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Pleural Mesothelioma

Pleural Mesothelioma (Lungs):

What is Pleural Mesothelioma?

Pleural mesothelioma is type of mesothelioma that develops in the mesothelial lining of the lungs(known as the pleura).
Pleural mesothelioma (PM) is the most common form of the disease, accounting for an approximate 80% of all mesotheliomas.
This form of mesothelioma is called malignant pleural mesothelioma (MPM).
Although, MPM is the most common type of malignant mesothelioma, the disease remains somewhat of a rarity.
Median overall survival of a person with pleural mesothelioma is only nearly 1 year.
Pleural mesothelioma occurs more commonly in older men (median age, 70 years) who have been exposed to asbestos, but in many instances can also be occur in younger people.

Why was named “pleural mesothelioma”?

Like other types of mesothelioma, it is named(PM) for the location where it forms — in the pleura, which is a soft tissue covers the lungs.

How common is pleural mesothelioma?

The highest rates of mesothelioma in the world occurs in Australia.
According to the Australian Mesothelioma Registry, each year about 600 Australians are diagnosed with MPM.
Men are more affected than women by pleural mesothelioma. This is probably due to many cases have been caused by exposure of men to asbestos at work.
The incidence of pleural mesothelioma is leveling off in the USA, because asbestos use has decreased since the 1970.
The incidence rate of pleural mesothelioma is increasing in other countries, such as Western Europe, Russia, India and China.
Mortality rates from MPM are highest in the United Kingdom, Netherlands, and Australia, and are increasing in several other countries, such as Japan, Argentina,
and Brazil.

What is the life expectancy of a person with pleural mesothelioma?

the life expectancy of a person with pleural mesothelioma is less than 18 months, but some patients may live much longer. Combining several treatments, such as chemotherapy, surgery and radiation therapy, helps people live longer with MPM.

It often takes 20 to 50 years for mesothelioma to develop after the first time of exposure to asbestos.

This lag time — called a latency period — explains why pleural mesothelioma usually affects older people.

causes of pleural mesothelioma:

What causes pleural mesothelioma?

Generally the only known cause of MPM is inhaling asbestos fibers into the lungs. reports suggest that it may sometimes also be caused by radiotherapy, and recent data suggest that erionite (a mineral that may be found in gravel roads) is also associated with the disease.
Genetic factors may also play an important role in MPM.

How Does Asbestos Cause Pleural Mesothelioma?

After a person inhales airborne asbestos, the human body struggles to remove the mineral’s needle-like fibers from the lungs.

Over a long period of time, trapped fibers migrate from the lungs to the pleural lining and cause chronic inflammation, irritation, and genetic damage.

In 2 to 10% of people heavily exposed to asbestos fibers, the trapped fibers cause PM by triggering genetic changes that turn cells into cancerous cells.

These cancerous cells grow fast and uncontrollably, forming tumors that wrap around the lungs.

approximately 80% of people diagnosed with pleural mesothelioma are men older than 75.

Asbestos exposure most commonly occurred at industrial jobs where men historically comprised the majority of the workforce in the U.S.

symptoms of pleural mesothelioma:

What are the symptoms of pleural mesothelioma?

Symptoms of pleural mesotheliom (The earliest signs and symptoms of pleural mesothelioma) are often vague and similar to other diseases or conditions, such as lung cancer and viral pneumonia.
But lung cancer differs from MPM in that it is a malignancy of the lung tissue itself, whereas pleural mesothelioma which is a malignancy of the tissue covering the lungs.

With regard to Viral pneumonia has certain symptomatic similarities with MPM and is often misdiagnosed as such.
MPM patients may experience symptoms associated with common illnesses, such as:

  • Shortness of breath (breathlessness, dyspnea):

Most patients with pleural mesothelioma experience Shortness of breath.
You may feel like you can’t catch your breath no matter what you do.
It usually feels worse with activity or when you are lying down.
In early mesothelioma, Shortness of breath is caused by a build-up of fluid in the chest (pleural effusion).

