Malignant Mesothelioma Treatment

Patients with malignant mesothelioma have several treatment options, but they aren’t considered curative.

Malignant mesothelioma, or just mesothelioma, is a very sneaky cancer. Usually deadly, this cancer has few symptoms — shortness of breath, maybe a dry cough — in its early stages. By the time a patient sees a doctor about his symptoms, the disease is often well advanced.

Bartolome R. Celli, MD, chief of pulmonary care at St. Elizabeth’s Medical Center in Boston, says that while some more “aggressive” medical hubs in the United States operate on mesothelioma patients, most patients are diagnosed too late for anything but palliative care designed to make them more comfortable. “Most patients will get supportive and comfort measures because the disease is too advanced,” says Dr. Celli.

That doesn’t mean that all patients face an immediately grim future. If the patient is young and the mesothelioma has not yet spread into the lymph nodes, then there is a good chance that the patient will still be alive in five years, says Neil Schachter, MD, medical director of respiratory care and professor of pulmonary medicine at the Mount Sinai Medical Center in New York City.

Malignant Mesothelioma: Treatment Options

Treatments for most cancers depend on many factors, like how far the cancer has spread, where the cancer is located, how old the patient is, and what he wants. Treatment for mesothelioma is no different.

The standard mesothelioma treatment options range from surgery to radiation therapy and chemotherapy — or a combination of all three — depending on a patient’s age and health condition.

The treatment plan that increases life expectancy is surgery first, along with chemotherapy and radiation, says Dr. Schachter. But again, this depends on the person’s situation.

Standard treatments for malignant mesothelioma include:

  • Surgery. This is performed to remove part of the chest or abdomen lining, a lung, and even some of the diaphragm.
  • Targeted radiation. “Mesothelioma is radiation-sensitive, so radiotherapy is also used for this,” says Schachter. “In some cases, you can shrink the tumor, improve quality of life, and possibly prolong survival with radiation. And radiation is often used in combination with surgery because with the lung removed, it’s easier to radiate the chest.”
  • Intravenous chemotherapy. The two drugs most commonly used for mesothelioma are cisplatin (Platinol) and pemetrexed (Alimta), Schachter says. “Given together, they seem to give the best results.”

Malignant Mesothelioma: Surgery

The main type of surgery for mesothelioma is called extrapleural pneumonectomy. This involves taking out the lung on the side that has the mesothelioma, along with some surrounding tissues, Schachter says.

“That’s major surgery,” he continues. Sometimes, part of the diaphragm on that side is also taken, but that happens primarily if the patient is under age 55 when he is diagnosed, or if there is no evidence that the cancer has spread into local lymph nodes. “Then, your chances of responding to surgery are better.”

And if surgery is out of the question? “Chemotherapy is the next best bet for primary therapy,” says Schachter.

Malignant Mesothelioma: Choosing Treatment Options

Choosing treatment is very individualized and should be done in consultation with a patient’s primary physician and oncologist.

But Schachter says the choice is often up to surgeons. “Obviously, patients have to make up their minds whether they want to go through this. But not everybody is a good candidate for these kinds of treatments.”

Patients may want to consider contacting experienced, large cancer centers for their malignant mesothelioma treatment. These places often offer patients better survival rates than hospitals that do not see many patients with the condition.

What Is Mesothelioma?

Mesothelioma caused by asbestos exposure may prove to be a public health crisis as more people are diagnosed with this rare form of cancer.

Mesothelioma, also called malignant mesothelioma, is a rare but deadly form of cancer that typically occurs in the membrane around the lungs, called the pleura. This type of cancer is usually the result of inhaling asbestos fibers over a long period of time. Most people with mesothelioma, were exposed to asbestos at work, such as in a shipyard, an asbestos mine, an automotive plant, or at a construction site.

Mesothelioma: What Is It?

The mesothelium is the generic term used to describe the lining that covers many organs and body cavities. Mesothelial tissue helps to protect organs and minimize trauma during movement. In addition to the pleura, other mesothelia include:

  1. The peritoneum, which covers the walls of the abdominal cavity
  2. The pericardium, which encases the heart
  3. The tunica vaginalis testis, which covers the male internal reproductive organs
  4. The tunica serosa uteri, which covers the female internal reproductive organs

Mesothelioma can affect any of these mesothelial tissues, though the pleura is by far the most common site.

Mesothelioma: The Asbestos Risk Factor

When asbestos fibers are inhaled into the lungs, they tend to remain there, and with continuous long-term exposure, the fibers begin to collect at the bottom of the lungs, where they become trapped in the pleura. Over time, this can lead to cancer, especially if there are other aggravating factors like a genetic predisposition or a history of smoking.

“Asbestos irritates the lining of the lung and causes inflammation, and then the inflammatory response and the secondary changes in the lungs and pleural space may eventually lead to a malignant degeneration,” explains Timothy Winton, MD, associate professor of surgery and division director of thoracic surgery at the University of Alberta Hospital in Edmonton, Canada.

One of the most striking things about mesothelioma is how long it takes for the disease to develop: Up to five decades may elapse from initial asbestosexposure to the development of cancer. But when mesothelioma finally develops, it often becomes very aggressive and can spread beyond the pleura to other mesothelial tissues. The average survival time for malignant mesothelioma ranges between four and 18 months, and about 10 percent of patient live at least five years after being diagnosed. In rare cases of slow-growing mesothelioma, survival can extend to 20 years.

Mesothelioma: A Public Health Issue

Mesothelioma is a rare disease — only 2,000 to 3,000 new cases are diagnosed each year in the United States. However, in other countries, the incidence of mesothelioma continues to increase.

“Because of the history of the use of asbestos and the known long latency between exposure and development of disease, the incidence of this type of disease around the world is going to continue to go up through the next two to three decades,” Dr. Winton says. “There are a lot of workers around the world who were exposed in an industrial setting and who need to be carefully followed.”

If you think you have been exposed to asbestos, let your doctor know and make sure you get regular checkups. As with most cancers, early diagnosis is important to treating this disease.