Mesothelioma

Surgical procedures involved in the treatment and diagnosis of mesothelioma are divided into three main categories:

• Diagnostic surgery is used to confirm whether or not cancer is present and where it is located. This is typically non-invasive.
  
• Curative surgery is carried out with the intention of removing as much cancer as possible with hopes of curing the patient. Radiation therapy or chemotherapy is often administered following curative surgery.
  
• Palliative surgery involves the removal of cancerous tissue and is used to provide symptomatic relief, but does not offer a cure.

Though researchers continue to develop new ways to diagnose and treat mesothelioma, there are a number of techniques that have been on the scene for several decades. One such technique, thoracentesis, was developed in the late 19th century and is still used today.

Thoracentesis, the extraction of fluid from the lungs and the pleura (pleural effusion), can be used for two purposes. The first is as a diagnostic tool. In this procedure, a doctor uses a hollow needle, or cannula, to extract pleural fluid. This procedure helps to determine the causes behind the fluid buildup. The fluid is then examined for certain qualities that may indicate disease. Usually, however, thoracentesis is not sufficient to determine whether or not a person has mesothelioma. A biopsy is typically required as well.

Before performing the test, doctors will first take an x-ray of the chest, which reveals the extent of the problem and allows them to make the best insertion possible. The skin around the insertion will be disinfected and local anesthesia will be injected to numb the pain. The needle is then inserted. This may cause a feeling of pressure, but not pain (with the help of anesthesia). The procedure is often followed by an x-ray to verify the success of the thoracentesis and the amount of fluid removed.

After the fluid is collected from the lung's chest cavity, it is sent to a lab for analysis. There are a number of factors that doctors examine to determine whether mesothelioma is present. These include:

• Protein levels
  
• Glucose presence
  
• pH levels
  
• Cell count
  
• Cholesterol

Fluid in the pleural region can indicate a number of concerns other than mesothelioma. Although cancer is a common cause of excess fluid in the chest, the fluid may also indicate lung infection, connective tissue disease, congestive heart failure, cirrhosis, and a number of other conditions.

Thoracentesis may also be used for palliative reasons to treat the uncomfortable and often debilitating symptoms of pleural effusion. Removing the fluid lessens pressure on the chest and lungs, eases pain in those areas, and provides more space for the lungs to expand.

Thoracentesis is not without risk. Some of the complications that may occur include the following:

• Pneumothorax: This condition, better known as a collapsed lung, can occur if the doctor accidentally punctures the lung or disrupts an accumulation of air in the pleural cavity.
  
• Hemopneumothorax: Often causing the lung to collapse, hemopneumothorax takes place when damage occurs and blood begins filling the pleural space.
  
• Pulmonary edema: While removing a sample of the fluid in the lung area is supposed to help, it can sometimes cause even more fluid buildup in the pleural space or swelling. This condition is known as pulmonary edema and can lead to lung failure.

There are also a number of minor conditions that may develop as a result of the thoracentesis procedure. These include subcutaneous hematoma (slight bruising or bleeding), anxiety, and cough.

The surgical procedure known as pleurodesis is used to treat pleural effusion, the buildup of fluid in the chest cavity between the lungs and their lining, called the pleural space.

Technically, the process of pleurodesis is used to eliminate the pleural space so fluid cannot continue to collect. Doctors perform this procedure by draining the fluid and inserting a talc-like substance that causes inflammation and serves to seal the pleural space.

There are two methods doctors may use to produce this inflammation. Usually, inflammation achieved chemically, but cancer doctors also use a surgical procedure to irritate the tissue. When surgery is performed, it is common for some of the suspicious tissue to be removed as well.

In the chemical pleurodesis process, the chest is first drained using a tube. Doctors then introduce a chemical into the pleural space. There are a number of chemicals that may be used, but the most common are bleomycin, tetracycline, povidone iodine, and talc. These chemicals remain in the chest for a few hours until the tissue is thoroughly irritated. Doctors then connect a tube to a suction device, which causes the two layers of the pleura to come together and seals the space where fluid once collected. This process takes place during the course of a few days because it takes some time for the fluid to drain thoroughly. During this time, anesthesia and pain medications are administered, but most patients still describe this procedure as quite painful.

The second form of pleurodesis is surgical. This surgery is performed by using either a thoracotomy or thoracoscopy. In both cases, the pleura are irritated with a rough pad, causing inflammation. As in chemical pleurodesis, the layers are then brought together so they can fuse and future fluid retention can be eliminated.

