Mesothelioma Treatment Goals
Each type of mesothelioma requires a different approach to treatment in regard to surgery and chemotherapy. Patients respond to treatments differently, so it is important for doctors to adjust treatments according to how the mesothelioma reacts. Each treatment accomplishes a certain objective.
Treatments goals can include:
- Kill existing cancer cells
- Shrink the overall size of tumors
- Remove tumors either partially or entirely
- Prevent the growth of new cancer cells
- Control the spread of cancer to surrounding areas and other systems
- Reduce pain
- Control and manage other symptoms such as weight loss or breathing and digestive problems
- Improve comfort and quality of life
Different treatments may cover one or more of these goals. Every case of mesothelioma is different. In turn, the needs of each patient are different.
There is no known cure for mesothelioma, but some treatments have been known to send this cancer into remission.
Treatment goals and options are determined by the specific mesothelioma case. Some treatments may be aimed at removing the tumors. On the other hand, some are meant to prevent the spread of existing cancer cells (metastasis).
To better understand your own treatment options, it is important to consider the factors that determine where and when the treatment types will be used.
Primary considerations of mesothelioma treatment options include:
- Location of mesothelioma (type of mesothelioma such as pleural, peritoneal or pericardium)
- Stage of cancer (if a diagnosis has been staged at 1, 2, 3 or 4)
- Age of patient
- Any current and pre-existing health conditions
- Any past history of cancer and treatments
- General health and fitness level
There may be other factors at play when it comes to the type of treatment your physician will recommend. These factors vary from patient to patient.
Types of Mesothelioma Treatments
There are four primary forms of mesothelioma treatment. Other pain management treatments and therapies are used to improve quality of life.
Researchers are currently developing and testing new treatments. This provides hope to those with current or future mesothelioma diagnoses. These emerging treatments are specific to the causes of mesothelioma (etiology). They are undergoing extensive research through clinical trials.
Here are the primary mesothelioma treatment types:
- Radiation therapy
- Physical therapy
Your doctor may prescribe multiple treatments at the same time or apply treatments in a subsequent manner. Multiple treatments are often used together because each type achieves a different outcome. This approach to treatment is called multimodal, and it can greatly increase patient life expectancy.
Chemotherapy, or “chemical therapy,” refers to a type of anti-cancer (cytotoxic) treatment. Chemotherapy drugs are designed to kill cancer cells and stop them from multiplying and spreading.
How Does Chemotherapy Work?
Cancer cells rapidly mutate, form tumors and grow out of control if left untreated. Chemotherapy attempts to break this pattern. It aims to protect the body from further damage caused by malignant tumor growth, such as organ failure.
When doctors administer chemotherapy, the drug circulates through the patient’s bloodstream and destroys cancer cells in the process. Chemotherapy drugs are designed to interfere with the DNA of cancer cells, preventing them from replicating and spreading.
By killing cancer cells and stopping them from spreading, chemotherapy also reduces painful symptoms that result from tumors.
How is Chemotherapy Administered?
Chemotherapy only works if it is administered regularly over an extended period of time. For mesothelioma, chemotherapy is usually administered intravenously (into the vein). This is done either through an IV (intravenous) drip or through a direct injection.
Chemotherapy for mesothelioma may involve one type of anti-cancer drug or multiple different types. The drugs your doctor chooses depend on factors like cancer stage and mesothelioma type.
Chemotherapy is administered in cycles of four to six weeks followed by a rest period. One chemotherapy cycle consists of multiple drug administering sessions. These sessions last anywhere between 30 minutes to four hours depending on the drug plan prescribed by your doctor. Some patients undergo multiple chemotherapy sessions per week as part of one cycle.
Administering chemotherapy in multiple sessions for multiple weeks allows for intense doses of the drugs to kill as much cancer as possible. Then, the body is given a break from side effects that occur with chemotherapy treatments.
Neoadjuvant & Adjuvant Chemotherapy Administration
Chemotherapy is used to treat pleural, peritoneal and pericardial mesothelioma patients.
There are two common ways to administer chemotherapy. The two ways determine how chemotherapy fits with the other mesothelioma treatment types.
Chemotherapy can be administered by:
- Neoadjuvant Therapy: Chemotherapy is administered to mesothelioma patients prior to surgery. In some cases, pleural or peritoneal mesothelioma can be treated with surgery. Sometimes doctors recommend neoadjuvant therapy to help shrink tumors and stop them from growing before or while they are removed surgically. This helps to improve the surgical success rate.
