Mesothelioma is a rare form of cancer that occurs in the mesothelial cells due to asbestos exposure. The mesothelial cells protect and moisten the organs through a lining covering known as mesothelium. However, when people are exposed to asbestos fibers released in the air, the body cannot properly expel them and they become trapped. These fibers roost in the mesothelial cells and irritate them, resulting in the formation of tumors. According to the location of the tumors, there are four different types of mesothelioma, which include pleural, peritoneal, pericardial and testicular mesothelioma.
There is currently no cure for this type of cancer and it is usually only diagnosed when it is already in advanced stages due to discreet or unnoticeable symptoms. Nevertheless, advancements in the field have resulted in better prognosis and in treatments that help ease the symptoms. Chemotherapy is one of the most common types of treatment options for patients with mesothelioma, while radiation therapy and surgery are also possible. There are, however, advantages and risks to be considered by both patients and physicians.
Chemotherapy as Treatment Option for Mesothelioma Patients
Chemotherapy is a type of cancer treatment that uses drugs to destroy cancer cells, by stopping or slowing its growth. The cancer cells divide and grow rapidly and these drugs are meant to interrupt the division. Therefore, the tumors tend to shrink and patients are expected to experience relief from their symptoms. In the long-term, this treatment is also expected to decrease the risk of metastasis and extend patients’ life expectancy. Drugs approved by the U.S. Food and Drug Administration (FDA) for patients with mesothelioma include Alimta, Carboplatin, Cisplatin, Gemcitabine, Onconase and Navelbine, which are the most common, while methotrexate, vincristine, vinblastine, mitomycin, doxorubicin, epirubicin, cyclophosphamide and ifosfamide can also be used. These can be prescribed alone or in combination, the most used chemotherapy option being the combination of Alimta with Cisplatin.
Different Forms of Chemotherapy to Treat Mesothelioma
Chemotherapy is a complex option with numerous options, tailored according to the patients’ and tumors’ characteristics and needs. To define a treatment plan, physicians take into consideration factors like the type of mesothelioma, stage and extent of the cancer, as well as patients’ health and most effective drug. In the case of patients with mesothelioma, the chemotherapy can be administered systemically, which means that it is injected into a vein or swallowed in pill form and it enters the bloodstream, or it can be administered directly to the body cavity, which is known as intrapleural or intraperitoneal — depending on the location — the drug being delivered through a small tube straight into the body cavity where the cancer is developing.
In addition, there are also other decisions to be made. Chemotherapy can be a treatment plan alone, which means that it is the only treatment the patient undergoes, or integrate a multimodal therapy, in which case it is combined with one or more other treatments like surgery and / or radiation therapy. When the patient is going to undergo surgery, and chemotherapy is used before to shrink the tumor, it is known as neoadjuvant treatment, while adjuvant treatment is the name given to the use of chemotherapy after the surgery with same purpose. In addition, in advanced cases of the disease, chemotherapy can also be used as form of palliative care to relieve the patient’s symptoms, which can be combined with radiation therapy.
Benefits and Disadvantages of Chemotherapy in Mesothelioma
“Chemotherapy has an important role in palliation. It can be administered systemically or directly into the abdomen. The overall response rate reported with a single agent chemotherapy, combined chemotherapy, intraperitoneal chemotherapy, continuous hyperthermic peritoneal perfusion are 13.1%, 20.5%, 47.4%, and 84.6%, respectively. Cisplatin is the most studied agent, with activity in 25% of patients,” state the authors of the study “Peritoneal Mesothelioma: A Review.” The study reveals the improvements in mesothelioma patients’ health after chemotherapy and defines it as preferable and most effective course of treatment to fight mesothelioma cells.
It is particularly indicated when surgery is no longer an option for being too dangerous. However, it also has numerous side effects, including hair loss, nausea and vomiting, lower platelet count, compromised immune system, body aches, tingling in the feet and hands, anemia (decrease of red blood cells), loss of appetite, constipation or diarrhea, rash, fatigue, and fever. Given its great impact, it is important for both patients and loved ones to be aware of the advantages and disadvantages of the treatment beforehand.
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