Mesothelioma Tumor Markers

There are a number of different methods used to diagnose various types of cancer. Examining the levels of certain tumor markers is one such diagnostic method that may help mesothelioma patients live longer.

What's a Tumor Marker?

Tumor markers are best described as substances produced by tumor cells (or sometimes other cells) in the body in response to certain cancerous and non-cancerous conditions. They are usually found in the blood, urine, or tissue of patients. Using tumor markers to diagnose cancer can be difficult because tumor marker levels are not altered in all patients with cancer. Even levels of the same tumor marker can be altered in more than one type of cancer. Some of these substances can also found at elevated levels when other non-cancerous diseases are present.

Are Tumor Markers a Reliable Diagnostic Tool?

Tumor markers are a good starting point in the detection of cancer. While an elevated level of a particular tumor marker does not necessarily indicate the definite presence of cancer, it does indicate the need for further testing. The additional tests may include a biopsy, CT scan, or MRI.

In addition to being used for the diagnosis of cancer, tumor markers can also be measured to determine how a patient is responding to treatment. Marker levels will often be measured before treatment begins to determine the correct course of action when addressing the cancer. Tumor marker levels can further be used to determine whether a patient has suffered a recurrence of their cancer.

Are Tumor Markers Used to Screen for Cancer?

Screening is a process during which a cancer can be detected before symptoms are evident. Many researchers believe tumor markers aren't sensitive enough to be used for screening, yet one tumor marker, the prostate-specific antigen (PSA), has been used in the screening of prostate cancer among men for several years and has shown much success. However, an elevated PSA level does not necessarily indicate cancer, but does indicate the need for further testing.

Mesothelioma Blood Test

The reason for high death rates among mesothelioma patients is the aggressive nature of the disease and the inability to diagnose it until its latest stages. Because mesothelioma symptoms can remain dormant for up to 50 years, most cases at the time of diagnosis have already reached Stage III or IV. As a result, mesothelioma treatment options are often more palliative than curative.

However, the ability to diagnose the disease at an earlier time would certainly result in a better prognosis for mesothelioma patients. That ability is now present in the form of a mesothelioma blood test known as Mesomark. Developed by Fujirebio Diagnostics Inc. of Malvern, Pennsylvania, a leader in the field of oncology testing, the test measures the amount of a particular biomarker in human serum.

The test was first released in Australia in March 2005 and distribution expanded to Europe just a few months later. Food and Drug Administration approval for the blood test was received nearly two years later in January 2007.

What Factors Affect Prognosis?

Mesothelioma is not generally diagnosed until the disease is its latest stages of the development. This is primarily because of the long latency period that is associated with the disease. In many cases, mesothelioma symptoms do not even appear until several decades after the initial asbestos exposure has occurred. As a result, the prognosis for the majority of patients is poor. Once a cancer has reached Stage III or IV, treatment options not only become more limited but less effective as well.

Malignant mesothelioma is typically diagnosed in individuals over 55 years old, though there are certainly exceptions. Because of this, some patients who are diagnosed already have multiple medical problems caused by advancing age, making treatment even more difficult and increasing the mortality rate among mesothelioma patients.

In addition to the stage of the cancer at diagnosis and the age of the patient, other factors that affect prognosis include:

• The type of mesothelioma – pleural, peritoneal, or pericardial
• The size of the tumor
• The location of the tumor and whether it can be surgically removed
• The extent of other symptoms, including fluid in the lungs or abdomen
• Whether or not the patient is a smoker

Mesothelioma Mortality Rates

Many studies have been conducted in regards to survival rates among mesothelioma patients. When discussing survival rates for this or any type of cancer, references to the "five-year relative survival rate" will often be made. This number refers to the percentage of patients who live at least five years after their cancer is diagnosed. However, in studies involving mesothelioma patients, the figures do not include patients that pass away from diseases other than mesothelioma.

According to statistics published by the American Cancer Society, the five-year relative survival rate for patients with mesothelioma is approximately 10 percent. That number has actually improved in the last five years, up from nine percent reported at the end of 2002. In addition, recent studies show that the one-year survival rate is now about 40 percent, a number that has also gone up in the past five years. Throughout the 1990s, it was rare for a patient to survive more than a year after diagnosis.

MESOTHELIOMA COMMON QUESTIONS

What is Mesothelioma?
The National Cancer Institute states that: "Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura), the lining of the abdominal cavity (the peritoneum) or the lining around the heart (the pericardium)."

What is peritoneal mesothelioma?
Peritoneal mesothelioma is a cancer of the lining of the abdominal cavity. This form of cancer makes up approximately one-fifth to one-third of the total number of mesothelioma cases diagnosed. More on peritoneal mesothelioma.

