Treatment Options for Mesothelioma : An Overview

Mesothelioma is a type of cancer that affects the mesothelial cells that can be found in the lining of the outer surface of many organs. This aggressive and rare form of cancer typically occurs due to exposure to asbestos and it tends to most commonly affect the pleura. The pleura is the tissue that lines the lungs. More rarely, though, it can also affect the abdomen, the heart, and the testicles. While there is no cure for mesothelioma, there are certain treatments that can help in the management of symptoms and also improve the overall quality of life. Read on to find out more about the current treatment options for mesothelioma, which include chemotherapy, radiation therapy, and surgery.

Mesothelioma is a very rare and aggressive type of cancer that affects the mesothelial cells, which can be found in the lining that covers the outer part of some of the body’s organs. It is so rare that every year it is estimated only about 3000 new diagnoses of mesothelioma take place in the United States alone. ^(1,2,3)

There are four types of mesothelioma, with pleural mesothelioma being the most common form. Pleural mesothelioma affects the pleura, which is the lining covering the outside of the lungs. The second most common type of mesothelioma is peritoneal mesothelioma, which affects the lining of the abdomen known as the peritoneum. The two rarest types of mesothelioma are pericardial mesothelioma which affects the protective layer of the heart known as the pericardium, and testicular mesothelioma which attacks the testicles.

It is estimated that mesothelioma usually takes around 30 to 45 years to develop and start showing symptoms. While some people can start experiencing the symptoms after ten years, others can remain asymptomatic for almost 50 years. The length of time depends on many factors, most importantly the intensity of the asbestos exposure. Individual factors and genetics also play a role. Since it takes so long to cause symptoms, mesothelioma tends to go undiagnosed until it reaches a fairly advanced stage. In fact, studies have shown that the average age of diagnosis of pleural mesothelioma is around 72 years. ^(4,5,6,7)

Since mesothelioma is an aggressive form of cancer, and diagnosing this form of cancer usually takes so long that the cancer already reaches an advanced stage, it is unfortunate that 35 percent of patients with mesothelioma end up passing away within a year after their diagnosis. ⁽⁸⁾

The exact treatment for mesothelioma depends on many factors, including the stage at which your cancer is diagnosed, the part of the body where the cancer is located, the patient’s age, and overall health. As mentioned above, mesothelioma is an aggressive form of cancer and the diagnosis usually happens at a late and advanced stage by when the cancer has already spread. In most cases, by this stage, surgery is not an option and treatments focus more on options like chemotherapy or radiation therapy, but these may also cause a lot of severe side effects. Sometimes, though, in serious cases, the only treatment option might be to manage the pain and other symptoms and keep the patient as comfortable as possible. ^(9,10)

Let us look at some of the potential treatment options for mesothelioma.

There are different types of treatments available for mesothelioma. Some treatments are conventional, while some are still being tested in clinical trials. There are typically three main types of treatment options currently being used for mesothelioma, with the first one being surgical intervention.

If your mesothelioma is diagnosed at an early stage, it is possible to use surgical intervention to even cure the cancer. Here are some of the surgical treatments used for mesothelioma:

• Wide local excision: Surgery by making a wide local excision is used to remove the cancer and also some of the healthy tissue around the tumor. ⁽¹¹⁾
• Decortication and Pleurectomy: This is a surgical technique that removes some parts of the covering of the lungs and also the lining of the chest. Surgery also removes some parts of the outer surface of the lungs. While this procedure does not cure mesothelioma, but it does help in relieving some of the signs and symptoms of the cancer. ^(12,13)
• Extrapleural pneumonectomy: This surgical technique removes one entire lung and also part of the lining of the diaphragm, the chest, as well as the lining of the sac around the heart. This is usually done in more advanced stages of mesothelioma. Removing the affected lung and the surrounding tissue can help alleviate the signs and symptoms of pleural mesothelioma. You might be prescribed radiation therapy to the chest after the surgery. This makes it possible for doctors to use higher doses of radiation as they no longer have to worry about protecting the lung from the damaging effects of radiation therapy. ^(14,15)
• Pleurodesis: This is a surgical procedure that makes use of drugs or chemicals to create a scar in the space that is present between the layers of the pleura. Fluid is first drained out from this space using a chest tube or catheter and the drug or chemical is inserted into the space. This scarring helps stop the accumulation of fluid in the pleural cavity, which is a common symptom of pleural mesothelioma. ^(16,17)

Surgery is sometimes also used for peritoneal mesothelioma to remove as much of the cancerous tissue as possible. After or before the surgery, chemotherapy is usually used. ⁽¹⁸⁾

Once the doctor has removed all the cancer that is visible at the time of the surgery, some patients are then administered chemotherapy or radiation therapy to kill any cancerous cells that might be left over. A type of treatment known as adjuvant therapy is administered after the surgery to reduce the risk of the cancer coming back. ⁽¹⁹⁾

Another form of treatment for mesothelioma is radiation therapy. Radiation therapy makes use of high-energy x-rays or other such particles to kill the cancer cells. Radiation therapy is administered by a doctor who specializes in this field and is known as a radiation oncologist. The most common type of radiation therapy for mesothelioma is known as external beam radiation. In this type of therapy, radiation is given from a machine outside the body. ⁽²⁰⁾

Radiation therapy is given as per a regimen or schedule and it typically consists of a certain number of treatments that are given over a pre-decided period of time.

