Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Mesothelioma Diagnosis
Mesothelioma is difficult for doctors to diagnose because it can be easily confused with other diseases. Even after a cancer diagnosis has been recognized, mesothelioma looks similar to other types of cancer in diagnostic tests. A biopsy and immunohistological analysis is needed, and even then other indicators are factored into the diagnosis, given the morphological variations that mesothelioma can appear in.
Your first step after receiving a mesothelioma diagnosis should be to discuss your case with your doctor. It is useful for the person diagnosed with mesothelioma to create a list of questions, including those from his or her family. Ask your doctor questions in different ways until all your questions have been answered. Following are some common questions that may arise after a diagnosis of mesothelioma.
What, exactly, is my diagnosis?
There are three forms of mesothelioma, pleural mesothelioma affects the lining of the lung; peritoneal mesothelioma affects the lining of the abdominal cavity; pericardial mesothelioma affects the lining around the heart. You'll need to know the official definition of your cancer, so you will be able to communicate with other medical professionals at a later date.
A more detailed description of the diagnosis process and thestages of mesothelioma.
A more detailed description of the diagnosis process and thestages of mesothelioma.
How was my diagnosis determined?
Ask your doctor how your diagnosis was determined. The only reliable test for a mesothelioma diagnosis is a tissue biopsy. Fluid biopsy is not considered reliable, since in the case of mesothelioma, the fluid tests negative a high percentage of the time even though cancer is present. A good question to ask is, "How accurate are the tests that diagnosed my disease?"
What is my next step?
Following discussion of your diagnosis, your doctor will most likely recommend the next steps you should take. If your diagnosis came from your primary doctor, he will most likely refer you to an oncologist (cancer doctor) for further analysis and treatment. If the doctor you are seeing is an oncologist, he will recommend a course of treatment and explain why he or she feels that specific treatment is best for you.
Should I get a second opinion?
It is always in your best interest to get a second opinion when dealing with mesothelioma. Although general oncologists are extremely competent doctors, they may not see the number of mesothelioma patients that a specialist sees, and may not have the most current information on treatment options. Perhaps the best place to get a second opinion is from a National Cancer Institute designated Comprehensive Cancer Center. You will find a list of these centers at www.mesotheliomaweb.org in the section on "Comprehensive Cancer Centers".
Will my doctor be offended if I get a second opinion?
No reputable physician will question your right to a second opinion. This is particularly important if your mesothelioma was discovered by a doctor without much experience with the disease. Mesothelioma is sufficiently rare that patients would benefit by seeing a specialist.
What type of treatment is available to me?
Once you have a second opinion and have perhaps gathered information on your own, you are ready to make a treatment decision. Time is always of the essence. The longer you postpone deciding on a course of treatment, the more likely your options may diminish. In early stage disease, surgery may be a viable option. If you are not a surgical candidate, chemotherapy is often offered. The Comprehensive Cancer Centers also offer a variety of clinical trials, which are the most recently developed investigative therapies targeting a particular disease. If a particular course of treatment is recommended, ask your doctor to explain the pros and cons of that treatment. Also, ask whether other options are available, and if so, why he chose the treatment offered.
If fluid has collected in the chest or abdomen, your doctor may initiallly drain the fluid out of your body by putting in a needle into the chest or abdomen and use gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is calledparacentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
If fluid has collected in the chest or abdomen, your doctor may initiallly drain the fluid out of your body by putting in a needle into the chest or abdomen and use gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is calledparacentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Are there any treatments I should avoid?
You should avoid unconventional, or scientifically unproven alternative treatments. Although you may hear these treatments have helped some people, they are not backed by sufficient scientific data to prove their effectiveness. Consult your doctor, the National Cancer Institute, or the American Cancer Society if you are unsure whether a treatment is unconventional, investigative, or standard. Bear in mind that unconventional treatments differ entirely from investigational treatments. Also, be assured that doctors do not disapprove of complementary treatments which address psychological or nutritional approaches that improve a patient's physical or emotional well-being and are used in conjunction with proven therapies.
Where should I be treated and by whom?
