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.

Side Effects of Chemotherapy

Chemotherapy treats many types of cancer effectively. But like other treatments, it often causes side effects. These are different for each person. They depend on the type of cancer, location, drugs and dose, and your general health.

Why does chemotherapy cause side effects?

Chemotherapy works on active cells. Active cells are cells that are growing and dividing into more of the same type of cell. Cancer cells are active, but so are some healthy cells. These include cells in your blood, mouth, digestive system, and hair follicles. Side effects happen when chemotherapy damages these healthy cells.

Can side effects be treated?

Yes. Your health care team can help you prevent or treat many side effects. Today, many more medications are available for side effects than in the past. Preventing and treating side effects is now an important part of cancer treatment. It is part of a type of care called palliative care.

Also, doctors and scientists work constantly to develop drugs, drug combinations, and ways of giving treatment with fewer side effects. Many types of chemotherapy are easier to tolerate than they were a few years ago.

Common side effects

Different drugs cause different side effects. Certain types of chemotherapy often have specific side effects. But, each person’s experience is different.

Tell your doctor about all the side effects you notice. For most types of chemotherapy, side effects do not show how well treatment is working. But they can for some types of drugs called targeted therapies. Learn more about targeted therapy.

Below is a list of common side effects of traditional chemotherapy.

Fatigue. Fatigue is feeling tired or exhausted almost all the time. It is the most common side effect of chemotherapy. Learn more about how to cope with fatigue.

Pain. Chemotherapy sometimes causes pain. This can include:

• Headaches
• Muscle pain
• Stomach pain
• Pain from nerve damage, such as burning, numbness, or shooting pains, usually in the fingers and toes

Pain usually gets less with time. However, some people have permanent nerve damage. This can cause symptoms for months or years after treatment.

Doctors can treat pain by:

• Treating the source of the pain
• Giving pain-relieving medications
• Blocking pain signals from the nerves to the brain with spinal treatments or nerve blocks

Learn more about cancer pain and how to manage it.

Mouth and throat sores. Chemotherapy can damage the cells inside the mouth and throat. This causes painful sores in these areas, a condition called mucositis.

Mouth sores usually happen 5 to 14 days after a treatment. The sores can get infected. Eating a healthy diet and keeping your mouth and teeth clean can lower your risk of mouth sores. Mouth sores usually go away completely when treatment ends. Learn more about managing mucositis and oral health during cancer treatment.

Diarrhea. Some chemotherapy causes loose or watery bowel movements. Preventing diarrhea or treating it early helps keep you from getting dehydrated (losing too much body fluid). It also helps prevent other health problems. Learn more about managing diarrhea.

Nausea and vomiting. Chemotherapy can cause nausea (feeling sick to your stomach) and vomiting (throwing up). Whether you have these side effects, and how much, depends on the specific drugs and dose. The right medications given before and after each dose of chemotherapy can usually prevent nausea and vomiting. Learn more about nausea and vomiting. Read ASCO’s guideline for preventing these side effects.

Constipation. Chemotherapy can cause constipation. This means not having a bowel movement often enough or having difficult bowel movements. Other medications, such as pain medication, can also cause constipation. Drinking enough fluids, eating balanced meals, and getting enough exercise can lower your risk of constipation. Learn more about managing constipation.

Blood disorders. Your bone marrow is the spongy tissue inside your bones. It makes new blood cells. Chemotherapy affects this process, so you might have side effects from having too few blood cells.

Your health care team uses the following tests to check for blood disorders:

• Complete blood count (CBC)– This test shows the levels of red blood cells (RBCs) and white blood cells (WBCs) in your blood.
  • Not enough RBCs causes a condition called anemia. Symptoms include fatigue, dizziness, and shortness of breath.
  •  Not enough WBCs causes a condition called leukopenia. This raises your risk of getting infections. Getting one when your WBCs are low can be serious. If you get an infection, you need antibiotics as soon as possible.
  • Platelet count – This test measures the number of platelets in your blood. Platelets are cells that stop bleeding. They do this by plugging damaged blood vessels and helping blood form clots.
    • Not having enough platelets causes a condition called thrombocytopenia. You can bleed and bruise more easily than normal.

Medications can treat all these blood disorders, and prevent leukopenia for patients with a high risk. The medications help your bone marrow make more blood cells. Learn more about managing anemia, infection, and thrombocytopenia.

