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Treatment procedure followed for mesothelioma depends on a number of factors, like, location and stage on cancer, patientís general health, age and medical history. General health and medical history are particularly crucial factors for chemotherapy. Standard treatment options include surgery, radiation therapy and chemotherapy, or a combination of two or more of them (multimodality therapy). Some new methods like gene therapy and immunotherapy are under experimentation, but they seem to provide promising treatment options.
Surgery is the most common treatment for mesothelioma. Depending on the extent to which cancer has metastasized, a part of lining of chest and some tissue around it can be removed. If cancer cells have invaded significant bulk of lung tissues, an entire lung may be removed, the procedure being called pneumonectomy. Sometimes a part of diaphragm, a muscle below lungs, which plays an important role in normal respiration, may also require removal.
RADIATION THERAPY OR RADIOTHERAPY
This technique involves use of high-energy radiations to destroy cancerous cells. An ultra-high-energy radiation beam is focused on the target tissue. This beam destroys the cancerous cells in that region. If this beam of radiations comes from an external machine, the therapy is known as external radiation therapy; and if it comes from radioisotopes put into the cancerous tissue using thin tubes, it is called internal radiation therapy.
This treatment option is called systemic treatment because usually, the drug is injected into a vein (intra venous or IV), thus the drug enters the blood-stream and acts on the target tissues. Less commonly, intra-cavitary chemotherapy is also used, that is, drug can be administered directly into the pleural cavity. A medical breakthrough occurred in chemotherapy for mesothelioma in 2004, when U.S. Food and Drug administration (FDA) approved a new drug for treatment of malignant pleural mesothelioma (MPM). This drug, Pemetrexed disodium, available under the brand name Alimta (in the U.S.) belongs to a group of medicines called antineoplastics. This drug is given along with cis-platin. Cis-platin is another anti-cancer drug. Pemetrexed is available only with doctorís prescription in the form of injections.
It is extremely important to take folic acid and vitamin B12 during treatment with this new drug to reduce the chances of harmful side effects. Doctors also prescribe a medicine called a Ďcorticosteroidí to be taken for 3 days during treatment with pemetrexed. The purpose of using corticosteroid is to lower the chances of getting skin reactions with this anti-cancer drug.
Since the drug is known to have a number of side effects, it is left entirely up to the patient to decide if he wants chemotherapy with this drug. The following points must be kept into account for pemetrexed treatment:
(a) Doctors must be informed about allergies, if any, to a particular type of foodstuff or chemicals prior to beginning of treatment. After the commencement of therapy, doctor must be informed about any type of allergic reaction with the drug immediately.
(b) Pregnant women or the ones planning to move on the family way must discuss this with their doctors, if they have used or are using this medicine.
(c) Breast-feeding is NOT recommended during use of pemetrexed. Breast-feeding must be stopped once the treatment with pemetrexed has begun. It should be made sure to discuss about it with doctor.
(d) Doctors must be informed if a mesothelioma patient is already using other prescription and non-prescription (over the counter) medicine. It is important for oneís health care professional to know about this because Non-steroidal anti-inflammatory drugs (like aspirin, ibuprofen etc.) together with pemetrexed can cause serious side effects. The doctor/ pharmacist would inform the patient if any of the medicines being used by him were NSAID.
(e) Medical history and general health, as already said, play an important role in chemotherapy. For instance, patients with renal disorders should not use pemetrexed, since they may have more pemetrexed in their bodies. Patients with ascites (extra fluid in stomach area) or pleural effusion (extra fluid in lungs and chest) or any third space fluid (extra fluid in body) should be administered pemetrexed carefully. The effect of this drug in these patients is not known.
Use of this drug brings a number of side effects. Not all of them may occur. But in case they do, medical attention is required. More common side effects include bleeding gums, black tarry stools, chills, cough, fever, chest pain, dysurea, pale skin, loss of co-ordination, pain in groin and legs (especially the calf region), pinpoint red spots on skin, onset of sudden severe head ache, ulcers or sores in mouth etc. Less common side effects are haematurea or blood with stools, decreased urination, skin rash, swelling of eyes and eyelids, weight gain etc.
IMPORTANT: THIS DRUG IS NOT TO BE USED, UNLESS PRESCRIBED BY DOCTOR (IN APPROPRIATE DOSES). OTHER PRECAUTIONS, AS INFORMED BY HEALTH CARE PROFESSIONAL, MUST ALSO BE FOLLOWED CAREFULLY.
Multimodality therapy refers to use of combinations of surgery, radiation therapy and chemotherapy. This combined therapy provides more assuring and promising option for some patients.
Gene therapy is a new approach to cancer therapy. One of the techniques involved uses special viruses that have been genetically modified in vitro. This modified virus is injected into the pleural space, where it infects mesothelioma cells. This infection of cancer by virus makes the mesothelioma cells sensitive to a drug, which in normal conditions does not harm the cancer. This therapy is in its experimental stages.
This technique involves boosting up the immune systemís reaction to fight mesothelioma more effectively. This therapy is being tested in clinical trials. Some of these treatments make use of interferons (or interleukins). These are hormone-like substances, which participate in activating the immune system.
# The candidates whose cancer cannot be removed surgically may be treated with pemetrexed.
# Intraoperative photodynamic therapy is a new type of treatment that makes use of special drugs and light to kill cancer cells during surgery. Several days before surgery, a drug is injected into a vein. This drug makes cancer cells more sensitive to light. During surgery, pleura is illuminated by a special light to remove the maximum bulk of cancer. This treatment is also under experimentation for early stages of mesothelioma in chest.
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NOTE: Medicine is an ever-changing subject. With development of new techniques and availability of the latest information, changes in treatment methods, diagnostic procedures and drug usage are liable to occur. We have, as far as it is possible, tried to bring to you the information, which is up-to-date. But still, to avoid any sort of risk, it is strongly advised to readers who go through the contents of this text, to confirm that the information given over here complies with the current practice- standards. Drugs mentioned should not be used without physicianís prescription.