How is Mesothelioma Treated Based on Stage of Tumor?

Mesotheliomas is very resistant to treatment irrespective of the stage of the tumor . It's very important that you understand the goal of treatment before it starts -- whether it is to try to cure the cancer or to help relieve symptoms ,you should also be aware of the potential side effects and likely outcome of your treatment method. This can help you make an informed decision when looking at your treatment options.

Resectable mesothelioma

In general terms, most stage I and some stage II and III mesotheliomas are potentially resectable, but there are exceptions. Resectability is based not only on the size of the tumor, but also on the subtype (most doctors believe only epithelioid tumors are potentially resectable), where it is located, and whether or not a person is healthy enough to have surgery.

Many patients with resectable pleural mesothelioma have their cancer removed by pleurectomy/decortication or extrapleural pneumonectomy. Patients with peritoneal mesotheliomas in an early stage might also benefit from surgery.

Surgery is more likely to result in long-term benefit in stage I cancers, where there is a better chance that most or all of the cancer can be removed. Some patients can have long remissions after extensive surgery by experts. Surgery may still be helpful for later stage cancers, but the benefits are more likely to be short term.

Doctors are still studying whether giving chemotherapy or radiation therapy after surgery (adjuvant therapy) is helpful. Many doctors advise adjuvant therapy, but not all doctors agree on when to use it or what the best course of treatment is.

If your general health is too poor to tolerate a major operation, radiation therapy and/or chemotherapy may be used instead. While these treatments may shrink or slow the growth or the cancer for a time, they are not likely to result in a cure.

If you have symptoms because of fluid buildup in the chest or abdomen, other approaches such as thoracentesis/paracentesis or pleurodesis may be helpful.

Because these cancers can be hard to treat, taking part in a clinical trial of a newer form of treatment may be a reasonable option. These types of studies are usually done in large medical centers.

Unresectable mesotheliomas

Stage IV mesotheliomas, as well as many earlier stage mesotheliomas, are not resectable by surgery because of the extent of the disease or because a person may not be able to tolerate an operation. Chemotherapy and/or radiation therapy may be treatment options that shrink or slow the growth of the cancer for a time, but they are very unlikely to result in a cure and can have their own side effects. Before starting such treatments, the goals of treatment should be clear to you and your family.

Because these cancers can be hard to treat, taking part in a clinical trial of a newer form of treatment may be a reasonable option.
In many cases, treatment aimed at this stage is aimed at relieving symptoms and making you as comfortable as possible. This could include treatments that prevent or reduce fluid buildup in the body that could affect your breathing or ability to take in nutrition.

Pain management is another important aspect of your care. Some minor operations and types of radiation therapy can help relieve pain if needed. Doctors can also prescribe strong pain-relieving drugs. Some people with cancer may hesitate to use opioid drugs (such as morphine) for fear of being sleepy all the time or becoming addicted to them. But many people get very effective pain relief from these medicines without serious side effects. It's very important to let your cancer care team know if you are having pain so that it can be treated effectively.

Recurrent mesotheliomas

Some mesotheliomas may recur (come back) after the initial treatment. If this happens, further treatment options depend on where the cancer is and what treatments have already been used. In most cases the options will be similar to those listed above for unresectable mesotheliomas. For example, chemotherapy may be used to try to shrink or slow the growth of the cancer and to relieve any symptoms. Because recurrent cancers can often be hard to treat, you should consider strongly the option of participating in clinical trials.

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