Straight Talk about Mesothelioma, a blog series created by Michael T. Milano, M.D., Ph.D., a radiation oncology specialist, as a resource for mesothelioma patients and their loved ones.
How Doctors Prolong the Life Expectancies of Mesothelioma Patients
As one of the most aggressive forms of cancer, mesothelioma is responsible for 2,000-3,000 deaths per year in the United States. Sadly, as many new cases of the disease develop each year, with few signs of decline. It’s especially tragic because mesothelioma is always caused by exposure to asbestos, meaning many of these deaths are preventable.
Efforts to control asbestos have been ongoing since the 1980s, with varying degrees of success. Still, patients and health professionals have to confront the reality that mesothelioma is a highly persistent health concern in the U.S. That also means confronting the reality that mesothelioma is a nasty disease with a very unfavorable prognosis. Survival rates, to be frank, are quite low.
One of the problems is that there is a long period of inactivity between exposure to a given carcinogen – in this case, asbestos – and the development of symptoms. This usually results in a late diagnosis, when the cancer is already at an advanced stage. To make matters worse, many of the early symptoms are similar to respiratory infections like pneumonia and influenza, prompting many doctors to misdiagnose the illness. It’s like a perfect storm of medical misfortune, the result of which is a 5-year survival rate of just 10 percent, and a remission rate that is almost non-existent.
Of course, there are different kinds of mesothelioma, and the prognosis can depend on when (in the course of disease), where (in the body), and how (after symptoms or incidentally seen) the cancer is discovered. Nonetheless, it’s important for patients to understand that this is one of the most deadly and aggressive forms of cancer, and to manage their expectations accordingly.
Dealing with the Problem
Great strides have been made in recent years to improve the prognosis for mesothelioma patients. Bold new treatments involving surgery, radiation, and chemotherapy have been developed to help target and destroy tumors. These efforts can help extend a patient’s life well beyond the initial prognosis.
The challenge is in developing a treatment plan that conforms to the specific circumstances of the patient. To do this, professionals from a variety of different disciplines – including oncology, pharmacology, nutrition, and primary care – work together to develop a plan that fits the patient’s individual needs. Age, overall health, personal preferences, as well as the type and stage of the cancer all factor into the treatment plan.
The plan may involve some or all of 3 primary strategies: surgery, radiation, and chemotherapy. Secondary approaches such as diet, pulmonary and physical therapy, and palliative care (the treating of symptoms) are all important, but they do not necessarily change the long-term outlook. Some patients may also choose to participate in clinical trials for new drugs or treatment approaches not currently adopted by the mainstream, with varying levels of success.
Surgery, Radiation, and Chemotherapy
Surgical treatment depends on of the site of mesothelioma –pleural or peritoneal. Either way, the procedure is highly invasive and may involve the removal of the lining around the lungs (in the case of pleural mesothelioma), or parts of the abdominal wall (in the case of peritoneal mesothelioma). Surgeons will attempt to remove as much of the tumor (or tumors) as possible, and may remove some normal tissues (i.e. the lung), with the goal of delaying the progression of the cancer. Depending on how successful they are, the patient will have more options for the next course of treatment.
Radiation therapy involves the use of high-energy x-ray radiation to destroy cancer cells. It is used to combat many different forms of cancer, and may occasionally be used against mesothelioma. Radiation can be considered for palliation (alleviation) of symptoms. For pleural mesothelioma, radiation is sometimes used after complete resection of the cancer and one lung to increase survival and tumor control. Because the potential severe side effects, radiation is used sparingly and with great caution. For example, sufferers of peritoneal mesothelioma, which affects much of the abdomen, rarely receive radiation treatment out of fear of damaging internal organs.
Chemotherapy is broadly defined as the use of drugs to help prevent the growth of cancer cells. Like surgery and radiation, any chemotherapy regimen depends heavily on the type and extent of the mesothelioma, as well as a host of other factors unique to the patient. Most often, it is delivered intravenously by a tube placed directly into the patient’s vein. Some patients may also receive a dose of chemotherapy drugs during surgery. In most cases, the side effects from these drugs are serious, and may include vomiting, fatigue, nausea, hair loss, and increased risk of infection. While these side effects subside in the weeks to months after treatment is complete, there are also potential long-term complications.
Living with Mesothelioma
All 3 approaches will help renew a patient’s lease on life, sometimes for many years beyond expectations. While mesothelioma remains a brutally resilient disease with heartbreakingly low survival rates, the outlook is not uniformly bleak. With the right treatment and the right attitude, many patients are able to live several years longer than doctors might have predicted. In that sense, mesothelioma treatment is really about managing expectations, but also about providing patients with as much time (and comfort) as medically possible.
If you or a loved one is currently suffering from mesothelioma, be sure to ask questions, do your research, and be sure you understand the various ways in which the disease can be treated.