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Disease name and definition

Posted by Unknown Wednesday, 15 May 2013 0 comments
Malignant mesothelioma is a fatal asbestos-associated malignancy originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis. The exact prevalence is unknown but it is estimated that mesotheliomas represent less than 1% of all cancers. Its incidence is increasing, with an expected peak in the next 10–20 years. Pleural malignant mesothelioma is the most common form of mesothelioma. Typical presenting features are those of chest pain and dyspnoea. Breathlessness due to a pleural effusion without chest pain is reported in about 30% of patients. A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations. Mesothelioma is directly attributable to occupational asbestos exposure with a history of exposure in over 90% of cases. There is also evidence that mesothelioma may result from both para-occupational exposure and non-occupational "environmental" exposure. Idiopathic or spontaneous mesothelioma can also occur in the absence of any exposure to asbestos, with a spontaneous rate in humans of around one per million. A combination of accurate exposure history, along with examination radiology and pathology are essential to make the diagnosis. Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement. Involvement of a multidisciplinary team is recommended to ensure prompt and appropriate management, using a framework of radiotherapy, chemotherapy, surgery and symptom palliation with end of life care. Compensation issues must also be considered. Life expectancy in malignant mesothelioma is poor, with a median survival of about one year following diagnosis.

Malignant mesothelioma is a cancer originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis [1]. Its distribution may be uni- or multifocal or may involve the lining cells in a continuous manner.

Stage 3 Mesothelioma Prognosis

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A prognosis of stage 3 mesothelioma means that the cancer is now in its advanced stage of development. The asbestos cancer has now spread from the mesothelium, which is the point of origin, to other nearby tissues or organs. The asbestos cancer has spread to the lymph node group closest to the primary tumor location. When the lymph nodes past the chest area are affected, this causes the disease to spread at a faster pace.
Signs and symptoms of stage 3 mesothelioma include:
  • Difficulty in breathing
  • Low vitality
  • Fatigue
  • Depression

The Butchart System: Mesothelioma Staging System

The spread of the mesothelioma in the body is assessed by one of the oldest cancer staging system – the Butchart System. The Butchart System is often used for staging pleural mesothelioma. It places an individual case of mesothelioma cancer in categories based on the size of the primary tumor and whether lymph nodes are affected.

Diagnosis of Stage 3 Mesothelioma

A stage 3 mesothelioma prognosis is very poor. At this stage, the disease is considered too far advanced for any type of curative surgery. The survival rate at this point is extremely low. Because the cancer has now spread to other locations beyond the primary location makes it extremely difficult for any type of curative surgery. And even if the main tumor is removed, the spread of the cancer cannot be contained.

Treating Stage 3 Mesothelioma

Treatments during a stage 3 mesothelioma prognosis are palliative in nature. Treatments at this stage are designed to keep the patient as comfortable as possible be relieving symptoms rather than to improve the prognosis of patients. However, if the patient is in excellent health and young, large tumors can be removed to ease discomfort in nearby organs or fluid buildup by mesothelioma paracentesis or thoracentesis. Radiation therapy and chemotherapy may also be used to relief any discomforts. Patients may also choose to participate in clinical trials which are used to test new drugs and therapies.

Four Stages of Mesothelioma

There are four stages of mesothelioma: Stage I, Stage II, Stage III and Stage IV. Staging is the process used to tell how far the mesothelioma has spread. Imaging studies such as x-rays, CT scans, and MRI scans are often used during the staging process. The type of treatment given and the prognosis for the patient will be determined by the stage of their cancer. The staging system often used includes the Butchart System, TNM, and Brigham Staging System.

Legal Help for Mesothelioma Victims Due to Asbestos Exposure

If you or a loved one has been exposed to asbestos, and is suffering from mesothelioma or any asbestos-related illnesses, you should contact an experienced mesothelioma lawyer in your area as soon as possible. Mesothelioma lawyers will almost certainly be able to help you obtain the monetary compensation you deserve for your pain and suffering.

