Mesothelioma Treatment Options

There are three main Mesothelioma treatment options:

  1. Surgery
    • Aggressive Surgery (long term control)
    • Surgery to Relieve Symptoms (palliative procedure)
  2. Chemotherapy and Mesothelioma Drugs
  3. Radiation Therapy

Surgery

Before any mesothelioma surgery is considered for the treatment of malignant mesothelioma, the patient's overall health is carefully evaluated. Tests are performed to make sure the patient has no metastatic disease (cancer spread to distant sites) and to evaluate the patient's lung and heart function. Lung function often is reduced patients with pleural mesothelioma for several reasons. The pleural effusion (fluid collection) and the tumor mass caused by mesothelioma can compress the lung. Also, the patient's exposure to asbestos may have decreased lung function, which also decreases with age. In addition, some patients have a history of smoking cigarettes, which further decreases lung function.

Surgery for malignant mesothelioma can be aimed at long-term control (aggressive surgery) or relief of symptoms (palliative procedures).

Aggressive Surgery (Long Term Control)

Extra pleural pneumonectomy involves removal of the pleura, the lung, the diaphragm and the pericardium. The intent of this very aggressive, complicated surgery is to remove as much of the tumor as possible. Not all mesothelioma Combination chemotherapy (using more than one drug at the same time) may be used to improve treatment.

Hospitals will perform this procedure because of its complexity and because it carries a high risk of death within 30 days after surgery. Extra pleural pneumonectomy typically is performed only in younger patients in good overall health with Stage I disease. Patients are evaluated carefully to determine their ability to tolerate the surgery.

Important Note: Surgeons at different mesothelioma hospitals have different criteria for staging as it relates to acceptance for surgery. Therefore it is important to check with each mesothelioma hospitals to determine if you meet the surgery criteria's.

Surgery to Relieve Symptoms (Palliative Procedures)

When malignant mesothelioma is advanced, palliative procedures can be performed to relieve and/or control symptoms such as breathlessness, which are caused by effusion (fluid collection) or by the tumor compressing the lung or other organs. These procedures do not aim to cure the disease.

  • Thoracentesis can be used to treat effusion in pleural mesothelioma. A needle is inserted into the chest to drain the fluid, relieving breathlessness and pain. Talc may be introduced into the pleura to limit recurrence of the effusion. Similar procedures are used to treat ascites (fluid collection) in peritoneal mesothelioma.
  • Pleurectomy/decortication is the surgical removal of the pleura. This procedure can be performed to reduce pain caused by the tumor mass or to prevent the recurrence of pleural effusion. For peritoneal mesothelioma, surgery generally is aimed at relieving symptoms, such as recurrent ascites or bowel obstruction. As with pleural mesothelioma, complete surgical removal of the entire tumor is unlikely.

Chemotherapy / Mesothelioma Drugs

The use of medications to treat cancer - has had mixed results in the treatment of malignant mesothelioma. Some chemotherapy drugs have a partial effect in some patients. Combination chemotherapy (using more than one drug at the same time) may be used to improve treatment. Some combinations have shown some promise, and some new mesothelioma drugs are being tried. Like radiation therapy, chemotherapy may be administered after surgery in an attempt to kill cancer cells that could not be removed during the procedure.

Radiation Therapy

Because of the location of malignant mesothelioma, it is extremely difficult to deliver sufficiently high doses of radiation to kill the tumor without damaging the surrounding organs. Lower doses of radiation can result in some reduction in the disease, but it is unclear whether this reduction actually results in longer survival than no treatment.

Using radiation therapy after surgery has not been shown to improve survival. However, because surgery is very unlikely to remove the entire tumor, radiation commonly is administered after surgery in the hopes of killing remaining tumor cells. In addition, radiation therapy can be used to relieve symptoms of mesothelioma, including chest pain.

Mark Lanier of The Lanier Law Firm discusses treatment options for Mesothelioma.