Anyone who has been told they have mesothelioma understands the dreadful feeling. This frequently fatal form of cancer is caused by prolonged exposure to asbestos.
Symptoms don’t appear for decades, as long as 50 years. Unfortunately, once the symptoms are apparent, mesothelioma has spread way too far to be able to use curative treatments. However, there are a range of treatments for mesothelioma, and more are being developed daily.
Generally, most treatments are palliative, that is, are more for a patient’s comfort. Life expectancy is short after a diagnosis, and most patients don’t survive more than a year or two once the mesothelioma is discovered. Without treatment, most patients have a survival rate of less than six months. While there is no cure for mesothelioma, some treatments can decrease its progression.
The most common treatment options for those with mesothelioma are:
- Radiation therapy
Patients who opt for a combination of all three of these treatments tend to have the best outcomes. When caught early, patients have an even better prognosis. The name for this three-tiered approach is called “multimodal therapy, and is generally made of subsets of options for treatment:
- Neoadjuvant –this is treatment administered before a primary treatment to reduce the tumor size or make subsequent treatments go easier. It usually consists of chemotherapy or radiation therapy.
- Primary – a treatment that’s administered as the main method to combat mesothelioma, usually surgery.
- Adjuvant – this is usually chemotherapy that is administered to decrease symptoms and thwart a recurrence
Options for treatment will vary depending on where mesothelioma has manifested. The types are:
- Pleural, located in the lining of the lungs
- Peritoneal, located in the lining of the abdominal cavity
- Pericardial, found in the lining of the heart
Here, we’ll discuss at length the main treatments for mesothelioma.
This is the most effective curative treatment for mesothelioma available, especially if the disease is caught early.
In some cases, options for surgery are only palliative, and intended to provide a patient with a better quality of life. But other surgeries are performed for diagnostic purposes and done to either acquire tissue samples for a biopsy, or to examine an area of the body a little closer. To examine the lining of a patient’s lungs or abdomen for signs of potential mesothelioma, physicians will employ a thoracoscopy. This procedure utilizes a fiber optic camera that helps doctors identify issues like fluid buildup and inflammation.
Other types of surgeries are available for patients with mesothelioma. Surgeries that include the removal of tumors, tissues and/or one or more organs are the most invasive, and can include:
- Pneumonectomy, removal of a cancerous lung
- Extrapleural pneumonectomy, the removal of a lung along with portions of the chest and heart lining and, sometimes, the diaphragm and lymph nodes
- Pleurectomy/Decortication, removing of the lung lining and nearby tumors but not necessarily the lung itself
- Peritonectomy and cytoreductive surgery, the removal of a portion of the abdominal lining while reducing cancerous growths throughout the abdomen
- Pericardiectomy, the removal of the lining of the heart, known as the pericardium
While these surgeries are usually performed to be curative, they are also performed as a palliative measure to help improve a patient’s quality of life. For example, a pericardiectomy is frequently performed to reduce related symptoms such as fluid buildup, pericarditis, heart palpitations and breathing difficulties.
In the right circumstances, these “removal” surgeries may be performed for curative goals. But not every mesothelioma patient is a good candidate for one of these major surgery treatments, and in some cases, may cause more problems than they solve. There is also a difficulty for doctors to precisely identify the patients for which these surgeries are suitable.
Robotic Surgery is a newer method that helps doctors and surgeons to make more informed judgments that help them decide which patients can benefit from this major surgery. This is an upgraded version of a thoracoscopy with video assistance, also called VATS.
Surgeons are allowed to see the inside of a patient’s body with a magnified 3-dimensional view, letting them make more exact incisions and movements by utilizing small-scale robotic “hands.” While this option isn’t yet widely available, it will one day become a standard surgery for mesothelioma patients.
