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Depending on local arrangements, it may help to has cancer the radiotherapy before the procedure is carried out. This canncer probably an underestimate as the response was unknown in 15 of the patients.

These series also included patients with superior has cancer caval obstruction (SVCO) and metastatic disease. Objective response of chest wall masses was seen in five out of nine patients.

Breathlessness is rarely improved by radiotherapy. Pain has cancer may be disappointingly short lived uas there has cancer no evidence for a dose response relationship to radiotherapy under these circumstances. Has cancer radiotherapy to other sites-None of haz nine patients with SVCO had relief of symptoms.

Randomised trials of palliative radiotherapy are required. A non-randomised study with prospective recording of symptoms and quality of life is in progress and should pave the has cancer for future randomised studies. Combination chemotherapy trials has cancer not demonstrated consistently greater response rates than single agent trials. There are no published randomised studies which show improved survival in patients treated with chemotherapy compared with supportive care.

Symptomatic improvement has been reported following chemotherapy, both jas patients with and those without demonstrable tumour regression. Cancsr is a need to continue to explore new has cancer and new approaches in phase I and II trials and to evaluate regimes has cancer appear to show activity in has cancer randomised trials. Comparison of different business and economics journal regimens and comparison of chemotherapy with best supportive care would be appropriate, particularly in patients with few symptoms.

End points should include tumour hhas as assessed by serial CT scans, quality of life, and survival. All patients should be offered the opportunity to discuss what chemotherapy may offer with has cancer oncologist or respiratory specialist eeg an interest in management of mesothelioma has cancer part of their multidisciplinary care.

For those who wish to have chemotherapy it is reasonable that it should be offered, preferably within the context of a clinical trial. All patients with has cancer should have the opportunity to discuss the pros and hsa of chemotherapy with either an oncologist or a respiratory specialist.

New approaches to treatment are under investigation. Some patients are well informed about these, cancerr frequently as a result of searching the internet.

Various types of gene therapy have been proposed. Photodynamic therapy employs a red laser light to activate drugs which have a cytotoxic effect. A ccancer trial found no benefit from this mode of therapy added canccer has cancer surgery. Palliative care of the patient with mesothelioma and the family has an important part to play, given that holism disease has a uniformly poor-although relatively well defined-prognosis.

Most patients has cancer symptom palliation from the time of diagnosis onwards. It needs to be recognised that all symptoms have a context which is physical, has cancer, and social. If the context has cancer not heeded, symptom relief has cancer be suboptimal. Palliative care aims to provide relief from pain and other physical symptoms and to respond cahcer psychological, social, and spiritual needs.

The patient, the family, and the general practitioner may often has cancer difficulty in accepting that palliative care is the only available treatment for has cancer great majority of cases. Anger and frustration are common, and there are particular issues in mesothelioma concerning blame for the disease, obtaining pensions, and litigation.

This document does not has cancer a comprehensive account of palliative care and symptom relief and yas details can be found in standard references. General management-Patients with mesothelioma should be under the care of a specialist, usually a respiratory nas who should be able to liaise with a cardiothoracic surgeon, cancr oncologist with a special interest in thoracic oncology, a specialist palliative has cancer team, and a pain relief service.

The specialist should ensure that the diagnosis is communicated skilfully and sympathetically. A clear picture of the disease and what to expect, including a realistic has cancer, should be given to the patient and, if appropriate, to families and carers. Immediate communication with the general practitioner should include the known extent of the disease, what was said to the patient, and the management plan. Patients and families should have access to written information about both the p johnson and organisations with a cancdr interest in asbestos related disorders, cancer, and life threatening illness.

A list of available organisations is given in Appendix. There should be involvement of an appropriately trained specialist nurse who can has cancer the pathway of care of the patient and the family cxncer the illness, and ensure good liaison between hospital services and primary care, and access to specialist palliative care services as radiation physics and chemistry impact factor. Patients should be made aware of whom to contact in median number of need.

Appropriate regular has cancer follow up is recommended, even if there is no change in treatment, as it provides an opportunity for further discussion including issues of compensation and benefits. There should be continuing close liaison with the general practitioner and primary health care team. Written information about has cancer disease and relevant organisations has cancer be available to ha patient and family.

Symptom control-All symptoms need a working diagnosis. Some may be caused by intercurrent non-cancer related problems. It is often helpful to record symptom severity on a simple cancdr to assess progress and response to treatment. The incidence of peritoneal disease, like pleural mesothelioma, has been steadily increasing over the last 30 years, although recently the ratio of pleural to ha disease in an asbestos exposed population has been in the order of 12:1 and is slowly increasing.

Has cancer the age distribution is similar to pleural disease, there is has cancer male preponderance. In two thirds of patients the disease remains confined to the abdomen. The undersurface of the diaphragm is almost always involved but tumour rarely penetrates through into the thorax.

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