Mesothelioma Treatment

While there is no cure for mesothelioma, there are many treatment options available that can extend a patient’s lifespan. The most commonly used treatments are surgery, chemotherapy, and radiation. Patients can work with mesothelioma specialists to determine what treatments will be most effective.

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Mesothelioma Treatment Options

While there is no known cure for mesothelioma, patients who undergo a specialized treatment plan after diagnosis have a much higher chance at living longer. Aggressive treatments can extend life by months or years.

Mesothelioma treatments are administered by top mesothelioma doctors at cancer centers across the nation. There are treatment options available for every patient.

The primary treatment options for mesothelioma are:

  • Surgery
  • Chemotherapy
  • Radiation

Doctors often use several of these treatments to increase for best results. New treatment options are also tested in clinical trials and may be available depending on your case.

Treatments can make the difference between living for a few months and achieving long-term survival. On average, aggressive surgeries improve a patient’s life expectancy by one year, and in many cases have extended life by 5 years or more.

Mesothelioma Treatment Types

There are three primary treatment types available to mesothelioma patients.

Surgery

Surgery is the most effective way to control mesothelioma and prevent it from spreading.

During surgery, doctors cut open the chest or abdomen and physically remove all visible tumor masses and, in some cases, surrounding tissues or organs.

Doctors have developed surgical procedures for different types of mesothelioma. Which surgery (if any) will be used depends on what type you have and how far it has spread.

In most cases, it is only used if the patient is strong enough to fully recover.

Chemotherapy

To stop cancer cells from multiplying and spreading to distant sites, doctors administer chemotherapy.

During chemotherapy, cancer-killing drugs circulate through the body and kill cancer cells. Patients undergo multiple rounds of chemotherapy to improve the treatment’s effectiveness.

Depending on the treatment approach, chemotherapy may be given before, during, or after surgery to increase the chances of long-term remission.

Radiation Therapy

When radiation is used, powerful particles and waves scramble the DNA of the mesothelioma cells. This prevents them from dividing and ultimately kills them.

When the cells die off, the tumor shrinks in size, allowing doctors to control the spread of the disease.

Since radiation can also damage healthy cells, it is often used alongside other forms of mesothelioma treatment.

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Multimodal Therapy

While surgery, chemotherapy, and radiation are key mesothelioma treatments, they are most effective when used alongside one another.

When two or more mesothelioma treatments are used together, it is known as multimodal therapy.

In most multimodal therapy plans, different forms of treatment are administered one after the other. For example, a patient may undergo surgery to remove visible cancer tumors, and then undergo chemotherapy to kill microscopic cancer cells.

Different treatment combinations may be used depending on the type of mesothelioma and the patient’s overall health.

Which Treatment Is Right for Me?

What treatment options will work best for you often depends on the type of mesothelioma you have, and how far it has spread.

Doctors develop treatment approaches primarily based on the mesothelioma location. Pleural and peritoneal mesothelioma are treated as different diseases because they have separate prognoses and treatment requirements.

Doctors administer the three standard treatments to patients in different stages. When each treatment type is administered depends on the unique case.

All three treatments can also be used to manage pain in late-stage patients. This is known as palliative care.

Mesothelioma Treatment Goals

Before doctors recommend treatments, they consider multiple factors in each patient case.

These factors include:

  1. The rate at which the mesothelioma is spreading
  2. How far the mesothelioma has already spread

The treatment goals for stage 2 mesothelioma are different than those for stage 4 mesothelioma.

While all treatments have a goal of improving the quality of life and giving the patient the best chance at survival, localized cancer is much easier to control than advanced cancer.

Depending on the diagnosis and unique patient case, doctors may work toward different treatment goals.

Possible mesothelioma treatment goals include:

  • Remove as much of the tumor as possible (surgery)
  • Shrink tumors in size
  • Kill mesothelioma cells
  • Stop the mesothelioma from spreading to distant sites
  • Alleviate fluid buildup in the mesothelium linings
  • Manage pain and symptoms
  • Increase comfort and quality of life

Treatments for Pleural Mesothelioma

Patients with pleural mesothelioma have multiple treatment options that can improve their prognosis.

While there are many possible approaches doctors may take, in general, there are two main procedures. Each is a multimodal approach, meaning it uses more than one treatment type.

Each procedure is different though both produce similar survival results. It’s up to the patient to decide which approach will work best for them after receiving consultation from a specialized mesothelioma doctor.

Extrapleural Pneumonectomy

The first pleural mesothelioma treatment procedure is the extrapleural pneumonectomy (EPP) surgery.

Considered a more aggressive surgery, the EPP involves removing the diseased lung and the entire pleura, as well as a portion of the diaphragm and pericardium (lung lining).

Preventing Mesothelioma Metastasis

By removing the surrounding tissue, doctors get rid of areas that may have already been infiltrated by mesothelioma cells to prevent the risk of metastasis (spreading to other parts of the body).