Nervous system effects. Some drugs cause nerve damage. This can cause the following nerve or muscle symptoms:

• Tingling
• Burning
• Weakness or numbness in the hands, feet, or both
• Weak, sore, tired, or achy muscles
• Loss of balance
• Shaking or trembling

You might also have a stiff neck, headache, or problems seeing, hearing, or walking normally. You might feel clumsy. These symptoms usually get better with a lower chemotherapy dose or after treatment. But damage is sometimes permanent. Learn more about managing nervous system side effects.

Changes in thinking and memory. Some people have trouble thinking clearly and concentrating after chemotherapy. Cancer survivors often call this chemo brain. Your doctor might call it cognitive changes or cognitive dysfunction.

Sexual and reproductive issues. Chemotherapy can affect your fertility. For women, this is the ability to get pregnant and carry a pregnancy. For men, fertility is the ability to make a woman pregnant. Being tired or feeling sick from cancer or treatment can also affect your ability to enjoy sex. Talk with your doctor about these possible side effects before treatment starts. Learn more about managing sexual and reproductive side effects.

Chemotherapy can harm a fetus (unborn baby). This is especially true in the first 3 months of pregnancy, when the organs are still developing. If you could get pregnant during treatment, use effective birth control. If you do get pregnant, tell your doctor right away. Learn more about pregnancy and cancer.

Appetite loss. You might eat less than usual, not feel hungry at all, or feel full after eating a small amount. If this lasts through treatment, you may lose weight and not get the nutrition you need. You may also lose muscle mass and strength. All these things lower your ability to recover from chemotherapy. Learn more about managing appetite loss.

Hair loss. Some types of chemotherapy cause hair loss from all over your body. It may come out a little at a time or in large clumps. Hair loss usually starts after the first several weeks of chemotherapy. It tends to increase 1 to 2 months into treatment. Your doctor can predict the risk of hair loss based on the drugs and doses you are receiving. Learn more about managing hair loss.

Long-term side effects. Most side effects go away after treatment. But some continue, come back, or develop later. For example, some types of chemotherapy may cause permanent damage to the heart, lung, liver, kidneys, or reproductive system. And some people have trouble with thinking, concentrating, and memory for months or years after treatment.

Nervous system changes can develop after treatment. Children who had chemotherapy may develop side effects that happen months or years after treatment. These are called late effects. Cancer survivors also have a higher risk of second cancers later in life.

Care after cancer treatment is important

Getting care after treatment ends is important. Your health care team can help you treat long-term side effects and watch for late effects. This care is called follow-up care. Your follow-up care might include regular physical examinations, medical tests, or both.

ASCO has cancer treatment summary forms. The forms help you keep track of the cancer treatment you received and develop a survivorship plan after treatment.

Sources:
http://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/side-effects-chemotherapy

Types of Radiation Therapy for Mesothelioma Patients

Radiation therapy is the application of ionizing radiation to destroy tumor cells. When ionizing radiation moves through cells, the radiation strikes some of the molecules, changing them. These molecules become ions and free radicals, which are toxic to living cells. The cells in the treated area then break apart, die, or become dysfunctional. Ideally, the ionizing radiation is directed toward tumor cells rather than healthy cells.

During radiation therapy, a team of specialists including a radiation oncologist, medical physicists, and other healthcare providers will create a treatment plan and conduct radiation therapy. The team will carefully review x-rays, CT scans, and MRI studies to view the mesothelioma as it is situated next to healthy tissue. These radiological images will be used to make precise measurements, and the team will identify the best dose of radiation for the given patient.

Several issues are considered during radiation therapy. The medical professionals will attempt to avoid directing the beam at healthy tissues that surround the tumor, but will calculate a radiation dose that should be toxic to the entire diseased area. Since mesothelioma rarely forms a discrete tumor and grows near many sensitive areas (e.g., spinal cord, heart, esophagus, liver, and the opposite lung), every effort is made to direct the beam at the cancer cells and limit damage to healthy tissues. Specialized radiation delivery techniques have been developed to more precisely target mesothelioma cells.
Read more: How Does Radiation Therapy Work for Mesothelioma?

External Beam Radiation

The traditional method of radiation therapy for mesothelioma is external beam radiation therapy. In external beam radiation therapy, a radiation source outside the patient’s body is pointed at the tumor. Positioning of the radiation delivery device is critical. During the first treatment, a small tattooed dot (the size of a freckle) or semi-permanent ink dots may be applied to the skin to mark a location for the current and subsequent radiation treatments. A precise dose of radiation is delivered by a radiation beam to the tumor. Since the beam is outside of the body, healthy tissue such as skin, muscle, and bone may receive some radiation as well.