Type of Mesothelioma Cancer

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Type of Mesothelioma Cancer

A Mesothelioma cancer victim’s prospects can be affected depending on the category of the disease they have been diagnosed with. The categories of Mesothelioma include:
  • Pleural
  • Peritoneal
  • Pericardial
  • Testicular Mesothelioma
Records indicate that roughly one out of ten 10 victims of Pleural Mesothelioma will endure past 60 months after discovery of the cancer. When we only look at the numbers, pleural mesothelioma victims have for the most part the best life expectancy.

Patient’s Physical Condition

Mesothelioma cancer victim’s life expectancy and prognosis depend a lot on the patient’s physical condition at the time of diagnosis. Patients that are otherwise fit might have a better response to enduring rigorous treatments. These treatments have side effects and any pre-existing health problems could complicate and exacerbate these side effects. Smokers also seem to have a harder time than those that do not partake in the destructive habit.

Stage of Mesothelioma Cancer

Oncologists in general confer on the severity of a victim’s disease by noting the stage of the cancer. There are four stages of Mesothelioma cancer. Those that are in Stages 3 and 4 of the cancer will usually have an inferior prognosis when compared to those in the other two stages.


Diagnosis and differential diagnosis

Posted by Unknown Tuesday, 14 May 2013 0 comments
The combination of accurate history, examination, radiology and the acquisition of pathology is essential in the diagnosis of mesothelioma. A careful history of asbestos exposure is essential, and the identification of at-risk occupations are strong markers of exposure. However, the delay between exposure and presentation may naturally preclude accurate recall of occupational exposure and working conditions which may have occurred up to 60 years previously.
In those patients with a pleural effusion, sampling of the fluid for cytological examination is the first step in confirming the diagnosis. Pleural fluid cytology is positive for malignant cells in about a third of cases and if the clinical, radiological and cytological results support a diagnosis of mesothelioma then this can be accepted. However, it is uncommon for the definitive diagnosis to be made on pleural fluid cytology alone and pleural biopsy for tissue diagnosis is therefore recommended. A contrast enhanced computed tomogram (CT) scan is essential to both identify the extent of the disease, and help guide a percutaneous biopsy if the pleural fluid cytological analysis is not sufficient.

Radiological findings

Radiological imaging is essential for the diagnosis, staging and management of mesothelioma. X-ray, CT, magnetic resonance imaging (MRI) and positron emission tomography (PET) have all been used to evaluate the disease.

CT

Intravenous contrast-enhanced CT is the primary imaging modality for suspected pleural malignant disease. CT allows visualisation of the whole pleural surface and diaphragm and use of a 45–60 second scan delay enables the pleural surfaces to be studied whilst still allowing assessment of the mediastinal nodes . A standard protocol should include the liver and adrenal glands, but in cases where there is a past history of abdominal or pelvic malignancy, the scan should also include the lower abdomen and pelvis .
Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement . The specificities of these findings were 100%, 94%, 94% and 88% respectively. The sensitivities were 41%, 51%, 36% and 56% respectively. The presence of bilateral pleural calcification on CT is uncommon in malignant mesothelioma . A significant reduction in thoracic volume seen on CT is more common, however, occurring in up to 73% of cases according to some series . Whilst these features have a high positive predictive value, absence of these signs does not reliably exclude the diagnosis of pleural malignancy.

MRI

MRI screening is not used routinely in the assessment of malignant mesothelioma, however in patients with potentially resectable disease, MRI can help to provide additional staging information over and above CT. Using gadolinium enhancement, MRI can improve the identification of tumour extension into the diaphragm or chest wall, allowing better assessment of the individual for surgical treatment. MRI also is the imaging modality of choice in those in whom intravenous iodinated contrast is contraindicated [29].

