NEW MESOTHELIOMA TREATMENT APPROACHES

New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include:

• Angiogenesis and Anti-angiogenesis Drugs

  Although progress has been made in the early detection of cancer, and in improved treatment options once cancer is diagnosed, there are still many cancers, including mesothelioma, which can not be cured and remain difficult to treat effectively. In recent years, researchers have learned a great deal about how cancer cells differ from normal cells and, in an effort to find drugs without the potentially severe side effects of chemotherapy, have now discovered drugs which target the tumor itself while sparing the body’s normal cells. One such group are the anti-angiogenesis drugs.

  Learn more about anti-angiogenesis agents in the treatment of mesothelioma.

• Immunotherapy, sometimes called biological therapy, uses the body's own immune system to protect itself against disease. Researchers have found that the immune system may be able to recognize the difference between healthy cells and cancer cells, and eliminate those that become cancerous. Immunotherapy is designed to repair, stimulate, or enhance the immune system's natural anticancer function.

  Substances used in immunotherapy, called biological response modifiers (BRMs) alter the interaction between the body's immune defenses and cancer, thereby improving the body's ability to fight disease. Some BRMs, such as cytokines and antibodies, occur naturally in the body, however, it is now possible to make BRMs in the laboratory that can imitate or influence natural immune response agents. These BRMs may:

  • Enhance the immune system to fight cancer cell growth.
  • Eliminate, regulate, or suppress body responses that permit cancer growth.
  • Make cancer cells more susceptible to destruction by the immune system.
  • Alter cancer cell's growth patterns to behave like normal cells.
  • Block or reverse the process that changes a normal cell into a cancer cell.
  • Prevent a cancer cell from spreading to other sites.

  Many BRMs are currently being used in cancer treatment, including interferons, interleukins, tumor necrosis factor, colony-stimulating factors, monoclonal antibodies, and cancer vaccines.

More on immunotherapy for mesothelioma.

• Photodynamic therapy (PDT) is a type of cancer treatment based on the premise that single-celled organisms, if first treated with certain photosensitive drugs, will die when exposed to light at a particular frequency. PDT destroys cancerous cells by using this fixed frequency light to activate photosensitizing drugs which have accumulated in body tissues.

  In PDT, a photosensitizing drug is administered intravenously. Within a specific time frame (usually a matter of days), the drug selectively concentrates in diseased cells, while rapidly being eliminated from normal cells. The treated cancer cells are then exposed to a laser light chosen for its ability to activate the photosensitizing agent. This laser light is delivered to the cancer site, (in the case of mesothelioma, the pleura), through a fiberoptic device that allows the laser light to be manipulated by the physician. As the agent in the treated cells absorbs the light, an active form of oxygen destroys the surrounding cancer cells. The light exposure must be carefully timed, so that it occurs when most of the photosensitizing drug has left the healthy cells, but is still present in cancerous ones.

  The major side effect of PDT is skin sensitivity. Patients undergoing this type of therapy are usually advised to avoid direct and even indirect sunlight for at least six weeks. Other side effects may include nausea, vomiting, a metallic taste in the mouth, and eye sensitivity to light. These symptoms may sometimes come as a result of the injection of the photosensitizing agent.

• Gene therapy is an approach to treating potentially fatal or disabling diseases by modifying the expression of an individual's genes toward a therapeutic goal. The premise of gene therapy is based on correcting disease at the DNA level and compensating for the abnormal genes.

  Replacement gene therapy replaces a mutated or missing gene, most often a tumor suppressor gene, with a normal copy of that gene which serves to keep cell growth and division under control. The p53 gene, the most common gene mutated in cancer has become a prime target for gene replacement, and has met with some success in inhibiting cell growth, inhibiting angiogenesis (the development of a tumor's blood supply), and inducing apoptosis (cell death).

  Knockout gene therapy targets the products of oncogenes (a gene that can induce tumor formation) in an effort to render them inactive and reduce cell growth.

