Meet GUEST BLOGGER Michelle Whitmer. Michelle has been a medical writer and editor for The Mesothelioma Center since 2008. Focused on the benefits of natural and holistic medicine for cancer patients, Michelle is a certified yoga instructor and earned her B.A. in Environmental Studies from Rollins College in Florida.
Accurately diagnosing a mesothelioma patient’s stage of cancer development is essential to getting appropriate treatment. The stages of mesothelioma are determined by the degree of tumor growth and spread. Stage I represents minimal tumor growth and stage IV indicates extensive tumor growth and spread.
Diagnosing the correct mesothelioma stage is challenging, but crucial to providing effective treatment recommendations. Unless your first opinion came from a mesothelioma expert, most people diagnosed with mesothelioma should seek a second opinion from one of the nation’s specialists. Because the cancer is relatively rare, few oncologists have experience diagnosing and treating mesothelioma. Seeking the opinion of a mesothelioma specialist could lead to better treatment.
For example, pleural mesothelioma specialist Dr. David Sugarbaker pioneered one of the most effective surgeries for the cancer, the extrapleural pneumonectomy. Patients with early-stage mesothelioma often qualify for his aggressive treatment approach that may significantly extend survival.
The same goes for people with peritoneal mesothelioma, which develops in the lining of the abdominal cavity. Specialist Dr. Paul Sugarbaker pioneered the most effective treatment for peritoneal mesothelioma, which is cytoreductive surgery with heated chemotherapy that is circulated throughout the abdominal cavity rather than systemically throughout the whole body. The treatment approach significantly improved survival rates for the cancer.
Mesothelioma is a challenging cancer to diagnose. There’s no officially adopted standard protocol for diagnosing mesothelioma, so patients will have different experiences. However, certain diagnostic tools are universally used to reach a mesothelioma diagnosis, such as imaging scans and biopsies.
In many cases, the first imaging scan patients receive is an X-ray, which is followed with more scans if anything unusual is seen in the X-ray. More detailed imaging scans like CT, PET and MRI come next. These scans help provide a clearer indication of how far the cancer may have spread.
To confirm a mesothelioma diagnosis, a biopsy is necessary. A thoracoscopy is a common biopsy for pleural mesothelioma that involves the use of a camera-tipped tube to collect a tumor sample. A mediastinoscopy might also be used to determine if the cancer has spread to the mediastinal lymph nodes, which are located between the lungs in the center of the chest. Spread to the lymph nodes is an indication of stage III cancer.
Treatment for Mesothelioma by Stage
Treatment recommendations are made based upon a patient’s stage. Early-stage tumors respond best to surgery, while stage IV mesothelioma has spread too far for surgery to be effective. Chemotherapy and radiation therapy may be used at any stage, except when a person’s general health is too poor to withstand the side effects.
Most people with mesothelioma receive multimodal therapy, which is the combination of two or more cancer treatments. The most effective combination for mesothelioma to date is surgery, chemotherapy and radiation therapy. This approach is most effective for stage I patients, but stage II and III patients often qualify for the aggressive approach with life-extending results. Stage IV patients may receive a combination of chemotherapy and radiation therapy to relieve symptoms and extend survival.
Stage I Treatment
Because tumor growth is minimal at stage I, surgery is highly recommended to remove as much cancerous tissue as possible. There are two surgeries patients may qualify for, a pleurectomy/decortication (P/D) and an extrapleural pneumonectomy (EPP). An EPP removes one lung while a P/D keeps the lung intact and only removes the lining of the lung.
Chemotherapy with the drugs cisplatin and Alimta is commonly administered after surgery in stage I patients. Radiation therapy is used after surgery to prevent local recurrence, though some centers are having improved success administering radiation prior to surgery to shrink tumors.
Stage II Treatment
Stage II surgery for pleural mesothelioma is usually an EPP. A P/D surgery wouldn’t be as effective since the cancer has spread to the lung in stage II. Following recovery from surgery, chemotherapy is recommended to kill remaining cancer cells the surgery couldn’t remove. Radiation therapy is then used to prevent recurrence, especially along surgery incisions (which is a common place for the cancer to recur).
Stage III Treatment
Certain patients in good health with stage III mesothelioma can qualify for an EPP. The surgery is extensive, so the person must be in adequate physical health to undergo the surgery. Chemotherapy and radiation therapy are given to destroy lingering cancer cells. If the cancer returns, second-line chemotherapy with other drugs, such as gemcitabine and vinorelbine, are recommended.
Stage IV Treatment
Stage IV tumors have grown too much and have spread too far for an EPP surgery to remove all the cancer. However, less aggressive surgeries might be recommended to otherwise healthy patients to reduce tumor size, which can help to relieve pain and improve breathing.
Chemotherapy and radiation therapy can be used to shrink tumors, which can help to relieve pain and improve breathing as well. They might also help to prolong life expectancy by several months.
Other therapies are given to alleviate symptoms, such as medication for pain, pulmonary rehabilitation to improve breathing and occupational therapy to reduce discomfort.
Because the cancer rarely causes symptoms in the early stages, the majority of mesothelioma patients are diagnosed in stage III or IV. Aggressive treatment is most effective at early stages, which stresses the importance of annual physical checkups for anyone who may have been exposed to asbestos in the past.
Guidelines for the diagnosis and treatment of malignant pleural mesothelioma.
Malignant mesothelioma: Review.
Malignant pleural mesothelioma: Update on treatment options with a focus on novel therapies.