Chemotherapy for malignant mesothelioma

Chemotherapy (chemo) is treatment with anti-cancer drugs. There are 2 main ways that chemotherapy can be given to treat mesothelioma. 

In systemic therapy, chemotherapy is injected into a vein. The drug enters the bloodstream and travels throughout the body to reach and destroy the cancer cells wherever they may be.

Chemo drugs can also be placed directly into the body cavity where the cancer is – either intrapleurally (directly into the chest) or intraperitoneally (into the abdomen) – with a small catheter (tube) placed through a small cut in the chest or abdominal wall. Chemo drugs given this way are still absorbed into the bloodstream, but the highest concentration of the drug goes directly to where the cancer cells are. 

Chemo drugs are sometimes heated before they are placed directly into a body cavity (called hyperthermic chemotherapy), which may help them work better. Sometimes this treatment is given as a single dose in the operating room, right after surgery to remove the cancer. This approach is called heated intraoperative chemotherapy or HIPEC. It is more often used to treat peritoneal cancers, in which case it may be called heated intraperitoneal chemotherapy.

Radiation therapy for malignant mesothelioma

Radiation therapy uses high-energy x-rays or particles to kill cancer cells. Mesotheliomas are often hard to treat with radiation therapy. They are not usually contained as single, discrete tumors, so aiming radiation at them while avoiding nearby normal tissues is difficult. But new radiation therapy techniques may make this form of treatment more useful.

Uses of radiation therapy

Radiation therapy may be used in different ways to treat mesothelioma:

• It can be used after surgery to try to kill any small areas of cancer that could not be seen and removed during surgery. This is called adjuvant radiation therapy.
• It can be used as a palliative procedure to ease symptoms of mesothelioma such as shortness of breath, pain, bleeding, and trouble swallowing.

Types of radiation therapy

Two main types of radiation therapy can be used to treat mesothelioma:

External beam radiation therapy (EBRT): This type of radiation therapy uses x-rays from a machine outside the patient’s body to kill cancer cells. It is the most common form of radiation therapy for mesothelioma. 

Palliative procedures used for malignant mesothelioma

Surgery to remove the cancer is not always an option for patients with malignant mesothelioma. In that case, less invasive procedures can be used to control some of the symptoms caused by mesothelioma, especially those due to built up fluid.

Removal of fluid

Procedures such as thoracentesis, paracentesis, and pericardiocentesis can be used to remove fluid that has built up and is causing symptoms. In these procedures, a doctor uses a long, hollow needle to remove the fluid. These procedures are described in the section, “How is malignant mesothelioma diagnosed?” The major drawback to these techniques is that the fluid often builds up again, so they may need to be repeated.

Pleurodesis

This procedure may be done to try to prevent fluid from building up in the chest. A small cut is made in the skin of the chest wall, and a hollow tube (called a chest tube) is placed into the chest so that the fluid can drain out. Then the doctor uses the tube to put a substance into the chest, such as talc mixed in a fluid (talc slurry), the antibiotic doxycycline, or the chemotherapy drug bleomycin. This inflames the linings of the lung (visceral pleura) and chest wall (parietal pleural) so that they stick together, sealing the space and preventing further fluid buildup. The tube is generally left in for a day or two to drain any new fluid that might accumulate. Pleurodesis can also be done at the time of thoracoscopy, either using the drugs doxycycline or bleomycin, or by blowing talc powder into the chest cavity. 

Surgery for malignant mesothelioma

Surgery for mesothelioma may be done for 1 of 2 reasons:

• To try to cure the cancer
• To relieve (palliate) pain and other symptoms caused by the tumor

Surgery to try to cure the cancer is known as potentially curative surgery. This type of surgery may be an option if you are in otherwise good health and the cancer has not spread too far to be removed completely. Unfortunately, even when the surgeon can remove all of the cancer that can be seen, some cancer cells are often left behind. These cells can grow and divide, causing the cancer to come back after surgery. Because of this, not all doctors agree on the exact role of surgery. In most cases it is not likely to cure you but may extend your life. Still, potentially curative surgery is being done in some major cancer centers, and a small number of patients who have had the surgery have had long remissions of their disease.

