Pleurodesis Treatment

After someone is diagnosed with Mesothelioma or malignant pleural effusion, they have several treatment options available. If the fluid accumulation in the lungs is causing the patient to have trouble breathing, a thoracic surgeon may recommend pleurodesis which is also sometimes called chemical pleurodesis.

Pleurodesis uses a chemical agent (a sclerosing agent) to cause an irritation between the two layers that cover the lung (the parietal and visceral pleura). The chemical causes the tissues to become inflamed, closing or obliterating the tiny space between the layers where the fluid accumulated. This also prevents any more fluid from collecting in these spaces. The chemical used in this procedure may be one of several including talc, bleomycin, and doxycycline.

Pleurodesis is administered in Two Ways

Either in the hospital bed or in the operating room. The doctor will usually decide which best suits the patient.

Bedside

1) In the bedside method, a chest tube is inserted to drain fluid after a local anesthetic is injected. Most patients will also be given a sedative. The tube is usually inserted near the underarm in lower chest area. The chest tube will be taped in place with a dressing. The fluid causing the breathing difficulty will be drained through the chest tube using suction to aid in the drainage. It can take several days for the fluid to drain out all the fluid. The collection container used in pleurodesis is called a Pleur-e-vac.

After the fluid is drained, the chemical agent, often talc is injected through the chest tube into the pleural space. The tube is clamped, to prevent the agent from draining back out. The patient will be asked to move around and change position in help spread the chemical in the chest. Additionally the chest tube is still attached to a Pleur-e-vac suction device, which is used to bring the two lung surfaces together. This usually takes several hours.

Overall the chest tube is in place for a several days, during the drainage process. This is an unpleasant procedure, as the chest tube is uncomfortable and the patient may need pain killers.

Operating Room

2) The second procedure uses thoracoscopy (also called video-assisted thoracoscopy (VATS) surgery). The patient is given a general anesthetic, by an anesthesiologist. The thoracic surgeon makes a small incision in the chest and inserts a thoracoscope. The surgeon can see the inside of the patients lung and inserts the agent directly on the pleural surface, after draining the fluid. This procedure has a greater risk of complications including the danger inherent in all general anesthetic, the risk of internal bleeding and infection. Many surgeons feel this procedure believe allows the agent to be more efficiently inserted. However, there are no conclusive evidence to support this.


Unfortunately, not every patient with serious pleural effusion can be treated with pleurodesis.

Additionally, although the procedure is proven to provide some relief, it does not work in every case. Patients with a short life expectancy of several months may not be candidates. Patients with a very low lung capacity or function or patients with a trapped lung also are not considered good candidates. A lung is "trapped" when it can no longer expand in the chest after the fluid is drained. A trapped lung occurs when the lungs are damaged by tumors or scarring. Since the lung cannot not Re expand, pleurodesis will not work.

Under the current programs, pleurodesis may be available to patients who qualify. Additionally, patients with mesothelioma may be entitled to large settlements to pay for treatment against employers or asbestos makers.

If you would like more information about Mesothelioma or your legal rights

Mesentery Cancer

The term mesentery cancer is more or less synonymous with peritoneal cancer (mesothelioma). Though the term mesentery technically refers to various sections of the peritoneum that attach different organs to the wall of the abdominal cavity, (i.e. mesogastrium for the stomach, mesojejunum for the jejunum), in this context it describes all abdominal peritoneal extensions. Tumors rarely originate in the actual mesentery, though it is a frequent route for the spread of mesothelioma through the abdominal cavity.

When a doctor suspects abdominal cancer he will perform an MRI, CT Scan or X-Ray in order to obtain a view of the chest and abdominal cavities. If the peritoneum is congested with fluid, the doctor will typically conduct a "fine-needle aspiration", which means he will use a syringe to collect a sample of the fluid. The fluid will than be examined to determine whether or not mesothelioma is present. The "fine-needle aspiration" also allows the doctor to alleviate symptoms caused by fluid build up. If a diagnosis can not be determined from the fluid sample, than generally a tissue sample or a 'biopsy' will be taken.