Because the positioning and radiation dose must be precise, the preparation for a radiation therapy treatment takes longer than the radiation exposure itself. The actual exposure to radiation takes a few minutes, but the positioning and preparation may take 20 minutes or more. The exposure to radiation is painless, much like having an X-ray or CT scan is painless. Standard external beam radiation therapy is administered five days a week over the course of several weeks.

3D-CRT

3D-CRT stands for three-dimensional conformal radiation therapy. 3D-CRT is a form of external radiation that matches the radiation beam to the shape of the tumor. In traditional external beam radiation therapy, treatment is provided based on a two-dimensional representation of the body. In 3D-CRT, specialized software is used to convert two-dimensional images into a three-dimensional representation of the body and the tumor. Therefore, the radiation treatment specialists can direct the radiation to the tumor in three-dimensional space. The result of this process is that more radiation is delivered to the tumor and less radiation is delivered to healthy tissue.

Like traditional external beam radiation, the 3D-CRT treatment is painless. Since targeting in 3D-CRT is more precise than in the traditional approach, higher doses of radiation can be used. Thus, the cancer-killing potential of the treatment is higher.

IMRT

IMRT stands for Intensity Modulated Radiation Therapy. Like 3D-CRT, IMRT delivers radiation precisely to areas with tumors while mostly sparing surrounding tissue. Unlike 3D-CRT, IMRT delivers different intensities of radiation to the tumor. For example, a high-intensity beam can be directed at areas of large, solid tumor mass while lower intensity energy can be directed at thinner or smaller collections of cancer cells. Because of this enhanced precision, very high doses of ionizing radiation can be used with IMRT.

IMRT may be more effective than external beam radiation therapy and may cause fewer side effects. When IMRT is compared to 3D-CRT, however, the differences in effectiveness are less impressive. IMRT is able to deliver higher amounts of radiation to the mesothelioma, but it still puts healthy organs at risk.

Recently, enhancements have been made to IMRT that may make it even safer. When IMRT is delivered with a technology called helical tomotherapy, high-dose radiation can be delivered more precisely to cancer cells and relatively little strikes healthy tissue. Just as computed tomography (CT) takes X-ray images in “slices,” helical tomotherapy delivers radiation therapy in horizontal “slices” of the body. The intensity of the beam changes with the size of the tumor in each slice. The result is an even higher level of precision than typical IMRT treatments.

Intraoperative Radiation

Intraoperative radiation is the application of ionizing radiation to tumor cells during the course of surgery. The theoretical advantage of intraoperative radiation is that the beam of radiation can be directed on the tumor itself rather than first traveling through healthy tissue. Another possible advantage of intraoperative radiation is the radiation will kill all mesothelioma cells within the chest cavity since, during surgery, the treating physician can see the tumor directly.

Unfortunately, intraoperative radiation has not shown much success. One research group deemed the treatment “prohibitively toxic” and reported serious complications when intraoperative radiation was combined with extrapleural pneumonectomy. It is not known whether intraoperative radiation is beneficial when combined with pleurectomy and decortication, however.

Benefits of Radiation Therapy

Your specific diagnosis will determine which type of radiation therapy will be most beneficial in terms of improving prognosis. It’s important that you refer to a mesothelioma specialist in order to determine if the benefits will outweigh the risks under your specific circumstances. If your doctor recommends radiation therapy as part of your mesothelioma treatment plan, it means they believe the benefits outweigh the possible side effects.

Sources:
1. Buduhan G, Menon S, Aye R, Louie B, Mehta V, Vallières E. Trimodality Therapy for Malignant Pleural Mesothelioma. Ann Thorac Surg. 2009.
2. Rosenzweig KE, Fox JL, Zelefsky MJ, Raben A, Harrison LB, Rusch VW. A pilot trial of high-dose-rate intraoperative radiation therapy for malignant pleural mesothelioma. Brachytherapy. 2005.
3. Lee TT, Everett DL, Shu HK, et al. Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. Dec 2002.

4. https://www.maacenter.org/treatment/radiation/types-of-radiation-therapy/

Side Effects of Radiation Treatment for Mesothelioma Patients

Radiation therapy uses beams of high-energy particles to reduce tumors. However, the biggest risk associated with radiation therapy is the potential for healthy tissues to get damaged, causing a number of side effects.

Treatment with external beam ionizing radiation may cause sunburn-like changes to the skin under the treatment beam. Patients also tend to lose hair over the treatment area. It is also quite common for people to experience fatigue after radiation therapy. These side effects may worsen or last longer if radiation therapy is combined with chemotherapy.

