Treatment for pleural mesothelioma

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1 Treatment for pleural mesothelioma This information is an extract from the booklet Understanding mesothelioma. You may find the full booklet helpful. We can send you a free copy see page 9. Contents Treatment overview Chemotherapy for pleural mesothelioma Radiotherapy for pleural mesothelioma Surgery for pleural mesothelioma Treatment overview For most people, treatment is given to help control symptoms and to slow the growth of the pleural mesothelioma. Treatments may include chemotherapy (see below), radiotherapy and other treatments, sometimes known as supportive therapies. Very occasionally, if mesothelioma is diagnosed before it s spread or if it s only spread to nearby tissues, surgery may be an option. Chemotherapy for pleural mesothelioma Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs disrupt the way cancer cells grow and divide but they also affect normal cells. You may be offered chemotherapy to help slow the growth of your mesothelioma, shrink your mesothelioma and control and improve symptoms such as pain and breathlessness. Your doctor will let you know if it s a suitable treatment for you. Questions about cancer? Ask Macmillan Page 1 of 9

2 How chemotherapy is given Chemotherapy drugs for pleural mesothelioma are usually given by injection into a vein (intravenously). Each session of chemotherapy may last between one and a few days, and is followed by a rest period of a few weeks. This is known as a cycle of treatment. The number of cycles you have depends on the stage of your cancer and how well it s responding to treatment. The drugs that are used The most commonly used drugs to treat pleural mesothelioma are pemetrexed (Alimta ) together with cisplatin (or sometimes carboplatin). You ll usually be given these drugs on the same day as an outpatient. You ll then have a rest with no chemotherapy for 20 days before starting your next cycle of treatment. If you have pemetrexed, you ll be given the vitamins B12 and folic acid. These help to reduce side effects of treatment without reducing its effectiveness. Other chemotherapy drugs may sometimes be used. These may be given as part of a clinical trial. We can send you a booklet about chemotherapy, which has more detailed information. Side effects of chemotherapy Chemotherapy drugs can affect some of the healthy cells in your body and this can cause side effects. Most side effects will go away when treatment is over. Each person s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The most common side effects of pemetrexed and cisplatin are: Risk of infection Pemetrexed and cisplatin can reduce the number of white cells in your blood. This will make you more likely to get an infection. Page 2 of 9 Questions about cancer? Ask Macmillan

3 Your white blood cells start to reduce seven days after treatment and are usually at their lowest days after. When the number of white blood cells is low it s called neutropenia. Contact the hospital straight away on the contact number you ve been given if: your temperature goes over 37.5 C (99.5 F) or over 38 C (100.4 F), depending on the advice given by your chemotherapy team you suddenly feel unwell, even with a normal temperature you have symptoms of an infection this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot. Your white cells usually increase steadily and return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your blood cells are still low, your doctor may delay your treatment for a short time. Bruising and bleeding Pemetrexed and cisplatin can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets. Anaemia (low red cells) Pemetrexed and cisplatin can reduce the number of red cells in your blood. These cells carry oxygen around the body. If they are low you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red cells (blood transfusion). Feeling sick This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It s easier to prevent sickness than to treat it after it has started. If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti sickness drug to one that works better for you. Questions about cancer? Ask Macmillan Page 3 of 9

4 Sore mouth Your mouth may become sore or dry, or you may notice small ulcers during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. Diarrhoea Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea. Numbness or tingling in hands or feet These symptoms are caused by the effect of cisplatin on nerves. It s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks. Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this. Tiredness (fatigue) Feeling very tired is a common side effect. It s often worse towards the end of treatment and for some weeks after it s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don t drive or operate machinery. Eye problems Pemetrexed may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to prevent this. It s important to use these as instructed. Hearing changes Cisplatin can affect your hearing. You may have a hearing test before you start treatment. During treatment you may get ringing in your ears (tinnitus) and lose the ability to hear some high pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing. Page 4 of 9 Questions about cancer? Ask Macmillan

5 Hair loss Your hair will thin. Very rarely people lose all the hair from their head. Hair loss usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun. Your nurse can give you advice about coping with hair loss. Although they may seem hard to bear at the time, most of the side effects are temporary and will disappear once your treatment is over. We can send you more information about these chemotherapy drugs and their side effects. Radiotherapy for pleural mesothelioma Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It is normally given as a series of short, daily outpatient treatments in the radiotherapy department. It uses equipment which looks similar to a large x-ray machine. Radiotherapy may be given: to help relieve symptoms such as pain and breathlessness alongside surgery and chemotherapy (this may be as part of a clinical trial our booklet Understanding cancer research trials describes clinical trials in more detail) to the chest wall at the place where a biopsy has been done or a drainage tube has been inserted. The radiotherapy may prevent the tumour from growing out through the scar trials are looking at how effective it is. Sometimes only one or two treatments are needed, but more often a course of treatment is given over a few days or weeks. Sometimes only one or two treatments are needed, but more often a course of treatment is given over a few days or weeks. Questions about cancer? Ask Macmillan Page 5 of 9

