There are various treatment options for malignant mesothelioma. All these are standard options used in the treatment of cancers and include

They form the mainstay for treating any cancer, including mesothelioma, doctors may use these treatment options alone or in combination, depending on the stage of mesothelioma and its type.

Mesothelioma treatment options

In the treatment of mesothelioma, usually, a combination of these cancer therapies is used because almost always mesothelioma is detected quite late.

Therefore, because of a late diagnosis, mesothelioma treatment is more of a palliative nature than a curative one.

 1. Surgery

Surgery involves surgical removal of the malignant mesothelioma tissue. There are several types of mesothelioma surgeries and the option will depend on the type of mesothelioma and whether there is metastasis.

Surgery options will also depend on the age and general condition of the patient, whether there is any collection of fluid as in pleural effusion, and whether the diagnosed mesothelioma is primary or a recurrence.

 Surgery for pleural or lung mesothelioma

Depending on how much the mesothelioma has spread, the surgery may be less or more extensive. The following surgery options may be used.

  • Tumor resection. With a wide incision, the mesothelioma tumor along with some tissue around is removed.
  • Pleurectomy and Decortication. This involves the removal of part of the affected pleura along with part of the adjacent lung.
  • Extrapleural Pneumonectomy. This involves removing the affected lung, the pleura, the part of the diaphragm on the affected side, and part of the pericardium.
  • Thoracentesis. Pleural mesothelioma often causes pleural effusion, which causes breathing problems for the patient. Pleurodesis is a surgical procedure wherein, a catheter or chest tube is inserted into the pleural cavity and the pleural fluid is drained with the help of mild suction. Medicines and drugs are then injected into the pleural cavity to stop more pleural fluid from building up. This is called thoracentesis.

 Surgery for peritoneal mesothelioma

  • Peritoneal mesothelioma is often diagnosed late and when it has advanced. As a result, surgery has a very limited role in treating peritoneal mesothelioma. When indicated, surgery involves the removal of the affected peritoneum.
  • As in thoracentesis explained above, a needle or catheter may be introduced into the peritoneum in the abdomen to remove peritoneal fluid, relieve symptoms and introduce medicines and drugs. This is called paracentesis.

 2. Radiation for mesothelioma

Radiation therapy for mesothelioma involves targeting the malignant tissue with high-energy X rays which destroy the cancer cells and shrink the mesothelioma tumor. Radiation has its side effects.

Radiation therapy for mesothelioma may be given by external radiation therapy where radiation is given by a machine from outside or internal radiation therapy where radiation is given by placing radioactive substances such as seeds, needles, or catheters inside the malignant tissue or near it. This is called brachytherapy treatment for mesothelioma.

3. Chemotherapy for mesothelioma

This therapy involves using chemotherapy medicines or drugs to kill the cancer cells of malignant mesothelioma. This treatment is not without side effects. Chemotherapy may be administered in different ways depending on the location, size, and stage of mesothelioma.

Chemotherapy for malignant mesothelioma may be administered either orally or by injection into the veins. The drugs reach the cancer site through the bloodstream and destroy the cancer cells. This is called systemic chemotherapy.

At times, the chemotherapy drugs are placed directly into an organ or in the body cavity (such as the pleura or peritoneum) where the cancer cells are destroyed by their direct action. This is called regional chemotherapy.

Sometimes a combination of chemotherapy drugs is used for better effect. This is called combination chemotherapy.

4. Immunotherapy for mesothelioma

Immunotherapy, also called biotherapy or biologic therapy, is therapy for mesothelioma which uses the immune system of the body to fight cancer. This is done in two ways:

  • By stimulating the immune system to fight the cancer cells by administration of a cancer vaccine. This is called Active Immunotherapy.
  • Or by administration of antibodies that fight the cancer cells with the help of the immune system. This is called Passive Immunotherapy.

Stage-wise management of malignant mesothelioma

Mesothelioma is classified into 4 stages. These progressively numbered stages have been created to identify the progression and severity of the disease. Identifying the stages with the help of diagnostic procedures helps the treating doctor to recommend the best line of treatment for that particular patient and the prognosis and the survival period.

Stage 1 mesothelioma treatment

Cytoreductive surgery is the surgical removal of part of a malignant tumor. It is the first choice of treatment for stage 1 mesothelioma patients and involves the removal of as much of the cancerous tumor as possible.

  • Pleural cases mostly undergo extrapleural pneumonectomy or pleurectomy/decortication.
  • Stage 1 peritoneal mesothelioma patients may be treated with hyperthermic intraperitoneal chemotherapy (HIPEC), a type of chemotherapy used during surgical procedures.

Stage 1 mesothelioma patients may also be treated with radiation therapy and intravenous chemotherapy drugs, such as pemetrexed and cisplatin.

Stage 2 mesothelioma treatment

Multimodal therapy is the widely accepted form of therapy for stage 2 patients and is most effective for improving mesothelioma survival. It usually includes combined treatment with surgery, chemotherapy, radiation, and/or immunotherapy. However, this therapy may not be an option for all stage 2 patients.

Doctors use this therapy for stage 2 cases by combining two or more cancer treatment options and is probably the most effective approach for improving the survival of mesothelioma patients.

Doctors can choose the best combination that will suit the particular mesothelioma patient best. Usually, they include a combination of surgery, chemotherapy, and/or radiation.

At this stage, surgery may not always be the option and its feasibility will depend on the overall health of the patient and the presence of metastasis.

Stage 3 mesothelioma treatment

Treatment options for stage 3 mesothelioma patients mainly remain palliative (supportive). Treatment at this stage mainly focuses on prolonging life, giving symptomatic relief, and improving a patient’s quality of life.

To achieve this, doctors usually recommend a combination of chemotherapy and radiation to improve the patient’s condition.

Cytoreductive surgery at this stage may not be an option because of the risks involved. However, doctors may use minor surgical procedures to drain the extra fluid (pleural, peritoneal, or pericardial) to ease symptoms. Pleurocentesis and paracentesis are commonly performed at this stage.

Stage 4 mesothelioma treatment

Treatment for stage 4 mesothelioma patients also remains largely palliative. Doctors choose options at this advanced stage that will help manage symptoms, prolong life and improve the patient’s quality of life.

Patients with stage 4 mesothelioma may undergo systemic chemotherapy, radiation, and/or palliative surgical procedures to alleviate symptoms.

However, prognosis and survival for stages 3 and 4 remain discouraging.