What's the treatment for mesothelioma?

Like most cancers, the outlook for recovery (prognosis) for people with mesothelioma depends on when the disease is diagnosed and how aggressively it is treated. The treatment plan depends on the stage and location of the cancer, as well as the age and desires of the patient. Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

Surgery is a common treatment for mesothelioma. Before any surgery is considered for the treatment of malignant mesothelioma, the patient's overall health has to be evaluated. Tests are done to make sure the cancer has not spread to distant sites, and to evaluate how well the patient's lungs and heart are functioning. Lung tests look for any signs of lung damage from tobacco or from other diseases, including asthma and chronic obstructive pulmonary disease (COPD). These tests determine how risky surgery would be, especially if a lung needs to be removed. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed. Surgery is a common treatment of malignant mesothelioma.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy uses drugs to kill cancer cells. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy). Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

Intraoperative photodynamic therapy is a new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.

Because mesothelioma is very hard to control, the U.S. National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

New treatments for malignant mesothelioma and possible preventive measures, such as a vaccine, are being evaluated in clinical trials, and the future holds some promise. Clinical trials are research studies that evaluate new treatments for safety and effectiveness. There are no guarantees that a new treatment will work, and there are some risks. However, a clinical trial is not undertaken unless the researchers believe the treatment may have some value.

Some treatments for malignant mesothelioma that are being evaluated. Different combinations of chemotherapy drugs have been tried with mixed results. Putting chemotherapy drugs directly into the pleural or peritoneal space is being researched because of its advantage over traditional chemotherapy. Because the drug is placed directly into the cavity, much greater doses can be given to patients without causing severe side effects. Some studies have shown this therapy to control effusions and reduce tumor size. In brachytherapy (intracavitary radiation therapy), a radioactive substance is placed directly into the pleural or peritoneal space. Multimodality therapy is any combination of surgery, radiation therapy and chemotherapy. In gene therapy a virus that has been genetically altered is introduced into the tumor. The virus infects the cancerous cells and makes them vulnerable to anticancer drugs. Treatments that stimulate the body's immune system to fight cancer cells are called immunotherapy.

Because mesothelioma now represents less than one percent of cancers and and are infrequently seen in the practice of most community oncologists, finding the correct treatment can be very difficult. Proper management of mesothelioma often requires evaluation at larger tertiary hospitals or Comprehensive Cancer Centers by specialists in medical, surgical and radiation oncology with experience in all aspects of the clinical care of mesothelioma patients, including the newest experimental treatments. Because treatment has resulted in modest benefit, patients may question the treatment options suggested. It is often a good idea to seek a second opinion. A second opinion can provide more information and help you feel more confident about the treatment plan that you choose. Also, some insurance companies require a second opinion before they will agree to pay for certain treatments.