How Is Mesothelioma Treated?
SurgeryPatients diagnosed in the early stages benefit most from mesothelioma surgery. It offers them the best chance at living longer lives. These procedures, often performed with chemotherapy, remove all visible tumors from the chest area and improve quality of life.
RadiationRadiation therapy controls symptoms when surgery is not an option. It eases symptoms such as chest pain and discomfort. Radiation can also reduce the risk of local recurrence when combined with surgery, and it can be used as a palliative procedure.
Combining Traditional Treatment Methods
Tumor Treating FieldsTumor Treating Fields, or TTFields, uses alternating electrical fields to disrupt cancer cells and limit growth. FDA approved, and ASCO recommended, a portable battery device delivers this treatment for malignant pleural mesothelioma through the skin via insulated adhesive pads.
ImmunotherapyBevacizumab is an ASCO-recommended immunotherapy drug for mesothelioma that uses antibodies to limit tumor growth. Other types of immunotherapy for treating mesothelioma, such as the FDA-approved pembrolizumab (Keytruda), help the immune system identify and kill cancer cells.
Treatments by Mesothelioma Type
The primary treatment options for pleural and peritoneal mesothelioma include surgery, chemotherapy and radiation therapy. These treatments can relieve symptoms, improve prognosis and extend life expectancy.
Benefits and risks of each option depend on cancer type and stage. For example, hyperthermic intrathoracic chemotherapy (HITHOC) for pleural mesothelioma is considered experimental and has not yet yielded the success rate that heated intraperitoneal chemotherapy (HIPEC) has for peritoneal mesothelioma.
Types of Mesothelioma
Pleural Mesothelioma Treatments
Pleural mesothelioma affects the pleura, the outer lining of the lungs. Almost 75% of mesothelioma cases are pleural. Doctors prescribe treatments to remove or shrink pleural tumors, minimizing symptoms and improving quality of life.
Extrapleural Pneumonectomy (EPP): EPP removes the entire affected lung and all nearby areas where mesothelioma has spread, including lymph nodes, chest and heart linings and diaphragm.
Pleurectomy Decortication (P/D): P/D spares the lung and only removes cancerous parts of the pleural lining, chest wall lining, heart lining and diaphragm. P/D is less aggressive than EPP but is still major surgery.
Combination Chemotherapy: For first-time, or first-line, treatment with mesothelioma chemotherapy drugs, doctors often prescribe pemetrexed (Alimta) with cisplatin. If cancer returns, second-line options may include gemcitabine (Gemzar) or carboplatin.
External Beam Radiation Therapy: EBRT is the most common radiation treatment for mesothelioma. An external machine delivers X-ray beams to kill cells at the cancer site. Doctors may use EBRT before or during surgery.
Brachytherapy: This type of radiation is internal and uses a radioactive implant inside the patient to kill nearby cancer cells. Similar to EBRT, doctors may combine brachytherapy with other conventional treatments.
Peritoneal Mesothelioma Treatments
Peritoneal mesothelioma accounts for around 20% of cases and grows in the peritoneum, which lines the abdominal cavity. Surgery with heated chemotherapy is typically the most effective treatment for this variant.
Cytoreductive Surgery: The goal of cytoreductive surgery is to eliminate cancerous growths. Portions of affected organs, such as the stomach, liver, intestines and others, are removed. When surgeons remove cancerous parts of the peritoneum, the procedure is called a peritonectomy. When treating mesothelioma, doctors often combine surgery with heated chemotherapy.
Heated Intraperitoneal Chemotherapy (HIPEC): HIPEC is the most effective mesothelioma treatment option for the peritoneal type. Using a special pump and infusion machine, doctors deliver heated chemotherapy drugs to wash the abdominal cavity after surgery. The HIPEC process helps kill the remaining cancer cells left behind after surgery.
Pericardial Mesothelioma Treatments
Pericardial mesothelioma is a rare variant of the disease, present in only 1% of all known cases. This cancer grows along the lining of the heart sac known as the pericardium. Treatment options are limited because many therapies can also damage the nearby heart.
Pericardiectomy: About half of pericardial patients are eligible for this surgery, removing part or all of the pericardium. A pericardiectomy can reduce fluid buildup and prevent excess pressure on the heart, which can impair function.
Pemetrexed and Cisplatin: The traditional chemotherapy regimen for pleural mesothelioma has shown some benefits for pericardial patients, helping to extend life expectancy. In some trials, gemcitabine and pembrolizumab, a new immunotherapy drug, have also proven advantageous.
Testicular Mesothelioma Treatments
Testicular mesothelioma is an aggressive form of cancer and can spread rapidly. The variant accounts for less than 5% of all cases and may develop as a secondary tumor from peritoneal mesothelioma. Nearly half of patients with this type live for five years or more with treatment.
