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Treatment options for asbestos related cancers

by Sharine Burgess

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Although there have been advances in the treatment of a number of asbestos-related cancers, mesothelioma in particular is still usually regarded as a terminal condition. Sadly, only around 5% to 10% of people diagnosed with mesothelioma will survive for five years or more.

This is partly due to the fact that the condition is most likely to be diagnosed at an advanced stage. In addition, because the latency period before symptoms become apparent in mesothelioma is so long (often decades) victims are often elderly and have other health problems.

Treatments are usually aimed at easing your symptoms and improving your quality of life, as well as trying to prolong your life.  We are still very far from a cure for mesothelioma, but researchers are optimistic that cancer treatment options currently available can prolong the lives of those diagnosed.

Modern treatments including immunotherapy and gene therapy have shown some potential in stopping tumour growth. Depending on the stage your cancer is at the time of diagnosis, your oncologist may recommend a combination of surgery, chemotherapy and/or radiotherapy to remove and/or shrink tumours and prevent them from spreading and to at least extend your life expectancy.

The four main types of treatment for mesothelioma most commonly used are:

  • Chemotherapy
  • Surgery
  • Radiotherapy
  • Palliative care

The Multimodal Approach

Once your mesothelioma has been diagnosed through biopsies, CT scans and/or other diagnostic procedures, the most appropriate treatment tailored to you personally will be developed. Oncologists typically recommend a multimodal approach that involves any or all of the following treatment options:

Chemotherapy

Chemotherapy drugs target fast growing cancer cells in the hopes of eliminating them from the body before they spread to other parts of the body. When surgery is combined with chemotherapy, the prognosis for a mesothelioma patient is improved. Even if your current diagnosis reveals that your cancer is in the later stages of development, you may still be offered chemotherapy treatments.

Surgery

If your mesothelioma has been detected in the earlier stages of development, your doctor may recommend surgical removal of the tumours by removing the lining of your chest wall (the pleura), lymph nodes, or any other organ where the cancer cells have been located.

Radiotherapy

Targeted radiation treatments can shrink mesothelioma tumours, making the treatment suitable for patients preparing to undergo surgery or for those whose illness has progressed beyond the point where surgical intervention is reasonable. Sometimes radiotherapy treatments are offered to provide pain relief for patients who are having trouble breathing due to the presence of tumours which interfere with the airways, nerves and/or blood vessels.

Palliative care

Palliative treatment is used to improve a patient’s quality of life rather than attempting to cure mesothelioma. Palliative treatment can be used alone or in conjunction with traditional cancer treatment and other therapies to reduce pain and increase a person’s mental wellbeing and physical state.

You may also be offered treatment for pleural effusion (a build-up of fluid in your chest). The fluid can be drained on a regular basis, but a procedure called pleurodesis may be used to try to stop the fluid build-up. This involves draining off the fluid and injecting sterile talcum powder into the pleural space between the two layers of the chest lining, causing the two layers to stick together so there’s nowhere for fluid to build up again.

Recent advances in treatment

Clinical trials in recent years have suggested that some new forms of treatment such as immunotherapy and gene therapy may have the potential to increase the quality of life for mesothelioma sufferers while improving their overall prognosis. New drug treatments are also being investigated:

Immunotherapy

Immunotherapy has been shown to extend the lifespan of many patients who undergo both chemotherapy and immunotherapy simultaneously. Immunotherapy drugs target a specific protein that stops the body’s immune system from attacking cancer cells. By negating that protein, the immune system can more effectively destroy the tumour cells.

Gene therapy

Gene therapy has caused great excitement in the medical community. This treatment manipulates the patient’s genes to prevent tumours from growing by injecting a modified form of a virus which can target and deliver the appropriate replacement gene to any damaged cells which ultimately could become cancerous.

Experimental drug treatments

Experimental drug treatments using a new compound called HRX9 also show great promise. HRX9 is said to directly target genes within mesothelioma cells, causing them to self-destruct by initiating a process known as apoptosis. Although the drug has currently only been used in mice injected with malignant human mesothelioma cells, the results have been striking.  Cancer cells stopped growing within the mice after three weeks of treatment with HRX9.

New diagnistic tools

New diagnostic tools, such as a test which measures the levels of a substance called microRNA in tumor tissue, are developing which may allow a much earlier diagnosis of mesothelioma. Survival rates are generally best when doctors can catch the disease early and begin treatment before the cancer starts to spread out of control. As diagnostic technologies continue to improve, it will be much easier for doctors to diagnose mesothelioma earlier with a high level of confidence.

IMRT

IMRT (intensity modulated radiation therapy) has shown impressive early results. This technology allows doctors to deliver higher doses of radiation with more accuracy, which may reduce accidental damage to healthy tissue. Researchers think combining IMRT with chemotherapy may not only kill the immediate tumours but also help prevent them spreading.

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