Once mesothelioma has been diagnosed, the next step is determining how far the illness has progressed. This is done by studying the imaging of MRIs or CT Scans and is known by doctors as 'staging'. Doctors chart mesothelioma in five stages of development i.e. Stage I mesothelioma, Stage II mesothelioma, etc. Stages II through V are considered advanced mesothelioma and typically removal of the cancer is no longer an option. In general, mesothelioma is very difficult to treat. First its tumors appear in the membranes surrounding the chest cavity and abdominal cavity, than spread to the underlying organs. This type of growth makes a complete surgical removal of mesothelioma very unlikely.

Chemotherapy, radiation, or surgical treatment, when used alone, are often ineffective in treating mesothelioma. Combined approaches that utilize these therapies together, particularly using chemotherapy prior to surgery, as well as new drugs that specifically target the genetic material in mesothelioma cells, are currently being tested.

When traditional methods have failed or seem unlikely to work, clinical trials are sometimes an option for patients. Clinical trials are human research studies conducted in order to assess the effectiveness of new treatments. The treatments have already been tested in laboratories and have shown enough promise to be tested on humans. If a patient takes part in a clinical trial, he or she may benefit from a new technique while helping scientists evaluate its effectiveness.

Stages of Mesothelioma

Doctors often determine treatment options depending on the stage of mesothelioma. Doctors currently use one of three staging systems. Each system measures somewhat different variables.

Doctors most often use the Butchart System, the oldest staging system and the one that mainly considers the extent of primary tumor mass and divides mesothelioma into four stages. The more recent TNM system considers tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System, the latest system, stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.

Butchart System

Stage I of the Butchart System consists of the presence of mesothelioma in the lining of the right or left lung and may also involve the diaphragm on the same side. Stage II includes the invasion of mesothelioma into the chest wall or esophagus, hear, or lung lining on bother sides. In addition, lymph nodes in the chest may also be involved. The onset of Stage III begins when the mesothelioma penetrates through the diaphragm into the lining of the abdominal cavity or peritoneum. In this stage the cancer may also affect lymph nodes beyond those in the chest. Doctors identify Stage IV, the final stage, when evidence of metastasis or the spread of cancer to other organs exists.

TNM System

Stage I of the TNM System involves the lining of the right or left lung, pericardium, or diaphragm on the same side. At this stage, lymph nodes are not involved. Stage II begins when mesothelioma spreads from the lining of the lung on one side to a lymph node on the same side. At this stage, the cancer may also spread to the lung, pericardium, or diaphragm on the same side. Stage III begins when mesothelioma exists in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side as the primary tumor. In the final stage, Stage IV, the mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends into the lung opposite the primary tumor, or directly into the organs in the abdominal cavity or neck. Metastasis is included in this stage.

Brigham System

The Brigham System concerns itself primarily with the resectability (or ability to surgically remove) the mesothelioma mass. In Stage I the tumor is resectable and lymph nodes are unaffected. In Stage II the tumor remains respectable but the mesothelioma affects the lymph nodes. In Stage III the tumor becomes unresectable and extends into the chest wall, heart, or through the diaphragm, peritoneum. Stage III can occur with or without lymph node involvement. Stage IV occurs when doctors discover metastasic disease of distant organs.

Once doctors identify the stage of a patient's malignant mesothelioma, the patient and doctor can discuss and consider the various treatment options available. The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, the location of the cancer, the spread of the cancer, the characteristics of the cancer cells under a microscope and the patient's age and desires.

Mesothelioma Surgery

Several types of surgery exist for treating mesothelioma. A pleurectomy/decortication removes part of the chest or abdominal lining and the surrounding tissue. Doctors most often use the pleurectomy as a palliative procedure to relieve pain and prevent pleural effusion, or the build-up of fluid between the lungs and the chest cavity. While a surgeon can remove a good deal of the tumor through pleurectomy, the procedure often leaves mesothelioma along the diaphragm and lungs. A more aggressive surgery, known as , removes an entire lung in order to remove the mesothelioma. In extrapleural pneumonectomy the surgeon removes the affected lung along with the lining and diaphragm on the affected side and the lining around the heart.

