Mesothelioma Treatment by Stage

Staging is a method of classifying the tumor according to its size and location, and whether it has metastasized into the lymph nodes and/ or other organs. The National Cancer Institute divides the four stages of mesothelioma into two groups:

  • Localized malignant mesothelioma (Stage I) – In this stage, the cancer is confined to the chest wall lining, and/or the lining of the lung, diaphragm and the sac that covers the heart.
  • Advanced malignant mesothelioma (Stages II-IV) – In stage II, the tumor has spread from the chest wall into the lymph nodes. Additional cancer sites may include the lining of the lung, diaphragm and the sac covering the heart. In stage III, the cancer has spread to other organs and tissues in the same area. It may also have spread to the lymph nodes on the opposite side of the chest and/or outside the chest. In stage IV, the tumor has spread to distant organs and tissues.

In Addition to the Mesothelioma Stage, Treatment can be Determined by Whether the Tumor is Operable

Another consideration that affects treatment is whether or not the tumor is resectable, meaning it is operable. In stages I-III, if the tumor can be removed completely, or even debulked, meaning removed as much as possible, then the patient will be given the standard of care. Currently this refers to what is known as multi-modality or tri-modality treatment, which includes surgery, chemotherapy and radiation.

In an article titled “Therapeutic Strategies for Resectable Malignant Pleural Mesothelioma” (English translation), published November 2009 in Nippon Geka Gakkai Zasshi (Journal of the Japanese Surgical Society), the author S. Hasegawa noted that because no single treatment is effective for malignant pleural mesothelioma, a combination of surgery, chemotherapy and radiation is currently considered the standard therapy. However, this aggressive form of treatment involves extremely high risk , which makes it necessary to carefully assess the patient prior to surgery for their ability to withstand the operation as well as whether or not the surgery will be curative. Hasegawa added:

Very recently, the results of three major clinical trials of trimodality treatment for MPM (malignant pleural mesothelioma) have been reported from North America and Europe. The therapeutic regimens and results of these trials were similar. Although the overall results were not encouraging, surprisingly good survival rates were noted in patients who had no mediastinal node involvement (lymph nodes in the space between the lungs) and completed the entire trimodality therapy regimen. This clearly illustrates that patient selection plays a key role in MPM treatment.

In mesothelioma stage IV, surgery is usually not an option

In this mesothelioma stage, the cancer is considered inoperable and has spread to distant sites. The treatment for these patients is chemotherapy or supportive care to alleviate symptoms. The standard regimen of chemotherapy treatment is the combination of cisplatin (brand name Platinol) and pemetrexed (brand name Alimta).

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