  With constantly expanding knowledge of the genes associated with cancer, their functions, and the delivery systems used in administering these genes, gene therapy has a promising future.

• Complementary and alternative medicine covers a wide range of healing philosophies that conventional medicine does not commonly accept or make available to its patients. Some of these practices include the use of acupuncture, herbs, homeopathy, therapeutic massage, and Far Eastern medicine to treat health conditions.

  These therapies may be used alone as an alternative to conventional medicine, or in addition to conventional medicine, in which case they are referred to as complementary. Many are considered holistic, meaning their focus is to treat the whole patient - physically, mentally, emotionally, and spiritually. These treatments are not widely taught as a part of the medical curriculum, are not generally used in hospitals, and, for the most part, are not covered under insurance policies.

  Many cancer patients try various complementary and/or alternative medicine techniques during the course of their treatment, and although they may not work for everyone, some patients benefit by managing their symptoms or side effects. One important caveat, is to discuss any complementary or alternative treatments you may be considering with your doctor to be sure nothing interferes with your conventional care. For instance, dietary supplements such as herbs or vitamins may be "natural", but not necessarily "safe". They may lessen the effectiveness of certain anticancer drugs, or when taken with other drugs or in large doses, may actually cause harm. Since supplements of this nature are not governed by the FDA (Food and Drug Administration), and a prescription is not necessary to purchase, it is up to the consumer to make informed and conscientious decisions regarding their use.

  Your personal physician may be able to advise you about the use of complementary and alternative treatments and therapies, and how they relate to mesothelioma.

The combinaton of complementary and conventional therapies is sometimes referred to as integrative medicine.

• Unconventional methods of cancer treatment make claims that can not be scientifically substantiated. They commonly claim to be effective against cancers that are considered incurable, and tout treatments with relatively few, if any, side effects.

  The use of these unconventional methods may result in the loss of valuable time and the opportunity to receive potentially effective therapy. It is always important to remain in the care of a qualified physician who uses accepted methods of treatment or who is participating in scientifically designed investigational therap

SURGERY

SURGERY

Diagnostic Procedures

As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Palliative Procedures

Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.

Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (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 sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.

Potentially Curative Procedures

These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.

For Pleural Mesothelioma:

• Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
• Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.

  General Patient Selection Criteria for Extrapleural Pneumonectomy

  Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient's chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.

  • Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others.
  • Adequate renal (kidney) and liver function tests; no significant kidney or liver disease.
  • Normal cardiac function per electrocardiogram and echocardiography.
  • Adequate pulmonary function to tolerate the surgery.
  • Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall.
  • Age of the patient is taken into consideration, but may not be as important as their overall status.

  Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.

For Peritoneal Mesothelioma:

• Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma.

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CHEMOTHERAPY

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:

• To control the cancer by stopping its spread or slowing its growth.
• To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
• To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
• To relieve 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 in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a drug approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry 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 infused 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 grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy. More on peripheral neuropathy. More on anti-nausea treatment for chemotherapy patients.

Click here if you are interested in learning more about chemotherapy for mesothelioma and the types of questions you should ask your doctor.

Chemotherapy Schedules

How often you will receive chemotherapy will be determined by your doctor, taking into consideration factors such as the stage of your cancer, the types of drugs you receive, the anticipated toxicities of the drugs and the time necessary for your body to recover from these toxicities. The doctor may also consider whether the goal of the chemotherapy is to control the growth of the cancer, or to ease symptoms associated with the disease.

In general, chemotherapy treatment is administered in "cycles" — a "cycle" being defined as a period of treatment followed by a period of rest. This cycle allows the cancer cells to be attacked by the drugs, and then allows the body's normal cells time to recover. The combination of drugs used, the length of time to administer the drugs, how often they should be repeated and the number of cycles recommended have been analyzed throughly in clinical trials. For mesothelioma patients, the "standard" treatment is a combination of Alimta and cisplatin, administered IV, with a 10 minute infusion of Alimta followed by two hours of cisplatin, given in 21 day cycles. Modifications to this schedule may be made according to what your doctor feels is appropriate in your particular case.