How do you get Mesothelioma?
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Others have been exposed to asbestos in a household environment, often without knowing it. More about the different ways in which people have been exposed to asbestos.

How much exposure does it take to get the disease?
An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later. Mesothelioma cause.

How long does it take after exposure for the disease to show up?
People exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.

What is the prognosis for mesothelioma?
Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated. Click on Treatment Options to find out more about traditional and new approaches.

Is there any promising research or are there promising drugs for mesothelioma?
Research is being conducted at various cancer centers all over the United States as well as by pharmaceutical companies. To find more about these studies, click on Clinical Trials. To read abstracts of the latest journal articles on mesothelioma research and to access these articles, click on Medical Journal Articles; or Mesothelioma News for news articles. A recent study of Alimta showed patients living much longer with Alitma than other chemotherapy drugs.

Where can I find information on living with mesothelioma?
Mesothelioma Aid is a good website for resource for families dealing with mesothelioma. It includes advice and referrals to other resources for coping with cancer, caregiving, financial challenges, and support groups. Alternatively, contact us here at Mesothelioma Web for help finding resouces for living with this disease.

What kinds of other resources are available for people with mesothelioma?
There are numerous cancer web sites, some specific to mesothelioma. Because they are often difficult to locate, we have listed some relevant medical sites under Leading Cancer Links. We are always on the lookout for more so check our site often.

MESOTHELIOMA'S CAUSE - ASBESTOS EXPOSURE

At some point in our lives, nearly all of us have been exposed to asbestos in the air we breathe and the water we drink; from natural deposits in the earth, and from the deterioration of asbestos products around us. Most of us, however, do not become ill as a result of our exposure. More commonly, those who at some point are diagnosed with asbestos disease, have worked in jobs where more substantial exposure occurred over longer periods of time. Nevertheless, cases of mesothelioma have been documented as the result of lesser exposure, affecting family members of workers who came into contact with asbestos and brought it home on their clothing, skin or hair, or affecting those who lived in close proximity to asbestos manufacturing facilities. Symptoms of asbestos disease usually are not be apparent until decades after exposure.

Asbestos was used commercially in North America as early as the late 1800s, but its use increased dramatically during the World War II era when shipyards produced massive numbers of ships for the war effort. Since that time, asbestos-containing products were used by the construction and building trades, the automotive industry and the manufacturing industry. All told, more than 5,000 products contained asbestos.

For more than 50 years, products containing asbestos remained unregulated, and the manufacturers of those products continued to prosper, knowing full well that many of the millions of workers who came into contact with their products would ultimately suffer as the result of their actions. Finally, in the late 1970s, the Consumer Products Safety Commission banned the use of asbestos in wallboard patching compounds and artificial ash for gas fireplaces because the fiber could easily be released during use. In 1989, the Environmental Protection Agency banned all new use of asbestos, but uses established prior to that time were still allowed. Although awareness of the dangers of asbestos and public concern over the issue have led to a decline in domestic consumption over the years, a total ban on asbestos has not come to fruition. Asbestos is still imported, still used and still dangerous.

Although it is suggested that the number of mesothelioma cases in the U.S. has reached its peak and has begun to drop, a forecast released by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER), in April, 2003, projected the total number of American male mesothelioma cases from 2003-2054 to be approximately 71,000. This number, however, does not take into consideration events such as the World Trade Center disaster on September 11, 2001, when millions of New Yorkers were potentially exposed to air filled with carcinogenic asbestos particles. When the latency period for asbestos disease is factored in, cases of mesothelioma will continue to be diagnosed for years to come. See our page on mesothelioma risk factors.

MESOTHELIOMA SYMPTOMS

MESOTHELIOMA SYMPTOMS in the lungs

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

PLEASE KEEP IN MIND THAT THESE SYMPTOMS MAY BE CAUSED BY MESOTHELIOMA OR BY OTHER LESS SERIOUS CONDITIONS. ONLY A DOCTOR CAN MAKE A DEFINITIVE DIAGNOSIS.

Information on the symptoms, diagnosis, staging, and treatment of peritoneal mesothelioma.

Information on the symptoms, diagnosis, staging, and treatment of pleural mesothelioma.

Pleural Effusion

One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these membranes are covered with mesothelial cells which, under normal conditions, produce a small amount of fluid that acts as a lubricant between the chest wall and the lung. Any excess fluid is absorbed by blood and lymph vessels maintaining a balance. When too much fluid forms, the result is an effusion.

