mesothelioma treatment - mesothelioma survival rate - lung disease

Mesothelioma Treatment and Survival Rate 2021-2022

This article discusses everything you need to know about mesothelioma, mesothelioma treatment and survival rate.

Mesothelioma, also called pleural disease is an unusual kind of cancer that affects the lining of the chest or abdominal cavities known as the mesothelium. It is most often attributed to exposure to airborne asbestos particles. Asbestos fibers are naturally occurring fibrous minerals that were usually used in construction and thermal insulation as a fire retardant until the 1970s.

What is Mesothelioma or Pleural Disease?

Mesothelioma is an uncommon kind of cancer that affects the lining of the chest or abdominal cavities. It is most often linked to exposure to airborne asbestos particles and occurs in both men and women. In this article, we will discuss mesothelioma treatment and survival rate.

Asbestos fibers are naturally occurring fibrous minerals that were commonly used in construction and thermal insulation as a fire retardant until the 1970s. Before the dangers of asbestos became known, workers in the industries that made or used the mineral were often exposed to microscopic asbestos fibers in the air they breathed. The fibers became embedded in the tissue of the lungs and mesothelium, eventually leading to the development of mesothelioma or pleural disease.

Mesothelioma can develop many years after the last exposure to asbestos, and its symptoms are much like those of other common, less deadly diseases. Because of this, mesothelioma is often diagnosed late in its course.

Causes of Mesothelioma

What Are the Risk Factors for Mesothelioma?

Risk factors affect a person’s chance of getting mesothelioma or pleural disease. Having one of the following risk factors, or even several, does not mean that someone will get cancer.

These having been said, the causes of mesothelioma, or the risk factors include;

#1. Asbestos exposure is the primary risk factor for mesothelioma. It accounts for up to 80 percent of all cases.

#2. Living with someone who works with asbestos may also increase an individual’s risk for developing mesothelioma because asbestos particles can travel on skin and clothing.

#3. Radiation exposure particularly to the radioactive substance thorium dioxide, which was used with X-rays to diagnose health conditions between the 1920s and 1950s may increase the risk of developing mesothelioma.

#4. A family history of mesothelioma may increase an individual’s risk of developing cancer.

Where Does Asbestos Exposure Occur?

Occupational asbestos exposure is the most common cause of mesothelioma, especially within factory, construction, mining, shipbuilding, other manufacturing industries and among veterans and mechanics.

Asbestos exposure can also occur through the disturbance of asbestos-containing materials, such as when building materials begin to degrade over time or through the removal of such materials during remodeling or construction. Environmental asbestos exposure occurs when naturally occurring asbestos found in soil and rocks is released into the air through either human activity or weathering.

How Does Exposure to Asbestos Cause Mesothelioma?

Mesothelioma can take anywhere between 15 to 50 years to develop after exposure to asbestos. The pleural, peritoneal and pericardial lining (mesothelium) is a protective covering for internal organs. Mesothelium is made from tissue comprised of mesothelial cells that reacts when exposed to asbestos. The asbestos fibers cause this tissue to inflame, leading to scar tissue plaques forming on the surface of the protective lining. It is within this scar tissue that malignant mesothelioma tumors begin to grow.

Pleural mesothelioma occurs when asbestos fibers are inhaled and become embedded in the protective lining of the lungs (pleura). Overtime, asbestos fibers cause inflammation and scarring within the lining that can lead to the progression of the disease.

When asbestos fibers are ingested they can develop into peritoneal mesothelioma, which forms within the abdominal lining (peritoneal lining).

An extremely rare form of the disease is pericardial mesothelioma, which develops in the membrane surrounding the heart (pericardium). Research suggests that pericardial mesothelioma forms when asbestos fibers travel through the blood stream where they then become embedded in the pericardial membrane.

What should you do if you have Symptoms of Mesothelioma?

If you are experiencing symptoms of mesothelioma contact your physician immediately. Your physician will schedule a series of tests to determine whether or not you have mesothelioma. If you are diagnosed with mesothelioma, Penn Medicine is equipped with a multi-disciplinary team of physicians that can treat your illness with the latest technology coupled with compassionate care.

Types of Mesothelioma or Pleural Disease

There are three main types of mesothelioma, categorized by where the disease is found in the body.