- Adjuvant Therapy: Chemotherapy is given to mesothelioma patients after surgery. While surgery is the best treatment to remove large tumors, it cannot get rid of microscopic cancer cells. These cells continue to spread and form new tumors. Administering chemotherapy post-surgery helps ensure that any remaining cancer cells are killed off and do not spread further.
In some cases, mesothelioma cannot be treated surgically. In these cases, chemotherapy on its own may be the main treatment. If surgery is not an option, doctors may prescribe radiation therapy. This may not completely eliminate cancer cells, but it can slow the spread of mesothelioma from attacking surrounding areas and damaging organs. Getting the spread of mesothelioma under control greatly increases life expectancy.
The main goals of chemotherapy treatment are to kill mesothelioma cancer cells, shrink tumor sizes and prevent the cancer from spreading. Chemotherapy supports other mesothelioma treatments like surgery. It is also useful in reducing painful symptoms and improving quality of life.
Other important benefits of chemotherapy include:
- A non-invasive treatment option
- Improved survival rates and life expectancy
- A tailored treatment option for each patient through multiple drugs and administration methods that support different tolerance levels
Chemotherapy Side Effects
Because chemotherapy attacks all cells in its path that divide quickly, chemotherapy drugs can also inadvertently damage healthy body cells that divide quickly. These cells include those in bone marrow, hair follicles or in the mouth and intestinal linings. When chemotherapy attacks healthy cells, it causes side effects.
Common chemotherapy side effects include:
- Hair loss
- Mouth ulcers
- Nausea and vomiting
- Loss of appetite
- Increased bruising
- Fatigue and general feeling of being unwell
- Increased risks of infection
Because these side effects are produced by the chemotherapy drugs, they usually go away after the treatment course is complete. Doctors anticipate chemotherapy side effects and may use certain drugs to manage and reduce them.
Radiation therapy is a form of cancer treatment that uses high-energy rays to kill cancer cells. By killing cancer cells, radiation therapy reduces tumor size. It also prevents or slows down the rate at which the cancer is spreading.
How Does Radiation Therapy Work?
Specialized equipment is used to send high levels of rays targeted at cancer cells. Because cancer cells grow and divide so quickly, radiation helps to stop that process by interfering with the cell’s DNA. DNA is crucial to the replication of cells. When it is interfered with, cancer cells cannot grow and divide. They will often die off because they are unable to spread.
Unlike chemotherapy, which is sent throughout the entire body, radiation therapy is highly targeted. As a localized treatment, radiation therapy is aimed specifically at the area of the body in need of treatment. This reduces the potential of harming nearby cells.
How is Radiation Therapy Administered?
Doctors administer radiation therapy using targeted, high-intensity rays. Radiation therapy is commonly used to treat pleural mesothelioma. It poses too many risks when used to treat peritoneal or pericardial mesotheliomas. Therefore, it is not used for these cancer types.
There are three different types of radiation therapy used to treat pleural mesothelioma:
- External Beam Radiation Therapy (EBRT): This type of radiation therapy uses a machine to send X-rays from outside the body directly to the cancer cells. The person administering the therapy first takes a measurement of the patient in order to determine the best angles at which to aim the rays to deliver the right dose. Each treatment lasts only a few minutes. Treatments are typically given for five consecutive days followed by a rest period. The cycle lasts several weeks with the total length dependent on the size of mesothelioma tumors.
- Intensity Modulated Radiation (IMR): Intensity Modulated Radiation Therapy (IMRT) delivers high-dosage radiation to a precise target using a computerized device. With the use of an accelerator, IMRT technicians are able to adjust the speed and precision of the radiation dosages to avoid damaging any surrounding healthy tissue. They use short bursts of radiation which target and kill the tumor more accurately than EBRT. This form of radiation is showing promising results in increasing the life expectancy of mesothelioma patients who are unable to undergo surgery.
- Brachytherapy: Brachytherapy uses a radiation source placed directly inside the body at or near the cancer site. The radiation is given off and travels a short distance to the mesothelioma cancer cells. This form of radiation therapy is not common for mesothelioma. Researchers are still testing brachytherapy in clinical trials.
Radiation Therapy Uses
Radiation therapy is generally given to pleural mesothelioma patients in stages 2, 3 or 4.
Sometimes doctors give radiation therapy to mesothelioma patients in stage 1 of the disease after they have had surgery to remove malignant tumors. This is called adjuvant radiation therapy, and it helps kill any leftover or missed cancer cells.
