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This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options.
In cancer care, different types of doctors often work together to create a patient's overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.
Descriptions of the most common treatment options for both plural and peritoneal mesothelioma are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient's preferences and overall health.
Surgery is the removal of the tumor and surrounding tissue during an operation.
A surgical oncologist is a doctor who specializes in treating cancer using surgery. The type of surgery for mesothelioma depends on the stage and location of the cancer.
Pleural mesothelioma. For patients with pleural mesothelioma, the surgeon may remove the affected lining around the lung in a procedure called a pleurectomy. Generally, the tumor cannot be completely removed with this procedure. A more aggressive surgery for pleural mesothelioma is called an extrapleural pneumonectomy. This is the removal of the lining of the lung, the entire lung, a portion of the diaphragm, and often a portion of the lining around the heart. This is a difficult surgery and is recommended only after the doctor has reviewed many factors, including the patient's overall health and the stage of the disease. If the entire tumor cannot be removed, other treatments such as radiation therapy or chemotherapy may be recommended.
Peritoneal mesothelioma. Patients with peritoneal mesothelioma may often have a surgery called a peritonectomy, which is the removal of the lining around the abdominal organs. Since patients with peritoneal mesothelioma often have tumors throughout the entire abdomen, it is difficult to remove all of them. The goal of surgery is to leave behind tumors that are as small as possible. After surgery, chemotherapy is often placed directly into the abdominal cavity, called intraperitoneal chemotherapy.
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.
Side effects from radiation therapy include tiredness, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Pleural mesothelioma. It is challenging to treat pleural mesothelioma with radiation therapy because of the risk of damaging the lung. When one of the two lungs has been surgically removed, radiation therapy is often given to the chest cavity to lower the risk of the mesothelioma returning in the chest. For some patients, radiation therapy may be given to a smaller area to help relieve symptoms, such as pain.
Peritoneal mesothelioma. For patients with peritoneal mesothelioma, radiation therapy can be used to treat the entire abdomen, but this often causes severe side effects and is not commonly done.
Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells' ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.
Pleural mesothelioma. The chemotherapy treatment best studied in mesothelioma is the combination of pemetrexed (Alimta) and cisplatin (Platinol) or carboplatin (Paraplatin). These medications are given intravenously (by vein) every three weeks. The most common side effects include, but are not limited to, fatigue, nausea, vomiting, damage to the kidneys, numbness and tingling in the fingers or toes, decreased hearing, rash, low white blood count that increases the risk infection, or anemia. Patients receiving this treatment are given the vitamins B12 and folic acid to decrease the risk of these side effects. Other medications, such as antinausea medications, are also available to relieve many of these side effects.
Peritoneal mesothelioma. As mentioned in the surgery section (above), chemotherapy is often given directly into the abdominal cavity after surgery. Intravenous chemotherapy is also used. Just as with pleural mesothelioma, the combination of pemetrexed (Alimta) with cisplatin (Platinol) or carboplatin (Paraplat, Paraplatin) are most often used for treatment.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person's symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.
Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Examples of palliative care for mesothelioma include draining fluid that has built up in the patient's chest or abdomen or using radiation therapy or chemotherapy to relieve symptoms.
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.
A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. It's important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.
People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope.
If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan.
For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
If treatment fails
Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.
This diagnosis is stressful and difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.
Palliative care given toward the end of a person's life is called hospice care. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families.
Coping with Side Effects
Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.
Common side effects from each treatment option for mesothelioma are described in detail within the Treatment section. Side effects depend on a variety of factors, including the cancer's stage, the length and dosage of treatment(s), and your overall health.
Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with mesothelioma.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies.
During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care.
After treatment for mesothelioma ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.
People treated for mesothelioma are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, and eating a balanced diet. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level.
Doctors are working to learn more about mesothelioma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.
New treatment approaches. Researchers are evaluating new treatments for mesothelioma, including several promising new drugs, gene therapy, and immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function.
Genetic research. Research is underway to identify genes that become mutated (changed) that may cause mesothelioma. Other studies aim to find blood markers (a substance found in higher than normal amounts in the blood of someone with cancer) that could help detect early-stage mesothelioma.
Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current mesothelioma treatments in order to improve patients' comfort and quality of life.