Types

Pleural effusion is broken down into two categories, transudates and exudates. A transudate is a clear fluid that forms not because the pleural surfaces are diseased, but because of an imbalance between the normal production and removal of the fluid. The most common cause of transudative fluid is congestive heart failure. An exudate, which is often cloudy and contains many cells and proteins, results from disease of the pleura itself, and is common to mesothelioma. To determine whether a fluid is a transudate or exudate, a diagnostic thoracentesis, in which a needle or catheter is used to obtain a fluid sample, may be conducted.

Symptoms

As the volume of fluid increases, shortness of breath, known as "dyspnea", and sometimes pain, ranging from mild to stabbing, may occur. Some patients may experience a dry cough. When the doctor listens to the patient’s chest with a stethoscope, normal breath sounds are muted, and tapping on the chest will reveal dull rather than hollow sounds.

TYPES OF SURGERY

SURGERY

Diagnostic Procedures

As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Side Effects of Chemotherapy

Cancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy. More on peripheral neuropathy. More on anti-nausea treatment for chemotherapy patients.

Click here if you are interested in learning more about chemotherapy for mesothelioma and the types of questions you should ask your doctor.

Chemotherapy Schedules

How often you will receive chemotherapy will be determined by your doctor, taking into consideration factors such as the stage of your cancer, the types of drugs you receive, the anticipated toxicities of the drugs and the time necessary for your body to recover from these toxicities. The doctor may also consider whether the goal of the chemotherapy is to control the growth of the cancer, or to ease symptoms associated with the disease.

In general, chemotherapy treatment is administered in "cycles" — a "cycle" being defined as a period of treatment followed by a period of rest. This cycle allows the cancer cells to be attacked by the drugs, and then allows the body's normal cells time to recover. The combination of drugs used, the length of time to administer the drugs, how often they should be repeated and the number of cycles recommended have been analyzed throughly in clinical trials. For mesothelioma patients, the "standard" treatment is a combination of Alimta and cisplatin, administered IV, with a 10 minute infusion of Alimta followed by two hours of cisplatin, given in 21 day cycles. Modifications to this schedule may be made according to what your doctor feels is appropriate in your particular case.

The number of treatment cycles, or the length of time between the beginning and end of chemotherapy may vary, however in general, 3 to 4 cycles of treatment are given before response is evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness. After response to the treatment has been determined, the following criteria will be used to decide whether chemotherapy should continue:

• If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
• If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.

The goal of setting a chemotherapy schedule is to make treatment as effective, timely and trouble-free as possible, but while the drugs are working to kill cancer cells, they may also affect healthy cells causing side effects. One of the most common side effects, and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which means your immune system is weakened, therefore leaving you more prone to infection. While this side effect is anticipated when someone is undergoing chemotherapy, it can cause delays in your treatment schedule, or changes in the dosage of the drugs you will receive. Click here for more on understanding your blood counts.

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Note to Patients:

Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.

1. It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
   These may include:
   • Fever of, or greater than 101 degrees
   • Nausea or vomiting
   • Diarrhea or constipation
   • Fatigue
   • Tingling or numbness in the fingers or toes
   • Ringing in the ears
   • Bruises or rashes
   • Sores in the mouth or throat
2. Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
   Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.
3. Take extra care with your daily health.
   Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.

   Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.




4. Be open about your feelings regarding your treatment.
   It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.

MESOTHELIOMA CHEMOTHERAPY

CHEMOTHERAPY

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:

• To control the cancer by stopping its spread or slowing its growth.
• To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
• To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
• To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.

The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a drug approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

RADIATION THERAPY

Radiation therapy, also called radiotherapy, treats cancer by using penetrating beams of high energy or streams of particles called radiation. In treating mesothelioma, radiation may be used aggressively in combination with surgery, or palliatively to control symptoms.

In an aggressive combined modality approach, radiation is used to attack microscopic or residual disease remaining in the chest cavity after extrapleural pnuemonectomy. An example of this is Intensity Modulated Radiation Therapy (IMRT), which uses x-rays of varying intensities in conjunction with computer generated images to deliver targeted radiation directly to cancer cells while reducing the amount of radiation to surrounding healthy tissue. More on Intensity Modulated Radiation Therapy (IMRT).

Used palliatively, radiation can help control metastases (spread) of the tumor along tracks left by invasive procedures such as thoracoscopy, needle biopsy and chest tube drainage, or to control disease symptoms, such as pain or shortness of breath.

An exciting new development in radiation oncology is tomotherapy. A brief description of

Complementary and alternative medicine

• Complementary and alternative medicine covers a wide range of healing philosophies that conventional medicine does not commonly accept or make available to its patients. Some of these practices include the use of acupuncture, herbs, homeopathy, therapeutic massage, and Far Eastern medicine to treat health conditions.