Before surgery, patients may undergo chemotherapy to kill mesothelioma cells and improve the effectiveness of the surgery. This is called neoadjuvant treatment.

Doctors may prescribe a combination of chemotherapy medications, with cisplatin and pemetrexed being the most common formula.

During surgery, patients may also receive an injection of chemotherapy directly into the chest through a catheter. Administering chemotherapy during surgery helps kill any remaining cancer cells the surgeon couldn’t remove.

After surgery, all patients receive further rounds of chemotherapy. This is known as adjuvant treatment.

Doctors may also give intensity-modulated radiation therapy (IMRT), which is computerized radiation that sends pre-measured doses directly to the tumor site to kill off remaining mesothelioma cells.

EPP Treatment Results

Aggressive surgeries like the EPP procedure are only given to patients who are healthy enough to withstand the surgery and recovery. Multimodal treatment with EPP is an approach that can significantly improve a patient’s life expectancy.

Most studies show that patients can survive up to 2 years with this procedure, while some studies have shown the survival of nearly 4 years.

Pleurectomy with Decortication

The second pleural mesothelioma treatment approach includes the pleurectomy with decortication (P/D) surgery. P/D is a lung-sparing surgery, in which doctors only remove the diseased pleura (lung lining) and leave the lung.

Lung-Sparing Surgery May Be Less Risky

Some experts consider this procedure to be less risky than the EPP and it may give the patient a better quality of life by allowing them to keep their lung.

Patients receive chemotherapy treatment before undergoing the P/D surgery to kill mesothelioma cells and help shrink the tumors.

Reducing the tumor’s size makes it easier for surgeons to remove the pleura and as much of the mesothelioma as possible during surgery.

After the surgery, patients remain on chemotherapy for several more weeks to further ensure surgical success and prevent a recurrence. Patients may also receive radiation therapy to support the surgery.

P/D Treatment Results

The median life expectancy of patients who receive the P/D procedure is around 29 months. Some studies have shown a high 5-year survival rate in stage 1 pleural mesothelioma patients.

P/D has also shown to have a lower short-term post-surgery mortality rate. Fewer patients develop fatal complications during or within 30 days after surgery compared to patients who undergo EPP.

Treatments for Peritoneal Mesothelioma

Specialists consider peritoneal mesothelioma the easiest location to treat. During treatment, doctors will debulk tumors and drain fluid buildup from the abdomen to help control the spread of disease.

Treatment for peritoneal mesothelioma focuses on:

  • Debulking tumors
  • Stopping and controlling mesothelioma cells from spreading
  • Draining fluid buildup from the abdomen

The primary surgical procedure for treating peritoneal mesothelioma is called cytoreduction with HIPEC. It was developed by Dr. Paul Sugarbaker with the goal of removing all visible signs of cancer.

For the right candidate, cytoreduction with HIPEC is a critical and lifesaving procedure that can lead to partial or full remission. For others, it helps to improve prognosis and life expectancy by several months or years.

Cytoreduction with HIPEC Survival Rates

Several studies, including one by the National Cancer Institute, have shown that the median life expectancy of patients after receiving cytoreduction with HIPEC is up to 7 years, though many patients have survived much longer.

Surgeons perform cytoreduction with HIPEC in two parts:

Cytoreductive Surgery

Surgeons remove the entire diseased peritoneum (abdominal lining) and any tumors or diseased tissue surrounding the abdominal cavity. By removing as much malignant tissue as possible, doctors control and potentially stop the spread of the tumors from the abdominal cavity to the rest of the body.

Heated Intraperitoneal Chemotherapy (HIPEC)

While the patient is undergoing cytoreductive surgery, the doctor administers chemotherapy directly into the abdominal cavity.

The chemotherapy drugs are first heated and then allowed to circulate throughout the abdomen for up to 90 minutes to kill off any remaining, invisible mesothelioma cells.

All peritoneal mesothelioma patients receive chemotherapy before surgery and then radiation after it.

A combination of chemotherapy drugs administered after cytoreductive surgery helps to inhibit mesothelioma cell regrowth and stop the growth of certain proteins that promote tumor development.

New Mesothelioma Treatment Options

Outside of standard mesothelioma treatments, many new treatments are currently being tested by doctors, scientists, and researchers.

These upcoming treatments are looking to improve the lifespan of mesothelioma patients, or even find a cure. There are many types of new and experimental treatments that are currently being studied.

With help from their doctor, patients may be able to receive new therapies if they don’t respond well to standard treatments.

Immunotherapy

With immunotherapy, a patient’s immune system is trained to kill cancer cells more effectively. This is done through the use of specific drugs that trigger different immune responses.

Once the patient’s immune system can target cancer cells, lab-grown antibodies are administered. These antibodies attach themselves to cancer cells and prevent them from multiplying.