6 Planning radiotherapy Before you start your treatment it needs to be planned. Planning makes sure that the radiotherapy is aimed precisely at the cancer so that it causes the least possible damage to the surrounding healthy tissue. All radiotherapy treatments are planned on an individual basis by your clinical oncologist, a physicist and sometimes by a senior or specialist radiographer. Your first planning visit will take minutes. The staff in the radiotherapy department will explain what to expect. It s important for you to feel that you re involved in your treatment, so feel free to ask as many questions as you need to. You ll usually have a CT (computerised tomography) scan taken of the area to be treated. You may have some marks drawn on your skin to help the radiographer to position you accurately and set where the treatment will be delivered. It s important not to rub them off until your treatment is finished. Sometimes tiny, permanent marks are made on the skin. At the beginning of your radiotherapy you ll be given instructions on how to look after your skin. Treatment sessions At the beginning of each session of radiotherapy, the radiographer will position you carefully on the treatment couch and make sure you re comfortable. Once you re in the correct position the radiographers will leave the room and you ll be given your treatment. They will tell you how long your treatment will take before you start. Radiotherapy isn t painful, but you will have to lie still for a few minutes during the treatment. The radiographers will be able to see you and many treatment rooms also have an intercom in the treatment room so they can talk to you during your treatment. I went through a period when my chest started to get very, very tight and thick with phlegm. I was put on radiotherapy and that stopped the phlegm coming up on my chest which helped me breathe a bit easier. Martin Page 6 of 9 Questions about cancer? Ask Macmillan

7 Side effects of radiotherapy You may develop side effects while you are having your radiotherapy treatment. These usually disappear gradually over a few weeks or months after treatment finishes. Your doctor, radiographer or nurse will discuss this with you so you know what to expect. Let them know about any side effects you have during or after treatment, as there are often things that can be done to help. Tiredness Not everyone feels tired during radiotherapy treatment but many people do. If you feel tired, get plenty of rest but balance this with some gentle exercise, such as short walks. This will give you more energy and help to keep your muscles working. Save some energy for doing the things you enjoy and ask others for help doing chores if these are tiring you out. Skin reactions Some people develop a skin reaction while having radiotherapy. How your skin reacts will vary depending on the amount of radiotherapy you are having. Your doctor, radiographer or nurse will tell you how to look after your skin during and after treatment. Difficulty swallowing After a week or two of treatment, you may find it difficult to swallow. You may also have heartburn and indigestion. This happens because the radiotherapy can cause inflammation in the tube that runs from your mouth to your stomach, called the gullet (oesophagus). Tell your doctors if you have problems swallowing, as they can give you medicines to help. If you don t feel like eating, or have problems with swallowing, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. Cough You may develop a cough while you are having your radiotherapy. This usually settles within a few weeks of finishing your treatment. If it doesn t settle, or if you develop a temperature, tell your doctor, radiographer or specialist nurse as you may have an infection. Feeling sick Some people find that their treatment makes them feel sick (nausea) and sometimes they may be sick (vomit). Your doctor (or sometimes a nurse or radiographer) can prescribe effective Questions about cancer? Ask Macmillan Page 7 of 9

8 anti-sickness drugs if this happens. Tell your doctor, nurse or radiographer if you have any nausea or vomiting. We can send you more information about coping with nausea and vomiting. These side effects should disappear gradually once your course of treatment is over, but it s important to let your doctor know if they continue. We can send you more information on coping with these side effects. Radiotherapy does not make you radioactive and it s perfectly safe for you to be with other people, including children, throughout your treatment. Our booklet Understanding radiotherapy explains this treatment in more detail. Surgery for pleural mesothelioma Surgery is only suitable for some people with pleural mesothelioma. The aim of surgery is to help with symptoms and to control the disease rather than to cure it. The operation will be done by a specialist chest surgeon who is experienced in the treatment of mesothelioma. An operation may be carried out as part of a clinical trial. Pleurectomy/decortication (PD) A pleurectomy/decortication involves removing only the tumour and pleura. The lung tissue is not removed. Extended pleurectomy/decortication (EPD) As well as removing the tumour and pleura, the surgeon will also remove the covering of the heart (pericardium) and the muscle between the lung and the abdomen (diaphragm). Page 8 of 9 Questions about cancer? Ask Macmillan

9 Partial pleurectomy A partial pleurectomy is occasionally used to help stop fluid building up in the lung. This can help reduce breathlessness and pain. It can also help a collapsed lung to reinflate with air, which will help reduce breathlessness. It may be possible to have a partial pleurectomy using keyhole surgery. With this type of surgery, only small openings are made instead of one large cut (incision). If surgery is a suitable treatment for you, your doctor will tell you more about what to expect. More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding mesothelioma or any other cancer information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN APRIL 2015 Planned review in 2017 Questions about cancer? Ask Macmillan Page 9 of 9

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