What Are My Mesothelioma Treatment Options?
Options for malignant mesothelioma treatment fall into two broad categories: curative and palliative.
Curative treatments are used to help extend a patient’s lifespan, while palliative treatments exist to manage symptoms and reduce discomfort. Doctors generally use the same mesothelioma treatments to achieve curative or palliative goals.
The top 3 types of treatment for mesothelioma are:
In most cases, a mesothelioma specialist will prescribe a combination of treatments (called multimodal therapy) in a customized plan designed to help you live as long as possible.
Video Summary: Registered Nurse Amy Fair discusses standard mesothelioma treatments and how patients can pick the best option. View Transcript.
What do I need to know about mesothelioma treatments?
It’s really important for your doctors, your oncologists, your surgeons to explain to you what stage you’re in – to explain to you what type of mesothelioma you have. You have to understand your disease, you have to understand the type of disease, and you have to understand the stage of the disease. Many people have to make decisions as far as quality and quantity of life.
What are my treatment options for mesothelioma?
The standard treatment options for mesothelioma is a surgical approach. In pleural mesothelioma, they will offer the patient a pleural decortication where they strip the lining of the lung. They may offer to the patient a pneumonectomy and that is removing the whole lung, not just the lining. They may offer radiation to shrink the tumor first. Also, radiation gives them palliative care if that tumor is pressing on vital organs or nerves and causing pain, they may want to go in and do radiation first to shrink that tumor. Then of course there is the chemotherapy approach, and again sometimes multiple modalities are used. Surgical approach, radiation, and chemotherapy. It is a clinical individual fit for that particular person.
How can I decide what treatment is best for me?
When deciding what treatment modality is best for you it’s important to communicate with your surgeon, to communicate with your oncologist. You need to get an understanding on their thoughts if you’re a candidate for chemotherapy. Are you a candidate to have surgery? Although all that is very important, the individual decision for what type of therapy lies within the mesothelioma patient.
Surgery is often the best treatment option to extend a patient’s lifespan.
During mesothelioma surgery, a specialist (usually an oncologist) works to control the growth of the cancer by physically removing all visible tumor masses and sometimes the surrounding tissues or infected organs. Patients are only eligible for surgery if they are strong enough to fully recover.
Doctors have developed surgical procedures for different types of mesothelioma. Which surgery a doctor recommends, if any, depends on what type of mesothelioma you have and how far it has spread.
Pleural Mesothelioma Surgery
The two main surgeries for malignant pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). EPP is considered the more aggressive of the two, but it removes the greatest amount of mesothelioma tumors in many cases.
On the other hand, unlike the EPP, P/D allows patients to keep both lungs, but some doctors argue that it doesn’t allow for maximum tumor resection (removal).
Ultimately, the type of surgery you may get depends on the specifics of your cancer and what your doctor recommends.
Extrapleural pneumonectomy is a curative surgery usually combined with chemotherapy or radiation to help improve patient life expectancy.
This invasive procedure involves removing:
- All visible tumors
- The diseased lung
- A portion of the parietal (outer) pleura
- A portion of the diaphragm
- A portion of the pericardium (lining of the heart)
A study of 183 pleural mesothelioma patients, conducted in part by mesothelioma specialists Dr. David Sugarbaker and Dr. Raja Flores, found that patients who received EPP surgery had a median survival time of 19 months. However, some studies show that patients can survive up to 2 years with this procedure.
Pleurectomy With Decortication
Eligible patients with pleural mesothelioma may also undergo the lung-sparing surgery pleurectomy with decortication.
During this procedure, doctors only remove:
- Visible tumors
- The diseased parietal pleura
- The diaphragm
- Part of the pericardium
- Some lung tissue, if necessary
P/D is considered to be less aggressive than the EPP because it allows patients to keep both lungs, giving them a better quality of life after surgery. Additionally, P/D patients develop fewer fatal complications within 30 days after surgery compared to those who undergo EPP.
The median life expectancy of patients who receive P/D is around 29 months.
Peritoneal Mesothelioma Surgery
There is one main curative surgery for peritoneal mesothelioma, called cytoreduction with HIPEC.
Cytoreduction With HIPEC
Developed by Dr. Paul Sugarbaker, cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) is a curative treatment that has two parts: cytoreductive surgery and heated chemotherapy.
Cytoreductive surgery, also called debulking, involves the surgical removal of the entire diseased peritoneum (abdominal lining) and any tumors or diseased tissue surrounding the abdominal cavity.