Chemotherapy

Chemotherapy uses drugs to kill meso cancer cells. Doctors may administer chemotherapy by pill or through a needle into a vein or muscle. Doctors can administer chemotherapeutic agents either systemically (through the blood stream) or intrapleurally (in the pleural cavity). When administered intrapleurally, the chemotherapy treatment is localized at the site of the tumor. The drugs used for chemotherapy are generally very toxic and are usually accompanied by serious side effects including nausea, vomiting, anorexia, hair loss, and exhaustion. Side effects vary depending on the particular drugs used for the chemotherapy.

Single-agent therapy utilizes only one drug in the chemotherapy regimen to treat the cancer. Several agents have demonstrated modest success in effectively treating mesothelioma. Doxorubicin, probably the most extensively studied agent, has a response rate in the 15 percent range, as do detorubicin, pirarubicin, and epirubicin. Other agents, such as carboplatin, mitomucin, cyclophosphamide, and ifosdamide have similar response rates ranging from 10 to 20 percent. Researchers have studies cisplatin in a number of trials and discovered an approximately 14 percent response rate. One small study of very high dose-intensity cisplatin demonstrated a 36 percent response rate, but the high responsiveness lasted only 2 to 8 months.

Because single-agent chemotherapy regimes have failed to show great effectiveness (response rates less than 20 percent), researchers have examined several combination regimens for treatment of patients with mesothelioma. Combinations including doxorubicin, cisplatine, mitoxantrone, and bleomycin have been reported to realize response rates of up to 44 percent. Such high response rates have not been consistent, and overall combination therapy yields response rates similar to singe-agent therapy.
A new agent, gemcitabine, in combination with cisplatin has showed promising results in a study conducted by Australian researchers. In their research, which included mesothelioma patients in Stages III and IV, the combination therapy reaped a 47 percent response rate with a response duration of 25 weeks. The researchers reported a one-year survival rate of 41 percent with this treatment.

Pemetrexed, a multitargeted antifolate (MTA) has shown promising results when combined with cisplatin. In addition, researchers are currently conducting promising studies of oxaliplatin/raltitrexed and cisplatin/irinotecan combinations. Other new agents researchers are now studying include bevacizumab and onconase both of which are considered novel drug treatment options.

With each new therapy development, doctors have another therapy tool with which to treat patients. The increase in options allows doctors and patients to more carefully tailor a chemotherapy regime that addresses the specific needs of the patient, including the stage of the mesothelioma and the patient's age.

More on Mesothelioma chemo treatments:

Mesothelioma Treatments

Three traditional kinds of treatment exist for patients with malignant mesothelioma: surgery which removes the cancerous masses from the body, chemotherapy, which uses a variety of potent drugs to kill the cancer, and radiation therapy, which uses high doses of x-rays to kill the cancer cells. Oftentimes, doctors use two or more of these treatment courses together to maximize the likelihood of success.

Epithelial Mesothelioma Cancer

Epithelial mesothelioma is a rare and deadly form of cancer affects the membrane lining the chest cavity, heart, lungs and abdominal cavity. There are three forms of epithelial mesothelioma: the most common, pleural mesothelioma; the second most common, peritoneal mesothelioma (accounting for only a quarter of the cases) and the rarest form, pericardial mesothelioma.

The vast majority of epithelial mesothelioma cases are the result of asbestos exposure. Indeed, one of the most frustrating aspects of this type of cancer is that patients who develop it were generally exposed 15 to 40 years before hand, which often makes the time and place the disease was contracted difficult to determine.

The early symptoms of epithelial mesothelioma are subtle and somewhat general. Shortness of breath and chest pain are the most common early symptoms. It is because these symptoms are so generic that epithelial mesothelioma is rarely detected early on. Usually when its discovered it is already in an advanced stage and treatment options, particularly localized options such as surgery, are somewhat limited.

If the cancer is in a less advanced stage, aggressive surgery treatments can be sought. Aggressive treatments are treatments aimed at curing the mesothelioma or at least increasing the patients longevity. In some cases an extrapleural pneumonectomy can be performed to try to stop the spread of the mesothelioma.

