Patients with lung cancer, mesothelioma and pulmonary metastases (disease that has spread from other areas of the body), as well as rarer tumors of the chest wall and mediastinum, benefit from the comprehensive, coordinated, multidisciplinary care offered through Cleveland Clinic Taussig Cancer Institute. Collaborating on diagnosis staging and lung cancer treatment are Clinic thoracic surgeons, medical and radiation oncologists, pulmonologists, and radiologists.
Clinic lung cancer specialists’ involvement in multi-center investigational trials gives patients with all stages of lung cancer the opportunity to participate in novel lung cancer treatment protocols involving surgery, radiation and/or promising chemotherapeutic agents or biologic response modifiers.
What is Mesothelioma?
The most common place for mesothelioma to develop is in the pleural lining, surrounding the lungs. Pleural mesothelioma is also known as cancer of the lung lining. Mesothelioma could also arise in the lining of the abdomen. This is less common than pleural mesothelioma and is called peritoneal mesothelioma.
What are the Symptoms of Mesothelioma?
The most common symptoms of pleural mesothelioma are difficulty in breathing, chest pain, or both. Occasionally, a patient may not have mesothelioma symptoms at diagnosis. Other less common symptoms include weight loss, fever, night sweats, cough, and a general feeling of not being well. Mesothelioma symptoms of peritoneal mesothelioma may include swelling, pain due to accumulation of fluid in the abdomen cavity, weight loss, and a mass in the abdomen. Other mesothelioma symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia (a lowered red blood cell count), and fever.
How is Mesothelioma Diagnosed?
It can be difficult to diagnose mesothelioma because many of the mesothelioma symptoms are similar to those of a number of other conditions, including lung cancer and other types of cancers. At the time of diagnosis, your doctor will first do a physical examination and complete a medical history, including asking about the possibility of prior exposure to asbestos.
Although there is no early detection test for mesothelioma, there are several tests that can be used to help in making the diagnosis of mesothelioma, including a chest x-ray, a CT scan, or an MRI scan. A chest x-ray yields an image of the lungs that will show many types of abnormal changes. A CT scan (computed tomography) is a type of x-ray, but it uses a computer rather than film to create detailed images.
Your doctor may need to remove a tissue sample from the tumor (a biopsy) or draw fluid (aspirate) from it to confirm it to confirm the diagnosis. This can be done in several ways.
The simplest way to obtain tissue samples involving making a small incision and placing a flexible tube in the area of the tumor. This is called a thoracoscopy if it is done in the chest area. A laparoscopy is the same procedure, but done in the abdominal cavity. A tube that is that is attached to a video camera is placed so that the doctor can look inside the body. A tissue sample may be taken at the same time. Sometimes, however, a more extensive surgical procedure may be advisable. A thoracotomy can be done to open the chest to take a tissue sample and, if feasible, to remove most or all of the visible tumor. If this procedure is done in the abdominal cavity, it is called a laparotomy.
Treatment of mesothelioma could include surgery, radiation therapy, and chemotherapy.
Surgery is sometimes used to remove fluid that usually accumulates between the lung and the pleura (lining of the lung). To prevent recurrence of this fluid a procedure call pleurodesis is sometimes used. In this procedure the doctor places a chemical substance (usually talc powder) between the lung and the pleura to cause the lung to adhere to the pleura by which preventing the build up of fluid (pleural effusion).
Radiation may also be used for the treatment of mesothelioma especially for pain control.
Chemotherapy may be used in some patients with mesothelioma and can lead to improvement in symptoms and in life expectancy.
In order to one day find a cancer cure, doctors engage in clinical trials where they test new drugs to determine if they are effective.
Clinical trials follow a plan of very strict scientific guidelines, which is called a protocol. The protocol explains everything that will happen in the study. It must be approved by review boards made up of health care professionals and other qualified people before the study can enroll patients.
When a potential drug is first identified, preclinical studies, which are conducted in a laboratory setting, help to find out whether the drug is safe to test in humans. During this stage, the drug is usually studied in animals to answer questions about how a drug works and how the body changes and disposes of it. Humans do not participate in preclinical studies. There are four possible phases of cancer clinical trials in humans, each designed to answer different questions about the treatment being studies.
In Phase I clinical trials, doctors are primarily studying the safety of giving new drugs to humans, while also looking for the best way to give a medication (for example, as a pill, an injection, or an infusion). They will usually study how the drug is eliminated from the body in humans. Also, doctors are trying to find the right doses for further testing. They carefully watch for any side effects. Phase I study drugs are usually given to small groups of humans. During this phase, for drugs used to treat cancer, investigators may be able to find out which tumors a treatment works best in.
In Phase II clinical trials, the drug is studies in a larger group. The primary purpose of these studies is to see how well the drug or treatment shrinks tumors in patients with specific types of cancer. The investigator will watch closely for side effects and will also watch how the disease responds to the treatment.
In Phase III clinical trials, the new cancer treatment is generally compared to a standard existing treatment. Patients are usually randomly assigned (that is, a process similar to flipping a coin is used to determine which treatment the patient receives) to receive either a standard treatment or the new treatment.
During the trial, patients may or may not be told which treatment they are getting but are told what to expect and what to watch for. Occasionally, even the doctor will not know which treatment each patient is getting so that he or she can remain unbiased about how the disease is responding to the treatment. (This is uncommon in cancer clinical trials). Phase III studies are designed to ensure that any side effects that patients experience are identified treated according to local standards of care.
Phase IV clinical trials study a drug that has already been approved by the Food and Drug Administration. Drug companies often sponsor these trials to study even more uses of drugs already available.
Patients battling lung cancer now have a new tool to aid them in making treatment decisions. The National Comprehensive Cancer Network (NCCN), in conjunction with the American Cancer Society, recently announced the release of its Lung Cancer Treatment Guidelines for Patients.
The NCCN Treatment Guidelines for Patients are a companion to the NCCN Clinical Practice Guidelines in Oncology used by physicians making treatment decisions. The guidelines provide the most up-to-date information about treatment options and are written in easy-to-understand language. Among the topics covered are: types of lung cancer, tests and exams, types of treatment, clinical trials information, and a helpful glossary of lung cancer terms.
Patients also are provided with the same decision trees used by their doctors. These flow charts represent the appropriate course of treatment for each stage of specific types of lung cancer.
The guidelines are available free of charge on the NCCN's web site and by calling toll free at 888.909.NCCN.