How Mesothelioma Is Treated

Medications and surgeries may have a role to provide relief

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Treatment of mesothelioma, a type of cancer of the mesothelium, the thin layer of tissue covering most internal organs, is highly dependent on the advice and guidance of a specialist. Nothing can replace the training and expertise of someone who also intimately understands the individual needs of a patient.

Consultation with a healthcare provider will help you understand what may be most effective in your case. Nevertheless, it can be helpful to review some of the therapy options for mesothelioma that may be available, including chemotherapy medications, surgery, pain relief, and alternatives. This article will review the treatment options for mesothelioma.

Prescriptions

Certain medications may be used to relieve symptoms associated with mesothelioma. Prescriptions that are directed toward treating the condition are limited to chemotherapy and would be administered by an oncologist, a doctor specializing in cancer diagnosis and treatment.

symptoms of pleural mesothelioma
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Chemotherapy, which uses powerful chemicals to kill fast-growing cancer cells, is usually given before surgery. How you respond to treatment will determine what type of surgery will be most beneficial for you. The disease progressing despite the use of chemotherapy is generally regarded as a poor sign of prognosis (outcome).

Failure to improve with induction chemotherapy (chemo administered at the start of cancer treatment) often means you should not undergo more radical surgical procedures since such treatment may not work. If a response is noted, additional assessment, including physical fitness, may occur before you undergo surgery or postoperative radiotherapy.

As an example, a typical chemotherapy drug regimen for mesothelioma is a combination of Platinol (cisplatin) and Alimta (pemetrexed), which has been shown to increase life expectancy over individual chemotherapy drugs by several months. These drugs are delivered intravenously (IV, through a vein) and can be used alone, as well. Other chemotherapy drugs for mesothelioma include:

  • Navelbine (vinorelbine)
  • Gemzar (gemcitabine)
  • Otrexup (methotrexate)

The oncologist will determine the best medications to use, the dosing, and the number and timing of treatment cycles.

Surgeries and Specialist-Driven Procedures

Surgical removal of mesothelioma is used as a treatment in the early and middle stages of mesothelioma if it is believed that the body can tolerate the risks of complications and the physical toll of surgery. Unfortunately, mesothelioma often develops in older people, and the potential health impacts can be a barrier to surgery.

If you are in stages 2 or 3, you may be offered treatment with a combination of surgery, chemotherapy, and radiation therapy (using intense energy beams to kill cancer cells). This is referred to as trimodality therapy. A combination of therapies has also been tried with stage 1. Though it is not yet clear the extent to which these additional therapies help patient outcomes, benefits cited include longer life expectancy after surgery.

There isn’t a medical consensus on which strategies are most effective. The mix of therapies you receive, including surgery, will depend on the nature and stage of the mesothelioma. Treatment decisions will be made by your medical team and surgical oncologists. Here are some possible surgeries that may be tried:

Lung-sparing cytoreductive surgery: This is a category of minimally invasive surgery often used in mid- to late-stage mesothelioma. This type of surgery involves removing layers of the membranes that line the thorax and the lungs called the pleura (a technique called decortication) or the entire pleural tissue (pleurectomy) while leaving the lung itself intact. 

In combination with increasingly advanced chemotherapy and radiation therapy techniques, lung-sparing cytoreductive surgery can have good outcomes. A review of 26 studies and 1,270 patients found lung-sparing cytoreductive surgery’s average survival rates were as follows:

  • 51% at one year
  • 26% at two years
  • 16% at three years
  • 11% at four years
  • 9% at five years

Extrapleural pneumonectomy (EPP): This surgery involves removing large amounts of the lung and pleura, with the goal of removing all mesothelioma tumors that may be present.

EPP is not proposed as a treatment for most people with mesothelioma. However, with stage 1 mesothelioma, EPP can be a viable treatment option given an experienced surgical team. As with any surgery, the balance of expected benefits from the surgery must outweigh the risks.

After surgery, it is possible that your healthcare provider will want to arrange radiation therapy to prevent seeding. Seeding occurs when the tumor cells are moved or dispersed by the surgeon’s instruments. Some medical professionals recommend this be performed two weeks after surgery, while others have found there is no benefit. Whether you receive this postsurgical radiation therapy may also depend on the staging and characteristics of the mesothelioma.

