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The stage (extent) of a mesothelioma is an important factor in determining treatment options. Treatment option used is also based on the patients state of general health and individual preferences. The stage of the tumor most importantly helps to determine whether the tumor is resectable {operable} or not.
Mesotheliomas are very resistant to treatment irrespective of their stage and it is always very important for the patient to know the goal of his or her own treatment before it is commenced, the patient should know whether the aim of the treatment plan is curative or whether it is palliative. The patient must also be informed about the likely side effects and benefits of the treatment. All these will help the patient to make up his/her mind on the preferred mode of treatment.
Early Stage Mesothelioma
Most stage I and some stage II and III mesotheliomas are potentially resectable, but there are exceptions. Resectability is based not only on the size of the tumor, but also on the histological {cellular type} of the cancer with the epitheliod histological type been the most favorable for surgery. Also the location of the tumor and the general state of health of the victim are also considered before surgery is recommended.
Many patients with resectable pleural mesothelioma undergo pleurectomy/decortication or extrapleural pneumonectomy operations to surgically remove their tumors. Patients with peritoneal mesotheliomas in an early stage might also benefit from surgery. Surgery is more likely to result in long-term benefit in stage I cancers, where there is a better chance that most or all of the cancer can be removed. Some patients can have long remissions after extensive surgery by experts. Surgery may still be helpful for later stage cancers, but the benefits are often temporary.
The use of Chemotherapy and radiotherapy as adjuvant therapy to surgery is also very common, they may also be used as the main therapy in early stage of the tumor if the tumor is not operable due to a poor general state of health.
Other forms of surgery for palliative purposes like thorancentesis can also used to alleviate symptoms in the early stages of the cancer.
Finally a patient can also opt to take part in a clinical trial to help to discover new forms of treatment.
Late Stage Mesothelioma
Stage IV mesotheliomas, as well as many earlier stage mesotheliomas, are not resectable by surgery because of the extent of the disease or because a person may not be able to tolerate an operation. The main treatment options at these stage include chemotherapy and radiotherapy to shrink the tumor mass and relieve some of the symptoms of the diseases. The aim of treatment at this stage is not curative and these modes of treatments have serious side effects which the patient must be aware of.
Patient should also consider taking part in available clinical trials as there is little hope of survival using the conventional methods of treatment.
Pain management is another important aspect of the care of terminally ill patients. Some minor operations and types of radiation therapy can help relieve pain if needed. Doctors can also prescribe strong pain-relieving drugs. Some people with cancer may hesitate to use opioid drugs (such as morphine) for fear of being sleepy all the time or becoming addicted to them. But many people get very effective pain relief from these medicines without serious side effects. It's very important to let your doctor know if you are having pain so that it can be treated effectively.
Recurrent mesotheliomas
Some mesotheliomas may recur (come back) after the initial treatment. If this happens, further treatment options depend on the location of the cancer and the kind of treatment that was previously prescribed for the patient. Most of the time treatment is limited only to palliative treatments. Chemotherapy could be used to shrink the tumor and provide relief for symptoms. Clinical trials should be highly considered as there is very little hope of any improvement with the use of traditional treatments.
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