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.

A mesothelioma cure seemed almost unattainable not long ago, but this negative outlook is beginning to change. Doctors and cancer specialists are constantly working towards the development of a cure and instilling mesothelioma hope in patients. During this search to find a cure for mesothelioma, stories of survival continue to surface, renewing hope and determination.
Mesothelioma Treatments

While a cure does not currently exist, intensive treatment can often increase the duration of a patient's survival and alleviate some of the pain and suffering associated with mesothelioma. Patients will typically undergo a combination of treatments to combat mesothelioma. Surgery, chemotherapy and radiation therapy are the most widely used treatments, though alternative therapies such as massage and TENS (transcutaneous electrical nerve stimulation), are often administered to aid in pain relief.

A combination of treatments, such as surgery to remove as much of the cancer as possible, used in conjunction with chemotherapy to prevent cancerous cell division, is typically recommended. The stage, or maturity level, at which mesothelioma is diagnosed greatly affects a patient's prognosis and treatment options. The earlier the cancer is found and treated, the more likely a patient will positively respond to treatment.

Mesothelioma Clinical Trials

Many patients elect to participate in clinical trials as a way of building mesothelioma hope. Clinical trials are conducted to test up-and-coming treatments and medications before they are released and recommended to the public as a safe and effective way to treat an illness. The three stages of clinical trials test new drugs extensively, from the correct dosage required to the effectiveness of the drug. To participate in a clinical trial, a patient must first qualify for the study and meet specific qualifications.

Clinical trials are imperative in the search for a mesothelioma cure. As results and information are gathered from a study, the knowledge gained helps medical professionals come closer to the discovery of a cure. Each successful clinical trial renews mesothelioma hope for all patients around the world.

Dr. Sugarbaker

Dr. David Sugarbaker, MD has taken an active role in the pursuit of better treatment options for mesothelioma patients and a cure for the asbestos-related cancer. Dr. Sugarbaker has been instrumental in the discovery of groundbreaking treatment options and his multi-modal approach to treating the disease has increased survival rates for mesothelioma patients. Dr. Sugarbaker is best known for his innovative treatment approach which involves surgery coupled with radiation and chemotherapy treatments for patients both before and after surgery.

Extrapleural pneumonectomy (EPP), a ground-breaking surgical procedure performed by Dr. Sugarbaker, involves the removal of the lung and its coverings and the coverings of the heart and diaphragm. This surgery has resulted in disease-free and long-term survival and yielded the greatest amount of cytoreduction, or decrease in the number of cancerous cells.

Another procedure performed by Dr. Sugarbaker is intracavitary chemotherapy. Though currently under evaluation, the procedure has demonstrated encouraging results for mesothelioma patients. Intracavitary chemotherapy is completed while the patient is in surgery. Surgery to remove the tumor is completed and the chemotherapy is administered into the chest and abdominal cavity, contacting surfaces containing tumor cells and killing them. Healthy cells are preserved as a cytoprotective agent is utilized throughout the procedure.

Dr. Sugarbaker also founded the International Pleural Mesothelioma Program, which focuses on developing new treatment strategies and researching the causes of mesothelioma in effort to aid in the development of improved care for mesothelioma patients.

Progress made by Dr. Sugarbaker and other passionate medical professionals help strengthen mesothelioma hope and keeps the search for a cure alive. The research completed about mesothelioma and the constant studies conducted will only help scientists and doctors increase the survival rate of mesothelioma patients as they come closer to the discovery of a cure.

Mesothelioma Prognosis and Survival

Though many patients and their loved ones often get discouraged if the prognosis following a mesothelioma diagnosis comes back poor, it is important to remember that a number of patients have survived much longer than their initial prognosis suggested. Prognosis is generally poor because most patients do not exhibit symptoms of mesothelioma until 20 to 50 years after initial exposure to asbestos occurred, allowing the cancer to develop and mature in the body. The development of tests to aid in early diagnosis, such as the Mesomark blood test, will hopefully help mesothelioma patients receive treatment in the earlier stages of the cancer. Early diagnosis results in greater treatment options available to mesothelioma patients which can greatly improve a patient's prognosis.


Research reveals that mesothelioma patients who have survived for many years with the disease have commonly participated in some sort of therapy to enhance their immune system. Participation in clinical trials in immunology and other alternative therapies relating to the immune system have yielded positive results in some instances. Researchers theorize that mesothelioma likely results from immune suppression and mesothelioma survivors that participated in treatments to improve the immune system may have experienced positive results because of this participation.

Mesothelioma Hope

Many 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 help provide insight into the road ahead for those newly diagnosed. To receive a complimentary copy of this book, click here.

Mesothelioma Nutrition

Without a current cure for mesothelioma, patients battling the cancer often want to fight it in every way possible. Nutritious eating is a wonderful way to instill mesothelioma hope and equip the immune system with positive fuel. The food and nutrients that we put into our bodies greatly affect our ability to heal and fight disease. Eating a balanced diet consisting of whole grains, proteins, dairy, fruits and vegetables enables the body to function properly and adequately fight infection and illness. Eating nutritious food while actively fighting mesothelioma through treatment may not cure the cancer, but fighting the disease from every angle will give patients the best possible outlook.

Mesothelioma patients undergoing various treatments may have additional nutritional concerns. Nutrition during chemotherapy is extremely important as the drugs used during treatment kill cancer cells, but simultaneously affect healthy cells as well, leaving the body in a weakened state. Many patients may experience side effects from the treatment, including nausea and diarrhea. Mild flavored foods such as whole grain toast may settle the stomach and be easier to keep down during treatment. To combat constipation, patients should select foods with a large amount of fiber such as apples, oatmeal and broccoli. Ensuring adequate protein consumption is also important and many patients include egg whites, beans, milk and lean meats in their daily diet.

