HOW IS MESOTHELIOMA TREATED?

Treating mesothelioma depends upon the disease stage, the location of tumors, the patient's age, history and health at the time of diagnosis, and many other factors. The most common types of treatment are surgery, radiation therapy and chemotherapy.

If mesothelioma is diagnosed, it is important to begin treatment as soon as possible. The material presented here is for information purposes only, and should not be construed as advising or endorsing one form of treatment over another.

Chemotherapy and Radiation Therapy

Chemotherapy uses drugs to kill cancer cells. The most common treatment option for mesothelioma, chemotherapy can be administered through a pill, injection or intravenously. It can be administered systemically (through the blood stream) or directly into an area such as the pleural cavity. Alimta [trademark symbol] is probably the most common form of chemotherapy used to treat mesothelioma.

One option to consider is participating in clinical trials. These are scientific studies of medications for different types of cancer. Doctors may be aware of current clinical trials for mesothelioma. For example, the drug Pemetrexed (brand name Alimta [trademark symbol]) has been studied and has been approved by the Food and Drug Administration for the treatment of mesothelioma.

Radiation therapy kills cancer cells or shrinks tumors with high-energy x-rays. Unfortunately, radiation therapy can damage healthy tissue in the process of treating cancer. Research is now examining ways of delivering radiation directly to the tumor. In radiation therapy, a machine may be used to emit radiation, or radioisotopes (materials that produce radiation) through plastic tubes in the part of the body where the cancer cells are found. This direct form of treatment allows a doctor to also administer drugs through the plastic tubes.

Surgery

In some cases, surgery for a patient with mesothelioma may extend and improve the quality of life. However, such surgery may be serious and complicated. Consultation with a specialist may be best if considering this treatment option. Surgery generally involves the removal of part of the lining or tissue, or even part of a lung, in an effort to remove the cancerous tissue or tumor.

One type of surgery, called a pleurectomy or decortication, involves opening the chest and removing the tumor from the lung. This procedure relieves chest pain and prevents the recurrence of effusions (escaping fluids) in the pleura.

Another type of surgery, extra pleural pneumonectomy, involves the removal of the lung, the diaphragm, or the lining around the heart on the side of the chest containing the mesothelioma. Gortex, a synthetic fabric, replaces the diaphragm (the muscle between the lungs and the abdominal cavity) and the pericardium (the lining around the heart). After surgery, the patient commonly undergoes chemotherapy and radiation to destroy any remaining cancer cells. A pneumonectomy involves the removal of only the effected lung.

Thoracentesis or Paracentesis

Thoracentesis is a form of palliative treatment which involves the removal of fluid from the pleural cavity; the space between the inner chest wall and the surface of the lung. The overproduction of fluid that often accumulates as part of mesothelioma can cause discomfort or shortness of breath. Once fluid is drained from the pleura space, a form of talcum powder or other material may be applied to the lung surface to cause the lung to adhere to the chest wall and prevent reaccumulation of fluid. Paracentesis is a similar procedure to remove fluid from the abdominal cavity. If there is a chronic problem with fluid buildup, a catheter can be inserted to drain fluid on an as needed basis. Fluid removal can alleviate difficulty with breathing and chest pain. Consultation with a specialist may be best before pursuing thoracentesis or paracentesis.

Nutritional Information

For mesothelioma patients, often the biggest challenge is getting enough calories in the body to avoid significant weight losses. As most nutritionists believe, what you eat and how you treat your body can have a very powerful impact on your health and quality of life. Following a healthy diet could impact your cancer survivability. While proper nutrition is not intended as a replacement for traditional treatments, eating health-giving foods may help stimulate your immune system, deter cancer growth and lessen the negative side effects of traditional therapies.

