Multimodal Therapy Improve Survival For Mesothelioma Patients

Multimodal therapy, or multimodality therapy, is the combination of several cancer treatments (or modalities), including surgery, chemotherapy, and radiation. Multimodal therapy may also include certain experimental treatments. For mesothelioma patients, multimodal therapy has been clinically shown to possibly improve survival. While a single treatment may not be effective on its own, a combination of treatments may be more successful at destroying cancer cells. Multimodal treatment is considered one of the standard treatment options for stage II, III, and IV malignant mesothelioma and may be considered in stage I disease.

Treatment Components of Multimodal Therapy

Surgery

Surgery may be palliative or potentially curative, though options are limited for mesothelioma patients. Multimodality therapy including surgery has become a standard treatment of mesothelioma in patients with surgically removable tumors.

Radiation Therapy

Radiation is used in all stages of mesothelioma and can reduce symptoms and disease recurrence. As a multimodal therapy, intraoperative radiation is often used after a pleurectomy/decortication surgery.

Chemotherapy

The main chemotherapy treatment used in multimodal mesothelioma treatment is the combination of cisplatin and pemetrexed. Chemotherapy alone is only modestly effective in treating malignant pleural mesothelioma. However, adding a chemotherapeutic regimen to other treatment modalities, such as radiation therapy and surgery, improves survival.

Emerging and Experimental Treatments

There are a number of emerging and experimental treatments that are used in multimodal therapy. These are treatments that are currently being tested during clinical trials and include immunotherapy, gene therapy, photodynamic therapy, and more.

Trimodal Therapy

Malignant mesothelioma is difficult to completely remove with surgery alone. Because the tumor invades such sensitive structures as the diaphragm, esophagus, and heart, surgeons cannot remove a sufficient margin of healthy tissue around the tumor to make sure that all cancer cells have been removed. Therefore, additional cancer fighting treatments are needed.

Trimodal therapy for malignant pleural mesothelioma is the use of all three standard mesothelioma treatments—surgery, radiation therapy, chemotherapy—in some order. It is now widely accepted by oncologists and cancer researchers that more than one treatment modality is better than any single treatment for mesothelioma. A number of studies have shown that a trimodal approach provides the greatest benefit in terms of survival in select patients who can tolerate all three treatments. Indeed, most clinical practice guidelines for malignant pleural mesothelioma recommend trimodality therapy.

Given the relative rarity of malignant pleural mesothelioma, clinical practice guidelines also recommend that anyone undergoing trimodal therapy should be enrolled in a clinical trial whenever possible.

Choosing The Best Order of Treatment

While trimodal therapy is widely accepted as a standard treatment for malignant pleural mesothelioma, the order of treatments is a matter of debate.

Any of the treatment options can be what’s called the primary therapy, an adjuvant or a neoadjuvant therapy.

• Neoadjuvant Therapy — Any treatment given before primary therapy to improve results.
• Primary Therapy — Considered the most effective treatment option. This will most often be surgery.
• Adjuvant Therapy — Any treatment administered after primary therapy to alleviate symptoms and prevent cancer from returning.

In most cases, trimodal therapy will begin with chemotherapy followed by surgery (i.e., extrapleural pneumonectomy) and will finish with external beam, hemithoracic radiation therapy. Second most commonly, the patient first undergoes surgery followed by chemotherapy and radiation therapy. Less common approaches combine surgery with intracavitary chemotherapy followed later by radiation therapy. In some trimodal treatment combinations, hemithoracic radiation is replaced with intensity-modulated radiation therapy (IMRT).

Survival Rates

There is no clearly superior order of treatments in trimodality therapy. When surgery comes first, median survival ranges from 17 months to 28 months, and 39% to 81% of patients complete all three phases of treatment. When chemotherapy is administered before surgery, median survival ranges from 14 to 25.5 months and 32% to 69% of patients fully complete trimodal therapy.