Once you have made a decision on a course of treatment, you must determine where that treatment is to be carried out. If you have opted for a specialized surgical procedure or clinical trial, chances are you may need to be treated at an NCI-designated cancer center by a specialist skilled in a particular area of expertise. This often raises concerns about travel to facilities which may be hundred of miles away. Organizations such as The National Patient Travel Helpline offer information on all forms of charitable, long distance medical air transportation as well as information on hospitality houses nationwide. You can also access information for travel and lodging at cancer centers in the of this website.
Standard treatment, for instance a standard form of chemotherapy, can most likely be carried out at a local hospital by one of your diagnosing physicians. Even if you received specialized treatment at an NCI-designated center, it is possible that your specialist may work co-operatively with your local doctor. Whoever you choose to carry out your treatment, it should be someone with whom you can find a comfort level and who will welcome your questions and answers them in a manner that is easily understandable. Remember though, that a good "bedside manner" is no substitute for expertise.
Standard treatment, for instance a standard form of chemotherapy, can most likely be carried out at a local hospital by one of your diagnosing physicians. Even if you received specialized treatment at an NCI-designated center, it is possible that your specialist may work co-operatively with your local doctor. Whoever you choose to carry out your treatment, it should be someone with whom you can find a comfort level and who will welcome your questions and answers them in a manner that is easily understandable. Remember though, that a good "bedside manner" is no substitute for expertise.
How can I make the most of my medical appointment time?
Open communication between you and your doctor is key. Bring a prepared list of questions to each appointment, including those about new or continuing symptoms, side effects of treatments and how to manage them, or other information you have come across through talking with family and friends, by reading, or on the Internet. If your doctor seems unwilling to answer your questions, don't hesitate to press for a response. It is to your benefit to be proactive in your care.
What else should I know?
A proper diagnosis is essential before treatment begins. A doctor should be seen if a person experiences shortness of breath, pain in the chest, persistent coughing, or pain or swelling in the abdomen. The doctor may order a chest x-ray or CT scan or fMRI as the first step in diagnosis. If theseimaging techniques show a suspicion of cancer, further tests may be ordered.
The doctor may examine the chest cavity with an instrument called a thoracoscope. An incision is made through the chest wall and the thoracoscope will be placed inside the chest through two ribs. This test, called a thoracoscopy, is done in the hospital. Prior to the test, the patient is given a local anesthetic. Some pressure may accompany this procedure, but usually there is no pain. The doctor may also look inside the abdomen with a special tool called a peritoneoscope. This is called a peritoneoscopy. This test is also performed in the hospital with a local anesthetic. Paracentesis is a related procedure often used in diagnosis.
If, during these tests, tissue is found that is not normal, the doctor will cut out a small piece to be examined under a microscope. This is called a tissue biopsy. The tissue will then be sent to a pathologist to diagnose disease.
Like any cancer, a doctor needs to be very accurate when making a diagnosis if a person comes in complaining of symptoms that could be mesothelioma. One of the most important things for the doctor to be aware of is if the person has ever been exposed to asbestos or if the person suspects he or she might have been exposed to asbestos at some point. This is the most important piece to diagnosing mesothelioma early.
Once the doctor knows that his or her patient has been exposed to asbestos or thinks he or she might have been exposed to asbestos, the doctor can begin ordering the various tests to confirm suspicions or to confirm that the person really just has asthma (better to be safe than sorry!).
The first thing to do for diagnosing mesothelioma is get the individual's complete medical history. This should include information on whether the patient was ever exposed to asbestos or if family members were exposed or diagnosed. There is an increasing trend towards the children or spouses of individuals who were exposed to asbestos being exposed by doing the laundry. If there is a family history of asbestos exposure and mesothelioma, that can help the doctor figure out what is going on.
The doctor will probably order chest x-rays next. These will show if a person has a variety of other signs of asbestos exposure, like scarring. A chest x-ray may also reveal that the person merely has pneumonia and will end the mystery.
