Mesothelioma: a deeper understanding of current treatments
Mesothelioma is a rare form of cancer that affects the cells that make up the mesothelium, the thin layer of tissue that covers many of the internal organs. The most common area affected is the lining of the lungs and chest wall. Less commonly the lining of the abdomen and rarely the sac surrounding the heart, or the sac surrounding the testis may be affected. Signs and symptoms of mesothelioma may include shortness of breath due to fluid around the lung, a swollen abdomen, chest wall pain, cough, feeling tired, and weight loss. These symptoms typically come on slowly. More than 80% of mesothelioma cases are caused by exposure to asbestos,
Mesothelioma: Statistics
About 3,000 people, each year, are diagnosed with mesothelioma in the USA. It occurs more often in men. The average age for a pleural mesothelioma diagnosis is 72. The overall 5-year survival rate for people with mesothelioma is only 10% because it’s usually diagnosed very late. If the cancer is found at an early, localized stage, the 5-year survival rate for people with mesothelioma is 20%. If the cancer has spread to nearby areas and/or lymph nodes, the 5-year survival rate is 12%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 8%.
How is Mesothelioma treated?
The American Society of Clinical Oncology recommends four Mesothelioma treatment options: 1) Surgery: patients diagnosed in the early stages benefit most from mesothelioma surgery. It offers them the best chance at living longer lives. These procedures, often performed with chemotherapy, remove all visible tumors from the chest area and improve quality of life. 2) Radiation: radiation therapy controls symptoms when surgery is not an option. It eases symptoms such as chest pain and discomfort. Radiation can also reduce the risk of local recurrence when combined with surgery, and it can be used as a palliative procedure. 3) Chemotherapy: doctors may recommend chemotherapy to mesothelioma patients deemed ineligible for surgery. Chemotherapy also helps extend survival rates. A 2016 Wayne State University study found patients given a chemo drug combination lived three times longer than patients without it. 4) Multimodal Therapy: also known as multimodality treatment, it’ss the combination of two or more conventional treatments to treat the pleural and peritoneal types of mesothelioma. This combined approach controls cancer growth better than using only one treatment.
Emerging treatment options include immunotherapy, photodynamic therapy, virotherapy, gene therapy, cryotherapy and epigenetic therapy. The NovoTTF-100L system, which the FDA approved in May 2019, is the newest first-line treatment for mesothelioma since 2004.
Pleural Mesothelioma
Pleural mesothelioma affects the pleura, which is the lining of the lungs. Doctors will choose the best treatment that will remove or reduce tumors from this area or minimize symptoms to improve quality of life.
There are 2 main Surgery treatments for Pleural mesothelioma: the Extrapleural Pneumonectomy (EPP) removes the entire cancerous lung and all nearby areas where mesothelioma spreads. Pleurectomy Decortication (P/D) spares the lung and only removes cancerous parts of the pleural lining, the chest wall lining, heart lining and the diaphragm.
Hyperthermic Intrathoracic Chemotherapy (HITHOC) is an experimental procedure that delivers heated chemotherapy drugs throughout the chest cavity. This procedure is performed after a surgeon has removed visible cancer growth through surgery.
External Beam Radiation Therapy (EBRT) is the most common form of radiation for treating mesothelioma. A machine placed outside the body delivers X-ray beams to kill cancer cells. Doctors may use EBRT before or during surgery. Brachytherapy is a type of internal radiation that uses a radioactive implant to kill nearby cancer cells. Brachytherapy can be used with other conventional treatments.
Peritoneal Mesothelioma
Peritoneal mesothelioma forms on the peritoneum, which is the tissue lining the abdominal cavity. While this type of mesothelioma can be treated with all conventional treatment options, a combination of heated chemotherapy and surgery works best.
The recommended surgery treatment is the Cytoreductive Surgery that removes cancerous growths from lining of the abdomen. HIPEC often follows this treatment. As Chemotherapy treatments, the Heated Intraperitoneal Chemotherapy (HIPEC) is the most effective mesothelioma treatment option for this type of the cancer. Doctors deliver heated chemotherapy drugs into the abdominal cavity after surgery. The process kills remaining cancer cells.
Palliative Cares
Mesothelioma palliative treatment is also known as supportive care with a focus on controlling symptoms. It can improve quality of life and relieve cancer and treatment symptoms. Common palliative procedures for mesothelioma can vary from Thoracentesis, PleurX catheter, Pleurodesis, Radiation, Paracentesis and Pericardiocentesis.
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