Remission is something that all mesothelioma patients hope for. When there are no visible signs of cancer, Mesothelioma is considered to be “in remission”.
Remission of Mesothelioma
Mesothelioma is an aggressive, malignant cancer that often carries a poor prognosis and a life-expectancy usually given in months. Despite these odds, the ultimate goal of any cancer treatment is remission of the disease and some patients prove to be exceptions. Though most mesothelioma cases will not ultimately be resolved, many patients have dramatically increased their life expectancy. With successful treatment, some patients have become mesothelioma survivors, with their disease in remission.
About Mesothelioma Remission
When a person has mesothelioma, the goal of most treatments is remission. Mesothelioma remission marks a significant turning point in cancer care and gives great relief to patients and family members.
Definition of Remission
Remission is defined as the absence of visible signs of disease. For cancer patients, including those with mesothelioma, being “in remission” means that tumors have been eradicated and treatments may be discontinued.
Mesothelioma is not ever considered “cured”. This is because there is no way to guarantee that all cancer cells are gone. Remission however, indicates that most of the cancer is gone and mesothelioma tumor tissue is no longer growing. It also means that treatments may be discontinued. Though the patient will be closely observed for recurrence or new cancer growth.
There are actually two types of remission:
Partial remission – The mesothelioma may be known to still be present in the body but most of it is gone. It also may mean that mesothelioma progression has stopped and that treatments may be discontinued for a while. Though nothing is certain, the patient’s life expectancy has increased by a significant amount. Most patients will not be diagnosed with “partial” remission and treatments will continue until complete remission occurs. Certain conditions such as declining health or personal matters may make it desirable to stop treatments temporarily. It is possible to do so when a patient is in partial remission, though treatments will resume if the cancer shows signs of recurrence.
Complete remission – No visible or obvious signs of cancer remain in the body. This means that tumors are gone and cancer cannot be seen on a scan such as X-ray or CT scan. Remission does not mean that cancer is “cured” because there is no certainty that all cancer cells have been eradicated. It does mean that mesothelioma treatments can be discontinued indefinitely but any time in the future, cancerous cells may begin to divide again and cause new tumor growth. This is known as “recurrence” and will require more mesothelioma treatments.
Increasing the Chance for Remission
Cancer of any type should be thought of as a chronic disease with treatment intended to stop advancement or worsening of the disease and elimination of tumors. Once a diagnosis of mesothelioma is made, every patient and their family members hope for remission.
Mesothelioma is an aggressive disease that in most cases, results in a poor prognosis. It is difficult to identify and challenging to treat. In addition, there are several location types of mesothelioma and multiple cell types of the disease, making each patient unique. Treatments are designed to slow or stop the progression of the cancer and even though they are not always successful, in some patients they are highly effective. These patients may have increased their life-expectancy and may be considered to be in remission. This makes them a mesothelioma survivor.
Early Diagnosis and Treatment
The chance for mesothelioma remission is increased when the disease has been diagnosed in the earliest stages and is treated aggressively. Even in some more advanced cases however, treatments such as surgery, chemotherapy, radiation and newer methods have led to remission.
Mesothelioma Specialists and Cancer Centers
When patients find a qualified mesothelioma specialist and are treated at a mesothelioma cancer center, the chance for remission may be increased. With these physicians and treatment facilities, patients have access to a variety of experts and health care professionals who are experienced at treating mesothelioma. Patients also are more likely to be treated with advanced techniques and newer medications and may be able to participate in clinical trials.
General Health
Mesothelioma treatments may be more effective if the patient is healthier. In addition, patients who are not in good health may not be able to tolerate certain treatments. Maintaining or even improving general health may increase the chance of going into mesothelioma remission. When approved by a physician, maintaining healthy habits such as eating right, drinking plenty of fluids, and getting moderate exercise may improve the likelihood of remission.
Treatment Types for Remission
There are several options for mesothelioma treatment, depending on the type of mesothelioma, cell type and other patient specifics. Surgery is most commonly considered to be the standard of treatment and can be highly effective, particularly when combined with other methods. Not all patients will be able to tolerate every treatment method.
Surgery
Surgery is the most common and the most effective method of treatment, especially if performed with other treatment methods. The most common surgeries intended to induce remission include:
- Pleurectomy with Decortication (P/D) – removal of the pleural lining of the lung.