If nothing shows up, a Computerized Tomography or CT scan could be necessary. The other option is a Magnetic Resonance Imaging (MRI) scan. These scans will show if there are suspicious looking blobs or dots in the lungs. If there are and the dots look suspicious, the doctor will most likely order a biopsy. A biopsy is a procedure that removes a tiny piece of a suspicious blob for testing. The testing will reveal whether the blob is benign (not harmful) or malignant (mean). If the blob is benign, chances are good that the patient doesn't have mesothelioma but still should be watched because benign tumors have been known to become malignant. If the blob, or tumor, is malignant, then it is pretty much confirmed that the patient has mesothelioma.
Once a diagnosis has been made, the doctor will be able to determine in what stage the cancer is and also where it has taken up residence in the lungs. A doctor will also perform tests to determine if the cancer cells have spread to any other portion of the body.
Mesothelioma, cancer of the mesothelium, is caused by exposure to asbestos. The disease can take decades to appear or to develop to the point that it is detectable. Once it forms, it takes time for the disease to be diagnosed and then treated. So why, exactly, is it so deadly?
One of the biggest problems with the disease is that it takes what seems like forever, to those who have been exposed to asbestos, to show up in tests. The disease usually takes around 20 years to develop but has been known to wait around 40 years to develop. What this means is that a person who knows he or she has been exposed to asbestos can wait a long time before a test shows anything either abnormal or serious.
This long period of inactivity means that individuals who do not know that they have been exposed to asbestos may ignore early signs and symptoms of the disease and explain them away as bronchitis or something else that will go away with time. This means that by the time they go see a doctor because they feel awful and can't breathe very well, the disease has progressed to the later stages.
Like all cancer, there is something very important in treatment about catching the disease early and getting treatment started as soon as possible. When a cancer is detected early and then treated early, the chances that it will be cured and the person's life saved go up drastically. The later cancer is detected in a person, the lower, usually, his or her chances of survival are.
Part of this is due to cancer's very aggressive nature. The unregulated growth of cancerous cells can quickly take over. Worse, in cancers located near major blood supplies or other fluid systems within the body, these cells can break away from the pack and end up halfway across the body and start a new colony.
Because most mesothelioma patients wait to see a doctor until they are having serious problems, they put themselves at risk and lower the chances that there is any hope for treatment. By the time most people go to see the doctor, the cancer has gotten to the point that it is inoperable. Chemotherapy and radiation can only do so much to kill cancer.
Surgery can have an important role within the treatment of malignant Mesothelioma in confirming the diagnosis, assessing the spread of the tumour (stage) and in the control of symptoms.
Surgery and Diagnosis
The diagnosis of malignant pleural Mesothelioma is made most firmly by the inspection of a biopsy of the pleura under the microscope. 
A diagnosis confirmed by biopsy helps when planning further treatment, for some treatments it is essential and it also verifies claims for compensation.
A diagnosis confirmed by biopsy helps when planning further treatment, for some treatments it is essential and it also verifies claims for compensation.It may be possible to obtain a reliable biopsy either by the removal of fluid from the chest (pleural fluid cytology) or a needle biopsy whereby a biopsy is obtained under local anaesthetic sometimes guided by a CT or ultra sound scanner. However, particularly in the early stages, negative results by these tests do not rule out the possibility of Mesothelioma. It may be felt that a surgical biopsy is warranted.
Picture Source - www.mayoclinic.org
There are two “keyhole” procedures that can be used. Under a local anaesthetic it is possible to have a medical thoracoscopy. This involves a small camera telescope being introduced through a single 1-2 cm cut from which a biopsy can be taken. If a general anaesthetic is performed, a thoracic surgeon may perform Video Assisted Thoracoscopic Surgery (VATS), through between 1 and 3 such cuts. This allows a larger biopsy to be performed and a full assessment of the pleura to be made.Video Assisted Thoracoscopic Surgery (VATS) - Picture Source - www.thoracicgroup.com
Staging
If the Mesothelioma is felt to be in an early stage and a surgical resection is being considered, it is essential to fully assess the tumour stage. This may require surgical biopsy of some of the lymph nodes in the centre of the chest (mediastinum). This may be achieved by a biopsy procedure called a mediastinoscopy. This involves a 4cm cut at the base of the neck, above the breast bone (sternum), and the introduction of a telescope (the mediastinoscope) down in front of the windpipe (trachea) into the chest.
