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If your mesothelioma recurs, your medical team will discuss the available range of treatment options for you. What treatment options exist for you depend on both cancer’s location and size as well as any treatments you have already received, and your general health. The various treatment options that might be recommended to you include radiation, chemotherapy, and surgery. You review the available options with your medical team as well as associated details including the focus of each treatment as well as the possible effects.
Resectable vs. Unresectable Mesothelioma
The stage of mesothelioma is a critical factor that influences your available treatment options. Other factors including whether the cancer is resectable also influence treatment options. Resectable means that all visible cancer is capable of being removed through surgery. Regardless of whether it is resectable, mesothelioma often tends to be hard to treat.
Most early-stage mesothelioma (stage 1 as well as some stage II and III pleural mesotheliomas) are resectable with some notable exceptions. Whether a tumor is resectable is also influenced by the subtype, where the cancer is in the body, how far the cancer has grown into nearby tissue, and if the patient is healthy enough to undergo surgery.
Most people with resectable pleural mesothelioma end up having it removed through surgical options like pleurectomy decortication or extrapleural pneumonectomy. Surgery most often has long-term benefits when cancer is still in its early stages because in these situations it is more likely the entirety of cancer can be removed. Not all patients can endure surgery, though.
Patients with early-stage peritoneal mesothelioma also sometimes benefit from surgery to remove as much of the cancer as possible. Sometimes, surgery is combined with heated intraperitoneal chemotherapy. Some patients end up experiencing lengthy remission following this treatment.
Surgery is also helpful for some later-stage cancer, but the advantages of surgery for late-stage cancer often only last for a short period. Surgeons sometimes think that cancer is resectable based on the results of imagery performed before surgery. Then, after the operation is begun, it becomes visible to the medical staff that the entirety of the cancer cannot be removed. In these situations, the surgery staff might switch to a less comprehensive operation. Treatment in this situation would then be the same as it is for unresectable mesothelioma.
Late-stage mesothelioma (in addition to some types of earlier-stage mesothelioma) cannot be fully removed with surgery. This might be due to either the degree or type of cancer or even because the individual in question is not healthy enough to undergo an operation. Chemotherapy is often the primary method of treating these cancers because it can reduce symptoms as well as either shrink or slow down the cancer’s growth for some time. In some situations, chemotherapy is used in addition to targeted therapy medications or devices that generate fields in a tumor. Sometimes, immunotherapy is also used.
Even though these treatments can increase the lifespan of patients, it’s not likely that these treatments will cure cancer. Before beginning treatment, the focus of treatment should be clear and understandable to you and your loved ones. In individuals with early-stage mesothelioma, watching the cancer closely might be a good idea in the beginning. Treatment can then be commenced if symptoms or signs appear that the cancer is progressing. Because these cancers are notoriously difficult to treat, participating in a clinical trial might be a reasonable idea.
In many cases, the treatment options for recurrent mesothelioma are similar to those for unresectable mesothelioma. For example, chemotherapy or radiation might be used to try to either reduce or slow the cancer’s growth and ease any associated symptoms. Because recurrent mesothelioma is difficult to treat, clinical trials of new kinds of treatment can be a good choice.
When Alternative Treatment Is Recommended for Recurrent Mesothelioma
If your first chemotherapy treatment proved successful and recurrence happens following the discontinuation of therapy, patients are often re-treated with the same regimen if the patient can tolerate the same medication. In situations where a patient experiences recurrence in a short period after completion of treatment, alternative options will be reviewed with the patient.
Chemotherapy for Recurrent Mesothelioma
Chemotherapy refers to treatment with medications that have been shown to kill cancer. These drugs are utilized in various ways to treat mesothelioma. Additional research is needed, however, concerning the best medications and the best way to utilize chemotherapy. Currently, the best results that chemotherapy has when treating mesothelioma are the combination of surgery with chemotherapy.
Medical professionals are still researching whether it is more helpful to give chemotherapy before or after surgery. Not all medical professionals agree on how to use the treatments together. If you are not healthy enough to receive surgery, however, you will receive treatment similar to those of people with unresectable mesothelioma. If you are experiencing symptoms due to fluid accumulation in the chest or abdomen, procedures including paracentesis and thoracentesis can prove helpful. Because these cancers are often difficult to treat, participating in a clinical trial might be another strategy. Studies of this kind are often performed in large medical centers.
