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Since still there is no curative treatment of mesothelioma more attention focused on finding providing patients with mesothelioma palliation. It doesn't help to slow or to stop the disease but it can reduce painful. But it can improve patient's day-to-day life, allowing them to live without pain in comfort until the last day.
1-5% of the patients has epithelioid tumours of low volume and is potentially suitable for radical surgery. CT scanning and, in selected cases, MRI scans can help to identify those potentially suitable for surgery.
Usually best candidates for radical surgery are patients with early epithelioid disease without radiological evidence of lymph node involvement. Interestingly but in such cases they avoid using chemical pleurodesis because it makes subsequent surgical exploration of the chest which is necessary to define the location and the size of the tumor. Before the operation patients must be given all information about the possible outcome of surgery.
A specialist who takes care over a patient with mesothelioma should coordinate his treatment with an oncologist with a special interest in thoracic oncology, a cardiothoracic surgeon, a pain relief service and a specialist palliative care team. Palliative radiotherapy should be used for patients with pain or a chest wall mass. Commonly there is a reason to explain to many patients that all used forms active treatment don't offer proven survival benefit but they can alleviate symptoms.
Some patients should be given the opportunity to discuss what may be expected from chemotherapy because it is very difficult for them to accept a treatment policy which does not include any specific anti-tumour therapy.
In cases when patient prefers the chemotherapy to be given, it should be offered preferably within the context of a clinical trial. For example one can use forthcoming BTS trial which compares active symptom control (ASC) with either ASC plus combination therapy of mitomycin, vinblastine and cisplatin or ASC with the single agent vinorelbine. In cases when there is no opportunity to use any trial, chemotherapy may be applied using regimens that has been reported to have some activity in mesothelioma.
Very important that the diagnosis is communicated sympathetically and skilfully. There is no reason to dissemble a clear picture of the disease and what to expect, including a realistic prognosis. But it is essential never to imply that "there is nothing that we can do".
Physicians should warn general practitioner, relatives and carers that a Coroner's post mortem can be required after the death of a patient with mesothelioma. Physician should also inform patients and families about organizations with a particular interest in asbestos related cancers.
Also a appropriately trained specialist nurse should be involvement to take care of the patient and the family throughout the illness. An access to specialist palliative care services is also necessary. Patients and their families must know whom to contact in case of problems.
Throughout the disease patient must have close liaison with the general practitioner and primary health care team. Even if there is no change in treatment, appropriate regular outpatient follow up is recommended, because it provides an opportunity for further discussion.
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