Mesothelioma

CISS relies strongly in its evaluations below on impartial analyses by the International Cochrane Collaboration and the British Medical Journal’s Clinical Evidence Group – two groups of researchers who specialise in Evidence Based Medicine.

Conventional medicine supports the paradigm that the tumour is the first stage of cancer; therefore treating and removing the cancer should cure the cancer. Unfortunately statistics show this is rarely the case.

Conventional medicine also advocates treatment should only be used if supported by appropriate clinical trials showing efficacy. 

Evidence based medicine suggests that the only reliable evidence for efficacy comes from properly run randomised controlled trials (RCTs).

As mentioned below, none of the RCTs evaluating conventional intervention for mesothelioma have shown any clear benefit.  Therefore the conventional cancer paradigm needs to be questioned.

The following is based on the conventional cancer paradigm. Treatments based on an alternative paradigm are given later.

(Malignant) mesothelioma is a disease in which malignant (cancer) cells form in the thin layer of tissue that covers the lung, chest wall, or abdomen. It may also form in the heart or testicles, but this is rare. The two main types are pleural and peritoneal.

The pleura are two membranes around the lungs: the visceral and parietal pleurae. The visceral pleura envelops the lung, and the parietal pleura lines the inner chest wall. The pleural fluid acts as a lubricant between the two membranes. Pleural mesothelioma arises in the cells of these membranes.

The peritoneum consists of two membrane layers around the abdominal organs that can move around independently. As with the pleural membranes, the visceral peritoneum surrounds all the organs within the abdominal cavity while the parietal peritoneum layer lines the entire abdominal cavity. Peritoneal mesothelioma arises in the cells of these two membranes.

The type of mesothelioma also depends on the cell in which it began. The most common type of mesothelioma is epithelial mesothelioma, which forms in the cells that line organs. The other types begin in spindle-shaped cells called sarcomatoid cells or are a mixture of both cell types. Epithelial mesothelioma may grow more slowly and have a better prognosis than other types.

The major cause of mesothelioma is being exposed to asbestos over a period of time. This includes people who were exposed to asbestos in the workplace and their family members.

After a person is exposed to asbestos it usually takes at least 20 years for mesothelioma to form. (NCI)

Signs and Symptoms:  Signs and symptoms of mesothelioma include shortness of breath and pain under the rib cage.

Sometimes the cancer causes fluid to collect in the chest or in the abdomen. Signs and symptoms may be caused by the fluid, mesothelioma, or other conditions. Check with your doctor if you have any of the following:

• Trouble breathing
• Cough
• Pain under the rib cage
• Pain or swelling in the abdomen
• Lumps in the abdomen
• Constipation
• Problems with blood clots (clots form when they shouldn’t)
• Weight loss for no known reason
• Feeling very tired

(NCI)

Dietary factors: There are no dietary factors that are known to increase the risk of mesothelioma. (CISS)

Tests for mesothelioma: Tests that examine the inside of the chest and abdomen are used to detect (find) and diagnose mesothelioma.

Sometimes it is hard to tell the difference between mesothelioma in the chest and lung cancer.

The following tests and procedures may be used to diagnose mesothelioma in the chest or peritoneum:

Physical exam and history: An examination of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos and past illnesses and treatments will also be taken.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that go through the body and onto film, making a picture of areas inside the body.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.

Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Procedures used to collect the cells or tissues include the following:

• Fine-needle aspiration (FNA) biopsy of the lung: The removal of tissue or fluid using a thin needle. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid and a sample is removed.
• Thoracoscopy: An incision (cut) is made between two ribs and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the chest.
• Thoracotomy: An incision is made between two ribs to check inside the chest for signs of disease.
• Peritoneoscopy: An incision is made in the abdominal wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen.
• Laparotomy: An incision is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.
• Open biopsy: A procedure in which an incision (cut) is made through the skin to expose and remove tissues to check for signs of disease. (NCI)

Prognosis (chance of recovery): Certain factors affect prognosis and treatment options.

The prognosis and treatment options depend on the following:

• The stage of the cancer
• The size of the tumour
• Whether the tumour can be removed completely by surgery
• The amount of fluid in the chest or abdomen
• The patient’s age
• The patient’s activity level
• The patient’s general health, including lung and heart health
• The type of mesothelioma cells and how they look under a microscope

• The number of white blood cells and how much hemoglobin is in the blood
• Whether the patient is male or female

• Whether the cancer has just been diagnosed or has recurred (come back) (NCI)

Treatment:

Localised Malignant Mesothelioma (Stage I)

If malignant mesothelioma is in one part of the chest lining, treatment may be the following:

Surgery to remove the part of the chest lining with cancer and the tissue around it.

If malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:

• Extrapleural pneumonectomy
• Pleurectomy and decortication, with or without radiation therapy, as palliative therapy to relieve symptoms and improve quality of life
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life
• A clinical trial of anticancer drugs placed directly into the chest after surgery to remove the tumor
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy
• A clinical trial of a new treatment

If mesothelioma is in the peritoneal lining, treatment may be the following:

• Surgery to remove the part of the peritoneal lining with cancer and the tissue around it.

You can search NCI-supported cancer clinical trials that are accepting patients for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Advanced Malignant Mesothelioma (Stage II, Stage III, and Stage IV)

If advanced malignant mesothelioma is found in the chest, treatment may be one of the following:

• Combination chemotherapy and targeted therapy with bevacizumab.
• Chemotherapy placed directly into the chest cavity to shrink the tumors and keep fluid from building up.
• Surgery to drain fluid that has collected in the chest, to relieve chest discomfort and improve quality of life. Pleurodesis may be done to stop more fluid from collecting in the chest.
• Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve quality of life.
• Radiation therapy as palliative therapy to relieve pain.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.

If advanced malignant mesothelioma is found in the peritoneum, treatment may be one of the following:

• Surgery to remove the tumor followed by hyperthermic intraperitoneal chemotherapy.
• Chemotherapy placed directly into the peritoneum to shrink the tumor and keep fluid from building up.

Recurrent Malignant Mesothelioma

Treatment of recurrent malignant mesothelioma may be one of the following:

• Surgery to remove part of the chest wall
• Chemotherapy, if it was not given as initial treatment
• A clinical trial of biologic therapy
• A clinical trial of targeted therapy
• A clinical trial of chemotherapy
• A clinical trial of surgery

(NCI)

Surgery: Where surgery is referred to above this is based on the unproven assumption that the tumour is the disease so removing the tumour removes the cancer.  There is no evidence from randomised controlled trials to support this assumption. (CISS)

References:

Benjamin DJ.  The efficacy of surgical treatment of cancer – 20 years later. Med Hypotheses (April) 2014; 82 (4): 412–420.  http://www.sciencedirect.com/science/article/pii/S0306987714000127

Waller DA, Dawson AG. Randomized controlled trials in malignant pleural mesothelioma surgery—mistakes made and lessons learned.  Ann Transl Med 2017; 5(11): 240.

http://dx.doi.org/10.21037/atm.2017.04.05

Radiation Therapy:  This uses high doses of radiation to kill cancer cells and shrink tumour (NCI).  Although radiotherapy can result in a reduction of the tumour or its symptoms, this is rarely accompanied by any increase in survival.  (CISS)

Radiotherapy also has side effects, including the suppression of the immune system and other cancers.  

Chemotherapy:  This uses drugs to kill cancer cells. (NCI)  There is no mention of mesothelioma among the types of cancer that benefit from the addition of chemotherapy as shown in randomised controlled clinical trials. 

Reference: Morgan G et al The Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies. Clinical Oncology (2004); 16: 549-560.

The above therapies all come with risks and side effects that should be discussed in detail with your treating physician.

Early detection/Screening: It is possible to detect early signs of mesothelioma before symptoms become apparent. Because most cases of mesothelioma occur in people exposed to asbestos it would seem logical to screen such people.  This has been tried.

However there has never been any proven survival benefits shown in randomised trials evaluating screening for any type of cancer, including breast, bowel, lung, ovarian, prostate or thyroid cancers. Considering the high risk of increased mortality observed in trials evaluating surgery for mesothelioma, mesothelioma is unlikely to be an exception.

References:

Roberts HC et al. Screening for malignant pleural mesothelioma and lung cancer in individuals with a history of asbestos exposure. J Thorac Oncol. 2009 May;4(5):620-8.

Benjamin DJ.  The efficacy of surgical treatment of cancer – 20 years later. Med Hypotheses (April) 2014; 82 (4): 412–420.
http://www.sciencedirect.com/science/article/pii/S0306987714000127.

Before deciding on one of these treatments you would benefit from asking your physician three questions:

Question 1: What are my treatment options? – these should include doing nothing.

Question 2: What are the possible outcomes of those options? – including benefits and side effects.

Question 3: How likely is each of the outcomes to occur?

If you feel your doctor or other health practitioner is not able to answer these questions, or shows that he or she is not comfortable with you asking these questions, it raises the question as to whether they are practising evidence based medicine and you should consider getting another opinion.

