Treating Pleural Mesothelioma
Standard treatment options for mesothelioma include surgery, chemotherapy, and radiation therapy. Doctors often combine two or more of these treatments into a multimodal therapy, which has significantly improved the life expectancy in patients with pleural mesothelioma.
Extrapleural Pneumonectomy (EPP)
The extrapleural pneumonectomy (EPP) is one of the most effective surgeries available to patients with pleural mesothelioma. It was developed by world-renowned mesothelioma surgeon Dr. David Sugarbaker.
During an EPP, a surgeon removes:
- The entire lung affected by mesothelioma
- Parts of the protective lining of the chest, lung and heart
- Nearby lymph nodes
- Part or all of the diaphragm
Many specialists believe the EPP offers the best chance at removing mesothelioma from the body. But it is a major, invasive procedure — your doctor will only suggest an EPP if you’re in good overall health and can recover from it. Despite its risk, researchers in several studies have demonstrated the effectiveness of the EPP. One study reported that the median survival rate for patients who received the EPP was as high as 27 months, over twice the average mesothelioma survival rate.
Pleurectomy with Decortication (P/D)
The pleurectomy/decortication (P/D) is a less invasive, lung-sparing alternative to the EPP. Mesothelioma specialist Dr. Robert Cameron developed the procedure, believing that the EPP was unnecessarily radical.
The P/D consists of two surgical techniques:
- Pleurectomy - surgeons remove the protective lining of the lung on which the tumor is growing
- Decortication- surgeons remove visible tumors around and on the diseased lung
Researchers have shown that the P/D can produce survival rates equal to, and sometimes better than, those of the EPP.
The pleurodesis is a palliative surgery doctors use to ease pain and pressure caused by fluid buildup in the chest. This fluid buildup is known as a pleural effusion. Pleural effusions build up between the inner and outer pleural linings, which inhibits lung and chest expansion.
Doctors perform a pleurodesis by inserting a hollow tube into the chest wall. They drain the excess fluid through the tube, relieving pressure in the lungs and chest. This allows patients to breathe easier and reduces overall chest pain.
Chemotherapy for Pleural Mesothelioma
As a treatment for pleural mesothelioma, doctors may use a chemotherapy drug by itself or combined with other chemotherapy drugs. The first notably successful combination of chemotherapy drugs for mesothelioma is Alimta and cisplatin. Together, the drugs increased the survival time of patients by an average 3 months.
Doctors also combine chemotherapy with surgery. Prescribing chemotherapy before (neoadjuvant), during (intraoperative) or after (adjuvant) the procedure has shown to bump up survival times.
A recent medical study showed that patients who had a combination of surgery and heated chemotherapy survived for 35 months while those who had only surgery survived for 22.
Radiation Therapy for Pleural Mesothelioma
Doctors use radiation therapy to shrink pleural mesothelioma tumors. Radiation is used as a palliative treatment or in combination with chemotherapy and surgery.
A recent study on the effect of radiation therapy with surgery and chemotherapy showed that the combination produced an average survival time of 33 months — up to 3 times the life expectancy of many patients with pleural mesothelioma.
Symptoms of Pleural Mesothelioma
Symptoms caused by pleural mesothelioma primarily affect the respiratory system, which includes the airways, lungs, and breathing muscles. The first signs a patient may feel are a persistent cough and shortness of breath. These symptoms are caused by excess fluids (pleural effusion) in the lining of the lungs.
Other symptoms felt by patients with pleural mesothelioma include:
- Shortness of breath
- Chest pains
- Dry cough
- Weight loss
Diagnosing Pleural Mesothelioma
Pleural mesothelioma is difficult to diagnose because its symptoms are nonspecific. A nonspecific symptoms is one that is the same for many other conditions. Pleural mesothelioma has the same symptoms as more common respiratory conditions, like pneumonia or chronic obstructive pulmonary disease (COPD).
Under a microscope, it’s also hard for doctors to distinguish between pleural mesothelioma and other cancers. For these reasons, your doctor runs tests to confirm the location, cancer stage, and cell type of the mesothelioma.
Your diagnosis can affect the type of treatment you receive. Doctors often won't perform a surgical operation on a later stage patient, for instance. Getting a second opinion from another specialist may yield a different diagnosis and open up your treatment options.
Diagnostic Imaging Tests
Doctors examine the chest area with a diagnostic imaging test, like an x-ray or CT scan, to find abnormal-looking masses or growths that may be tumors. The imaging scans can show the location and stage of the tumor. Imaging tests are painless, but some require you to be still for long periods of time.
Common imaging tests doctors use to start a diagnosis include:
- Magnetic resonance imaging (MRI).
- Computerized tomography (CT) scan.
- Positron emission tomography (PET) scan.
Depending on the imaging test results, the doctors may request a biopsy. This requires a small fluid or tissue sample. A biopsy is the only way to confirm a pleural mesothelioma diagnosis. It also provides important information (like the cell type of the mesothelioma) that doctors use to create the most effective treatment plan possible.
Stages of Pleural Mesothelioma
As part of the diagnostic process, your doctor will also determine the stage of the mesothelioma, which describes how far it’s spread from where it first appeared in the lining of the lung. This helps doctors determine which treatment options are available to you: patients with stage 1 or stage 2 pleural mesothelioma have more standard treatment options than patients with stage 3 or stage 4.
The stages of pleural mesothelioma:
- Stage 1: The cancer is localized to the lining of the lung.
- Stage 2: The cancer has spread to the lung itself, part of the diaphragm, and nearby lymph nodes.
- Stage 3: The cancer spread throughout one side of the chest, into the chest wall, esophagus and more lymph nodes.
- Stage 4: The cancer has spread into both sides of the chest, affecting other organs, the blood, and bone cells.
Improving Your Prognosis
If you’re diagnosed with pleural mesothelioma, you have a more favorable prognosis than patients diagnosed with mesothelioma in another location. It’s the most common form of the disease; compared to the other locations of mesothelioma, more doctors have seen and treated it.
Your prognosis depends on a number of factors, including:
The cell type and cancer stage of the mesothelioma play the biggest roles in your prognosis. If you’re diagnosed with pleural mesothelioma that’s made up of the epithelioid cell type, you’ll have a better prognosis. Epithelioid cells don’t spread as quickly as other cell types, and respond better to treatment.
Similarly, if you’ve been diagnosed with stage 1 or stage 2 pleural mesothelioma, you have more treatment options available. Early–stage pleural mesothelioma hasn’t spread far from the lining of the lung, and is easier for doctors to surgically remove.
Take Charge of Your Prognosis
You can't change your diagnosis, but you can take control of certain aspects of your prognosis. Make it your mission to find treatment that gives you the best odds to extend your life. You can accomplish this by asking for second opinions and getting help finding a specialist from someone on our Patient Help Team.
We can help you find an oncologist that specializes in treating pleural mesothelioma at a cancer center near you. Get connected with a specialist now.
- Mccaughan, B. C. “A Systematic Review of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma.” Journal of Thoracic Oncology, 1692-1703. Retrieved July 9, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/20802345.
- “Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up.” Retrieved on October 16, 2014 from http://www.sciencedirect.com/science/article/pii/S016950021300457.