The number of treatment cycles, or the length of time between the beginning and end of chemotherapy may vary, however in general, 3 to 4 cycles of treatment are given before response is evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness. After response to the treatment has been determined, the following criteria will be used to decide whether chemotherapy should continue:

• If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
• If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.

The goal of setting a chemotherapy schedule is to make treatment as effective, timely and trouble-free as possible, but while the drugs are working to kill cancer cells, they may also affect healthy cells causing side effects. One of the most common side effects, and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which means your immune system is weakened, therefore leaving you more prone to infection. While this side effect is anticipated when someone is undergoing chemotherapy, it can cause delays in your treatment schedule, or changes in the dosage of the drugs you will receive. Click here for more on understanding your blood counts.

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Note to Patients:

Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.

1. It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
   These may include:
   • Fever of, or greater than 101 degrees
   • Nausea or vomiting
   • Diarrhea or constipation
   • Fatigue
   • Tingling or numbness in the fingers or toes
   • Ringing in the ears
   • Bruises or rashes
   • Sores in the mouth or throat
2. Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
   Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.
3. Take extra care with your daily health.
   Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.

   Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.




4. Be open about your feelings regarding your treatment.
   It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.

RADIATION THERAPY

Radiation therapy, also called radiotherapy, treats cancer by using penetrating beams of high energy or streams of particles called radiation. In treating mesothelioma, radiation may be used aggressively in combination with surgery, or palliatively to control symptoms.

In an aggressive combined modality approach, radiation is used to attack microscopic or residual disease remaining in the chest cavity after extrapleural pnuemonectomy. An example of this is Intensity Modulated Radiation Therapy (IMRT), which uses x-rays of varying intensities in conjunction with computer generated images to deliver targeted radiation directly to cancer cells while reducing the amount of radiation to surrounding healthy tissue. More on Intensity Modulated Radiation Therapy (IMRT).

Used palliatively, radiation can help control metastases (spread) of the tumor along tracks left by invasive procedures such as thoracoscopy, needle biopsy and chest tube drainage, or to control disease symptoms, such as pain or shortness of breath.

An exciting new development in radiation oncology is tomotherapy. A brief description of steps in the helical tomotherapy process.

Mesothelioma Treatment

MESOTHELIOMA TREATMENT OPTIONS

The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope and the patient’s age and desires.

TIME MATTERS

People diagnosed with this disease are often told the expected survival rate is only eight to twelve months. However, specialists in treating malignant mesothelioma at the leading cancer centers often have better statistics.

For instance, the five-year survival rate has approached 40% for selected patients of Dr. David Sugarbaker at Brigham and Women’s Center in Boston. To qualify for Dr. Sugarbaker’s treatment you must meet certain criteria. One of them is being in the early stages of the disease, so time is of the essence. To find out more about Dr. Sugarbaker and other physicians and cancer centers specializing in mesothelioma click on Finding Specialists.

Keeping track of your medical treatment is useful and a personal medical records file can help.

TRADITIONAL CARE

There are three traditional kinds of treatment for patients with malignant mesothelioma:

• Surgery (taking out the cancer)
• Chemotherapy (using drugs to fight the cancer)
• Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

Often two or more of these are combined in the course of treatment. (NEW! Click here for the newest trial of trimodal lung-sparing treatment for pleural mesothelioma: The Columbia Protocol.)

MESOMARK BLOOD TEST

In January 2007, the Food and Drug Administration (FDA) 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 may be able to 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.

SURGERY

Diagnostic Procedures

As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Palliative Procedures

Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.

Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (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 sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.

Potentially Curative Procedures

These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.

For Pleural Mesothelioma:

• Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
• Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.

  General Patient Selection Criteria for Extrapleural Pneumonectomy

  Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient's chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.

  • Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others.
  • Adequate renal (kidney) and liver function tests; no significant kidney or liver disease.
  • Normal cardiac function per electrocardiogram and echocardiography.
  • Adequate pulmonary function to tolerate the surgery.
  • Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall.
  • Age of the patient is taken into consideration, but may not be as important as their overall status.

  Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.

For Peritoneal Mesothelioma:

• Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma.

TOP

CHEMOTHERAPY

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:

• To control the cancer by stopping its spread or slowing its growth.
• To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
• To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
• To relieve 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 in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a drug approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry 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 infused 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 grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy. More on peripheral neuropathy. More on anti-nausea treatment for chemotherapy patients.

Click here if you are interested in learning more about chemotherapy for mesothelioma and the types of questions you should ask your doctor.

Chemotherapy Schedules

How often you will receive chemotherapy will be determined by your doctor, taking into consideration factors such as the stage of your cancer, the types of drugs you receive, the anticipated toxicities of the drugs and the time necessary for your body to recover from these toxicities. The doctor may also consider whether the goal of the chemotherapy is to control the growth of the cancer, or to ease symptoms associated with the disease.

In general, chemotherapy treatment is administered in "cycles" — a "cycle" being defined as a period of treatment followed by a period of rest. This cycle allows the cancer cells to be attacked by the drugs, and then allows the body's normal cells time to recover. The combination of drugs used, the length of time to administer the drugs, how often they should be repeated and the number of cycles recommended have been analyzed throughly in clinical trials. For mesothelioma patients, the "standard" treatment is a combination of Alimta and cisplatin, administered IV, with a 10 minute infusion of Alimta followed by two hours of cisplatin, given in 21 day cycles. Modifications to this schedule may be made according to what your doctor feels is appropriate in your particular case.

The number of treatment cycles, or the length of time between the beginning and end of chemotherapy may vary, however in general, 3 to 4 cycles of treatment are given before response is evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness. After response to the treatment has been determined, the following criteria will be used to decide whether chemotherapy should continue:

• If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
• If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.

The goal of setting a chemotherapy schedule is to make treatment as effective, timely and trouble-free as possible, but while the drugs are working to kill cancer cells, they may also affect healthy cells causing side effects. One of the most common side effects, and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which means your immune system is weakened, therefore leaving you more prone to infection. While this side effect is anticipated when someone is undergoing chemotherapy, it can cause delays in your treatment schedule, or changes in the dosage of the drugs you will receive. Click here for more on understanding your blood counts.

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Note to Patients:

Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.

1. It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
   These may include:
   • Fever of, or greater than 101 degrees
   • Nausea or vomiting
   • Diarrhea or constipation
   • Fatigue
   • Tingling or numbness in the fingers or toes
   • Ringing in the ears
   • Bruises or rashes
   • Sores in the mouth or throat
2. Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
   Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.
3. Take extra care with your daily health.
   Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.

   Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.




4. Be open about your feelings regarding your treatment.
   It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.

RADIATION THERAPY

Radiation therapy, also called radiotherapy, treats cancer by using penetrating beams of high energy or streams of particles called radiation. In treating mesothelioma, radiation may be used aggressively in combination with surgery, or palliatively to control symptoms.

In an aggressive combined modality approach, radiation is used to attack microscopic or residual disease remaining in the chest cavity after extrapleural pnuemonectomy. An example of this is Intensity Modulated Radiation Therapy (IMRT), which uses x-rays of varying intensities in conjunction with computer generated images to deliver targeted radiation directly to cancer cells while reducing the amount of radiation to surrounding healthy tissue. More on Intensity Modulated Radiation Therapy (IMRT).

Used palliatively, radiation can help control metastases (spread) of the tumor along tracks left by invasive procedures such as thoracoscopy, needle biopsy and chest tube drainage, or to control disease symptoms, such as pain or shortness of breath.

An exciting new development in radiation oncology is tomotherapy. A brief description of steps in the helical tomotherapy process.