After recovering from the surgery, patients should experience a marked difference in their ability to breathe, and pain and coughing should lessen as well.

Along with surgery and chemotherapy, radiation therapy is one of the most commonly recommended treatments for mesothelioma. Radiation has long been a standard treatment for many types of cancer and is often used in mesothelioma patients as a palliative measure (a form of therapy that helps reduce the pain of symptoms, but does not offer a cure for the disease).

What is Radiation Therapy?

Radiation therapy uses a form of radiation called "ionizing radiation" that is designed to kill and control the growth of cancer cells. Radiation therapy is used as a curative treatment as well as a palliative therapy to provide symptomatic relief.

Radiation therapy is often used in conjunction with other cancer treatments such as surgery and chemotherapy. For example, radiation therapy may be administered before surgery to shrink tumors, or in conjunction with chemotherapy to improve the success of both treatments.

There are three main types of radiation therapy: external beam radiotherapy, unsealed source radiation therapy, and brachytherapy.

Brachytherapy Treatments for Mesothelioma

Brachytherapy is a type of radiation therapy that involves the implantation of tiny radioactive rods in or near tumors. It is most commonly used to treat cervical, breast and prostate cancers, as well as cancers of the head and neck, but has also been used to treat mesothelioma.

An advantage of brachytherapy is that the radioactive rods placed inside tumors (often referred to as "seeds") emit radiation across short distances of approximately one centimeter. This treatment allows for the delivery of a strong and highly-concentrated dose of radiation directly to tumor cells, but causes very little damage to surrounding healthy cells and tissue. Because of this, healthy tissue is spared and side effects are less severe.

Brachytherapy seeds are very small (about the size of a grain of rice) and insertion of the seeds is carried out under general anesthetic. This means that patients must be evaluated to ensure they are fit enough to undergo surgery. Additional tests are done to determine the size and location of tumors so that seeds can be placed for maximum effect.

The seeds may be implanted using one of two methods. Intracavitary treatment involves inserting radioactive seeds housed in small containers into body cavities. In interstitial treatment containers are not used, and instead the seeds are placed directly into cancer tumors. For this procedure, the seeds are inserted through the use of a thin needle.

Brachytherapy Types

There are two main types of brachytherapy treatment for mesothelioma: temporary and permanent.

When a patient undergoes temporary brachytherapy treatment, radioactive seeds are placed inside tumors for a short period of time and are then removed. If the therapy is to be permanent, the seeds are never removed. However, over time the remaining seeds produce less radiation, until eventually radiation emission ceases. Depending on the type of radioactive material used in the treatment, radiation emission will most likely end within three to 12 months.

High Dose and Low Dose Brachytherapy

Brachytherapy treatments for mesothelioma are separated into two further types according to the strength of the dose that is administered and the duration of the treatment.

High dose brachytherapy is administered via a catheter, with the seeds being delivered into tumors one by one at regular intervals. This treatment takes place over the course of a single session that typically takes only a few minutes to complete, and is carried out as an out-patient procedure. Patients typically receive up to 12 separate treatments over the course of two or more weeks.

Low dose brachytherapy administers continuous low-dose radiation over several hours or even days, but the patient is given only one treatment rather than several. This is carried out as an in-patient procedure and requires at least one overnight hospital stay.

Pros and Cons of Brachytherapy

The immediate side effects of brachytherapy treatment for mesothelioma are pain, swelling and sometimes bruising at the treatment site. These symptoms are typically mild and last for just a few days. However, there are few other side effects, and the side effects of brachytherapy are much less severe than with other types of radiation therapy.

Brachytherapy is a non-invasive procedure because of the delivery method used to administer treatment. Patients can typically resume normal levels of activity within just a few days. People who receive this treatment also benefit from a reduced risk of developing post-operative infections and other complications that may result from more invasive surgical procedures.

Despite the lack of side effects for patients, there are some other concerns surrounding brachytherapy. The amount of radiation emitted by patients who receive brachytherapy is very low, but patients are still advised by their physicians to avoid contact with young children and pregnant women, who are typically more vulnerable to the effects of the radiation.

In addition to chemotherapy and surgery, radiation therapy is one of the three most commonly used treatments for mesothelioma.

Radiation therapy makes use of a type of radiation called "ionizing radiation," which is used to kill existing cancer cells and control the growth of new cancer cells. Depending on the nature of the patient's condition and their type of asbestos cancer, radiation therapy may be used as a stand-alone treatment or may be used in conjunction with surgery or chemotherapy.

