Pleural mesothelioma treatment

Your treatment options for pleural mesothelioma will depend on a number of factors. These include

• The stage of your cancer
• Any other medical conditions you may have
• Your general fitness

Unfortunately mesothelioma can be very difficult to treat as it is often found when it is advanced. Nearly all treatment is aimed at controlling the mesothelioma for as long as possible and keeping symptoms under control. You may have chemotherapy to try to shrink the mesothelioma and reduce symptoms. Research has shown that chemotherapy can help some people to live some weeks or months longer. Radiotherapy may also reduce the tumour size and so control symptoms. Surgery is also sometimes used to take away some of the tumour and reduce symptoms in some people with advanced mesothelioma.

Some people with early mesothelioma may have surgery, followed by chemotherapy or radiotherapy or a combination of both.

Doctors and researchers are working to improve mesothelioma treatment all the time. You may be offered treatment as part of a clinical trial. The results of the trials will be used to improve treatment in the future. We have information about taking part in clinical trials on CancerHelp UK.

Chemotherapy uses anti cancer drugs, which for mesothelioma are usually injected into a vein. Depending on the type of chemotherapy drugs used, you may have treatment weekly, or every 2 to 3 weeks.

Chemotherapy may be used to control symptoms in more advanced mesothelioma which cannot be removed surgically. The treatment may also help to slow down the growth of the cancer.

If you have surgery for early stage mesothelioma, you may have chemotherapy before or afterwards. Chemotherapy before surgery is called neoadjuvant chemotherapy and aims to shrink the tumour and make it easier to remove. Chemotherapy after surgery is called adjuvant chemotherapy and aims to delay the cancer coming back for as long as possible.

We have detailed information about chemotherapy for mesothelioma in this section.

Radiotherapy is usually given to reduce the symptoms of stage 2, 3, or 4 mesothelioma. It may also slow down the growth of the tumour. Radiotherapy is sometimes given after fluid has been drained from around your lung. This is to try to stop new growths of mesothelioma developing in the scar on your chest wall.

If you have surgery for stage 1 mesothelioma you may have radiotherapy afterwards to try to stop the cancer coming back or to delay it coming back for as long as possible. Radiotherapy given after surgery is called adjuvant radiotherapy.

The length of your radiotherapy treatment will depend on the type and size of your mesothelioma and on why you are being treated.

We have detailed information about radiotherapy for mesothelioma in this section.

Surgery can be used to try to completely remove localised mesothelioma. There are 2 main types of operation for this. These are removing the pleura (pleurectomy) or removing the lung and pleura (extrapleural pneumonectomy).

For people with advanced mesothelioma, the surgery aims to remove as much tumour as possible to relieve symptoms - this is called palliative surgery or debulking.

Removing the pleura (pleurectomy)

Pleurectomy means removing the pleura from around the lung. The lung is left behind. This type of surgery is also called decortication. The pleural space around the lung is treated so that no further fluid can collect there. If you have stage 1 mesothelioma, you may have a pleurectomy to remove the cancer. If you have a more advanced stage, pleurectomy can slow the growth of the mesothelioma, and help to relieve symptoms such as pain and fluid collecting around the lung (pleural effusion). Removing as much of the cancer as possible may also help other treatments to work better, for example chemotherapy.

Removing the lung and pleura (extrapleural pneumonectomy)

Extrapleural pneumonectomy (EPP) is extensive surgery, which is only possible for some people with early stage mesothelioma. Pneumonectomy means removing the lung. Extrapleural means that the pleura, diaphragm, and the covering of the heart (pericardium) are removed as well on the side affected by mesothelioma. It may help some people to live longer when combined with chemotherapy and radiotherapy.

This operation is only possible if you are fit enough and have good heart and lung function. If your heart and lung function is already poor, this operation is not suitable.

Research comparing EPP to no surgery shows that it causes a lot of side effects and it takes many months to recover.  In this study the benefits did not outweigh the risks. This was a small study but many doctors are now not recommending it as a treatment.

We have detailed information about surgery for mesothelioma in this section of CancerHelp UK.

Mesothelioma is often diagnosed when it is quite advanced. Some people with very advanced disease may be too ill to cope with treatments such as chemotherapy, radiotherapy, or surgery. But they can still have treatment to try to relieve symptoms such as pain, breathing problems and weight loss. Your care will be managed by a palliative care team. This is a team of doctors and nurses who are expert in controlling symptoms of advanced cancer. The team may also include a physiotherapist and a dietician.

If you are having trouble with fluid collecting around your lungs, the fluid may be drained off. This procedure is called a pleural tap or thoracocentesis.

If the fluid comes back you may be offered treatment to try to stop this from happening. Removing the pleura (pleurectomy) is one option and this helps the lung to expand better. Often sterile talc is put in to seal the space and stop the fluid collecting again. This is called pleurodesis and is carried out either through a chest drain or by the doctor putting a tube into the area through a small cut (keyhole) in the chest wall. The keyhole surgery is called a video assisted thoracoscopy.

If the lung cannot expand fully after draining the fluid, your doctor may put in a tube that drains the fluid continuously for a few weeks. This is called an indwelling catheter. You can go home with this tube and it means that you do not have to keep going to the hospital to have the fluid drained off.

We have information about pleural taps and pleurodesis in our lung cancer and mesothelioma questions section.