  These therapies may be used alone as an alternative to conventional medicine, or in addition to conventional medicine, in which case they are referred to as complementary. Many are considered holistic, meaning their focus is to treat the whole patient - physically, mentally, emotionally, and spiritually. These treatments are not widely taught as a part of the medical curriculum, are not generally used in hospitals, and, for the most part, are not covered under insurance policies.

  Many cancer patients try various complementary and/or alternative medicine techniques during the course of their treatment, and although they may not work for everyone, some patients benefit by managing their symptoms or side effects. One important caveat, is to discuss any complementary or alternative treatments you may be considering with your doctor to be sure nothing interferes with your conventional care. For instance, dietary supplements such as herbs or vitamins may be "natural", but not necessarily "safe". They may lessen the effectiveness of certain anticancer drugs, or when taken with other drugs or in large doses, may actually cause harm. Since supplements of this nature are not governed by the FDA (Food and Drug Administration), and a prescription is not necessary to purchase, it is up to the consumer to make informed and conscientious decisions regarding their use.

  Your personal physician may be able to advise you about the use of complementary and alternative treatments and therapies, and how they relate to mesothelioma.

The combinaton of complementary and conventional therapies is sometimes referred to as integrative medicine.

• Unconventional methods of cancer treatment make claims that can not be scientifically substantiated. They commonly claim to be effective against cancers that are considered incurable, and tout treatments with relatively few, if any, side effects.

  The use of these unconventional methods may result in the loss of valuable time and the opportunity to receive potentially effective therapy. It is always important to remain in the care of a qualified physician who uses accepted methods of treatment or who is participating in scientifically designed investigational therapies.

NEW MESOTHELIOMA TREATMENT APPROACHES

New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include:

• Angiogenesis and Anti-angiogenesis Drugs

  Although progress has been made in the early detection of cancer, and in improved treatment options once cancer is diagnosed, there are still many cancers, including mesothelioma, which can not be cured and remain difficult to treat effectively. In recent years, researchers have learned a great deal about how cancer cells differ from normal cells and, in an effort to find drugs without the potentially severe side effects of chemotherapy, have now discovered drugs which target the tumor itself while sparing the body’s normal cells. One such group are the anti-angiogenesis drugs.

  Learn more about anti-angiogenesis agents in the treatment of mesothelioma.

• Immunotherapy, sometimes called biological therapy, uses the body's own immune system to protect itself against disease. Researchers have found that the immune system may be able to recognize the difference between healthy cells and cancer cells, and eliminate those that become cancerous. Immunotherapy is designed to repair, stimulate, or enhance the immune system's natural anticancer function.

  Substances used in immunotherapy, called biological response modifiers (BRMs) alter the interaction between the body's immune defenses and cancer, thereby improving the body's ability to fight disease. Some BRMs, such as cytokines and antibodies, occur naturally in the body, however, it is now possible to make BRMs in the laboratory that can imitate or influence natural immune response agents. These BRMs may:

  • Enhance the immune system to fight cancer cell growth.
  • Eliminate, regulate, or suppress body responses that permit cancer growth.
  • Make cancer cells more susceptible to destruction by the immune system.
  • Alter cancer cell's growth patterns to behave like normal cells.
  • Block or reverse the process that changes a normal cell into a cancer cell.
  • Prevent a cancer cell from spreading to other sites.

  Many BRMs are currently being used in cancer treatment, including interferons, interleukins, tumor necrosis factor, colony-stimulating factors, monoclonal antibodies, and cancer vaccines.

More on immunotherapy for mesothelioma.

• Photodynamic therapy (PDT) is a type of cancer treatment based on the premise that single-celled organisms, if first treated with certain photosensitive drugs, will die when exposed to light at a particular frequency. PDT destroys cancerous cells by using this fixed frequency light to activate photosensitizing drugs which have accumulated in body tissues.

  In PDT, a photosensitizing drug is administered intravenously. Within a specific time frame (usually a matter of days), the drug selectively concentrates in diseased cells, while rapidly being eliminated from normal cells. The treated cancer cells are then exposed to a laser light chosen for its ability to activate the photosensitizing agent. This laser light is delivered to the cancer site, (in the case of mesothelioma, the pleura), through a fiberoptic device that allows the laser light to be manipulated by the physician. As the agent in the treated cells absorbs the light, an active form of oxygen destroys the surrounding cancer cells. The light exposure must be carefully timed, so that it occurs when most of the photosensitizing drug has left the healthy cells, but is still present in cancerous ones.

  The major side effect of PDT is skin sensitivity. Patients undergoing this type of therapy are usually advised to avoid direct and even indirect sunlight for at least six weeks. Other side effects may include nausea, vomiting, a metallic taste in the mouth, and eye sensitivity to light. These symptoms may sometimes come as a result of the injection of the photosensitizing agent.

