Treatment
Treatment for mesothelioma varies depending on the type, stage, and location of the tumor. In general, treatment may include surgery, chemotherapy, or radiation therapy. Here are some procedures your doctor may recommend to treat mesothelioma:
Surgery
Surgery is one of the primary treatments doctors use to treat mesothelioma. Doctors may try to completely surgically remove your cancer, or if your cancer has spread too far, doctors may use surgery to relieve symptoms. There are two main types of surgery for mesothelioma:
Extrapleural pneumonectomy (EPP)
This is an extensive and complex surgery that offers the best chance of curing mesothelioma. Your doctor will remove the pleura that lines the chest wall (parietal pleura), the pericardium, a portion of the diaphragm, some lymph nodes, and the lung closest to the tumor. This is a major operation, and you must be in good health to tolerate it. About one in every three people experience major complications from this surgery, but it does offer the best chance at curing the disease. You will probably receive adjuvant chemotherapy and radiation therapy after this surgery.
Pleurectomy/Decortication
Your doctor removes the pleura that lines the chest wall (parietal pleura) on one side of your chest, and also the pleura that lines the lung (visceral pleura) on the same side. Your doctor will also remove the pleura lining the mediastinum as well as the diaphragm. Your doctor does not remove the lung or diaphragm. Your doctor may recommend this surgery if you are unable to undergo an EPP. This surgery may be able to cure the disease, but the risk of recurrence with the procedure is much higher. You will probably receive adjuvant chemotherapy and radiation therapy after this surgery.
Surgery in the form of extrapleureal pneumonectomy or pleural/decortication can be offered if the tumor is limited to the lung and surrounding pleura and is resectable. The surgery may be followed by chemotherapy and/or radiotherapy depending on the extend of the original tumor and the ability to completely remove the tumor.
Additional Treatments
The doctor may also recommend any of the following treatments:
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Doctors may give chemotherapy neoadjuvantly to shrink the tumor before surgery or adjuvantly, to kill any cancer cells remaining after surgery. In some studies, chemotherapy for mesothelioma has been given intraperitoneally or intrapleurally, in which the doctor administers the drug into the abdominal or chest cavity through a catheter or port, often starting the day of surgery. This method delivers higher doses of chemotherapy directly to the tumor and limits damage to the rest of the body. Intraperitoneal or intrapleural chemotherapy, however, is not a routine community practice.
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Radiation Therapy
Radiation therapy uses waves of high energy rays to target and kill cancer cells. Radiation therapy can't cure mesothelioma, but your doctor may administer radiation to reduce the risk of your cancer coming back after surgery, or to relieve symptoms caused by malignant tumors. In external beam radiation, the doctor delivers radiation to your tumor from a machine outside your body. Doctors commonly use a new form of external beam radiation called intensity-modulated-radiation-therapy (IMRT) to treat mesothelioma. IMRT shapes the radiation beams, aims them from different angles, adjusts their intensity to limit damage to healthy tissue and reduces side effects.
Immunotherapy
Immunotherapy is a type of antibody treatment that prevents downregulation of the T-cells in your body. T-cells are a part of your immune system that recognize cancer cells as bad cells in the body and then kill them. Cancer turns off your T-cells. Immunotherapy turns on your T-cells. Two immunotherapy drugs through the vein are often used in combination to treat mesothelioma.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation. You may need to be referred to a University hospital for consideration to be included in a clinical trial as not all hospitals are able to conduct clinical trials.
