Mesothelioma Treatment
UT 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 UT 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 factors, including:
- Type of mesothelioma
- Stage of disease
- Location of cancer
- Your age and general health
Mesothelioma treatment plans
In most cases, cancer drugs like chemotherapy and immunotherapy are the first treatment for mesothelioma.
Recent data suggests that most patients may not benefit from surgery. Only patients who have a small amount of disease are surgical candidates. These patients also receive other treatments such as chemotherapy.
Radiation therapy is an option when mesothelioma has spread to just a few spots in the body. It is also used to help relieve symptoms of the disease.
Surgery
Surgery is used to treat mesothelioma only in limited cases. Because of the way mesothelioma grows, it is usually not possible to remove every cancer cell, so the goal of surgery is usually not to cure the disease.
Instead, reducing the amount of cancer in the body can slow the disease’s progress. Patients can then receive additional treatments, such as radiation therapy, chemotherapy and immunotherapy.
Mesothelioma surgery can also be used to relieve symptoms like pain and shortness of breath.
The two main surgeries for mesothelioma are pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP).
Pleurectomy/decortication
P/D involves removal of the parts of the pleura, lymph glands, diaphragm and pericardium that are impacted by cancer. 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.
Getting pleurectomy/decortication
P/D is performed under general anesthesia. It is an inpatient surgery and usually requires five to seven nights in the hospital. The procedure itself usually takes around six hours.
Extrapleural pneumonectomy (EPP)
EPP is an option only when the patient meets specific criteria. It is an extensive surgery that involves removal of several structures, including:
- The entire pleura (lining of the lung and chest wall)
- The affected lung
- The diaphragm and the membrane surrounding the heart
- Lymph nodes in 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 may provide a more complete removal of the tumor than pleurectomy/decortication.
Getting an extrapleural pneumonectomy
EPPs are done under general anesthesia and usually take around six hours. Patients usually spend five to seven nights in the hospital.
Recovering from mesothelioma surgery
After surgery, mesothelioma patients should start walking as soon as they can do so safely. This can help speed up their recovery time.
Patients can do routine tasks like cooking or shopping as soon as they feel able, though they often need a few days to recover after surgery.
If the patient works a desk job, they usually need three to four weeks of recovery time before returning to work.
For patients whose job involves physical labor, the return to work is usually two to three months after surgery and they should start with light-duty tasks.
Radiation therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors use these to accurately target a tumor while limiting damage to healthy tissue.
Radiation therapy can be part of a plan to cure mesothelioma cancer. It can also be used to manage advanced disease and help relieve symptoms.
Intensity modulated radiation therapy
Intensity modulated radiation therapy (IMRT) focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose. Volumetric modulated arc therapy (VMAT) is a type of IMRT that utilizes a rotating treatment machine to deliver radiation at multiple angles.
Mesothelioma patients getting IMRT typically receive treatment Monday through Friday for five to six weeks. Each session lasts around 30 minutes.
Stereotactic body radiation therapy
Stereotactic body radiation therapy (SBRT) uses dozens of tiny radiation beams delivered at different angles to accurately target tumors with a high dose of radiation.
This treatment can be used to control mesothelioma that has developed just a few distant metastatic tumors.
Patients typically get one to five sessions, all in consecutive days. In most cases, each session takes under 45 minutes.
Radiation therapy side effects often depend on the location of the tumor and the exact treatment the patient receives.
Radiation therapy side effects
Short term side effects include:
- Fatigue
- Cough
- Nausea
- A narrowing of the esophagus, which can cause swallowing problems
- Irritation or inflammation of lung tissue
Long term radiation therapy side effects:
- Scarring of the lung tissue
- Heart damage
- Pain in the chest wall
- Rib fractures
- Kidney dysfunction
Doctors design radiation treatment plans to prevent or limit these problems and will recommend radiation only when it is the best treatment for the patient.
Patients should talk to their care team about any side effects they experience. These side effects can often be managed with treatment.
Immune checkpoint inhibitors
Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is completely eliminated. Patients may receive a single immunotherapy drug or multiple drugs in combination.
Immune checkpoint inhibitors are a treatment for mesothelioma that can’t be removed surgically. They are also used to help control the disease in patients with more advanced cancer.
Getting immune checkpoint inhibitors
Mesothelioma patients get these drugs through IV. Infusions are given every two to three weeks for up to two years. Sessions usually last under an hour.
Immune checkpoint inhibitor side effects
The short-term side effects of immune checkpoint inhibitors can include fatigue, rash, diarrhea and joint pain.
Long-term side effects can include endocrine system problems, inflammation of the lung tissue and hepatitis.
The side effects can usually be managed with medication or other interventions. Patients should talk to their care teams about any side effects they experience.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Chemotherapy is a standard therapy for mesothelioma. It can be used on its own or in combination with other treatments, including before or after surgery. It can also be used to control symptoms in patients with advanced disease.