Palliative surgery may be an option if the tumor has already spread beyond where it started and is difficult to remove completely, or if you are too ill for a more extensive operation. The goal of this surgery is to relieve or prevent symptoms, as opposed to trying to cure the cancer.

How is malignant mesothelioma treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

 

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

 

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options. If you have mesothelioma, your cancer care team will recommend one or more treatment options for you to consider. This is an important decision and you should take time to think about all of your choices. 

Survival statistics for mesothelioma

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or even don’t want to know them. If you don’t want to read about the survival statistics for mesothelioma, stop here and skip to the next section.

To get survival rates, doctors have to look at people who were treated at least several years ago. Although the numbers below are among the most current we have available, improvements in treatment since then could result in a more favorable outcome for people now being diagnosed with mesothelioma.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot be used to predict what will happen in any particular person’s case. Knowing the type and the stage of a person’s cancer is important in estimating their outcome. But many other factors can affect survival, such as a person’s age and overall health, the treatment received, and how well the cancer responds to treatment. Even taking these other factors into account, survival rates are at best rough estimates. Your doctor can tell you if the numbers below apply, as he or she is familiar with your situation.

How is malignant mesothelioma staged?

Staging is the process of finding out how far a cancer has spread. Your treatment and prognosis (outlook) depend, to a large extent, on the cancer’s stage. 

Staging is based on the results of physical exams, biopsies, and imaging tests (CT scan, PET scan, etc.), which are described in the section, “How is malignant mesothelioma diagnosed?”

A staging system is a formal way for doctors and nurses to sum up the extent of a cancer. Pleural mesothelioma, the most common type, is the only mesothelioma for which a formal staging system exists.

The TNM staging system

The system most often used to describe the growth and spread of pleural mesothelioma is the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM system is based on 3 key pieces of information:

• T sums up the extent of spread of the main (primary) tumor.
• N describes how much the cancer has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread first.
• M indicates whether the cancer has spread (metastasized) to other organs of the body. (The most common sites are the pleura on the other side of the body, the lungs, and the peritoneum.

How is malignant mesothelioma diagnosed?

Mesothelioma is most often diagnosed after a person goes to a doctor because of symptoms. If there is a reason to suspect you might have mesothelioma, your doctor will use one or more tests to find out. Symptoms might suggest that the problem could be mesothelioma, but tests will be needed to confirm the diagnosis.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have mesothelioma, your doctor will want to take a complete medical history to learn about your symptoms and possible risk factors, especially asbestos exposure. You will also be asked about your general health.

A physical exam can provide information about possible signs of mesothelioma and other health problems. Pleural mesothelioma can cause fluid to build up around the lungs in the chest (called a pleural effusion). In cases of peritoneal mesothelioma, fluid can build up in the abdomen (called ascites). In pericardial mesothelioma, fluid builds up in the sac around the heart (called a pericardial effusion). Rarely, mesothelioma can develop in the groin and look like a hernia. All of these might be found during a physical exam, such as when the doctor listens to these areas with a stethoscope.

Signs and symptoms of mesothelioma

Early symptoms of mesothelioma are more often caused by other things, so at first people may ignore them or mistake them for common, minor ailments. Most people with mesothelioma have symptoms for at least a few months before they are diagnosed. 

Symptoms of pleural mesothelioma (mesothelioma of the chest) can include:

• Pain in the lower back or at the side of the chest
• Shortness of breath
• Fluid in the area around the lung
• Cough
• Fever
• Excessive sweating
• Fatigue
• Weight loss (without trying)
• Trouble swallowing (feeling like food gets stuck)
• Hoarseness
• Swelling of the face and arms

Symptoms of peritoneal mesothelioma can include:

• Abdominal (belly) pain
• Swelling or fluid in the abdomen
• Weight loss (without trying)
• Nausea and vomiting

The symptoms and signs above may be caused by mesothelioma, but more often they are caused by other conditions. Still, if you have any of these problems (especially if you have been exposed to asbestos), it's important to see your doctor right away so the cause can be found and treated, if needed.