  • Chest Pain:

This can be a sharp pain in the chest, which affects your breathing, or a dull pain in the shoulder and upper arm.
The pain might not improve with pain relievers.

  • Other general symptoms include:

Dry or Painful Cough,

Fever or Sweating (especially at night),

Tissue Lumps in the Chest,

Coughing up Blood (Hemoptysis),

Swelling of Face or Arms,

Fluid Buildup (Pleural Effusion): A buildup of fluid inside the pleural space can cause severe and chronic chest pains, weight loss,

Pleural mesothelioma is difficult to be detected because its symptoms, such as fever and shortness of breath, are common in other respiratory ailments.

How Is Pleural Mesothelioma Unique?

MPM accounting for an approximate 80 – 90% of all mesotheliomas cases.

Pleural mesothelioma differs from other types of mesothelioma in four primary ways:
Location: Pleural mesothelioma develops in the mesothelial linings of the chest wall and the lungs, (known as the pleura).

Symptoms: because the disease essentially affects the lungs, the primary symptoms of the disease affect the respiratory system, as shortness of breath, or the thoracic cavity, as chest pain.

Treatment: Mesothelioma is generally resistant to chemotherapy and/or radiation treatment, for this reason the standard treatment for pleural mesothelioma is surgery, that may includes removal of some or all of the pleura and possibly part of the lung.

Survival: Mesothelioma prognosis is generally poor, with median overall survival time of about 1 year. However, there are cases of long-term survival, in some cases as long as 20 years.

Diagnosis of pleural mesothelioma:

How is Pleural Mesothelioma Diagnosed?

Diagnosis of pleural mesothelioma usually begin by seeing your GP or by going to a hospital emergency room probably for chest pain, shortness of breath or another symptom.

The doctor will examine you, arrange for a number of tests and probably refer you to a specialist, usually a respiratory physician.

The doctor will also take a history of general health and exposure to asbestos.

Malignant pleural mesothelioma symptoms are often simalr to those of other diseases, and mesothelioma cells can look similar to other types of cancer cells. this is making diagnosis extremely difficult in many cases.
That is why the diagnosis of the disease is undergo a series of tests that can rule out other diseases, including various types of cancer.

And there will be different health professionals involved in working out whether you have MPM. Each person’s pathway to diagnosis will be unique.
The first step in the diagosis of malignant pleural mesothelioma is usually to perform one or more imaging scans (x-ray, PET, CT, or MRI) to identify potential tumors.

If such that tumor is detected, blood tests may be performed to detect certain biomarkers ( refers to a measurable indicator of some biological condition or state).

If these tests point toward the possibility of precence of mesothelioma, the diagnosis will need to be verified through a biopsy sample – usually through a thoracoscopythoracentesis, thoracotomy, or mediastinoscopy.

General tests for the diagnosis of pleural mesothelioma:

Blood test:

You will have blood taken to examine your overall health. A blood test won’t show up mesothelioma, but it can let doctors to know how your liver, blood cells and kidneys are working.

Chest x-ray:

You will have a chest x-ray to look for any abnormalities in the lungs, thickening of the pleura, and fluid in the space between the lungs and the chest wall.

If abnormal growth or other changes are found, you will need more tests to find the cause as these changes can also be due to other conditions.

CT scan

A CT (short for computerised tomography) scan uses x-ray beams to make a detailed, three-dimensional image of the inside of the body.
The CT scan provides exact information about the placement and thickness of the tumour(s) within the chest. It can may also show if the mesothelioma has spread to other organs.

The information obtained by the CT scan is used to help choosing the best way of obtaining tissue for examination by a pathologist.
A CT scan is painless and takes about 10 minutes. You will need to lie flat on a table that slides in and out of a large, round scanner.
CT scans are usually done at a hospital or a radiology service. Before the scan, an iodine contrast dye is usually injected into a vein in your arm to make the scan pictures clearer. You will be asked if you have any allergies to iodine.

