Ask the Doctor
With Dr. Nicholas J. Vogelzang, MD FASCO, FACP
Dr. Nicholas J. Vogelzang has dedicated his professional life to researching and treating rare forms of cancer. He has become one of the nation’s leading mesothelioma specialists and researchers. Dr. Vogelzang revolutionized mesothelioma treatments when he discovered the first life-extending treatment method, a chemotherapy combination of ALIMTA and Cisplatin. He continues to lead clinical trials and pioneer groundbreaking therapies.
Q: What are the symptoms of mesothelioma?
A: Mesothelioma is a disease that comes in many shapes and sizes, and you have to be vigilant. I remember one of the men in Las Vegas who was an umpire and father of baseball players my son was playing with. All he had was weight loss and a little bit of pain, and they sort of said they got worse and worse. So, it can be very subtle, but usually, the common symptoms are chest pain, shortness of breath, and weight loss. But it’s hard to say this is it. It’s like anything else that cancer does: It usually does it fairly slowly over time and patients sometimes don’t realize that they’re getting sick. They’ll say, you know, ‘I thought it was kind of good to lose 20 pounds.’ I know that’s not okay, but sometimes they’re quite happy with weight loss, until their wife says ‘Hey, how come you’re not feeling so good?’ So, it is something. Sometimes, there are certain patients that stand out and those patients are the ones who do very well for very long periods of five or six years. I can’t say that I’ve had anybody who’s been cured with chemo but we have had a number of patients who have had chemotherapy, then surgery and radiotherapy, and they have done exceptionally well. We always look for those patients, those exceptional responders. You go on to do very, very well for a long time.
Q: Hello Dr. Vogelzang! My father was recently diagnosed with mesothelioma and was told he was not the “right candidate” to undergo surgery. However, my uncle was diagnosed with the same cancer five years ago and his physician performed surgery on him. Why are some patients able to undergo surgery and others are not? Is the decision for a surgical approach usually based on the patient’s age?
Mesothelioma is like most common cancers: It starts in one organ and generally stays there unless you can remove it. But if you can’t remove it, mesothelioma can spread through the body, often to the other lung or lymph nodes. I’ve seen it spread to the liver, the brain, and other places after advancing significantly. We’ve looked at the many combinations of treatments, and chemotherapy first followed by surgery is the best option. Only 10-20 percent of patients are candidates for surgery. The majority of patients with advanced mesothelioma have heart disease or lung disease, or the cancer is outside the expected ability of operation. I suggest chemotherapy, and if the response is successful, then we’ll consider surgery. For the young and healthy patient, surgery is the first option.
The question of how old is too old always comes up in oncology. Old is physiologic, not chronologic. You can be 70 and run marathons, or you can be 80 and on the golf course every day, but in general the cut-off age is 70. Risks of surgery go up, and we always concern ourselves with potential unexpected complications after surgery. I counsel the very healthy 70-year-olds out doing everyday activities like golfing, swimming, and hiking to consider it. But, if they lose a lung or part of a lung at age 70, it makes life pretty difficult. If a tumor grows through the chest into the muscles or the bones causing severe pain, those patients cannot often be operated on successfully.