By 
Cytoreductive Surgery (CRS)
Cytoreductive surgery is a major procedure aimed at removing as much of the cancerous tissue as possible. This surgery is often the first step in treating peritoneal mesothelioma. The goal is to reduce the number of cancer cells, which can help other treatments work better.
Peritonectomy Procedures
Peritonectomy procedures involve removing parts of the peritoneum, the lining of the abdomen, where the cancer has spread. These procedures are often done in combination with cytoreductive surgery to ensure that as much cancerous tissue as possible is removed.
Eligibility for Surgery
Not everyone is a candidate for surgery. Doctors consider several factors to determine if a patient is eligible, including the stage of the cancer, the patient’s overall health, and how well other treatments have worked. Patients need to undergo various tests to assess their suitability for surgery.
Chemotherapy for Peritoneal Mesothelioma
Systemic Chemotherapy
Systemic chemotherapy is often used when surgery isn’t an option. Doctors may prescribe this treatment to help control the spread of cancer cells throughout the body. Common drugs include pemetrexed and cisplatin. These medications travel through the bloodstream, targeting cancer cells wherever they may be.
Combination Chemotherapy
Sometimes, a combination of chemotherapy drugs is more effective. This approach can increase the chances of killing more cancer cells. Patients might receive a mix of drugs to attack the cancer in different ways. This method can be more powerful but may also come with more side effects.
Side Effects of Chemotherapy
Chemotherapy can cause various side effects. These might include nausea, fatigue, and hair loss. Some people may also experience weight loss and a decrease in blood cell counts. It’s important to discuss these potential side effects with your doctor to manage them effectively.
Understanding HIPEC for Peritoneal Mesothelioma
What is HIPEC?
Hyperthermic intraperitoneal chemotherapy, or HIPEC, is a treatment that combines surgery with heated chemotherapy to fight peritoneal mesothelioma. After the bulk of the tumors are removed through cytoreductive surgery (CRS), heated chemotherapy drugs are circulated throughout the abdominal cavity to target any remaining cancer cells. This method allows for a higher concentration of chemotherapy to be used directly where it’s needed, reducing the risk of side effects compared to traditional chemotherapy.
How HIPEC Works
The HIPEC procedure involves two main steps:
- Cytoreductive Surgery (CRS): Surgeons remove as much of the visible tumor as possible.
- Heated Chemotherapy: A perfusion machine heats the chemotherapy drugs and pumps them into the abdomen. The heated drugs are circulated for 1 to 2 hours to kill any remaining cancer cells.
This combination of surgery and heated chemotherapy is effective because the high temperature of the chemo fluid helps to kill cancer cells more efficiently than unheated drugs.
Benefits of HIPEC
HIPEC offers several benefits for patients with peritoneal mesothelioma:
- Higher Drug Concentration: The localized application allows for a higher dose of chemotherapy, which can be more effective in killing cancer cells.
- Fewer Side Effects: Since the chemotherapy is confined to the abdominal cavity, it causes fewer side effects than systemic chemotherapy.
- Extended Life Expectancy: Studies have shown that patients who undergo HIPEC in combination with CRS have improved survival rates.
- Symptom Relief: HIPEC can help reduce symptoms and improve the quality of life for patients.
Overall, HIPEC is a promising treatment option that targets cancer cells directly and offers a better quality of life for patients.
Immunotherapy and Targeted Therapy
Immune Checkpoint Inhibitors
Immune checkpoint inhibitors are a type of immunotherapy that helps the body’s immune system find and destroy cancer cells. These drugs are often used to treat pleural mesothelioma but can also be prescribed for peritoneal mesothelioma. They work by blocking proteins that stop the immune system from attacking cancer cells, making it easier for the body to fight the disease.
Gene Testing and Targeted Therapy
Targeted therapy focuses on specific genetic changes in cancer cells. Some people with peritoneal mesothelioma have genetic mutations that can be treated with these therapies. Doctors perform gene testing on tumor samples to identify any targetable changes. If such changes are found, targeted therapies can be used to attack the cancer cells directly, leaving healthy cells mostly unharmed.
Clinical Trials for New Treatments
Clinical trials are research studies that test new treatments to see if they are safe and effective. Patients with peritoneal mesothelioma may have the option to join clinical trials for new immunotherapy and targeted therapy treatments. These trials offer access to cutting-edge treatments that are not yet widely available. Participating in a clinical trial can provide patients with additional treatment options and contribute to medical research.
Palliative Care for Advanced Peritoneal Mesothelioma
Managing Symptoms
When peritoneal mesothelioma is in its advanced stages, palliative care becomes crucial. The main goal is to reduce painful or immobilizing symptoms and side effects of the disease. This type of care is managed by a team of doctors and nurses who specialize in controlling symptoms of advanced cancer. They may also include a physiotherapist and dietician to help manage overall well-being.
Paracentesis Procedure
One common issue for patients is the buildup of fluid in the abdomen, known as ascites. This can cause discomfort and make the abdomen feel heavy. A procedure called paracentesis can help. During this procedure, a doctor drains the excess fluid from the abdomen, providing relief from the uncomfortable pressure.
When to Consider Palliative Care
Palliative care is often recommended when a patient is not healthy enough for surgery or if the cancer is in a later stage. It focuses on improving the quality of life by managing symptoms and treatment side effects. This type of care can be the best option for those who are too ill to cope with more intensive treatments like chemotherapy or surgery.
Evaluating the Success and Risks of HIPEC
Success Rates of HIPEC
HIPEC, combined with cytoreductive surgery, has shown promising results for patients with peritoneal mesothelioma. Studies, including those by Dr. Paul Sugarbaker, have reported a five-year survival rate of up to 52% for patients undergoing this treatment. The success of HIPEC largely depends on the completeness of the cytoreduction and the patient’s overall health.
Potential Risks and Side Effects
While HIPEC can be effective, it is not without risks. Patients may experience side effects such as:
- Bleeding
- Blood clots
- Digestive issues
- Fatigue
- Infection
- Severe bleeding
- Tissue perforation
The procedure also carries a small mortality rate of about 1.1%, and serious complications can occur in 4.5% to 19% of cases.
Patient Eligibility for HIPEC
Not all patients are suitable candidates for HIPEC. The best candidates are those with resectable tumors and good overall health. Factors such as the extent of the disease and previous treatments also play a role in determining eligibility. HIPEC means hope for many, but it is crucial to consult with a specialist to understand the potential benefits and risks.
Comments