Biopsy:

A biopsy is the main method used to diagnose malignant pleural mesothelioma.

A doctor also remove pleural tissue sample to examine under a microscope by a pathologist  to define if the tumour is pleural mesothelioma and, if so, the type of mesothelioma cells present, (i.e. sarcomatoid , epithelioid or biphasic).

Obtaining a biopsy sample for diagnosis can be challenging, so a respiratory physician, thoracic surgeon, radiologist, and pathologist can all be involved.

A biopsy can be taken in 2 ways. While either technique will diagnose pleural mesothelioma, both have cons and pros .

Video-assisted thoracoscopic surgery (VATS):

VATS is a type of keyhole surgery. You will be given a general anaesthetic, then small cuts will be made between your ribs and a camera will be inserted into the pleural cavity.

Samples of the pleura are taken and the tissue is sent to the pathologist for examination.

After the VATS you may spend a few days in hospital. Soreness in the front and lower parts of the chest is common because the nerves between the ribs will have been irritated during surgery.

 CT-guided core biopsy:

You will have a local anaesthetic and a needle (with a tip for cutting out tissue) will be passed between your ribs into the thickest part of the diseased pleura.

A CT scan will be used to guide the needle into position. During the procedure, you will need to lie still on a table, either on your back or front, for about 30 minutes.

Afterwards you will stay in the radiology suite for a couple of hours to watch for potential complications such as bleeding or a collapsed lung.

Other ways to diagnose mesothelioma

The current clinical practice guidelines for mesothelioma state that some techniques are not a reliable way to diagnose pleural mesothelioma.

These include tissue obtained through a fine needle aspiration or a biopsy without CT image or ultrasound guidance.
In some cases, a fluid sample rather than a tissue sample may be used to make a diagnosis because it’s easier to collect fluid removed while draining the pleural cavity.

However, it is difficult to see cells under the microscope with fluid samples, particularly as abnormal mesothelioma cells can look similar to cells found in other conditions.
However, some of the mesothelioma specialist diagnostic centres have developed a high level of experience in using fluid samples for mesothelioma diagnosis, provided a large volume of fluid is obtained.

Combining results obtained from the fluid samples with information collected from an x-ray and CT scan (that show the tumour present in adjacent tissue) can give us an acceptable level of certainty of the diagnosis in experienced hands.

Further tests

Sometimes mesothelioma diagnosis is challenging and the pathologist needs to do additional test known as special staining.
This looks for specific molecules in the biopsy sample that may assist to distinguish pleural mesothelioma from other cancers.
After pleural mesothelioma has been diagnosed, further tests  can be done to find out if the disease has spread to other parts of the patient body and, if so, by how much and how far.

This process is known as staging. Knowing the stage of the cancer helps doctors plan the best treatment for you.

misdiagnoses for pleural mesothelioma:

The most common misdiagnoses for pleural mesothelioma include:

1- Chronic Obstructive Pulmonary Disease (COPD)
2- Pneumonia
3- Asthma
4- Influenza (the flu)
5- Other chest cancers, such as lung cancer or adenocarcinoma

Malignant Pleural Mesothelioma Staging:

How Is Malignant Mesothelioma Staged?

The following tests are generally used in the staging process:

  1.  CT scan – This is the main test used to stage pleural mesothelioma.
    You may have had a CT scan test earlier when mesothelioma was detected, or during a CT-guided core biopsy.
    If this CT scan showed advanced disease, a further CT scan may not be necessary.
  2. Spiral CT scan – This scan takes detailed pictures of the organs, chest lymph nodes and other locations where mesothelioma may be present.
  3. FDG-positron emission tomography (FDG-PET) – This involves the injection of a specially modified sugar molecule (fluorodeoxyglucose or FDG) that is taken up by cells and helps distinguish between benign and malignant tumours.
    FDG-PET can find disease in lymph nodes and at other sites that may not have been seen on a CT scan.
  4. Mediastinoscopy – This procedure is used to examine and sample the lymph nodes at the centre of the chest. A small cut is made in the lower neck, and an instrument is inserted through the opening and passed down into the chest. The surgeon will remove some tissue from the area between the lungs (mediastinum).
  5. Endobronchial ultrasound (EBUS) – This relatively new procedure may be used along with, or instead of, mediastinoscopy. A tube, called a bronchoscope, with a small ultrasound probe on the end, will be put down your throat into your trachea. This allows the respiratory physician to target lymph nodes for biopsy.
  6. Surgical staging – Surgical staging is the most accurate way of staging cancer, but it is suitable for only a small number of people.

