The stage of mesothelioma is an important part of figuring out how to treat it. But other things, like the person's general health and preferences, as well as whether the doctor thinks the cancer is resectable (all visible cancer can be removed by surgery), also play a role.
In this article, we'll find out what is the best mesothelioma treatment?
Treatment for Mesothelioma
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| The best mesothelioma treatment: The full magic guide to treating all types |
Malignant mesothelioma can be treated with surgery, chemotherapy, radiation therapy, immunotherapy, and therapies that are specifically aimed at the cancer. Patients with mesothelioma can also get palliative care to ease their symptoms.
The best mesothelioma treatment
Mesothelioma is hard to treat, whether or not the cancer can be cut out. The best way to get treatment for mesothelioma is from a team of doctors who have dealt with it a lot. Before starting treatment, it's also important to know what the goal is, whether it's to try to cure the cancer or to help relieve symptoms, as well as what the benefits and risks might be. This can help you make a better choice about how to treat your condition.
Mesothelioma that can be cut out
Most stage I and some stage II and stage III pleural mesotheliomas can be removed, but there are some cases where this is not possible. Whether or not a tumor is resectable also depends on its subtype (most doctors don't think that resection helps sarcomatoid tumors), where it is in the body, how much it has spread into nearby tissues, and whether or not the person is healthy enough to have surgery.
Many people with resectable pleural mesothelioma have it removed by pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP). In early stages of cancer, when most or all of the cancer is more likely to be removed, surgery is more likely to help in the long run. EPP might be the best way to get rid of the cancer, but it is a long and complicated procedure that is more likely to cause problems, and not all patients can handle it.
Patients with early-stage peritoneal mesotheliomas might also benefit from surgery to remove as much of the cancer as possible. This can be used with heated intraperitoneal chemotherapy (HIPEC). After this treatment, some people feel better for a long time. (This means the cancer is under control and isn't getting worse or spreading.)
Some late-stage cancers may also be helped by surgery, but the effects are likely to be short-lived.
Imaging tests (like CT scans) done before surgery can sometimes lead the surgeon to believe that the cancer can be removed. However, once the surgery starts, it becomes clear that not all of the cancer can be removed. In these situations, the surgeon might switch to a less invasive procedure like P/D (which is easier to handle) or even stop the surgery if it doesn't look like it will help. The treatment would then be the same as for mesotheliomas that can't be cut out (see below).
Doctors are still looking into whether or not it is helpful to give chemotherapy (chemo) before surgery (called neoadjuvant therapy) or chemotherapy and/or radiation therapy after surgery (called adjuvant therapy). Not all doctors agree on how to use these treatments together in the most effective way. Some doctors would rather do chemotherapy before or after surgery. After surgery, radiation therapy could be used alone or with chemotherapy.
If you're not healthy enough to have a major surgery, you'll get the same treatment as people with mesothelioma that can't be cut out (discussed below).
If fluid builds up in your chest or belly and makes you sick, other methods like thoracentesis/paracentesis or pleurodesis may help. (Palliative procedures explain how to do these things.)
Because these cancers can be hard to treat, another option may be to take part in a clinical trial of a new and possibly better treatment. Most of the time, these kinds of studies are done in big medical centers.
Mesotheliomas that can't be cut out
Surgery can't remove all of a stage IV mesothelioma, and many earlier stages can't be removed either. This could be because of how bad the cancer is or what kind it is, or because the person isn't healthy enough to have surgery.
Most of the time, chemotherapy is the main way to treat these cancers. It might make the cancer less painful and slow or stop growing for a while. Chemotherapy is sometimes used with a drug for targeted therapy or a device that sends electric fields into the tumor. Some people may also be able to use immunotherapy. Even though these treatments may help people live longer, it's very unlikely that they will cure these cancers. Before you start treatment, you and your family should know what the goals of the treatment are.
If a person has an early-stage mesothelioma that is likely to grow slowly and isn't causing any symptoms, it may be a good idea to keep an eye on it at first. Then, treatment can begin if there are signs that the cancer is spreading quickly or if it starts to hurt.
Because these cancers can be hard to treat, it may be a good idea to take part in a clinical trial of a new way to treat them.
In many cases, treatment that focuses on getting rid of your symptoms and making you feel better is the best choice. This could include thoracentesis, paracentesis, or pleurodesis, which are all ways to stop or reduce fluid buildup in the body (described in palliative procedures). Pleurectomy/decortication can sometimes help with breathing and chest pain.