Recent clinical trials have focused on pleurectomy with decortication in trimodality therapy. This surgical approach is associated with fewer complications than extrapleural pneumonectomy and, perhaps, better overall survival when incorporated in a trimodal therapy regimen. Moreover, 84% to 94% of patients were able to complete trimodal therapy when pleurectomy with decortication was used. One small clinical trial reported median survival of 30 months using this surgical approach. While the type of surgery used in trimodal therapy should be individualized to the patient’s circumstances, initial reports of a higher completion rate with pleurectomy and decortication are promising.

The course of therapy is different for each patient. A multidisciplinary team of cancer specialists decides on the best order of treatments based on patient preferences and circumstances.

Creating a Treatment Plan

Not everyone with malignant pleural mesothelioma is a candidate for multimodal therapy. Prior to this treatment, several diagnostic tests need to be run to determine a patient’s suitability for surgery, whether it is extrapleural pneumonectomy or pleurectomy with decortication. At a minimum, patients will undergo the following examinations:

• Physical examination – If other health problems are present, is the patient healthy enough to undergo major surgery?
• Pulmonary function testing – Will the patient have enough lung function in the remaining lobes of the lung after the diseased lung has been removed?
• Cardiac function testing – Does the patient have a strong enough heart to maintain blood pressure after some of the pulmonary blood vessels have been removed? Is the patient’s heart strong enough to undergo major surgery?
• Radiological studies – Radiological studies such as CT, MRI, and PET scans may be used to determine whether cancer cells have extended well beyond the affected lung to distant sites. If they have, trimodal therapy may not be successful.
• Histological examination – Patients do better if their mesothelioma is of the epithelial type rather than sarcomatoid. Because of the aggressive nature of sarcomatoid mesothelioma, doctors may decide not to use multimodal therapy. A third cancer cell type called biphasic mesothelioma has both epithelial and sarcomatoid cells. The prognosis for biphasic mesothelioma is not as good as epithelial mesothelioma, but multimodal therapy can still proceed with this cancer type.

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From Initial Symptoms to Diagnosis: Mesothelioma Testing Procedures

Undergoing treatment for mesothelioma is a battle no one wants to fight, but for many mesothelioma patients, the rocky road begins even before their diagnosis. Because mesothelioma is a rare disease that affects approximately 3,200 people every year, many general medical professionals do not have the experience or training to diagnose the disease . Initial mesothelioma symptoms can mimic those of the common cold or flu, so when a patient arrives in their office complaining of fatigue, a bad cough, and shortness of breath, most doctors do not automatically assume this rare cancer caused by asbestos exposure could be the problem.

If you think that you or someone you care about may have mesothelioma, there are tests and procedures to be aware of as you make an appointment for an initial consultation. By understanding how mesothelioma is diagnosed, you can begin to advocate for yourself if you feel your doctor is not picking up on the warning signs.

The Initial Consultation

In your initial consultation, it is important that you explain all troublesome symptoms to your doctor. They will likely review your medical history with you and conduct a thorough physical examination. At this time, you should be sure your doctor is informed of any history of asbestos exposure, especially if you ever had a high-risk occupation in which you were exposed at work on a regular basis.

Your doctor may order blood tests, but mesothelioma cannot be diagnosed from a blood test alone. A routine metabolic profile and blood count can provide your doctor with some general information about your health. Blood tests that may be ordered to specifically assess for mesothelioma include osteopontin and mesothelin-related peptides, which are not diagnostic, but more commonly elevated in people with mesothelioma.

Chest X-Ray

Most medical professionals will order a chest x-ray as an initial screening test because it is quick, easy, and may give them an idea about what is causing your symptoms. They will be looking for an abnormal thickening of the pleura, calcium deposits on the pleura, or fluid anywhere around or in the lungs/chest.

