The treatment options available to mesothelioma patients mostly depend on the stage of the cancer. Patients who are diagnosed with mesothelioma in the earliest stages of the disease will have the most options available to them and will also have a better prognosis. By the later stages of the disease, mesothelioma patients may only have palliative treatment options available to them and no hope of remission. As research advances, it is hoped this will change, but as of right now the prognosis is poor for those diagnosed in the late stages. There are several staging systems which can be used for mesothelioma. Here, the Butchart staging system is used for simplicity.
Stage 1 Mesothelioma Treatments
During Stage 1 mesothelioma, the cancer has not spread far from the point of origin and has not affected lymph nodes.1 This is good news for a patient. There is a good chance that the mesothelioma will be resectable which means the cancer can be removed through surgery. The type of surgery which is performed will depend on where the mesothelioma is located, such as pleurectomy/decortications for pleural mesothelioma. It is common for patients to receive adjuvant chemotherapy or radiation therapy after surgery to kill any remaining mesothelioma cells which were not removed with surgery. This is typical for most cancer treatments.2
Experimental treatments may be used during stage 1 mesothelioma as well, such as immunotherapy or gene therapy. Patients with stage 1 mesothelioma may also be eligible for clinical trials of new treatment methods.
Stage 2 Mesothelioma Treatments
Patients diagnosed with Stage 2 mesothelioma still have numerous treatment options available to them because the cancer has not spread far from the site of origin and the lymph nodes may not be involved. In the case of pleural mesothelioma, surgery may still be possible if the cancer is only in one lung. Chemotherapy and/or radiation are almost always recommended for stage 2 mesothelioma as primary treatment, adjuvant therapy, or neoadjuvant therapy.
As in stage 1 mesothelioma, experimental treatments may be used in the second stage. However, stage 2 mesothelioma patients may not be eligible for some clinical studies. Remission is usually not possible from treatment of stage 2 mesothelioma though treatment can significantly prolong prognosis. This is just one more indication of the seriousness of mesothelioma and the fact that the time it takes such a long time to become apparent means the cancer has usually advanced before discovery.
Stage 3 Mesothelioma Treatments
During the third stage of mesothelioma, the cancer has metastasized out from the origin site and affected lymph nodes, though it has not yet spread to distant parts of the body. Metastasis means the cancer has begun to spread and the tumor is releasing cancer cells. During this stage, surgery is not possible as a curative mesothelioma treatment because the cancer cells are now in the bloodstream or lymph nodes. Chemotherapy or radiation treatments may be given but they are not curative at this stage. Rather, treatment aims to prolong prognosis and reduce symptoms of the mesothelioma. Other palliative treatments may involve surgery for removing fluid buildup.
Stage 4 Mesothelioma Treatments
Stage 4 mesothelioma is the final stage when the cancer has spread throughout the body. Patients with Stage 4 mesothelioma have very poor prognoses and no curative treatments are likely to succeed.
Surgery may be used during stage 4 mesothelioma but it is palliative rather than curative. Palliative means the treatment is designed to make the patient more comfortable and to improve the quality of life in the coming months. There is no expectation that surgery will cure the person. Surgery can remove large tumors which may alleviate some symptoms associated with the mesothelioma, such as pain or breathing difficulties. However, as the cancer has spread throughout the body, it is impossible to remove all cancerous cells with surgery. Minimally-invasive surgeries like a thoracentesis may be used for draining fluids from the body to alleviate symptoms.
Chemotherapy and radiation may also be used during stage 4 of mesothelioma but mainly for palliative purposes also. These therapies can also slow down the progression of the mesothelioma and prolong the lifespan of patients.
Treatments Available at All Stages
There are many alternative mesothelioma treatments which can be used during any stage of the disease. These include massage therapy, acupuncture, homeopathy, and many more. While some of these alternative mesothelioma treatments do have hope of being curative, they are mostly palliative and meant to reduce stress and pain. In stage 1 mesothelioma, patients are not advised to use alternative treatments as their main approach as there is still a chance of complete remission with conventional treatment options.
Palliative treatments can also be used at any stage of mesothelioma. These treatments focus on alleviating symptoms of the disease and side effects of treatment.
As research continues to search for treatments that can stop disease progress there is hope that a breakthrough will soon be found. It is highly likely that state-of-the-art research in gene therapy will produce new treatments that are targeted to the patient.3 Gene therapy is producing some of the best results to date in mesothelioma treatments. Still in the early stages of use, these treatments hold great promise of future success
References
1 After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body (2011) Retrieved from National Cancer Institute at: http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/patient/page2
2Bölükbas,Servet, Christian Manegold, Michael Eberlein, Thomas Bergmann, Annette Fisseler-Eckhoff, Joachim Schirren, Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy, Lung Cancer, Volume 71, Issue 1, January 2011, Pages 75-81.
3Joseph Treat, Larry R. Kaiser, Daniel H. Sterman, Leslie Litzky, Alan Davis, James M. Wilson, and Steven M. Albelda. Human Gene Therapy. October 1996, 7(16): 2047-2057. doi:10.1089/hum.1996.7.16-2047.
