Mesothelioma treatment

American Cancer Society: Mesothelioma diagnosis and treatment (2020)

What does diagnostics of mesothelioma consist of in foreign clinics?

After the initial consultation, the doctor prescribes an individual diagnostic plan. In each individual case, the diagnosis of mesothelioma is different, because the tumor may be located near the lungs, heart or abdominal cavity.

During the diagnosis, such examinations can be scheduled:

• Radiography of the lungs. Often, this is one of the first examinations that a doctor prescribes if the pleura mesothelioma is suspected. The X-ray gives the doctor information about changes in the lungs, the heart, shows fluid in the chest and thickening of the pleura.
• Computed tomography shows the exact location of the tumor, its size, as well as its location relative to other tissues and organs. From the CT images, the doctor determines the stage of the process. This affects the further treatment plan.
• Echocardiogram is prescribed if the doctor has any suspicions of fluid accumulation around the heart. Doctors call it pericardial perspiration.
• PET-CT is a study of the entire patient’s body in order to identify areas of primary tumor proliferation. At the same time, the patient is administered a glucose solution, which is marked with radioactive particles. These particles can be seen on the pictures and allow doctors to estimate the degree of development and growth of malignant formation.
• MRI scans provide detailed information about the size and location of the tumor. This examination can be assigned when examining a tumor located at the aperture.
• Laboratory blood tests. Phybulin-3 and Mesotheline-related soluble peptides (SMRPs) are increased in patients with mesothelioma. In addition to specific tests, general laboratory diagnostics are performed to evaluate liver and kidney function before therapy is prescribed.
• Pulmonary function test. The examination is prescribed if the mesothelioma is located in the chest and doctors decide on a surgical intervention.
• Biopsy and fluid extraction from the sweat. Examination of cells under a microscope is the «golden standard» for any type of tumor diagnosis. For this purpose, part of the tumor is taken during the biopsy with a thin needle, which the doctor injects through the skin under the control of ultrasound.

How are mesothelioma treated abroad?

Modern foreign clinics use such methods as mesothelioma treatment:

• Surgical removal of the tumor,
• Chemotherapy,
• Radiation Therapy,
• Immunotherapy,
• Therapy with targeted action (targeting therapy),
• Palliative care in late stages of the disease.

Surgical treatment

The choice of operation in mesothelioma directly depends on the tumor localization. In pleural mesothelioma, such types of operations are performed:

• Extrapleural pneumonectomy is a complex operation in which the surgeon removes the affected lung, pleura, lymph nodes, part of the diaphragm and pericardial sac on the side of the tumor, after which the diaphragm and pericardium are reconstructed using artificial tissue. Radical removal of tissue increases the chances of the patient for complete tumor removal. Due to its complexity, this operation is performed only by experienced specialists in large medical centers.
• Pleurarectomy is a less traumatic operation. The doctor removes the tumor together with the pleura lining the diaphragm, sternum and lung. This technique is used in the early stages of cancer, as well as for palliative care. The surgery improves the patient’s breathing, reduces fluid accumulation and pain.
• Citoreduction (partial pleuralectomy). In this operation, as many tumors as possible and partially pleura are removed.

In case of peritoneal mesothelioma, cytoreduction is also performed. During the operation, all available part of the tumor on the abdominal wall is removed. Sometimes, it may be necessary to partially remove the intestine. In some cases, the doctor performs an omenectomy. The omentum is a layer of adipose tissue that covers the organs of the abdominal cavity.

In mesothelioma of the pericardium, surgeons perform the removal of the pericardial sac — pericardiectomy or make an artificial hole, the so-called «pericardial window». These operations reduce the pressure on the heart and allow doctors to administer chemotherapy locally.

Chemotherapy

Chemotherapy in mesothelioma is prescribed by a doctor before (neoadjuvant) or after (adjuvant) surgery. If the operation can not be performed, chemotherapy is the only method of treatment or is prescribed along with radiation therapy.

Chemicals in mesothelioma are prescribed systematically, ie in the form of drops and pills or injected into the pleural cavity or peritoneum. In order to achieve maximum results, doctors may administer chemopreparations during the operation, preheating the solution. This procedure is called hyperthermal intraperitoneal chemotherapy (HIPEC). Foreign clinics use Pemetrexed, Paclitaxel, and a combination of drugs – Cisplatin and Doxorubicin for HIPEC therapy.

Radiation Therapy

The doctor may prescribe radiation therapy after removal of the tumor to reduce the risk of recurrence and kill cancer cells that are not visible during surgery. New methods of remote radiotherapy are being used abroad. One of them is Intensive Modulated Radiation Therapy (IMRT). With its help, doctors can influence the tumor more accurately and with greater force. In this way, healthy tissue is less damaged than with standard radiation therapy.

Immunotherapy

Immunotherapy stimulates its own immunity to develop specific agents that better recognize and kill cancer cells. This method of treatment is more gentle for the patient, as healthy tissues and organs are not damaged.

For the treatment of mesothelioma, such immune preparations are used:

• Pembrolysumab (Keitruda),
• Nivolumab (Odivo),
• Ipilimumab (Yervoy).

Targeted therapy

In some cases, the doctor may prescribe target therapy, a new method of treatment of mesothelioma and other cancer diseases. Target therapy is based on the point effect of the drug on the growth and multiplication of cancer cells. This helps to avoid a large number of complications associated with the action of chemotherapy drugs on the body.

To treat mesothelioma uses a drug that affects the formation of blood vessels in the tumor – Bevatsizumab (Avastin). Under the influence of the drug, the tumor is insufficiently supplied with blood and, as a result, does not receive the necessary nutrients for its growth.