Computerized Tomography (CT) Scan

Another common mesothelioma diagnostic procedure is the CT scan, which allows for more detailed imaging than a regular x-ray. A CT scanner rotates around your body and takes multiple pictures that are combined to create imaging “slices” of your body. CT scans are used to help pinpoint the exact location of the mesothelioma and to stage the cancer. The CT scan can help determine what sites to biopsy to confirm the diagnosis of mesothelioma (which can only be diagnosed by a pathologist who looks at cancer cells under a microscope – see below).

Positron Emission Tomography (PET) Scan

With a PET scan, a radioactive substance is injected into your blood and a specialized scanner will take a picture of any radioactive activity in the body. With cancer staging, a radioactive form of sugar (called FDG) in injected; cancer cells readily absorb this sugar allowing the PET scanner to detect where the cancerous tumors are in the body. A CT scan is often done at the same time as the PET scan so that the doctors can correlate where in the body the radioactivity is coming from. A PET/CT scan can show doctors if and where the cancer has spread.

Magnetic Resonance Imaging (MRI) Scan

MRI scans, like CT scans, provide imaging slices of your body. Unlike a CT scan which uses high energy radiation, an MRI uses (safe) radio frequency waves and magnetic fields (which will preclude it use in people with cardiac devices, cochlear implants or some metal implants). The MRI provides a more detailed view of your body’s soft tissues and can be helpful in better determining the exact location and extent of disease.

Biopsies

After undergoing 1 or more of the above imaging tests, your doctor will likely have an understanding as to what is going on in your body — at the very least, he or she will know if anything looks abnormal. If they feel you may have mesothelioma (or another cancer), a biopsy will usually be done to get a diagnosis.

Biopsies can be obtained in different ways (i.e. surgical vs. nonsurgical), but the idea is the same behind all of them: Doctors collect a sample of tissue or fluid and pathologists will examine the tissue or fluid to look for the presence of cancer cells, and analyze those cancer cells if they are found. Accurately identifying and staging mesothelioma is critical to successful treatment.

Getting a Mesothelioma Diagnosis: The Sooner, The Better

As is the case with most cancers, the sooner you can see a doctor and get an accurate diagnosis, the better your chances are for survival. Once your doctor has determined mesothelioma is the culprit, you will learn about the stages of mesothelioma, the type you have, treatment options, and your overallprognosis.

Advocate for yourself, be an active participant in the entire process, and try to stay optimistic — you didn’t choose your mesothelioma diagnosis, but you can choose how you fight it.

Pleurectomy Decortication is Effective Treatment for Mesothelioma Cancer

Lung-Sparing Pleurectomy With Decortication (P/D)

For some patients with pleural mesothelioma, pleurectomy/decortication (P/D) surgery is an aggressive but effective treatment option that can improve prognosis. This is a two-part surgical procedure that removes the thickened, diseased membranes lining the lung and chest wall (pleurectomy) along with visible tumors in the chest (decortication). The membrane enclosing the heart (the pericardial membrane) may also be removed if it appears similarly thickened and stiff, limiting the heart’s ability to efficiently pump blood.

Main Goals of Pleurectomy With Decortication:

• Serve as an alternative to the extrapleural pneumonectomy (EPP).
• ŸDelay mesothelioma progression by removing as much tumor bulk as possible.
• Improve breathing problems and pain caused by the typical thick fibrous bands and adhesions that encase the lung.
• Diminish or eliminate pressure from the excessive fluid that surrounds the lung in the majority of patients.
• Remove the membrane surrounding the heart (pericardial membrane) when its function is also affected.
• Patients facing surgery, and their families, are strongly encouraged to discuss the choice of surgery with their treatment team.

P/D is one of the two surgical approaches that account for the vast majority of procedures for malignant mesothelioma. The other is extra pleural pneumonectomy (EPP), a more radical procedure that, in contrast, requires removal of the lung and diaphragm on the cancerous side.  There is no clear consensus about which procedure is best, and many experienced mesothelioma surgeons strongly favor one over the other. It is most likely that one is more effective than the other in different settings. Nonetheless, the proportion of patients undergoing P/D has been increasing through the last few decades. This trend is supported by numerous studies in the medical literature.

