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The stage (extent) of mesothelioma is an important factor in determining treatment options. But other factors, such as whether the doctor feels the cancer is resectable (all visible cancer can be removed by surgery), as well as a person’s general health and preferences, also play a role.
Most stage I and some stage II and III pleural mesotheliomas are potentially resectable, but there are exceptions. Whether a tumor is resectable is also based on the subtype (most doctors don’t believe that sarcomatoid tumors are helped by resection), where it is in the body, how far it has grown into nearby tissues, and if the person is healthy enough to have surgery.
Many people with resectable pleural mesothelioma have it removed by either pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP). Surgery is more likely to have long-term benefits in early-stage cancers, where there’s a better chance that most or all of the cancer can be removed. EPP might offer the best chance to remove the cancer, but it’s a complex and extensive operation that’s more likely to cause complications, and not all patients can tolerate it.
Doctors are still studying whether giving chemotherapy (chemo) before surgery (called neoadjuvant therapy) or giving chemo and/or radiation therapy after surgery (adjuvant therapy) is helpful. Not all doctors agree on the best ways to use these treatments together. Some doctors prefer to give chemo, either before or after surgery. Radiation therapy might be used after surgery, either alone or along with chemo.
In most cases the options will be a lot like those listed above for unresectable mesotheliomas. For example, chemo or radiation therapy might be used to try to shrink or slow the growth of the cancer and to relieve any symptoms. Because recurrent mesothelioma is hard to treat, clinical trials of new types of treatment may be a good option. For more on dealing with cancer that comes back, see Understanding Recurrence.
Biopsy, a procedure to remove a small portion of tissue for laboratory examination, is the only way to determine whether you have mesothelioma. Depending on what area of your body is affected, your doctor selects the right biopsy procedure for you.
Unfortunately, mesothelioma often is an aggressive disease and for most people a cure isn’t possible. Mesothelioma is usually diagnosed at an advanced stage — when it isn’t possible to remove the cancer through an operation. Instead, your doctor may work to control your cancer to make you more comfortable.
Most of the time, it isn’t possible to remove all of the cancer. In this situation, surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in your body.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For mesothelioma, some basic questions that you might consider asking your doctor include:.
Try to avoid anything that worsens your signs and symptoms. For instance, if you’re experiencing shortness of breath, try to take it easy until you can meet with your doctor. If your breathlessness becomes distressing or uncomfortable, seek immediate medical attention.
Standard treatments for malignant mesothelioma include surgery, chemotherapy and radiation. Treatment plans may incorporate a combination of the three, if possible for the patient. For cases where standard treatments do not work, mesothelioma patients may be able to participate in clinical trials to try experimental treatments.
There is no cure for mesothelioma, but it is possible for treatment to improve patient prognosis. Treatment options will vary based on the type of mesothelioma, patient characteristics and staging. For late-stage patients, there are alternative therapies and palliative care options that can help improve symptoms and quality of life.
When determining which treatment type is best for the patient, mesothelioma doctors will consider mesothelioma type, cell type and patient characteristics. The patient’s age and overall health may limit what treatment options are viable. The stage of cancer is also an influential factor. If the disease is localized, more treatment options are available than if spreading has occurred.
In many cases, mesothelioma specialists will recommend a multimodal approach, which combines surgery, chemotherapy and/or radiation therapy, or even emerging treatments in some cases. In various studies, multimodal treatment has been shown to be more effective than any of the individual treatments alone. In particular, surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC), a heated chemotherapy wash applied directly to the abdominal cavity, has demonstrated around a 50% survival rate or higher for peritoneal mesothelioma patients in recent clinical studies. With aggressive multimodal plans, patients should be aware of all potential treatment side effects.
Palliative treatments can be invasive or non-invasive, including anything from pain medication to physical therapy, massage, acupuncture, yoga and other alternative therapies. Mesothelioma patients may undergo palliative care during their treatment journey, as their sole treatment plan during the late stages of their diagnosis or after treatment.
Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
There are different types of treatment for patients with malignant mesothelioma.Four types of standard treatment are used:SurgeryRadiation therapyChemotherapyTargeted therapyNew types of treatment are being tested in clinical trials. Biologic therapyTreatment for malignant mesothelioma may cause side effects.Patients may want to think about taking part in a clinical trial.Patients can enter clinical trials before, during, or after starting their cancer treatment.Follow-up tests may be needed.
Combination chemotherapy and targeted therapy with bevacizumab.Chemotherapy placed directly into the chest cavity to shrink the tumors and keep fluid from building up.Surgery to drain fluid that has collected in the chest, to relieve chest discomfort and improve quality of life. Pleurodesis may be done to stop more fluid from collecting in the chest.Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve quality of life.Radiation therapy as palliative therapy to relieve pain.A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
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