Lung Diagram Picture Source - www.usctransplant.org
Radical Surgery
There are two approaches to surgical resection of malignant pleural Mesothelioma; radical and palliative.
The intention of radical surgery is to remove all or the majority of the visible tumour, dependent on which surgical procedure is carried out. With any cancer type radical surgery is performed with the aim of gaining local control in the area of the tumour, in patients in whom tests have not been able to demonstrate the spread of cancer cells elsewhere in the body. This, of course, cannot be guaranteed, as small deposits of cancer cells may be undetectable. With Mesothelioma, although wide margins of normal tissue around the removed cancer are difficult to achieve, the goal of local control can be obtained. It is important to remember that, unlike radical surgery in breast, bowel and lung cancers, where it is possible to offer the chance of a cure, this is not the case in Mesothelioma. No patient has yet been cured of the disease, even after radical surgery combined with chemotherapy and radiotherapy. Radical surgery is appropriate for only a small number of patients since the majority have disease that has already spread. However, palliative surgery may have an important role in improving and controlling symptoms and maintaining the quality of life. There are two radical surgical options - extrapleural pneumonectomy (EPP) and radical pleurectomy and decortication (P/D).
Radical Surgical Options
Extrapleural Pneumonectomy (EPP)
EPP was a procedure which gained initial favour amongst some surgeons in the UK and overseas, but it is now less commonly performed. It is the most aggressive surgical option but it is only appropriate for a very small number of patients. Pre-operative tests must demonstrate that patients have good, adequate lung and heart function before acceptance for surgery. EPP involves removing the entire lung and pleura together with the diaphragm and the side of the pericardium (the sac around the heart) in one piece. After removal of the tumour, the diaphragm and pericardium are reconstructed with artificial patches.
EPP was a procedure which gained initial favour amongst some surgeons in the UK and overseas, but it is now less commonly performed. It is the most aggressive surgical option but it is only appropriate for a very small number of patients. Pre-operative tests must demonstrate that patients have good, adequate lung and heart function before acceptance for surgery. EPP involves removing the entire lung and pleura together with the diaphragm and the side of the pericardium (the sac around the heart) in one piece. After removal of the tumour, the diaphragm and pericardium are reconstructed with artificial patches.
Lung-Sparing Total Pleurectomy (LS-TP)This procedure is also known as Radical Pleurectomy and Decortication (P/D). With LS-TP, the lung is left in place but the thickened pleural membrane covering it is peeled off and the pleura stripped off the chest wall. The pericardium and diaphragm are often removed, depending on the extent of the tumour. LS-TP is still, however, a very big operation that is only suitable for patients with sufficient reserves. As the lung remains in place, and it may even function better after surgery as it can often now expand more easily, recovery from surgery may be quicker and in the longer term quality of life may be preserved or even improved. However, compared to EPP, it slightly less likely to remove all the tissue that may contain tumour cells and therefore there is a greater chance of recurrence around the operated lung. In addition, it may not be possible to administer as high a dose of radiotherapy to the chest after the operation, as it may damage the underlying lung. LS-TP may be useful for patients in whom there is possible spread of the mesothelioma to the lymph glands in the centre of the chest (mediastinum). Not all thoracic surgeons in the UK have experience of this technique and some will prefer to operate after a few cycles of chemotherapy have been given.
Radical Pleurectomy and Decortication (P/D)
P/D is a less radical procedure than EPP and is generally better tolerated by patients. With radical P/D, the lung is left in place but the thickened pleural membrane covering it is skimmed off and the pleura stripped off the chest wall. The pericardium and diaphragm may be removed, depending on the extent of the tumour. As the lung remains in place, and it may even function better after surgery as it can often now expand more easily, recovery from surgery may be quicker. However, compared to EPP, it is not possible to remove all the tissue that may contain tumour cells and therefore there is a greater chance of recurrence around the operated lung. In addition, it may not be possible to administer as high a dose of radiotherapy to the chest after the operation, as it may damage the underlying lung. P/D may be useful in patients who are not fit enough to tolerate the loss of a lung, or those in whom there is spread to the lymph glands in the centre of the chest (mediastinum).