• Gene therapy is an approach to treating potentially fatal or disabling diseases by modifying the expression of an individual's genes toward a therapeutic goal. The premise of gene therapy is based on correcting disease at the DNA level and compensating for the abnormal genes.

  Replacement gene therapy replaces a mutated or missing gene, most often a tumor suppressor gene, with a normal copy of that gene which serves to keep cell growth and division under control. The p53 gene, the most common gene mutated in cancer has become a prime target for gene replacement, and has met with some success in inhibiting cell growth, inhibiting angiogenesis (the development of a tumor's blood supply), and inducing apoptosis (cell death).

  Knockout gene therapy targets the products of oncogenes (a gene that can induce tumor formation) in an effort to render them inactive and reduce cell growth.

  With constantly expanding knowledge of the genes associated with cancer, their functions, and the delivery systems used in administering these genes, gene therapy has a promising future.

Continue Pain Management

Fatigue

Cancer-related fatigue may be the result of the general progression of the disease, the effects of medication, or the after effects of treatments such as surgery, chemotherapy, or radiation therapy. The following symptoms are usually associated with fatigue:

• Diminished energy level disproportionate to activity
• Diminished activity associated with physical or intellectual performance
• Diminished motivation; lack of interest in activities
• Exhaustion, apathy, or lethargy
• Generalized tiredness
• Sleep abnormalities
• Irritability, impatience, or changes in mood

The treatment of fatigue is based on first identifying, and then managing, the underlying cause of the fatigue. Once that is accomplished, interventions such as medication, exercise, stress management, and nutrition are used. More on fatigue in mesothelioma patients.

Dry Mouth

Dry mouth, or xerostoma, is another symptom addressed in palliative care. Causes may be dehydration, depression or anxiety, or may be a side effect of medications such as pain relievers, antidepressants, diuretics, or tranquilizers. Chemotherapy treatments or radiotherapy may also be a cause.

Relief of dry mouth can often be achieved by:

• Drinking plenty of fluids
• Sucking on ice chips or Vitamin C tablets
• Chewing sugarless gum
• Maintaining good oral hygiene
• Providing humidified air

Loss of Appetite

Patients with life-threatening illnesses often lose their appetite, and subsequently, lose weight. If the condition becomes too severe, it is called cachexia. Doctors uniformly agree that nutrition plays a vital role in the patient's well being. Causes of weight loss include inadequate intake of nutrients because the patient can not or does not want to eat, poor absorption of the food that is eaten, and changes in the patient's metabolism.

Weight loss may be managed by:

• Eating smaller, more frequent meals
• Eating high calorie, high protein foods
• Receiving nutritional counseling

There are also medications which may help depending on the patient's desired goal. Some of these medications stimulate appetite, but do not usually increase weight, some stimulate appetite and cause slight weight gain, and still others help prevent nausea and vomiting.

Gastrointestinal Problems

Gastrointestinal problems may be associated with the disease process itself, or as a side effect of treatments or medications the patient is receiving. These may include nausea, vomiting, constipation, and diarrhea.

As mentioned above, there are medications which can help with nausea and vomiting. Your doctor or a nutritionist may also be able to provide eating hints and/or special diets tailored to fit the patient's individual needs. More on diarreah in mesothelioma patients.

Skin Problems

There are a variety of skin problems which may accompany cancer, including dryness, itching, rash, sores, and ulcers. It is important to treat these conditions as quickly as possible in order to reduce discomfort and the risk of infection.

• Dryness may be lessened by adding baby or mineral oil to warm bath water, and by applying moisturizers. It is also important to drink 8-10 glasses of water per day.
• Itching and rash may be lessened by adding baking soda to cool bath water, or by applying a cool, moist cloth to itchy areas. Avoid harsh laundry detergents, and change sheets and towels daily.
• Keep skin clean and dry and check skin daily for pressure sores or ulcers which may become infected.

Anxiety/Depression

Anxiety is a hallmark of a life-threatening illness. Feelings of fear, worry, or apprehension may lead to long-term generalized anxiety, or short, intense panic attacks. Causes may include difficulty in coming to terms with the illness, fear of isolation and separation, poorly controlled pain, or side effects of medication.

Treatments to control anxiety may include stress management techniques, counseling, support of family and friends, and control of pain or side effects from medication.

Depression, while less common, often affects family members as well as the patient themselves. Depression may be related to loss of the ability to function, changing family roles, limited social and financial support, pain, or other symptoms such as shortness of breath.

Control of the above symptoms is accomplished through antidepressant medication, support and counseling, pain management, and stress management.