It is challenging to treat pleural mesothelioma with radiation therapy since there is a risk of causing damage to the lung. If one of the two lungs gets removed surgically, radiation therapy is usually given to the chest cavity itself to reduce the risk of the cancer returning to the chest area. This approach is commonly used after an extrapleural pneumonectomy. However, in some patients, radiation therapy might be administered to a lesser area just to provide supportive care to help alleviate the symptoms such as pain. ⁽²¹⁾

In peritoneal mesothelioma, if radiation therapy is administered to the whole abdomen, it can cause a lot of severe side effects, which is why no doctor prefers to do this. If a patient is experiencing pain in a certain area, radiation therapy is usually provided as supportive care to help alleviate the pain. ⁽²²⁾

As mentioned, radiation therapy can have several side effects. Some of the common side effects of radiation therapy include:

• Fatigue
• Mild skin reactions
• Loose bowel movements
• Upset stomach

Most of these side effects tend to disappear once the therapy is completed.

The most common type of treatment used for mesothelioma is chemotherapy. In treating this form of aggressive cancer, chemotherapy is usually combined with other treatments as well. Chemotherapy works by preventing the cancerous cells in the body from multiplying, growing, and from reproducing to make more cells.

Your oncologist will come up with a regimen or schedule for your chemotherapy course. It generally consists of a certain number of cycles that have to be completed within a set period of time. A patient might receive only one drug at a given time or they may be administered a combination of different drugs that are all administered at the same time. ^(23,24)

For pleural mesothelioma, the recommended course of chemotherapy treatment is a combination of Platinol (cisplatin) or Paraplatin (carboplatin) and Alimta (pemetrexed). These drugs are administered once every three weeks, with each three-week period known as a cycle. Patients may need to take four to six treatment cycles. Some people may also receive additional treatment, known as maintenance therapy after the treatment cycles come to an end. However, this combination of drugs can cause many side effects in some people. Due to this, some patients may be given only one drug. Bevacizumab is another drug that is sometimes added to the chemotherapy regimen of some patients. ^(25,26)

In cases of peritoneal mesothelioma, chemotherapy is usually administered directly into the abdomen after surgery takes place. In such cases, chemotherapy may also be given through a vein (intravenously). Similar to pleural mesothelioma, the drug combination of cisplatin or carboplatin and pemetrexed is the most commonly used chemotherapy regimen. ⁽²⁷⁾

Again, there are many side effects of chemotherapy and it varies from person to person and also depends on the dosage being used. Some of the common side effects may include:

• Fatigue
• Hair loss
• Loss of appetite
• Nausea and vomiting
• Risk of infection
• Diarrhea

There are many side effects from the drugs that are used to treat mesothelioma, including numbness and tingling in the toes or fingers, damage to the kidneys, anemia, and a high risk of infection due to low white blood cell count. Patients may also experience other types of side effects. ⁽²⁸⁾

Mesothelioma patients who are undergoing chemotherapy are usually administered vitamin B12 and folic acid in an attempt to reduce the risk of such side effects. The side effects tend to go away on their own after the treatment is completed.

Surgery, chemotherapy, and radiation therapy are the three most common treatment options being used for treating mesothelioma today. In some cases, other treatments may also be used to treat this form of cancer, including immunotherapy and targeted therapy. Being handed a diagnosis of mesothelioma can be devastating not only for you but also for your family and friends. Remember that your entire healthcare team is there to support you and guide you during this difficult time. This is why it is important to carry out proper research and learn about mesothelioma to make informed decisions about your treatment and care. With the right treatment, it is possible to relieve your symptoms and also lead a better quality of life.

References:

Also Read:

• What is Malignant Pleural Mesothelioma: Causes, Signs, Symptoms
• Malignant Pleural Mesothelioma: Risk Factors, Diagnosis
• Malignant Pleural Mesothelioma: Treatment, Alternative & Complementary Therapy
• Life Expectancy in Malignant Pleural Mesothelioma & its Prognosis and Prevention
• What is Peritoneal Mesothelioma: Causes, Signs, Symptoms, Diagnosis
• Treatment & Stages of Peritoneal Mesothelioma
• What is Malignant Mesothelioma: Causes, Signs, Symptoms, Risk Factors, Diagnosis, Facts
• Treatment for Malignant Mesothelioma: Surgery, Radiation, Chemotherapy, Clinical Trial, Coping, Home Remedies