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.

Nutritional requirements are of two types:

1. Before mesothelioma treatment
2. During mesothelioma treatment

1. Before mesothelioma treatment

At early stages of the disease if patients may feel well enough then they can build up their strength by eating normal meals/foods that are high in proteins, as well as fruits, vegetables and whole grains, while those suffering from moderate to advanced mesothelioma symptoms — and those undergoing treatment —are forced to alter their diets substantially.

You should consult with a doctor and/or registered dietician about creating a dietary strategy.

Some tips offered by American Cancer Society (ACS):

• Limit alcohol consumption
• Eat five “colorful servings” of fruits and vegetables per day. This includes dark green and deep yellow vegetables, which contain important nutritional substances called phytochemicals which strengthen and enhance the body’s immune system
• Limit foods that are pickled, smoked or salt-cured
• Cook large dishes and freeze them in meal-sized portions
• Be physically active and maintain proper weight
• Consume few sugars and refined carbohydrates (body uses like sugar) as possible.
• Try new foods, because tastes can change during cancer treatment
• Eat plant-based foods such as peas and dried beans
• Keep the freezer and pantry stocked so you don’t have to run to the store when you’re feeling ill

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.

Chest or abdomen x-rays can reveal fluid build-up, masses in the chest, or signs of non-cancerous pleural disease, scarring of the lungs and areas of fluid accumulation. Based on a patient’s x-ray results, a doctor will usually order more sensitive tests.

Computerized Tomography (CT) scans:

A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. A computerized axial tomography (CAT or CT) scan produces a cross-sectional image of the parts of your body that your doctor wants to study, such as the chest and abdomen. An x-ray source rotates around your body sending data to a computer. A CAT scan helps your doctor determine how large any tumors are, where they are in relation to the heart, lungs and diaphragm, if there is pleural thickening, and how much fluid there is. A CAT scan also helps your doctor determine what stage your cancer is in.

The computer then analyzes the data and produces a series of images. CT scans are also able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures, or possible chest wall invasion. CT scans cannot differentiate between benign or malignant mesothelioma. CT scans may also be valuable in guiding fine needle aspiration of pleural masses for tissue diagnosis.

Positron Emission Tomography (PET) scans:

PET imaging tests have become one of the most efficient ways of diagnosing mesothelioma tumors as well as determining the staging of the cancer. In a positron emission tomography (PET) scan, abnormal areas show up as bright spots. These bright spots may or may not be cancer, so not all doctors believe that these scans are helpful in trying to diagnose mesothelioma cancer. If you have mesothelioma cancer, a PET scan can show whether the cancer has spread outside the area of the body in which it originated (whether it has metastasized).

While PET scans are more expensive than other types of imaging, and are not always covered under insurance, they are now considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma.

MRI scans:

Magnetic resonance imaging (MRI) is a type of scan that uses a magnetic field linked to a computer to create an image of the internal structures of your body. An MRI uses powerful magnets and radio waves to produce a detailed, three-dimensional view of the areas where mesothelioma is suspected.

MRI scans use a computer-linked magnet to photograph details of the inside of the body and can determine the severity of a tumor. MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. Sometimes, an MRI can show whether a tumor has invaded the diaphragm or chest wall.

They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes (those lymph nodes which lie between the two lungs), as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy.

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.