However this operation is risky and many medical centers will not perform it because of its high mortality rate. Additionally this procedure involves removing an entire lung, as well as extensive epithelial tissue, thereby reducing the patients breathing capacity in half. Even when it is successful it rarely eliminates the mesothelioma, but rather only slows its progress.

Palliative surgery (surgery only aimed at alleviating symptoms) is an option at any stage of the disease. Usually this comes in the form of a "fine needle aspiration" or pleural tap. A pleural tap involves injecting a long needle into the chest or abdomen cavity and draining the pleural space of fluid build up. This procedure may greatly reduces symptoms associated with mesothelioma.

Radiation therapy and chemotherapy are other options. Both are systemic treatments and have the draw back of affecting surrounding tissues as well as cancerous tissues. Radiation therapy is often used in combination with surgery treatments as a way of attempting to remove cancerous growth that could not be removed through surgery. Chemotherapy still has not proved very effective against epithelial mesothelioma but doctors and researcher continue to experiment with new techniques.

Zofran (Ondansetron) and Anti Nausea Drugs

Mesothelioma patients undergoing an aggressive course of chemotherapy may need to consider anti-nausea drugs such as Zofran. This drug has allowed many people under going chemotherapy to keep their nausea under control.

Not all patients react the same to chemotherapy. Some experience severe nausea, sometimes vomiting every day of treatment others experience only mild nausea. The duration of nausea is also variable. In some cases nausea will continue up to a week after treatment ends. In some cases it will only be present during the initial stages of treatment.

For mild cases of nausea, very simple, low tech palliatives can be effective. Sniffing a cut surface of fresh ginger, for instance, may be all that is required in some instances of nausea (this is the same idea as drinking ginger ale to mitigate nausea during a fever). There is also anecdotal support for the "sea band" a product that is designed to alleviate motion sickness for people traveling in boats and cars. Acupuncture, visualization, and meditation are also techniques that some patients have found effective. Than of course there are medicines.

The primary medicines for mild nausea during chemotherapy are Torecan (thiethylperazine) and Compazine (prochlorperazine). For mild to serve cases of nausea, however, one of the most effective treatments available is an anti nausea drug called Zofran.

Zofran can be taken in tablet form or taken intravenously. Generally it is administered intravenously during chemotherapy and than subsequently taken in tablet form every 12 hours. For the most part, it effectively subdues nausea occurring with in one to two days of chemotherapy treatment and has no major side effects. It is particularly effective in combating nausea resulting from the use of cisplatin and cyclophosphamide. If used more than two days after chemotherapy its effectiveness is diminished. The one major drawback to Zofran is that it is very expensive. Zofran pills may cost up to $50 dollars a day, with individuals pill costing anywhere between $12 and $20.

Patients that are too ill to hold down the tablet form of Zofran can use a preparation form that quickly dissolves on the tongue. If nausea is reduced but persists, patients using Zofran can also take another anti-nausea pill such as Torecan. The Torecan tablet can be taken every six hours in between the Zofran doses. If patients are too nauseated to keep the Torecan tablet down, the Compazine suppository is another option. Ativan is also another option.

Kytril (granisetron HCI) and Anzemet (dolasetron mesylate) are alternatives to Zofran and may be worth investigating. Both can be taken intravenously or in tablet form. In tablet form, Anzemet is generally taken once a day while Kytril may be taken once or twice a day.

Mesothelioma Prognosis

Typically the most important variable determining the prognosis and life expectancy of a mesothelioma patient is the stage of the cancer when it is diagnosed. Unfortunately, mesothelioma is more difficult to "stage" than other cancers. This is true for a couple of reasons:

1) because its somewhat rare, and
2) because its initial symptoms are subtle it is usually advanced when diagnosed, making it difficult to stage.

Peritoneal mesothelioma in particular can be difficult to stage because, while pleural mesothelioma has multiple staging systems, pathologists still haven't developed a staging system for peritoneal mesothelioma. Both pleural and peritoneal types of mesothelioma are very serious conditions and neither have a good outlook.