Types of mesothelioma include:

#1. Pleural mesothelioma – affects the lining of the chest (pleura) and is the most common form of the disease

#2. Peritoneal mesothelioma – begins in the lining of the abdomen (peritoneum)

#3. Pericardial mesothelioma – primarily grows in the lining of the heart (pericardium)

Mesothelioma by Cell Type

Mesothelioma can be further characterized by cell type. The disease is generally divided into four cell subtype categories that differ in aggressiveness and how they respond to treatment.

Theses cell types include:

#1. Epithelioid – the most common cellular subtype comprising of 50-70% of all cases of mesothelioma. Known as the least aggressive cell type that typically responds best to treatment.

#2. Sarcomatoid – a rare cellular subtype and is known as the most aggressive and least responsive to treatment.

#3. Biphasic (also called mixed type) – a combination of both epithelioid and sarcomatoid cells within one tumor. Treatment options and response may vary depending on ratio of each cell type.

#4. Dermoplastic – the least common cellular subtype often highly associated with chest wall pain.

Symptoms of mesothelioma

Mesothelioma symptoms can occur anywhere between 15 to 50 years after a person has been exposed to asbestos. Symptoms may resemble less severe illnesses and do not show up until after the cancer is already present. The main types of mesothelioma are pleural, peritoneal, and pericardial with different symptoms accompanying each.

Symptoms of Pleural Mesothelioma

The symptoms of pleural mesothelioma include;

#1. Weight loss

#2. Fatigue

#3. Night sweats

#4. Chest or rib area pain, painful breathing

#5. Shortness of breath (dyspnea)

#6. Persistent cough/wheezing

#7. Fluid around the lungs (pleural effusions)

#8. Development of lumps under the skin on the chest

#9. Difficulty swallowing (dysphagia)

Symptoms of Peritoneal Mesothelioma

The symptoms of peritoneal mesothelioma include;

#1. Nausea or vomiting

#2. Weight loss

#3. Sweating or fever

#4. Fluid accumulation in the abdomen (Ascites)

#5. Fatigue

#6. Anemia

#7. Diarrhea, constipation or any other inexplicable changes in the bowels

#8. Development of lumps under the skin on the abdomen

Symptoms of Pericardial Mesothelioma

The symptoms of pericardial mesothelioma include;

#1. Heart palpitations, irregular heartbeat

#2. Pain in the chest

#3. Difficulty breathing (dyspnea)

#4. Sweating or fever

#5. Fatigue

Mesothelioma and Pleural Disease Risks and Prevention

Mesothelioma, or pleural disease is a rare cancer that affects the mesothelium, with approximately 2,000 to 3,000 new cases diagnosed each year in the Unites States. There are several risk factors associated with the development of mesothelioma. Having one of the following risk factors, or even several, does not mean that you will get cancer.

Risk factors for mesothelioma include:

#1. Asbestos exposure, accounting for up to 80% of all cases

#2. Living with someone who works with asbestos, because asbestos particles can travel on skin and clothing

#3. Radiation exposure, particularly to the radioactive substance thorium dioxide

#4. A family history of mesothelioma

Where Does Asbestos Exposure Occur?

Occupational asbestos exposure is the most common cause of mesothelioma, especially within factory, construction, mining, shipbuilding, other manufacturing industries and among veterans and mechanics.

Asbestos exposure can also occur through the disturbance of asbestos-containing materials, such as when building materials begin to degrade over time or through the removal of such materials during re-modeling or construction. Environmental asbestos exposure occurs when naturally occurring asbestos found in soil and rocks is released into the air through either human activity or weathering.

An accurate diagnosis is the key to providing the highest level of care possible for mesothelioma or pleural disease.

Diagnosing mesothelioma can be difficult because symptoms of the disease are similar to many other conditions. At Penn Medicine Abramson Cancer Center, our specialists have extensive experience diagnosing and treating these complex conditions, and employ the latest tests and tools to provide you with a timely, accurate diagnosis. Your physician will discuss with you and help identify whether or not you have been exposed to asbestos. Then, a series of diagnostic tests, a complete medical history and a thorough physical exam will be performed.

Mesothelioma Diagnostic Tools

There are a variety of diagnostic tools and tests used at Penn Medicine to diagnose mesothelioma.

Staging Mesothelioma or Pleural Disease

Staging is a system that provides doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body.