PET

The standardized uptake value (SUV) in PET is a semi-quantitative measure of the metabolic activity of a lesion and the SUV is significantly higher in mesothelioma than in other benign pleural diseases such as pleural plaques or inflammatory pleuritis , and one study found PET scanning to have a 96.8% sensitivity and an 88.5% specificity at distinguishing benign from malignant pleural disease . PET scanning has also increased the accuracy in diagnosing mediastinal nodal metastases and therefore the combination of metabolic and anatomical information provided by PET makes it useful in the staging and preoperative evaluation of mesothelioma. PET may also help as a guide to the optimal site for CT guided pleural biopsy, and there is evidence that changes in the fluorodeoxyglucose (FDG) uptake within the tumour might indicate response to treatment suggesting its role in the assessment of response to both chemotherapy and chemo-radiotherapy .

Staging and assessment of disease response

At least six different staging systems have been suggested for malignant mesothelioma, but none have been accurately shown to predict survival. Currently, a TNM staging system , similar to that used in non-small cell lung carcinoma has been proposed by the International Mesothelioma Interest Group (IMIG) .

How is Malignant Mesothelioma diagnosed?

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How is Malignant Mesothelioma diagnosed?

Malignant Mesothelioma will typically be suspected if the patient complains of chest pain, difficulty breathing, shortness of breath, chronic cough, or difficulty swallowing. While any of these could indicate mesothelioma, they are also associated with many other respiratory conditions so further diagnostic procedures are typically warranted before an accurate malignant mesothelioma diagnosis can be made. These may include imaging scans, such as computer topography or magnetic resonance imaging. A diagnostic biopsy is also required for cancer specialist to examine the behavior of these cells before a diagnosis is determined.
Misdiagnosis is not uncommon in patients of the malignant mesothelioma, because the disease's symptoms so closely resemble those of other related conditions, including lung cancer, and other respiratory ailments. For this reason those who are at high-risk of mesothelioma (including those with asbestos history) should consult with physicians and cancer centers well versed in the treatment and diagnosis of malignant mesothelioma.

How is Malignant Mesothelioma Treated?

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How is Malignant Mesothelioma Treated?

Malignant mesothelioma prognosis is poor, as often the disease will be diagnosed in its later stages after symptoms have appeared. However, there are several treatment options for the management of the cancer. Among these are mesothelioma chemotherapy, radiation therapy, and surgical resection. Chemotherapeutic and radiation therapy methods are more likely but surgery is often an option for those whose disease is diagnosed early enough.
More aggressive therapies are now possible for patients with mesothelioma diagnosed in its earlier stages. For instance, extrapleural pneumonectomy is now possible in many pleural mesothelioma patients who are deemed eligible for aggressive surgery. Extrapleural pneumonectomy involves the removal of the entire affected lung, the pericardium, the pleura, and the diaphragm. This aggressive surgery is performed frequently in early stage mesothelioma patients by Dr. David Sugarbaker at the Brigham and Women's Hospital in Boston, MA.
Patient's who are eligible to receive an aggressive surgery, like an extrapleural pneumonectomy, will have a far more favorable prognosis than those diagnosed with advanced stage inoperable disease. However, there are treatment options for nearly all mesothelioma patients. Chemotherapy cocktails such as the use of Alimta® in conjunction with Cisplatin, as well as numerous other clinical trial being carried out give mesothelioma patients the ability to slow the advance of the disease and extend survival rates.

What Causes Malignant Mesothelioma?

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What Causes Malignant Mesothelioma?

Mesothelioma is known only to be caused by asbestos exposure. Asbestos is a nature, yet toxic mineral that was used commonly in heavy industry. Microscopic asbestos fibers enter the body through the lung or ingestion. Once inside, the durable fibers are unable to be broken down or expelled by the body, causing a harmful inflammation and scarring of the mesothelium. This scarring lays the groundwork for malignant mesothelioma and other respiratory conditions, such as asbestosis.
There is a great deal of latency associated with asbestos exposure and the onset of mesothelioma. Often patients will not encounter mesothelioma symptoms until 30-50 years following exposure to asbestos. In many cases, those diagnosed with mesothelioma are not those who were directly exposed to asbestos in a jobsite setting. Spouses and children of those exposed to asbestos who frequently came into contact with the fibers on the clothing or person of those exposed have also developed malignant mesothelioma as a result.

