Types of Treatment
Mesothelioma doctors create a course of treatment based on his or her patient's diagnosis. The doctor considers the patient's cancer stage, cell type, and location of the mesothelioma. These factors play an important role in determining which types of treatment the patient is eligible for.
Curative Treatment. Doctors use curative treatments to remove mesothelioma from a patient’s body. Patients diagnosed with pleural mesothelioma—and eligible for curative treatment—may have one of the two standard surgeries for pleural mesothelioma: the extrapleural pneumonectomy (EPP) or the pleurectomy with decortication (P/D). Those diagnosed with peritoneal mesothelioma might undergo cytoreduction, which doctors often combine with heated chemotherapy in a procedure called cytoreduction with HIPEC.
Palliative Treatment. A treatment is palliative when a doctor uses it to relieve pain or discomfort caused by symptoms of mesothelioma. The most common palliative treatments drain fluid buildup in the chest or abdomen. Patients with pleural mesothelioma receive a thoracentesis. Patients with peritoneal mesothelioma patients receive a paracentesis.
Multimodal Therapy. Multimodal therapy is the combination of two or more treatments, usually surgery, chemotherapy, or radiation therapy. Using multiple treatments, doctors can attack mesothelioma in more than one way. For example, using cytoreductive surgery to remove most of a tumors, and heated chemotherapy to destroy any remaining cancer cells. A study by researchers at Dana Farber Cancer Center — one of the highest–rated cancer centers in the U.S. — showed that 22 percent of patients lived at least 5 years after having multimodal therapy.
Surgery for Mesothelioma
Surgery for Patients with Pleural Mesothelioma
Pleurectomy with Decortication (P/D). A pleurectomy with decortication (P/D) is a surgery doctors use to remove the lining of the lung most affected by tumor growth, and any visible tumors on the surface of the lung itself. If mesothelioma has spread beyond the lining of your lung, your doctor may also remove parts of the diaphragm and pericardium, the protective lining of the heart. The goal of using a P/D is to relieve symptoms of mesothelioma without sacrificing the lung. 90 percent of patients who have the procedure experience a reduction of symptoms, and retain 100 percent of their breathing function.
Extrapleural Pneumonectomy (EPP). Doctors use an extrapleural pneumonectomy (EPP) to remove the entire lung and nearby tissue affected by mesothelioma. To prevent the disease from coming back, he or she may also remove the diaphragm, nearby lymph nodes, and the lining of the heart.
Surgery for Patients with Peritoneal Mesothelioma
Peritonectomy. Surgeons use a peritonectomy to remove any part of the peritoneum — the protective lining of the abdomen — affected by tumor growth. They also remove any visible tumors that may have spread to nearby organs, like the diaphragm or stomach.
Cytoreductive Surgery. Cytoreductive surgery is when a surgeon combines multiple peritonectomies to completely remove mesothelioma from the abdominal cavity. Doctors often combine cytoreductive surgery with heated chemotherapy in a procedure called cytoreduction with HIPEC to maximize its effectiveness.
Chemotherapy for Mesothelioma
Chemotherapy is the use of drugs to attack and kill cancer. Its effectiveness depends on your diagnosis, specifically on the cancer stage and location of the mesothelioma. Chemotherapeutic drugs work better when they are combined with other drugs—the most common combination of drugs being Alimta and cisplatin—or surgery.
Doctors use chemotherapy before surgery (neoadjuvant), during surgery (intraoperative), or after surgery (adjuvant).
There is a difference in administration between systemic chemotherapy and intraoperative chemotherapy:
- Systemic. Systemic chemotherapy travels through your bloodstream, attacking any cancer cell it contacts. Your doctor will give you systemic chemotherapy in pills or through an IV.
- Intraoperative. The doctor administers the drugs during surgery. Depending the procedure, he or she applies the chemotherapy directly into the lung or abdominal cavity and usually heats the drugs to increase their cancer-killing effectiveness.