If it is possible to treat mesothelioma with surgery, neoadjuvant therapy or chemotherapy that is given before surgery to reduce the cancer’s size might be a good idea. Adjuvant therapy refers to the opposite when chemotherapy is given after surgery.
Medical professionals often give chemotherapy in cycles. The period of chemotherapy treatment is often followed by a period of rest where the patient’s body can recoup. Chemotherapy cycles often last between 3 to 4 weeks.
Chemotherapy is given in one of two ways for people with mesothelioma. During systemic therapy, chemotherapy is injected into the patient’s blood through a vein. In systemic therapy, chemotherapy enters the blood through a person’s veins. The medication enters the bloodstream and then travels around a person’s body to eliminate cancer cells, wherever they might be located.
Chemotherapy drugs can be placed into a person’s body space either through the chest (intrapleural) or the abdomen (intraperitoneally). The medication is administered through a small cut in a person’s abdomen wall or chest. Chemotherapy medication given this way is absorbed by the blood, but the highest concentration of the chemotherapy goes immediately to where cancer cells are located. For both intrapleural and intraperitoneal chemotherapy, the medication in hyperthermic chemotherapy is heated before being placed into the body space. Heating chemotherapy medication helps the drug work better. In the case of heated intraoperative chemotherapy, the treatment is given as a sole dose either immediately before or after surgery.
A range of chemotherapy medications exist. Some of the types of chemotherapy drugs most commonly utilized to treat mesothelioma include carboplatin, cisplatin, gemcitabine (Gemzar), pemetrexed (Alimta), and vinorelbine. These medications are sometimes administered as a combination of 2 drugs. Single drugs are often used in people who might not be able to tolerate 2 drugs. If 2 drugs are used, medical teams tend to use cisplatin and pemetrexed. Other common combinations include cisplatin with gemcitabine.
Chemotherapy medication attacks cells that are quickly dividing. Cells in the bone marrow, mouth, intestines, and hair follicles also quickly divide and can similarly be attacked by chemotherapy. Some of the most common side effects that people experience in response to chemotherapy include diarrhea, hair loss, mouth sores, nausea, and loss of appetite. Side effects often go away once treatment has concluded.
Considering Surgical Options
Surgery is often reserved for individuals who experience recurrence at the site of previous incisions. Sometimes, surgeons can remove local recurrences provided no evidence exists of spread to any other areas. Surgery is sometimes followed by radiation of that area to try to eliminate cancerous cells that might remain in a person’s body. If you undergo an extrapleural pneumonectomy and your chest is stable, you might be referred to a peritoneal surgeon who can assess the impact that chemotherapy and surgery would have if the disease recurs in the abdomen.
You should only consider these surgical options under the guidance of a medical team that is experienced in treating mesothelioma because various factors must be taken into consideration before exposing someone to the risks connected to potentially extensive surgery involving the abdomen. A nuanced balance exists between the benefits and risks of any type of procedure against the goal of the procedure, which is often to make sure that a patient has the best possible quality of care for as long as possible.
Cytoreductive Surgery
Cytoreductive surgery is the only surgical option known to effectively treat peritoneal mesothelioma. This invasive procedure involves the removal of abdominal tumors. Cytoreductive surgery is sometimes used in combination with hyperthermic intraperitoneal chemotherapy (HIPEC).
Research has shown that the average survival time for people receiving cytoreduction in combination with HIPEC is 41 months, which is three times longer than the average life expectancy of people who do not receive these procedures.
The procedure is broken into two parts. First, debulking occurs which involves the removal of visible abdominal tumors. This surgery is performed through an open incision extending from the bottom of the sternum to the top of the pubic bone. The extent of the overall surgery is influenced by the stage of the disease as well as the location of tumors in the impacted area. Second, HIPEC occurs which involves flushing the abdominal cavity with a warm chemotherapy drug. Medical professionals during this step introduce a saline solution to the abdominal area through either closed or semi-closed incisions. The abdomen is then flushed out with the solution. A chemotherapy drug is then heated to 108 degrees Fahrenheit and introduced to the saline. The surgeon then massages the abdomen to make sure that even coverage of the chemotherapy medication occurs.
The doctor who introduced this combined therapy has performed the procedure more than 1,500 times. Other medical professionals who specialize in surgical oncology also perform this technique. The procedure tends to take around 10 to 12 hours.