It involves taking a biopsy of lymph nodes and other areas of the body that may be affected by mesothelioma.
The goal is to find previously unknown disease and assist doctors decide if radical surgery is an adequate treatment option.

several systems have been used for staging malignant pleural mesothelioma, but the recommended one now is the international tumour-nodemetastasis or TNM staging system.

Two other staging systems are used less often, including the Brigham and Women’s staging system and the Butchart staging system.

Pleural mesothelioma specialist Dr. David Sugarbaker created the Brigham and Women’s staging system based upon his extensive surgical experience.

Butchart, developed by Eric Butchart in 1976, is the oldest staging system.

Pleural Mesothelioma Prognosis:

What is prognosis means: it means the expected outcome of a disease.
You can discuss your prognosis with your doctor, but it is not possible for any doctor to predict the exact course of the illness.
Pleural mesothelioma behaves differently in different people.

Therefore, it can in many instances be available for many months and be diagnosed at an advanced stage, that may affect the prognosis step.
After diagnosis, cancer may progress quickly or more slowly. If mesothelioma progresses slowly, some people may live for many years.
While knowing the stage helps doctors plan the best treatment for you, it is not always useful for determining prognosis for people with pleural mesothelioma.
This is partly process because scans do not always pick up all the areas the cancer has spread to.

Several factors Your doctor will consider when discussing prognosis with you, include the following:
  • mesothelioma cell type you have – epithelioid mesothelioma tend to have a better outcome than the other types (sarcomatoid or mixed types)
  • the stage
  • the type of treatment you are able to have
  • your symptoms, such as weight loss or chest pain
  • white blood cell count – people with normal levels usually have a better prognosis
  • your overall health – doctors refer to this as your performance status.

Prognostic Indicators:

Several poor prognostic factors have been identified in patients with MPM.

  •  non-epithelioid histology
  • advanced stage disease
  • poor performance status
  • pleural involvement
  • lactose dehydrogenase (LDH) greater than 500 IU/L
  • platelets greater than 400,000 ?L
  • white blood cell count greater than 8.3 x 109/L
  • age greater than 75 years
  • male gender
  • low CRP

Treatment of pleural mesothelioma:

For many people, pleural mesothelioma is diagnosed at an advanced stage.
What is the goal for treatment of pleural mesothelioma?
The main goal of treatment is to manage your symptoms and keep them under control for as long as possible.
though there’s no cure for pleural mesothelioma, treatment could cause you to feel better and help you live longer. This is often referred to as palliative treatment.
So, here we will describes several ways of managing symptoms.
You may have a combination of these treatments. If the symptoms return after a period of wellness, you may be offered a different combination of treatments.
Treatment options for patients with malignant pleural mesothelioma may include radiotherapy, chemotherapy, and/or surgery in a select number of patients.
All patients diagnosed with MPM should thus be managed by a multidisciplinary treatment team.

  • Breathlessness:

Breathlessness is the most common symptom of pleural mesothelioma.
In the first stages of pleural mesothelioma, controlling the pleural fluid build-up around the lungs and using surgery can improve breathlessness.
The level of this improvement will rely upon how healthy your lungs were before you developed pleural mesothelioma, and the level of lung function after surgery.
During malignant pleural mesothelioma diagnosis process, fluid build-up will have been drained off, and further accumulation of fluid can be prevented by pleurodesis.
Although living with breathlessness can be difficult and can cause distress, there are surgical and non-surgical ways to prevent or reduce its impact on your life.

