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This is then converted to a stage, between 0 and IV (four), with higher numbers denoting more advanced disease. Patients with earlier stage tumors tend to live longer and respond better to available treatments. The staging system is very complex, and the entire staging system is outlined at the end of this article. The stage of cancer, or extent of disease, is based on information gathered through the various tests done as the diagnosis and work-up of the cancer is being performed.
The first step to deciding on treatment is to determine if the disease is operable - meaning can surgery be performed and be beneficial to the patient. Younger, healthy patients with early-stage malignant pleural mesothelioma may be candidates for surgery that removes the mesothelial tissue around the tumor. Surgery to either remove the entire lung with the tumor (termed extrapleural pneumonectomy) or lung-sparing surgery that removes only the tumor and the lining of the lung (termed extended or radical pleurectomy), is the most common option for these patients.
Similar comprehensive surgery is often considered in patients with peritoneal mesothelioma. In addition, patients with peritoneal mesothelioma may also receive intraperitoneal chemotherapy (chemotherapy delivered directly into the peritoneal space) with surgery.
This has been shown to improve survival in patients with peritoneal mesothelioma. All of these definitive thoracic or peritoneal surgeries are extensive. Many patients are not able to undergo surgery due to having advanced disease at diagnosis or not being able to tolerate the surgery due to their health. For patients that have surgery to remove the entire lung, radiation therapy is commonly given after surgery to kill any remaining cancer cells not removed by surgery.
Radiation therapy after lung-sparing surgery, however, is not routinely given. The radiation can damage the remaining healthy lung tissue and result in toxicity that outweighs any benefit of radiotherapy. Radiation therapy is often delivered to surgical incision sites to prevent the cancer from recurring in that area.
In patients who do not undergo surgery, radiation therapy may be given to treat problem areas with the goal of relieving symptoms, like pain or trouble breathing. Chemotherapy is also a standard treatment for mesothelioma and can provide significant relief of symptoms. Chemotherapy can be given before, after, or without surgery. Agents that are used, either alone or in combination, include: cisplatin, carboplatin, doxorubicin, pemetrexed, gemcitabine, and vinorelbine.
People with mesothelioma may encounter a recurring build-up of fluid in the pleural space. This fluid can be removed with a pleural catheter (a tube that is put into the chest wall and left in to allow the fluid to be drained when needed) or a procedure called thoracentesis (a small needle is put through the chest wall into the pleural space, the fluid is drained, and the needle is removed).
In many cases, this will be followed by a procedure called pleurodesis, in which a medication (i. In the abdomen, the procedure to remove fluid is called paracentesis. In this procedure, a needle is inserted through the abdomen into the fluid filled space, and the fluid is drained.
If this is a chronic problem, patients may have a catheter placed, allowing them to drain the fluid themselves at home as needed. Removal of the fluid alleviates the difficulty breathing and pain that is caused by fluid build-up. Your healthcare team will also work to manage other symptoms, including pain, nausea, and vomiting you may experience as a result of your diagnosis and treatment. These symptoms can be managed through a combination of medical treatments (i. Talk with your healthcare team about the role of palliative care in your treatment plan.
Palliative care can help relieve side effects and symptoms of illness. Because the current therapies have limited effectiveness, researchers are continuing to look for new ways to treat mesothelioma. Patients should talk with their healthcare team about current clinical trials for mesothelioma. You can also explore currently open clinical trials using the OncoLink Clinical Trial Matching Service.
Your healthcare team will provide regular physical examinations and surveillance imaging throughout your treatment for mesothelioma. Fear of advanced illness, anxiety, advanced care planning, the financial impact of cancer treatment, legal and employment issues, and coping strategies are common emotional and practical issues experienced by people with mesothelioma. Your healthcare team can identify resources for support and management of these practical and emotional challenges faced during and after cancer.
Cancer survivorship is a relatively new focus of oncology care. With some 15 million cancer survivors in the US alone, there is a need to help patients transition from active treatment to survivorship.
What happens next, how do you get back to normal, what should you know and do to live healthy going forward. A survivorship care plan can be a first step in educating yourself about navigating life after cancer and helping you communicate knowledgeably with your healthcare providers. Create a survivorship care plan today on OncoLink. National Comprehensive Cancer Network Guidelines for Patients www.
The N describes lymph node involvement and the M describes if the cancer has spread. These numbers are combined to determine the stage of the cancer using the chart below. Tumor involving each of ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following:Locally advanced but potentially resectable tumor.
Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura), with at least one of the following:Locally advanced technically unresectable tumor. Tumor involving all of the ipsilateral pleural services (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following:Metastases in the ipsilateral bronchopulmonary, hilar, or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal) lymph nodesMetastases in the contralateral mediastinal, ipsilateral, or contralateral supraclavicular lymph nodesAmerican Cancer Society.
Erionite exposure in North Dakota and Turkish villages with mesothelioma. In Proceedings of the National Academy of Sciences of the United States of America. Proceedings of the National Academy of Sciences of the United States of America.
Carbone, Michele, Bevan H. Dodson, Ian Pagano, Paul T. Pass, and Haining Yang. Malignant mesothelioma: facts, myths, and hypotheses. Journal of Cellular Physiology,227(1), 44-58. Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma. The Annals of Thoracic Surgery, 93(5), 1658-1667. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma: A Systematic Review and Meta-analysis.
Annals of Surgical Oncology 22(5), 1686-1693. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with oxaliplatin for peritoneal mesothelioma: Preliminary results and survival analysis.
Surgical Oncology, 24(1), 41-46. Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group. Journal of Clinical Oncology, 30(20), 2509-2515. Journal of Thoracic Oncology, 7(4), 737-743. Mesothelioma and Asbestos Awareness Center. NCCN Guidelines Version 2.