Other side effects of radiation vary depending on the location of the body receiving treatment. In other words, patients receiving radiation therapy to the chest may have different side effects than individuals who receive radiation therapy directed at the stomach or upper abdomen.

Side Effects of Pleural Mesothelioma Radiation Treatment

Below are side effects of radiation therapy directed to the chest that may occur in patients with pleural mesothelioma.

• Fatigue
• Hair loss
• Skin changes
• Cough
• Shortness of breath
• Throat changes and problems swallowing
• Breast/nipple soreness
• Radiation pneumonitis
• Radiation fibrosis
• Irregular heart beats
• Heart valve damage
• Premature hardening of the arteries (atherosclerosis)      

Side Effects of Peritoneal Mesothelioma Radiation Treatment

Peritoneal mesothelioma patients who receive radiation to the abdomen or stomach region may experience the following side effects.

• Fatigue
• Diarrhea
• Nausea and vomiting
• Hair loss
• Skin changes
• Bladder and urinary problems

Common Side Effects

Skin Problems

For most people receiving external beam radiation treatment, the changes to the skin of the treated area are similar to that of a moderate or severe sunburn. The affected area may become red, itchy, dry, or flake and peel much as it does after sunburn. If the skin cells in the treated area slough off and do not have time to grow back during treatments, the skin may become moist, swollen, inflamed, and even infected. Radiation therapy may cause the darkening discoloration of the skin in the treated area.

• Redness
• Irritation
• Itchiness
• Flaking or Peeling
• Darkening

The radiation treatment team takes any skin changes seriously. Skin in the treated area will be thoroughly examined before each radiation treatment. Patients should voice any concerns they have to their treatment team.

It is always a good idea to protect the skin from excessive amounts of direct sunlight, but this is especially true during radiation therapy. Additional radiation from the sun can be avoided by keeping skin covered or by using sunscreen with an SPF of 30 or higher. Tanning beds should be avoided. Certain lotions and creams may help moisturize the skin, reduce peeling, and relieve itchiness and burning. The radiation therapy team should be notified of any creams, lotions, or anything else applied to the skin. These products should not be used immediately before radiation therapy unless approved by the radiation oncologist. If the skin becomes infected, rather than simply inflamed, antibiotic treatment is usually required. This may be a topical antibiotic placed directly on the skin. For cellulitis, a more serious skin infection, an oral or intravenous antibiotic may be needed.

The skin changes associated with radiation therapy may develop in the days to weeks after the first treatment session. Many of the skin changes will go away within the weeks following the last treatment; however, some changes may be permanent. Redness, itching, and swelling of the skin usually only lasts for a short time. Skin discoloration and dark blotchy areas may never go away. Because of the radiation received during treatment, this area of skin is at increased risk of developing skin cancer the rest of the patient’s life. Moreover, the treated area will be permanently more sensitive to the effects of the sun, such as sunburn.

Fatigue

Fatigue is a vague term that describes a number of different feelings such as weakness, tiredness, heaviness, slowness, and exhaustion. While fatigue is a common side effect of radiation therapy, the precise cause of fatigue may be different for different people. In fact, more than one cause of fatigue may be occurring at any given time. Moreover, most patients with mesothelioma receiving radiation therapy will not know their precise cause or causes of fatigue.

Fatigue that occurs during radiation therapy may be caused by:

• Anemia
• Depression
• Infection
• Chronic stress
• Physical inactivity
• Older age
• Poor overall health
• Sleep disturbances
• Certain medications

If fatigue is caused by anemia (an abnormally low number of red blood cells), depression, infection, sleep disturbances, or medications, a specific treatment or change in treatments may help resolve the issue. For example, severe anemia can be treated with blood transfusions or drugs stimulate the production of red blood cells. Likewise, depression can be treated with a combination of medications and psychotherapy. People who experience fatigue should discuss the symptom with their oncologists.

There are other ways to manage and reduce feelings of fatigue during radiation therapy. Patients can plan work, responsibilities, personal tasks, and medical appointments such that they do not overexert themselves. Patients should strive to get at least 8-9 hours of sleep every night and supplement that sleep with 20 minute naps during the day, as needed. Excessive daytime sleeping should be avoided, however, because it may disrupt the patient’s natural sleep cycle and make it more difficult for them to get a solid eight hours of nighttime sleep. Patients who can tolerate exercise may find it helpful to exert themselves during the day so that they can build up a reserve through greater physical fitness. Moreover, people who physically exert themselves during the day are more likely to be ready for sleep at a normal hour at night, which can help with insomnia.