Patients undergoing radiation therapy may also experience side effects such as vomiting and loss of appetite. Since radiation can zap energy, it is important to eat nutritious foods with healthy calories to fuel the body properly. Limiting the amount of salt, alcohol and caffeine ingested during treatment is also very important. Speaking with a doctor or a nutritionist can help a patient receive guidance about proper nutrition and recommended foods to eat or avoid during radiation.

There are several types of treatment available for patients with mesothelioma, some recommended more frequently than others. The most commonly used treatments are surgery, chemotherapy, and radiation therapy. In addition, some experimental treatments are becoming more widely used, or are showing some encouraging results in clinical trials. These treatments include photodynamic therapy, gene therapy, and immunotherapy, among others.

Mesothelioma Cure

Though a cure for mesothelioma does not currently exist, many patients elect to undergo treatment to combat the cancer. Patients may also wish to participate in clinical trials conducted to test up-and-coming treatments and medications before they are released and recommended for public use. Clinical trials are extremely important in the search for a mesothelioma cure. Knowledge gained from study results greatly help medical professionals come closer to the discovery of a cure for mesothelioma.

Certain doctors such as Dr. David Sugarbaker have actively pursued better treatment options for mesothelioma patients and have been instrumental in the quest for a cure. Utilizing a multi-modal approach, Dr. Sugarbaker has made great strides in mesothelioma treatment and has increased survival rates for mesothelioma patients.

Learning that a cure does not exist can be discouraging to mesothelioma patients and their loved ones, but stories of survivors continue to surface, instilling hope in those affected by the cancer.

Mesothelioma Surgery

Surgical treatments for mesothelioma include three main types - diagnostic surgery, curative surgery, and palliative surgery. Some types of surgery fall into more than one category.

For example, thoracentesis may be used as a diagnostic procedure, and as a palliative treatment to provide symptomatic relief. Only curative surgery can potentially remove all cancer from a patient with mesothelioma.

However, for curative surgery to be effective, it is particularly important that mesothelioma be diagnosed as early as possible. Unfortunately, mesothelioma is not usually diagnosed until it reaches Stage III or IV, when surgery is not an option.

Mesothelioma Chemotherapy

Most forms of chemotherapy involve the intravenous administration of drugs such as Alimta and Cisplatin. Chemotherapeutic drugs are targeted to kill cells that are rapidly dividing by interfering with processes that occur during cell division.

However, while cancer cells themselves divide rapidly, so do some types of healthy cells, causing some of the unpleasant side effects that are often associated with this form of treatment. Though older chemotherapy medications seemed to do little to fight mesothelioma, newer chemotherapy drugs are showing much promise.

A relatively new form of chemotherapy called heated chemotherapy is an option for patients with peritoneal mesothelioma.

This treatment is carried out following surgery, and involves the perfusion of heated chemotherapeutic medications into the peritoneum.

Mesothelioma Radiation

Radiation therapy, or "ionizing radiation", is used to kill cancer cells and to limit the spread of cancer. For patients with mesothelioma, radiation therapy is most often used in conjunction with surgery.

However, in some cases radiation may be used as a stand-alone treatment to relieve pain and other symptoms associated with mesothelioma. In either case, it is rare for radiation therapy to provide more than short-term symptomatic relief.

Mesothelioma patients may receive one of two types of radiation therapies, depending on whether or not they are suitable candidates for either procedure.

External beam radiation therapy is the traditional type of radiation therapy, where tumors are bombarded with beams of radiation to kill cancer cells. Brachytherapy is a newer type of radiation treatment. It involves tiny radioactive rods which are implanted within a tumor to provide a strong, concentrated dose of radiation to tumors while doing very little damage to surrounding healthy tissue.

Photodynamic Therapy

Photodynamic therapy is a highly specialized and specific form of treatment that is most often used to treat skin cancers, some types of lung cancer, and pleural mesothelioma.

However, this treatment is usually unsuitable for patients with metastasized cancer; it is most effective in patients who have localized disease.

This type of therapy involves the use of light energy to kill cancer cells. In photodynamic therapy treatment, the patient is given an intravenous solution of a medication that makes cancer cells highly sensitive to a particular kind of light.

One to three days after this treatment, the patient is exposed to the light, and cancer cells that have absorbed the medication are killed.

Gene Therapy

Gene therapy involves using genetic material to specifically target cancer cells and make them more vulnerable to chemotherapy treatment.

The main type of gene therapy being developed for use in mesothelioma patients is called "suicide gene therapy," because it forces cancer cells to produce substances that cause their death.

When undergoing this type of gene therapy, the patient is treated with a non-infectious virus that has been altered with genetic material that makes them produce a particular protein.

Following this procedure, the patient is then treated with a chemotherapeutic medication that is specially formulated to be toxic only to cancer cells. This type of therapy has produced some promising results for mesothelioma patients, but it is still only available through clinical trials.

Immunotherapy is a type of treatment in which the patient's own immune system is 'tricked' into killing cancer cells. A healthy, normally-functioning immune system does not kill cancer cells, because even though these are diseased cells, the immune system is unable to recognize them as being harmful.

There are two main types of immunotherapy: active and passive. In active immunotherapy, mesothelioma cancer cells are removed from a patient and then treated in a laboratory to turn them into a vaccine. Following this laboratory treatment, the patient is injected with the vaccine and if the treatment is successful, the patient's immune system recognizes the vaccine as a harmful substance, thus recognizing the cancer as being harmful as well.

Passive immunotherapy is somewhat different in that it does not attempt to activate the patient's immune system. Instead, it uses substances such as cytokines (molecules that direct and regulate the immune system) and other agents to help boost the patient's immune response to their cancer.