What is the treatment for mesothelioma?
There are three traditional kinds of treatment for patients with malignant mesothelioma. Often two or more of these are combined in the course of treatment:
- surgery (taking out the cancer),
- radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells), and
- chemotherapy (using drugs to fight the cancer).
Additional information
Surgery: There are several types of surgery used in treating mesothelioma.
- A pleurectomy is the removal of part of the chest or abdomen lining and some of the tissue around it.
- Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy.
- In an extrapleural pneumonectomy, the lung is removed along with the lining and diaphragm (the muscle that helps you breathe) on the affected side. In this surgery, the lining around the heart is also removed.
- Sometimes a pleurectomy/decortication is performed. In this surgery, the lining of the lung is removed along with as much of the tumor as possible.
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be administered by pill, or it may be put into the body by a needle in the vein or muscle.
Chemotherapeutic agents can be administered either systemically (through the bloodstream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.
Mesothelioma treatment options (traditional and new treatments being studied)
Treatment options are determined by the stage of mesothelioma (the extent to which the tumor has spread in the body). There are three staging systems currently in use, and each one measures somewhat different variables.
The oldest staging system and the one most often used is the Butchart system, which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages.
Butchart system extent of primary tumor mass
- Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
- Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
- Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
- Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.
The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis.
TNM system: variables of T (tumor), N (lymph nodes), and M (metastasis)
- Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
- Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
- Stage III: Mesothelioma is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
- Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, extended to the pleura or lung on the opposite side, or directly extended into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.
The Brigham system is the latest system and stages mesothelioma according to resectability (the ability to surgically remove the tumor) and lymph node involvement.
Brigham system: variables of tumor resectability and nodal status
- Stage I: resectable mesothelioma and no lymph node involvement
- Stage II: resectable mesothelioma but with lymph node involvement
- Stage III: unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph-node involvement
- Stage IV: distant metastatic disease