Mesothelioma is a rare and aggressive form of cancer that primarily affects the lining of the lungs, abdomen, and heart. It is mainly caused by exposure to asbestos, a naturally occurring mineral that has been widely used in construction, insulation, and other industries.
The treatment of mesothelioma is complex and depends on various factors, such as the stage of the disease, the patient’s overall health, and the specific type of mesothelioma. This comprehensive guide will provide an overview of the various treatment options for mesothelioma, along with insights into the latest research and clinical trials.
Diagnosis of Mesothelioma
Before discussing the treatment of mesothelioma, it is essential to understand the diagnostic process. If you have signs and symptoms that might indicate mesothelioma, your doctor will conduct a physical exam to check for any lumps or other unusual signs. Imaging scans, such as a chest X-ray and a computerised tomography (CT) scan of your chest or abdomen, might be ordered to look for abnormalities.
A biopsy is the only way to determine whether you have mesothelioma. It involves removing a small portion of tissue for laboratory examination. Depending on the affected area of your body, your doctor selects the right biopsy procedure for you. Options include:
Inserting a needle through the skin The doctor might remove fluid or a piece of tissue with a thin needle inserted through the skin on your chest or abdomen.
Collecting a sample of tissue during surgery. A fluid or tissue sample might be collected during an operation. The surgeon might make a small incision and insert a tube with a video camera to see inside your chest or abdomen. Special tools can be passed through the tube to collect a tissue sample.
Determining the extent of the cancer
Once your mesothelioma is confirmed, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body. Tests may include CT scans of the chest and abdomen, magnetic resonance imaging (MRI), and positron emission tomography (PET). Your doctor uses the information from these tests to assign your cancer a stage. The stages of pleural mesothelioma are indicated using Roman numerals ranging from I to IV. A lower numeral means the cancer is more likely to be localised to the area around the lungs, and the highest numeral means the cancer has spread to other areas of the body.
Treatment options for mesothelioma
The treatment of mesothelioma depends on your health and certain aspects of your cancer, such as its stage and location. Unfortunately, mesothelioma is often an aggressive disease, and for most people, a cure isn’t possible. Instead, your doctor may work to control your cancer to make you more comfortable. Discuss treatment goals with your doctor and consider the following options:
Surgery is one of the primary treatment options for early-stage mesothelioma. In some cases, this may cure the cancer. Most of the time, it isn’t possible to remove all of the cancer, but surgery may help reduce the signs and symptoms caused by mesothelioma spreading in your body.
Surgical options may include:
Surgery to decrease fluid buildup. Pleural mesothelioma may cause fluid to build up in your chest, causing difficulty breathing. Surgeons insert a tube or catheter into your chest to drain the fluid. Doctors may also inject medicine into your chest to prevent fluid from returning (pleurodesis).
Surgery to remove the tissue around the lungs. Surgeons may remove the tissue lining the ribs and the lungs (pleurectomy). This procedure won’t cure mesothelioma but may relieve signs and symptoms.
Surgery to remove a lung and the surrounding tissue. Removing the affected lung and the tissue that surrounds it may relieve the signs and symptoms of pleural mesothelioma. If you’ll be receiving radiation therapy to the chest after surgery, this procedure also allows doctors to use higher doses since they won’t need to worry about protecting your lung from damaging radiation.
Surgery for peritoneal mesothelioma Peritoneal mesothelioma is sometimes treated with surgery to remove as much of the cancer as possible. Chemotherapy may be used before or after surgery.
Chemotherapy uses chemicals to kill cancer cells. Systemic chemotherapy travels throughout the body and may shrink or slow the growth of a mesothelioma that can’t be removed using surgery. Chemotherapy may also be used before surgery (neoadjuvant chemotherapy) to make an operation easier or after surgery (adjuvant chemotherapy) to reduce the chance that cancer will return.
Chemotherapy drugs may also be heated and administered directly into the abdominal cavity (intraperitoneal chemotherapy) in the case of peritoneal mesothelioma.
Radiation therapy focuses high-energy beams from sources such as X-rays and protons on a specific spot or spots on your body. Radiation may be used after surgery to kill any remaining cancer cells. It may also help reduce the signs and symptoms of advanced cancer in situations where surgery isn’t an option.
Targeted therapy uses drugs that attack specific vulnerabilities in cancer cells. These drugs aren’t commonly used for treating mesothelioma, but your doctor might recommend targeted therapy based on the results of tumour DNA testing.
Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. This treatment might be an option if other treatments aren’t working.
Clinical trials are studies of new mesothelioma treatment methods. People with mesothelioma may opt for a clinical trial for a chance to try new types of treatment. However, a cure isn’t guaranteed. Carefully consider your treatment options and talk to your doctor about what clinical trials are open to you. Your participation in a clinical trial may help doctors better understand how to treat mesothelioma in the future.
Clinical trials are currently investigating a number of new approaches to mesothelioma treatment, including new targeted therapy drugs and new approaches to immunotherapy.
Treatment for Other Types of Mesothelioma
Pericardial mesothelioma and mesothelioma of the tunica vaginalis are very rare. Early-stage cancer may be removed through surgery. Doctors have yet to determine the best way to treat later-stage cancers, though. Your doctor may recommend other treatments to improve your quality of life.
Preparing for Treatment and Life Afterwards (Prehabilitation)
There are things you can do to help you feel more in control of your physical and mental health when preparing for treatment. In the hospital, preparing for treatment is also called prehabilitation or prehab.
Treatment Options for Pleural Mesothelioma
Treatment options for pleural mesothelioma include chemotherapy, radiotherapy, and surgery. Your treatment plan depends on several factors, including the stage of your cancer.
Treatment Options for Peritoneal Mesothelioma
You are often diagnosed with peritoneal mesothelioma when it is quite advanced. Unfortunately, it can be difficult to treat. Treatment options include chemotherapy, and a few people might have surgery.
Follow-Up and Survivorship Care
Follow-up services are provided through the Dana-Farber Cancer Institute’s Adult Survivorship Programme, a member of the LIVESTRONG Survivorship Centre of Excellence Network. The Adult Survivorship Programme provides clinical care and services for adult-onset cancer survivors, including research that focuses on finding solutions to key problems adult survivors may face after cancer treatment.
The treatment of mesothelioma is a complex process that involves multiple factors and requires a personalised approach. It is essential to work closely with your healthcare team to develop a treatment plan that meets your needs and preferences. With the right care and support, many patients with mesothelioma can achieve better outcomes and a better quality of life.