There are other, less invasive surgical options available for some mesothelioma patients. Using a hollow needle, doctors remove built-up fluid (called “effusion”) from the affected areas, including:
- Pleurodesis, which removing fluid buildup in the pleura or lining of the lungs to prevent future fluid buildup
- Thoracentesis or Pleurocentesis, removal of fluid buildup in the pleura
- Paracentesis, removal of the excess fluid from the abdominal cavity
- Pericardiocentesis, removal of fluid buildup in the heart sac
These procedures are used both as a diagnostic tool as well as symptom relief. Fluid removal can both offer fluid samples for pathology examination to determine the reason for the buildup as well as alleviate symptoms such as breathing difficulties. However, fluid removal is usually a palliative treatment, performed to alleviate symptoms like pain and improve the quality of life for a patient.
Pleurodesis is one of the best examples of a type of palliative treatment. This surgery both drains the fluid buildup and removes the pleural space to make sure that it doesn’t return. Many patients with short-term life expectancy choose these palliative treatments to help them forestall the long recovery periods and discomfort of other more intrusive procedures.
Different procedures will have different recovery times. A procedure that removes fluid buildup will have a recovery time that is unlike a major surgery removing tumors or major organs, which can involve multiple weeks of hospital recovery time in a hospital. An extrapleural pneumonectomy procedure has an average recovery time of six to eight weeks, but it can last for many months.
On the other hand, fluid buildup surgery involves a shorter-term hospital stay, usually no more than a couple of days. Pleurodesis may require as long as a week of recovery.
Treating mesothelioma with chemotherapy includes specific medications that help with combating cancer cells and limit the development of tumors in a patient’s body. About 70% of mesothelioma patients choose to use chemotherapy, and it’s one of the most common therapies, frequently used in combination with other therapies like radiation and surgeries. Chemotherapy is frequently used to reduce the size of tumors before a surgical procedure as neoadjuvant therapy, as well as an adjuvant to thwart the recurrence of mesothelioma.
Chemotherapy can be administered in two ways, intraoperative and systemic. The most common is systemic chemotherapy, adding the medication into the bloodstream to allow it to traverse through the entire body. Drugs are administered either in pill form or intravenously (through an IV.) Pills are not given during standard hospital treatments, only during clinical trials.
Patients visit a hospital every few weeks for chemotherapy, when they are injected with a new series of medication. Frequently a combination of drugs is administered and produces better results. An aggressive first, second, third and fourth line of chemotherapy involves multiple cycles of different drug combinations, strongly attacking cancerous cells. The most commonly drugs used include:
- Pemetrexed (Alimta) – The most common mesothelioma chemotherapy medication, frequently used with cisplatin. Vitamin supplements are often paired with corticosteroids to help patients mitigate the side effects.
- Cisplatin – this commonly used drug is platinum-based and often used with Pemetrexed and prescribed when a patient’s tumors cannot be removed surgically.
- Carboplatin –similar to Cisplatin but with less side effects. It can obstruct blood cell production, which can lead to a greater risk of infection and chronic fatigue.
- Gemcitabine (Gemzar) – frequently coupled with Carboplatin and used as a second-line treatment. This drug was developed for lung, bladder, and ovarian cancers.
- Vinorelbine (Navelbine) – This medication is known to produce apoptosis (cell death) in cancer cells and is moderately effective in mesothelioma treatment.
- Ranpirnase (Onconase) –breaks down the RNA in mesothelioma cells and but avoids the elimination of healthy cells. Ranpirnase has fewer side effects than other drugs.
- Raltitrexed (Tomoduex) – While it’s normally used to treat colorectal cancer, Raltitrexed works by attacking the cancer cell’s DNA. It has demonstrated some effectiveness with mesothelioma where other drugs failed.
These drugs offer different effectiveness for some patients while others have inadequate results. The patient’s individual immune response is what determines the total effectiveness of each drug.
One intraoperative method of chemotherapy administration requires the heating of medications to as high as 105o Farenheit and injecting them directly into the site of the tumor. There are two forms of this therapy, used in combination with major surgeries:
- Heated Intraperitoneal Chemotherapy (HIPEC) for peritoneal mesothelioma, used with cytoreductive surgery. It is very efficient for the improvement of survival rates.
- Hyperthermic Intrathoracic Chemotherapy (HITHOC) for pleural mesothelioma, used with many surgeries for tumor removals
As much help as they provide, chemotherapy also has many downsides. Most people are aware of the typical side effects of chemotherapy, such as hair loss, vomiting and nausea, along with other unpleasant side effects. This is the result of a treatment targeting more than just the disease cells, which includes healthy cells.