Malignant mesothelioma in women.

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Malignant mesothelioma reportedly shows different epidemiology and pathology in females, and a proportion are believed to arise spontaneously. METHODS: One hundred and seventy seven cases of malignant mesothelioma in females were reviewed, examined by histochemistry and immunohistochemistry, assessed for asbestosis and lung fibre burden by transmission electron microscopy with energy dispersive x ray analysis, and compared with 31 female controls. RESULTS: Two of one hundred and three cases tested for carcinoembryonic antigen were positive and were excluded from further analysis. Tumour cases showed increased amphibole burdens; in those in whom exposure information was known, 74 (80%) of 93 patients had a history of exposure to asbestos. Seventy two (47%) of 152 patients had lung fibrosis. Tumour site and histological type were little different from those reported in adult males. Mixed type histological pattern, lung fibrosis, and peritoneal site were associated with heavier lung asbestos burdens, but not exclusively. Thirty five (30%) of 117 patients had amphibole burdens of less than 2 x 10(6) fibres/g; the sites affected and the histological pattern of tumours in this group were similar to those in cases with amphibole fibre counts of > or = 2 x 10(6)/g lung. A higher lung amphibole burden than the mean burden in control females was found in 115 (98%) of 117 patients tested. CONCLUSIONS: The pathology of malignant mesothelioma appears to be similar in women and in men, and in cases associated and unassociated with asbestos.

MESOTHELIOMA MORTALITY IN EUROPE

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Mesothelioma and asbestos

When we correlated male pleural cancer death rates in 18 European countries with per capita asbestos consumption 25 to 30 years earlier, we found a linear relationship (Figure ​(Figure1).1). The Spearman's correlation coefficient of the two variables is R = 0.603 (P = 0.008). Notably, all European countries with available information on asbestos consumption and pleural cancer mortality were included in the analysis (the sources are indicated in the methods section). For females, no linear relationship could be demonstrated (Figure ​(Figure2).2). The Spearman's correlation coefficient of the two variables is R = 0.293 (P = 0.239).
Figure 1
Figure 1
Correlation between per capita asbestos consumption and male pleural cancer mortality rates (R = 0.603, P = 0.008). In the legend SV40 detection refers to SV40 nucleic acid detection at a cut-off level of 10%. Per capita asbestos consumption in a state ...
Figure 2
Figure 2
Per capita asbestos consumption and female pleural cancer mortality rates in European countries. In the legend SV40 detection refers to SV40 nucleic acid detection at a cut-off level of 10%.Per capita asbestos consumption in a state was calculated as ...

SV40 data

According to our criteria, 55 original articles on SV40 in human tissue samples or body fluids derived from 13 European countries contained information relevant to our analysis (Figures ​(Figures33 and ​and4,4, Table ​Table1).1). For all countries except the U.K., data for pleural cancer mortality and past asbestos use were available. Thus, 12 countries were included in the statistical analysis. The cut off level for SV40 detection was set at 0% or 10% positive tumor samples, respectively (Figure ​(Figure3).3). Before analyzing the effect of SV40 prevalence, we corrected male pleural cancer rates for asbestos consumption because these two variables are highly correlated. However, whether SV40 DNA had been detected in tumor samples from a particular country or not, had no effect on pleural cancer mortality rates at either cut-off level, neither in males (asbestos-corrected rates) nor in females (Table ​(Table22).
Figure 3
Figure 3
Frequencies of SV40 nucleic acid detection in European human tissue samples. Only reports using polymerase chain reaction or hybridization techniques were included. The original reports are cited in Table 1. Pleural cancer mortality data were not available ...
Figure 4
Figure 4
Map of SV40 nucleic acid detection and historical vaccine contamination with SV40 in European countries. For nucleic acid detection a cut-off level of 10% (SV40 positive samples from a country of total examined samples) was chosen.
Table 1
Table 1
SV40 nucleic acid detection in human samples
Table 2
Table 2
Comparison of pleural cancer mortality rates in countries with or without molecular genetic evidence of SV40