• As a more extensive surgical procedure, EPP is associated with consistently higher complication and mortality rates compared to P/D.
• For most patients, EPP does not result in sufficiently better results to justify the increased risks. In some settings P/D appears the better choice.
• When anti-cancer drug treatment and/or radiotherapy (multimodal or trimodal therapy) are combined with either procedure, survival is significantly longer than surgery alone.
• However, several studies have concluded that patients undergoing P/D are more likely to tolerate these additional treatments with better results.

The Pleurectomy/Decortication Procedure

P/D surgery combines two interrelated procedures done in a single session and only on the cancerous side. In most cases, P/D involves removal of the abnormal and constrictive pleural membranes, excision of all visible tumor tissue, and elimination of the accumulated excess fluid.  P/D in any form is a major surgical procedure, but unlike EPP, it stops short of complete removal of the lung, pericardial membrane and diaphragm. The three basic steps are:

1. Thoracotomy (Incision)
   The P/D procedure requires inflation of the lung and a rather long incision to provide a sufficiently large opening into the chest cavity to visualize and remove as much abnormal tissue as possible. This incision usually begins in the mid back on the side of the tumor and then follows the rib curvature around to the same side of the chest wall.
2. Pleurectomy
   In the pleurectomy part of the procedure, the diseased membrane lining the inside of the chest cavity (the parietal pleural membrane) is removed, exposing the underlying membrane covering the lung (visceral pleural membrane).
3. Decortication
   In the decortication part, the tumor-laden visceral membrane is surgically separated and removed from the underlying lung.  All other visible tumors are excised and, when appropriate, the heart’s covering membrane and any other similarly abnormal tissue are removed.  Separation and removal of these membranes require a lot of time and surgical skill since they often adhere extensively to each other and the surfaces they cover.

Once completed, the incision is closed and at least one tube is inserted into the chest cavity in order to drain any fluids that accumulate thereafter. Since P/D is done under deep general anesthesia, the patient is unaware of the surgery and does not experience pain during the operation.

Alternative Method

Patients deemed ineligible for a P/D may opt for a video-assisted thoracoscopy for pleurectomy. This procedure is less invasive than P/D, but also is more limited. Using a small fiber optic camera and several other surgical instruments inserted through 3 very small incisions in the chest and back, it provides visualization of the pleural cavity, and can be used to obtain biopsies and perform a partial pleurectomy.

Recovery From Pleurectomy With Decortication

Pain following major surgery should be expected, and numerous options to control pain and discomfort are available. At the conclusion of surgery, one or more tubes will emerge from the chest in order to drain any accumulated fluid. During the early recovery period, breathing support is provided through a tube in the airway that is connected to a respirator. While the tube is in, you will be both unable to speak or ingest fluids. Before hospital discharge, the chest tube(s) will be removed as a bedside procedure that does not require further surgery.

On average, hospitalization lasts 1-2 weeks, followed by an additional 2-4 weeks before returning to normal activities.

Success Rates And Complications

Most estimates of mortality associated with P/D range from 1% to 5%; for the more extensive EPP surgery this is usually 2 to 3 times higher. P/D has a good track record for improving or relieving symptoms present before surgery. More than 80% of patients report satisfactory results for chest pain, excess fluid in the chest, cough, and breathing difficulties.

The causes of serious problems following P/D and EPP are essentially the same, but they occur more frequently after EPP. Between 5 – 15% of P/D patients will experience one or more serious complications compared to about 40-60% with EPP.

Complications that are commonly encountered are listed below along with estimates based on medical reports.  For comparison, similar estimates are also provided for EPP.

Benefits and Life Expectancy

The main benefit of opting for a P/D is improved life expectancy. While the average life expectancy for patients with pleural mesothelioma is around a year with only about 5% of patients surviving for five years, patients who had a P/D experienced improved survival rates. In a study by Dr. Raja Flores, stage 1 mesothelioma patients experienced a survival rate of 40% after five years.

