1. Traditional mesothelioma treatments
2. New mesothelioma treatments.

1. Traditional mesothelioma treatments are the same as those used to treat most other cancers, and include:

• Surgery
• Chemotherapy
• Radiation therapy

2.   New treatments for mesothelioma include:

• Development of new chemotherapy agents
• Intensity modulated radiation therapy (IMRT)
• Photodynamic therapy (PDT)
• Immunotherapy
• Gene therapy

A number of alternative therapies can also be combined with traditional treatment options. Many patients choose to add alternative therapies such as massage, acupuncture, or TENS therapy to their conventional treatment approach in an effort to enhance or compliment the treatment process. A variety of alternative therapies, including aromatherapy, meditation, or yoga, are often added to a treatment regimen to provide pain relief and foster relaxation.

Chemotherapy can cause anorexia {poor appetite}, constipation and diarrhea. Nausea and vomiting are two of the most common symptoms. Alimta and Cisplatin, two chemotherapy medications often prescribed to patients with malignant mesothelioma, can cause both nausea and vomiting. Although some patients are unable to eat without a feeding tube, others require no assistance.

Following advice offered by the National Cancer Institute (NCI) for patients undergoing cancer treatment:

• Low saturated fats, moderate good fats, and a high fiber intake.
• Eat foods that are easy to digest
• Eat when you’re feeling best
• If chemotherapy does not make you nauseous, eat a few hours beforehand, as this may make you feel better following treatment (many people feel sick following chemotherapy sessions)
• Stay hydrated, but don’t drink so much that it fills you up and suppresses hunger
• Avoid eating when you feel nauseous, which may make you feel more sick and discourage you from eating at other times
• Eating modest quantities is fine, just make sure that they add up to a full day’s worth of meals

If you are unable to eat full meals, consider eating multiple nutritious snacks throughout the day, taking advantage of the times when you are most hungry. Focus on foods you like that are high in calories and proteins, and avoid snacks that might exacerbate your symptoms; shakes are a good way to accomplish both of these tasks.

Following are some general guidelines of what various nutrients provide in the diet.

• Protein:

Protein helps ensure growth, repairs body tissues damaged by surgery, chemotherapy and/or radiation, and helps to maintain a healthy immune system. Most patients require additional protein during and after aggressive treatments to help heal tissues and lower the risk of infection.

• Fats and carbohydrates:

Fats and carbohydrates help supply the body with the majority of its daily caloric intake. Each patient’s age, frame size and level of physical activity will determine what is considered normal for them.

• Vitamins and minerals:

Vitamins and minerals help ensure growth and development, in addition to allowing the body to use the calories supplied by the foods eaten. While it is not always necessary to supplement vitamins and minerals during times when one is maintaining good eating habits, it may become more important when the challenges of being ill or undergoing treatment make eating difficult.

• Water:

Water is essential for life. Without enough water, the body becomes dehydrated. Discuss how much water you should be drinking each day with your doctor or nutritionist.

The ACS has a very useful chart showing good snacks for patients suffering from cancers such as mesothelioma. The chart below shows good sources of protein and calories.

Proteins are essential for patients suffering from mesothelioma treatment-related fatigue, as are fluids and vitamins. None of these, however, is a substitute for calories, a lack of which causes wasting syndrome (cachexia), or massive weight loss, in many mesothelioma patients.

Your dietician can also teach you how to pack more calories into small meals, and can help you overcome symptoms such as difficulty swallowing, fullness and taste changes.

It is the most recent staging system for mesothelioma and looks at variables such as lymph node status and tumor resectability (ability to surgically remove a tumor). The Brigham staging system consists of four stages:

This system considers three components; the first letter of each forming the name of the system. Doctors using TNM will look at the tumor, lymph nodes, and whether the cancer has metastasized. Like the Butchart system, it is divided into four stages.

The three established and recognized clinical staging systems for mesothelioma are:

• The Butchart System
• TNM Staging
• The Brigham System

The Butchart Staging System:

Butchart is the oldest system and is still the most commonly used.  Its four stages are based on the extent of primary tumor mass.

To keep a track of mesothelioma cancer, the extent of its spread and the size of tumor(s); mesothelioma has been divided into a few stages or staging systems. These mesothelioma staging systems keep a track of the development of cancer in the human body. The tests and scans when diagnosing cancer give some information about the stage. It is important because treatment is often decided according to the stage of a cancer.
Some elements common to most staging systems are:
• Location of the primary tumor.
• Size and number of the tumors.
• Lymph node involvement.
• Cell type and tumor grade.
• Metastasis.

Many cancer registries, such as the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) use summary staging, a system used for all types of cancer. Summary staging groups cancer into five main categories:

• In situ – cancer that is present only in the layer of cells in which it began.

• Localized – cancer that is limited to the organ in which it began with no evidence of spread.

