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The stage (extent) of a mesothelioma is an important factor in
determining treatment options. But other factors, such as whether the
doctor feels the cancer is resectable by surgery and person's general
health and preferences also play a role.
Mesotheliomas can be hard to treat, no matter what stage of
the cancer is. It's very important that you understand the goal of
treatment before it starts -- whether it is to try to cure the cancer
or to help relieve symptoms -- as well as the likelihood of the
benefits and risks. This can help you make an informed decision when
looking at your treatment options.
Resectable mesotheliomas
In general terms, most stage I and some stage II and III
mesotheliomas are potentially resectable, but there are exceptions.
Resectability is based not only on the size of the tumor, but also on
the subtype (most doctors believe only epithelioid tumors are
potentially resectable), where it is located, and whether or not a
person is healthy enough to have surgery.
Many patients with resectable pleural mesothelioma have their
cancer removed by pleurectomy/decortication or extrapleural
pneumonectomy. Patients with peritoneal mesotheliomas in an early stage
might also benefit from surgery. Surgery is more likely to result in
long-term benefit in stage I cancers, where there is a better chance
that most or all of the cancer can be removed. Some patients can have
long remissions after extensive surgery by experts. Surgery may still
be helpful for later stage cancers, but the benefits are more likely to
be short term.
Doctors are still studying whether giving chemotherapy or
radiation therapy after surgery (adjuvant therapy) is helpful. Many
doctors advise adjuvant therapy, but not all doctors agree on when to
use it or what the best course of treatment is.
If your general health is too poor to tolerate a major
operation, radiation therapy and/or chemotherapy may be used instead.
While these treatments may shrink or slow the growth or the cancer for
a time, they are not likely to result in a cure.
If you have symptoms because of fluid buildup in the chest or
abdomen, other approaches such as thoracentesis/paracentesis or
pleurodesis (described in the Surgery
section) may be helpful.
Because these cancers can be hard to treat, taking part in a
clinical trial of a newer form of treatment may be a reasonable option.
These types of studies are usually done in large medical centers.
Unresectable mesotheliomas
Stage IV mesotheliomas, as well as many earlier stage
mesotheliomas, are not resectable by surgery because of the extent of
the disease or because a person may not be able to tolerate an
operation. Chemotherapy and/or radiation therapy may be treatment
options that shrink or slow the growth of the cancer for a time, but
they are very unlikely to result in a cure and can have their own side
effects. Before starting such treatments, the goals of treatment should
be clear to you and your family.
Because these cancers can be hard to treat, taking part in a
clinical trial of a newer form of treatment may be a reasonable option.
In many cases, treatment aimed at relieving symptoms and
making you comfortable may be a good choice. This could include
treatments that prevent or reduce fluid buildup in the body that could
affect your breathing or ability to take in nutrition.
Pain management is another important aspect of your care. Some
minor operations and types of radiation therapy can help relieve pain
if needed. Doctors can also prescribe strong pain-relieving drugs. Some
people with cancer may hesitate to use opioid drugs (such as morphine)
for fear of being sleepy all the time or becoming addicted to them. But
many people get very effective pain relief from these medicines without
serious side effects. It's very important to let your cancer care team
know if you are having pain so that it can be treated effectively.
Recurrent mesotheliomas
Some mesotheliomas may recur (come back) after the initial
treatment. If this happens, further treatment options depend on where
the cancer is and what treatments have already been used. In most cases
the options will be similar to those listed above for unresectable
mesotheliomas. For example, chemotherapy may be used to try to shrink
or slow the growth of the cancer and to relieve any symptoms. Because
recurrent cancers can often be hard to treat, clinical trials of new
types of treatment may be a good option.
Last Medical Review: 03/17/2009
Last Revised: 03/17/2009
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