Treatment of Pleural Mesothelioma
Your choice of treatment will depend on a number of factors
The stage of your cancer
Any other medical conditions you may have
Your general fitness
Unfortunately mesothelioma can be very difficult to treat. Nearly all treatment is aimed at controlling the diseaes for as long as possible and keeping symptoms under control. Mesothelioma can be treated with
Surgery
Radiotherapy
Chemotherapy
Doctors and researchers are working to improve treatment all the time. You may be offered treatment as part of a clinical trial and not as a standard treatment. The results of the trials will be used to improve treatment in the future.
Mesothelioma treatment is designed to treat the immediate area of the pleural mesothelioma or the whole body. Whole body treatments are called systemic treatments. Localised treatments include surgery and radiotherapy. Systemic treatments act on cancer cells no matter where they may be in the body and include chemotherapy.
Surgery
Surgery can be used to remove localised mesothelioma, or to take out as much as possible so that other treatments have a better chance of working. This is sometimes called de-bulking. There are 2 major operations that can be done
Pleurectomy
Extrapleural pneumonectomy
Pleurectomy
This means removing the pleura. The lung is left behind. The pleural space around it is sealed so that no further fluid can collect there. If you have stage 1 mesothelioma, it may be done to remove the cancer. If you have a more advanced stage, it will not cure you but can help to relieve symptoms such as pain and fluid collection around the lung (pleural effusion). Removing as much of the cancer as possible may also help other treatments to work more effectively, for example, chemotherapy.
Extrapleural pneumonectomy
This is extensive surgery, which is not suitable for everyone with mesothelioma. It can be done if you have mesothelioma that is up to TNM stage T3,N1. This means stage 1, stage 2 and some stage 3 mesotheliomas. It will not cure mesothelioma, except possibly in cases that are diagnosed unusually early. This operation can slow down the disease though, and give people better quality of life for longer. Pneumonectomy means removing the lung. Extrapleural means that the pleura, diaphragm, covering of the heart (pericardium) are removed as well on the side affected by mesothelioma.
This operation is only possible if you are fit enough and have good heart and lung function. If your heart and lung function is already poor, the operation may do you more harm than good.
There is a trial soon to start that is looking into extrapleural pneumonectomy. Half the patients in this trial will have this operation and the other half will have chemotherapy or radiotherapy to control their symptoms as needed. This trial will help to show if going through the trauma of major surgery is helpful or not in the long run in delaying the disease or in controlling symptoms.
Radiotherapy
Radiotherapy can be used to try to slow down the disease or to control symptoms. You may be given radiotherapy after surgery for stage 1 mesothelioma to try to slow down the return of the cancer as much as possible. Radiotherapy given after surgery is sometimes called adjuvant radiotherapy.
Radiotherapy may also be used for stage 2, 3, or 4 mesothelioma. It is given to slow the cancer down, or to control symptoms. The length of your treatment will depend on the type and size of your cancer and on why you are being treated. Radiotherapy is sometimes given after fluid has been drained from around your lung. This is to try to stop new growths of mesothelioma developing on your chest wall.
Chemotherapy
Chemotherapy uses anti-cancer drugs, which are usually injected into a vein. For mesothelioma, chemotherapy may be given directly into the pleural space (intrapleurally). Depending on the type of chemotherapy drugs used, this treatment can be given weekly or every two to three weeks.
Chemotherapy for mesothelioma is given to slow down the cancer and to control symptoms. If you have had surgery, you may be given chemotherapy afterwards. This is called adjuvant chemotherapy. It is given to delay the return of the cancer as much as possible.
Chemotherapy can be used to control symptoms in more advanced mesothelioma. The treatment may also help to slow down the growth of the cancer. There is a clinical trial planned that is looking into giving chemotherapy in mesothelioma that cannot be operated on. The trial is comparing having chemotherapy to not having chemotherapy to see if chemotherapy can control symptoms and improve quality of life.
Supportive care (Palliative care)
Mesothelioma is often diagnosed when it is quite advanced. Some people with very advanced disease may be too ill to cope with very intensive chemotherapy, radiotherapy, or surgery. But they can still be given treatment to try to relieve symptoms such as pain, breathing problems and weight loss. Your care will be managed by a palliative care team. This is a team of doctors and nurses who are expert in controlling symptoms of advanced cancer. The team may also include a physiotherapist and a dietician.
If you are having trouble with fluid collecting around your lungs, you may be offered treatment to try to stop this from happening. Pleurectomy is one option. Another is thoracocentesis. This is often called a pleural tap.
The fluid that has collected in the pleural space is drained off.
Often sterile talc or an antibiotic is put in to seal the space and stop the fluid collecting again. This is called pleurodesis.
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