Mesothelioma Treatment

In Summary: Treatment is available to improve a mesothelioma prognosis for many patients using a variety of cancer-fighting methods and medications. Doctors make treatment recommendations based on the type and stage of mesothelioma, as well as the patient’s overall health and the ability of their bodies to recover. Patients may receive multiple rounds of a single form of treatment or a combination of several types, including surgery, chemotherapy, radiation, immunotherapy and targeted therapy. New, emerging mesothelioma treatment techniques and drugs may only be available through clinical trials in certain hospitals.

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What Are the Treatment Options for Mesothelioma?

Mesothelioma, or any cancer, is a life-altering diagnosis. With only 3,300 diagnosed cases a year, it’s unlikely that you know someone who has gone through treatment for this form of cancer before. Luckily, there are dozens of sources to learn more about what treatments are available and how they work. Familiarize yourself with your treatment options before heading to your next doctor’s appointment so that you can have a thoughtful conversation and figure out what is best for you or your loved one.

There are many treatment options that can significantly prolong life expectancy and improve quality of life. Your treatment options will depend on a number of factors, including the site of mesothelioma you’ve been diagnosed with (usually in the pleura, peritoneum, or pericardium), the cell type present in the tumors (epithelioid, sarcomatoid, or biphasic), and the stage (1–4). Your demographics (sex, age) and your overall health will also impact your options and prognosis.

Patients diagnosed at stages 1 or 2 are sometimes candidates for curative treatment options that aim to remove as much of the cancer as possible. Because curative treatments can be aggressive — often involving a combination of surgery, chemotherapy, and radiation — they are usually only recommended for patients who are otherwise in good health. For later-stage patients and those who are not in good health, doctors generally focus on palliative care to relieve pain and discomfort and mitigate symptoms (such as breathing difficulties).

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Phases of Mesothelioma Treatment

Doctors tailor treatment plans to the individual patient, but most patients pursue multimodal therapy, which involves a combination of treatment types. This often involves a three-step process (also known as trimodal therapy) of neoadjuvant therapy, primary therapy, and adjuvant therapy. If patients are not candidates for surgery they may then receive what is called palliative chemotherapy or best supportive care if they can’t get chemotherapy.

Neoadjuvant Therapy

Neoadjuvant therapy refers to procedures that take place before primary treatment. These kinds of therapies are typically meant to be done before surgery as a way to shrink tumors or stop the spread of the cancer.

Primary Therapy

Just as it sounds, primary therapy is the main treatment or treatments employed to treat an illness. An oncologist or surgeon will advise the best options for the individual patient based on their specific case. This can be one or a combination of several therapies. The primary therapy for mesothelioma is usually surgery to remove cancerous tumors. The primary therapy for peritoneal mesothelioma often includes heated chemotherapy administered during surgery.

Adjuvant Therapy

Adjuvant therapy occurs after primary therapy is over. Typically, adjuvant therapies like chemotherapy or radiation are done after surgery to improve the results, prevent a recurrence, or relieve pain or symptoms that may have been caused by either the cancer or the treatment itself.

Video Transcript

“The most important thing is to figure out where your patient is coming from. Older patients sometimes don’t want to be as aggressive. They say, “Doc, do whatever you can to get rid of the tumor, but I really don’t want to fight so hard, I’m worried about my quality of life.” Younger patients will tend to really want to hit it with the kitchen sink. With younger patients, they’re willing to go through more difficult procedures that are higher risk, but they perceive as a higher benefit as well. And I think it’s important to really realize that just because it’s bigger and more painful and harms your quality of life doesn’t necessarily mean it’s better. And you have to really get a sense of “is this a tumor that’s really invasive, that no matter what we do, it’s going to get them? Or, that it’s so non-invasive that no matter what you do, you’re okay?” What we need to do is focus on is the middle part, where it’s a tumor that our intervention can actually make a difference in its trajectory.”Dr. Raja Flores

Treatment Options

There are multiple treatment options for mesothelioma, including surgery, chemotherapy, radiation, and immunotherapy, as well as clinical trials to test emerging treatments. Doctors also employ palliative care or best supportive care to relieve symptoms and improve the patient’s quality of life.

