Mesothelioma Treatment

While there is no known cure for mesothelioma, emerging technologies and combination treatments may improve the quality of life while slowing the progression of the disease

In addition to traditional mesothelioma treatment options including surgery, chemotherapy and radiation therapy, some patients may be eligible to participate in new drug clinical trials.

Alternative treatments for mesothelioma are emerging as a possible alternative to more invasive procedures.

Mesothelioma Surgery

Surgery to treat mesothelioma is extremely invasive and complicated. The abdomen is filled with a variety of easily damaged and extremely important organs. Surgery alone is not expected to cure mesothelioma but is intended to extend the patient’s life.

Often, an operation is not appropriate and you may have only smaller procedures to relieve symptoms. In the case of pleural mesothelioma, this may include a thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity; or a pleurodesis, where talc or drugs that cause scarring may be injected into the chest cavity to try to prevent the fluid from returning.

According to the American Cancer Society, these techniques are successful in controlling the fluid, at least temporarily, in as many as 90 percent of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help you breathe more easily; however, they do not cure the cancer.

In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, in the case of pericardial mesothelioma, a needle inserted into the pericardium (sac around the heart) can drain pericardial fluid and help relieve circulatory problems.

Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area. This concern should not prevent fluid removal, though.

Surgery may be undertaken to treat mesothelioma affecting the pleura (a thin layer of tissue covering the lungs and lining the interior wall of the chest cavity), or the peritoneum (the abdominal lining). Surgery is often used in combination with other treatments, including chemotherapy and radiation.

The pleura is found inside a rigid space (the rib cage) and is difficult to reach without cutting through bone. Thoracic (chest) surgery to remove the pleura almost always involves the permanent removal of at least one rib.

According to the American Cancer Society, two surgical procedures are offered for the treatment of pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy.

The ACS says pleurectomy/decortication is usually a palliative procedure (relieves symptoms without curing the cancer) in cases where the entire tumor cannot be removed. This procedure removes the pleura, where the majority of the tumor is located. It can control the build up of fluid improve breathing and decrease pain caused by the cancer.

Extrapleural pneumonectomy is a far more extensive operation and is most often used in patients with localized mesothelioma of the epithelioid type, according to the ACS. It is a difficult operation and is done only by surgeons in large specialized medical centers. The operation removes the pleura lining the chest wall, diaphragm, pericardium, and the whole lung on the side of the tumor. The diaphragm and the pericardium are then reconstructed with prosthetic material. This operation attempts to remove all or most of the cancer and some surrounding tissues as well.

 

To undergo surgery of this severity, a patient needs to have a healthy heart, a viable second lung and, in the case of adjuvant chemotherapy during surgery, strong kidney functions and a healthy liver.

The peritoneum is located in an area of soft tissues, more easily accessed and pliable. Surgical treatment of peritoneal mesothelioma is often done either to help relieve symptoms or to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely.

Similar operations can be done to remove a mesothelioma from the pericardium (the sac around the heart).

Mesothelioma and Chemotherapy Treatments

Depending on the type and stage of the cancer, chemotherapy may be given as the main treatment or along with surgery. Chemotherapy for this disease is generally given to relieve symptoms, not to cure the cancer.

To date, the biggest obstacle to treating peritoneal mesothelioma with chemotherapy alone is either that the amount of tumor present is too large for the chemo to destroy it or that the tumor develops resistance to the chemo. Surgery can assist with the first problem by reducing the tumor remaining to a manageable amount that chemo can handle.

Mesothelioma and Radiation Treatments

As a rule, radiation treatment doesn’t help much for mesothelioma, and the need to treat a large part of the lung leads to problems with lung damage.

But radiation can be used along with surgery to kill small areas of cancer that cannot be seen and removed during surgery. It can also be used as a way to ease symptoms such as shortness of breath, pain, bleeding, or trouble with swallowing. If fluid builds up in the chest, radioactive drugs can be put into the space after the fluid is drawn out. This might help keep the fluid from coming back.

Radiation has proved to be of limited use in abdominal mesothelioma as a primary treatment but has proved useful in preventing malignant seeding of the incision sites. Its use is highly recommended in both pleural and peritoneal mesothelioma to prevent the appearance of mesothelioma in the area of surgical incisions.

Complementary and Alternative treatments

In the ongoing quest for a cure for mesothelioma and other life-threatening illnesses, the debate over the validity and effectiveness of complementary and alternative medicine (CAM) continues to stir up strong emotions.

Complementary medicine is used along with standard medicine, while alternative medicine is used in place of standard treatments.

Major categories of CAM therapies, as determined by the National Cancer Institute’s Office of Complementary and Alternative Medicine (OCCAM), include alternative medical systems (built upon complete systems of theory and practice, like traditional Chinese medicine or homeopathy), energy and electromagnetic based therapies, exercise therapies (like yoga), manipulative and body-based methods, mind-body interventions (like hypnotherapy), nutritional therapeutics, pharmacological and biologic treatments (like vaccines), and spiritual therapies (healing, prayer).