In addition, radiation may be used either as a curative treatment or as a palliative treatment. In the latter case, the purpose of radiation therapy is not to cure the patient, but simply to provide relief from pain and other symptoms of the cancer. This is often the case for mesothelioma patients that are prescribed radiation therapy.

There are three main types of radiation therapy: external beam radiotherapy, unsealed source radiation therapy, and brachytherapy. In most cases, only external beam radiotherapy and brachytherapy are used to treat mesothelioma. The type of radiation treatment a patient receives depends on several factors, including the type of mesothelioma, the stage of the disease, and whether other treatment options are also viable.

External Beam Radiotherapy

External beam radiotherapy is the most common type of radiation therapy for the treatment of cancer. During this procedure, the patient sits or lies down to expose the area that requires treatment, and an external source of radiation is directed at the treatment area.

Over the course of a series of treatments, mesothelioma tumors are bombarded with radiation to kill cancer cells and limit the growth and spread of these cells. However, in most cases involving mesothelioma, radiation therapy is not able to completely eradicate all tumor cells. As such, this type of therapy is usually given to provide the patient with some relief from pain and other symptoms associated with mesothelioma, such as shortness of breath and coughing.

Due to the nature of the treatment, it is common for healthy tissue near the treatment area to be affected by radiation. This damage causes side effects such as skin irritation, pain near the treatment site, digestive problems, and difficulty swallowing.

External beam radiotherapy is rarely effective as a stand-alone treatment for mesothelioma and is most often used in conjunction with chemotherapy or surgery.

Mesothelioma Brachytherapy

Brachytherapy, also known as sealed source radiation therapy, is a procedure that involves the implantation of tiny radioactive rods in or near tumors of mesothelioma and other types of cancer such as breast, cervical, and prostate cancer. This treatment method allows the delivery of a highly-concentrated and closely targeted dose of radiation to mesothelioma tumors that might be resistant to other types of radiation therapy.

This type of radiation therapy is beneficial because it causes little damage to healthy cells surrounding the affected area and is less invasive than traditional radiation.

Patients with mesothelioma may receive either temporary or permanent brachytherapy treatment. For temporary treatment, radioactive seeds are placed within tumors for a short time and are then removed. In the case of permanent treatment, the seeds are not removed, but are simply left within tumors and eventually cease the emission of radiation.

Unsealed Source Radiation Therapy

Treatment with unsealed source radiation involves the administration of soluble forms of radioactive substances. This type of treatment is administered either orally or via injection, but is only used to treat very specific types of cancer. For example, patients with thyroid cancer are often treated with a solution of radioactive iodine.

One major disadvantage of unsealed source radiation therapy is that people who receive this treatment are considered to be radioactive for the duration of the treatment and for several weeks after - this means they can actually pose a health risk to other people. Note that this is not a treatment that is used for patients with mesothelioma.

The term "remission" generally refers to a state of absence of any disease activity among patients with cancer. Doctors typically cite two types of remission, which includes complete remission and partial remission. Complete remission is the total absence of the disease without signs of cancer. Partial remission only indicates shrinkage of the tumor and lessening of the disease.

Mesothelioma Patients and Remission

For mesothelioma patients, remission is certainly less likely to occur. Most cases of mesothelioma are not detected until symptoms arise, which is when the cancer has already reached Stage III or IV of development. Nevertheless, some doctors have reported a handful of cases of both drug and therapy-induced remission. Researchers believe remission after treatment or therapy may be linked to changes in the immune system.

In particular, many long-term survivors of mesothelioma indicate they drastically changed their diet and added daily supplements to enhance their immune system. Many of these same survivors promote the efficacy of alternative treatments as part of their regimen and several have shunned conventional treatments such as chemotherapy, radiation, or surgery.

However, that does not mean conventional treatments should be discounted. There have been a number of cases where mesothelioma patients have experienced remission after chemotherapy. In one case, a 71-year-old Japanese woman with peritoneal mesothelioma went into remission after receiving intraperitoneal injections of the chemotherapy drug Cisplatin. She also received other chemotherapy medications that were administered in the traditional manner. The case, as reported by Yokohama City University School of Medicine, was judged to be quite rare and the disease did return less than a year later. Nevertheless, the woman enjoyed several additional disease-free months.

Today, with the advent of new medications, improved treatments, early detection methods and clinical trials, remissions are becoming more common. Additional money is now being spent on mesothelioma research and support groups nationwide are receiving more donations. Unfortunately, research still has a long way to go in conquering this aggressive disease.

