In order to determine what type of treatment you will receive, staging of mesothelioma is required. This allows doctors to plan accordingly based on the extent of the disease. During your diagnosis, certain procedures may help your doctor determine what stage your cancer is in. Staging gauges exactly how far the cancer has spread in the patient, if it has spread at all. The general stages are:
- Stage I is considered localized and the cancer would be found in the lining of the chest wall, lining of the lung, lining of the diaphragm or the lining of the sac covering the heart.
- In stage II, cancer has spread to the lymph nodes as well
- In stage III, cancer has spread to any of the following areas: the chest wall, the mediastinum, the heart, beyond the diaphragm, and the peritoneum. It may have also spread to the lymph nodes
- In stage IV, cancer has spread to distant organs or tissues
Two types of curative surgeries are:
Mesothelioma patients with cancer only in one lung are candidates for this type of surgery. The diseased lung is removed in this type of surgery. This is a very complicated surgery and it could possibly make it very difficult for the patient to breathe because it is essentially reducing the breathing capacity available to the patient. Before performing this type of surgery, your doctor will be absolutely sure that you are able to handle it and can breathe normally afterward.
This type of surgery is very risky and only performed in rare situations. It is a removal of the entire lung as well as the areas surrounding it, including the pericardium (membrane covering the heart), part of the diaphragm and the parietal pleura (membrane lining the chest cavity) on the same side of the chest as the diseased lung. This type of surgery can slow the spreading of cancer and make it easier for the patient to breathe. An xtrapleural pneumonectomy is considered one of the best options for treatment and has paved the way for the highest rates of long-term survival.
The process for performing an extrapleural pneumonectomy is:
- General anesthesia will be administered.
- The surgeon will make a large incision in the chest and may remove the sixth rib to make more space.
- The surgeon will collapse the diseased lung and tie off its major blood vessels.
- The main bronchial tube will be clamped (it will be stapled later on).
- The surgeon then cuts away the diseased lung.
- Synthetic material is put into the places where the chest wall and parts of the pericardium were removed.
- The chest incision is then closed up with sutures and a temporary drain is inserted into the chest cavity.
- An epidural anesthetic for pain is administered in the days following your surgery and recovery usually involves a two-week hospital stay.
Two types of palliative treatments are:
When there is a build-up of fluid in the chest (pleural effusion), your doctor may perform a pleurodesis. A local or general anesthetic will be administered and then your doctor will insert talc with a large needle or thoracoscope into the pleural space to cause inflammation and stop fluid from collecting for up to a few years. The talc causes an irritation of the pleural membranes and in result they become inflamed and bond together eliminating space between the pleural membranes so that more fluid cannot accumulate.
The process for a pleurodesis procedure is:
- The tip of the needle is inserted into the pleural space between the membranes and attached to a drainage tube.
- In order to avoid an extreme drop in blood pressure, drainage is performed slowly.
- Once the fluid is removed, your doctor will use the needle to inject talc solution into the pleural space.
- The drain is then clamped into place for an hour and afterward, the doctor may attach the drain to a suctioning device to make sure that the pleura layers bond correctly.
This type of treatment is an outpatient procedure of withdrawing fluid from the pleural space with a long thin needle to relieve pain symptoms for the patient. It generally takes less than 30 minutes and doesn't cause much pain, just some pressure, for the patient.
The process for a pleurocentesis/thoracentesis procedure is:
- While the patient is sitting up and leaning on a table, the doctor will clean and numb the area between the ribs and a thin needle will be inserted to draw out the fluid.
- After a sufficient amount of fluid has been removed, the doctor will remove the needle and cover the area with a bandage.
- You will be sent home and instructed to rest for at least 24 hours.
Radiation has progressively become more advanced even though it is one of the original treatments for cancer. There are generally two options for patients seeking radiation therapy:
External Beam Radiation
An external source of radiation is emitted directly to the tumor source to kill the cancer cells. This type of radiation also kills healthy cells in the body. This is an outpatient treatment that is painless.
This type of radiation involves either temporarily or permanently implanting a seed of radiation into the body on or near the tumor to kill the cancer cells and is intended to cause little damage to other healthy cells in the body. Some brachytherapy is temporary and the seeds are removed after a certain amount of time, while other brachytherapy procedures are permanent and the seeds remain in place but will eventually stop emitting radiation.
Just like the word infers, chemotherapy is "chemical therapy" and is a form of treatment that was developed in the 1940's. Systemic chemotherapy is administered by pill or through intravenous methods and travels directly through the bloodstream also affecting cells other than cancer cells. This is why chemotherapy has such strong side effects on the rest of the body. Intrapleural chemotherapy is an injection of chemicals directly into the pleura, therefore not affecting healthy cells in the body as significantly.
There are also several alternative therapies available to you that may make living with mesothelioma symptoms easier.