Getting chemotherapy
Chemotherapy for mesothelioma is delivered through an IV infusion. Patients get one infusion every three weeks and four to six total infusions. Each session generally lasts one to three hours.
Chemotherapy side effects
Short-term side effects include:
- Nausea and vomiting
- Fatigue
- Low blood counts
- Mouth sores
Long-term side effects of chemotherapy include:
- Neuropathy, which can cause pain, tingling or numbness in different parts of the body
- Damage to ear tissue, which can cause hearing and balance problems
- Kidney damage
These side effects can typically be managed with medications and other interventions. Patients should talk to their care team about any side effects they experience.
Clinical trials
UT MD Anderson's clinical trials cover all stages of mesothelioma, including treatments for early-stage disease, mesothelioma that has spread to other parts of the body, and mesothelioma that has returned or recurred.
UT MD Anderson mesothelioma patients can get treatment at the following locations.
Asbestos exposure and cancer: 8 things to know
Most cases of mesothelioma are caused by exposure to a substance called asbestos. This rare cancer develops in the mesothelial cells, the thin layer of tissue that lines the chest cavity and is also known as the pleura.
But what is asbestos? How might you be exposed to it? And, is there anything you should do to lower your risk of developing asbestos-related cancers?
We spoke with , vice president and head of Cancer Prevention and Population Sciences. He’s what he shared.??
What is asbestos, and how might the average person be exposed to it?
Asbestos is a group of six naturally occurring mineral fibers that have special properties, such as being fire resistant and good insulators. They are found in certain types of rock and extracted through mining. Their names are:
- Actinolite?
- Amosite?
- Anthophyllite?
- Chrysotile?
- Crocidolite
- Tremolite
Until the 1970s, asbestos was used a lot in manufacturing. It could be found in everything from roof shingles and brake pads to flooring and insulation. Once asbestos was identified as a carcinogen, though, government agencies stepped in to start limiting its use. They also developed strict protocols on how materials containing asbestos could be handled, removed and disposed of.
Asbestos exposure is not considered as much of an issue today because its use has declined so much in the past 50 years.?
Is there anything I should do to reduce my risk of asbestos exposure?
For the most part, no. Asbestos finds its way inside our bodies primarily through respiration. In other words, we breathe in the fibers and dust when we’re exposed to ore or other materials containing asbestos, and they get caught inside our lungs.
Small amounts of asbestos are still used in some products and industries today. But the average person probably won’t encounter it in high enough concentrations to increase their risk of developing a related cancer.?
Prolonged, repeated exposure to asbestos is required for cancer to become an issue. That’s why people who lived or worked close to Ground Zero after the 9/11 World Trade Center attacks are at increased risk. And, anyone involved in the renovation or demolition of older residential or commercial structures could also be exposed to asbestos.
But unless you’re a miner, auto mechanic, roofer or construction laborer who worked in those industries mostly before about 1970, your risk is pretty low.
Which cancers are caused by asbestos exposure??
Mesothelioma is by far the most common. But asbestos exposure has also been linked to lung cancer, laryngeal cancer, ovarian cancer and even some gastrointestinal cancers.?
Interestingly, asbestos was a factor in the recent lawsuits linking talcum powder to ovarian cancer, too. I’ve often wondered how something that's primarily inhaled can get so far inside the body. Maybe that connection will someday become clearer.
Are there any warning signs or symptoms of asbestos exposure?
No. That’s one of the challenges. There weren’t any screening tests to look for asbestos-related cancers in otherwise healthy individuals back in the 1970s. There still aren’t today. That’s why these cancers tend to be found in more advanced stages.?
How are asbestos-related cancers usually diagnosed?
Mesothelioma and lung cancers caused by asbestos exposure are normally diagnosed with a chest X-ray in someone who complains of shortness of breath, trouble breathing, persistent coughing or other symptoms.
Why does asbestos exposure cause cancer?
There are currently three theories:
- Chronic inflammation
- Changes in cell signaling, or how our cells communicate with one another
- Free radicals, or highly unstable oxygen molecules that can damage cell DNA?
But none of these offers a really satisfying explanation. So, it’s still a bit of a mystery.?
Are there any unique features to help identify asbestos-related cancers?
No. I’ve seen reports that researchers are exploring potential blood markers. But it’s all still very experimental, so there’s nothing definitive yet. And, there are no distinctive, signature mutations related to asbestos exposure that I know of.
Even when we find actual asbestos particles in a biopsy specimen and can infer that it played a major part in causing a cancer, it doesn’t really influence treatment, as there is no treatment tailored to it.
What’s the most important thing to know about asbestos and cancer?
This is one instance in which government regulation has been really helpful. There’s always a bit of second-guessing involved at the beginning of that process, when you wonder, “Are we overdoing this?”
But there’s no doubt now that asbestos regulation has significantly decreased the incidence of all exposure-related diseases, including cancer. Recognizing the link between asbestos and cancer — and then acting on it by removing the source of exposure — has proven to be a highly effective prevention strategy.
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