Depending on your tolerance, chemotherapy may affect you severely, mildy, or not at all. Its side effects disappear slowly after treatment and vary according to the type of drug, amount of dose, and length of time it’s given.
Common side effects experienced during chemotherapy are:
- Hair loss
- Loss of appetite
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Radiation Therapy for Mesothelioma
Radiation therapy is the use of high energy rays to kill mesothelioma cells. Doctors may use radiation by itself — as a palliative treatment — or combine it with chemotherapy and/or surgery. With some types of radiation therapy, patients may not experience as many side effects as chemotherapy because doctors can target tumors, minimizing damage to healthy cells.
Radiation therapies commonly used for mesothelioma patients include:
Three-Dimensional Radiation Treatment (3D-CRT). Using 3D scans of the tumor, doctors customize the amount and intensity of each radiation dose according to its size and shape. Customizing the amount of radiation helps doctors target tumors more effectively and minimizes damage to healthy, non-cancerous cells surrounding the tumors.
Intensity-Modulated Radiation Therapy (IMRT). IMRT is an advanced form of 3D-CRT. Doctors use computers to adjust the amount and intensity of a radiation beam as it passes over a tumor. Researchers in a recent study showed that IMRT used after an extrapleural pneumonectomy (EPP) produced a median overall survival rate of just over 2 years. Of these patients, 41 percent survived an additional 3 years after the procedure.
Side Effects of Radiation Therapy
Doctors do have to use high doses of radiation to get the same cancer-killing effectiveness as chemotherapeutic drugs. As doctors increase the amount and intensity of radiation, the chances of radiation damaging healthy cells also increases and more side effects can occur.
Radiation therapy can cause the following side effects:
- Inflammation of the esophagus
- Skin redness
- Hair loss
Palliative Treatments for Mesothelioma
Doctors use palliative treatments to relieve pain caused by symptoms at all stages of mesothelioma. Doctors may use them to complement curative treatments for patients diagnosed with stage 1 or stage 2 mesothelioma. Stage 3 and stage 4 patients receive palliative treatment to reduce pain and increase their quality of life.
Several types of palliative treatments are available to mesothelioma patients.
Thoracentesis. A thoracentesis is the draining of excess fluid from the pleural cavity — the space between the inner and outer lining of the lungs — with a needle. It reduces pressure caused by too much fluid, which pushes on the lung and makes it difficult to breath.
Video Assisted Thoracoscopic (VAT) Talc Pleurodesis. Assisted by a camera, the doctor drains excess fluid from the pleural cavity and seals it with talc powder. The talc causes an inflammatory reaction that closes the pleural space. Over time, scar tissue forms and prevents more fluid from collecting there. Doctors use this procedure to reduce chest pain and relieve pressure caused by buildups of fluid.
Partial Pleurectomy. Doctors use partial pleurectomy to remove the lining of a lung affected by mesothelioma. Tumor growth hardens the lung’s lining, which makes breathing difficult. Removing part of the hardened lining lets the lung re-expand and makes breathing easier.
Paracentesis. A paracentesis is the draining of excess fluid from the abdominal cavity. The fluid is drained via a needle. It eases the pressure caused by the buildup of fluid in this space. Too much fluid in the abdominal cavity creates pressure on the organs, causing intense discomfort and pain.
New Treatments in Clinical Trials
If you’re not eligible for traditional treatments, like surgery or chemotherapy, participating in a clinical trial may give you a chance to improve your prognosis with new treatments. In clinical trials, researchers develop new ways to fight mesothelioma like immunotherapy, a treatment that strengthens your immune system and helps kill mesothelioma cells.
Learn more about clinical trials, new treatments, and how to improve your life expectancy in our free informational guide—order a copy today.
You can also speak to an experienced member of our Patient Help Team about anything and everything related to mesothelioma. A member of our team can even help you find treatment and connect you to doctors—start a conversation about improving your prognosis today.