Mesothelioma Treatment

Surgery

Mesothelioma surgery alone usually does not cure patients of the disease. Instead, it is meant to reduce the amount of cancer to minimal levels. At the end of the procedure, the surgeon should not be able to see or feel any tumor in the chest or abdomen. However, it is usually not possible to remove every microscopic tumor cell.

By reducing the amount of cancer in the body, though, the disease’s progression can be slowed. This allows patients to receive additional therapies, such as radiation, chemotherapy and immunotherapy.

Mesothelioma surgery can also be used to relieve symptoms like pain and shortness of breath.

Two main types of mesothelioma surgery are performed at MD Anderson. Your surgeon will discuss which is best for you. This decision depends on many factors, including:

• Age
• Physical fitness
• Lung health
• Extent of the tumor
• Type of mesothelioma (epithelioid vs. non-epithelioid)
• Whether the tumor has travelled to the lymph glands

The types of mesothelioma surgery are:

Extrapleural pneumonectomy (EPP): This is an extensive surgery that involves removal of the entire pleura (lining of the lung and chest wall) as well as the affected lung, diaphragm and pericardium (the membrane surrounding the heart). Lymph nodes are also removed from the chest. The diaphragm and pericardium are rebuilt with a sheet of artificial material.

Patients must be in good physical shape to undergo EPP. It has a higher risk of mortality and complications, but it provides a more complete removal of the tumor than pleurectomy/decortication.

Pleurectomy/decortication (P/D): P/D involves removal of the affected areas of the pleura, lymph glands, diaphragm and pericardium. Unlike EPP, the lung is not removed. The diaphragm is reconstructed with an artificial membrane. Because the lung remains in place, this surgery has fewer major complications than EPP. It is also safer for older patients and usually offers a higher quality of life. However, the tumor is more likely to return in the chest than with EPP.

Radiation therapy

Radiation therapy uses high energy beams to kill cancer cells. By itself, radiation therapy does not cure mesothelioma. It is typically used after surgery to kill any cancer cells the surgeon could not see with the naked eye. These cells are called microscopic residual disease.

Patients who get radiation after surgery usually receive intensity-modulated radiation therapy (IMRT). IMRT focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose.

In some cases, radiation may help relieve pain or discomfort. This is known as palliative radiation. Patients getting palliative radiation often undergo 3D conformal radiation therapy. This uses three-dimensional scans to determine the exact shape and size of the tumor. The radiation beams are shaped by tiny metal leaves that are arranged to fit the tumor dimensions, minimizing the side effects to healthy tissue. Learn more about radiation therapy.

Chemotherapy

Chemotherapy works by directly killing cancer cells. Chemotherapy is proven to prolong life in mesothelioma patients. It is the main treatment for mesothelioma patients who are not good candidates for surgery. For patients who are good surgical candidates, it is given before their procedure. Learn more about chemotherapy.

Targeted therapy

Targeted therapy works by stopping or slowing the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. Learn more about targeted therapy.

Immunotherapy

Cancer immunotherapy improves the immune system’s ability to eliminate cancer. There are several types of immunotherapies, and each helps the immune system in a different way.

Immune checkpoint therapy is an option for some patients with mesothelioma. This treatment helps cancer-fighting immune cells, called T cells, mount a longer-lasting response against the disease. Learn more about immunotherapy.

Clinical trials

As a top-ranked cancer center, MD Anderson conducts multiple mesothelioma clinical trials, many of which may not be offered anywhere else. Doctors only suggest a clinical trial if they believe it is the best treatment for the patient. MD Anderson's mesothelioma clinical trials cover all stages of the disease, including treatments for early-stage disease, mesothelioma that has spread to other parts of the body, and mesothelioma that has returned or recurred Learn more about clinical trials.

Our treatment approach

MD Anderson offers pioneering treatments for mesothelioma, some of which are available at only a few cancer centers in the nation. When we treat mesothelioma, we also focus on lung function and quality of life.

Doctors often suggest a clinical trial for mesothelioma treatment. Some of these are available only at MD Anderson. A clinical trial may include surgery, radiation therapy, immunotherapy, chemotherapy or a combination of different treatments.

If you have mesothelioma, your doctors will discuss the best treatment options based on your specific condition. This depends on several things, including:

• Type of mesothelioma
• Stage of disease
• Location of cancer
• Your age and general health

Mesothelioma treatment plans

Doctors consider two main factors when developing a mesothelioma treatment plan: The extent of the disease, including whether it has spread to other parts of the body; and the patient’s age and overall health.

If the cancer has not spread and the patient is fit enough, he or she may be a good candidate for surgery. Surgical candidates may undergo chemotherapy before the procedure to help shrink the tumor. After surgery, patients may receive radiation therapy to kill any cells that were not visible to the naked eye.

Because the disease is usually diagnosed in older individuals or can present in more advanced stages, many mesothelioma patients are not able to undergo surgery. Instead, they receive systemic therapies, such as chemotherapy or immunotherapy.

For other treatments, the care teams may recommend targeted therapies or clinical trials with new novel therapies.