Although the majority of those diagnosed with mesothelioma are told their survival rate is less than one year from the time of diagnosis, cases of patients living past their predicted survival date are continuing to surface. With each survivor story that comes to light, current mesothelioma sufferers are gaining a little more hope about their future.

Poor Outlook & Prognosis for Mesothelioma

In order to understand why most mesothelioma patients only survive for a short time, it is necessary to understand the nature of the disease. In most instances, mesothelioma is not detected until it has reached its later stages. This is because symptoms can take as long as 50 years to appear once a person has been exposed to asbestos. Without the presence of symptoms, those with mesothelioma usually do not even realize they have developed the disease.

However, with the development of new tests that aid in early diagnosis, such as the Mesomark blood test, doctors and scientists expect more mesothelioma patients to live longer, healthier lives. An early diagnosis can often open the door to more treatment options and a higher success rate in shrinking or removing tumors.

Patients and their loved ones may enjoy reading “Lean on Me – Cancer through a Carer’s Eyes,” a touching story by Lorraine Kember about her husband’s battle with mesothelioma. Reading about the emotions the Kember family experienced may provide insight into the road ahead for those recently diagnosed. To receive a complimentary copy of this book, click here.

Why Do Some Mesothelioma Patients Survive Longer?

There have been a number of patients that have survived far beyond the usual one year survival period and a handful that have even been cured, with no trace of the aggressive cancer several years after treatment (though recurrence is always possible). This has stumped many medical professionals as they experience difficulty in explaining why some mesothelioma patients survive and others do not.

Research seems to show one common thread – the immune system. Studies of those who have either survived or been cured of the disease reveal that most of these patients participated in some sort of therapy that enhanced their immune system. Some treatments included clinical trials in immunology while others involved alternative therapies dealing with the immune system.

A report released more than 20 years ago theorized that "the presence of asbestos fibers in exposed workers may have caused the eventual breakdown of the host's surveillance system and the onset of neoplasm [malignant mesothelioma]."

With this philosophy in mind, some researchers believe treatments that improve the immune system can stabilize and even cure the disease. Currently, this is the most prevalent theory in explaining why some patients continue to live a healthy life while mesothelioma is in remission and why others have apparently defeated the disease.

About Mesothelioma Survivors

A number of mesothelioma survivors have posted their stories on the Internet and have spoken to patients and their families with the hope of providing a brighter outlook for their future. These same survivors have also presented their cases to doctors and researchers.

The most outspoken of these individuals is Paul Kraus, an Australian mesothelioma survivor. Kraus was diagnosed with peritoneal mesothelioma in 1997, a form of the disease that is tougher to treat than the more common pleural variety. Kraus worked in a factory 35 years earlier where he was exposed him to blue (crocidolite) asbestos.

Upon his diagnosis, Kraus decided he would do everything possible to fight the cancer. He altered his diet (he's now a vegetarian), added many vitamins and supplements to his daily routine, began "juicing," and tried a treatment known as ozone therapy. Kraus explains, "They took blood out of a vein, used an ozone machine to add ozone (a molecule composed of three oxygen atoms) to the blood and reintroduced it into my body through a drip. The rationale for that was that cancer does not like an oxygenated environment."

The research in putting the protocol together took a lot of time, but in the long-run, Kraus believes the combination of all these treatments stabilized his mesothelioma. Today, tests show he still has the disease and his body is a bit weaker than it was, but he has no pain and his doctors tell him he could continue living for many more years.

Kraus stresses the fact that he is not the only mesothelioma survivor. He has cited the case of a man diagnosed 14 years ago at age 58 (no name given) who had a chest wall resection after diagnosis and has had no symptoms or recurrence since. His doctors believe there was "moderate host inflammatory response" and that spontaneous regression may be an immune-mediated phenomenon" - in other words, his immune system played a role in his survival. (Pilling, J.E., et al., Prolonged Survival Due to Spontaneous Regression and Surgical Excision of Malignant Mesothelioma, Ann Thorac Surg, 2007; 83: 314-5.)

Another survivor, Rhio O'Connor - who recently published a book about his fight with mesothelioma - has lived with the disease for seven years. He opted against surgery, chemotherapy and radiation. Instead, with the help of several medical physicians, he developed a regimen that included 100 supplements per day, changed his diet drastically, and now practices what he calls "mind-body medicine" (such as non-stress techniques like meditation). In his book, he recommends a variety of alternatives to traditional medicines and treatments.