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Mesothelioma: Treatment Options for an Incurable Disease


Mesothelioma is a rare and aggressive form of cancer. In most cases, the prognosis is very poor at the time of diagnosis. In general, patients have not more than twelve months to live following a positive mesothelioma diagnosis. Hence, the treatment options for such an aggressive and rapidly developing disease are quite limited. Mesothelioma treatment is usually palliative. In other words, the objective of treatment is simply to relieve the patient of the pain associated with the mesothelioma symptoms. There is no hope of curing the patient from the disease for several reasons:

(i) Diagnosis occurs very late in the development of the disease. By the time diagnosis is made there is no hope for the patient.

(ii) The development of the disease is very rapid and affects key organs like the heart and the lungs.

Surgery

Surgery or cytoreduction involves the removal of all or nearly all visible tumor. In cases of mesothelioma, this is generally combined with chemotherapy to give a more effective elimination of cancerous cells. Some surgical operations aim to cure the patient completely especially if the cancer is still localized. In most other cases, surgery may only have a palliative effect as the cancerous mass is reduced. The following types of surgical procedures are used in mesothelioma treatment:

(i) Pleurodesis: insertion of an irritant in the pleural space causing an inflammation; this closes down the pleural space thus preventing build-up of fluid (pleural effusion). Most symptoms associated with pleural mesothelioma can be abated with this method for some time. A thoracoscope is used for this.

(ii) Pleurectomy or peritonectomy: removal of part of the chest lining or abdomen lining (depending on where the cancer is).

(iii) Decortication: removal of all or part of the membrane covering an organ.

(iv) Pneumonectomy: removal of the whole affected lung (in most cases, mesothelioma develops on only one lung so that removal of that lung may cure the patient if the cancer has not spread).

Chemotherapy

Chemotherapy involves the administration of drugs that destroy cancerous cells. Chemotherapy in the treatment of mesothelioma can have the following objectives:

(i) Shrinking of tumors prior to surgery (neo-adjuvant chemotherapy).

(ii) Destruction of cancer cells after surgery (adjuvant chemotherapy).

(iii) Increase the effectiveness of radiotherapy (immunotherapy).

Chemotherapy is also used in cases where the cancer cells have spread beyond the initial site of occurrence. It is also used where the patient is not a candidate for surgery.

The most used drug for mesothelioma is pemetrexed which is an inhibitor of numerous proteins that are needed for DNA synthesis and cell replication.

Chemotherapy has various side effects because in the process of destroying cancer cells healthy cells are also harmed.

Radiotherapy

This refers to the treatment of cancer through the use of penetrating beams of high energy. In the case of mesothelioma, radiotherapy can be used in combination with surgery in an attempt to cure or to control severity of symptoms. An example of radiotherapy is the Intensity Modulated Radiation Therapy (IMRT) which uses computer generated images to target cancer cells directly with limited effect on surrounding tissue.



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