Mainly associated with occupational exposure to asbestos fibers, pleural mesothelioma is a scary tumor because of the reduced probability of cure (more than for its diffusion). The numbers, although increasing, are contained. But it is on the therapeutic response of the tumor that affects the membrane that surrounds the lungs (pleura) that we need to work, if the survival rate five years after diagnosis is still less than ten percent. Again, as with many other cancers, there is no one-size-fits-all answer. Surgery – followed by chemotherapy – is the first step for advanced forms (as long as they have not affected the lymph nodes). Immunotherapy is the great hope for the future. As for the present, instead, in a combined approach, it is radiotherapy to appear as a possible solution to increase survival rates.
Determining the stage of the tumor, i.e., how extensive the disease is, is essential to deciding on the type of therapy. Four stages are identified for mesothelioma based on TNM criteria that take into account tumor size (T), possible lymph node involvement (N), and metastasis (M).
As with most cancers, the lower the stage of mesothelioma, the greater the likelihood of successful treatment, although often the diagnosis of this tumor comes when the disease has already passed the early stages and is difficult to treat.
The choice of treatment
The choice of the most suitable type of treatment is usually complex and depends on many factors such as: the stage of the disease, the affected body regions, the presence of metastases and the general health conditions of the person.
In the case of mesothelioma, the decision is made even more difficult by the fact that it is a rare tumor and therefore it is not easy for doctors to compare the effectiveness of different treatments or to have the necessary experience to make the right choice. This is why it is necessary to turn to centers that specialize in its treatment.
When deciding on treatment, the possibility of surgery is first evaluated: a resectable tumor, that is, one that can be removed by surgery, is more likely to be cured than one that cannot be operated on. In general, stage I, II, and III mesotheliomas are operable, but the possibility of removal depends not only on the size of the tumor, but also on the subtype, its location, and the patient’s condition.
Once all the necessary investigations have been made, doctors have several options for treating mesothelioma: surgery, radiation therapy and chemotherapy.
Surgery can have a curative or palliative purpose. In the first case the surgery is aimed at completely removing the tumor which must be well localized, while in the case of palliative surgery the tumor has already spread and the main purpose is to prevent or reduce symptoms.
There are also other treatments, less invasive than surgery itself, that can be used for palliative purposes: the removal of fluid with a long, thin needle from the thoracic cavity (thoracentesis), abdominal (paracentesis) or around the heart (pericardiocentesis) can for example give relief, but has the defect of having to be repeated periodically, since the fluid tends to reform.
In some cases, radiotherapy is opted for, which can be useful for people who, for various reasons, cannot undergo surgery or can have a palliative purpose. This type of therapy can also be used after surgery (adjuvant radiotherapy) to destroy small groups of cancer cells that are not visible and therefore cannot be removed during surgery.
Chemotherapy for mesothelioma is based on the use of a single drug or combinations of several drugs and can help slow the progression of the disease even though it is unlikely to cure it permanently.
The drug can be administered systemically, i.e. with an intravenous injection that carries it throughout the body, or directly into the thoracic cavity (intrapleural route) or abdominal cavity (intraperitoneal route). This localized administration allows to hit the tumor with higher doses of chemotherapy, which is sometimes heated to increase its effectiveness hyperthermic chemotherapy, limiting the side effects to the rest of the body.
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