- Extrapleural Pneumonectomy (EPP) – removal of the pleural lining, section of the diaphragm and entire lung affected by mesothelioma.
- Perinectomy with debulking– removal of tumor and portion of peritoneal lining affected by mesothelioma.
- Cytoreduction – removal of the entire peritoneal lining of the abdominal cavity and other tissue as required.
Chemotherapy
Chemotherapy is treatment with medication to kill cancer cells and shrink tumor size. It is most commonly used with other treatment methods such as surgery.
· Neoadjuvant therapy – chemotherapy given before to surgery to reduce tumor size and make surgery easier and more effective.
· Adjuvant therapy – chemotherapy given after surgery to help ensure that cancer cells remaining behind are killed.
· Intraoperative therapy – chemotherapy applied directly to tumor during surgery. Heated intraoperative peritoneal chemotherapy (HIPEC) uses warmed chemotherapeutic medication to “wash” out the abdomen to kill cancer cells.
Radiation Treatment
Radiation therapy uses concentrated energy beams which are focused on the tumor site. It is most commonly used with other treatment methods intended to increase the chance for remission.
· External Beam Radiation – “traditional” radiation treatments used before surgery to decrease tumor size or after surgery to ensure that cancer cells are killed.
- Intensity-Modulated Radiation Therapy – a highly concentrated form of radiation which is targeted through computerized imagery.
· Intraoperative Radiation Therapy – involves the application of radiation during surgery to minimize risk to healthy tissues
Newer Treatments
Newer and emerging treatment methods include medications that target mutations or certain DNA types that may be more effective with some cell types. Other medications may make cancer cells more susceptible to chemotherapy or radiation. Procedures such as photon and photodynamic therapy which use light energy to eradicate mesothelioma cells are also under investigation.
Recurrence
When a new tumor starts to grow after a patient has been in remission, it is known as recurrence. The recurrence of mesothelioma is always a possibility as no case can ever said to be “cured”. Re-emergence of mesothelioma occurs because even though visible evidence of cancer was gone, some mesothelioma cancer cells were left behind in the body. As mesothelioma is caused by cells that start to divide uncontrollably, even a single cell that remains alive after treatment can cause recurrence.
These few remaining cancer cells may go into a dormant-type state and may not begin new cancers for a period of time but most recurrences of cancer occur within the first 5 years after remission. With appropriate and effective treatment, many patients have gone into remission and become mesothelioma survivors.
Follow-up care
If a patient goes into remission, they should closely follow care instructions. This includes attending to follow-up appointments which re-examine the patient to look for new mesothelioma growth. If recurrence does happen, just like with the first mesothelioma occurrence, the earlier treatment is started, the better the outcome is likely to be.
References:
American Cancer Society, (18 May 2015), What is Mesothelioma?, ACS Cancer.org, Accessed on 29 January 2016 http://www.cancer.org/cancer/malignantmesothelioma/detailedguide/malignant-mesothelioma-malignant-mesothelioma
Medline Plus, (12 January 2016), Mesothelioma, U.S. National Library of Medicine, Accessed on 29 January 2016 https://www.nlm.nih.gov/medlineplus/mesothelioma.html
MSKCC, (2016), About Mesothelioma, Memorial Sloan Kettering Cancer Center, Accessed on 29 January 2016 https://www.mskcc.org/cancer-care/types/mesothelioma/about-mesothelioma
Mesothelioma Applied Research Foundation, (2013), What is Mesothelioma?, MARF CureMeso.org, Accessed on 29 January 2016 http://www.curemeso.org/site/c.duIWJfNQKiL8G/b.8578801/k.639A/What_is_Mesothelioma.htm
National Cancer Institute, (2016), Malignant Mesothelioma – Health Professional Version, National Institutes of Health, Accessed on 29 January 2016 http://www.cancer.gov/types/mesothelioma/hp
National Cancer Institute, (2016), NCI Dictionary of Cancer Terms, National Institutes of Health, Accessed on 29 January 2016 http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45867
Web MD, (01 April 2014), What does cancer remission really mean?, Web MD, Accessed on 29 January 2016 http://www.webmd.com/cancer/remission-what-does-it-mean