Doctors use staging as a way of recording the size and growth of a cancer, and determining the plan for treatment. Mesothelioma is broadly staged into two categories: localized (the tumor is restricted to the membrane surface where it originated) and advanced (the tumor has spread to neighboring structures and distant organs and tissues).

By understanding the stage of your cancer, you and your care team can make informed decisions about your treatment.

What happens during staging mesothelioma

When staging mesothelioma, doctors attempt to discover the following:

  1. The size of the tumor
  2. Whether the cancer has spread to nearby tissues
  3. Whether the cancer has spread to other parts of the body

Pleural Disease Mesothelioma Treatment

Our pleural specialists at Penn Medicine develop personalized treatment plans for mesothelioma and pleural disease, designed to give you the best possible outcome.

mesothelioma treatment options include:

#1. Surgery

#2. Radiation Therapy

#3. Photodynamic Therapy

#4. Chemotherapy for the Treatment of Mesothelioma

#5. Immunotherapy

#6. Treatments by Stage

#1. Surgery

Surgery for mesothelioma treatment is a valuable option for patients because it often improves results in mesothelioma survival. Penn Medicine’s mesothelioma surgery program in Philadelphia is unique. Few surgeons have the same level of experience in caring for pleural mesothelioma patients as do the thoracic surgeons at Penn. As the cornerstone of their approach to care, Penn thoracic surgeons collaborate closely with their colleagues in radiation and medical oncology to develop individualized treatment plans for patients with mesothelioma.

Mesothelioma treatment plans depend largely upon the location and stage of the tumor as well as the patients’ overall health. In all cases, Penn’s specialists strive for the safest and least invasive treatment options to preserve quality of life.

Surgery for Mesothelioma Treatment at Penn

The following surgical treatments for mesothelioma are offered at Penn Medicine in Philadelphia:

Extrapleural Pneumonectomy for Mesothelioma

In this surgery, the surgeon removes the lung, pericardium (membrane covering the heart), part of the diaphragm (muscle between the lungs and abdomen), and part of the parietal pleura (membrane lining the chest) to treat malignant mesothelioma.

Indwelling Pleural Catheter (IPC) for Mesothelioma

Patients with recurrent pleural effusion are sometimes treated with an indwelling pleural catheter. The device, inserted into the pleural space by Penn surgeons, removes excess fluid from the chest cavity and relieves symptoms associated with pleural effusion while allowing patients to remain at home.

Lung-sparing Radical Pleurectomy or Peritonectomy for Mesothelioma

Patients with mesothelioma may undergo a pleurectomy (removal of the lining around the lungs) or peritonectomy (removal of the membrane that lines the cavity of the abdomen) to remove diseased tissue. Penn surgeons combine this procedure with photodynamic therapy and are achieving promising results.

Minimally Invasive – Video-Assisted Thoracoscopic Surgery (VATS) for Mesothelioma

This minimally invasive technique diagnoses and treats problems in the chest including mesothelioma. A tiny camera called a thoracoscope and surgical instruments are inserted in the chest through small incisions, and the thoracoscope transmits images to a video monitor, guiding the surgeon in performing the procedure. VATS can be used to perform a biopsy, to remove tumors or remove an entire lobe from the lung.

Peritoneal Cytoreductive Surgery for Mesothelioma

In cytoreductive surgery, sometimes called “debulking” surgery, the surgeon removes as much of a tumor as possible. It is commonly combined with radiation therapy or chemotherapy.

Pleural Sclerosis and Fibrinolytics for Mesothelioma

Pleural sclerosis is used to obliterate the pleural space in order to prevent the recurrence of a spontaneous pneumothorax or the reaccumulation of a pleural effusion. Many different agents, ranging from antibiotics to talc are used to eliminate the space in which air or fluid can accumulate.

Therapeutic Thoracentesis for Mesothelioma

This simple procedure drains the fluid and relieves the symptoms of pleural effusion. It may also be used as a diagnostic test to look for causes of a pleural effusion. During therapeutic thoracentesis, physicians insert a needle into the pleural space to remove the fluid, relieving the pressure on the lungs to make the patient’s breathing easier.

Thoracotomy for Mesothelioma

In a thoracotomy, surgeons make an incision between the ribs on one side of the chest to remove all or part of a lung, avoiding the heart and spinal cord.

