This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

If you have mesothelioma, you doctor will suggest one or more ways to treat the cancer. This is an important decision and you should take time to think about all of your choices.

You may want to get a second opinion. A second opinion can give you more information and help you feel better about the treatment choice you make. Also, some insurance companies require a second opinion before they will agree to pay for certain treatments.

Because this is such a rare cancer, it has been hard for doctors to compare the value of different treatments. Since many doctors have little or no experience treating this disease, you may be referred to a specialist at a large medical center. Treatment options include surgery, chemotherapy, and radiation therapy. One problem with treating mesothelioma is that it does not grow as a single tumor. Instead, it tends to spread along surfaces, nerves, and blood vessels. This makes it hard for treatment to get rid of all of the disease.

Surgery

Surgery for some types of mesothelioma might be done to try to bring about a cure or to relieve symptoms. Surgery to relieve symptoms (called palliative surgery) is often done in cases where the tumor has already spread or when the patient is too sick to go through more involved surgery.

Surgery to try and cure the cancer

To attempt a cure, major surgery might be needed. This might be done if the patient is in good health (other than the cancer) and if it seems as if the tumor is only in one place. While surgery is not likely to cure the cancer, it might extend the patient's life.

But in most cases, the cancer has often spread to other places before it is found. So the role of surgery in treating this cancer is not clear. If your doctor recommends surgery, ask for more details about the operation and what the goal is.

Palliative surgery

Palliative surgery may be an option if the tumor has already spread beyond the mesothelium and is hard to remove completely, or if you are too ill for a bigger operation. The goal of this surgery is to relieve or prevent symptoms, rather than trying to cure the cancer.

Other measures to relieve symptoms

In many cases, treatments other than surgery are used to relieve symptoms. Fluid in the chest can be removed by placing a needle into the chest cavity and drawing the fluid out. Sometimes talc or drugs are injected into the chest. This causes the linings of the lung and chest wall to stick together, sealing the space and preventing further fluid build-up

Fluid in the abdomen (belly) or around heart can be removed by placing a long, hollow needle through the skin, into the fluid, and removing it. Numbing medicine is used on the skin before the needle is put in. This may be done in a doctor's office or in the hospital. While these methods can relieve symptoms, they are not meant to cure the cancer.

If the above methods don't work, a shunt might be placed in the chest. A shunt is a device that allows fluid to move from one part of the body to another. The shunt is a long, thin, tube with a small pump in the middle. In the operating room, the doctor puts one end of the shunt into the chest cavity and the other end into the abdomen (belly). Once the shunt is in place, the patient uses the pump several times a day to move the fluid from the chest to the abdomen, where it is more likely to be absorbed by the body.

Another approach sometimes used to control the build-up of fluid is a catheter -- a thin flexible tube. One end of the catheter is placed in the chest or abdomen and the other end is left outside the body. This is done in a doctor's office or hospital. Once in place, the catheter can be attached to a special bottle or other device to drain out the fluid.

Radiation therapy

Radiation therapy is treatment with high energy rays (such as x-rays) to kill cancer cells and shrink tumor. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (internal or implant radiation). External radiation is the preferred type for mesothelioma. It is given in the same way as the type of x-ray used to find a broken bone, although it takes longer. Treatments are usually given daily (5 days a week) for 3 to 5 weeks.

As a rule, it is hard to treat mesothelioma with radiation -- the need to treat a large part of the lung leads to problems with lung damage. But newer types of radiation therapy may be used in different ways to treat mesothelioma:

• It can be used as the main treatment of mesothelioma in some patients, especially those whose health is too poor to have surgery.

• It can be used after surgery to try to kill any small deposits of cancer that could not be seen and removed during surgery.

• Radiation therapy can be used to ease symptoms of mesothelioma such as shortness of breath, pain, bleeding, and trouble swallowing.

There can be side effects from radiation. Most of these will go away after a short while. The skin in the area treated may look sunburned and then become darker. You may also feel tired. Be sure to talk with your doctor about any side effects. Often there are medicines or other things that can be done to help control them.

Chemotherapy

Chemotherapy ("chemo") is the use of drugs to kill cancer cells. The drugs can be swallowed in pill form or they can be injected by needle into a vein or muscle. Once the drugs enter the bloodstream, they spread throughout the body. In treating mesothelioma, these drugs may also be given directly into the chest (or abdominal) cavity at the site of the tumor. More than one drug may be used to make the treatment work better.

Depending on the type and stage of the cancer, chemo may be given as the main treatment or along with surgery. Chemo for mesothelioma is given to relieve symptoms, not to cure the cancer.

Doctors give chemo in cycles, with a rest period in between cycles to allow the body time to recover. Chemo cycles often last about 3 to 4 weeks. Chemo is often not recommended for patients in poor health, but being older should not keep a person from getting chemo.

Chemo can cause side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Side effects could include the following:

• nausea and vomiting
• loss of appetite
• hair loss
• mouth sores
• an increased risk of infection
• bleeding or bruising after minor cuts
• tiredness
• shortness of breath

Most side effects go away once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

Last Medical Review: 04/01/2009
Last Revised: 04/01/2009