Another important part of care for these cancers is dealing with pain. Some small surgeries and types of radiation therapy can help ease pain. Doctors can also give you powerful painkillers. Some people with cancer are afraid to take opioid drugs like morphine because they don't want to be sleepy all the time or get hooked on them. But these medicines help a lot of people feel less pain without making them sick. It is very important to tell your cancer care team if you are in pain so that it can be treated.
Mesotheliomas that come back
When cancer comes back after treatment, this is called recurrent. Recurrence can happen close to where it started or in a different place (spread to organs such as the brain or liver). After the first treatment, mesotheliomas often come back. If this happens, there are different ways to treat the cancer depending on where it is, what treatments have already been done, and how healthy the person is overall.
Most of the time, the choices for mesotheliomas that can't be cut out will be similar to those above. Chemotherapy or radiation therapy, for example, could be used to try to shrink or slow the growth of the cancer and ease any symptoms. Because recurrent mesothelioma is hard to treat, clinical trials of new treatments may be a good idea. See Understanding Recurrence to find out more about how to deal with cancer that comes back.
How do you treat mesothelioma?
Mesothelioma can be treated with surgery, chemotherapy, radiation, and other tried-and-true and new methods. The American Society of Clinical Oncology makes the current recommendations for how to treat mesothelioma.
Surgery
Mesothelioma surgery is most helpful for people who are diagnosed early. It gives them the best chance of staying alive longer. These procedures take out chest tumors that can be seen.
Chemotherapy
Patients with mesothelioma who are not good candidates for surgery may be given chemotherapy instead. Chemotherapy can also help people live longer. Researchers found that combining chemo drugs can make people live longer.
Radiation
When surgery is not an option, radiation therapy is used to treat symptoms. It helps relieve pain and discomfort, like in the chest. When used with surgery, radiation can lower the chance of a local cancer coming back.
Multiple Therapies
With multimodality treatment, two or more mesothelioma treatments are used together. The growth of cancer can be stopped better with a combination of treatments than with just one.
Fields That Treat Tumors
Tumor Treating Fields uses electrical fields to disrupt and stop the growth of cancer cells. This treatment for pleural mesothelioma is done with adhesive pads that are attached to a portable battery device.
Immunotherapy
Immunotherapy drugs for mesothelioma help the body's immune system find cancer cells and kill them. Immunotherapy drugs like Keytruda and Bevacizumab use antibodies to stop the growth of tumors.
Treatments for Each Type of Mesothelioma
Surgery, chemotherapy, and radiation therapy are the main ways to treat pleural and peritoneal mesothelioma. These treatments can ease symptoms, make the prognosis better, and lengthen the time a person has to live.
The pros and cons of each choice depend on the type and stage of cancer. For example, the treatment of pleural mesothelioma with hyperthermic intrathoracic chemotherapy (HITHOC) is still being tested. The treatment of peritoneal mesothelioma with heated intraperitoneal chemotherapy (HIPEC) has worked very well.
1. Treatments for Pleural Mesothelioma
The pleura, which is the outer lining of the lungs, is affected by pleural mesothelioma. Nearly 75% of all cases of mesothelioma are in the pleura. Tumors in the pleura can be removed or shrunk by these methods. They can lessen symptoms and make life better.
Extrapleural Pneumonectomy (EPP): This surgery takes out the cancerous lung and parts of the lungs around it. Surgeons might take out lymph nodes, the linings of the chest and heart, and the diaphragm.
Pleurectomy Decortication (P/D): This procedure doesn't hurt the lung. In this surgery, tumors are taken out of the pleura, the lining of the chest, and the diaphragm. P/D is not as harsh as EPP.
Chemotherapy
Combination Chemotherapy: Pemetrexed (Alimta) and cisplatin are often given to people with mesothelioma. Chemotherapy drugs are used for the first time to treat mesothelioma in this first-line treatment. If the cancer comes back, gemcitabine (Gemzar) or carboplatin may be used as a second-line treatment.
Radiation
External Beam Radiation Therapy, or EBRT, is the most common way to treat mesothelioma with radiation. An outside machine sends X-ray beams to the cancer site to kill the cells there. EBRT can be used by doctors either before or during surgery.
Brachytherapy is an internal radiation therapy that kills nearby cancer cells by putting an implant in the body. Like EBRT, brachytherapy can be combined with other types of treatment.
2. Treatments for Peritoneal Mesothelioma
About 20% of people with mesothelioma have it in their peritoneum, which is the lining of the abdominal cavity. Surgery combined with heated chemotherapy is usually the best way to treat this type of cancer.
