A diagnosis of mesothelioma is always difficult, whether it is pleural mesothelioma or another variety. Because this is such an aggressive and stubborn form of cancer, patients and their families may have a difficult time addressing the issue of treatment, but because options for mesothelioma patients are steadily increasing, the discussion of treatment is quite important, even if all hope seems lost.

Each mesothelioma case is considered individually and there is no right or wrong treatment for the disease. What's best for you or your loved one will depend on a number of factors. Diagnostic tools such as x-rays, MRIs, CT scans, and biopsies will be used to determine these factors and these tests will assist the doctor and/or oncologist in determining the best treatment for the patient in question.

What are the Options?

Cancer treatment usually focuses upon destroying malignant cells and preserving healthy ones. This can be accomplished in a number of ways. At present, mesothelioma patients are faced with three major options for treatment of their disease - surgery, radiation, and chemotherapy. What course of treatment is recommended will largely depend on these issues:

• The type of mesothelioma and location of the tumor
• The size of the tumor(s)
• The degree to which the cancer has spread or metastasized
• The stage of the cancer - beginning, advanced, etc.
• The age of the patient
• The overall physical health of the patient

Setting up any type of treatment may involve seeing a variety of doctors, including an oncologist (cancer specialist), pulmonologist (lung specialist), or radiologist. Patience is sometimes necessary, but doctors will no doubt set up treatment as soon as possible after diagnosis.

SURGERY

Surgery is commonly used in the treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed. Depending on how far the cancer has spread, a lung also may be removed (pneumonectomy). The following are some of the most commonly used surgical treatments of mesothelioma:

Pleurodesis

Pleurodesis is a treatment administered through a thoracoscopy or existing chest tube. Pleurodesis creates inflammation effectively eliminating the pleural space. The elimination of this space then inhibits the accumulation of a pleural effusion. Generally used when the pleural effusion is symptomatic. Talc is used most commonly and effectively for this procedure, thus it is often referred to as "talcing" or as a patient having been "talced."

Pleurectomy

Surgery to remove part of the chest (pleura) or abdomen lining (peritoneum) and some of the tissue surrounding it. This procedure is performed for a variety of disorders including pleural effusion, malignant pleural mesothelioma, and trauma.

Pleurectomy/decortication

Surgery to remove part of the chest (pleura) or abdomen lining (peritoneum) and as much for the tumor mass as possible. This procedure may be performed to reduce pain caused by the tumor mass or to prevent the recurrence of pleural effusion. For peritoneal mesothelioma, surgery is generally aimed at relieving symptoms, such as recurrent ascites or bowel obstruction. As with pleural mesothelioma, complete surgical removal of the entire tumor is unlikely.

Radiation Therapy for Mesothelioma

Radiation therapy uses high-energy x-rays to kill mesothelioma cancer cells and to shrink tumors. There are two types of radiation therapy.

External radiation therapy uses a machine outside the body that beams x-rays to the location of the mesothelioma. There are newer ways to deliver radiotherapy that minimize contact with other tissue. Intensity-modulated radation therapy (IMRT) is a type of three-dimensional therapy. A computer-driven machine delivers radiation as it moves around the patient. The machine shapes the beams, aims them from several angles, and adjusts the strength of the beams. IMRT is available at many hospitals and cancer treatment centers.

Brachytherapy, also called internal radiation therapy, involves putting chemicals that produce radiation directly into the site of the mesothelioma cancer. This is done by inserting a thin plastic tube into the chest or abdomen. However, it is not often used for mesothelioma treatment.

Mesotheliomas are not discrete solid tumors, but are usually spread out over a large area. Because of this, it is very difficult to deliver high-enough doses of radiation to kill the tumor without damaging surrounding organs. As a result, it is unclear whether radiation therapy is a successful method of treating mesothelioma. It has, however, been effective in killing remaining tumor cells after surgery has been performed.

Radiation therapy is also used as a palliative therapy to relieve symptoms of mesothelioma, such as shortness of breath, chest pain, and internal bleeding.

