Mesothelioma and Asbestos

Mesothelioma remains an incurable cancer, as well as long-term survival is uncommon. Surgery to remove the pleura, ipsilateral lung, phrenic nerve, hemidiaphragm, as well as pericardium combined with chemotherapy or radiation therapy may be considered, although it does not substantially change prognosis or survival time. No treatment substantially prolongs survival. Survival from time of diagnosis averages 8 to 15 mo, depending on the location as well as cell class. A few patients, usually younger patients with shorter duration of symptoms, possess a more favorable prognosis, sometimes surviving for several years after diagnosis.

Treatment

Supportive care
Pleurodesis or pleurectomy for pleural effusions as well as relief of dyspnea
Analgesia with opioids as well as sometimes radiation therapy
Chemotherapy for tumor shrinkage as well as symptom relief
Experimental therapies

Complete surgical resection usually isn’t feasible. Combination pemetrexed (an antifolate antimetabolite) as well as cisplatin shows promise but warrants further study.

The major focus of treatment is supportive care as well as relief of pain as well as dyspnea. Given the diffuse nature of the disorder, radiation therapy is usually unsuitable except to treat localized pain as well as for needle-tract metastases. It isn’t usually used for treatment of nerve root pain. To help lower dyspnea caused by pleural effusions, pleurodesis or pleurectomy can be used. Adequate analgesia is substantial but difficult to achieve. Usually opioids, both transdermal as well as delivered via indwelling epidural catheters, are used. Chemotherapy using cisplatin
relieves symptoms in most cases as well as sometimes decreases tumor size. Multimodality therapies are advocated by some authorities. Intrapleural injection of granulocyte-macrophage colony-stimulating factor or interferon-γ1b, IV ranpirnase (a ribonuclease), as well as gene therapies are under study.