Surgery

Surgery for mesothelioma is usually performed as a curative, primary treatment. Depending on the type and stage, the surgeon will attempt to remove as much of the tumor as possible. They may also remove parts of the affected organs. This is resectable mesothelioma. In cases where it’s unresectable, less-invasive surgical procedures may be used as palliative treatments, helping to ease pain or discomfort caused by the disease.

Chemotherapy

Chemotherapy is one of the better-known treatments for cancer. After someone has been diagnosed with mesothelioma, chemotherapy drugs may be administered as a neoadjuvant therapy to shrink any tumors present to make surgery easier or to avoid surgery altogether. Chemotherapy may also be implemented after surgery to eradicate any remaining cancer cells. Doctors may use the term cycle to reflect the number of chemotherapy treatment sessions needed. Your doctor may also use chemotherapy as a palliative to slow the spread of the cancer and extend your life expectancy.

Radiation

Radiation oncologists use targeted, high-energy particle beams to shrink or eradicate cancer cells and prevent them from spreading throughout the body. This form of therapy can be used alone or as a neoadjuvant treatment, though it is primarily used after surgery or the primary therapy as an adjuvant therapy. Radiation can also be a part of palliative care to help reduce the symptoms.

Immunotherapy

Immunotherapy is becoming increasingly common in the treatment of mesothelioma. Also called biotherapy, immunotherapy enhances the body’s own immune system to help it fight the spread or recurrence of cancer cells. This treatment is generally reserved for patients whose tumors continues to spread after they’ve already been through chemotherapy. Although it is still being tested, immunotherapy is an established emerging treatment for cancer and has had some promising results. This is good news for patients, since it is less harsh on the body that many other cancer treatments.

Clinical Trials and Emerging Treatments

As science and technology advances, new clinical trials and emerging treatments become available. Many patients are candidates for clinical trials. These may involve access to emerging or new versions of current treatments, such as chemotherapy drugs or types of immunotherapy or targeted therapy. Many of the new treatments and medications being developed for mesothelioma care cause fewer and less-harmful side effects. Clinical trials and emerging treatments are usually part of a multimodal plan. They can come before or after standard therapies such as surgery, chemotherapy, and radiation. As more data is collected, some of these experimental treatments may become part of the standard treatment program. That’s why clinical trials for mesothelioma are so important.

Palliative Care

This form of care relieves pain and discomfort caused by the disease and its accompanying symptoms. Palliative care is not intended to be curative, but it can be combined with curative treatment to provide relief from both symptoms and side effects of therapy. It is typical for a mesothelioma patient’s medical team to include palliative care as a way to ease some of the side effects of their primary treatment. This can include removing fluid via pleurodesis, shunt placement, or catheter placement. A referral to a pain management team can also be part of the palliative approach to cancer care.

Cancer Care and Mesothelioma Specialists

Because the disease is so rare, you should consider working with a doctor who specializes in treating this type of cancer. Together, you will be able to craft a custom treatment plan.

You’ll also interact with many other health care professionals, from nurses to surgeons to mental health workers. This is your cancer care team. Dealing with so many doctors can be confusing, but becoming familiar with each specialist can make everything a bit less scary.

Improving Your Prognosis

While it may seem like there is little to be done outside of doctor-administered therapy, working on physical health can improve the way the body responds to treatment and improve the patient’s prognosis. Regular exercise and changes to diet are the two biggest ways to affect this.

Affording Treatment

A common concern among anyone who has been diagnosed with cancer is how to afford treatment. People suffering from mesothelioma are no different. What sets cases apart from other cancer diagnoses is that there is often legal action that can be taken. This can result in compensation that may pay for all or some of the treatment. If you or a loved one have been diagnosed with mesothelioma and you are trying to figure out your options, reach out to a lawyer that specializes in mesothelioma cases or get a free case evaluation.