There are now many treatments available to mesothelioma patients. Although it is very difficult to treat, and is regarded as a terminal condition, research into the treatment of mesothelioma has come on leaps and bounds in recent years and more and more people are living for years rather than months after diagnosis.
Treatment options will depend on a variety of factors and each patient will be assessed on a case by case basis by their treating medical team.
Treatment of mesothelioma will depend on:
- Where you mesothelioma is
- What type of mesothelioma you have
- How developed your mesothelioma is (the stage of cancer you have)
- Your general level of health
Not everyone who is diagnosed with mesothelioma wants to have treatment, often the side effects outweigh the benefits. Here we present an overview of potential mesothelioma treatment options that may be available to you.
Treatment of mesothelioma
The aim of radiotherapy treatment for pleural mesothelioma is to control the symptoms and slow the growth of the cancer. The treatment uses radiation, usually in the form of x-rays.
If your mesothelioma has not progressed too far (stage 1), you may have surgery to remove the tumour(s) and radiotherapy can be used following this to prevent or delay the cancer from returning. Radiotherapy is also often used at the site of biopsies or chest drains to prevent the spread of mesothelioma.
If your mesothelioma is more advanced (stages 2, 3 or 4), radiotherapy may be used to slow the progression of the disease.
How is radiotherapy administered?
The number of radiotherapy sessions you have will depend on the stage and size of your mesothelioma, as well as the reason for the treatment, and so will differ from patient to patient.
Before you start radiotherapy you will have a CT scan to pinpoint the exact location of the cancer, this ensures the highest dose of radiation is delivered to the cancer, avoiding healthy cells as much as possible. After the scan you will have small, permanent marks put on your skin, this is necessary to be certain that the same area is targeted at each treatment session.
Patients usually receive radiotherapy treatments five times a week, i.e. one treatment a day, Monday to Friday. The most common type of radiotherapy is external radiotherapy. This is where a radiotherapy machine directs beams of radiation at the cancer. The other type is internal radiotherapy, where a radioactive implant is put inside the body, near the cancer, or a radioactive liquid is injected or swallowed. Generally, external radiotherapy is given for pleural mesothelioma treatment.
The treatment is done at hospital in a radiotherapy room using a radiotherapy machine. This is a large machine that will usually move around you during your treatment. At no point during the treatment should the machine touch you.
Before you have your first radiotherapy session your radiographer will talk you through the whole process. Many hospitals have docks for personal music players so you may be able to listen to your own playlist during your treatment which may help you relax.
You will lie down on a table and the radiographers will go into an adjacent room, they will be able to see and hear you throughout your treatment and will talk to you through an intercom system.
You will need to lie as still as you can while the treatment is being administered, it should only take a few minutes and should be painless.
Side effects vary from patient to patient, some people will not get any and some might suffer with every single one.
Possible side effects include:
- Sore skin, similar to sunburn
- Hair loss in the area targeted by the treatment
- Loss of appetite
- Discomfort when swallowing
After the treatment
Once the treatment session has finished you should be able to go home straightaway.
Radiotherapy doesn’t make you radioactive so you can safely be with other people after your treatment, including pregnant women and children.
A common mesothelioma treatment is chemotherapy. This uses cytotoxic (anti-cancer) drugs to kill cancer cells. Chemotherapy may be used before surgery to shrink tumours, making them easier to remove, or after surgery to prevent the cancer returning.
How is chemotherapy administered?
Chemotherapy tends to be a weekly treatment, but can be given every two to three weeks, depending on the type of chemotherapy drugs used.
Before you have chemotherapy you will have to have blood tests to ensure you can safely start treatment. These may be done a few days before the treatment or on the day of your treatment.
Chemotherapy is administered by a drip in the arm. A cannula or small tube, is inserted into a vein in the arm and the drip is connected. Some patients may need a central line, this is a long plastic tube that allows the drugs to be administered into a large vein, either in the chest or arm. If you have a central line, it will stay in throughout your treatment.
Chemotherapy treatment is usually done at a day clinic. You will sit in a chair and the treatment can take a few hours. It is a good idea to take a newspaper or book and most places allow you to have a family member or friend with you while you have your treatment.
Chemotherapy can cause a number of side effects. These will vary from patient to patient as they depend on what chemotherapy drugs you have, the amount you have and your body’s reaction to them.
Common side effects are:
- Nausea (feeling sick)
- Loss of appetite
- Weight loss
- Fatigue (feeling very tired)
- Bruising or bleeding easily
- Diarrhoea or constipation
- Hair loss
Thankfully side effects tend to only last for a few days after the treatment and your treating medical team should be able to help you manage any side effects you might suffer with. It is important to tell your team what, if any, side effects you have.
