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Presently, mesothelioma treatment options include one or more of the following: surgery, ionizing radiation, chemotherapy, photodynamic therapy, and gene therapy.
Medical researchers continually work to improve existing treatment options and come up with new mesothelioma treatment opportunities. Mesothelioma is a rare cancer, but a very aggressive one. Advancements in mesothelioma research bring about increased life expectancy and survival rates for the asbestos cancer patients.
Dr. Raja Flores of Mount Sinai Medical Center, New York City, one of the leading mesothelioma doctors and researchers in the U.S., reports that the longest-term mesothelioma survivors are almost invariably those who have undergone an appropriate surgery.
Moreover, surgery can be useful for relieving the pain associated with the cancer, according to a mesothelioma treatment article in the New England Journal of Medicine.
Extrapleural pneumonectomy is the name of a surgical procedure to treat malignant pleural mesothelioma (the most common form of the disease). Also known as EPP, this surgery is utilized to attack large tumors when the disease is in its more advanced phases. It involves what doctors refer to as “radical resection,” meaning healthy portions of the lung must be cut out along with the bad. Mesothelioma treatment experts generally agree that EPP may be the most appropriate choice where the lung is so far gone that the patient has little or no lung function to begin with.
Pleurectomy/decortication, also known as P/D, is another surgery to treat malignant pleural mesothelioma. However, unlike EPP, P/D is intended to spare as much of the lung as possible. For that reason, it’s most useful during the early stages of the disease. In a P/D procedure, the lung’s lining called the pleura is removed. With it goes the cancerous tissues beginning to grow there.
P/D surgery does carry risks. Mesothelioma treatment studies have found that between 1 percent and 5 percent of patients who undergo this procedure die from complications. The most serious complication is the risk of hemorrhage. Another serious complication — but one that is not always life-threatening — is where the lung no longer completely holds air (this problem develops in as many as 10 percent of cases, according to studies).
With EPP, on the other hand, the biggest risk is the possibility that the patient — in a far weakened condition because of the advanced state of the disease – simply won’t survive the mesothelioma surgery. EPP recently became the subject of renewed debate within the medical community when the journal Lung Cancer published findings suggesting that malignant pleural mesothelioma patients tend to derive scant benefit from EPP performed in the early stages of the disease.
One thing many mesothelioma treatment specialists do agree on is that surgery should be followed at the very least by radiation therapy.
Mesothelioma radiation therapy entails use of an ionizing beam of radiation precision-aimed at the cancer cells in order to cause them to die. They do exactly that if radiation is delivered in a sufficiently high dose to disrupt the DNA of the targeted mesothelioma cells.
To achieve the requisite dosage, the target mesothelioma cells are bathed in radiation coming from multiple angles and typically generated by an intensity-modulated radiation therapy system (IMRT for short). This technique concentrates the radiation on the cancerous tissues while limiting the amount of ionizing rays striking nearby healthy tissues.
A recent report published by the American Journal of Health System Pharmacy made reference to a study that evaluated high-dose radiation therapy for mesothelioma treatment. It found that use of radiation after an EPP surgery lowered the risk of localized recurrence to 13 percent and contributed to a reduction of the chest-wall pain patients typically experience after that mesothelioma surgery.
However, earlier studies have found radiation therapy to be of limited value because, while it did indeed help prevent local recurrence (as noted immediately above), the treatment modality did nothing to reduce the possibility of the remnant cancer cells being transferred via blood, lymph fluid and membranes to other parts of the body where they can lodge and take root to catastrophic effect.
Also used after mesothelioma surgery (alone or in tandem with radiation) is chemotherapy.
Chemotherapy employs what are known as cytotoxic agents to kill cancer cells. The agent of first choice for this purpose is either cisplatin or carboplatin. Until fairly recently, these were customarily administered alone, but new science has demonstrated that pairing them with the drug pemetrexed can boost their effectiveness.
