Treatment of mesothelioma
The best treatment option for you as an individual, will depend on many factors such as your age, general health status, stage of cancer, cell type (which determines the aggressiveness of the cancer) and, most important, your personal desires. In order to help you assess these options, a "multidisciplinary team" (MDT) doctors will discuss your case and offer their treatment strategy. This team may include a cardio-thoracic surgeon, a medical oncologist, a radiologist oncologist, a pain management specialist and a specialist in palliative care. Nurses and other health care providers may also be involved in your care.
Conventional treatment of mesothelioma offers several options, and you should discuss thoroughly each option with your EMD before taking a decision of treatment. Make sure you have the information on risk factors, the prognosis of the treatment, the potential secondary effects and quality of life that each option offers. How does asbestos relate to, and what is mesothelioma anyways?
Surgery
There are two surgical approaches of mesothelioma, the pleurectomie / decortication (P/D) and extrapleurale pleuropneumonectomie (PPEP). They are extremely specialized surgeries, and which may not be available in all institutions. All Thoracic Surgeons are not qualified for these types of surgeries. The ultimate objective of these procedures is the elimination of a large part of the disease, knowing that most likely residual microscopic disease will remain. The adjunctive therapy by which additional forms of treatment are used in conjunction with primary therapy, typically aims to eliminate residual disease. The most common forms of adjuvant therapy are radiotherapy and/or chemotherapy.
Pleurectomie/decortication is considered the least radical of the two approaches since it implies that the elimination of the pleura (lining of the lung) without removing the in-jascent lung. In some cases, the pericardium and diaphragm must be removed, depending on the extent of the tumor. The advantages of this procedure are usually faster recovery time, and the usefulness for patients who may not be able to tolerate a more radical PPEP. The disadvantages include an increased risk of recurrence of the disease due to the inability to remove all the tumor, and inability to use high doses of rays adjuvants because of potential damage to underlying lung.
The extrapleurale pleuropneumonectomie is a more radical procedure that involves the removal of the lung, pleura (lining of the lung), a part of the diaphragm and the pericardium surrounding the heart. During surgery, the pericardium and diaphragm are reconstructed with the Gortex-like material. To be eligible for this surgery, patients must meet certain criteria for step and demonstrate pulmonary and cardiac functions appropriate to be able to withstand the procedure.
Chemotherapy
Chemotherapy involves the use of anticancer drugs that Act by preventing cancer cells from multiplying. In most cases, combinations of drugs are used to increase efficiency. Chemotherapy can be used aggressively to shrink the tumor, or palliativement to relieve symptoms such as shortness of breath or pain. Chemotherapy can be administered by injection into a vein or a muscle, by ingestion or can sometimes be administered directly into the pleural or peritoneal cavity. The most commonly used drugs are:
- Pemetrexed(Alimta)
- Cisplatin(Platinol)
- Carboplatin(Paraplatin)
- Gemcitabine(Gemzar)
- Doxorubicin(Adriamycin)
- Mitomycin
- Raltitrexed(Tomudex)
- Vinorelbine(Navelbin)
New drugs are constantly being studied by the pharmaceutical companies, so do not hesitate to ask your doctor about the latest drugs and more promising. Such a drug, Alimta (pemetrexed) was approved for Europe in September 2005.
Radiotherapy
Radiation therapy involves using high-energy x-rays to kill cancer cells and shrink tumors. It can be used in conjunction with surgery to contribute to aggressively remove microscopic seeding which can cause recurrence of disease or palliativement to treat pain caused by tumors that compress nerve endings or other body. Radiotherapy has also proven effective to prevent tumor seeding from biopsy or drainage of the chest tube sites.
Clinical trials
The purpose of clinical trials is to involve patients in the discovery of new and better treatments for their illnesses. Various clinical trials have different objectives which may include testing of new drugs, comparing several ways to treat a disease or test several techniques to prevent cancer. Clinical trials are divided into three phases. Short summaries of each phase of the test seeks to accomplish are described below.
Trials phase I are those of the earliest phase in the clinical trials system. At this point, drugs have been tested in the laboratory only, but have had a destructive effect on cancer cells. These trials enrolled only a limited number of participants, and are available only in few institutions of cancer. The objective of Phase I trials are to determine the maximum dose tolerated the drug without causing serious side effects what side effects are the most common, and if the drug continues to have anti-cancer activity when administered to human beings human. If the drug shows an effect on cancer at a safe dosage, the drug will be then tested in Phase II trials.
The essays of Phase II continue to test the safety of the drugs or procedures, but are also beginning to analyse more closely their specific effectiveness for certain types of cancer. These tests include larger numbers of participants, and can be scattered across several institutions. These tests may be "randomized", it means that different groups of participants are chosen by computer, rather than by a physician.
The Phase III trials compare promising new drugs and procedures to the current standard treatment. Large numbers of participants from widely dispersed regions are participating in these trials, and receive either the new treatment or standard treatment. One of the primary objectives of the Phase III trial is to determine if cancer is reduced or slowed by medication, how long patients remain stable without progression of the disease and how the drug affects the quality of life of the patient.
If you are interested to participate in a clinical trial for mesothelioma, your doctor should be able to provide you with information on eligibility and availability in your area.
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