Radiation Therapy Benefits
Radiation is an intensive form of mesothelioma therapy that directly targets and kills cancer cells. This helps to control the spread of mesothelioma as much as possible and prevent it from shutting down nearby vital organs.
There are other important benefits of radiation therapy as part of mesothelioma disease treatment.
Other radiation therapy benefits include:
- A targeted form of therapy that helps preserve healthy tissue and cells
- Increased life expectancy by preventing mesothelioma cells from spreading (in some cases)
- Pain relief through shrinking the size of tumors
Radiation Therapy Side Effects
Radiation therapy produces different side effects than chemotherapy.
Common radiation therapy side effects include:
- Skin redness and irritation at site of radiation (like a sunburn)
- Breathing difficulty when administered to the chest
- Diarrhea, nausea or vomiting when administered near the abdominal area
Certain precautions help ease these potential side effects. Your health care team will be able to watch the side effects on your skin and make recommendations to help ease any soreness. Each person reacts differently to radiation, so discuss any concerns with your radiographer.
Some mesothelioma patients will undergo surgery to have malignant tumors removed. Surgeons will make incisions to open up a specific portion of the chest or abdomen and remove as much of the tumor as possible.
When is Surgery Needed?
Though surgery is not suitable for all mesothelioma patients, there are two situations in which surgery is beneficial for treating the disease. First, doctors may feel that surgical removal of tumors could potentially stop it from spreading or coming back. Second, doctors may recommend surgery as a form of palliative treatment to reduce painful symptoms.
As with all surgeries, mesothelioma surgery is only performed on patients that are healthy enough to withstand the effects of surgical procedures. Surgery is a serious form of treatment that always presents risks. Your health care team will discuss these risks to ensure that the best and most effective form of treatment is pursued.
Types of Surgery
Depending on the mesothelioma location, surgeons may perform different types of procedures to remove tumors. These types of surgeries vary in complexity and potential.
Below are the different types of mesothelioma surgeries.
A pleurectomy is a type of surgical procedure for patients with pleural mesothelioma. It involves removing the pleural lining from the chest wall on the affected side while the lung is left in. In some situations, a pleurectomy may be used to try to cure early stage mesothelioma. In other situations, a pleurectomy can alleviate fluid buildup, improve breathing and reduce pain. This offers palliative care for patients.
An extrapleural pneumonectomy (EPP) is an intensive surgery performed on patients when the doctor feels there is a high chance of curing the disease through surgery. This is almost always during the early stages of pleural mesothelioma.
During this procedure, the affected lung, the pleural lining, the diaphragm, the pericardium (the lining around the heart) and the nearby lymph nodes are all removed. A synthetic diaphragm and pericardium are then constructed and inserted in place of the natural ones.
Surgery is not always possible, especially for patients with peritoneal (abdominal) mesothelioma. However, in some cases, doctors will perform a peritonectomy which removes the peritoneum lining of the abdomen. Surgeons do this through a technique known as cytoreduction.
Cytoreduction removes as much of the peritoneal mesothelioma as possible. During the procedure, chemotherapy is often administered directly into the peritoneal cavity to help support the cancer removal process. This technique has been effective in extending life expectancy in many patients.
Immunotherapy uses different medications to stimulate the body’s immune system, allowing it to destroy more mesothelioma cells than it normally would.
These two drugs, Ipilimumab (brand name Yervoy®) and nivolumab (brand name Opdivo®), complement each other. Ipilimumab helps the body activate more T-cells, which kill cancer cells and other illnesses. Nivolumab helps the T-cells find cancer cells more easily.
Mesothelioma treatments such as chemotherapy, radiation therapy and surgery can be very hard on the body. Therefore, many doctors will recommend physical therapy to improve quality of life after treatment. There are different types of physical therapy that can help improve overall health.
Physical therapy can help:
- Rebuild muscle strength
- Improve breathing and pulmonary function
- Heal scar tissue
- Reduce fatigue, pain and other chronic symptoms
Physical therapy is by no means a treatment for mesothelioma. However, it can help improve the outcomes of certain treatments by minimizing physical complications afterward.
Ongoing mesothelioma research will help find specific disease treatments that further increase life expectancy and eventually cure the disease.
Emerging treatments are being studied in clinical trials around the world. Clinical trials offer mesothelioma patients the opportunity to undergo the latest treatments. This does more than improve a participating patient’s life expectancy and quality of life. It also provides patients with more treatment options. Information gathered in these trial is used to improve existing mesothelioma treatments and develop new ones.
Talk to your team of health care providers about how to participate in clinical trials and whether they are right for you.