Recurring Mesothelioma

Mesothelioma recurrence is almost impossible to avoid, even after the most aggressive surgery, after a multimodality approach to treatment and after adjuvant follow-up therapy. The recurrence of mesothelioma cancer is likely because of the unique characteristics of this disease, which can spread through the lining of the lungs, heart and abdomen.

The location of tumors so close to organs makes it difficult for doctors to eliminate it completely, even with the most advanced medical technology. The key – and the hope – is to delay the eventual recurrence, keeping it under control for as long as possible.

What is cancer recurrence?

Cancer recurrence is typically defined as a return of the cancer after treatment and after an extended period when it cannot be detected. Cancer progression is when it gets worse or spreads. The difference between the two is often murky with mesothelioma because there is no proven cure.

In one recent study from Italy covering a 20-year period, 93 percent of the mesothelioma patients who opted to undergo an aggressive extrapleural pneumonectomy (EPP) surgery, later developed tumor recurrence , highlighting the inadequacy of current treatment strategies and underscoring the difficulty of dealing with this disease.

In another study (covering six years) from the Toronto General Hospital that followed 60 patients who were healthy enough for the EPP surgery, the median survival rate was 14 months. The five-year survival rate post-surgery was 10 percent.

EPP is an extensive procedure intended to remove the disease fully from the body, taking both the affected lung along with everything around it that could be affected in the future. It includes removal of the pleura, the lining around the lung, and the pericardium, the lining around the heart, as well as much of the diaphragm, which is rebuilt with prosthetic material.

The multi-disciplinary approach also includes chemotherapy and radiation in an effort to eradicate any disease left in the body. Even with those efforts, recurrence normally happens at some point.

There are other, less radical, surgeries for mesothelioma, including pleurectomy and decortication (P/D), which eliminates fewer cancer cells but is far less taxing physically and preserves a patient's lung.

"Sometimes, we get stuck in the concept of having to cure cancer and don't always understand that we can be good at controlling it"

Robert Cameron, M.D., one of America's leading mesothelioma surgeons who practices at the UCLA Medical Center. "It's much more likely to be able to control it (mesothelioma), then being able to kill every last (cancer) cell. If you can do that, you can live a long time with it." Cameron is a proponent of the P/D surgery, preferring it over the EPP. He concedes there likely will be recurrence of mesothelioma but believes in the work to control it within the body.