an option for those who are not surgical candidates or as an adjunct to surgery.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously. A thin needle is inserted into a vein in the hand or in the lower arm. This allows for rapid entry of the chemotherapy drugs into the blood stream. Drugs may also be delivered via catheters and/or ports.

• Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.
• The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.

Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be delivered directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.

Side Effects of Chemotherapy

Cancer cells are normal cells that begin to grow and divide out of control. The problem is that there are some normal cells that grow, divide and multiply quickly. In particular, cells in the digestive tract, the reproduction system, and hair follicles all grow and divide rapidly. It is the damage done to these normal cells that just happen to grow rapidly also, that causes the side effects of chemotherapy. The type of side effects a patient might experience and how severe those side effects are, depend on the type of chemotherapy the patient is receiving; the dosage given to him/her; and how the patient's own body reacts to the chemotherapy drugs.
How long a chemotherapy regime takes and how often the treatments are given depend on a number of factors such as the overall health of the patient, the type and location of the tumors, the patient's reaction to the chemotherapy drugs and how severe the side effects are and the particular type of chemotherapy drugs that are used.
Before beginning any chemotherapy treatment, the patient will be asked to sign a consent form. Before signing the form, the patient should be sure that the doctor informs him/her of all the facts regarding the treatment he/she will be receiving. This consent form should include information about the particular drug or combination of drugs to be used, the possible risks or side effects, the number of treatments he/she will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis.
Radiation Treatment for Malignant Mesothelioma
When using radiation as a treatment for malignant Mesothelioma, a high energy source of radiation (such as X-rays) is used to kill cancer cells by ionizing the material of the cells nucleus. This process prevents the cells from growing and reproducing.
Radiation is most useful for tumors which are well defined and have not spread to other parts of the body. It may be used in cases in which surgery has removed most of a well defined tumor but can not remove all of the mass or as an adjunct to chemotherapy I the same manner.
Since malignant Mesothelioma is a cancer of the thin sack like structure, it is generally spread over relatively large areas. This makes it make it almost impossible to use a high enough dose of radiation to kill the cancer without injuring other organs and tissues around the tumor. Because of this radiation is almost always an adjunct to either surgery or chemotherapy.