Factors
that Impact a Mesothelioma
Receiving the news that you have malignant pleural
mesothelioma can be overwhelming, but knowing your diagnosis is a positive
first step in fighting the battle. Next, your team of healthcare providers need
to determine how extensive your disease is. This will help them decide which
treatments are the most appropriate for you and which ones are not worth the
expense and side effects.
Staging
systems are inadequate
There are several treatment options for mesothelioma
patients: chemotherapy, radiation therapy, surgery or a combination of any of
these. Deciding which regimen to undergo depends partly on how advanced the
disease is.
Experts from the National Cancer Institute say that
surgical options – either extrapleural pneumonectomy or
pleurectomy/decortication – are typically only recommended for patients who are
in stage I of the disease. This means that the cancerous tissue is limited to
certain areas of the chest lining. For stages II-IV, radiation or chemotherapy
are often prescribed. However, some patients may still be eligible for
pleurectomy/decortication.
The options for patients who have recurrent mesothelioma
are mostly limited to participating in a clinical trial.
One problem with the staging system for mesothelioma is
that, by the time patients are diagnosed, the disease is usually in its
advanced stages. This underscores the need for better techniques to identify
the disease and determine its extent.
Reviewers
go from macro to micro
Although cancer prognoses often rely on staging systems,
the amount of information that can describe mesothelioma is more vast than some
medical professionals may know. The review recently published in Oncology
grouped the various predictive factors of this disease into three main groups:
Clinical
factors.
These include sex, age, extent of asbestos exposure,
symptom severity, performance status, radiological imaging, blood cell
abnormalities, enzyme abnormalities and the presence of certain proteins in the
blood serum. Additionally, both patients’ cancer staging and their responses to
treatment may also impact their prognoses.
Genetic
factors.
Although asbestos exposure is the only known direct cause
of mesothelioma, the carcinogen interacts with a unique set of genes in each
patient. Prognoses may depend in part on the presence of mutations in
individuals. Furthermore, the severity of a disease can be affected by
mechanisms in the cells that control how certain genes are expressed.
Molecular
pathway factors.
The way in which the machinery in your cells behaves can
influence how well the diseased tissue thrives. For example, most healthy cells
are programmed to die after a certain time, or after an extensive amount of
damage takes place. It is not uncommon for cancerous cells to be missing this
mechanism for cell death.
The Environmental Working Group estimates that
mesothelioma claims the lives of more than 2,500 individuals in the U.S. every
year. Having more effective methods of forming prognoses can help doctors
decide which patients are eligible for certain treatments, including those that
are more targeted.
“Until the suggested novel gene and immunologic therapies
have demonstrated their effectiveness, the best approach that can be offered to
patients remains as extensive a surgical cytoreduction as possible, followed by
adjuvant chemo- and radiotherapy,” the reviewers wrote. “Still, an adequate
knowledge and evaluation of prognostic factors can help in defining the
multidisciplinary approach to therapy in order to reduce the mortality from
this lethal disease.”