Since mesothelioma is usually diagnosed at an advanced stage, the statistics for five year survival for early stage mesothelioma are usually unreliable. It also can not be said with certainty which of the two types is a worse diagnosis; peritoneal mesothelioma or pleural mesothelioma. Many studies show that peritoneal is a more deadly, and rapidly spreading mesothelioma than pleural mesothelioma, but these studies are often contradicted by specialists who argue pleural mesothelioma is the more dangerous and more difficult to treat of the two. Usually patients diagnosed with either peritoneal or pleural mesothelioma are told that they may have less than a year to live. However, according to researchers in leading research centers around the world this is not necessarily the case. More recent studies indicate that patients with mesothelioma might, in some instances, have a better out look than originally believed.

According to these studies about 10% of all people diagnosed with mesothelioma will be alive 3 years later and about 5% will be alive 5 years later. However, if the mesothelioma is detected in its earlier stages and treated, 50% will survive 2 years and 20% people will survive 5 years.

In one clinical trial involving 120 patients with different types of pleural mesothelioma, all of the patients underwent pleural pneumonectomies (removal of the lung and pleura), followed by radiotherapy and chemotherapy. 45 % were alive two years later and more than 20% were alive five years later.

In the same study, patients with sarcomatoid and mixed mesothelioma did not fare as well. Only 20% of these patients were alive two years later, and none of them survived five years.

However, patients that had no cancer in the lymph nodes and epithelioid type tumors did much better. Almost 75% survived longer than two years and nearly 40% were alive after five years.

Another much broader study conducted in Italy looked at the records of 4.5 million people diagnosed with mesothelioma. The survival rates were as follows: 24% of people with pleural mesothelioma and 34% diagnosed with peritoneal mesothelioma were still alive one year after diagnosis. Two other major studies, also reviewing comparable populations, also revealed similar findings.

Another variable that is extremely important to a patients out look is his or her overall health at the time of diagnosis. Generally the healthier a patient is, the better he or she will react to cancer treatments, and the greater the chances of longer survival. Doctor's have a method of grading a patients health and give each patient a score at the time of diagnosis. This method of grading is referred to as a patient's "performance status" (PS). The best score is 0 and indicates a patient can basically take care of him or herself with out assistance. A performance status of 1 indicates that a patient can do most things, but may need some assistance. The more deteriorated the patient's health, the higher the number.

The patient should always bear in mind that statistics such as the ones mentioned here are in no way definitive. Survivability has a lot to do with a number of different factors including health, type of mesothelioma, treatment choice, and even a patient's morale. The statistics listed here are too general for individual patients to get an exact idea of their own out look.

Patients should consider taking part in clinical trials. Though no one can say exactly why; patients who are treated in clinic trials fare better on average than those who are treated conventionally. Perhaps with all the tests and monitoring that is done, patients become more confident that all that can possibly be done, is being done.

Ascites and Peritoneal Cavity Fluid

Ascites build up inside the abdomen in a membrane called the peritoneum. This membrane consists of two layers, one that lines the abdominal wall and one that encloses the organs of the abdomen. The peritoneum produces a fluid that serves as a lubricant allowing the organs of the abdomen to glide easily over one another. Usually this fluid is present in a very small quantity. Ascites is the build up, or overabundance of this fluid and is often the first tangible indication that mesothelioma is present in the body, it the most common early sign of peritoneal mesothelioma.

The symptoms of ascites are unpleasant. Usually the stomach becomes bloated and sometimes pain, and nausea accompanies this bloating. Its not uncommon for patients to experience a loss of appetite, or for sitting, standing, and walking to become restricted and uncomfortable. Fatigue, lethargy and breathlessness are also possible symptoms.

When ascites is first detected, the treating doctor will drain the fluid in a procedure known as a Paracentesis. By draining the fluid doctor's can reduce symptoms caused by the build up as well as gather a sample to learn the reason for its occurrence. A paracentesis is a relatively easy procedure that can take place in the hospital bed or in the outpatient clinic. Occasionally doctors will perform the procedure in the ultra sound department so that they can more easily locate the fluid build up. Ultra sounds are particularly useful when fluid has collected in multiple pockets, as will sometimes occur when the ascitic build up is smaller.