“Chemo brain” is another well-known side effect that involves the impairment of memory, concentration, and multitasking abilities. Patients can help mitigate “chemo brain” with a good diet, a healthy lifestyle and moderate exercise.
It’s been a standard of cancer treatment for decades, and is particularly helpful with mesothelioma, since it targets fast-replicating cells. While radiation therapy isn’t a cure, it’s an effective treatment that helps in a number of ways. Typically, radiation is prescribed for:
- Seeding Prevention – Since surgical procedures can displace cancer cells, radiation therapy can prevents those mobile cells from “seeding” and flourishing in new regions.
- Pain Relief – Radiation therapy can also be a palliative treatment to decrease tumor size and reduce accompanying pain.
- Improvement of life expectancy – The combination of radiation therapy, surgery, and chemotherapy and can help lengthen a patient’s life span by 3 to 5 years.
The two types of radiation therapy are internal and external, with external being the most common. External beam radiation is the most frequently used, sending a beam of radiation into the tumor or affected area directly through the skin. The beam is controlled by the doctor and focused to limit any damages to the surrounding healthy cells. However, patients do end up having radiation on their muscles and skin.
Two other types of external radiation therapy include:
- Three- dimensional conformal radiation therapy (3D-CRT), which allows a doctor to see a three-dimensional representation of the body instead of the standard 2D of external beam radiation. Doctors can utilize higher doses of radiation due to the increased precision of the beam.
- Intensity modulated radiation therapy (IMRT), which cansimilarly utilize higher doses of radiation into an affected area, as well as multiple areas at once. A doctor can send a more intense beam of ionizing radiation into a larger tumor while sending a small cluster of mesothelioma cells a beam of lower intensity.
Brachytherapy, or internal radiation therapy, goes from the inside out. Instead of sending radiation into an area from the outside, irradiated pellets or seeds are implanted into the mesothelioma tissue, either temporarily or permanently. Brachytherapy is usually used in patients where their tumor are in a difficult position, and a beam of external radiation doesn’t reach.
Side effects of radiation therapy are similar to the ones from chemotherapy due to the potential for damage to the surrounding healthy cells and tissues. However, the more negative aspects of radiation are much better than those from chemotherapy. Radiation side effects can include:
- A decrease in the production of white blood cells, leading to increased risk of infection
- Loss of appetite
- Dry mouth
Finding A Cure
The long-term life expectancy of patients with mesothelioma is still not very good. Even after many decades of research, patients who see two years after their original diagnosis are considered fortunate. However, doctors and researchers are continually working toward better treatment options for mesothelioma patients that will lead to longer life expectancy, and eventually, a complete cure.
Currently, researchers are working toward introducing new treatment options and perfecting the current ones. For example, new chemotherapy drugs are always being developed, and surgical techniques and procedures are always being improved.
Additional newer options such as immunotherapy, treatments that suppress or activate an immune response, and gene therapy, where genes are manipulated to prevent and/or treat a disease, show encouraging and favorable results.
Participation in clinical trials present the best chances for the discovery of a cure for mesothelioma. Trials offer patients the newest of experimental treatments and medications that could finally end the pain and suffering from mesothelioma.
As with many challenges, there are also obstacles. Mesothelioma is complicated and problematic because of the way it mimics many other routine illnesses. The best time for researchers to study and understand it is in the early stages, but it’s very seldom diagnosed at that point. Patients are routinely diagnosed at Stages 3 and 4, which renders them ineligible for the benefits of clinical studies. In spite of these obstacles, mesothelioma will, one day, be a curable and eradicated disease.
These are our best chances for finding cures for mesothelioma. Some of these treatments aren’t being developed, researched or designed specifically for mesothelioma, but their effectiveness could extend to mesothelioma. Since many types of cancer share some of the same characteristics, it wouldn’t be a stretch for some types of treatments to be effective for many forms of mesothelioma.