Pleurodesis: One of the effects of late-stage mesothelioma is the buildup of fluid around the lungs (called a pleural effusion), which makes breathing difficult and painful. People with mesothelioma often have a procedure to drain excess pleural fluid and to prevent re-accumulation in efforts to restore comfortable breathing. 

The area around the lungs may be drained as part of a surgical procedure called thoracoscopy. In order to prevent the re-accumulation of fluid, the area may be treated by inserting a talc powder in the space surrounding the lung. This may help the tissues to adhere to each other, preventing fluid from gradually filling the void.

This procedure may be done late in the course of the disease as part of palliative care (symptom relief). Alternatively, a pleural catheter can be placed, which continuously drains fluid around the lungs through a tube.

Tumor treating fields devices: There is a new tumor treating field device that is now approved by the Food and Drug Administration (FDA). The therapy, called Optune Lua, manufactured by Novocure, creates electrical currents to disrupt cancer cell division and limit tumor growth. It works by creating low-intensity alternating electrical fields delivered noninvasively to the upper torso. The device must be worn continuously at home. It is considered a first-line treatment for unresectable, locally advanced, or metastatic malignant pleural mesothelioma. A similar device is approved for treatment of an aggressive brain cancer called glioblastoma.

Home Remedies and Lifestyle

The most important prevention for mesothelioma is to avoid exposure to asbestos. This may require specialized safety gear, such as wearing a breathing mask when working on certain construction projects. After the condition is diagnosed, there are limited home remedies that may be helpful.

One question that is often raised is whether it is important to quit smoking. Smoking is not directly linked to the development of mesothelioma. Nevertheless, any smoke inhaled into the lungs prior to or after a diagnosis of mesothelioma may worsen symptoms by creating additional lung damage. It is also possible for resulting lung disease to further compromise long-term health.

Over-the-Counter (OTC) Therapies

Asbestos causes cancer by inflaming mesothelial tissue and mutating cells’ genes over a long period of time until they become cancerous. Compounds related to salicylic acid, found in nonsteroidal anti-inflammatory (NSAID) painkillers like aspirin and Advil or Motrin (ibuprofen), are able to suppress the body’s inflammatory response. It’s been suggested that they may even prevent some forms of cancer, including blood cancer.

However, it is too early to recommend these medications for the purpose of preventing or treating mesothelioma. Clinical research evaluating medications that may prevent mesothelioma is especially difficult because of how slowly the cancer develops. You may not receive a diagnosis of mesothelioma until decades after exposure to asbestos. 

More research is needed to understand if salicylic acid-related anti-inflammatory compounds may prevent or treat mesothelioma. Someone who is at high risk of developing mesothelioma may want to participate in low-risk medical trials to better understand how the disease may be better treated.

No existing medical guidelines recommend NSAIDs as a prevention or treatment tool for mesothelioma. Before taking NSAIDs, discuss it with a healthcare provider because of potential negative side effects of these drugs, such as stomach ulcers and liver damage. People who are at high risk for complications when taking NSAIDs include those taking certain medications, such as diuretics and blood thinners, and those with:

  • Prior stomach bleeding
  • High blood pressure (hypertension)
  • Heart disease
  • Liver disease
  • Kidney disease

Ask your healthcare provider before starting a regimen of NSAIDs. Remember that NSAIDs are not currently recommended as a prevention or treatment tool for mesothelioma by any existing medical guidelines.

Complementary and Alternative Medicine (CAM)

While you're being treated for mesothelioma, you may be interested in comfort measures to manage symptoms. If the disease cannot be cured, these interventions may be used to offer relief.

Pain control may be the most obvious benefit from CAM. There may be a role for acupuncture, medicinal marijuana, or other interventions to ease pain symptoms. Discuss with a healthcare provider any alternative options you may be considering.

A Word From Verywell

It is best to seek out mesothelioma specialists for diagnosis and treatment. Depending on your condition, you may be offered various treatment options. As the disease progresses, there may be a natural transition to providing comfort. Quality of life may take precedent, and supportive care that offers pain relief may be important. Though this is a serious disease, it is possible to make treatment choices that respect your wishes while offering welcomed relief.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.