Orchiectomy: The surgical option available for over 98% of testicular mesothelioma patients is an orchiectomy. In this procedure, the surgeon removes the cancerous testicle and the spermatic cord.
Pemetrexed and Cisplatin: The standard chemotherapy regimen of pemetrexed and cisplatin for mesothelioma often follows surgery to help kill any remaining cancerous cells. Chemotherapy after surgery has proven to improve mesothelioma prognosis.
A small percentage of testicular mesothelioma patients, about 5%, receive radiation therapy after surgery. Researchers are still determining the benefits of this treatment, but radiation could help prevent testicular mesothelioma recurrence after surgery.
The Mesothelioma Center’s website is, in my opinion, the best resource for anyone suffering from cancer due to asbestos. Thank you for helping me determine the best treatment plan for my cancer and being part of my miracle.Karen F.Mesothelioma Survivor
Palliative Care for Mesothelioma
Common Palliative Care Procedures
ThoracentesisThis procedure involves a long needle inserted into the pleura to remove fluid buildup around the lungs.
PleurX CatheterSurgeons place this small drain in the chest to prevent fluid buildup around the lungs.
PleurodesisA more invasive procedure, this surgery eliminates the space in the pleura where fluid can develop.
RadiationRadiotherapy in combination with other treatments can shrink tumors to reduce chest pain and other cancer symptoms.
ParacentesisSimilar to a thoracentesis, this procedure for peritoneal patients uses a long needle to remove fluid buildup and reduce pressure from the abdominal area.
PericardiocentesisTo remove fluid and pressure from the sac surrounding the heart, doctors perform a pericardiocentesis, similar to thoracentesis and paracentesis.
Supportive care medicine is a new specialized branch of medicine that reduces pain, increases appetite and boosts morale. Every mesothelioma patient should ask to be seen by this type of medical specialist, in addition to a thoracic surgeon and medical oncologist.Dr. Jacques FontaineThoracic Surgeon for Mesothelioma
Clinical Trials & Emerging Treatments
Emerging Treatments for Mesothelioma
- Cryotherapy is a minimally invasive surgical procedure that freezes cancer cells to kill them. Patients may receive the therapy before surgery to shrink tumors, after surgery to treat recurrences or as a palliative treatment to control symptoms.
- Gene Therapy
- Genetically modifying cells and viruses can help control cancer. For example, repairing the defective tumor-suppressing p53 gene kills cancer cells before they can replicate out of control.
- Photodynamic Therapy
- After injecting a light-sensitive drug into the patient, doctors use laser light energy to activate the drug and kill cancer cells.
- Virotherapy is a cancer treatment that uses viruses to find and attack cancer cells. Some types of virotherapy involve gene therapy or immunotherapy to make the treatment more effective.
Nutrition & Self-Care During Mesothelioma Treatment
Important self-care tips to consider
Diet & Nutrition
Following proper nutrition guidelines, advice and a treatment plan from a dietitian can improve a patient’s well-being and recovery time.
As a part of any treatment plan, patients should try to keep a balanced diet to maintain weight and energy. Maintaining an appropriate weight before surgery can reduce the risk of infection.
Diets rich in protein and calories can benefit every cancer patient before, during and after treatments such as chemotherapy and surgery.
Protein allows muscles to heal faster from damage during surgery. Increased caloric intake gives your body the energy to repair cells and tissues injured during chemotherapy or radiation
However, some mesothelioma treatments can make eating more difficult. Several techniques, including certain foods and meals, can manage these challenges. Some patients may consider taking over-the-counter vitamins or supplements, but they should always talk with their doctor first.
Exercise & Fitness
Regular exercise improves strength and can speed recovery after treatment. Oncologists also recommend specific fitness exercises for cancer patients that can reduce fatigue, increase appetite and positively impact mood.
Examples of safe and effective low-impact exercises include:
- Lightweight strength training
- Stair climbs
Pleural mesothelioma patients should take precautions when undertaking any exercise. Some activities, such as cardiovascular and upper body workouts, can impact breathing and make it more challenging to take full breaths.
People undergoing intense treatments, such as surgery or chemotherapy, should also follow their doctor’s recommendation for resuming exercise. Safe workouts can include gentle activities without worsening fatigue.
Mesothelioma cancer can be a significant burden on mental health. Patients undergoing active treatment often struggle with negative thoughts, depression and anxiety. However, a strong focus on self-care and mental health awareness can significantly improve your quality of life.
Mesothelioma patients have several options for improving their mental health, including:
- Mesothelioma support groups
- Mental health counselors
- Physical therapy and exercise
- A healthy, well-balanced diet
- Palliative care and pain management
Mental health resources are available from doctors, nurses and caregivers. Health care teams are familiar with the emotional drain of a mesothelioma diagnosis. Professional psychological care can improve sleep and limit feelings of anxiety and depression.