After the treatment
Most chemotherapy patients will go home after their treatment but some types of chemotherapy require a stay in hospital.
Surgery for pleural mesothelioma
Surgery for pleural mesothelioma can be radical. The aim of the surgery is to completely remove the mesothelioma and often surgery is done alongside chemotherapy or radiotherapy for the best results.
There are two surgeries used for pleural mesothelioma:
Pleurectomy or decortication
In this operation part or all of the pleura, the lining of the lung, is removed. This can help with chest pain, fluid build-up (pleural effusion) and breathlessness.
The operation can be done through keyhole surgery. Three small wounds are made in the chest and as much of the pleura is taken away as possible. If keyhole surgery is not an option, a large cut will be made in the chest. With both methods, a substance is put into the space made by removing the pleura to prevent further fluid build-up.
If the whole pleura is being removed (total pleurectomy) a large cut is made in the chest and the pleura is removed and replaced with a specialised mesh layer.
After the surgery
A pleurectomy is a major operation with most patients staying in hospital for a week after their operation. It then takes between four and six weeks to fully recover.
If you have a total pleurectomy, you will stay in hospital for between 10 and 15 days and full recovery takes between six and eight weeks.
This is usually only a surgical option where mesothelioma has been diagnosed at an early stage, where it has not spread to the lymph nodes or beyond the lungs. It is a major operation which involves the removal of the lung and pleura.
As it is such a large operation, there are risks, and between 5 and 10% of patients who have this surgery will sadly die during or shortly after the surgery.
The surgery is similar to that for the pleurectomy in that a large incision is made in the side of the chest, the affected lung is removed, along with the pleura, the diaphragm and the pericardium (lining of the heart).
After the surgery
Following this surgery patients will need to stay in hospital for at least two weeks and full recovery takes around three to four months.
Surgery for peritoneal mesothelioma
Peritoneal mesothelioma surgery aims to remove the mesothelioma but, unfortunately, cannot usually get rid of the disease completely. Surgery does help to control the disease and improve quality of life and life expectancy.
The surgery is major and so the patient needs to be fit and diagnosed at an early stage to be eligible for this treatment.
This surgery removes the peritoneum (lining of the abdomen). Often cytoreductive surgery is used, this is also known as debulking. The peritoneum is removed and in most cases, chemotherapy is given straight into the abdominal cavity during the operation.
Surgery for pericardial mesothelioma
Although pericardial mesothelioma is a very rare form of the cancer, surgery is a treatment option. This involves removing the pericardium (lining of the heart), the heart is then encased in an artificial lining.
Immunotherapy is a relatively new treatment for mesothelioma. In the UK it is not generally available on the NHS but some patients may be able to access this treatment on the NHS through clinical trials. Many patients get this treatment privately and we can claim the costs of private immunotherapy treatment as part of a mesothelioma compensation claim.
Immunotherapy is a biological therapy which harnesses the patient’s immune system to help fight the disease.
There are a number of different immunotherapy treatments that can be used for mesothelioma. There are some benefits to this treatment over chemotherapy, mainly that there are fewer side effects as the treatment takes a targeted approach, attacking the cancer cells and leaving the healthy cells alone.
For some people, the treatments discussed above are not an option. They may have been diagnosed with mesothelioma at a very late stage and are not eligible for these treatments, or they may have decided that the benefits of the treatments do not outweigh the side effects.
There are palliative treatments that can be offered in the alternative. Although this term tends to be associated with end of life treatment, palliative mesothelioma treatments can be used at any stage.
A common symptom of pleural mesothelioma is a build-up of fluid in the space between the lungs and their lining. A thoracentesis procedure uses a needle to drain this fluid. This can help to relieve a patient’s breathlessness symptoms.
For patients who suffer with recurring fluid build-up, a pleurodesis would be considered. This is a procedure where talc or another irritant is put in the space between the lungs and the lining so that the tissue becomes inflamed and sticks the lining to the lungs so there is no space for the fluid to build up in. This can be a painful and uncomfortable procedure but, once recovered, the patient should see an improvement in breathless symptoms. Unfortunately the procedure is not always successful.
Similar to a thoracentesis for pleural mesothelioma, a paracentesis is used to drain fluid build-up in the abdomen in peritoneal mesothelioma patients. This fluid is called ascites and a needle is used to drain it from the abdomen, making the patient more comfortable.
As with the thoracentesis and paracentesis, a pericardiocentesis drains fluid from around the heart.
These are just some of the treatments that you may be offered, your treating medical team with go through all of your options with you.