MESOTHELIOMA INFORMATION

Mesothelioma Information

Mesothelioma is one of the deadliest diseases known to man; the average life span of an inflicted person from the time of diagnosis until death is less than 24 months. It’s a disease that strikes approximately 3,000 United States citizens each and every year; hard working people who have labored for a lifetime to provide for their families, doing the work that keeps this country running and a great place to live. They worked in factories, at shipyards, in mines, for the US military, as engineers, as pipe fitters, as steel workers, as auto mechanics, and in so many other professions. They came home to their loved ones exhausted and covered in dirt and dust; tired, but content that they had a job and were providing for their family. Content that they were putting food on the table and a house over their loved one’s heads. They were working to make a better life for their families in this generation and the next.

What they didn’t know was that while they were working so hard, they were not only slowly killing themselves, but those that they were working so hard to help; their family, their loved ones.

Mesothelioma is a disease that is almost 100% preventable; the only known cause is via exposure to the deadly mineral Asbestos. It comes from inhaling the particles of dust as the asbestos degrades; eating away at the lining of your lungs and developing into a deadly cancer. Dust that was inhaled in clouds of white powder, dust that was carried home on the clothes of the men who built this country, dust that was cleaned from the clothes by the wives and children who supported their sole provider at home, dust that was packed around the heating systems in houses and offices and schools, dust that carried a deadly price; and dust made a fortune in blood money for the companies that produced it.

Unfortunately, the effects of asbestos on the human body were known to be deadly for years by the companies who employed the ‘greatest generation’ and made hundreds of millions, if not billions, of dollars off of their backs. But instead of taking simple steps to alleviate the problem and save the lives of thousands of their workers, they choose to do nothing and continue to make a “healthy” profit with a “deadly” product. Many even went so far as to hide the truth from their workers and their families. And because the normal latency period for Mesothelioma (The time from exposure until the patient falls ill) is 20 to 30 years, many got away with this for years. We are only now beginning to see the full effects of the disease, and feel the terrible outcry of the people against those who put profits before human lives to a degree that is simply unfathomable.

MESOTHELIOMA'S CAUSE - ASBESTOS EXPOSURE

Mesothelioma Causes

Mesothelioma is most often linked to exposure to asbestos. So much of the research into this disease is based on finding out exactly how asbestos affects the normal cells of the lining of the chest and abdominal cavities. If we can have a better understanding of how asbestos fibres cause cancer and how exposure to this chemical affects us, then we may be able to help prevent the disease.

Researchers know that there can be an incredibly long time lag between exposure to asbestos and developing mesothelioma. It can be 40 years or more. This probably meant that it took longer to spot the connection between asbestos and cancer than it otherwise would. But we know now, and the use of asbestos in many countries is now illegal.

There has been talk for the past few years about a link between a virus called the simian virus (SV40) and developing mesothelioma. Some polio vaccine preparations were contaminated with SV40 between 1955 and 1963 and doctors were concerned that people who'd had them may be at increased risk. One large study has indicated that these people are not at an increased risk of mesothelioma or other types of cancers. The study was published in 2003 and found that mesothelioma rates were actually falling in this group of people. The link between SV40 and mesothelioma (if there is one) is likely to be much less important that the link with asbestos.

There is some evidence that your genetic make up could affect your risk of mesothelioma. As well as asbestos, exposure to a mineral called erionite is a risk factor. Researchers in Turkey found that in families exposed to this mineral, in some families all the family members developed mesothelioma and in other families, no one developed it. They think that there is a gene in some families in Turkey that increases their risk. (This article is published in The Lancet, volume 357, issue 9254, page 444.) This could explain why some people are exposed to asbestos and do not develop mesothelioma, while others who are exposed do. There is a lot more research to be done before we will know if there are specific gene changes that can increase your risk of mesothelioma. It will be some years after this has been completed before there will be any chance of testing for such a gene.

In the past, asbestos was used widely in the

· Building industry

· Ship building industry

· Manufacture of household appliances

· Motor industry

MESOTHELIOMA DIAGNOSIS

Mesothelioma diagnosis

Most people begin by seeing their GP when they have symptoms. Your GP will examine you and may arrange for you to have some tests or x-rays. You may be referred to hospital for these tests and for specialist advice and treatment.