Patients sometimes require either intravenous or oral chemotherapy treatment before or following surgery. The process of applying chemotherapy drugs to the abdomen can lower the risk of negative side effects from chemotherapy.
Even though this type of treatment is the leading procedure for treating peritoneal mesothelioma, various factors must be taken into consideration before a person is selected to receive the treatment. The primary factor is the patient’s baseline health. Due to the length of the procedure, the patient must be in good health.
Recovery from the procedure can take several months. The first part of recovery is a short hospital stay. Patients are then discharged and return home. Patients recuperate at home for several weeks. Patients report feeling back to normal after 4 months. The data shows that a patient’s quality of life is then substantially increased from 8 months to one year.
Due to the procedure’s invasive nature, complications are a common occurrence. Some of the most common complications from cytoreductive surgery in combination with HIPEC treatment include clots, digestive issues, heart failure, and infection. Some of the side effects from the combined treatment about which patients should be aware include diarrhea, bleeding easily, hair loss, constipation, and loss of appetite.
Extrapleural Pneumonectomy
Extrapleural pneumonectomy addresses malignant pleural mesothelioma through the removal of a cancerous lung, part of the chest lining, the heart lining, and the diaphragm. The focus of the procedure is to control the growth of tumors. This is one of the most aggressive procedures for pleural mesothelioma.
Some studies suggest that patients with mesothelioma who receive the procedure have a survival time of as much as 27 months, which is three times the life expectancy of most patients.
The first extrapleural pneumonectomy was performed on a person with mesothelioma in 1976. The procedure is always performed with chemotherapy and sometimes radiation before, during, or after surgery. Extrapleural pneumonectomy is a complex process. Only patients who are healthy enough to withstand the potential complications can receive the procedure.
The procedure begins with the patient being given general anesthesia before the procedure starts. The surgeon then opens up a patient’s chest cavity and examines the lining. Sometimes, the sixth rib is removed so the cavity can be widened. Surgeons then remove the impacted lung as well as other impacted areas which might include the diaphragm or heart lining. Medical professionals are cautious to not enter the pleural cavity because this could result in cancer cells spreading to other areas. Patients routinely require prolonged hospital stays to recover from the procedure.
This procedure is only for patients who are still in good health and in the early stages of mesothelioma. The procedure can increase the life expectancy of these patients as well as improve their quality of life. Unfortunately, the procedure raises many risks for patients including blood clots, pneumonia, chest fluid accumulation, bleeding, and changes in the rhythm of the heart.
Despite these risks, many medical professionals believe that extrapleural pneumonectomy is the best procedure to address malignant mesothelioma.
Pleurectomy with Decortication
One newer and less risky procedure is referred to as pleurectomy with decortication, which is similar to extrapleural pneumonectomy. Some medical professionals claim that pleurectomy with decortication is less risky but more effective.
Pleurectomy with decortication is a popular treatment for people with early-stage malignant pleural mesothelioma. Referred to as a “lung-sparing” procedure, the process can both reduce symptoms from mesothelioma and increase a person’s lifespan.
Patients who are diagnosed early on typically respond better to the procedure. Pleurectomy with decortication involves two separate phases. Unfortunately, the procedure is risky and around 2 percent of patients pass away either during or immediately after pleurectomy with decortication. The first procedure involves the pleurectomy while the second process involves decortication.
A pleurectomy involves removing the lining of the lungs or the pleura while the lungs are left intact. A more nuanced pleurectomy is required if the tumor is bigger or more integrated into the tissue lining the lungs. The decortication process involves removing visible tumors. Surgeons often utilize various techniques to remove tumors and scrape the lung lining to lower the possibility of remission.
Both decortication and pleurectomy involve anesthesia. The operation takes around five hours and is overseen by a thoracic doctor who specializes in the treatment of pleural mesothelioma. The procedures help reduce disease symptoms while also increasing a patient’s life span.
Clinical Trials Might Be Right For You
When speaking with your doctor or medical team make sure to ask about any clinical trials that might exist. New studies might have been released since you were initially diagnosed. You might need to prepare yourself to travel because clinical trials vary between centers. It is not abnormal to see more than one specialist while receiving treatment for mesothelioma. This is the best way to treat and address the possibility of any future recurrences.Many people who have faced these choices a second time have stated that knowledge in combination with understanding were the primary factors in guiding them through the decision-making process. Find out whatever you can about cancer and your available options so you can make informed choices and directly meet the challenges with which you are faced.