These three questions can be expanded.

Prevention: Because most cases of mesothelioma are claimed to be related to exposure to asbestos, it is plausible to expect that mesothelioma could be largely eliminated by:

1. Identifying areas where asbestos has been used as a construction material and thereby avoiding exposure; or
2. Where work on or near asbestos is necessary (such as in its removal or disposal), suitable personal protective equipment needs to be worn.

Alternative Cancer Therapies

As mentioned above, conventional medicine supports the paradigm that the tumour is the first stage of cancer; therefore treating and removing the cancer should cure the cancer. There is little evidence to support this paradigm.

Another paradigm states that cancer is a systemic disease and the tumour is only a late stage symptom, element or manifestation of that disease. Therefore treating the disease should be systemic and wholistic (meaning treating the whole body) and should include the following principles:

1. Treatment should cause no harm
2. Treatment should be wholistic (ie consider the whole person – body, mind, emotions and spirit)
3. The person with cancer needs to take control of their own health.                                                                                      

This latter paradigm is supported by CISS (See Introduction to CISS)

Alternative cancer therapies are generally consistent with the above principles. In fact those believed to be the most effective in controlling cancer – psychotherapy and immunotherapy – also have strong supporting evidence from randomised controlled trials.

There are approximately 200 alternative cancer therapies that have been shown or anecdotally reported to help a person with cancer have reduced morbidity and mortality. The following are those with the most scientific evidence for benefit. What is important in any cancer treatment is to both understand and believe in your chosen therapy.

• Psychotherapy

Although trials evaluating Creative Novation Behaviour Therapy and other types of psychotherapy did not include any patients with mesothelioma, they showed that patients with the eight most common types of cancer did respond with increased survival.

References:

Eysenck, HJ & Grossarth-Maticek, R.  Creative Novation Behaviour Therapy as a Prophylactic Treatment for Cancer and Coronary Heart Disease: Part II – Effects of Treatment. Behav Research and Therapy 1991; 29 (1): 17-31.

Benjamin, Don. The role of psychotherapy in the treatment of cancer. J Altern Med Res 2010; 2 (4): 429-438.
https://www.novapublishers.com/catalog/product_info.php?products_id=26210

• Immunotherapy

Several RCTs have shown benefits of Iscador therapy on patients with different types of cancer.

References:

Ziegler R and Grossarth-Maticek R. Individual Patient Data Meta-analysis of Survival and Psychosomatic Self-regulation from Published Prospective Controlled Cohort Studies for Long-term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador)  Evid Based Complement Alternat Med. (Jun) 2010; 7(2): 157–166; 28;

Salzer G: [30 years of experience with mistletoe therapy in public health facilities]. In: Leroi R, ed.: [Mistletoe Therapy: A Response to the Challenge of Cancer]. Stuttgart, Germany: Freies Geistesleben, 1987, pp. 173-215;

Grossarth-Maticek R, Kiene H, Baumgartner SM, et al.: Use of Iscador, an extract of European mistletoe (Viscum album), in cancer treatment: prospective nonrandomized and randomized matched-pair studies nested within a cohort study. Altern Ther Health Med 7 (3): 57-66, 68-72, 74-6 passim, 2001 May-Jun; and Leroi R: [Postoperative Viscum album therapy after surgery of breast neoplasms] Helv Chir Acta 44 (3): 403-14, 1977.

The results for the non-randomised studies were also in favour of the Iscador therapy.

Issels’ Wholebody Therapy

Although not based on RCTs the most successful therapy for late stage cancers was Issels’ Wholebody Therapy that focussed on restoring the body’s immune systems.

It was estimated that a representative sample, 252 of Issels’ patients with late stage cancers cancer showed a 16.6% five year survival following his treatment and 15% 15 years survival.  

References:  Issels, J.  Immunotherapy in Progressive Metastatic Cancer – A Fifteen-Year Follow-up. Clinical Trials Journal, August 1970: 357-365 – editorial by Phillips S.  Dr Joseph Issels and the Ringberg Klinik.  Clinical Trials Journal. August 1970: 355-56.

The above studies, that include RCTs, show that systemic therapies are much more successful than therapies based on the orthodox paradigm.

For mesothelioma, Ralph Moss, Cancer Therapy, The Independent Consumers Guide to Non-Toxic Treatment and Prevention, reports the following alternative therapy has been shown to benefit people with mesothelioma:

Immuno-augmentative Therapy

 This therapy is based on extracting blood of the person with cancer and measuring the level of four major blood components: deblocking protein (DP); Tumour antibody 1 (TA1); Tumour antibody 2 (TA2); and Tumour complement (TC). In a person with cancer these components are out of balance, with the DP usually low.