Improving breathlessness with surgery Video-assisted thoracoscopic surgery (VATS) and talc pleurodesis – If you were diagnosed with pleural mesothelioma after a CT guided core biopsy and the symptoms of breathlessness remain, your surgeon may suggest you have VATS.
During the VATS, some of the lining of the chest wall and lung will be removed (pulmonary decortication) and some sterile talcum powder will be injected into the pleural cavity (talc pleurodesis).
This causes inflammation that closes the pleural cavity and prevents fluid from building up again.

In most cases, this procedure improves your ability to breathe.
Open surgery (thoracotomy, pleurectomy and pulmonary decortication) – Following VATS and talc pleurodesis, the fluid build-up around the lungs may come back, making you feel breathless again.
The surgeon may suggest more extensive surgery called thoracotomy with pleurectomy and pulmonary decortication.
In rare cases, if you are experiencing pain in the chest, the surgeon may suggest open surgery to relieve the pain.
Under a general anaesthetic, the surgeon will open the chest by making a cut from the back to the side of the chest, and between the ribs.
The pleural fluid is drained and that part of the pleura most affected with cancer will be removed.
After this procedure, the lung is inflated by the anaesthetists and the chest is closed.

Chest tubes are left in place for at least 48 hours to drain blood and any air that is leaking from the peeled lung surface.
This type of surgery controls recurring pleural effusion in most cases.
Pain results after open surgery can last longer than that after VATS, but the improvement in symptoms and lung function can make this worthwhile if VATS has been unsuccessful.

Indwelling pleural drain – An indwelling pleural drain can be offered to people who are too sick for VATS or open surgery.
It can also be used if the pleural fluid builds up again after pleurodesis.
The surgeon or interventional radiologist inserts a thin tube (catheter) through the chest wall into the pleural cavity.
The pleural fluid is connected to a bottle to drain off fluid and assist your breathing.

You may have to drain the fluid 1–2 times a week depending on how quickly it builds up again.
You can manage the drain at home with the help of a community nurse.
Your family or a friend can also be taught how to do this.
Sometimes with an indwelling pleural drain, the pleural cavity can close up over time and stop producing fluid. If this occurs, the drain can be removed.

  • Difficulty sleeping:

Getting a good night’s sleep is important for maintaining your energy levels and reducing your fatigue.
Difficulty sleeping may be due to pain, breathlessness, anxiety or depression.
Talk to your doctor about what might be helpful for you, and whether medication may be an option.

You may want to limit use of technology, such as television or computers, before bed and set up a calm sleeping environment with soothing music.

  • Fatigue:

Fatigue means feeling very tired and lacking energy to carry out day-to-day activities.

For people with cancer it different from tiredness. It does not always go away with rest or sleep.
If fatigue continues for long periods of time, you may lose interest in things that you usually enjoy doing or feel unable to concentrate on one thing for very long.
Fatigue can influence how you feel about yourself and others, which may affect your close relationships.
If fatigue is a problem, talk to your treatment team.
Sometimes fatigue can be caused by a low red blood cell count or the side effects of drugs, and can be treated.
While you cannot always get rid of fatigue, you can find ways of managing it and boosting your energy levels.

  • Loss of appetite and weight loss:

For many individuals, losing weight and interest in eating are common even before MPM is diagnosed.
Weight loss may be caused by breathlessness, difficulty swallowing, nausea, changes in taste or smell, or feeling down.
Maintaining good nutrition will help you cope better with day-to-day living, treatment and side effects, and improve your quality of life.

  • Constipation

Constipation is when your bowel motions are difficult to pass and infrequent.
It may be caused by reduced physical mobility, low fibre intake, and not drinking enough fluids.
Some medications, particularly strong pain medicines and anti-nausea medicines, may cause constipation.