Can malignant mesothelioma be found early?

Mesothelioma is uncommon, and there are no widely recommended screening tests for this cancer in people who are not at increased risk. (Screening is testing for cancer in people who don't have any symptoms.) 

For people with known exposure to asbestos, some doctors recommend imaging tests such as chest x-rays or computed tomography (CT) scans to look for changes in the lungs that might be signs of mesothelioma or lung cancer. But it is not clear how useful these tests are in finding mesotheliomas early.

In recent years, doctors have found that people with mesothelioma often have high levels of certain substances in their blood, including osteopontin and soluble mesothelin-related peptides (SMRPs). Blood tests for these substances may one day be useful in finding mesotheliomas early, and in monitoring the course of the disease in people who have mesothelioma.

Most mesotheliomas are found when a person goes to a doctor because of symptoms. People who have been exposed to asbestos should know the possible signs and symptoms of mesothelioma (discussed in the next section). Many of these symptoms are more likely to be caused by something other than mesothelioma, but it's important to report any new symptoms to your doctor right away so that the cause can be found and treated, if needed.

Can malignant mesothelioma be prevented?

Being exposed to asbestos is by far the biggest risk factor for mesothelioma, so the best way to reduce your risk is to limit your exposure to asbestos in homes, in public buildings, and at work. 

People who might be exposed to high levels of asbestos at work include some miners, factory workers, insulation manufacturers and installers, railroad and automotive workers, ship builders, gas mask manufacturers, and construction workers. If there is a chance of on-the-job exposure, such as during the renovation of old buildings, then you should use all protective equipment and safety procedures designed for working around asbestos. 

Older homes may have insulation containing asbestos or other materials. A knowledgeable expert can check your home to find out if there is any asbestos and whether it poses any risk of exposure. This may mean testing the air for asbestos levels. Just because asbestos exists in a home does not necessarily mean that it needs to be removed. As long as the material is not damaged or disturbed, for example by drilling or remodeling, the fibers will not be released into the air. If asbestos needs to be removed from your home, you should hire a qualified contractor to do this to avoid contaminating your home or causing any exposure to your family or to the workers. You should not attempt to remove asbestos-containing material yourself.

Do we know what causes malignant mesothelioma?

Cancers, including mesotheliomas, occur when cells in the body suffer damage to their DNA. DNA is the chemical in each of our cells that makes up our genes - the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look. Some genes control when cells in the body grow and divide into new cells. Changes in these genes may cause cells to grow out of control, which can lead to cancer.

Asbestos exposure is the main cause of mesothelioma. After these fibers are breathed in, they travel to the ends of small air passages and reach the pleura, where they can damage mesothelial cells. This leads to inflammation and scarring. This may damage cells’ DNA and cause changes that result in uncontrolled cell growth. If swallowed, these fibers can reach the abdominal cavity where they have a role in causing peritoneal mesothelioma.

But most people exposed to asbestos, even in large amounts, do not get mesothelioma. Other factors, such as a person’s genes, may make them more likely to develop mesothelioma when exposed to asbestos. For example, researchers have found that some people who seem to be at high risk have changes in BAP1, a gene that normally helps keep cell growth under control. Other genes are probably important as well.

What are the risk factors for malignant mesothelioma?

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can't be changed.

But risk factors don’t tell us everything. Having a known risk factor, or even several risk factors, does not mean that you will get the disease. And some people who get the disease may have few or no known risk factors.

Researchers have found some factors that increase a person's risk of mesothelioma.

Asbestos

The main risk factor for developing mesothelioma is exposure to asbestos. In fact, up to 3 of every 4 cases of mesothelioma have been linked to asbestos exposure. Most often, people are exposed in the workplace.

Asbestos is a group of minerals that occur naturally as bundles of fibers. These fibers, found in soil and rocks in many parts of the world, are made of silicon, oxygen, and other elements.

What is malignant mesothelioma?

Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially the chest cavity or abdominal cavity..