Another benefit of this surgery, which is often referred to as the lung-sparing or lung-saving option, is that the lung is not removed. In an EPP, the lung along with parts of the diaphragm and lining of the heart are also removed where tumors are present.

Dr. Robert Cameron, a known pioneer and leading doctor of P/D, believes “taking out a lung does harm and there is absolutely no benefit to the patient.” Dr. Sugarbaker, the creator of EPP, believes in both removing visible tumors and whatever is left “at the microscopic level.”

Ultimately, the right option is up to the patient and the advisement of their doctor based on eligibility and individual circumstances.

Sources:
1. “Malignant Mesothelioma Treatment.” National Cancer Institute. N.p., n.d. Web. 29 Jan. 2016.
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9. https://www.maacenter.org/treatment/surgery/pleurectomy-decortication/

Asbestos is the only confirmed cause of mesothelioma.

While the causes of many types of cancer remain unknown, that is not the case with mesothelioma. Up to 85% of all diagnosed cases of mesothelioma can be definitively linked to exposure to asbestos. For decades, concerned doctors and research scientists speculated about the dangers of asbestos and warned industries to discontinue its use, but a conclusive link wasn’t actually made until 1999, when it was too late for the millions around the world who had already suffered prolonged exposure to the dangerous mineral.

How Asbestos Makes You Sick

Asbestos is a naturally-occurring mineral that possesses excellent insulating and heat-shielding properties. Because of this, it has long been used in a variety of products, including building materials like insulation, gaskets, floor and ceiling tiles, and drywall tape, as well as in automotive products such as brake pads and shoes and clutch plates.

Asbestos is not dangerous when left undisturbed. In fact, scientists estimate that asbestos occurs naturally in our air and drinking water and that everyone breathes in the mineral at some time or another. However, when asbestos is damaged and becomes “friable” – soft and weak – it is more easily airborne, and hence, inhalation can occur more easily.

People who worked with asbestos that was cut, crushed, sanded, torn, or otherwise manipulated were prone to inhaling these dangerous fibers. Prior to the asbestos warnings of the 1970s, individuals who worked with asbestos were given little or no protective gear, even though it has been proven that experts have known about the dangers of asbestos for more than a century and warned industries of the risks.

Usually, those exposed to asbestos on a regular basis do not get sick immediately. As a matter of fact, asbestos diseases often do not appear for 20-50 years after exposure. However, a handful of workers who were first responders at the World Trade Center disaster in 2001 have already died of mesothelioma due to extreme exposure to the material.

Asbestos fibers that are breathed into the lungs cannot be expelled, so they remain there, embedding themselves in the lining of the lung (the mesothelium) and causing inflammation. Cancerous tumors may develop decades later and require very harsh mesothelioma treatment.

Who Is at Risk?

Individuals who have worked many years at particular jobs where asbestos was in plentiful use are most at risk for developing mesothelioma or any other sort of asbestos-related disease.

One of the highest incidences of mesothelioma is among shipyard workers who were employed during the peak years of World War II, not only in America but also in other countries. Because shipyards often performed overhauls on war ships, workers were exposed to large amounts of friable asbestos and inhaled the mineral on a regular basis for long hours at a time. Shipyard workers and other workers that are consistently at risk include:

Secondary Exposure

In addition, home renovations or other DIY projects can lead to direct exposure to asbestos. Tearing apart walls and ceilings or installing new insulation, for example, can lead to dangerous levels of exposure, especially without proper protective gear. Though experts note that no amount of exposure is safe, prolonged exposure increase susceptibility to the disease.

Others at risk for developing mesothelioma include the families of those who worked with asbestos on a regular basis. While mesothelioma is not contagious, it wasn’t unusual for workers to bring home asbestos dust on their clothing. Numerous cases of this rare cancer have been diagnosed among women who washed asbestos-laden clothing, as well as adults who, as children, enjoyed close contact with their father (or grandfather) when he got home from work, before he changed and showered, never realizing that they were inhaling dangerous fibers as well.

