Mesothelioma Treatment Overview

Mesothelioma treatments can be divided into three types:

  • Treatments for removing the cancerous cells
  • Treatments for destroying the cancerous cells
  • Treatments for alleviating symptoms

The course of treatment which is used largely depends on the stage of the mesothelioma.  In the early stages of the cancer, patients have more treatment options available to them, including surgery.  During the later stages of mesothelioma, the treatments may only be aimed at alleviating symptoms rather than attempting to abate the cancer.

Surgery for Mesothelioma 

Surgery for mesothelioma can be used either for palliative purposes, meaning that its goal is to reduce symptoms, or for curative purposes, meaning that its goal is to remove the cancer.  In some cases, surgical treatment for mesothelioma may be done during the diagnostic process of a surgical biopsy.

The extrapleural pneumonectomy in which the entire lung and surrounding tissue is removed is an invasive surgery that is chosen for a curative intent to treat malignant pleural mesothelioma. Chemotherapy treatments are administered first and radiation follows the surgery. It is a difficult process that doesn’t always improve the prognosis. The key according to one study is the careful selection of patients most likely to benefit from the trimodality treatment.1 This example is given to demonstrate why doctors will not always choose the most radical treatments involving surgery. Many people do not want to go through painful difficult treatments that are not likely to cure or extend life.

A less radical surgery is the Pleurectomy or decortication in which as much of the tumor is removed as possible but not the entire lung.

Palliative mesothelioma surgeries often involve removing fluid that has built up as a result of the cancer.  Curative surgery for mesothelioma is usually only performed in Stage 1 or 2 of the disease before the cancer has spread distantly throughout the body. While mesothelioma cannot be cured, a successful curative surgery can put a patient in remission – a period when the patient is free of mesothelioma.

In some cases surgery is done mostly to relieve pain or symptoms and improve the quality of life with no expectation of increasing survival.

Radiation for Mesothelioma 

Radiation treatment involves administering a dose of radiation to a patient.  The radiation will kill cancerous cells.  However, the radiation can also kill healthy cells, which causes adverse side effects of the treatment such as nausea, breathlessness, and hair loss. Radiation can be used either for palliative or curative purposes in mesothelioma treatment. It is often used along with surgery or chemotherapy for treating cancers such as mesothelioma.

There is a fairly new type of radiation called intensity-modulated radiotherapy (IMRT) that represents an advance in technology. It can kill cancer cells while leaving surrounding tissue intact. It has had some success in minimizing the chance of cancer recurrence in cases of malignant pleural mesothelioma. Because the radiation can target only diseased tissue, the surgeon is able to deliver radiation doses to the cancer cells that are close to internal organs like the heart. In other words, more of the mesothelioma cells are destroyed safety than with traditional radiation.2

Chemotherapy for Mesothelioma 

Chemotherapy treatment uses drugs which weaken or destroy cells which are rapidly dividing.  Rapid cell division is a characteristic of cancer cells thus making chemotherapy one of the most effective treatments for mesothelioma.  However, there are also many other cells which divide rapidly – such as bone marrow and digestive tract cells.  Thus, chemotherapy can be very detrimental to the body and produce numerous adverse side effects like nausea, exhaustion, and hair loss. Advances in chemotherapy may allow only the cancerous cells to be targeted and the healthy cells to be spared.

Chemotherapy may be used in conjunction with radiation or surgery treatments. In some cases, chemotherapy is used before surgery to reduce the cancerous mass before removal.  Chemotherapy may also be used after surgery to destroy any cancerous cells which were not removed.

Alternative Therapies for Mesothelioma

There are many alternative therapies available for treating mesothelioma.  An alternative therapy replaces the conventional therapy. Some of these include acupuncture, macrobiotic diets, supplements, meditation, and massage therapy.  Many cancer survivors have attributed their remission to some of these techniques.  However, there is little clinical evidence which supports the effectiveness of these methods for treating cancer. Most doctors will recommend only using complementary therapies in addition to the conventional route of treatment suggested.

The complementary therapies may be useful for relieving physical and mental stress. Unlike the alternative therapy, the complementary therapy is used in conjunction with the traditional therapies. Sometimes therapies like massage can give some relief from muscle pain. Complementary therapies may help you manage treatment or disease symptoms and thus improve the quality of life.  Complementary therapies include activities like aromatherapy and herbal remedies to name a couple.3

References 

1 Haseqawa, S. (2011) Current status of surgical treatment for malignant pleural mesothelioma, Kyobu Geka, v64(8 Suppl), 714-718.

2 Ahamad, Anesa MBBS, FRCRa; Stevens, Craig W. MD, PhDa; Smythe, W. Roy MDb; Liao, Zhongxing MDa; Vaporciyan, Ara A. MDb; Rice, David MDb; Walsh, Garrett MDb; Guerrero, Thomas MD, PhDa; Chang, Joe MD, PhDa; Bell, Brent PhDa; Komaki, Ritsuko MD, FACRa; Forster, Kenneth M. PhDc. (nov.Dec 2003) Promising Early Local Control of Malignant Pleural Mesothelioma Following Postoperative Intensity Modulated Radiotherapy (IMRT) to the Chest.  Cancer Journal, v9:6, 476-484.

3 Cassileth, B. R. and Deng G. (Feb 2004) Complementary and Alternative Therapies for Cancer. The Oncologist, v9:1, 80-89.