• Regional – cancer that has spread from the primary site to nearby lymph nodes or organs.

• Distant – cancer that has spread from the primary site to distant lymph nodes or organs.

• Unknown – cases where not enough information exists to indicate stage.

If, after performing all above tests, a doctor suspects mesothelioma, a biopsy should be taken to confirm the mesothelioma diagnoses.

If tests and health history are consistent with mesothelioma, a biopsy allows the doctor to make a conclusive diagnosis. The biopsy is an effective diagnostic tool, but is not used first because the removal of sample of cells or tissue is more invasive than a simple X-ray or blood draw.

The most definitive test for diagnosing mesothelioma is a biopsy (tissue sample) of affected or suspicious tissues. In that doctor who specializes in diagnosing and treating cancer removes sample of tissue for microscopic examination by a pathologist. The pathologist usually also looks for the rate of growth and strength of the tumor.

Types of biopsies:

A biopsy may be done in different ways, depending on where the abnormal area is located.

•Fine-needle aspiration biopsy: The physician uses a thin needle to remove a sample of possibly-diseased cells.

•Thoracotomy: In this an incision or small cut is made by physician between two ribs to check inside for signs of disease and to collect a tissue sample.

•Thoracoscopy: If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure the incision is made by physician between two ribs and inserts a thin, lighted tube into the chest called a thoroscope. The tube contains a tool to collect cells for examination under a microscope. This test is usually done in a hospital using a local anesthetic or painkiller. If fluid has found in the chest, doctor may drain the fluid out of the body by putting a needle into the chest and using gentle suction to remove the fluid. This is called thoracentesis.

•Peritoneoscopy and laparotomy: If the cancer is found in the abdomen, the doctor may perform peritoneoscopy and laproscopy. These procedures are similar to the thoracoscopy, but the incision is made in the abdominal wall. A thin, lighted tube is used to examine inside the abdomen is called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen and to collect cells for examination under a microscope. Before the test is done, a local anesthetic will be given. If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.

After the sample has been removed, it will be sent to a pathologist, a physician who specializes in cancer and its diagnosis. This doctor will examine the cells under a microscope to check for any abnormalities that might indicate cancer. In some cases, the first biopsy will remove fluid from around the lungs or from the abdomen. The pathologist will examine the cells found in this fluid for signs of cancer; however, many physicians consider this test insufficient for mesothelioma diagnosis.

The physical exam should involve a number of imaging tests to search for suspicious cell formation. These typically diagnostic tests include medical imaging scans such as:

Blood tests:

Blood tests are not specifically for mesothelioma. Blood tests will be performed to check white blood cells (WBC) count and platelet count. White blood cells fight infection and platelets are blood cells that help the blood clot.

A new and promising method to detect mesothelioma is MESOMARK assay. This is a blood test used to detect peptides released into the blood stream by mesothelioma cells. Mesothelioma patients usually have an elevated MRP in their blood stream years before actual diagnosis is made. This test is only FDA approved for humanitarian use. It only used to follow someone already diagnosed with mesothelioma (of an epitheloid type) to give an indication of whether or not the cancer is growing.

Some specific substances present in the blood which act as biomarkers, by using one or more biomarkers, a blood test can detect mesothelioma.

Osteopontin, a protein in the liquid part of the blood, is also being investigated as a biomarker for asbestos. In October 2005, The New England Journal of Medicine reported a study showing that persons who have been exposed to asbestos and have pleural mesothelioma, in those patients level of osteopontin is different than in those who have been exposed to asbestos but who do not have cancer.

Medical history:

Diagnosis begins with a review of the patient’s medical history. The first step involved in diagnosis is providing a full and accurate medical history to your doctor, including details about current and past health concerns, as well as the types of symptoms and signs signs including shortness of breath, chest pains, swollen abdomen, and more you are currently experiencing.

It is important to mention any possible exposure to asbestos. Without revealing this fact, your doctor may not consider asbestos-related diseases in his or her examination. Mesothelioma patients are typically diagnosed within three to six months of their first visit to a doctor with complaints about breathing problems or chest and abdominal pain.

Asbestos has also been shown to aid the entry of foreign DNA into healthy cells. This foreign DNA can insert itself into the human genome, causing mutations by one of the following mechanisms:

• Activation of oncogenes
• Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
• Prevention of apoptosis
• Inactivation of tumor suppressor genes
• Activation of DNA repair enzymes

Different types of asbestos fibers were studied in rats and mice, showed that long, thin fibres caused a higher incidence of mesothelioma than did short fibres and that cells will actually phagocytose longer fibres more effectively than shorter fibres. Interactive analysis between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or gets entangled within the chromosome. This direct contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms. Common gene abnormalities in pleural and peritoneal mesothelioma cell lines include deletion of the tumor suppressor genes.

Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences. Asbestos also may possess immunosuppressive properties.