Poliomyelitis virus vaccines

Information regarding the type of poliomyelitis virus vaccine (and whether it had been SV40-contaminated or not) was eligible from 15 countries (Table ​(Table3).3). In ten countries, the usage of SV40-contaminated polio vaccines is unambiguously documented, while in three other countries SV40-contaminated vaccines had apparently not been used (Table ​(Table3,3, Figure ​Figure4).4). For Spain and Poland, contradictory reports exist (Table ​(Table3).3). For ten countries with either positive or negative SV40 contamination of vaccines, data on asbestos consumption and pleural cancer were available (see Figure ​Figure1,1, sources are indicated in the methods section). Our statistical analyses revealed that whether the polio vaccine was contaminated or not, had no impact whatsoever on male asbestos consumption-corrected or female pleural cancer rates. In males, the mean asbestos-corrected mortality rate was 0.77/100 000 (n = 7) in countries with SV40-contaminated vaccines and 0.83/100 000 (n = 3) in countries without SV40-contaminated vaccines (P = 0.700). In females, the mean mortality rate was 0.24/100 000 (n = 7) in countries with SV40-contaminated vaccines and 0.31/100 000 (n = 3) in countries without SV40-contaminated vaccines (P = 0.377).
Table 3
Table 3
SV40 in poliomyelitis virus vaccines in European countries
In addition, we analyzed the impact of the type of vaccine (IPV or OPV) used between 1957 and 1963 on pleural cancer rates in Europe. In two of the ten countries (Sweden and Finland), IPV was the only vaccine used at least until 1996, in two other countries (Denmark and Norway) OPV was used as well as IPV, but not before 1967, when Western European vaccines were SV40 free. In four countries, OPV was used between 1957 and 1963, together with variable exposure to IPV. In one country (Hungary) the predominant type of vaccine used between 1957 and 1963 is unclear, and in one country (Turkey) apparently no vaccine has been used between 1957 and 1963. In countries with past use of contaminated IPV, the mean male asbestos-corrected pleural cancer rate was 0.95/100 000 (n = 3), and was 0.77/100 000 (n = 5) in all other countries (P = 0.381). In countries with past use of contaminated OPV, the mean male asbestos-corrected pleural cancer rate was 0.77/100 000 (n = 3) and was 0.87/100 000 (n = 5) in all other countries (P = 0.619). In countries with past use of contaminated IPV, mean female pleural cancer rate was 0.23/100 000 (n = 3) and was 0.28/100 000 (n = 5) in all other countries (P = 0.636). In countries with past use of contaminated OPV, mean female pleural cancer rate was 0.25/100 000 (n = 3) and was 0.27/100 000 (n = 5) in all other countries (P = 0.844). Therefore, we did not find any significant differences in pleural cancer rates from countries with past use of SV40-contaminated IPV or OPV compared to the other European countries.

Peritoneal mesothelioma

Posted by Unknown Monday, 13 May 2013 0 comments


Peritoneal mesothelioma is a rare disease. The total number of cases per year in the United States is estimated between 100 and 500. A number of patients have a history of asbestos exposure. Because of the frequent dissemination of pleural mesothelioma to the peritoneal cavity, one must rule out spread from a primary pleural malignancy as the cause of peritoneal disease. No genetic, dietary, employment or geographic associations have been reported.
Peritoneal mesothelioma is unusual in that it demonstrates a wide spectrum of biological aggressiveness. The cystic variant of mesothelioma may cause recurrent episodes of severe lower abdominal pain but may not result in the death of the patient for many years. In contrast, the most aggressive mesothelioma variants may show metastases from the peritoneal surface to mesenteric lymph nodes at the time of initial surgery. Patients are diagnosed as having a malignant mesothelioma by histologic and immunocytochemical study. Frequent mitoses and increased size of the nucleus indicate an aggressive malignant process. Dissemination by cancer seeding and peritoneal fluid production would result in disease progression. As the peritoneal fluid produced by mesothelial nodules increased, dissemination to sites of peritoneal fluid resorption would be expected. Patients who are diagnosed with peritoneal mesothelioma often present to their physician with a large volume of ascites.