Surgery
The goal of cytoreductive surgery is to get rid of growths that are cancerous. Parts of the stomach, liver, intestines, and other organs that are affected are removed. A peritonectomy is a surgery in which cancerous parts of the peritoneum are cut out. Doctors often use both surgery and heated chemotherapy to treat mesothelioma.
Chemotherapy: Heated Intraperitoneal Chemotherapy (HIPEC): A 2022 study found that HIPEC is the best way to treat peritoneal mesothelioma. After surgery, doctors use a special pump and infusion machine to wash the inside of the abdomen with heated chemotherapy drugs. The HIPEC process kills any cancer cells that are still alive after surgery.
3. Treatments for Pericardial Mesothelioma
Pericardial mesothelioma is a rare form of the disease that has only been found in 1% of known cases. This cancer grows along the pericardium, which is the lining of the heart sac. Few treatments are available because many of them can also hurt the heart, which is close by.
Surgery
About half of people with pericarditis can have this surgery, which removes part or all of the pericardium. A pericardiectomy can stop the buildup of fluid and stop the heart from having to work harder than it needs to.
Chemotherapy
Pemetrexed and Cisplatin: The standard chemotherapy treatment for pleural mesothelioma has helped pericardial patients live longer. Gemcitabine and pembrolizumab, a new immunotherapy drug, have also shown to be helpful in some trials.
4. Treatments for Testicular Mesothelioma
Testicular mesothelioma is a type of cancer that spreads quickly and is very dangerous. The variant makes up less than 1% of all cases and can happen when peritoneal mesothelioma spreads to other parts of the body. With treatment, almost half of people with this type live for five years or longer.
Surgery: An orchiectomy is the only surgery option for over 98% of people with testicular mesothelioma. In this procedure, the cancerous testicle and the spermatic cord are taken out.
Chemotherapy
Pemetrexed and Cisplatin: The standard chemotherapy treatment for mesothelioma is a combination of pemetrexed and cisplatin. This is done after surgery to help kill any cancerous cells that are still alive. Chemotherapy after surgery has been shown to improve the outlook for people with mesothelioma.
Radiation: About 5% of people who have had surgery for testicular mesothelioma also get radiation therapy. Researchers are still trying to figure out how effective this treatment is, but radiation could help keep testicular mesothelioma from coming back after surgery.
Mesothelioma Palliative Care
Palliative care for mesothelioma focuses on controlling symptoms. As a form of supportive care, it can improve the quality of life and ease symptoms.
Thoracentesis
When there is too much fluid around the lungs, doctors use a long needle to get rid of it.
Catheter PleurX
This small drain is put in the chest by a surgeon to keep fluid from building up around the lungs.
Pleurodesis
With this surgery, the space in the pleura where fluid can build up is taken away. It may be harder to do than other choices
Radiation
Radiotherapy can shrink tumors, which can help relieve chest pain and other symptoms of cancer.
Paracentesis
Ascites is a buildup of fluid that is removed by putting a long needle into the abdomen. This lowers pressure in the abdomen in people with peritoneal cancer.
Pericardiocentesis
With this procedure, fluid and pressure are taken out of the sac around the heart.
Clinical trials and new medicines
In clinical trials, doctors test new treatments for mesothelioma to make sure they are safe and work.
The goal of clinical trials is to find a cure for mesothelioma or make people live longer if they already have it. At some point, these therapies that are still being tested could become the norm.
Mesothelioma Treatments on the Rise
Cryotherapy
Cryotherapy is a type of surgery that freezes cancer cells to kill them without cutting into the body. Tumors can shrink before surgery with this method. After surgery, it can be used to treat recurrences or control symptoms.
Genome editing
Cancer can be controlled by making changes to the DNA of cells and viruses. One way to kill cancer cells before they multiply is to fix the p53 gene.
Photodynamic Treatment
Laser light is used to turn on a special drug that kills cancer cells.
Virotherapy
Cancer can be treated with virotherapy, which uses viruses to find and kill cancer cells. Some ways to make the treatment work better use gene therapy or immunotherapy.
Eating well and taking care of yourself during mesothelioma treatment
It's important to eat well and take care of yourself. They can reduce side effects, improve the outlook for people with mesothelioma, and make people live longer. A full plan to treat mesothelioma includes all of these methods.
A. Diet & Nutrition
A dietitian's advice on what to eat can help you feel better and get better faster.
To keep their weight and energy up, patients should try to eat a balanced diet. Keeping a healthy weight before surgery can make it less likely that you will get an infection.