Cancer and nutrition is such a growing area, and research is underway daily to find out how we can better protect ourselves from this disease.Tejal ParekhRegistered & Licensed Dietitian
Complementary & Alternative Medicine
While these practices and supplements are not conventional cancer treatments, some patients may use these alongside their cancer treatments to reduce pain or improve well-being. Patients should consult their doctor before using any supplement or alternative medicine.
Common Complementary Treatments
TENS TherapySmall at-home devices use low-voltage electrical stimulation over the skin to relieve muscle pains.
Acupuncture & MassageThin needles stimulate nerves and muscles to relieve pain. Therapeutic massage can lower fatigue and anxiety.
Medical MarijuanaNatural compounds reduce chemotherapy side effects such as nausea and vomiting, loss of appetite, pain and insomnia.
Herbal MedicineBotanical products that may ease symptoms related to treatment or the cancer, and they may improve immunity.
Energy TherapiesTreatments such as music therapy, Therapeutic Touch or reiki may soothe patients but are not effective in cancer care.
Mind-Body TherapiesTechniques such as hypnosis and biofeedback may reduce pain and discomfort using thought exercises and whole-body mindfulness.
Top Mesothelioma Doctors
Several mesothelioma specialists have spent years treating this rare disease. Unlike general oncologists, specialists offer the latest treatment options for patients. Experienced specialists stay up to date on the latest methods of improving mesothelioma prognosis and extending life expectancy.
Dr. Robert B. CameronPleural MesotheliomaLos Angeles, California (CA)
Dr. Paul H. SugarbakerPeritoneal MesotheliomaWashington, Washington D.C.
Dr. Abraham LebenthalPleural MesotheliomaBoston, Massachusetts (MA)
Dr. Andrea WolfPeritoneal MesotheliomaNew York, New York (NY)
Dr. R. Taylor RipleyPleural MesotheliomaHouston, Texas (TX)
Dr. W. Charles ConwayPleural MesotheliomaSanta Barbara, California (CA)
Because mesothelioma is a very rare cancer, finding a specialist is crucial to ensuring the best possible treatment plan and prognosis.
Top Mesothelioma Cancer Centers
How Much Does Treatment Cost?
Average Mesothelioma Treatment Costs by Type of Therapy
$30,096A 2017 Harvard Medical School study reported that a lung cancer patient could pay an average of $30,096 for the initial surgery and $4,263 in monthly costs.
$9,600 per monthA 2019 study compared lung cancer chemotherapy costs at various stages. The researchers showed that initial chemotherapy could cost up to $9,600 per month.
$8,005A 2019 National Institute of Health study reported the median cost of an initial radiation course for lung cancer was $8,005. Repeat radiation can cost about $4,500.
How to Pay for Mesothelioma Treatment
Paying for mesothelioma treatment is a challenge for many patients and their loved ones. Health care expenses can accumulate from out-of-pocket fees, caregiving, symptom management and lost wages due to missed work.
Although many Americans rely on private health insurance to pay for the treatment of severe illnesses, other opportunities such as federal programs and legal options may cover the cost of cancer treatment.
Resources to Help Pay for Treatment
- Government Programs
- Government assistance includes Social Security Disability Insurance, Supplemental Security Income and VA services.
- Charity Resources
- Hospitals, non-profit groups and social workers can help you find financial resources such as free travel and lodging.
- Clinical Trials
- Patients in clinical trials pay for standard treatment, but the trial sponsor pays for the experimental treatments.
- Filing a Legal Claim
- Patients and loved ones can file a legal claim for compensation to cover medical bills, lost wages and other expenses.
Common Questions About Mesothelioma Treatment
- What are the main types of treatment for mesothelioma?
The primary types of mesothelioma treatment included chemotherapy, surgery, radiation therapy and multimodal therapy, which is a combination of two or more of these treatments. New treatments, such as immunotherapy and gene therapy, are available through clinical trials.
- Are there any new treatment types that have shown to be effective for mesothelioma?
Yes. The FDA approved a new type of treatment called Tumor Treating Fields for pleural mesothelioma in May 2019. Average survival is around one year for mesothelioma with chemotherapy. Adding Tumor Treating Fields to chemotherapy helps patients extend average survival by six months.
- Are there doctors who specialize in mesothelioma?
There are specialized oncologists, surgeons and other types of doctors who have extensive experience treating mesothelioma. These doctors can confirm a mesothelioma diagnosis and develop an effective treatment plan for a particular type of mesothelioma.
- Will a COVID-19 diagnosis affect my mesothelioma treatment?
Yes, developing COVID-19 could delay cancer treatments such as chemotherapy, surgery or immunotherapy. Due to the severe effects of COVID-19, patients must first recover from infection before their doctor can continue treating mesothelioma.
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