Other mesothelioma treatments such as chemotherapy or radiation therapy are recommended to follow surgery or are prescribed in combination with surgery. These additional treatments for mesothelioma help ensure the cancer is removed as much as possible.

#2. Radiation Therapy

Radiation therapy precisely targets and attacks diseased tissue to slow or stop tumor growth. RT for mesothelioma treatment is an integral component of many mesothelioma treatment plans developed by physicians at Penn Medicine.

Mesothelioma can be treated with radiation therapy in different ways. Often, it is a tool to remove cancer that could not be completely removed during surgery. Radiation therapy can also be used to relieve symptoms of mesothelioma such as shortness of breath, pain, bleeding and difficulty swallowing.

The mesothelioma program at Penn offers patients a full complement of radiation treatments including new cancer treatments such as proton therapy — a powerful tool available at only a few cancer centers in the nation.

The following radiation therapy treatments for mesothelioma are offered:

Brachytherapy for Mesothelioma

Brachytherapy involves placing small, radioactive implants, such as metal pellets, seeds, ribbons, wires, needles, capsules, or tubes in small, sealed holders inside the body. This is done in a hospital operating room and requires imaging technology (such as X-ray or MRI) to determine the exact location for the radiation to be placed to most effectively treat the cancer. Implants may be left in the body for only a short time, or permanently.

The advantage of brachytherapy is that it delivers a high dose of radiation to a smaller area than may be possible with external radiation treatment, which is delivered by machines located outside the body.

Intensity-modulated Radiation Therapy (IMRT) for Mesothelioma

IMRT is a form of radiation therapy administered by a linear accelerator — a computer-controlled device that delivers precise doses of radiation to tumors or specific areas within the tumors. Because IMRT uses 3-D computed tomography (CT) images and computerized dose calculations, it can conform, or modulate, the radiation beam more precisely to the shape of the tumor. This helps ensure that exposure to healthy surrounding tissue is minimized.

#3. Photodynamic Therapy

Penn was the first health system in the Philadelphia region to use photodynamic therapy to treat pleural cancers. Also known as photoradiation therapy, phototherapy, or photochemotherapy, PDT brings together light-sensitive medication (photosensitizer) and low-level beams of light to destroy cancer cells.

Proton Therapy for Mesothelioma

Penn Medicine’s Roberts Proton Therapy Center is the largest and most sophisticated facility in the world for this advanced form of radiation treatment. Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles — in this case protons — onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Volumetric-modulated Arc Therapy (VMAT) for Mesothelioma

VMAT radiation beams sweep in uninterrupted arc(s) around the patient, speeding treatment delivery and reducing treatment time. Imaging increases the precision and allows physicians to visualize the tumor target at the time of treatment and to guide therapy that both maximizes the radiation dose to the target and minimizes exposure to surrounding healthy tissues.

How Does Photodynamic Therapy Work?

Photodynamic therapy is a multi-step treatment process.

First, the photosensitizer medication is injected into the bloodstream of a patient. The drug typically takes a few days to be absorbed by the body. The drug gets absorbed by cells throughout the body, but stays in cancer cells longer than normal cells.

Then, when ready, the physician directs a laser light source at the cancer cells. The light causes the drug to react with oxygen to form a chemical that kills the cancer cells. The amount of time that the laser is applied will vary from patient to patient.

Photodynamic therapy can also work by destroying the blood vessels that feed the tumor.

Photodynamic therapy is only affective in areas that the light can actually reach. It works as a treatment for mesothelioma because mesothelioma is a cancer that affects the lining of the lung. During the surgery, the light is applied to the pleural space, or area surrounding the lungs.

Led by Associate Professor of Surgery, Joseph Friedberg, MD, Penn Medicine’s researchers continue to learn ways to improve photodynamic therapy’s effectiveness in fighting cancer. New cancer treatments may involve combining photodynamic therapy with gene therapy or with tumor vaccines to stimulate the immune system to fight cancer.

#4. Chemotherapy for Mesothelioma Treatment

Chemotherapy for mesothelioma may be used alone, or in combination with other treatments for mesothelioma.

How Does Chemotherapy Treat Mesothelioma?

Chemotherapy may be administered via a pill or ingested liquid, or intravenously (through an IV). For most mesothelioma patients, chemotherapy is given through an IV.

