TIME IS SIGNIFICANT
Most cancer patients often receive bad news when it comes to expected survival rate. Most frequently, they are given at least eight months and the more fortunate, twelve months. However, some specialists of malignant mesothelioma have much better statistics.
Take this as an example. Dr. David Sugarbaker is a mesothelioma specialist from Boston's Brigham and Women's Canter; survival rate of five years has reached to about 40% for his selected patients. Treatments under Dr. Sugarbaker have certain qualifications which patients must meet. First, it should be at the early stage of the disease, so time is of utmost significance.
Please note that it is also important to keep a file of your personal medical records. It will be very useful for your treatment.
TRADITIONAL CARE
Here are three kinds of traditional treatment for mesothelioma:
• Surgery (removing the cancer)
• Chemotherapy (the use of drugs to fight against cancer)
• Radiation Therapy (the use of high-dose rays, such as X-rays, to destroy cancer cells)
During the course of the treatment, sometimes two or all of these are combined.
MESOMARK BLOOD TEST
To assist in monitoring the responses to treatment in bi-phasic and epithelial malignant mesothelioma patients, the MESOMARK assay was approved by the FDA (Food and Drug Administration) in January 2007. Using this test is beneficial but the effectiveness has not yet been measured at this time due to the limited data presently available. A certain protein is released into the blood by the mesothelioma cancer cells; this is called SMRP (Soluble Mesothelin-Related Peptide). The amount of SMRP is measured in the blood samples, and through this measurement the doctors are able to monitor a patient's progress better.
For the early diagnosis of mesothelioma, the MESOMARK blood test is NOT yet approved. However it has been approved as a HUD (Humanitarian Use Device) – this means that doctors must see to it that certain procedures are met for their patients to qualify for testing. Once certified, the doctor receives informational brochures which he will distribute to each of his applicable patients. Those who want to undergo MESOMARK testing will need to provide one or more blood samples to be sent for testing to a national reference laboratory.
In addition to other laboratory and clinical data gathered by your physician, decisions about your treatment and may be made easier, until such time that you may discontinue with the testing. You may need to pay from your own pocket the entire cost or part of it as MESOMARK blood testing may not be covered by health insurance, but you can verify this information with your insurance provider.
SURGERY
Given the fact that mesothelioma diagnosis more often inconclusive (as mentioned in this section: Symptoms), diagnostic surgery is highly recommended as a next step in verifying and staging mesothelioma.
Thoracoscopy – this procedure allows a doctor to examine the pleural cavity and carry out multiple biopsies. During this process, chemical pleurodesis can also be performed, which is aimed to relieve the build-up of fluid within the intrapleural space. The doctor can also measure the extent of the tumor in order to identify the surgical respectability. Even though this is less invasive than open biopsy, this can only be carried out on mesothelioma patients where the tumor has not destroyed the pleural space. A definitive diagnosis may be obtained up to 98% of the cases.
Video-Assisted Thoracis Surgery (VATS) – this may be an alternative to thoracoscopy although issues of tumor seeding escalate because it is more invasive. With small incisions, the doctor can observe the pleural space through a camera and get adequate tissue samples for the pathologist's findings. The extent of the tumor may be determined in order to recommend the proper treatment.
Mediastinoscopy – this is used in staging the extent of the cancer when enlarged nodes are found using imaging techniques.
Laproscopy – this method is used in cases where there is a possible tumor invasion through the diaphragm. Information obtained will be helpful in determining the necessity of pleurectomy or an extrapleural pneumonectomy.
PALLIATIVE PROCEDURES
Palliations are surgical procedures that treat a symptom of mesothelioma with no aggressive treatment of the disease itself.
Chest Tube Drainage and Pleurodesis – this is the most common palliative treatment. The first symptom of mesothelioma is pleural effusion or fluid build-up, which sometimes becomes persistent making patients return after the first procedure of the fluid draining (thoracentesis). For this reason pleural space should be closed which can be done by using talc slurry and other sclerosing agent that produces adhesion.
Thoracoscopy and Pleurodesis – this process is done in concurrence with video-assisted thoracic surgery (VATS) using powdered talc. Like the chest tube drainage and pleurodesis, this is only useful if no tumor encases the lungs.
Pleuroperitoneal Shunt – for some reasons this can only play a limited role in palliation. It is done through the insertion of a catheter under the skin, from the pleural up to the peritoneal cavity. Problems may occur if there is catheter obstruction or growth of the tumor in the abdominal cavity.
Pleurectomy – this may be performed when there is no option for a more extensive surgery. All gross or visible tumors will not be eliminated. This procedure is known as the most effective method to control pleural effusion in cases where the expansion of the lung is limited by the disease.
POTENTIALLY CURATIVE PROCEDURES
Performed with "curative intent", these procedures are aimed at removing all gross diseases, knowing that microscopic disease will likely remain. To add up to the primary therapy, adjuvant therapy is another type of treatment which is mainly aimed at getting rid of residual disease.
For Pleural Mesothelioma
• Decortication/Pleurectomy – is normally done to remove tumors on patients in Stage I and selected Stage II. However, the surgeon cannot remove all tumors without removing the lung, which may be done simultaneously. This is called pneumonectomy.
• Extrapleural Pneumonectomy – this is significantly more radical than most surgical approaches and methods. It is currently done in combination with traditional radiation and/or chemotherapy, or other new methods like gene therapy, photodynamic therapy or immunotherapy. This is so because studies show that in the past, surgery alone failed to effect treatment or extended life for any period of time. This procedure has to be carefully done by experts.
Standard Criteria In Patient Selection for Extrapleural Pheumonectomy
Doctors specializing in extrapleural pneumonectomy carefully choose their patients because it is a serious procedure. They appropriately advise the patient on the feasibility of the procedure and explain to them the tests necessary to maximize the chances for recovery and survival. This list of patient selection criteria is not all inclusive and varies according to the surgeon's preference:
o Score of >70 on Kamofsky Performance Status. This relates to the symptoms of the disease and how well the patient is able to conduct his normal daily activities. Other surgeons may require higher scores.
o Kidney (Adequaterenal) and liver function tests. The patient shows no significant disease on the kidney or the liver.
o Cardiac function. The patient has normal cardiac function as per echocardiogram and electrocardiogram.
o Extent of the disease. Disease is limited to the same side where the mesothelioma is located (ipsilateral hemithorax) with no invasion of the diaphragm, heart or chest wall.
o Age. The patient's age is also a factor although it is not as essential as the overall status.
If you are thinking about having a surgery, it is important that you communicate with your doctor in order for you to completely understand the benefits and risks involved in the procedure. You may have issues and concerns that need to be given attention.
For Peritoneal Mesothelioma
Cytoreductive Surgery is performed in order to remove nearly all (if not all) visible or gross tumor in the peritoneal cavity. For treatment of the remaining cancer cells, IPHC (Intra-Peritoneal Hyperthermic Chemotherapy is done in the abdominal cavity. Drugs used may vary depending on the doctor's preferences.
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