Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells. This technique is also used in patients with malignant pleural mesothelioma.

The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments. Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.

Surgery

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston. 

Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Mesothelioma Prognosis and Survival 

Though many patients and their loved ones often get discouraged if the prognosis following a mesothelioma diagnosis comes back poor, it is important to remember that a number of patients have survived much longer than their initial prognosis suggested. Prognosis is generally poor because most patients do not exhibit symptoms of mesothelioma until 20 to 50 years after initial exposure to asbestos occurred, allowing the cancer to develop and mature in the body. 

The development of tests to aid in early diagnosis, such as the Mesomark blood test, will hopefully help mesothelioma patients receive treatment in the earlier stages of the cancer. Early diagnosis results in greater treatment options available to mesothelioma patients which can greatly improve a patient's prognosis. 

Research reveals that mesothelioma patients who have survived for many years with the disease have commonly participated in some sort of therapy to enhance their immune system. Participation in clinical trials in immunology and other alternative therapies relating to the immune system have yielded positive results in some instances

Researchers theorize that mesothelioma likely results from immune suppression and mesothelioma survivors that participated in treatments to improve the immune system may have experienced positive results because of this participation.

Mesothelioma Nutrition

Without a current cure for mesothelioma, patients battling the cancer often want to fight it in every way possible. Nutritious eating is a wonderful way to instill mesothelioma hope and equip the immune system with positive fuel. The food and nutrients that we put into our bodies greatly affect our ability to heal and fight disease. 

Eating a balanced diet consisting of whole grains, proteins, dairy, fruits and vegetables enables the body to function properly and adequately fight infection and illness. Eating nutritious food while actively fighting mesothelioma through treatment may not cure the cancer, but fighting the disease from every angle will give patients the best possible outlook. 

Mesothelioma patients undergoing various treatments may have additional nutritional concerns. Nutrition during chemotherapy is extremely important as the drugs used during treatment kill cancer cells, but simultaneously affect healthy cells as well, leaving the body in a weakened state.

Many patients may experience side effects from the treatment, including nausea and diarrhea. Mild flavored foods such as whole grain toast may settle the stomach and be easier to keep down during treatment. To combat constipation, patients should select foods with a large amount of fiber such as apples, oatmeal and broccoli. Ensuring adequate protein consumption is also important and many patients include egg whites, beans, milk and lean meats in their daily diet. 

Patients undergoing radiation therapy may also experience side effects such as vomiting and loss of appetite. Since radiation can zap energy, it is important to eat nutritious foods with healthy calories to fuel the body properly. Limiting the amount of salt, alcohol and caffeine ingested during treatment is also very important. Speaking with a doctor or a nutritionist can help a patient receive guidance about proper nutrition and recommended foods to eat or avoid during radiation.

It is also important for those recovering from cancer to be mindful of their diet. Additional information about nutrition and cancer recovery can be found in the Mesothelioma Cancer and Nutrition section of our Web site.

Benign Mesothelioma

In most cases, forms of asbestos cancers, such as mesothelioma, do not surface for 20 to 50 years after exposure. However, a rare disease known as benign (non-malignant) mesothelioma can occur much sooner. Since it is not a form of cancer, benign mesothelioma is typically addressed easily and immediately once detected. It can also act as a sort of "wake-up call," prompting the patient's doctor to search for other asbestos-related diseases, or at least signal the need for consistent monitoring.

In contrast to malignant mesothelioma, which has an extremely high mortality rate, effective treatment and full recovery is possible for most people who are diagnosed with benign mesothelioma.

Malignant Versus Benign Mesothelioma

Tumors form when previously healthy cells begin rapid division. This rapid pace of cellular growth leads to the formation of tumors as cells mass on top of one another, forming a solid lump of cells. Tumor cells are not all the same, which may be classified as benign or malignant. It is important to note that benign tumors are not cancerous. The term cancer only refers to malignant tumors.

There are two important differences between malignant and benign tumor cells. First, malignant tumors can invade nearby tissues and cause damage to healthy tissues and organs, whereas benign cannot. Second, malignant tumor cells can 'relocate' to other parts of the body by traveling through the blood or lymphatic system. When this occurs, these cells can begin forming new cancerous tumors in other locations.