Common emerging therapies include:
- Gene therapy
- Epigenetic therapy
- p53 gene therapy
- Photodynamic therapy
The most well-known of these treatments is immunotherapy, in use for many diseases. The most common of these treatments are a class called “checkpoint inhibitors,” which help trigger an immune cell response that targets the cancerous cells instead of just ignoring them. Two of these inhibtors, Keytruda and Opdivo, have been approved for use in multiple types of cancers, and are also currently being tested with mesothelioma.
Another emergent treatment is gene therapy, although not as much is understood about the effects it may have on cancers. These trials have been conducted for under 20 years, and the trials have been around about the same period of time. The goal is to introduce healthy new genes to a patient that have been engineered to repair the cancerous mutation. The gene p53 is a known suppressor of tumors that researchers are currently working with to develop for gene therapy use.
Photodynamic therapy is an unusual treatment that couples a “photosynthesizing agent” medication with a beam of light calibrated to a precise wavelength creating a reaction in cancerous cells. This is a promising treatment for mesothelioma as well as other diseases.
Virotherapy involves introducing cancer-killing viruses into a patient, and cryotherapy uses extremely cold temperatures to destabilize cancer cells. Epigenetic theory modifies an individual’s epigenome, that his, their DNA’s list of chemical changes.
Access to these interesting and emergent treatments will require a patient to join clinical trials. By participating, these trials are valuable to a patient’s long-term survival and prognosis for living with mesothelioma.
Any form of treatment that is outside of the standards of current medicine are grouped into a category called “alternative.” Many physicians use the term “complementary treatments,” since they may be used in conjunction with mainstream medicine, such as chemotherapy and radiation therapy. The term “alteranative” may give the appearance of additional and viable options that are separate from standard or emergent treatments for mesothelioma. Unfortunately, this isn’t the case. Attempting to treate mesothelioma without the use of current medical protocols will not help defeat it.
Thinking of alternative treatments as complementary to standard and emerging treatments can help you experience benefits from them. Multiple alternative treatments are available that provide pain relief and emotional calm to many patients with mesothelioma.
Maintaining a healthy diet is one of the best “alternative” treatments available. Many oncologists prescribe detailed diets for patients with mesothelioma as well as other cancers. Diets created for cancer patients can help patients who have trouble swallowing, as well pain and nausea. Medical cannabis and other herbal remedies can also be incorporated into your diet and routine as well.
While undergoing any form of cancer treatment, do not neglect your emotional and mental wellbeing. Consider undertaking activities that are engaging to both the mind and body, such as:
- Mental health counseling and therapy
- Support groups
- Music and sound therapy
- Pet therapy
Other holistic treatments focus on the individual as a whole instead of an illness by itself. These methods can include lifestyle changes, healthy eating, whole body cleanses, herbal medicines, and focusing on natural instead of pharmacological treatments, including:
- Naturopathic medicine
- Traditional Chinese medicine
- Osteopathic medicine
These are complementary treatments that should not replace scientifically proven medical treatments for mesothelioma. However, they can be combined with standard medical therapies and be very helpful throughout the course of your treatment.
One thing that is included with any diagnosis of mesothelioma is the presence of pain. Depending on the location, the disease may exhibit a variety of symptoms. For instance, Pleural mesothelioma includes a buildup of fluid that causes both breathing difficulty and chest pain. In peritoneal mesothelioma, the same type of fluid buildup limits the natural movement of the abdomen, leading to a lack of appetite, nausea, and issues with bowels. Tumors from mesothelioma also cause a considerable amount of pain because they are growths that develop in a place where there is no room for them, and they should not be there.
To help lessen and ease these symptoms, doctors will often prescribe palliative treatments, such as radiation therapy, surgery and chemotherapy to reduce the discomfort and pain. These treatments also have their own complications and side effects. Both chemotherapy and radiation therapy can kill off healthy cells alongside the cancerous cells, leading to fatigue and nausea in patients. Doctors frequently prescribe folic acid and vitamins B12 and B9 to help.
As mesothelioma advances, pain can become more extreme, leading physicians to prescribe more potent pain medications. Some patients may be prescribed an anti-anxiety medication such as Xanax to calm the mind. Alternative treatments for pain may also help if you or a loved one are suffering with pain from mesothelioma.
