Mesothelioma is a diffuse malignancy that develops in patients due to prolonged exposure to asbestos—either through occupancy or secondary exposure. The term occupancy exposure refers to when patients are exposed to asbestos at the workplace. Whereas in secondary exposure, workers become carriers of the asbestos fibers for their family through their clothes or bodies. Whichever is the reason, patients may not show symptoms for a long time since mesothelioma has a long latency period.
Typically, doctors can only detect mesothelioma in its later stages when patients are ineligible for aggressive treatment. In the advanced stages of cancers, treatment aims to reduce symptoms and improve quality of life. Some patients are willing to undergo any treatment regardless of its side effects in order to cure themselves; others just want to live pain-free for as long as possible.
Factors affecting the choice of a mesothelioma treatment
There are many traditional and non-traditional treatment options available to patients, and the choice will depend on many factors. It's also important to consider the patient's health overall, the location of cancer, its cell type, its stage, and the pace of its spread. A doctor may devise a treatment plan for a patient after accounting for these factors.
The most common treatments for all types of mesothelioma, including the malignant pleural mesothelioma, include a combination of surgery, radiation, and chemotherapy. The combination of these treatments, also called multimodal treatment plans, has improved patients' outcomes in many situations.
Traditional treatment options for mesothelioma
Mesothelioma treatments can be broadly categorized into traditional and non-traditional/emerging treatments. Below is a list of the most commonly used traditional treatments for mesothelioma.
- Surgery: Surgery is one of the many treatments that doctors may use on their patients and is the most aggressive form of treatment for mesothelioma.
- Extrapleural Pneumonectomy (EPP): Patients who require the removal of the whole lung may also require other nearby tissues to be removed: chest linings, diaphragm, and linings of the heart sac. Because of removing so many tissues and organs, EPP is regarded as the most invasive surgical procedure.
- Pleurectomy and Decortication: The second is Pleurectomy and Decortication, also known as P/D. It does not involve the removal of the organ. Instead, the affected parts of the linings of the lungs, chest, and other damaged areas are separated from the healthy parts and removed with the surgical procedure.
- Pleurodesis: Pleurodesis prevents fluid from building inside the lining. To remove the fluid, chemicals and drugs are used to create a scar in the space available between various layers of pleura. A later stage involves injecting drugs and chemicals into the space to prevent fluid build-up.
- Debulking: Debulking removes the maximum amount of mesothelioma. Overall, this procedure involves less tissue removal than the Pleurectomy/Decortication procedure.
- Chemotherapy: Another widely used treatment for mesothelioma is chemotherapy. It cures patients by controlling the tumor's growth with powerful drugs, which travel through the body, attacking cancer cells on contact. The drugs can limit tumor growth by killing the cells. Once the tumor stops growing, the prognosis improves.
Chemotherapy is sometimes used as a primary treatment, but doctors frequently use it in combination with surgery, radiation, and other non-traditional treatment. When used before the surgery to shrink the cancer cells, it is known as neoadjuvant chemotherapy. However, when chemotherapy is administered after the surgery, it is called adjuvant therapy. It kills the cells missed during surgery.
How is chemotherapy administered to a patient?
There are two primary ways through which chemotherapy is administered to the patients, they are:
- Systemic chemotherapy: During this chemotherapy, doctors and other medical professionals inject drugs into an IV line, in a port or a vein. Medication is then absorbed into the bloodstream and circulates throughout the body. Finally, it contacts both healthy and cancerous cells in the body. Overall, the method is less invasive than surgery, but it may have some side effects. Doctors may use systematic chemotherapy as a standalone treatment or in conjunction with other therapies.
- Intraoperative Chemotherapy: The second type is Intraoperative Chemotherapy, in which the drug is administered when the tumor site is exposed during surgery. This therapy involves warming chemotherapy, rinsing the cancer site with medications, and draining the fluid from the pleura using a pump. By targeting cancer at its specific location, the medication protects the surrounding healthy tissues and organs.
- Radiation: Radiation can also be used to treat mesothelioma. It comes from powerful high-energy X-rays that permanently destroy the DNA of tumor cells. This procedure is intended to prevent the tumor from spreading to other parts of the body. When the cells are killed with radiation, the tumor shrinks in size, leading to a better prognosis for the patients.
Radiation can be challenging when treating mesothelioma since it is not a location-specific tumor. It often grows outwards, affecting the nearby tissues and nerves. Therefore, when using radiation therapy, it is crucial that doctors know their way around the organs, destroying only the unhealthy cells.
Radiation can also be used before surgery to kill cancer cells or as a palliative treatment to reduce symptoms like pain and shortness of breath.
Non-traditional treatments for mesothelioma
Medical science has successfully developed emerging treatments for mesothelioma patients to improve their symptoms and prognosis. These treatments include the following:
- Cryotherapy: It freezes cancer cells with nitrogen gas and can alleviate pain by shrinking tumor cells pressing against internal organs. During cryotherapy, the doctor sends long, needle-like devices into the body to target solid tumors. Doctors can precisely target tumor cells using CAT scans and computed tomography.
- Immunotherapy: As the name implies, immunotherapy is used to enhance the patient's immunity so they can fight the disease. Instead of outside invasive treatments, immunotherapy prepares patients to fight cancer.
- Gene Therapy: In medical terms, gene therapy is a third-line treatment for advanced mesothelioma-diagnosed patients. It allows new genes to be inserted into the cancer cells, making it easier to kill the tumor cells. Overall, this involves modifying the genetic makeup of the cells.
- Photodynamic Therapy: Doctors use light-sensitive drugs to kill and destroy cancer cells. Laser light activates light-sensitive drugs, causing them to immediately start working. Photodynamic Therapy is mostly administered to patients whose bodies have been weakened by drugs.
- Virotherapy: The use of viruses to kill and destroy the tumor cells is known as virotherapy. Often it is used in combination with gene and immunotherapy to improve the efficacy of the treatment.
Conclusion
As medical science grows, doctors are no longer limited to using traditional methods to cure patients. Emerging breakthroughs in science and technology have led to new and effective drugs and treatments to cure diseases that have found no cure in the past. In the case of mesothelioma as well, modern and traditional therapies have been used together to improve the symptoms and prognosis of the disease.