All cancer patients can benefit from eating foods that are high in protein and calories. You can get benefits before, during, and after treatment.
When muscles are hurt during surgery, protein helps them heal more quickly. When you eat more calories, your body has more energy to fix damaged cells and tissues.
Some treatments for mesothelioma can make it harder to eat. These problems can be solved in a number of ways, such as by eating certain foods and meals. Patients who want to buy vitamins or supplements over-the-counter should always talk to their doctor first.
B. Exercise & Fitness
Regular exercise can make you stronger and help you get better faster after treatment. Cancer doctors may suggest exercises to help patients feel less tired, get more hungry, and feel better overall.
Low-impact exercises that are safe and work well are:
Yoga\sWalking\sSwimming\sCycling
Stair climbs are a light way to build strength.
When doing any kind of exercise, people with pleural mesothelioma should be careful. For instance, cardio and upper body workouts can make it harder to breathe.
People who are having surgery or chemotherapy should talk to their doctor about when they can start exercising again. Safe workouts can include light activities that don't make tiredness worse.
C. Health of the mind
Mesothelioma cancer can be hard on a person's mental health in a big way. People who are actively getting treatment often have trouble with negative thoughts, depression, and anxiety. Focusing on self-care and being aware of your mental health can make your life better.
Patients with mesothelioma have a few ways to improve their mental health, such as:
- Groups for people with mesothelioma
- Counselors for mental health
- Therapy and exercise for the body
- A healthy diet that is well-balanced
- Care for the dying and pain relief
- Doctors, nurses, and caregivers can give you information about mental health. When someone is told they have mesothelioma, it can be hard on their emotions. Professional mental health care can help people sleep better and feel less anxious and sad.
Medicine that doesn't fit the mold
Some patients can benefit from using complementary therapies along with traditional medicine. They might ease pain or make people feel better. Before taking any supplement or alternative medicine, a patient should talk to their doctor.
TENS Therapy is a small device that can be used at home. It uses electrical stimulation on the skin to ease muscle pain.
Accupuncture & Massage
Thin needles are used to ease pain by stimulating nerves and muscles. A therapeutic massage can help reduce tiredness and stress.
Medical Some of the side effects of chemotherapy may be lessened by CBD and THC options in marijuana. They can help with things like nausea, vomiting, pain, and trouble sleeping.
Herbal Drugs
Botanical products may help with symptoms caused by cancer or its treatment. They may also make you healthier.
Therapies with energy
Music therapy, therapeutic touch, or reiki can help calm you down or relieve stress. Energy therapies don't work as a way to treat cancer.
Therapies for the mind and body
Hypnosis and biofeedback are mind-body therapies that may help reduce pain and discomfort. They include exercises for the mind and for the whole body.
How much does the treatment cost?
Malignant pleural mesothelioma costs about the same as lung cancer to treat on average. Treatments for lung cancer can cost $73,225 in the first year, according to the National Cancer Institute. Every situation is different, and so are the costs of therapy. Planning ahead for money can make payments easier to handle and lessen stress.
How Much Does Mesothelioma Treatment Cost on Average?
SURGERY
$30,096
A 2017 Harvard Medical School study found that a lung cancer patient could pay an average of $30,096 for the first surgery and $4,263 each month after that.
Chemotherapy costs $9,600 per month
A 2019 study compared the costs of chemotherapy at different stages of lung cancer. The study showed that the first month of chemotherapy could cost up to $9,600.
RADIATIONs $8,005
A 2019 study by the National Institutes of Health found that initial radiation treatment for lung cancer cost an average of $8,005. About $4,500 can be spent on repeat radiation.
How to Pay for Treatment for Mesothelioma
Many people with mesothelioma and their families have trouble coming up with the money for treatment. Out-of-pocket costs, caregiving, dealing with symptoms, and missed work can all add up to a lot of money spent on health care.
Even though many Americans rely on private health insurance to pay for treatment of serious illnesses, there are other ways to cover the cost of cancer treatment, such as federal programs and the law.
There are ways to pay for treatment:
- What the government does
- Social Security Disability Insurance, Supplemental Security Income, and VA services are all types of government help.
- Help for Charity
- Hospitals, non-profit groups, and social workers can help you find money-saving options like free travel and lodging.
- Clinical Trials
- People who take part in clinical trials pay for regular care. The experimental treatments are paid for by the sponsor of the trial.
- Filing a Legal Claim
- Patients and their loved ones can file a claim in court to get money. The reward helps pay for lost wages, medical bills, and other costs.