Some patients will no longer have feelings of fatigue as early as six weeks after the final radiation treatment area. That said, most people who undergo radiation therapy for malignant mesothelioma will have less energy than they did before treatment. While fatigue is common, it does not mean it is untreatable or unmanageable. Patients should talk to their physicians about possible solutions for fatigue as needed.

Nausea and Vomiting

Radiation therapy for peritoneal mesothelioma may cause nausea and vomiting. Patients may also experience dry heaving. These side effects may occur when the stomach and/or intestines receive radiation. Usually, nausea and vomiting will occur soon after a radiation treatment has ended and may last for several hours. Some people may experience nausea prior to a treatment, especially if they have apprehensions or fears about treatment. Nausea and vomiting may be worse for patients who are also being treated with chemotherapy.

Nausea is less likely to occur when patients eat frequent, small, relatively bland meals during the course of treatment. Likewise, patients should avoid foods that are spicy, densely sweet, or high in fat. Foods and beverages should be neither too hot nor too cold. Some people have less nausea if they eat a small meal before radiation treatment. Others find it is best to not have food in the three hours prior to radiation treatment. A list of foods that tend to be easy on the stomach are listed in Table 2.

Some patients find activities such as meditation, yoga, or acupuncture help relieve sensations of nausea and reduce vomiting. If nausea tends to occur prior to treatment, experts recommend patients pursue relaxing activities before therapy such as listening to relaxing music, reading light nonfiction, or meditating. Medicines are available that can reduce sensations of nausea, so patients are encouraged to speak with a medical professional about treatment options.

Bladder Irritation

If radiation is directed towards the bottom of the abdomen near the urinary bladder, as may be done in the treatment of peritoneal mesothelioma, it may cause bladder irritation and urinary problems. Bladder irritation may manifest itself in many ways, including:

• Difficulty urinating, such as starting to urinate
• Not being able to fully empty the bladder
• A frequent need to urinate
• Urgently needing to urinate
• Burning or pain during urination
• Incontinence, especially stress incontinence, which is unintended urination after a cough or sneeze
• Painful bladder cramps
• Blood in the urine
• Frequently waking at night to urinate

Most patients who experience bladder irritation from radiation therapy first notice problems within a month of beginning therapy. For most people, these bladder issues will end on their own within two months after radiation therapy is finished. While patients can take comfort from the knowledge that bladder irritation is temporary, there are measures that can be taken to avoid or reduce this complication.

Patients should avoid caffeinated beverages such as black tea, coffee, and soda because these beverages tend to increase the frequency of urination. Alcohol has the same effect on urination, and should also be avoided. On the other hand, experts recommend patients undergoing radiation therapy drink sufficient amounts—at least 6 cups per day—of non-caffeinated beverages such as water, sports drinks, and juices (especially cranberry juice). While patients may need to urinate more frequently because of increased fluid intake, the bladder is less likely to become irritated or infected during treatment.

If bladder irritation or incontinence becomes unmanageable, patients should ask their doctor about specific treatments. Physical therapists can teach patients pelvic muscle exercises and relaxation techniques that can improve incontinence. If the bladder becomes infected, antibiotics will be prescribed to treat the infection. Since the symptoms of a bladder infection and bladder irritation from radiation therapy are the same, namely pain on urination, increased frequency of urination, and an increased need to urinate, it is important patients talk to their doctor about the symptoms so that an accurate diagnosis can be made.

Factors That Impact A Patient’s Risk of Experiencing Side Effects

Whether or not a patient experiences side effects depends on a variety of factors, including:

• Overall Health
• Dose of radiation, daily and total
• Location of treatment on the body
• Genetics
• Other treatments such as chemotherapy

Sources:
1. Rice DC, Stevens CW, Correa AM, et al. Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg. Nov 2007
2. Buduhan G, Menon S, Aye R, Louie B, Mehta V, Vallières E. Trimodality Therapy for Malignant Pleural Mesothelioma. Ann Thorac Surg.
3. Krayenbuehl J, Dimmerling P, Ciernik IF, Riesterer O. Clinical outcome of postoperative highly conformal versus 3D conformal radiotherapy in patients with malignant pleural mesothelioma. Radiat Oncol. 2014.
4. Krayenbuehl J, Oertel S, Davis JB, Ciernik IF. Combined photon and electron three-dimensional conformal versus intensity-modulated radiotherapy with integrated boost for adjuvant treatment of malignant pleural mesothelioma after pleuropneumonectomy. Int J Radiat Oncol Biol Phys. Dec 1 2007.
5. Rosenzweig KE, Fox JL, Zelefsky MJ, Raben A, Harrison LB, Rusch VW. A pilot trial of high-dose-rate intraoperative radiation therapy for malignant pleural mesothelioma. Brachytherapy. 2005.
6. Lee TT, Everett DL, Shu HK, et al. Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. Dec 2002.
7. https://www.maacenter.org/treatment/radiation/side-effects-of-radiation/

