How Mesothelioma Is Treated

Medications and surgeries may have a role to provide relief

Treatment of mesothelioma 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 physician will help to understand what may be most effective in an individual 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. Review the treatment options that may be used to address this condition.

Prescriptions

Certain medications may be used to relieve symptoms associated with mesothelioma. Prescriptions that are directed towards treatment of the condition are limited to chemotherapy and would be administered by an oncologist.

symptoms of pleural mesothelioma
Verywell / JR Bee

Chemotherapy is usually employed before surgery and the cancer’s response to the treatment is a deciding factor in what type of surgery will be most beneficial. If the disease progresses despite the use of chemotherapy, this is generally regarded as a poor prognostic sign. Failure to improve with induction chemotherapy often means that the affected person should not undergo more radical surgical procedures. Such treatment may be futile. If a response is noted, additional assessment including physical fitness may occur prior to undergoing surgery or postoperative radiotherapy.

As an example, a typical chemotherapy drug regimen for mesothelioma is a combination of cisplatin and pemetrexed, which has been shown to increase life expectancy over individual chemotherapy drugs by several months. These drugs are delivered intravenously. Further chemotherapy drugs used in monotherapy may include:

  • Vinorelbine
  • Gemcitabine
  • Cisplatin
  • Methotrexate
  • Pemetrexed

The oncologist will determine the optimal medications used, dosing, and number and timing of treatment cycles.

Surgeries and Specialist-Driven Procedures

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

Stages II and III may be offered treatment with a combination of surgery, chemotherapy, and radiation therapy. This is referred to as trimodality therapy. More recently, stage I surgery has also been accompanied by a combination of therapies. Though it is not yet clear the extent to which these additional therapies help patient outcomes, benefits cited include longer post-surgery life expectancy,

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

Lung-sparing cytoreductive surgery: This is a category of less invasive surgery often employed for mid-to-late stage mesothelioma. This type of surgery involves removal of layers of the pleura (a technique called decortication) or the entire pleura 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 1 year
  • 26% at 2 years
  • 16% at 3 years
  • 11% at 4 years
  • 9% at 5 years

Extrapleural pneumonectomy (EPP): This surgery involves the removal of 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 I mesothelioma, an extrapleural pneumonectomy 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 the treating physician 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 an affected person receives this post-surgery radiation therapy may also depend on the staging and characteristics of the mesothelioma.

Pleurodesis: One of the effects of late-stage mesothelioma is the build-up of fluid around the lungs (called a pleural effusion) which negatively affects breathing and can be painful. People with mesothelioma often have a procedure to drain excess pleural fluid and to prevent reaccumulation 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 reaccumulation 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. 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 U.S. Food & Drug Administration. The therapy, provided by Novocure's Optune Lua system, 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. It must be worn continuously in the home setting. 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 in certain construction jobs. 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 exacerbate symptoms due to additional lung damage. It is also possible for resulting lung disease to further compromise long-term health.

Over-the-Counter 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 non-steroidal anti-inflammatory (NSAID) painkillers like aspirin and ibuprofen, are able to suppress the body’s inflammatory response. They have been suggested as potentially preventative for 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 it develops. The delay from exposure to asbestos to the development of mesothelioma may be decades in length. 

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.

NSAIDs are not currently recommended as a prevention or treatment tool for mesothelioma by any existing medical guidelines. Before starting a regimen of NSAIDs, discuss it with a doctor due because of potential negative side effects, such as stomach ulcers and liver damage. People who are at high risk for complications if using NSAIDs include those with:

  • Prior stomach bleeding
  • Hypertension (high blood pressure)
  • Heart disease
  • Liver disease
  • Kidney disease
  • Certain medication use (diuretics, other blood thinners, etc.)

Ask your doctor before starting a regimen of NSAIDs. It should be remembered that NSAIDs are not currently recommended as a prevention or treatment tool for mesothelioma by any existing medical guidelines.

Complementary and Alternative Medicine (CAM)

Beyond the primary treatments of mesothelioma, coexisting symptoms may need to be addressed to provide comfort. If the disease cannot be cured, these interventions may have a larger role to offer relief.

Pain control may be the most obvious benefit. There may be a role for acupuncture, medicinal marijuana, or other interventions. Discuss with a physician 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 the state of the disease, various treatment options may be offered. 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 the wishes of the affected person while offering relief.

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