The first step to diagnosing mesothelioma is a complete evaluation of a patient's medical history to determine symptoms and any past asbestos exposure, as well as a complete physical. In addition, physicians may request an MRI (magnetic resonance imaging) scan or an X-ray of the abdomen or chest region to help determine the location and size of the tumor.

In cases of pleural and peritoneal mesothelioma, fluid (effusion) may collect in the chest or abdominal region. Physicians may use a procedure known as fine needle aspiration to obtain a sample of this fluid for further testing. In addition, this procedure can be used to drain the effusion to temporarily relieve chest pain or other symptoms.

Usually, a biopsy of the tumor is required to make a diagnosis, however, sometimes only a fluid sample is needed. Below are a number of procedures commonly used.

Peritoneoscopy

In a case of peritoneal mesothelioma the doctor will use a tool called a peritoneoscope, which will be placed inside an opening made in the patient's abdomen. If fluid is found in the abdomen it will be drained through a process called paracentesis, which requires a needle to be placed inside the abdomen in order to extract the fluid.

Thoracoscopy

In diagnosing pleural mesothelioma a doctor may use a special instrument called a thoracoscope in order to examine the patient's chest cavity. This test requires an incision to be made in the chest wall, which will be used to place the thoracoscope between the patient's ribs. If the doctor finds fluid collected in a patient's chest, it will be drained out of the chest cavity through a needle. This test commonly requires anesthetic or another form of pain suppression.

Biopsy

If cancerous tissue is found in the patient's lungs or abdomen it will be extracted and examined by the doctor. This process helps the doctor determine potential ways of treatment and is usually done during the above two processes or may require additional surgery.

MESOTHELIOMA SYMPTOMS

Mesothelioma Symptoms

In early stages of the disease, mesothelioma may not have any visible symptoms and is very hard to detect. Mesothelioma often starts as many tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they are quite large. The main symptoms of pleural mesothelioma are pain in the chest and breathlessness. Some people also notice that their voice becomes hoarse and they have a cough that does not go away. In later stages of development, certain symptoms begin to develop and are usually caused by the growth of cancer and its pressure on certain nerves.

The symptoms of the two main types of mesothelioma (Pleural and Peritoneal) are described below:

Pleural Mesothelioma:

• Lower back of chest pain
• Continual Cough
• Breath shortness
• Husky voice
• Losing over 10% of your body weight while not dieting
• Fever or sweating
• Trouble swallowing

Peritoneal Mesothelioma:

• Abdominal pain (stomach)
• Abdomen swelling
• Feeling sick
• Loss of appetite
• Losing over 10% of your body weight while not dieting
• Constipation and diarrhea

The above symptoms may be caused by other illnesses not related to mesothelioma, however, if you have been exposed to asbestos in the past or if the symptoms persist, it is very important that you consult with your physician or health care provider immediately.

PERITONEAL MESOTHELIOMA

Peritoneal Mesothelioma

Peritoneal Mesothelioma is the name given to the cancer that attacks the lining of the abdomen. This type of cancer is caused by asbestos exposure, and it affects the lining that protects the contents of the abdomen and which also provides a lubricating fluid to enable the organs to move and work properly.

This disease is sometimes referred to as diffuse peritoneal mesothelioma, and this is where the cancer has spread out. Accountable for around ten percent of mesothelioma cases, this type asbestos-related cancer is the second most common (after Pleural Mesothelioma).

There are a number of symptoms for this disease. However, like all other types of mesothelioma, there is a very long latency period, and symptoms may not become evident for decades after exposure. This means that by the time symptoms have begun, it is often already too late to offer any real constructive treatment. Further delay can be caused due to the fact that the symptoms are generally non-specific and can therefore be attributed to a number of more common ailments. Unless your doctor is aware that you have been exposed to asbestos in the past, he or she is likely to look at other options before even contemplating mesothelioma. It is therefore important to let your doctor know of any exposure to this substance.