More on palliative care and hospice for mesothelioma patients.

PALLIATIVE CARE

Palliative care is a specialized form of care that alleviates pain and other symptoms. The goal of palliative medicine is not to prolong life or hasten death, but rather, to keep the patient as comfortable as possible, while offering support to the patient and their family. Palliative care contributes to the quality of life for patients with life-threatening illnesses at any phase of the disease.

For the patients who are undergoing life-prolonging therapies, palliative care includes symptom management and therapy aimed at restoring function. For the dying patient, it addresses the traditional roles of the hospice movement. During the course of a serious illness, patients and their families should realize that the goals of care can, and do, change, sometimes rapidly. An open line of communication is essential to optimize patient care.

Symptoms Managed through Palliative Care

Some of the common symptoms managed through palliative care include:

• Pain
• Shortness of breath
• Fatigue
• Dry Mouth
• Loss of appetite
• Gastrointestinal problems
• Skin problems
• Anxiety/Depression

Pain

Pain management is one of the most important aspects of palliative care. Because it is now considered a medical specialty, you may wish to consult a physician well versed in pain management if your physician seems unable or unwilling to provide adequate pain control.

Many people with cancer experience pain. Statistics show that 30 to 40 per cent of patients in active cancer therapy, and 70 to 90 percent of patients with advanced cancer report pain. In most cases, pain can be controlled through medications prescribed according to the World Health Organization's Analgesic Ladder, an approach using various levels of medication based on the severity of pain. This type of pain treatment, using drugs, is called pharmacological therapy. Medications may include innon-opioid pain relievers, opioid pain relievers, adjuvant medications (those whose primary purpose is not for pain, but for other conditions), and topical treatments such as a patch, gel, or cream. A study published the Annals of Oncology found a reluctance among cancer patients to take opioid medications due to a belief that such medications are offerred only at the end of life.

Non-pharmacological therapies, those that do not rely primarily on medication to achieve effect, include therapeutic exercise and cognitive behavioral techniques such as deep breathing, muscle relaxation, imagery, meditation, biofeedback therapy, and distraction. Complementary and/or alternative approaches include acupuncture and massage therapy. Integretive medicine refers to the combination of mainstream conventional treatment such as surgery, chemotherapy and radiation with complementary therapies proven to have sound scientific evidence as to their safety and effectiveness.

Shortness of Breath

Shortness of breath, or dyspnea, affects 20 to 80 percent of palliative care patients. Causes of this condition may include, lung disease, fluid in the lungs, infection, anemia, or emotional factors such as anxiety. While medications or oxygen may be used to treat shortness of breath, sometimes measures such as changing position, using relaxation techniques, or improving air circulation may help. More on anemia from chemotherapy treatment.

Fatigue

Cancer-related fatigue may be the result of the general progression of the disease, the effects of medication, or the after effects of treatments such as surgery, chemotherapy, or radiation therapy. The following symptoms are usually associated with fatigue:

• Diminished energy level disproportionate to activity
• Diminished activity associated with physical or intellectual performance
• Diminished motivation; lack of interest in activities
• Exhaustion, apathy, or lethargy
• Generalized tiredness
• Sleep abnormalities
• Irritability, impatience, or changes in mood

The treatment of fatigue is based on first identifying, and then managing, the underlying cause of the fatigue. Once that is accomplished, interventions such as medication, exercise, stress management, and nutrition are used. More on fatigue in mesothelioma patients.

Imaging Techniques and Their Value in Diagnosing and Assessing Mesothelioma

There are several imaging techniques which may prove useful when mesothelioma is suspected due to the presence of pleural effusion combined with a history of occupational or secondary asbestos exposure. While these imaging techniques can be valuable in assessing the possibility of the cancer, definitive diagnosis is still most often established through fluid diagnosis or tissue biopsy.

Some of the most commonly used imaging methods include:

• X-ray

A chest x-ray can reveal pleural effusion (fluid build-up) which is confined to either the right (60%) or left (40%) lung. On occasion, a mass may be seen. Signs of prior non-cancerous asbestos disease, such as pleural plaques or pleural calcification, or scarring due to asbestosis may also be noted.

• Computed Tomography (CT)

CT scans are also able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures, or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease (pleural disease), or differentiate between adenocarcinoma of the lung wh

ich may have spread to the pleura verses mesothelioma. CT scans may also be valuable in guiding fine needle aspiration of pleural masses for tissue diagnosis.

• Magnetic Resonance Imaging (MRI)

MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes (those lymph nodes which lie between the two lungs), as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy.

• Positron Emission Tomography (PET)

PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. While PET scans are more expensive than other types of imaging, and are not always covered under insurance, they are now considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma. Further explanation of PET scans.