P/D is a less radical procedure than EPP and is generally better tolerated by patients. With radical P/D, the lung is left in place but the thickened pleural membrane covering it is skimmed off and the pleura stripped off the chest wall. The pericardium and diaphragm may be removed, depending on the extent of the tumour. As the lung remains in place, and it may even function better after surgery as it can often now expand more easily, recovery from surgery may be quicker. However, compared to EPP, it is not possible to remove all the tissue that may contain tumour cells and therefore there is a greater chance of recurrence around the operated lung. In addition, it may not be possible to administer as high a dose of radiotherapy to the chest after the operation, as it may damage the underlying lung. P/D may be useful in patients who are not fit enough to tolerate the loss of a lung, or those in whom there is spread to the lymph glands in the centre of the chest (mediastinum).
The Mesothelioma and Radical Surgery Trial (MARS)
Radical surgery will not result in a cure and it will reduce the immediate quality of life. One theory is that, following radical surgery, the progression of the disease would be slower, meaning patients would be better off in the medium and long term. By investigating in clinical trials the effects on the quality and length of life after radical surgery, compared to non-surgical treatment, it is hoped that evidence can be gathered to determine the value of surgery. The MARS trial was a study designed to examine the role of EPP in Mesothelioma. MARS has now closed to recruitment and its final results are awaited. The next part of the MARS trial will investigate LS-TP in a bigger study: funding for "MARS-2" is being sought.
Radical surgery will not result in a cure and it will reduce the immediate quality of life. One theory is that, following radical surgery, the progression of the disease would be slower, meaning patients would be better off in the medium and long term. By investigating in clinical trials the effects on the quality and length of life after radical surgery, compared to non-surgical treatment, it is hoped that evidence can be gathered to determine the value of surgery. The MARS trial was a study designed to examine the role of EPP in Mesothelioma. MARS has now closed to recruitment and its final results are awaited. The next part of the MARS trial will investigate LS-TP in a bigger study: funding for "MARS-2" is being sought.
Palliative Surgery
The type of operation depends on whether the lung on the affected side will expand or not. If after drainage of the fluid around the lung (pleural effusion) the lung will expand, then the options are either the insertion of sterile talc around the lung to seal the space between the pleural linings (pleurodesis) or the removal of the bulk of the tumour (pleurectomy). Both these procedures can be performed reliably by keyhole surgery Video Assisted Thoracoscopic Surgery (VATS). The MesoVATS trial is comparing outcomes of talc pleurodesis with VATS pleurectomy. Please refer to the Clinical Trials section of this website.
If, however, the lung is encased by tumour and cannot expand after fluid has been drained, then skimming the surface of the lung (decortication) will be required to make it possible for the lung to expand and thereby improve the function of the lung and improve shortness of breath. It is sometimes possible to decorticate the lung by VATS, but the majority of surgeons would perform decortication by opening the chest with a large cut made around the back below the shoulder blades, between the ribs this is called a thoracotomy. A trial to examine whether VATS decortication is worthwhile is being planned. Thoracotomy and decortication is a larger procedure reserved for the younger, fitter patients. In the elderly, more infirm patient, a tunnelled indwelling pleural catheter (TIPC) can be inserted. This is a permanent drain with a valve which empties the pleural fluid into a vacuum bottle, every few days as required.
Referral for Surgery
Patients can discuss the appropriateness of surgical treatment with the doctor who is currently caring for them. Not all hospitals are able to offer surgical treatment for Mesothelioma. Referral to other hospitals for treatment can be done by the hospital team currently caring for the patient or the GP where this is not feasible. Mesothelioma UK may be able to help identify the nearest surgical unit, where this is requested.
Conclusion
Surgery is frequently used across the UK to gain a diagnosis and treat pleural effusion. The provision of radical and palliative surgery may vary between parts of the UK and different hospitals. However, not all thoracic surgeons in the UK have experience of radical surgery for malignant pleural Mesothelioma and opinions can differ as to the benefits. It may be necessary for patients to be referred to a specialist centre.
The treatment of Mesothelioma will depend on a number of things including the type of Mesothelioma, how advanced the disease is, the general health and fitness of the patient and their personal preferences.