  • Pain:

People are naturally fearful of experiencing pain, and it’s vital to let your health care team know if you are in pain.
If it is caused by the malignant pleural mesothelioma itself, it is usually a dull, generalised pain, but if the disease has spread or presses on the ribs, it can be sharp and affect individual breathing.

Pain may also be a side effect of treatment.
Chemotherapy and surgery can injure nerves and cause pain or numbness in certain parts of your body.

Managing pain with medicines, radiotherapy and chemotherapy:

Pain medicines may be mild, like aspirin or paracetamol; moderate, like codeine; or strong opioid-based, like morphine.
Pain-relieving drugs may be taken as tablets, other oral mixtures, patches, injections and intravenous infusions.
Other drugs may also be prescribed, like non-steroidal anti-inflammatory drugs
(NSAIDs) or drugs specifically for nerve pain.
To help find the right medicine for you, your doctor may prescribe different drugs, different doses or a combination of drugs.
Pain can usually be relieved with the right medicine.

Opioids – Opioids, such as morphine, are the most common drugs used to control moderate to severe cancer pain.
Morphine is available in quick-acting and long-acting forms.
Some people feel concerned about taking morphine, thinking they will become
addicted.
However, pain specialists believe that a person does not become addicted to morphine if they are taking it as prescribed by their doctor to relieve pain.
Morphine can be taken for a long time and in increasing doses, if needed.
It doesn’t have to be kept for ‘when the pain gets really bad’.

Radiotherapy – This is used when malignant pleural mesothelioma spreads, or presses on specific parts of the body like bones, nerves or major blood vessels, causing pain.

Chemotherapy – This is can be use to reduce the size of the malignant pleural mesothelioma tumours which are causing the pain.

Palliative treatment of Pleural Mesothelioma:

Palliative treatment helps to improve a person’s quality of life by reducing pain and managing other physical and emotional symptoms.
Treatment may include radiotherapy, chemotherapy or other medicines.
It is often assumed that palliative treatment is for people at the end of life; however, it is beneficial for people at any stage of a mesothelioma diagnosis.
Contacting the palliative care team soon after diagnosis gives them the opportunity to get to know you, your family and your circumstances.
Although other specialists will be responsible for your treatment in the first part of your diagnosis, the palliative care team may become involved when needed and manage your care when active medical management becomes less effective.
Ask the doctor in charge of your medical care about making an appointment with the palliative care team.

Active treatment:

A range of active cancer treatments are recommended for some people with pleural mesothelioma.
These can include chemotherapy, radiotherapy or surgery, or a combination of these treatments called trimodality therapy.
Your specialist will discuss suitable treatment options with you.
These suggestions will be based their on a number of factors, including the location, stage and type of mesothelioma.
Each individual with pleural mesothelioma is different, and the age, health and fitness, family circumstances and support can be considered to define the best treatment options suitable for you.
Although there is no cure for malignant pleural mesothelioma, the active cancer treatments  help some individuals to achieve a longer period of control over the disease and improve prognosis.
These types of treatments differ from palliative treatment, which primarily aims to improve quality of life without extending survival.

  • Chemotherapy:

Chemotherapy treats cancer using anti-cancer (cytotoxic) drugs.
It aims to destroy cancer cells while causing the least possible damage to healthy cells.

The most popular used chemotherapy drugs for treatment a person with malignant pleural mesothelioma include the following:

pemetrexed (Alimta®) with cisplatin or carboplatin.
Research shows that this combination can increase survival by a few months and improve quality of life, and is better than receiving a single chemotherapy drug. However, chemotherapy doesn’t work for some people.
The majority of doctors recommend that you start chemotherapy treatment when the CT scans show signs of active disease and/or you have developed mesothelioma symptoms.
Sometimes your doctor will recommend that you start chemotherapy before symptoms develop further.
Talk to your specialist about the best time for you to begin.
Chemotherapy is generally administered into a vein through a drip (intravenously).

