Treating Mesothelioma

Staging. There are a number of staging and grading (histological) systems used by physicians. These systems are in place so that your physician can determine the extent and spread of the cancer. Knowing the various stages needs to go hand in hand with treatment options. Any and all information gathered is crucial to implement an aggressive treatment schedule. Here are two common ones in use today:

A) Butchart Staging System

Stage I - Tumor confined to the ipsilateral pleura, lung, or pericardium
Stage II - Tumor invading the chest wall or mediastinal structures or metastases to thoracic lymph nodes
Stage III - Tumor penetrating the diaphragm to involve the peritoneum or metastases to extrathoracic lymph nodes
Stage IV - Distant blood-borne metastases

B) TNM Staging System

Stage	Location
T1a	Limited to ipsilateral parietal pleura (including mediastinal and diaphragmatic pleura), with no involvement of visceral pleura
T1b	Ipsilateral parietal pleura (including mediastinal and diaphragmatic pleura), with scattered foci of visceral pleural involvement
T2	Ipsilateral pleural surface has at least 1 of the following: Diaphragmatic muscle involvement Confluent visceral pleural tumor involvement (including fissures) Extension from visceral pleura into pulmonary parenchyma
T3	Locally advanced but resectable tumor; each ipsilateral pleural surface has at least 1 of the following: Involvement of the endothoracic fascia Extension into the mediastinal fat Solitary, completely resectable tumor focus in chest wall soft tissues Nontransmural involvement of the pericardium
T4	Locally advanced, technically unresectable tumor; each ipsilateral pleural surface has at least 1 of the following: Diffuse extension or multifocal chest wall masses with or without rib destruction Direct transdiaphragmatic extension into the peritoneum Direct extension to contralateral pleura Direct extension to 1 or more mediastinal organs Direct extension into spine Extension through to internal surface of pericardium, with or without pericardial effusion or myocardial involvement
NX	Regional lymph nodes not assessable
N0	No regional lymph nodes metastases
N1	Metastases in ipsilateral bronchopulmonary or hilar lymph nodes
N2	Metastases in subcarinal or ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary nodes
N3	Metastases in contralateral mediastinal, contralateral internal mammary, and ipsilateral or contralateral supraclavicular lymph nodes
MX	Distant metastases not assessable
M0	No distant metastases
M1	Distant metastases present

Treatment Options

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined. In general, mesothelioma is very difficult to treat.

Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed (extrapleural pneumonectomy). Surgical complications include pneumonia, broncho-pleural fistulae, bronchial leaks, empyema, chylothorax, respiratory insufficiency, myocardial infarction, congestive heart failure, hemorrhage, cardiac volvulus, subcutaneous emphysema, incomplete tumor removal, and vocal cord paralysis.

Radiation therapy , also called radiotherapy , involves the use of high-energy rays to kill cancer cells and shrink tumors . Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation ) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy). Complications of radiotherapy include nausea and vomiting, radiation hepatitis, esophagitis, myelitis, myocarditis, and pneumonitis with deterioration of pulmonary function

Chemotherapy is the use of anti-cancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous , or IV ). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy). The drug Pemetrexed (Alimta) is on the market today.

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.


Asbestos And Disease	Mesothelioma Basics

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