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.
At Kazan Law, we try to keep up with the latest medical developments. We know that when it comes to forming prognoses of cancer patients, doctors often rely on staging systems that describe the physical extent of the malignancy. However, when it comes to mesothelioma, arriving at an opinion may be more challenging. One team of scientists from Rome decided to comb through the various prognostic factors that researchers studied throughout the years and published their review in the journal Oncology.
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.”