Smoking and Mesothelioma

Though smoking doesn’t directly cause mesothelioma, it does make a person more likely to develop the disease. Reports have shown that smokers who worked with asbestos are up to 90 percent more likely to develop mesothelioma than those who don’t smoke. Furthermore, smokers who already have asbestosis are also more likely to develop mesothelioma. Simply put, smoking and asbestos don’t mix.

Types of Asbestos

Asbestos naturally occurs in six types, which fall into two categories, differentiated by their basic structure.

Sources:
1. American Cancer Society. What are the risk factors for malignant mesothelioma?
2. National Institute for Occupational Safety and Health.
3. National Cancer Institute. Asbestos Exposure and Cancer Risk.
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Stages and Life Expectancy of Mesothelioma

Pleural mesothelioma progresses through four stages.

Oncologists diagnose cancer and monitor its progress in terms of “stages.” Staging allows doctors to determine to what extent an individual’s cancer has developed and spread. It also allows the oncologist to determine the best course of mesothelioma treatment for the patient.

Pleural mesothelioma, the most common form of the disease, is staged in the same manner as most cancers, though a staging system is not yet in place for peritoneal and pericardial mesothelioma, the rarer forms of this aggressive cancer.

Currently, the three systems that are used to stage this disease are the Butchart, TNM, and Brigham systems. Each differs slightly, and which is used may depend on the physician in charge or the facility at which the patient is being treated.

The Butchart System

Butchart is the oldest system in place and is still the most commonly used. This system is based on the extent of primary tumor mass.

TNM System

This system considers three components; the first letter of each forming the name of the system. Doctors using TNM will look at the tumor, lymph nodes, and whether the cancer has metastasized. Like the Butchart system, it is divided into four stages.

Brigham System

The system used least for the diagnosis and staging of mesothelioma is the Brigham System. It addresses the ability to surgically remove the tumor (resectability) and the involvement of the lymph nodes. (Because mesothelioma is often diagnosed in its later stages, surgery is often not an option.) Its stages include:

Treatment by Stage

Treating Stage 1 Mesothelioma

Typically, a patient found to be suffering from Stage 1 mesothelioma will be referred to a surgeon for removal of the tumor. This may be followed up by chemotherapy and/or radiation to be sure all the cancer is eradicated. Again, patients with mesothelioma are rarely found to be in Stage 1 at the time of diagnosis, so surgery is often not an option.

EXTRAPLEURAL PNEUMONECTOMY

This is a surgery that is only offered to those in the early stages of the disease who are in otherwise good physical health. The cancer must not have spread to any other major parts of the body, including the lymph nodes. During this surgery, the affected lung will be removed as well as the pleura (lining of the lung), the diaphragm, and the pericardium (covering of the heart). This is major surgery, necessitating a 2-week or so hospital stay and a 2-month recovery period. It carries about a 6% mortality rate. Patients should understand that this is not a curative surgery but can extend their life significantly. Radiation or chemotherapy may be offered along with the surgery.

PLEURECTOMY

Also a surgery, this procedure removes the pleura and the tissue surrounding it. It requires an approximate 7-day hospital stay and a recovery period of about 2-3 weeks, barring any complications. A pleurectomy is performed only to relieve symptoms, not as a cure.

RADIATION

For those who are not candidates for surgery, radiation will be offered to help control the uncomfortable symptoms of the disease.

CLINICAL TRIALS

A wealth of clinical trials are available to those suffering from mesothelioma. These involve the use of volunteers who are stricken with the disease who will, in turn, test experimental drugs or procedures that are not yet approved by the Food and Drug Administration (FDA). Many volunteers have benefited greatly from participation in clinical trials. Ask your doctor if there are any available for which you fit the criteria.