A healthy diet for an individual with mesothelioma may be a low fat (not more than 20% of total calories), right fat, high fiber, mainly vegetarian diet with minimal refined sugar, white flour, processed foods and additives. You might wish to consider complex carbohydrates selected from foods with low glycemic indices. Some dieticians believe that protein should be mostly from plant, not animal, sources (e.g. soy). Others believe that Omega-3 fatty acids in the form of flaxseed, flax oil or fish oil should be taken daily in adequate amounts. You may wish to consider minimizing your consumption of alcohol, caffeine, smoking and trans-fats (all foods that contain partially hydrogenated oils and fats).

Fruits, vegetables, whole grains and legumes all have important nutrients, particularly substances called phytochemicals which may strengthen or enhance the body’s immune system. Some research has shown that people who eat a diet free of animal products and one low in most fats have a significantly lower cancer risk. Such a diet might also inhibit cancer growth in those individuals already diagnosed with cancer. Cancer cells exclusively metabolize glucose (sugar) for their energy, so the avoidance of sugar and highly refined carbohydrates that easily turn into sugar is a possible consideration for any anti-cancer diet.

You may wish to include the following foods in your cancer fighting diet: fruits, vegetables, whole grains and legumes.

Fruits are rich in fiber, Vitamin C and beta-carotene. Typically, fresh whole fruit has more fiber and nutrients than fruit juice. Vegetables contain a host of antioxidant phytochemicals, Vitamin C, beta-carotene, riboflavin, iron, calcium and fiber. Dark green leafy vegetables such as broccoli, collards, kale, mustard and turnip greens, chicory, spinach and leaf lettuces are good additions to daily meals as are red, orange and yellow vegetables like carrots, squashes, sweet potatoes, pumpkin, tomatoes, and peppers. Gourmet mushrooms (not button) like porta bella and oyster mushrooms contain specific immune system nutrients.

Grains including bread, pasta, cereals, corn, millet, barley, bulgur, buckwheat, grits and tortillas are good additions to your cancer fighting diet. Grains are rich in fiber, minerals and B-vitamins, however, processing removes much of the nutrient value. You may wish to choose whole grains and avoid refined white four and its products.

Legumes are another name for beans, peas and lentils. These foods are good sources of fiber, protein, resistant starches, iron, minerals and B-vitamins. Beans when combined with whole grain rice, pasta or bread are as complete a protein as meat. Soy beans are a complete protein by themselves.

If you are interested in nutritional information, you may wish to view the Cancer Project website sponsored by the Physicians Committee for Responsible Medicine. In addition to nutritional information, the site contains sample menus and recipes. See “The Cancer Project” at http://www.cancerproject.org

Are you interested in a cooking class for cancer patients? The Physicians Committee for Responsible Medicine began a cooking and nutrition class designed to help individuals diagnosed with cancer. For more information, go to the Cancer Project website and click on classes. Another option is to seek advice from a nutritionally oriented physician, dietician or other health care professional.

Remember that each case of mesothelioma and each patient is unique. Please consult your physician regarding dietary choices.

Alternative and Unproven Therapies

Researchers are now studying how to imitate or stimulate the immune system’s natural response to cancer. There may be ways to assist your own immune system in fighting cancer without interfering with chemotherapy, radiation or other traditional forms of treatment. In fact, some may actually enhance the efficacy of traditional methods. You could help your immune system by any of the following:

• Elicit your relaxation response often. You might consider massage, Yoga, meditation, breathing methods or other less structured forms of relaxation.
• Incorporate the right fats into your diet. Eliminate trans fats, add Omega 3's with 1-2 tablespoons of flax oil, or 2-4 tablespoons of freshly ground flax seed, or 2-4 grams per day of fish oil.
• Consider taking Melatonin (10 to 20 milligrams one hour before bed).
• Take an immune modulator: eat gourmet mushrooms, take mushroom extracts, herbal preparations of Astragalus and Ecchinacea, purified in concentrated colostrum products. A product called AG-Immune by BodyWise has these elements in one capsule.
• Add enzymes before meals to enhance chemotherapy drugs and possibly extend survival. Over-the-counter supplements are available at health food stores. If you are serious about enzyme therapy, you should consult a practitioner familiar with appropriate dosages.

