Treatment options for pleural mesothelioma

Treatment options for pleural mesothelioma include:

immunotherapy
chemotherapy
radiotherapy
surgery
supportive treatments to control symptoms of advanced cancer

Mesothelioma usually starts in the tissue covering the lung (the pleura). Less often, it can start in tissue in your tummy (peritoneum). This page is about treatment options for pleural mesothelioma.

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

where your cancer is
how far it has grown or spread (the stage)
the type of cancer
your general health and level of fitness
your personal wishes

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

The main treatments

Unfortunately mesothelioma can be difficult to treat. It is often diagnosed at an advanced stage. So, nearly all treatments aim to control the mesothelioma for as long as possible. And keep symptoms under control.

Surgery for early stage mesothelioma

For early stage mesothelioma, you might have surgery if you are well enough. You might also have chemotherapy or radiotherapy, or a combination of both.

Advanced mesothelioma

For more advanced mesothelioma, you might have immunotherapy or chemotherapy. This is to shrink it and reduce symptoms. Treatment can help some people live weeks or months longer. Radiotherapy might also shrink the cancer and control symptoms.

Immunotherapy

Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells. It is a treatment for some people with pleural mesothelioma.

You might have immunotherapy drugs if you can’t have surgery. Immunotherapy helps to control the cancer.

You have it as your first treatment, before other treatment such as chemotherapy. You have to be fit and well enough to have immunotherapy.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The chemotherapy drugs circulate throughout the body in your bloodstream.

You might have chemotherapy:

for early stage pleural mesothelioma, alongside surgery and radiotherapy
to shrink or control advanced pleural mesothelioma

Common chemotherapy drugs for mesothelioma are pemetrexed and cisplatin.

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells.

You might have radiotherapy:

after surgery for early stage mesothelioma (adjuvant radiotherapy)
to control mesothelioma symptoms and slow down the growth of your cancer.

Surgery

Surgery isn't a common treatment for mesothelioma. Unfortunately, it can be difficult to remove all the cancer and get rid of the mesothelioma for good. To have surgery you have to be fairly fit and well so that you can recover without too many problems.

You might have an operation to control and relieve symptoms. The surgery might also help you live longer.

Your surgeon might remove:

part of the pleura (partial pleurectomy)
the whole of the pleura (pleurectomy)
as much cancer as possible to relieve symptoms (debulking surgery)

Supportive care (palliative care)

Mesothelioma is often diagnosed when it is quite advanced. Some people might be too ill to cope with some treatments. For example, chemotherapy, radiotherapy or surgery. But you can still have treatment to relieve symptoms such as pain or breathing problems.

This is called palliative care. It is managed by a team of doctors and nurses who are experts in controlling symptoms of advanced cancer. The team might also include a physiotherapist and dietician.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

whether you need extra appointments
if you need more tests
the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.