A layer of specialized cells called mesothelial cells lines the inside of the chest, the abdomen, and the space around your heart. These cells also cover the outer surface of most of your internal organs. The lining formed by these cells is called the mesothelium.

The mesothelium helps protect your organs by making a special lubricating fluid that allows organs to move. For example, this fluid makes it easier for your lungs to move (expand and contract) inside the chest when you breathe. The mesothelium has different names in different parts of the body:

• The pleura coats the lungs and the cavity containing the lungs in the chest.
• The peritoneum coats the abdominal cavity and many of the organs within that cavity.
• The tunica vaginalis coats the testicles.
• The pericardium coats the heart and creates the cavity that holds the heart in the chest.

Mesothelial tumors can be non-cancerous (benign) or cancerous (malignant). 

Mesothelioma Staging

There are four primary stages of mesothelioma doctors use to identify the seriousness of a mesothelioma diagnosis. Mesothelioma staging is labeled I, II, III or IV. The lower the number, the more treatment options you have, and the better your chances are for long-term survival.

Staging is an accepted way for cancer doctors to describe to patients – and to one another – how advanced the disease is, how prevalent tumors are and how far the cancer has spread. Given the aggressive nature of the cancer, mesothelioma staging is a key part of proper diagnosis and treatment.

Why? Because knowing where a cancer is in its development sets the table for treatment, what's possible and what's not. Doctors determine if someone can have surgery and, if so, what kind.

Mesothelioma Diagnosis

Cancer specialists utilize a number of diagnostic tools to accurately confirm mesothelioma, including blood tests such as MESOMARK and SOMAmer panel, imaging tests such as MRIs, CT scans, PET scans, X-rays and biopsies to investigate cancerous growth in tissue samples.

There is no clear path to a mesothelioma diagnosis for every patient. Because the disease is so rare and has such common symptoms, doctors sometimes confuse it for a less-serious illness or a different type of cancer.

Pinpointing the disease involves several procedures, including X-rays, CT scans, MRIs, biopsies and PET scans. Each of these tests is performed by a different medical professional, and most people get their diagnosis within two or three months from the time they notice their symptoms.

Diagnosing the cancer in its earliest stages supports a wider range of treatment possibilities that could extend your life expectancy. So it's important you start looking for a mesothelioma expert.

Mesothelioma

Malignant mesothelioma, otherwise known as mesothelioma cancer, commonly develops in the lungs of people exposed to asbestos. Effective treatments are available to ease symptoms and improve your prognosis.

The cancer usually affects the thin, protective membrane surrounding the lungs, heart or abdominal cavity. Doctors diagnose an estimated 3,000 cases a year in the United States, and the majority of those are traced to job-related asbestos exposure.

Although asbestos use declined dramatically in recent decades in this country, the incidence of malignant mesothelioma remains steady. That difference can be traced to the distinct latency period linked to the cancer. The disease can take anywhere from 20 to 50 years after exposure to asbestos before it shows obvious symptoms and an oncologist can make a definitive diagnosis. While no cure for the disease exists and the prognosis is typically poor, researchers made significant progress in recent years in understanding the cancer and developing new treatment options and alternative therapies.

Dandruff: Symptoms and Treatment

What is dandruff?

Dandruff is a condition of the scalp that makes flakes of dead skin appear in the hair, and on the collar and shoulders.

Dandruff is common, affecting around half of all people at some stage.

You cannot catch dandruff and while it isn’t usually serious, it can be embarrassing or itchy.

What are the symptoms of dandruff?

Why Your Dandruff Treatment Isn’t Working

There’s a much discussed natural treatment for dandruff that’s all over the Internet.

But is it legit?

That’s the question that one recent graduate of St. Louis University School of Medicine in Missouri, Erica Glenn, MD, asked herself while she was working with a pediatric dermatologist and encountered many parents asking about natural remedies for their babies’ dandruff. So she searched the scientific literature on the topic and made an interesting discovery.

She found that not only does this popular natural treatment not cure dandruff—it actually may make dandruff worse.

To set the record straight, she cowrote a letter that was recently published in a major medical journal, and then I spoke with her to get the lowdown on which dandruff remedies actually work…