MESOTHELIOMA DIAGNOSIS QUESTIONS

Doctor-Patient Communication

An open line of communication between a patient and his or her physician is vital when dealing with a serious disease such as mesothelioma. There will be many questions regarding treatment, whether palliative or aggressive, choices to deal with, and life issues to confront. Being informed and proactive in your care will give you a sense of empowerment.

Although most physicians have limited time to spend with each patient at appointments, it is important to address issues as they occur and resolve them to the satisfaction of all parties involved. Initially, this may mean going to your appointment with a list of symptoms or concerns, or questions regarding specific tests that are recommended. Once mesothelioma has been diagnosed, you may have questions regarding treatment options.

Most questions from patients stem from an initial diagnosis of mesothelioma and subsequent treatment options. Following are some frequently asked questions regarding these two important issues.

What Is My Diagnosis?

There are three types of mesothelioma. Pleural mesothelioma is a cancer of the lining of the lung (pleura), peritoneal mesothelioma is a cancer of the lining of the abdominal cavity (peritoneum), and pericardial mesothelioma is a cancer of the lining surrounding the heart (pericardium). Sub-types (or cell types) of mesothelioma are epithelioid (the most common, and considered the most amenable to treatment), sarcomatous (a much more aggressive form), and biphasic or mixed (a combination of both of the other cell types).

The structural appearance of cells under the microscope determine the cell or sub-type of mesothelioma. Epithelioid is the least aggressive; sarcomatoid, the most aggressive. The biphasic or mixed cell type shows structural elements of both of the other two. More on the histologic subtypes of mesothelioma.

Traditional Mesothelioma Treatment Options

Traditional Mesothelioma Treatment Options

• Surgery (physical removal of the cancer)
  There are several types of surgeries that may be available for mesothelioma. The disease type, stage and the individual’s age and condition will determine if and what type of surgery may be performed.
  
  
• Chemotherapy (using drugs to fight the cancer)
  Chemotherapy uses drugs to kill cancer cells and may be used as the primary treatment to mesothelioma, or it may be used as part of a multi-modal approach. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle.
  
  
• Radiation Therapy (using high-dose x-rays to kill cancer cells)
  Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation).

Doctors will often use two or more of these treatment courses jointly to provide the maximum likelihood of success. This multi-modal approach holds the most promise for survival of malignant mesothelioma patients. Trimodality therapy, in which all three of these modalities are used, is considered the most effective, and aggressive, approach.

Non-Traditional Mesothelioma Treatment Options

• Photodynamic Therapy
  Photodynamic therapy destroys cancer cells by using the energy from light and may also be effective when combined with surgery. Although this treatment is in the experimental stage for mesothelioma, it has shown promising results in treating other cancers.
  
  
• Gene Therapy
  This is a new treatment, currently in clinical trials. This approach allows treatment to target tumors, rather than destroying healthy cells which is the negative of traditional chemotherapy.
  
  
• Immunotherapy
  Immunotherapy (or biological therapy) treats cancer by using the body’s own immune system to fight cancer cells. Another name often applies to this therapy: biological response modifiers (BRMs).

Mesothelioma Treatments

While there is currently no known cure for malignant mesothelioma, treatments are available with the most common being surgery, chemotherapy and radiation therapy.

Your doctor will recommend one treatment or a combination of therapies that are best for your situation. The course of treatment will depend on a number of factors including the location of the disease, the stage of the disease, your age, overall health and your preferences.

The information provided throughout this website is for your information only, and should NOT take the place of a full medical diagnosis.

Mesothelioma Prognosis: Conclusion

Mesothelioma Prognosis: Conclusion

As you can see, there are a number of factors that can impact the determination of a mesothelioma prognosis. The biologic facts of the disease as presented and the individual characteristics of the patient are all important co-factors and have serious implications for overall prognosis. Along with these factors, improving treatment regimens are another major element in one’s prognosis. There is still no cure for mesothelioma, but the treatments are improving, as is our knowledge of the actual mechanisms of the disease itself. Doctors are hopeful that we can translate our growing knowledge of the disease into more effective treatments and, therefore, better prognoses for patients.

