Resectable Mesothelioma

Resectable mesothelioma refers to cases of mesothelioma in which surgery is an option for the removal of all visible tumors.  During the surgery, the tumors will be removed, and it is hoped that all mesothelioma cells are removed from the tissue in the process. Benign mesothelioma is almost always treated with surgery. When the mesothelioma tumors are cancerous, the doctor must decide if the tumors appear to be operable. If they are not then the cancer is unresectable.

Whether or not malignant mesothelioma can be treated with surgery depends on various factors including the stage of the cancer, the patient’s health, the location of the tumor, the type of tumor, and whether the tumor has spread. The doctor must evaluate all of these factors before deciding if surgery is a good treatment choice.

When is Mesothelioma Resectable? 

In most cases of cancerous mesothelioma, the disease is usually only resectable when the cancer is in the first stage. There are several different systems for labeling cancer stages and they include the Butchart, TNM, and Brigham systems. Each of these systems divide the patient’s cancer into groups based on its characteristics such as whether the tumor has spread or has invaded surrounding tissue.

Regardless of which system is being used, Stage I mesothelioma means that the tumor has not spread or has spread minimally.  At Stage I of mesothelioma, the cancer has not reached the lymph nodes and does not appear to have entered the bloodstream. Therefore, it is one of the most treatable forms of malignant melanoma. The later stages of cancer involve a growing cancer that has become more invasive and thus more serious. However, in some cases mesothelioma may be resectable even in the later cancer stages. The doctor will evaluate:

  • Patient’s overall health
  • 5-year survival rate prognosis
  • Type of tumor
  • Whether the tumor has metastasized
  • Tumor size
  • Mesothelioma cell type
  • Where the tumor is located

There is a much higher success rate of surgical treatment of mesothelioma if it is performed in the first stage. Because the tumor has not spread throughout the body at this stage, a surgeon may be able to remove the entire tumor and all mesothelioma cells.  Even in Stage I, a doctor may still recommend following up surgery with chemotherapy or radiation to ensure that all cancerous cells have been destroyed.

In stages II or III, surgery may still be used as a treatment of mesothelioma.  However, it will likely be used only for reducing symptoms of the mesothelioma and not treating the disease. Chemotherapy and radiation are the most common methods of treatment for Stage II and III mesothelioma.

Types of Resectable Mesothelioma Surgeries 

The surgical procedure for removing mesothelioma varies on a per-patient basis.  There are three main types of surgeries used for resectable mesothelioma:

  • Pleurectomy: during this procedure, a section of the pleura (the membrane which lines the lungs) is removed
  • Decortication: during this procedure, sections of the outer membrane on affected organs is removed
  • Extrapleural Pneumonectomy: during this procedure, sections from the lining of the lung, heart, and diaphragm or the entire diseased lung are removed.

The very rare cases of testicular mesothelioma are typically resectable.  They may be treated with removal of part of the testicle or the entire testicle.

In some cases, surgery is used for palliative care. In other words, surgery is done to relieve mesothelioma symptoms or to add some quality to patient’s remaining life. The surgery is not considered a potential cure in these cases.

There is no single mesothelioma treatment considered effective and that includes the surgical option. For this reason, a combination of treatments are almost always used. For example, in the case of malignant pleural mesothelioma, treatment normally includes chemotherapy before surgery, an extrapleural pneumonectomy, and post surgery radiation. Studies have indicated that the success of this aggressive treatment strategy in prolonging survival depended on patient factors like the extent of the mesothelioma and the ability of the patient to manage the difficult trio of treatments.1

What’s New in Treatment Options

The question is: what’s new in the treatment approach to mesothelioma? The latest research seems to be focusing on combining new chemotherapy drugs with surgery or radiation as the first-line regimen and usually just a combination of chemotherapy drugs in the second-line treatment. However, other new treatments being tried include proton therapy and intensity- modulated radiation therapy coupled with chemotherapy drugs.2

State-of-the-art treatments include molecular targeting agents or targeted therapies and gene therapy. Researchers have recently discovered that immunotherapy may also be beneficial in some cases. Research in this area is focusing on identifying biomarkers that will enable the doctor to predict treatment responses.3 Many of these latest techniques are not fully tested, but they do offer hope for the future. When you choose a doctor, it is important to verify that he or she has stayed current on the latest research in order to locate the ideal treatments for your situation.

References

1 Haseqaqa S. (Nov 2009) Therapeutic strategies for resectable malignant pleural mesothelioma. Nihon Geka Gakkai Zasshi. v110:6, 338-342.

2 Takigawa, N., Kiura, K. and Kishimoto, T. (2011)  Medical Treatment of Mesothelioma: Anything New? Current Oncology Reports. v13:4, 265-271.

3 Disis, M. L. (2011) Immunologic biomarkers as correlates of clinical response to cancer immunotherapy. Cancer Immunology, Immunotherapy. v60:3, 433-442.