The symptoms of peritoneal mesothelioma include: abdominal pains and weakness; weight loss; nausea; loss off appetite; abdominal swelling; bowel obstruction. Depending on the location of the tumour, additional problems can be experienced such as breathing problems and severe pains.

Treatment for peritoneal mesothelioma can also vary, and is dependant upon a number of factors. The doctor, once a diagnosis has been made, will make a recommendation based upon details such as: the extent of the cancer and how advanced it is; the patient’s general condition and health; past medical history of the patient; and the patient’s age.

Mesothelioma Treatment

Mesothelioma Treatment

The treatment for mesothelioma will depend on whether it is only in one place or has spread. Currently, there is no cure for mesothelioma, unless it can be removed by an operation.

The three main types of mesothelioma treatment include radiation therapy, chemotherapy and surgery.

Radiation Therapy

It is extremely difficult to deliver adequate doses of radiation necessary to kill the tumor without harming the surrounding organs due to the location of mesothelioma cells. There is an option of lowering the radiation dose, however, it is hard to determine whether low doses of radiation are significant in reducing the survival rate among patients. Unfortunately, using radiation therapy after surgery has not been very successful in terms of increasing the rate of survival, however, since surgery does not always remove the entire tumor, radiation therapy can help kill the remaining cancer cells and relieve certain symptoms of the disease such as chest pain.

Surgery

Before considering surgery as a treatment option a patient should always contact their doctor or primary healthcare provider to go over other options of treatment and examine the overall condition of the patient. Various tests should be performed to determine how safe the option of surgery is depending on the patient.s condition and the spread of the tumor. There are a number of reasons why a patient.s lung and heart function can decrease such as exposure to asbestos, smoking and age, all of which must be considered before surgery is performed.

There are two types of surgical procedures performed in most mesothelioma cases: aggressive surgery, which can prove to be a long-term solution and palliative procedures usually performed as a means of symptom relief.

Aggressive surgery can be performed in order to remove the affected organs such as a lung, pleura, or a diaphragm with the purpose of removing as much of the cancer as possible. Such procedures are extremely complicated and not hospitals will be willing to perform them. This type of operation is usually only performed on younger patients with good overall health and the consequences of such operation are evaluated thoroughly. Please check with your doctor or healthcare professional in order to determine your eligibility.

Pallative procedures are usually performed in order to alleviate some of the symptoms of mesothelioma and are performed in later stages of the disease. These procedures are performed in order to remove the collected fluid in a patient.s lungs in order to relieve loss of breath and are not aimed at curing mesothelioma. During such procedures a needle is usually inserted into the chest and the fluid is drained therefore easing the pain and shortness of breath.

Chemotherapy and Drugs

Chemotherapy as another common method of treating mesothelioma generally has mixed results due to the variety of patients. conditions and their overall health. Combination of chemotherapy and mesothelioma drugs is usually more effective in treating the disease especially as more and more new drugs are being developed. Similarly to radiation therapy, chemotherapy can be used in addition to surgery in order to remove cancer cells missed by surgical operations.

Stages of Treatment

Stage 1: Localized mesothelioma

This stage usually allows aggressive surgery to be performed in order by removing the affected organs in order to cure the disease. Additionally, other surgical operations may be beneficial in order to alleviate certain symptoms of mesothelioma such as breathlessness. Please contact your doctor or healthcare provider in order to determine if such options would be beneficial to your condition and for more information on hospitals performing the above surgical operations.

Stages II, III, and IV: Advanced mesothelioma

Pallative procedures may be performed in order to drain excess fluid from the patient.s lungs in order to relieve certain symptoms of the disease. Other methods of treatment such as chemotherapy and/or mesothelioma drugs may be used as well in order to fight the disease.

Stage V: Recurrent Mesothelioma

Unfortunately there are currently no effective methods of treatment in this stage of the disease. However, treatment options not considered in the earlier stages can be considered and may be beneficial. Please contact your doctor in order to determine which treatment options are right for you.

MESOTHELIOMA STAGES

Stages of Mesothelioma

The staging of pleural mesothelioma is different to the staging of peritoneal mesothelioma.