There are various treatments that may be recommended for Mesothelioma. These include active symptom control, radiotherapy, chemotherapy and surgery. A patient may have just one of these types of treatments or a combination of them.
Chemotherapy can be used to treat Mesothelioma. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of the cancer cells.
Chemotherapy is used in an attempt to shrink the disease and relieve some of the symptoms it is causing. This may improve your quality of life. Some doctors believe it may also help people with Mesothelioma to live a little longer but this is uncertain. Chemotherapy cannot cure Mesothelioma.
Chemotherapy may also be given before or after major surgery for Mesothelioma to prevent or delay the recurrence of the cancer cells. This is called adjuvant treatment.
The chemotherapy drugs that may be used for the treatment of Mesothelioma include Cisplatinum (Platinol), Carboplatin (Paraplatin), Doxorubicin (Adriamycin), Gemcitabine (Gemzar), Mitomycin, Pemetrexed (Alimta), Raltitrexed (Tomudex) and Vinorelbine (Navelbine).
CancerBackup and Macmillan merged in 2008 - the website contains information about individual chemotherapy drugs including how each drug is given and possible side effects that may be experienced with each drug.
In Mesothelioma there is, as yet, no agreement among experts as to when, if at all, during the course of the illness, to use chemotherapy. It is also unknown which is the best drug or the best combination of drugs to treat this disease.
Chemotherapy - How is it Given?
Chemotherapy drugs are carried in the bloodstream to the cancer cells and it can be given in a number of ways. These include:-By injection into a vein or through a drip
A fine needle called a cannula will be inserted into a vein, usually in the back of the hand. This procedure is no more painful than any other injection or blood test.
A fine needle called a cannula will be inserted into a vein, usually in the back of the hand. This procedure is no more painful than any other injection or blood test.
By infusion pump
These are used to give a controlled amount of drug/s into the bloodstream over a number of hours or days. The pumps are compact and can be carried in a bag or on a belt.
These are used to give a controlled amount of drug/s into the bloodstream over a number of hours or days. The pumps are compact and can be carried in a bag or on a belt.
By mouth
Some chemotherapy drugs are given as a tablet, capsule or liquid.
Some chemotherapy drugs are given as a tablet, capsule or liquid.
Chemotherapy Treatment Sessions
On the day of your chemotherapy session, the nurse will explain what is involved and answer any questions you may have before treatment commences.
- You can eat and drink normally on the day of your treatment. However, it is advisable not to have a heavy meal prior to your chemotherapy session.
- Small amounts of alcohol are safe but it is advised that alcohol is avoided for 48 hours after treatment.
- Chemotherapy may be given on a hospital Day Ward (where you visit hospital for a few hours for your treatment) or as an inpatient. Your doctor or nurse will discuss this with you.
Chemotherapy - Picture Source - www.show.scot.nhs.uk
Chemotherapy Side Effects
Chemotherapy drugs act on the cancer cells in your body but they also temporarily reduce the number of some of the normal cells in your blood. When the numbers of normal blood cells are lowered you are more at risk of developing infections and you may tire easily.
The side effects of chemotherapy drugs differ from drug to drug. Possible side effects include feeling sick, being sick, loss of appetite, loss or thinning of hair, constipation and diarrhoea, sore mouth and fatigue. Before you start treatment, your doctor or nurse will explain the side effects you may have and offer advice.
As the side effects of chemotherapy can be significant, the benefits of having chemotherapy need to be carefully weighed up against the side effects that may be experienced. Patients are advised to discuss with their oncologist (cancer doctor) about chemotherapy in their individual situation.
The treatment of Mesothelioma will depend on a number of things including the type of Mesothelioma, how advanced the disease is, the general health and fitness of the patient and their personal preferences.
There are various treatments that may be recommended for Mesothelioma. These include active symptom control, radiotherapy, chemotherapy and surgery. A patient may have just one of these types of treatments or a combination of them.
Radiotherapy is the use of high-energy radiation to kill cancer cells in the body. All the cells in the part of the body being treated have the potential to be affected by the radiotherapy. Normal, healthy cells will to some extent recover. Radiotherapy is used to treat a particular localised area of the body (for example, an area of the chest where pain is felt). The area being treated is often referred to as the radiotherapy field.