You should always inform your doctor of any type of treatment you are considering. More information on diet and nutrients for the cancer patient is found in the very readable and short book by dietician and three time cancer survivor, Diana Dyer, “A Dietician’s Cancer Story.”

Immuno-Augmented Therapy

Researchers are examining ways in which your immune system distinguishes between healthy cells and cancer cells. Types of immunotherapy may allow for repair of cells or stimulation of the immune system to fight and destroy cancer cells. Some immune therapies have been studied in traditional cancer programs and have been incorporated into traditional treatment programs for certain cancer, notably, melanoma.

Immuno-Augmentation Therapy (IAT) was developed by the late Lawrence Burton, Ph.D. and has been used with patients in the Bahamas since 1977. The treatment program is based on an assessment of immunocompetence. It is believed that cancer patients may be lacking in various elements that would normally keep their immune system vigilant. Certain blood factors are used to reestablish the proper immune balance so their immune system can fight the cancer cells. Recently, The National Cancer Institute had a clinical trial to investigate the efficacy of this therapy.

Antineoplaston Therapy

Antineoplastons are naturally occurring proteins found in the urine and blood of humans and other animals. Certain of these proteins are believed by their discoverer, Stanislaw Burzynski, M.D., Ph.D., to inhibit cancer cell growth. “Health” patterns of these substances have been identified in urine. Also, patterns associated with certain disease states including cancer have also been observed. It is believed that abnormal patterns may involve absence or lack of some of the substances. Restoring the missing or lacking substances to “healthy” levels is thought to actually reprogram diseased cells to become normal again. The National Cancer Institute has interest in studies to determine the effectiveness of antineoplaston therapy in patients with several advanced malignancies. For more information on clinical trials involving Complementary and Alternative Methods of Cancer Therapy, visit the website of the National Cancer Institute or the OCCAM www.cancer.gov/cancerinfo or www3.cancer.gov/occam or www.clinicaltrials.gov

Gene Therapy

Gene Therapy or Replacement Gene Therapy both hold hope for the future. Gene Therapy or Replacement Gene Therapy may be a way to correct an abnormal gene that causes cancer to grow out of control. Gene Therapy treats cancer at the DNA level. Replacement Gene Therapy involves replacing a mutated or missing gene to prevent cancer from growing out of control.

Photodynamic Therapy

PDT uses a laser to stimulate a photosensitive drug. Used in conjunction with surgery, the laser kills only the cancer cells when they react to the photosensitive drugs. For a patient with mesothelioma, a laser light chosen for its ability to activate the photosensitizing agent targets the pleura or other area of the tumor through a fiber optic device.

Visual or Guided Imagery

Visual Imagery refers to the creation of mental images which could positively effect the state of one’s health. Cancer patients often use relaxation and mental imaging to improve their immune response or to combat negative side effects of traditional chemotherapy or radiation. Imagery may be a powerful weapon against cancer. It is practiced extensively by some cancer patients, and some therapists who work with cancer patients, even though its potential for bringing about physical recovery remains an open question. The classic book on imagery is “Healing Yourself: A Step-By-Step Program for Better Health Through Imagery” by Martin Rossman, M.D.

Other alternative therapies include treatments such as acupuncture, herbs, homeopathy, and therapeutic massage. Many patients use alternative practices in conjunction with traditional therapies. This type of “integrative” approach is considered holistic because it treats the “whole” person, physically, mentally, emotionally and spiritually.

Consultation with a specialist in these fields and with your doctor is always recommended before beginning any treatment.

For more information regarding alternative treatments, you are encouraged to read “Choices in Healing,” by Michael Lerner. You can actually view this book online at www.commonweal.org/choicescontents.html This site is sponsored by the Commonweal Cancer Help Program.

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