Radiation therapy has several side effects, such as fatigue, nausea, and vomiting. Some of the side effects depend on where the mesothelioma is located. Although side effects are sometimes temporary, you should let your doctor know, since they often can be controlled. There are very effective medications to control nausea and vomiting.

Chemotherapy

Like radiation, chemotherapy provides no cure for mesothelioma but can go a long way in providing relief from the horrendous symptoms of the disease. As researchers continue to test different combinations of chemotherapy drugs, patients continue to benefit from their findings, and someday, chemo may go a lot further in prolonging the life of a mesothelioma victim.

Chemotherapy is given in pill form or injected. In the case of mesothelioma patients, the drugs are given intrapleurally (into the chest cavity) or intraperitoneally (into the abdominal cavity). Doctors usually combine two drugs for the best result. Currently, the preferred combination is Alimta© (pemetrexed) and Cisplatin, but other drugs are used in tandem if deemed preferable for a specific patient. In some cases, patients can only tolerate a single drug so only one is used for treatment.

Other drugs are given to the patient to combat the unpleasant side effects of chemo, such as medication to relieve nausea and vomiting or vitamins to replace essential ones lost during chemotherapy.

Some patients decide that the side effects of chemotherapy are too severe and opt not to receive this treatment.

Mesomark Blood Test

In January 2007, the Food and Drug Administration (FDA) approved the MESOMARK assay to help monitor response to treatment in epithelial and bi-phasic malignant mesothelioma patients. A specific protein, or biomarker, called Soluble Mesothelin-Related Peptide (SMRP), may be released into the blood by mesothelioma cancer cells. By measuring the amount of SMRP in a blood sample, doctors may be able to better monitor a patient's progress. Based on the limited amount of data currently available, use of this test may be beneficial, but effectiveness has not been determined at this time. The MESOMARK blood test has NOT yet been approved for the early diagnosis of mesothelioma.

This test has been approved as a Humanitarian Use Device (HUD), meaning that physicians must follow certain procedures to qualify their patients for testing. Once the physician is certified, informational brochures will be sent to be distributed to each applicable patient.

Those wishing to take part in

MESOMARK testing will be asked to provide one or more samples of blood. The blood samples will then be sent to a national reference laboratory for testing. In conjunction with other clinical and laboratory data obtained by your doctor, decisions regarding your treatment and care may be simplified. You may discontinue testing at any time.

The costs associated with the MESOMARK blood test may not be covered under health insurance, therefore, you may be required to pay all or part of the costs out of pocket. It is recommended that you check with your insurance carrier to determine whether coverage is available under your policy.

Intraoperative Photodynamic Therapy

A new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.

Gene Therapy

involves using genetic material to specifically target cancer cells and make them more vulnerable to chemotherapy treatment.

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The main type of gene therapy being developed for use in mesothelioma patients is called "suicide gene therapy," because it forces cancer cells to produce substances that cause their death.

When undergoing this type of gene therapy, the patient is treated with a non-infectious virus that has been altered with genetic material that makes them produce a particular protein.

Following this procedure, the patient is then treated with a chemotherapeutic medication that is specially formulated to be toxic only to cancer cells. This type of therapy has produced some promising results for mesothelioma patients, but it is still only available through clinical trials.

Immunotherapy is a type of treatment in which the patient's own immune system is 'tricked' into killing cancer cells. A healthy, normally-functioning immune system does not kill cancer cells, because even though these are diseased cells, the immune system is unable to recognize them as being harmful.

There are two main types of immunotherapy: active and passive. In active immunotherapy, mesothelioma cancer cells are removed from a patient and then treated in a laboratory to turn them into a vaccine. Following this laboratory treatment, the patient is injected with the vaccine and if the treatment is successful, the patient's immune system recognizes the vaccine as a harmful substance, thus recognizing the cancer as being harmful as well.

Passive immunotherapy is somewhat different in that it does not attempt to activate the patient's immune system. Instead, it uses substances such as cytokines (molecules that direct and regulate the immune system) and other agents to help boost the patient's immune response to their cancer.

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