Malignant mesothelioma

Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos . Like most cancer, malignant mesothelioma is best treated when it is found (diagnosed) early. You should see your doctor if you have shortness of breath, pain in your chest, or pain or swelling in your abdomen.

If you have symptoms, your doctor may order an x-ray of your chest or abdomen. Your doctor may look inside your chest cavity with a special instrument called a thoracoscope. A cut will be made through your chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy , is usually done in the hospital. Before the test, you will be given a local anesthetic (a drug that causes you to lose feeling for a short period of time). You may feel some pressure, but you usually do not feel pain.

Your doctor may also look inside your abdomen ( peritoneoscopy ) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, you will be given local anesthetic. If tissue that is not normal is found, your doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy . Biopsies are usually done during the thoracoscopy or peritoneoscopy. Your chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and your age.

Stages of malignant mesothelioma

Once malignant mesothelioma is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. Your doctor needs to know the stage of your cancer to plan treatment. The following stages are used for malignant mesothelioma.

Localized malignant mesothelioma Stage I: The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung.

Advanced malignant mesothelioma Stage II: The cancer has spread beyond the lining of the chest to lymph nodes in the chest.

Stage III: Cancer has spread into the chest wall, center of the chest, heart, through the diaphragm, or abdominal lining, and in some cases into nearby lymph nodes. Stage IV: Cancer has spread to distant organs or tissues.

Recurrent malignant mesothelioma: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lining of the chest or abdomen or in another part of the body.

Treatment

There are treatments for all patients with malignant mesothelioma. Three kinds of treatment are used:

• surgery (taking out the cancer)
• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• chemotherapy (using drugs to fight the cancer).

Surgery is a common treatment for malignant mesothelioma. Your doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy . Sometimes part of the muscle below the lungs that helps you breath (the diaphragm) is also removed.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy). Intraoperative photodynamic therapy is a new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.

Treatment by stage

Your treatment depends on where the cancer is, how far it has spread, your age, and your general health. You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are going on in many parts of the country for many patients with malignant mesothelioma.

Localized malignant mesothelioma (stage I)

If the cancer is only in one place in the chest or abdomen, your treatment will probably be surgery to remove part of the pleura and some of the tissue around it. If the cancer is found in a larger part of the pleura, your treatment may be one of the following:

1. Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
2. Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
3. External beam radiation therapy to relieve symptoms.
4. A clinical trial of surgery followed by chemotherapy given inside your chest.
5. A clinical trial of surgery, radiation therapy, and/or chemotherapy.

Advanced malignant mesothelioma (stages II, III, and IV)

Your treatment may be one of the following:

1. Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.

2. Surgery to relieve symptoms.

3. Radiation therapy to relieve symptoms.

4. Chemotherapy.

5. A clinical trial of surgery, radiation therapy, and chemotherapy.

6. Chemotherapy given in the chest or abdomen.

Recurrent malignant mesothelioma

Your treatment depends on many factors, including where the cancer came back and what treatment you received before.