The widespread progression of malignant cells on peritoneal surfaces results in copious fluid production. The fluid production can be attributed to the retention of a functional property of normal mesothelial cells. In these patients the peritoneal space becomes a free conduit for mesothelioma cells to migrate from place to place. In the production of ascites fluid, the cancer cells provide themselves with a carrier solution to disseminate throughout the abdominal and pelvic spaces. 
 

CHEMOTHERAPY, ONE OF SOLUTION FOR MESOTHELIOMA

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CHEMOTHERAPY
Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying.
Purposes of Chemotherapy
Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered “curative”, the goal is:
  • To control the cancer by stopping its spread or slowing its growth.
  • To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
  • To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
  • To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.
The most common use for chemotherapy in mesothelioma patients is as an option for those who are not surgical candidates; however, cancer centers are conducting trials using the neoadjuvant approach (giving chemotherapy before surgery). Alimta (pemetrexed) is a drug approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.
The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent.
As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.
Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment consists of a 10-minute IV infusion of Alimta followed by a 2-hour infusion of Cisplatin. How many cycles of treatment you receive depends on your response to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.
Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.
Administration of Chemotherapy
The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.
  • Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.
  • The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.
Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity for treatment of peritoneal mesothelioma. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.
Frequently asked questions about being a chemotherapy patient.
Side Effects of Chemotherapy
Cancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy.

Chemotherapy Schedules
How often you will receive chemotherapy will be determined by your doctor, taking into consideration factors such as the stage of your cancer, the types of drugs you receive, the anticipated toxicities of the drugs and the time necessary for your body to recover from these toxicities. The doctor may also consider whether the goal of the chemotherapy is to control the growth of the cancer, or to ease symptoms associated with the disease.
In general, chemotherapy treatment is administered in “cycles” — a “cycle” being defined as a period of treatment followed by a period of rest. This cycle allows the cancer cells to be attacked by the drugs, and then allows the body’s normal cells time to recover. The combination of drugs used, the length of time to administer the drugs, how often they should be repeated and the number of cycles recommended have been analyzed throughly in clinical trials. For mesothelioma patients, the “standard” treatment is a combination of Alimta and cisplatin, administered IV, with a 10 minute infusion of Alimta followed by two hours of cisplatin, given in 21 day cycles. Modifications to this schedule may be made according to what your doctor feels is appropriate in your particular case.
The number of treatment cycles, or the length of time between the beginning and end of chemotherapy may vary, however in general, 3 to 4 cycles of treatment are given before response is evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness. After response to the treatment has been determined, the following criteria will be used to decide whether chemotherapy should continue:
  • If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
  • If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.
The goal of setting a chemotherapy schedule is to make treatment as effective, timely and trouble-free as possible, but while the drugs are working to kill cancer cells, they may also affect healthy cells causing side effects. One of the most common side effects, and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which means your immune system is weakened, therefore leaving you more prone to infection. While this side effect is anticipated when someone is undergoing chemotherapy, it can cause delays in your treatment schedule, or changes in the dosage of the drugs you will receive. 
Note to Patients:
Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.
1. It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
These may include:
  • Fever of, or greater than 101 degrees
  • Nausea or vomiting
  • Diarrhea or constipation
  • Fatigue
  • Tingling or numbness in the fingers or toes
  • Ringing in the ears
  • Bruises or rashes
  • Sores in the mouth or throat
2. Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.
3. Take extra care with your daily health.
Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.
Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.
4. Be open about your feelings regarding your treatment.
It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.

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