Mesothelioma has a very poor prognosis to date. The outcome of very extensive operations is nothing short of disappointing and operations are therefore very rare. Mesothelioma mainly affects the pleura or lung membrane, which is almost always accompanied by the formation of fluid behind the lung (pleural fluid).
Getting the diagnosis of mesothelioma is difficult. We are not always diagnosed with only a puncture of the fluid behind the lungs, often a small operation (VATS procedure) must be done afterwards to obtain adequate pieces of tissue from the lung membrane. Sometimes we need to conduct multiple investigations to eventually arrive at a diagnosis of mesothelioma. When the fluid behind the lung (pleural fluid) has been removed, we then try to stick the two lung sheets together using talc. With this we want to prevent the moisture from coming back, so we can reduce the symptoms of shortness of breath.
Once mesothelioma is diagnosed, the patient may qualify for palliative chemotherapy. If the patient’s condition permits, combination treatment of pemetrexed and platinum-based chemotherapy is preferred. This is a relatively mild treatment without too many side effects, trying to bring back or stabilize the disease.
Treatment of invasive cancer requires close coordination between different medical and allied health disciplines. Depending on the needs, different medical and non-medical concerns are involved. Therefore, the therapeutic strategy is never decided by one physician. Every cancer patient should be discussed in a Multidisciplinary Oncological Consultation (MOC). Doctors from different disciplines are involved, together with experts from other fields (such as nurses, psychologists, dieticians, etc.).
Thus, the treatment is always tailored as much as possible to the individual. The doctors will propose a treatment tailored to your specific situation, including the following elements:
• the type of cancer
• the stage (extent) of the cancer;
• the general health of the patient.
Types of cancer treatment
There are various cancer treatments that are used individually or in combination. Depending on what the MOC decides (and therefore among other things of the type of cancer), certain of these treatments will be chosen, but rarely all:
- Surgery (surgery)
• Hormone treatment
• Targeted treatments
Breast cancer treatments
The surgery is often the first treatment after breast cancer was discovered. If possible, the surgeon will try to preserve the breast by performing breast conserving surgery. In addition, one or more lymph nodes under the arm are always removed (in the armpit). We call this glandular clearance.
For small tumors, a technique called “Sentinel gland” is used. If the sentinel node does not contain cancer cells, it is not necessary to remove the other deeper glands. That is because the sentinel node is the first gland to which the lymph fluid from the breast flows.
The presence or absence of cancer cells in glands will largely determine the additional treatments for breast cancer. Different techniques are possible depending on the characteristics of the tumor.
The radical mammectomy
This surgical procedure, also called a mastectomy, is equivalent to a complete removal of the breast. After a radical mammectomy, the patient will be offered an external prosthesis in a light fabric when she returns home to balance the silhouette.
Again, this involves surgical removal of the tumor, but attempts are made to leave the healthy surrounding tissues on site. If necessary, more tissues will be removed later to remove a sufficiently large safety margin around the tumor. Thanks to this “conservative” surgery it is possible to preserve the breast. The quadrantectomy (also called a partial mammectomy) is a larger tumorectomy.
Side effects of surgery
The most common symptoms or complaints after surgery are on the side of the operated breast:
- swollen arm and hand
- stiff neck, arm and shoulder muscles
- an itchy hand
- possibly a wound infection or hematoma
- insensitivity to the scar and chest (late after effects)
The removal of lymph nodes under the arm (armpit) leads to a swollen arm and hand on the side of the operated breast in some women. That phenomenon is called ‘thick arm’ or ‘lymphedema’. Treatment consists mainly of specialized physiotherapy (lymph drainage), because there is no effective medicine to remedy this problem. However, this risk can be greatly reduced if it is possible to remove only a small number of lymph nodes (sentinel node technique).