Treating Stage 2 Mesothelioma

As mesothelioma progresses through the stages, it becomes more difficult to treat. Therefore, those with Stage 2 cancer have fewer options than those with Stage 1 meso. Also, life expectancy for Stage 2 patients goes down because the cancer has spread further.

Surgery may still be recommended in order to remove the primary tumor and the affected lymph nodes. In some cases, patients are already not candidates for surgery and may be prescribed less-invasive treatments. Chemotherapy and/or radiation is usually recommended either post-operatively (to kill any remaining cancer cells) or as the only sources of treatment at this stage.

THORACENTESIS (LUNGS) OR PARACENTESIS (ABDOMEN)

These procedures remove the fluid that has accumulated around the lungs or, in the case of peritoneal mesothelioma, the abdomen. The retention of fluid is a common symptom of mesothelioma. These procedures can be done on an outpatient basis but may require a short hospital stay (possibly overnight) if the patient is high risk.

TRADITIONAL RADIATION OR CHEMOTHERAPY

Either of these procedures is used to reduce symptoms of mesothelioma, such as chest pain or breathing difficulty.

BRACHYTHERAPY

This is a form of radiation therapy that involves implanting small radioactive rods into the tumor or the area around the tumor in hopes of killing cancer cells in that specific area. As the patient may be “radioactive” after the insertion of the rods, a hospital stay may be required and visitors may be limited.

CLINICAL TRIALS

As with Stage 1, there may be clinical trials to help people with Stage 2 mesothelioma.

Treating Stage 3 Mesothelioma

Patients whose mesothelioma has reached Stage 3 generally have a poor prognosis. Unfortunately, the disease is often not diagnosed until it has reached this point, which is why the survival rate is so low in general.

Curative surgery is no longer an option at this point. Instead, chemotherapy and radiation are usually recommended and patients may opt to participate in clinical trials that are testing new drugs and therapies.

However, at Stage 3, treatments are often palliative in nature (i.e., designed to reduce the pain of symptoms rather than treat the disease), and doctors do not expect them to do much to halt the spread of the cancer. Instead, the treatments are designed to keep the patient as comfortable as possible, relieving symptoms of the disease rather than offering an improved prognosis. Chemo, for example, can provide symptomatic relief by shrinking tumors, and surgical procedures like thoracentesis, the removal of fluid around the lungs, can assist with breathing.

Procedures used in treating Stage 3 mesothelioma are similar to those used to treat Stage 2 (see above).

Treatment of Stage 4 Mesothelioma

As this is considered “end stage” cancer, there are few treatment options left at this point and none that offer the potential for cure. The patient is too weak to withstand anything but palliative therapies designed to relieve pain and ease breathing. Treatments like chemotherapy should be carefully considered when recommended as the side effects can be debilitating and little success will result from taking advantage of the treatment at this stage.

Families of the victim should begin to consider end-of-life issues at this point if they have not already done so, including wills and funeral plans.

CHEMOTHERAPY OR RADIATION

Goals for these treatments should be clearly defined so that the patient is not subject to furthering suffering through the use of treatments that may cause serious side effects.

PAIN MEDICATION

Many Stage IV patients and their families describe the pain at this point as unbearable. Don’t hesitate to ask for additional pain medications, if needed.

SUPPORTIVE CARE

Often, those at this stage of the disease enter hospice care as their families are no longer able to care for them nor can they care for themselves. Hospice facilities also offer end-of-life emotional support for the patient’s family and friends.

COUNSELING

In addition to all the treatment options above, doctors may suggest psychotherapy or counseling to help patients and their families deal with the diagnosis of mesothelioma and the impending outcome of the disease.

Sources:
1 Cancer Help, UK: The Stages of Mesothelioma.
2 National Cancer Institute: Stages of Mesothelioma
3 American Cancer Society: How is Malignant Mesothelioma Staged?
4 https://www.maacenter.org/mesothelioma/stages/