A drawback of chemotherapy is that it indiscriminately kills rapidly dividing cells – mesothelioma cancer cells are of that type, but so are many beneficial ones necessary for healthy organs and other anatomic structures. Also, doctors have yet to determine when to begin a chemotherapy regimen for optimal effectiveness.
The good news is that researchers are working to develop better cytotoxic agents that can differentiate between cancerous and normal cells.
Still largely experimental, gene therapy revolves around altering the molecular makeup of mesothelioma cancer cells in ways that render them vulnerable to various forms of attack.
One approach seeks to infect mesothelioma cells with special, lab-engineered viruses. These designer viruses are programmed to weaken the mesothelioma cells in such a way that the body’s immune system can take over and wipe them out naturally, much as it does when invaded by ordinary impurities.
Another approach, again relying on designer viruses, aims to rob mesothelioma cells of their ability to ward off the effects of certain drugs that are otherwise harmless to the patient. Labeled “suicide gene therapy,” the infection alters the DNA of the mesothelioma cells in such a way that they end up producing substances fatal to their metabolic functioning.
Researchers some years ago began testing the use of special-wavelength light as a way to safely kill mesothelioma cancer cells. This is referred to as photodynamic therapy. This mesothelioma treatment begins with administration of a drug that causes the cancer cells to develop a fatal sensitivity to light waves at certain frequencies. When exposed to those light waves, the cancer cells respond by emitting a reactive species of oxygen that then induces cytoreduction. Translation: the cancer cells die. At least that is the theory. In practical application, researchers have noted only limited improvement in mesothelioma patients treated with this therapy, not the big gains for which they have hoped. Scientists are currently trying various types of sensitivity-inducing drugs and drug combinations in an attempt to improve the effectiveness of photodynamic therapy.
Mesothelioma is a hyper-aggressive cancer. It typically begins in mesothelial cells that line the chest’s pleura, peritoneum, and pericardium.
According to Doctor Flores, the mesothelioma tumor usually starts on the outer lining of the lung, then to the inner lining, then starts to invade the lung itself, the diaphragm, the covering of the heart, the pericardium and, at the last, the lymph nodes close to and away from the tumor.
The main cause of mesothelioma is exposure to asbestos fibers. Inhaled, they irritate the tissues of the lung and eventually produce scarring. This, in turn and after the passage of several decades, triggers a reaction that leads to breakage or mutation of the cells making up those tissues. Mesothelioma then rears its deathly head.
Some researchers theorize that the inhaled asbestos fibers contribute to the onset of mesothelioma by interfering with a gene that naturally suppresses tumors. Others speculate that asbestos causes overly abundant secretion of a growth-factor protein that nourishes those budding tumors.
“There are three types of mesothelioma: epitheliod, sarcomatoid, and bi-phasic,” says Flores, noting that patients with the epithelioid are likeliest to live the longest — provided they receive the right medical intervention as soon after diagnosis as possible.
Unfortunately, some patients who could have their lives extended decide against the kind of help Flores and other specialists offer due to fears that the costs of mesothelioma treatment will be prohibitively expensive. Such fears are not baseless — mesothelioma treatment is very costly (fortunately, however, mesothelioma victims can turn to attorneys who know how to win compensation for medical bills and related care costs, plus lost wages and more).
Without treatment, a newly diagnosed mesothelioma patient has a life expectancy of about 6 months to a year. With surgery, life expectancy increases to two years. And with treatment that includes surgery, radiation and chemotherapy, a patient can survive even longer — median survival for 31 patients involved in one mesothelioma treatment study was 51 months, according to David Sugarbaker, a leading mesothelioma specialist.
Yet, there are indications that longer survival will be possible for more of the disease’s victims as science continues to advance.
It may be years yet before these are ready to add to the armamentarium of mesothelioma treatment options, but the important thing now is that these and other coming advances offer more hope to the victims of this worst of all cancers.
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The family of a former Navy shipfitter who died earlier this year of mesothelioma received a verdict of against a manufacturer of boilers that were insulated with asbestos.
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