Directly after the surgical removal of tumors, doctors will administer HIPEC (heated chemotherapy drugs) directly into the abdomen for up to 90 minutes. This helps kill off any remaining mesothelioma cells and prevent regrowth.
According to the National Cancer Institute (NCI), patients with peritoneal mesothelioma who receive cytoreduction with HIPEC may survive up to 7 years or more after diagnosis.
Chemotherapy is used most often for patients with pleural or peritoneal mesothelioma. For patients with pericardial mesothelioma, chemotherapy has shown mixed results.
During mesothelioma chemotherapy, patients are given cancer-killing medications that work to shrink and slow the growth of tumors. Chemotherapy may be administered before (neoadjuvant), during, after (adjuvant), or in place of surgery.
Doctors usually recommend multiple rounds of chemotherapy to increase effectiveness and, in turn, the chances of long-term remission. Mesothelioma patients are usually given a combination of the drugs cisplatin and pemetrexed.
Cancer centers with experience treating mesothelioma patients will know the best chemotherapy medication(s) for your specific condition, all while helping you stay comfortable during the process.
“Chemotherapy is a scary term. Experienced centers are going to be very good at all the supportive care measures — the things that help you feel better.”
– Dr. Hedy Lee Kindler, Mesothelioma Specialist
Mesothelioma Radiation Therapy
Radiation is most commonly used for patients with pleural mesothelioma. Using powerful electromagnetic waves, mesothelioma radiation therapy destroys cancerous cells by scrambling their DNA.
Radiation is usually used alongside other forms of mesothelioma treatment, either before, during, after, or in place of surgery or chemotherapy. The purpose of the radiation may change depending on when it’s used.
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Other Mesothelioma Treatment Options
Immunotherapy (also called biologic therapy) boosts a patient’s immune system so it can better target and destroy cancer cells. This immune boost is achieved by way of medications.
For years, immunotherapy for mesothelioma had only been available through clinical trials. This changed in 2020 when The Food and Drug Administration (FDA) approved two drugs — Opdivo® and Yervoy® — for use in certain pleural mesothelioma patients.
With the FDA’s approval, the combination marked the first additional treatment for mesothelioma in 16 years.
Gene therapy changes the DNA of either cancer or healthy cells in order to fight cancer. This is done by using modified viruses to inject new genes into the cells.
Tumor Treating Fields (TTF) System
This cancer treatment uses carefully-tuned electric fields to interrupt cancer cell division and kill cancer cells. In 2019, the United States Food and Drug Administration (FDA) approved a new TTF treatment, Optune Lua™.
Cryotherapy, or cryosurgery, uses liquid nitrogen to freeze and destroy cancerous cells. Pleural mesothelioma specialist Dr. Robert B. Cameron has helped to pioneer the use of this treatment for mesothelioma.
“We’re making tremendous advances in the diagnosis of mesothelioma, the staging of this disease, treatment, and research, and this is providing hope to patients and families.”
– Daniel H. Sterman, Pleural Mesothelioma Pulmonologist
Palliative Treatment for Mesothelioma
Palliative mesothelioma treatments are beneficial for helping reduce pain and discomfort. This is true for both patients who undergo aggressive first-line treatments and for those unable to receive curative treatment.
Palliative Care Options for Pleural Mesothelioma
- Partial Pleurectomy: This procedure involves the surgical removal of part of the pleura and is performed to help prevent fluid from filling the pleura, relieving symptoms.
- Thoracentesis: This procedure is done to remove pleural effusions (fluid buildup in the chest wall) to help a patient breathe more easily.
- Video-Assisted Thoracoscopic Surgery (VATS) Talc Pleurodesis: This procedure is an effective technique used to manage repeated pleural effusions, in which the space between the two layers of the pleura is sealed so that it can no longer fill with fluid.
Palliative Care Options for Peritoneal Mesothelioma
- Paracentesis: During this procedure, the space between the lining of the abdominal wall and the lining surrounding the internal organs is drained of fluid, potentially reducing peritoneal mesothelioma symptoms.
Options for Both Pleural and Peritoneal Mesothelioma
- Alternative Treatments: Alternative treatment options for mesothelioma may include massage, yoga, and meditation. While these practices may provide symptom relief and increase overall wellbeing, they are not a replacement for medical treatment.
