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Malignant mesothelioma is a rare but fast-spreading cancer, typically associated with long-term exposure to fibrous carcinogens such as asbestos. Mesothelioma is most often diagnosed in people whose job involved close exposure to asbestos, such as construction workers, HVAC professionals, and factory workers whose plants were involved in the manufacture of asbestos-containing items (such as vinyl flooring or auto parts). Due to the unusually-long latency period that mesothelioma has (the time from first carcinogen exposure to actual diagnosis), many people being diagnosed with mesothelioma have not had any asbestos exposure in decades — and the diagnosis comes unexpectedly in their retirement years.
If you or someone you know have been diagnosed with an unresectable mesothelioma tumor, you may have serious questions and concerns. The word itself sounds dire, and indeed having an unresectable tumor is a serious situation. However, unresectable mesothelioma tumors are not an automatic death sentence. Here is what you should know:
What does “unresectable” mean?
The word “unresectable” indicates that a tumor cannot be fully removed from the body by surgery alone, and that other treatment methodologies will be necessary in order for the tumor to be effectively treated.
Unresectable does not mean untreatable
Although learning that you have an unresectable mesothelioma tumor is alarming, it does not mean that your tumor is untreatable. It simply means that your tumor cannot be cut out of your body. There are still several treatments your oncologist can use to fight the malignant mesothelioma in your body.
Unresectable does not mean incurable
While most unresectable mesothelioma tumors are at an advanced stage of the disease, it is not impossible to use curative treatments in the hope of beating back the cancer cells and extending life expectancy (as well as increasing quality of life) for the person with cancer. Although there is no cure for unresectable mesothelioma, new treatments are constantly being explored and showing promise in the battle against advanced-stage mesothelioma.
What are my options if my tumor is deemed unresectable?
Even if your tumor cannot be removed by surgery alone, there are treatment options available, both curative and palliative, for people with unresectable mesothelioma cancer.
Chemotherapy is an option for people whose tumors are unresectable. What a surgeon cannot remove, chemotherapy drugs may be able to treat. For example, chemo drugs such as pemetrexed can slow the growth and spread of the cancer, thus preventing metastasis and keeping the progression of the cancer at bay. Chemotherapy is often the first line of treatment for unresectable malignant mesothelioma tumors. Platinum-based chemotherapy is the current first-line standard therapy for unresectable malignant mesothelioma patients. Studies also showed promising results for bidirectional chemotherapy in unresectable mesothelioma patients where they treated with combination of intravenous cisplatin-pemetrexed and intra-peritoneal cisplatin treatment. This treatment allows patients to undergo surgery even they were initially unresectable mesothelioma patients.
Targeted therapies attack cancer cells specifically, leaving the healthy tissues surrounding the tumors relatively unharmed (as compared with traditional chemotherapy or radiation therapy, which can hurt normal tissue). This treatment has fewer serious side effects, and shows great promise in treating parts of the tumor that cannot be reached by a surgeon’s scalpel. Recently, immune-checkpoint inhibitors have been investigated as immunotherapy drugs for mesothelioma patients. A phase 2 Japanese clinical trial showed very good results in patients in response to Nivolumab treatment. They approved the use of nivolumab in unresectable recurrent malignant mesothelioma patients.
Palliative treatments comfort the person suffering with cancer. Rather than trying to cure the cancer, palliative measures aim to increase a cancer patient’s quality of life by alleviating pain and discomfort caused by the cancer. Such treatments may include use of pain-killing medications or draining of fluid from the lungs or abdominal cavity to relieve pressure. For people whose cancer is incurable, palliative treatments ensure that a higher level of quality of life can be experienced even with aggressive cancer. Such treatments are often combined with curative treatments to reduce suffering.
Clinical trials are often conducted to discover new treatments that may prove effective in the battle against mesothelioma cancer. Each clinical trial has a specific focus, and many of them aim to study and treat people with unresectable, advanced-stage mesothelioma tumors. To find out if clinical trial participation is an option for you, discuss your interest at your next appointment with your oncologist. He or she should be able to point you in the right direction so that you can find the resources you need to become a clinical trial participant.
Page Medically Reviewed and Edited by Pinar Kanlikilicer, PhD
Dr. Pinar Kanlikilicer has a PhD in Biomedical Engineering. She completed her 5-years of postdoctoral training in the Department of Experimental Therapeutics at MD Anderson Cancer Center. She is currently working in the field of cancer as a research scientist.