Another difficult aspect of any major illness is the cost to obtain treatment. Because mesothelioma is complex, the costs can rapidly accumulate. After receiving a distressing diagnosis of mesothelioma, the last thing you may be thinking of is the cost of treatment. However, it’s not uncommon for treatment costs to go over a million dollars.
Remember that every patient is different, and treatments as well as costs will vary from patient to patient. Pricing for different hospitals may vary. Diagnostics and therapies are the primary charges for treatment of mesothelioma, and can include:
Treatment costs are different for every patient, however. Not every patient is going to have the same treatments, and some hospitals may offer a different pricing structure than another. The primary cost of any mesothelioma treatment includes diagnostics and actual therapies to treat the disease, and can include:
- CT scan ($400 to $800)
- MRI (up to $1,600)
- PET scan ($2000 to $2800)
- Needle biopsy ($500 to $700)
- HIPEC ($700 to $1,200)
- Chemotherapy ($35,000 to $50,000 per course)
- Radiation therapy ($7,000 to $12,000)
- Thoracoscopy/Laparoscopy ($3,500 to $5,000)
- Surgeries like pneumonectomy or peritonectomy ($13,000 to $30,000)
These charges do not include hospital stays, blood tests, prescriptions, palliative treatments, lost wages, follow-up care, credit card interest and other multiple secondary costs.
Patients fortune enough to have good health insurance will have some of these charges covered. However, providers have their own individual rules and restrictions on what their policies cover. Prior to a diagnosis, you can choose a form of insurance that is specific to cancer that covers a number of your expenses if you are ever found to have cancer. It is also possible to negotiate with some medical institutions, or make a request for any type of grants that may be available.
Patients who are veterans may qualify for VA benefits, and others may qualify for government assistance programs such as Medicare or Medicaid. Enrolling in clinical trials for mesothelioma can also have some of your care covered by researchers, and will allow you to test out new and possibly more effective treatments that are not yet widely available.
Patients with mesothelioma can seek a financial settlement to cover at least some of their medical expenses. This is because most producers of asbestos exercised negligence in using it, and mesothelioma is a direct result of exposure to asbestos. A settlement can provide some financial relief, although it may not cover all of your medical treatment.
Clinical Trial Participation
Because researchers are always working to develop new drugs and treatment options, they need patients to test the treatments for effectiveness. Clinical trials afford them the opportunity, and help mesothelioma patients acquire low-cost or free medical care while trying out new and investigational treatments. These treatments help both the participant and the researcher, who can bring it to more patients once it’s perfected and approved.
Engaging in a clinical trial is great for both researchers and patients. You’ll receive excellent treatment, since the sponsoring institutions are frequently well-funded universities, pharmaceutical companies or government programs. You insurance may cover all or some of your expenses associated with the clinical trial, as well as the sponsoring institution.
To get involved in one, speak with your local cancer care center or your physician to find out about clinical trials that are currently recruiting patients, and what eligibility requirements they have. Requirements can include:
- Type and stage of the disease
- Your overall health
- The existence of any other medical conditions
- Your past treatment history
If accepted by the trial, they will provide treatment that includes the therapy being investigated as well as additional options for treatment.
There is, of course, a degree of risk associated with clinical trials, since many new treatments are untested, known as Phase I trials. However, Phase IV trials are for treatments that have been well-researched and tested and are at the point of being approved by the FDA.
Mesothelioma research is continual, with a future state of curing the disease, even if it’s not yet visible.
When mesothelioma was first classified in 1920, the primary treatment method was the removal of a patient’s lungs with complicated surgeries. But the link between asbestos and mesothelioma was not revealed until the 1960’s.
Treatment options were extended in the 2000’s to include chemotherapy and radiation therapy. The most common current chemotherapy combination of cisplatin and pemextrexed commenced use in 2004.
Mesothelioma research is more advanced, from the development of immunotherapy treatments or biomarkers for early detection. More options available to patients than ever before, and more treatments are being developed and researched every day.