Each session may last for several hours followed by a rest period of several weeks. This is known as a cycle.
You will probably have up to six cycles. However, the length and timing of the treatment and rest days of the cycle may vary.
During the chemotherapy, you will have CT scans to check if the malignant pleural mesothelioma is shrinking.
Other scans, such as FDG-PET or FDG-PET-CT, may be used to help whether the treatment is working and show how active the disease is.
Certain blood tests may also show whether the disease is responding to chemotherapy.
For some people, quality of life improves for a while after chemotherapy.
If the disease activated again, you may be offered further courses of the same type of chemotherapy.
If this treatment is unsuccessful, you may be offered a different chemotherapy drug option such as ‘second line’ chemotherapy, or an experimental drug.
Your medical oncologist will use new information from clinical trials to decide on the best treatment options for you.
Side effects of chemotherapy:
individuals react to chemotherapy differently – some people can have few side effects, while others have more side effects.
The side effects depend on the type and dose of drugs you’ve been prescribed.
Your doctor may change the dose or type of chemotherapy if necessary.

The most common side effects you may experience include:
  • tiredness and feeling weak (fatigue)
  • nausea and/or vomiting
  • bowel problems (diarrhoea or constipation related to
    anti-nausea drugs)
  • sore or dry mouth, or small ulcers in the mouth
  • taste changes and/or loss of appetite
  • increased risk of infection (low level of white blood cells) and anaemia (low level of red blood cells)
  • reduced kidney function
  • ringing in the ears (tinnitus)
  • skin changes
  • numb or tingling hands or feet
  • red and itchy eyes (conjunctivitis).

While hair loss and scalp problems are rare with the pemetrexed and cisplatin or carboplatin combination, there may be hair thinning.
Some people have trouble thinking clearly or experience short-term memory loss after chemotherapy, but this usually improves once treatment ends.
You will be given medicines to control any side effects related to the chemotherapy treatment.

  • Radiotherapy

Radiotherapy is the use of high-energy x-rays to kill or damage cancer cells.

It can be used at different stages of malignant pleural mesothelioma treatment and in different ways.
It can relieve pain or other symptoms caused by tumours.

Radiotherapy is also given after chemotherapy and surgery (adjuvant radiotherapy) to help kill remaining cancer cells.
Treatment is carefully planned to break down as many cancer cells as possible with minimum  normal tissue damage.
To plan your treatment, you will have CT scans of the affected area.

The radiation oncologist may mark your skin with a special ink to make sure the radiation is directed at the same place on your body every time you receive radiotherapy.
Although the ink is permanent, the mark is the size of a freckle.
The initial appointment to see the radiation oncologist and set up the machine may take a few hours, but the treatment itself takes only a few minutes.
It is usually given Monday to Friday as an outpatient treatment.
The length of the treatment course can vary depending on why you’re having radiotherapy – usually 2–4 weeks for managing palliative symptoms or 6 weeks for radical radiotherapy.
Radiotherapy does not hurt and you are not radioactive afterwards.

Side effects of radiotherapy

Radiotherapy may cause some side effects during treatment or shortly afterwards, but most side effects go away after the treatment stops.
Side effects may vary depending on the area of the body treated, but include tiredness, reddened and peeling skin, painful swallowing and loss of hair in the treatment area.
Also radiotherapy to the chest area can cause difficulty swallowing and symptoms of reflux for a few days or weeks.
If radiotherapy with high doses are given to the chest area, it can cause permanent changes (fibrosis) in the lung tissue.

Your doctors and nurses will tell you about what side effects to expect from radiotherapy.

  • Trimodality therapy

Trimodality therapy includes a combination of induction chemotherapy, radical surgery and radical radiotherapy.
The aim of the three phases is to control the disease for as long as possible.
The benefits of trimodality therapy are not yet clear. Not all mesothelioma specialists recommend trimodality therapy, and it’s available in only a few treatment centres.

There has not yet been an evidence-based trial comparing the results of radical trimodality treatment to more limited treatment.

 

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