Immunotherapy can also be combined with standard treatments like chemotherapy and surgery.

Gene Therapy

Gene therapy changes the DNA of cancer cells. This is done by administering viruses that add new genes to the cells.

By changing the genetic makeup of the cells, doctors hope to slow or halt the growth of cancerous tumors.

Currently, doctors are investigating several different forms of gene therapy. Some gene therapies seek to reprogram cancer cells so they die at a faster rate. Others want to make cancer cells more responsive to chemotherapy and radiation.

Clinical Trials

Clinical trials test upcoming new therapies with the hopes of extending the lifespans of mesothelioma patients.

Many patients who stopped responding to chemotherapy and radiation have undergone treatments in clinical trials and extended their life by several months.

Other patients who are experiencing recurrence (when the mesothelioma comes back) can also benefit from advanced treatments in clinical trials.

Testing new treatments in clinical trials is essential for the research community and its goal of finding a cure for mesothelioma.

Clinical trials take place in a safe and controlled environment that allows researchers to test the safety and effectiveness of treatments and treatment combinations while offering patients renewed hope at improving their quality of life.

Clinical trials typically look at specific treatments. Because of this, researchers will accept only patients that meet certain qualifications for specific trials.

Mesothelioma patients can speak with their doctors to learn more about clinical trials and if they may be able to join one.

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Mesothelioma Palliative Care

Late-stage mesothelioma patients may not be healthy enough to undergo life-extending treatments, as the cancer has spread throughout their body. However, palliative care options can keep patients comfortable and reduce their symptoms.

Palliative care options include chemotherapy and radiation. These treatments help reduce the size of cancerous tumors, which in turn eases symptoms. Low-risk surgeries can also be used to reduce fluid buildup and remove tumors.

Medications may also be used to ease pain and other symptoms. Patients and their families should consult with their care team to determine what palliative options will work best.

Mesothelioma Treatment Centers

Patients can receive treatment from mesothelioma specialists at mesothelioma treatment centers. Working with doctors who have experience treating mesothelioma improves your odds of survival.

Find a specialist who has experience in treating your exact location, stage, and cell type.

Some of the nation’s top mesothelioma doctors include:

  • Dr. Avi Lebenthal: Pleural mesothelioma specialist at Brigham and Women’s Hospital, Boston
  • Dr. Paul Sugarbaker: Peritoneal mesothelioma specialist at Washington Cancer Institute, Washington D.C.

Cost of Mesothelioma Treatment

The costs of medical treatment can be burdensome on families. If you’re a mesothelioma patient undergoing treatment, you may be eligible for compensation.

Anyone who has developed mesothelioma as a result of their exposure in the workplace or their time in the military is a victim of negligence on the part of the asbestos manufacturers.

Companies knowingly sold and distributed dangerous asbestos products and concealed any knowledge they had regarding health risks. As a result, many former industrial workers and veterans have developed mesothelioma and other asbestos-related diseases.

Today, special court-ordered trusts have been set up to provide money for asbestos victims and their families.

These trust funds may help pay for medical bills and provide financial security. In addition, veterans are eligible for VA benefits.

The cost of mesothelioma treatment is high — start your free case review today to learn if you are eligible for compensation.

Author:Stephanie Kidd

Editor-in-Chief of the Mesothelioma Justice Network

Stephanie Kidd

Stephanie Kidd works tirelessly as a dedicated advocate for the vulnerable and underrepresented. Stephanie worked as a copywriter for an agency whose focus was communicating safety procedures on construction work sites. With her extensive background in victim advocacy and a dedication to seeing justice done, Stephanie works hard to ensure that all online content is reliable, truthful and helpful.

Last modified: July 31, 2019

View 6 Sources
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  2. Canadian Cancer Society, “Treatments for Mesothelioma.” Retrieved from: http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/treatment/?region=on. Accessed on December 1, 2017.
  3. US National Library of Medicine, “A nuanced view of extrapleural pneumonectomy for malignant pleural mesothelioma.” Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497104/. Accessed on December 1, 2017.
  4. The Annals of Thoracic Surgery, “Meta-Analysis of Survival After Pleurectomy Decortication Versus Extrapleural Pneumonectomy in Mesothelioma.” Retrieved from: http://www.annalsthoracicsurgery.org/article/S0003-4975(14)01926-2/fulltext. Accessed on December 1, 2017.
  5. American Cancer Society, “Treatments for Mesothelioma Based on the Extent of the Cancer.” Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/by-extent.html. Accessed on December 1, 2017.
  6. Cancer Research UK, “Treatment decisions for peritoneal mesothelioma.” Retrieved from: http://www.cancerresearchuk.org/about-cancer/mesothelioma/treatment/decisions-peritoneal. Accessed on December 1, 2017.
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