Chemotherapy uses medicines that stop the growth of cancer cells, either by killing the cells or by preventing them from dividing. The drugs enter the bloodstream and can reach cancer cells throughout the body.

Multiple drugs that attack cancer in different ways can be combined to increase their effectiveness.

Chemotherapy Approaches for Mesothelioma

Chemotherapy is used in several ways. It may be the primary mesothelioma treatment, be used in combination with other treatments or act as a supporting treatment before and/or after surgery. For cancers that cannot be removed surgically, chemotherapy may be the main treatment.

For mesotheliomas that can be treated with surgery, chemotherapy may be given before surgery to minimize the cancer and lower the risk of spread. This is called neoadjuvant therapy. In some cases patients who were once considered inoperable may become surgical candidates following administration of chemotherapy.

Adjuvant therapy treatment is chemotherapy given after surgery. Chemotherapy after surgery is often used in combination with other forms of cancer treatment to reduce the chance of recurrence. This approach may include chemotherapy, hormone therapy, targeted therapy, immunotherapy (biologic therapy) or vaccine therapy. It is often effective in killing any cancer cells that were left behind because they were too small to be seen. Adjuvant therapy may also help delay or prevent the mesothelioma cancer from growing back, improving the outcome.

Targeted therapy is another approach to medical treatment for mesothelioma. Medical oncologists sometimes use targeted therapies, such as drugs or other substances to block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression.

#5. Immunotherapy

The Penn Mesothelioma and Pleural Program is a center made up experts from different fields who are dedicated to uncovering new cancer treatments for cancer treatments for patients with pleural mesothelioma and other pleural diseases.

Improving Mesothelioma Survival with Innovation

In addition to offering the best treatments available today, through in-house and collaborative research, Penn Medicine develops the best new treatments for mesothelioma. Biological therapies, (also referred to as immunotherapy, biological response modifier therapy, or biotherapy) are among the most innovative mesothelioma treatments available in the world.

Biological therapy for mesothelioma is designed to use the body’s immune system to actually fight cancerous cells so the body can heal itself. Penn’s medical oncologists use biologic or synthetic agents to repair stimulate or enhance the immune system, triggering the body’s natural defenses to eliminate the cancer cells.

#6. Gene Therapy for Mesothelioma

Researchers at Penn are pioneering the use of two forms of gene therapy to treat mesothelioma. In the first approach, a new gene is placed in a modified cold virus and inserted into the tumor itself. This new gene makes a substance called interferon that causes the body to reject the tumor using its own immune system.

In the second approach, patients own white blood cells are collected and modified to recognize the tumor. When injected back into the patient, they attack and kill the tumor.

#7. Mesothelioma Treatments by Stage

Penn Medicine physicians determine the best treatment options for mesothelioma depending upon the stage of the cancer. Along with age, general health, and the location of the cancer, three primary staging systems are used to assess how far mesothelioma has spread. Four stages describe the progression of the disease, and treatments options may vary depending upon the stage of the cancer.

Stage I Mesothelioma Treatment

Mesothelioma is localized in this stage and surgery is most commonly recommended to remove the tumor and affected tissue. A pleurectomy or extrapleural pneumonectomy are procedures that remove the tumor from the lung and nearby tissue. An assessment will be made to determine if chemotherapy or radiation treatment is necessary. Clinical trials may also be considered in this stage.

Stage II Mesothelioma Treatment

Surgery may also be performed in Stage II to remove as much of the tumor as possible. However, because the cancer has spread, surgery may be performed to relieve symptoms as opposed to curing the disease. Chemotherapy and radiation therapy are the most common treatments recommended. A variety of alternative treatments may be used to slow the progression of the disease and help manage the pain and stress associated with conventional treatments.

Stage III Mesothelioma Treatment

Treatment options recommended for Stage III typically focus on relieving pain, prolonging life, and improving the quality of life. Clinical trials may be beneficial in aiding the quest to find a cure.

Stage 4 Mesothelioma Treatment

This is the most advanced stage of mesothelioma. Pain management and keeping the patient comfortable is the primary focus. At this advanced stage, therapies such as chemotherapy and radiation are not typically considered. Many families consider the supportive network offered through a local Hospice program. Medications are also available to treat pain and suffering.

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