Mesothelioma Prognosis: Exceptions to the Statistics

As we said above, the statistical prognosis of mesothelioma is generally not in the patient’s favor. Seen only as a set of numbers, many people are understandably disheartened when they learn about their diagnosis. However, notable exceptions to these statistics do exist. Among the most famous of these exceptions was Dr. Stephen J. Gould of Harvard University. Dr. Gould was an internationally respected paleontologist and evolutionary biologist who conducted important research in both of these fields. Dr. Gould was diagnosed with peritoneal mesothelioma in 1982. After an initial period of depression, motivated by all of the negative statistics he read regarding his diagnosis, he became determined to not let the statistics regarding life expectancy rob him of all hope. When he died in 2002, it was from another form of cancer, totally unrelated to his mesothelioma. Dr. Gould has written about his experience with peritoneal mesothelioma and his determination to not let simple statistics dictate his reaction to his diagnosis in the essay, “The Median Isn’t the Message.” We recommend Dr. Gould’s essay for everyone who has been diagnosed with this disease, or with any other form of cancer.

Dr. Gould’s experience certainly may not be standard, but his hopeful approach to his disease cannot be discounted.

Performance Status

Another important prognostic factor is the overall health of the person, with the patient’s age an important sub-factor in this determination. Generally, the healthier a patient presents, the better he or she will respond to cancer treatments and the better chances he or she has of longer survival. When grading a patient’s health, doctors develop a figure known as a patient’s “performance status.” There are a number of competing scales used to gauge this, but the scale sponsored by the World Health Organization goes from 0 to 5, with 1 and 4 being the general limits of description.

Performance Status Measurements

Number	Description
0	Asymptomatic
1	Symptomatic but completely ambulant
2	Symptomatic, <50%>
3	Symptomatic, >50% in bed, but not bedbound
4	Bedbound
5	Death

Performance status is revisited at multiple times during the course of treatment. It is initially developed after diagnosis and is then updated in response to the patient’s reaction to the treatment regimen he or she is a part of.

Mesothelioma Prognosis: Patient Status

Along with the biological aspects of mesothelioma as presented, another set of important prognostic factors includes the stage of the disease at diagnosis, the health of the patient and his or her age. All three will have a major impact on life expectancy and the future course of the disease.

Stage of the Disease

The stage of disease at diagnosis is a crucial factor in the development of the patient’s prognosis. As with all forms of cancer, early detection is important, but this is especially true of mesothelioma. Because mesothelioma generally resists curative treatment, doctors can manage the disease more efficiently if they have caught it in its early stages. The diffuse nature of the disorder means advanced tumor progression will invade large areas of tissue, making treatment even more difficult. Mesothelioma presents with symptoms shared by a number of other diseases and often goes undiagnosed because of these similarities. An early diagnosis is absolutely crucial if one hopes to control the disease.

Mesothelioma Prognosis: Biology of the Disease

The most important disease-specific prognostic factors for patients with mesothelioma involve the form of mesothelioma as presented and the histological subtype of the presented disease. Of the two major forms of mesothelioma, pleural mesothelioma generally presents with a worse prognosis than peritoneal mesothelioma does. The physiological reasons for this difference are not completely understood, but a major factor is the histological aspect of the cancer. Pleural mesothelioma presents about fifty percent of the time with an epitheloid histologic subtype, twenty percent of the time with sarcomatoid subtype and the remaining thirty percent is the biphasic subtype, which is a combination of the previous two subtypes. Peritoneal mesothelioma presents in the vast majority of diagnoses with the epitheloid subtype. This is significant because epitheloid mesothelioma responds more favorably to treatment than sarcomatoid mesothelioma or biphasic mesothelioma does. Thus, with the majority of peritoneal cases featuring the most treatable histological subtype, one would expect for it to have a better overall prognosis. Conversely, with only half of pleural cases involving the most treatable subtype, one would also expect a generally worse prognosis.

Mesothelioma Prognosis

The overall prognosis for individuals with mesothelioma is not very good. The disease has among the lowest five year survivability rates among different cancers and remains extraordinarily difficult to treat. While research is ongoing and our knowledge of the disease is definitely increasing faster than it ever has, doctors know an actual cure is still years away. However, large variabilities exist in many mesothelioma patients and there are people who have lived full lives after their diagnoses.

Mesothelioma Prognosis: Statistics

When mesothelioma is examined in purely statistical terms, the prognosis figures are discouraging. Pleural mesothelioma typically presents in an advanced stage of progression with a ten-to-fourteen month lifespan expectation from diagnosis. Peritoneal mesothelioma often presents with a slightly more optimistic lifespan expectation and patients surviving two to five years are not uncommon. However, after five years, statistics show survivability dropping to well below thirty percent.

Statistics, however, do not tell the whole story. There are a variety of factors in the development of a patient’s mesothelioma prognosis and subtle differences among these factors can have a dramatic impact on the course the disease will take. The statistical models used in mesothelioma often miss the extraordinary differences between a person’s stated prognosis/diagnosis and the way in which the disease actually impacts his or her life. While rare, it is not unknown for an individual to live for ten or sometimes even twenty years after a diagnosis of mesothelioma.