A form of cancer caused by exposure to asbestos fibres, mesothelioma is often difficult to diagnose and treat because symptoms only tend to appear after many years, by which time the condition has become advanced.
Nevertheless, there are a number of treatments which doctors can prescribe to patients in order to lengthen and improve their quality of life. This guide explores the treatment of the most common type of mesothelioma – pleural, which affects the membrane lining of the lungs.
To compliment this article, also view our guide titled Understanding the Types of Mesothelioma and their Symptoms.
Primary Treatments for Pleural Mesothelioma
Bear in mind that the treatments prescribed to you by your oncology specialist will depend on the stage of your cancer (how far it has progressed), any existing medical conditions and your fitness level in general.
Chemotherapy for mesothelioma entails taking anti-cancer drugs that are injected into your vein. Whether you will need treatment weekly or every 2 to 3 weeks will depend on the type of chemotherapy drugs used.
If you have early stage mesothelioma, chemotherapy may be prescribed before surgery (neoadjuvant chemotherapy) to shrink the tumour so that it is easier to remove. Alternatively you may undergo treatment after surgery (adjuvant chemotherapy) with the aim of delaying the cancer from returning for as long as possible.
If you suffer from more advanced mesothelioma, chemotherapy may be successful at shrinking cancerous tumours, slowing their growth and reducing symptoms to improve your quality of life. Research has shown that chemotherapy can help some people live weeks or months longer.
Radiotherapy, the use of high-energy rays, is another common prescription for cancer patients because it has been proven to slow the growth of tumours and reduce the symptoms for people suffering from advanced mesothelioma.
How long your radiotherapy treatment will be prescribed for will depend on the type and size of your pleural mesothelioma.
Sometimes, patients will need to have fluid drained from around their lungs before radiotherapy treatment – the reason for this is to stop new mesothelioma growths developing in the scar tissue on the chest wall.
If you have early stage mesothelioma (stage 1), your specialist may prescribe treatment after surgery (adjuvant radiotherapy) to delay the cancer from returning for as long as possible.
Commonly, people with early stage mesothelioma have surgery to remove as much tumour as possible and hopefully increase the effectiveness of complimentary treatments such as chemotherapy. In advanced cases, surgery can often slow the growth of tumours and relieve a patient’s symptoms (also called palliative surgery or debulking).
There are 2 main types of operation to remove localised pleural mesothelioma tumours:
1 – Pleurectomy
Also called decortication, this surgery entails removing the pleura (membrane) from around the lung, while the lung itself is left intact. The pleural space around the lung is treated to prevent further fluid collecting there.
2 – Extrapleural Pneumonectomy (EPP)
This is a serious and extensive operation, which is only possible for people with early stage mesothelioma that are otherwise in good shape. The aim is to prolong their life span when combined with chemotherapy and radiotherapy.
The term pneumonectomy means removal of the entire lung, while extrapleural entails removal of the pleura, diaphragm and the covering of the heart (pericardium) on the side affected by mesothelioma.
According to Cancer Research, the medical profession are currently no longer recommending EPP, since a small study concluded that the risks outweigh the benefits – there are many side effects involved and recovery takes many months
Because mesothelioma is frequently only diagnosed when it is advanced, some people may already be too ill for the more aggressive treatments of chemotherapy, radiotherapy and surgery. Nevertheless, the medical profession have developed palliative treatments to control the symptoms of advanced cancer such as breathing problems, pain and weight loss.
Palliative treatments include:
• Physiotherapy and dietician guidance.
• Thoracocentesis (otherwise called a pleural tap) which drains excess fluid that collects around the lungs.
• Pleurodesis which involves sterile talc used to seal the pleural space and prevent fluid from collecting. A doctor performs the procedure either by draining the chest or inserting a tube into the area through a small cut in the chest wall (i.e. a type of keyhole surgery called video assisted thoracoscopy).
• Indwelling catheter – this is prescribed if the lung cannot expand fully after fluid drainage. Your doctor will then insert a tube that continuously drains fluid from your chest for a few weeks while you rest at home.
The effectiveness and aggressiveness of treatments for mesothelioma vary depending on how advanced the cancer is by the time it is diagnosed, so it’s highly important to have regular check-ups if you’ve ever been exposed to asbestos materials. Also bear in mind that the medical profession continues to work on improving mesothelioma treatment, and sometimes patients may be able to take advantage of clinical trials – if this interests you, visit www.cancerresearchuk.org/about-cancer/trials.