There are two main staging systems in use for pleural mesothelioma. These are called the TNM system and the Brigham system. The system that is mostly commonly used is the TNM system. Specialists generally don't use the Brigham system any more, but we've left it in here for now in case your own doctor refers to it.

The TNM system

This is also sometimes called the International Mesothelioma Interest Group staging system.
The TNM system is the staging system most commonly used in cancer staging generally. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).

Once the TNM categories have been decided, this information is grouped together to give the stage. Stage 1 is the earliest stage and stage 4 is the most advanced stage.

* Mesothelioma Stage 1 affects one layer of the pleura only. It may have grown into the covering of the heart (pericardium) and the diaphragm

* Mesothelioma Stage 2 has spread to both layers of the pleura on one side of the body only

* Mesothelioma Stage 3 has spread to the chest wall, food pipe (oesophagus) or lymph nodes on the same side of the chest

* Mesothelioma Stage 4 has spread via the bloodstream to other organs in the body such as the liver, brain or bone or to lymph nodes on the other side of the chest

The Brigham staging system

This is based on whether the mesothelioma can be removed by surgery and whether the lymph nodes are involved or not. Again there are four stages, which are similar to the TNM system.

* Stage 1 mesothelioma can be removed with surgery and there are no lymph nodes containing cancer cells

* Stage 2 mesothelioma can be removed with surgery but there are lymph nodes containing cancer cells

* Stage 3 mesothelioma cannot be removed with surgery because it has spread into the chest wall, heart, or through the diaphragm into the peritoneum. There may or may not be lymph nodes containing cancer cells

* Stage 4 mesothelioma has spread via the bloodstream to other organs in the body such as the liver, brain or bone

There is no established staging system for peritoneal mesothelioma. If your cancer is staged it may be done according to the TNM system. The TNM system is the staging system most commonly used in cancer. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).

Mesothelioma cancer

Mesothelioma cancer is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body’s internal organs. Most people who develop mesothelioma cancer have worked on jobs where they inhaled asbestos particles.

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma cancer begin in the pleura or peritoneum.

Although reported incidence of mesothelioma rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

Mesothelioma Treatment

Mesothelioma is a cancerous disease that affects the serous linings of various internal organs in the human body. Among them, the lungs, heart and the stomach are the mostly affected.

It is estimated that each year, 2,000 new cases of Mesothelioma are reported. The patients suffering from this cancerous disease have had prior exposure to asbestos, which is considered to be the only known cause of Mesothelioma.

Mesotheliomic patients are often told of the short survival duration of 6 – 12 months. But doctors specialized in treating malignant Mesothelioma at leading cancer centers expect better survival rates. Though Mesothelioma causes immense pain and suffering to the victim along with short life expectancy, certain treatments have resulted in the successful reduction and removal of the cancerous tumors of Mesothelioma.

Treatment of Mesothelioma depends on many factors, including the stage of the cancer, the circulation of the malignant cells, pathology reports determining the nature of the cancer cells and patient’s age and health. Following is a detail description of the options for Mesothelioma Treatment.

CHEMOTHERAPY:

Chemotherapy is a “systematic treatment” of Mesothelioma that uses drugs, chemicals and medicines in an efficient manner to kill cancer cells. It is given to patients in either pills form or is injected directly into the body. In some cases, the medicines are directly inserted into the chest, known as intrapleural chemotherapy, or into the abdomen, known as intraperitoneal chemotherapy, to destroy the growth of cancerous cells. It is also given to patients before and after a surgery to limit the growth of Mesothelioma cancer.
The widely used pemetrexed, Alimta ®, is given in combination of Cisplatin (a standard platinum compound) to treat pleural Mesothelioma. The drug was approved by the U.S. Food and Drug Administration (FDA) in February, 2004. The working of this drug is simple: it enters the blood stream of a patient and kills the cancer cells throughout the body, while stopping the malignant cell growth. The drug has some side-effects for which vitamin B 12 and folic acid is given to the patients undergoing this treatment.