The therapy consists of reinjecting these four components each day with a modified balance, with the DP, an alpha 2 macroglobulin, derived from the pooled blood serum of healthy donors, usually those who accompany the cancer patient. The new balance is then measured later in the day and readjusted the next morning.

Reference: Clement, RJ.  Peritoneal Mesothelioma. Quantum Medicine 1988; 1: 68-73.

In addition to the above alternative therapy there are several supplements believed to have anti-cancer properties that are not confined to specific types of cancer.

1. Selenium – Selenium is believed to reduce the incidence of cancer by stopping carcinogens corrupting the genetic material of the cell; slowing the spread of cancer cells; and enhancing the body’s normal anticancer immunity.

Researchers believe this might explain why people who have a relatively abundant supply of selenium in their diets experience less cancer.

The National Academy of Sciences (NAS) advises that no more than 150 micrograms of selenium be taken orally daily. However in the treatment of cancer the dosage is generally about 10,000 micrograms (or 10 milligrams), nearly 100 times the NAS’ recommended dose. Some surgeons familiar with the role of selenium use injections of selenomethianine.

References: Schrauzer G. Selenium and cancer. A review. Bioinorganic Chemistry 1975; 5: 275-81. Schrauzer GN et al. Cancer mortality correlation studies.III. Statistical associations with dietary selenium intakes. Bioinorganic Chemistry 1977; 7: 23-24.Ladas HS. The potential of selenium in the treatment of cancer. Holistic Medicine 1989; 4: 145-156.

(NOTE: In many Western countries the soil is claimed to be depleted in selenium as a result of several factors.  As a result less selenium is present in locally produced foods.  This suggests supplementing the diet with selenium-rich foods or with selenium supplements in forms such as selenomethionine. CISS)

2. Hydrazine Sulphate – This is a common industrial chemical that was used as a component of rocket fuel during World War II. It was first proposed as a cancer treatment in the early 1970s by Joseph Gold MD, of the Syracuse Cancer Research Institute, NY. Hydrazine Sulphate is a prohibited import in Australia.

Gold drew on the work of Nobel laureate Otto Warburg, who theorised that cancer derived its energy from anaerobic glycolysis (fermenting sugar) rather than respiring in the normal way. Gold proposed using chemicals to control cancer’s growth by exploiting this process.

He suggested that by cutting off a tumour’s supply of new glucose, formed in the liver, the drug could starve the tumour, in turn stopping the cancer from depleting the body’s energy pools and putting an end to cachexia, the terrible wasting process that appears in the final stages of the disease. It is this wasting process that often kills the cancer patient.

A team of 11 scientists at the N.N Petrov research Institute of Oncology, Leningrad have been working on hydrazine sulphate since the 1970s. The Russians have had the greatest single experience with hydrazine sulphate having treated and evaluated over 740 patients. Thus in the Russian studies it was shown that hydrazine sulphate inhibited the wasting process. Hydrazine Sulphate is a prohibited import in Australia.

References: Filov, V, et al. Results of clinical evaluation of hydrazine sulfate. Vopr Onkol 1990; 36: 721-6. Filov, V, et al. Experience of the treatment with Sehydrin (Hydrazine Sulfate, HS) in the advanced cancer patients. Investigative New Drugs 1995; 13: 89-97. Chlebowski, RT. Hydrazine sulfate in cancer patients with weight loss. A placebo-controlled clinical experience. Cancer 1987; 59: 406-10.

Another useful resource are books written by people who have recovered from mesothelioma that outline the methods they used. E.g. CISS member Paul Kraus was diagnosed with peritoneal mesothelioma in 1997. He was told he would probably survive about 12 months but is alive and well in 2017 – 20 years later. His book ‘Surviving Mesothelioma and Other Cancers – A Patient’s Guide’ was published in 2005 by Cancer Monthly, Raleigh, North Carolina. It is available from CISS.

If you or someone close to you has just been diagnosed with cancer it is important that you research and understand your chosen treatment, whether that be conventional, alternative or a mixture of both. For the best results your treatment should include physical, mental, emotional/psychological and spiritual treatment.

If you don’t know where to begin in your journey to wellness then we suggest you read Where To Start. This provides an introduction to the alternative approach to treating cancer and also information about some evidenced based alternative cancer treatments.