Treatments for mesothelioma
If you have mesothelioma, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for mesothelioma, your healthcare team will consider:
- where the mesothelioma started
- the subtype of mesothelioma
- whether it can be removed by surgery
- your overall health
- your personal preferences
You may be offered one or more of the following treatments for mesothelioma.
Surgery may be offered for mesothelioma if it can be removed and you are healthy enough to have surgery.
The following types of surgery are used for pleural mesothelioma.
Extrapleural pneumonectomy removes the parietal and visceral pleura, the lung on the side where the mesothelioma started, part of the diaphragm and the lymph nodes in the chest. The sac surrounding the heart (pericardium) may also be removed.
Pleurectomy and decortication removes both the parietal pleura and the visceral pleura, along with the mesothelioma. The lung is not removed.
Palliative surgeries are used to relieve symptoms, such as pain or difficulty breathing.
- Debulking surgery removes as much of the mesothelioma as possible, but not as much as a pleurectomy and decortication.
- Thoracentesis drains fluid from around the lungs.
- Pleurodesis seals the parietal pleura and visceral pleura together to stop fluid building up between them.
Surgery is usually not possible for people with peritoneal mesothelioma because the cancer has usually spread too much for it to be completely removed. Surgery is often used to relieve symptoms caused by peritoneal mesothelioma. The following types of surgery may be offered.
Debulking surgery removes all or as much of the mesothelioma as possible. The lining of the abdomen (peritoneum) and the fatty layer of tissue that covers the organs in the abdomen (the omentum) are removed. Other tissues and organs may need to be removed, such as part of the bowel, the gallbladder or the appendix.
Paracentesis drains fluid that has built up in the abdomen (ascites). A hollow needle or tube (catheter) is used to drain the fluid from the abdominal cavity.
Most people with mesothelioma will have chemotherapy.
Chemotherapy for pleural mesothelioma is used after surgery or as the main treatment if surgery can’t be done.
The most common chemotherapy drug combinations used to treat pleural mesothelioma are:
- cisplatin and pemetrexed (Alimta)
- cisplatin and raltitrexed (Tomudex)
- pemetrexed and carboplatin (Paraplatin, Paraplatin AQ) – may be offered to people who have other health problems and can’t be given cisplatin
- cisplatin and gemcitabine (Gemzar)
The most common chemotherapy drugs used alone to treat mesothelioma are:
- vinorelbine (Navelbine)
Chemotherapy for peritoneal mesothelioma is given as a regional therapy, which means that it is put directly into the peritoneal cavity. This is called intraperitoneal chemotherapy.
The most common chemotherapy drugs used for intraperitoneal chemotherapy of peritoneal mesothelioma are:
- mitomycin (Mutamycin)
- doxorubicin (Adriamycin)
External beam radiation therapy is used to treat mesothelioma.
Radiation therapy may be offered after an extrapleural pneumonectomy on the side of the chest where the lung was removed. It is not offered after a pleurectomy and decortication as the lung could be damaged by radiation.
Radiation therapy may also be used to relieve symptoms caused by pleural mesothelioma, such as a cough or shortness of breath.
Radiation therapy is not used as the main treatment for peritoneal mesothelioma as the organs in the abdomen are sensitive to the effects of radiation. It may be used to relieve pain and other symptoms caused by advanced peritoneal mesothelioma.
If you can’t have or don’t want cancer treatment
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment. Follow-up for mesothelioma depends on the treatments you had for mesothelioma and on your overall health.
There may be a clinical trial in Canada open to people with mesothelioma. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.