- Chemotherapy/Radiation: Chemotherapy and radiation can be used as both curative and palliative treatment options, with the latter designed to ease symptoms.
- Pain Medication: Doctors may prescribe pain medication to help relieve symptoms.
- PleurX™ Catheter: This device is an FDA-approved catheter that allows cancer patients to manage fluid buildup in the chest or abdomen without going to the hospital, reducing pain and discomfort from home.
Mesothelioma Treatment Timeline
Mesothelioma treatment looks different from patient to patient, but most treatment plans follow the same basic steps from diagnostic testing to final treatment.
Here are the steps you may expect as you seek treatment:
- Examining Symptoms: After you begin experiencing symptoms of mesothelioma and consult your doctor, you can expect to undergo early testing, starting with a physical exam and imaging tests (like an X-ray or CT scan).
- Getting a Diagnosis: After this initial testing, you will get a biopsy in which your doctor removes a tissue or fluid sample and examines it for cancer cells. A biopsy is necessary to confirm a mesothelioma diagnosis.
- Getting a Second Opinion: It is encouraged to seek a second opinion from a specialist, as mesothelioma is a rare cancer that many doctors have little to no experience with.
- Following a Treatment Plan: Once you have consulted a specialist, your care team will build a treatment plan tailored to your specific condition and personal wishes.
- Receiving Second-Line Treatment: If your cancer comes back, talk to your doctor about second-line treatments, which may include chemotherapy, radiation, or experimental therapies.
Factors Affecting Mesothelioma Treatment
Before doctors recommend treatments, they consider multiple factors, which influence a patient’s mesothelioma prognosis and treatment regimen.
Factors that may impact treatment include:
- Location of the tumors (mesothelioma type)
- Mesothelioma cell type
- Overall health
- Cancer stage at diagnosis
- How fast the cancer is spreading
- The patient’s personal wishes
Mesothelioma Doctors and Cancer Centers
Top mesothelioma doctors specialize in diagnosing and treating mesothelioma. They are able to perform highly complex, mesothelioma-specific biopsies and surgeries that result in several more months or even years of life for many people.
When possible, patients should seek doctors who not only have experience with mesothelioma but also with their cancer type.
Contact us for help finding a mesothelioma specialist or distinguished mesothelioma cancer center near you.
Common Questions About Mesothelioma Treatmen
What is the best treatment for mesothelioma?
The best mesothelioma treatment for you will depend primarily on the type and stage of your cancer.
Your mesothelioma doctor and health care team will work with you to determine the best course of treatment based upon multiple factors. For example, they will discuss with you the risks and side effects of a particular treatment compared to its potential benefits.
Working with a mesothelioma specialist may help give you peace of mind knowing you’re getting the most effective treatments possible.
What are the side effects of mesothelioma treatment?
Mesothelioma treatments may come with long recovery times and uncomfortable side effects.
For example, if you undergo mesothelioma surgery, you’ll have to stay in the hospital for around a week after the procedure. You’ll also have months of recovery at home, during which you may not be able to carry out everyday tasks like work, house upkeep, and exercise.
Chemotherapy and radiation also come with potential side effects, including nausea, vomiting, and fatigue. While the side effects of chemotherapy are generally more severe, your doctor will provide you with detailed information about what to expect after your chosen treatment(s).
Are there any new treatments for mesothelioma?
The latest developments in the treatment of mesothelioma often come from clinical trials taking place at top cancer centers. During mesothelioma clinical trials, doctors test new therapies with the hopes of curing this type of cancer.
Examples of emerging treatments for mesothelioma include photodynamic therapy, which uses high-intensity light to destroy cancer cells, and epigenetic therapy, which works to help cancer cells become more resistant to chemotherapy over time.
How much does mesothelioma treatment cost?
Treatment for mesothelioma generally costs somewhere between $400,000 and $600,000. This figure does not account for related costs such as lost wages, at-home care, and travel and lodging expenses.
However, financial assistance such as private or government health insurance, VA benefits, and other mesothelioma compensation routes may help you lower costs.
Get Help Finding and Paying for Mesothelioma Treatment
As medical researchers have gained more and more insight into treating mesothelioma, there is new hope for longer lifespans, better quality of life, and a cure for this deadly disease.
If you or a loved one were recently diagnosed with mesothelioma, you may be eligible to receive various forms of financial assistance to help cover the costs of treatment.
For more insights on mesothelioma treatment, contact us today.