Mesothelioma Thoracentesis Therapy, used to address painful symptoms

Thoracentesis (also called pleurocentesis) is a medical procedure performed on mesothelioma patients who have a pleural effusion, a condition where a significant amount of excess fluid builds up in the space between the lungs and chest wall (the pleural space). This palliative therapy, meaning it’s used to address painful symptoms as opposed to an attempt to cure disease, is more likely to be used in patients with advanced mesothelioma in order to drain this fluid buildup, as it is a less aggressive option than a pleurodesis.

Normally, when breathing, the body produces a small amount of fluid to lubricate the lungs and prevent friction as the lungs move up and down (or in and out). Mesothelioma causes abnormal changes in the tissues, often leading to excess production of this fluid. This results in lung compression that can make it difficult to breathe comfortably, or take deep breaths.

Thoracentesis is also performed as a diagnostic procedure, in which a small amount of fluid is removed and sent to a pathology lab for analysis. Examination of the pleural fluid can help doctors determine the cause of fluid buildup. In addition to mesothelioma, pleural effusion can also be a sign of other conditions, including lung infections, kidney and liver disease, and congestive heart failure. Thoracentesis is not used as a sole diagnostic test for mesothelioma, however, which usually requires a tissue biopsy.

The Thoracentesis Procedure

Thoracentesis uses a special hollow needle that is very carefully inserted into the pleural space so excess fluid can be gently extracted to reduce pressure on the lungs. It’s not a cure or treatment for the disease itself, but rather a treatment to ease symptoms and improve quality of life.

The procedure can be performed in a doctor’s office, a medical center or a hospital. Before beginning the procedure, a numbing anesthetic will be injected into the chest wall where the larger hollow needle will be inserted. Once the area is numb, the hollow needle will be guided into the pleural space using an imaging technique like ultrasound, CT scanning or a special “real-time” X-ray to make sure the needle tip is accurately placed.

Patients may feel pressure in the chest as the needle moves into the pleural space. After the placement of the needle is confirmed, the fluid will be carefully drawn out. The procedure takes less than a half hour. Once complete, the needle location will be covered with a small bandage. Thoracentesis is usually followed by a chest X-ray to verify the amount of fluid removed and to check for complications such as air accumulation in the chest cavity.

Palliative Benefits

Most patients experience an improvement in breathing right after the procedure is complete and the excess fluid has been removed. There may be some soreness at the incision site which will resolve soon afterward. Overall benefits include:

• Improved breathing
• Reduced chest and lung pressure
• Lessened pain
• Increased space for lung expansion

Risks and Complications

Thoracentesis is generally a safe procedure, and it can offer significant benefits to many mesothelioma patients. Still, when considering whether or not to have the procedure, there are a few potential risks to be aware of, including:

• Complete or partial collapse of the lung, which can occur if the lung is accidentally punctured by the needle during treatment.
• Excess fluid in the lungs, a condition called pulmonary edema, which occurs most commonly if too much fluid is removed from the pleural space.
• Rarely, damage to the liver or spleen if the needle is not properly placed.

As with most surgeries, infection and bleeding are also risks. An X-ray of your chest may be taken afterward to ensure no complications are present.

Is Thoracentesis Right for You?

Thoracentesis is a relatively safe and painless procedure that removes the fluid buildup of a pleural effusion. Although thoracentesis does not treat or cure mesothelioma, it can be very helpful for diagnosing the underlying cause of the effusion and for dealing with patients’ symptoms. However, not every mesothelioma patient is a candidate for thoracentesis. Talk to your doctor to determine whether or not this procedure will be helpful for you.

Sources:
1. Thoracentesis. WebMD.
2. Brauner, Mark E. Thoracentesis. Medscape.
3. Thoracentesis. Johns Hopkins Medicine Health Library.
4. Thoracentesis. American Thoracic Society.
5. https://www.maacenter.org/treatment/surgery/thoracentesis/