A course of radiotherapy is individually prescribed. The course may involve several doses, usually referred to as fractions, or just a few. The number of fractions required would depend on the amount of tissue that is to be treated. Radiotherapy treatment is not routinely given over the weekend.
Radiotherapy can be used in Mesothelioma to reduce the size of the tumour to help to relieve symptoms, such as pain or discomfort.Radiotherapy can also be given to the scar left by a biopsy, drainage tube or operation. This is to prevent the Mesothelioma from spreading into the site as small microscopic deposits may have occurred during the insertion and removal of drains, biopsy needles or surgical instruments.
In Mesothelioma radiotherapy may also be given to much larger areas. The whole chest area on the affected side of a patient can be treated following surgery, to kill diseased cells that it was not possible to remove during surgery. (Please see the Surgery section for further details about Surgery and Mesothelioma).
In Mesothelioma small scars are often treated with 3 doses (fractions) of radiotherapy. When treating to relieve symptoms such as pain up to 10 doses (fractions) may be necessary. When given after surgery to a large area up to 30 treatments may be required.
Before Radiotherapy Begins
Before your treatment begins you will be asked to attend the Radiotherapy Department in order to plan your radiotherapy. Depending on the course of treatment you have been prescribed it may be necessary for X-rays of the area to be treated to be taken by a special machine called a simulator. There may be an interval between this visit to the Radiotherapy Department and the start of the radiotherapy.
Radiotherapy Sessions
The radiographer will ensure that you are comfortable on the couch in the treatment room before starting the session. During your treatment you will be left alone in the room. You will be able to talk to the radiographer through an intercom and the radiographer will be watching you from the next room.- Radiotherapy does not make you radioactive – it is safe for you to be with other people (including children) throughout your treatment.
- You can eat and drink normally before and after each radiotherapy session.
- Radiotherapy treatments are totally painless (like having an ordinary x-ray).
- You will be asked to remain still during treatment but you can breathe normally.
- Each radiotherapy session lasts from a few seconds to several minutes.
Radiotherapy - Picture Source - www.cancerbacup.org.uk
Radiotherapy Side Effects
Radiotherapy can cause side effects such as poor appetite, feeling sick, being sick and tiredness. Some patients also experience soreness and itchiness of the skin and difficulty in swallowing. The extent of the side effects does depend on the dose of the radiotherapy, length of treatment and the size of the area being treated. If you are receiving radiotherapy to a scar or drain site usually side effects are limited to soreness and itchiness of the skin. However, if a larger area is being treated, as well as skin problems, tiredness, difficulty in swallowing and poor appetite can be experienced. If you are undergoing an extensive course of radiotherapy it is possible that other organs within the treatment field, such as the heart, liver, spleen and kidneys, will suffer long-term damage, however this is rare.
If you are having radiotherapy you should discuss the side effects with your radiographer, doctor or nurse. They will advise you who to contact should you experience side effects in between your hospital visits.
Once your course of treatment is finished the side effects should gradually disappear.
It can take many years after being exposed to asbestos for mesothelioma to occur. The length of time taken is referred to as the latency period and is usually between 15-45 years.
In the early stages when the mesothelioma is present as small lumps it will not show up on any scans or x-rays and is unlikely to cause any symptoms. As it progresses pleural and peritoneal mesothelioma can both cause general symptoms such as sweating, tiredness, loss of appetite and weight loss. As the disease advances pleural mesothelioma typically causes patients to feel breathless and/or experience chest pain.
Breathlessness may be due to a combination of factors. The pleura being thickened can act like a rind around the lung restricting its movement and preventing the lung from expanding.Pain can be quite severe as the mesothelioma can extend into the tissues surrounding the pleura including nerves and bone. A variety of medication is available to combat any pain experienced. Fluid may also accumulate in the space between the two layers of the pleura occupying space and again this restricts lung expansion. A cough or altered voice is also sometimes experienced. Peritoneal mesothelioma often causes swelling and pain in the abdomen.
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