Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy and chemotherapy, or a combination of these treatments. At Mayo Clinic experimental treatments are also available for patients who meet the requirements.
Surgery
Surgery is used to remove the cancer. Depending on how far the cancer has spread, the surgery may involve the removal of part of the lining of the chest or abdomen and some surrounding tissue. For cancer of the pleura (pleural mesothelioma), a lung may be removed, and in some cases the muscle below the lungs that helps with breathing (diaphragm), is also removed.
Radiation Therapy
Radiation therapy, also called radiotherapy, uses high-dose X-rays or other high-energy rays to destroy cancer cells. Radiation therapy affects cancer cells only in the treated area. The radiation may come from a machine or from radioactive materials placed directly in the area of the cancer (brachytherapy).
Chemotherapy
Chemotherapy involves the use of drugs to fight the cancer. Most drugs used to treat mesothelioma are intravenous (given by injection into a vein). Some doctors are also employing intracavitary chemotherapy — putting chemotherapy directly into the chest or abdomen.
Thoracentesis
Thoracentesis is a supportive treatment used to relieve symptoms and control pain. It involves placing a needle or a thin tube to drain fluid that has built up in the chest. The procedure for removing excess fluid in the abdomen is called paracentesis.
Additional Support Services
Additional supportive services available to mesothelioma patients include:
>Pulmonary rehabilitation
>Pain management
>Psychosocial care
>Nutritional assessment
>On-site patient education
Treatment is dependent on the stage of the disease, the location of the tumor, the patient's age and state of health at the time. Younger, healthy patients, with early stage disease may be candidates for surgery that removes the mesothelial tissue around the tumor. This surgery is extensive and it is not well understood how much benefit it provides the patient.
Traditional radiation therapy has not shown a benefit, and can cause damage to the healthy lung tissue in the process of treating the cancer. Research is investigating ways of giving radiation directly to the tumor, using implants or UV light therapy. Chemotherapy has often been used to treat patients with mesothelioma, but until recently trials did not find any one medication to be superior to others. These medications have had responses in 10 to 20 percent of patients, but combining more than one medication has not increased these rates. Recently, a new medication called pemetrexed (Alimta) was given in combination with cisplatin with positive results. Patients received either cisplatin alone or cisplatin in combination with pemetrexed. Patients who received the combination of drugs had increased response rates, survived longer, and had fewer side effects. This regimen is now considered standard of care for mesothelioma not treatable with surgery. Researchers are conducting studies that administer the chemotherapy directly into the pleural space. So far, the results of these studies have been disappointing.
Because the current therapies have limited effectiveness, researchers are studying new ways to treat mesothelioma. Some of the treatments being investigated include interleukin 2 (a biologic therapy), lovastatin (a cholesterol-lowering drug), immunotherapy, gene therapy (a method that attempts to correct the abnormal gene that causes the cancer to grow out of control), and Photodynamic Therapy (PDT-a treatment that uses a laser to activate a photosensitizing drug during the surgical removal of the cancer). Patients should talk with their physicians about current clinical trials for mesothelioma.
One problem that patients may encounter is the recurring build-up of fluid in the pleural space. This fluid can be removed with a chest tube (a tube that is put into the chest wall and left in for a period of time to allow drainage) or a procedure called thoracentesis (a small needle is put through the chest wall, into the pleural space, the fluid is drained, and the needle removed). In the abdomen, the procedure to remove fluid is called paracentesis. In this procedure, a needle is inserted through the abdomen into the fluid filled space, and the fluid is drained.
If this is a chronic problem, patients may have a catheter placed in the chest semi-permanently, allowing them to drain the fluid themselves at home as they need to. Removal of the fluid alleviates the difficulty breathing and chest pain caused by the build-up.
0 comments:
Post a Comment