When a person is diagnosed with mesothelioma, one of the first questions asked is what treatments are available. Treatments are, of course, dependent upon the patient. For mesothelioma they can depend on these factors and others:
- The type of mesothelioma
- The stage and cell type
- The health of the patient
- The patient’s decisions
Type of Mesothelioma
There are six types of mesothelioma. Four are malignant and two are generally considered benign.
The malignant ones are:
The benign ones are:
- Multicystic peritoneal
- Well-differentiated papillary
Typically, malignant disease requires more aggressive treatments to stop the cancer from growing and spreading. Such treatments may include surgery, chemotherapy, radiation therapy, or some combination. But despite these therapies, most malignant mesothelioma patients are not cured.
The benign forms, by definition, can generally be cured by surgery alone because these tumors do not invade other organs. However, there are cases where the benign forms did become aggressive.
Mesothelioma Stage and Cell Type
Like all cancer, the stage of the mesothelioma (how much it has grown and spread throughout the body), plays a role on what treatments are available. For some patients with metastatic disease, surgery will not be an option because the surgeon believes that they cannot remove all of the cancer. Chemotherapy is often prescribed. Unfortunately, the chemo combination used most widely (Alimta and Cisplatin) is a one-size-fits-all approach. The medical literature suggests that chemo, by itself, is not curative, in the vast majority of cases.
Cell type can also play a role. In mesothelioma there are three cell types:
- Epithelioid is the most common type of Mesothelioma cell and has the best prognosis of the 3 types.
- Sarcomatoid is the rarest of the 3 types and tends to be more aggressive than epitheloid cells.
- Biphasic is a mix of both cell types (epithelioid and sacromatoid) and usually has a prognosis that reflects the dominant cell type.
Chemotherapy may not be recommended in the case of sarcomatoid because the doctor may not believe it will provide a significant enough benefit.
Health of the Patient
Available treatments may also depend on the health of the patient. For example, perhaps the mesothelioma is operable, but the patient has a chronic heart condition. Performing an operation could risk that the patient dies from a myocardial infarction or heart attack. Therefore, that treatment option may not be available. In another example, perhaps the removal of a lung is a possibility but the doctor decides it is too risky because the patients remaining lung is not healthy enough to perform the function alone.
As discussed under Treatment Paths, there are different types of treatment options including conventional treatments (chemo, radiation, surgery), clinical trials, and alternative modalities. Some patients prefer to trust conventional doctors with their health, while others prefer to other approaches. This decision is often based on patient’s belief system. For example, do they believe that their body has failed them and the cancer must be cut out or killed with cell killing approaches like chemo? Or, do they believe that the body’s immune system has the ability to keep the cancer under control, but that the body needs some type of support to do this? These paradigms or thoughts about what cancer represents to a patient may also play a role in treatment choices.