After the doctor injects the patient with a local anesthesia he will make a small incision in the abdomen wall in order to pass a cannula into the abdomen. The cannula is a thin tube that is attached to drainage bag for the paracentesis. Using gentle suction the doctor will draw the ascitic fluid from the abdomen into the drainage bag. If there is only a small amount of ascitic fluid the procedure can usually be accomplished in an outpatient setting, if there is a larger amount, however, the drain may remain in place for two to three days.

At the beginning of the paracentesis up to a liter of fluid may be drained quickly and safely. After this initial amount, however, the drain must be performed slowly because a sudden release of abdominal pressure may cause blood pressure to drop as well. During the procedure doctors will monitor the heart rate of the patient to make sure this doesn't occur. Sometimes during the procedure the drain will become blocked, but often the solution is just a matter of the patient repositioning him or herself (sitting up, lying back etc.). Occasionally the cannula can be a source of infection (a variation in blood pressure will tell doctors if this is the case).

If a patient has been diagnosed with ascites but the cause has not yet been determined, it is very possible that the ascites is not a result of mesothelioma. Cirrhosis is the most common cause of the ascites build up, accounting for 80% of its occurrences. Tuberculosis, endometriosis, Familial Mediterranean fever, Whipple's disease, are all possible causes of ascites. Generally speaking cancer is the cause of ascitic build up only 10 % of the time.

Lung Lining Cancer: Cancer of The Lung Lining

Lung Lining cancer is very different from a lung cancer. Lung Lining cancer occurs in an area of the body called the mesothelium, a thin membrane that covers many of the internal organs of the body. This thin membrane is comprised of two layers---one that surrounds the organ and another that forms an exterior sac around the first layer. Between the layers of the mesothelium is a fluid that allows vital organs to glide easily against objects that come in contact with them. The mesothelium of the lungs is called the Pleura. Lung Lining cancer is alos sometimes called mesothelioma after the area in which it occurs.

If the lung lining cancer near the pleura is localized (i.e. is only found in the mesothelium where it originated) than typically it is not fatal and can often be completely removed via a surgical procedure. Additionally, localized pleural mesothelioma may or may not be caused by asbestos exposure. However, if it has spread to other parts of the body, for instance the lymph nodes, lungs, chest wall, or abdominal organs, then it is considered malignant and is more often than not the result of asbestos exposure.

Asbestos exposure is thought to be responsible for roughly 75% of all cases of lung lining cancer. Those who worked in "at risk" industries during or before the 1970s frequently ingested harmful asbestos fibers that penetrated deep within the layers of the lungs. The body is unable to dispel these fibers, which eventually cause an inflammatory condition in the lungs (asbestosis). This condition worsens and eventually becomes malignant.

A typical lung cancer grows as a single distinct mass which is generally anywhere from the size of a grape to the size of a baseball when discovered. Because most lung cancers grow as a solitary defined mass, sometimes they can be surgically removed and a follow up of chemotherapy or radiation treatment may succeed in removing the cancer all together.

In contrast, mesotheliomas grow on the lining of the lung (or the lining of the abdomen) as a diffuse multi-site tumor with masses being spread on a wide area of the pleura. Even when an individual undergoes surgery for removal of the entire pleura, the entire lung where the mesothelioma is located, and parts of the diaphragm, this almost never results in total removal of the cancer.

Lung lining cancer is usually diagnosed by x-rays and CT scans but may also be diagnosed by tissue biopsy, pleural tap, and fiberoptic examination. Its symptoms are: persistent cough, sputum streaked with blood, chest pain, recurring pneumonia or bronchitis.

Chemotherapy, radiation, or surgical treatment, when used independently, are often ineffective in treating cancers of the lung lining. Combined approaches that use these therapies together as well as new drugs that specifically target the genetic material in mesothelioma cells are currently being tested.