Frequently Asked Questions About Mesothelioma Treatment

Quick Summary

Get answers to top mesothelioma treatment questions, including who is eligible for mesothelioma surgery, chemotherapy and radiation.

General Treatment FAQs

What Are the Primary Treatment Combinations?

Patients with early-stage mesothelioma are usually prescribed with a trimodal treatment approach, which gives patients their best chance at survival by combining:

  • Surgery
  • Chemotherapy
  • Radiation therapy

Surgery is often performed first, allowing surgeons to remove as much cancer as possible. Chemotherapy and radiation therapy are then used to target any mesothelioma cells that can’t be removed through surgery—either because the cells were too small to see or removing them would cause too much risk. In rare cases, chemotherapy may be administered before surgery.

Treatment for Stage 4 Mesothelioma

Patients with stage 4 mesothelioma are often treated with chemotherapy and radiation, without surgery.

Why Is Personalized Treatment Essential?

While there are standard primary treatment combinations, mesothelioma can’t be treated using a one-size-fits-all approach.

Every patient is different, and numerous factors must be considered. Mesothelioma cell type, location, and disease stage must all be taken into account. Doctors also consider the patient’s age, their willingness to fight and available support systems. A personalized treatment will consider all the variables and determine a treatment strategy that is best for the patient.

Who Is Eligible for Mesothelioma Treatment?

Every patient with mesothelioma is eligible to receive some form of treatment. However, the goals of the treatment will differ depending on the patient’s unique circumstance. The treatment strategy will be tailored based on their medical needs and personal desires.

Where Should I Receive Mesothelioma Treatment?

NCI-designated Comprehensive Cancer Centers with a dedicated mesothelioma division are the best hospitals to receive mesothelioma treatments, from a medical perspective.

However, that doesn’t make these hospitals the best choice for every patient. For example, patients who aren’t well enough to travel may find a local hospital is the best place to receive mesothelioma treatment. Others may choose a hospital that is closest to their social support network.

Choosing a Mesothelioma Cancer Center

Physical, emotional, mental and spiritual factors should all be considered when determining where one receives their mesothelioma treatment. Some cancer centers may be a better fit for patients based on these factors.

What Health Professionals Are Involved in Mesothelioma Treatment?

Mesothelioma is best defeated by a holistic, whole-body approach. Therefore, patients may receive their treatment from a medley of experts with a variety of specialized backgrounds.

Typically, an oncologist, GP, or mesothelioma specialist will act as the point of contact for a patient, directing and working with dozens of additional medical professionals, which may include surgeons, radiologists, and nurses.

How Does Cell Type Impact Treatment?

There are 3 types of mesothelioma cells—sarcomatoid, epithelioid, and biphasic—and each cell type responds to treatment differently.

Epithelioid cells respond best to treatment, with the best patient outcomes, while sarcomatoid cells are more resilient to it. Biphasic cells are a mix of epithelioid and sarcomatoid cells, and their treatment difficulty is determined by the ratio of cells that are sarcomatoid .

Choosing Treatments for Mesothelioma Cell Types

The trimodal treatment approach is typically used to treat all types of mesothelioma cells, but cell type has an impact on how aggressive the prescribed treatment is and palliative care.

Surgical Treatment FAQs

What Types of Surgery Are Available for Mesothelioma?

Surgery is usually the first line of defense against surgery. Surgeons will attempt to remove any visible mesothelioma tumor masses from the body’s linings, whenever it’s relatively safe to do so.

The most common pleural mesothelioma surgeries involve removing part or all of the lung (see below). Peritoneal mesothelioma surgery and pericardial mesothelioma surgery both focus on removing any visible nodules or tumors from the abdominal lining.

What’s the Difference Between EPP and P/D?

Extrapleural pneumonectomy (EPP) is a pleural mesothelioma surgery in which the lung is completely removed from the body. EPP may also involve the removal of heart and chest lining, the diaphragm and lymph nodes. EPP is considered an aggressive surgery.

Pleurectomy with decortication (P/D) is the other pleural mesothelioma surgery, which attempts to save the lung by only removing the visibly infected part of the lung. However, the medical community is still divided on whether EPP or P/D is the best course of action, as there are pros and cons to each surgery.

What Is the Typical Surgery Recovery Time?

Mesothelioma patients who undergo surgery will spend approximately 2 weeks in the hospital, with another 6 to 8 weeks of at-home care and physical therapy.

In some cases, P/D patients can recover in about half that time. However, each patient’s recovery time is different.

Are There Side Effects of Mesothelioma Surgery?

Mesothelioma surgery side effects are most often related to recovery. Patients may feel pain or soreness for weeks following the surgery.

The most common mesothelioma surgery side effects include:

  • Pain
  • Fatigue
  • Loss of appetite
  • Bleeding
  • Swelling, bruising, and drainage from the surgery site
  • Numbness in the incision site
  • Infection
  • Nausea, vomiting, stomach cramps and/or bloating
  • Lymphedema, if lymph nodes are removed

Mesothelioma surgery also puts patients at risk of other more severe side effects, including infection, blood clots, severe bleeding, respiratory or heart issues, and organ damage.  Mesothelioma patients should talk to their surgeon before the surgery to discuss the most likely side effects of their specific circumstance.

Who Administers Surgery?

Mesothelioma surgery is performed by a surgeon alongside support staff that includes surgical assistants, anesthesiologists and nurses. The surgeon may be a mesothelioma specialist, a specialist in a specific type of surgery (such as cardiothoracic surgery), or both.

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Chemotherapy Treatment FAQs

What Should I Expect From Chemotherapy Treatment?

Mesothelioma patients who receive chemotherapy are treated with potent pharmaceuticals that specifically target cancer cells. Chemotherapy may be administered orally, intravenously (IV), or directly into the chest or abdominal cavities.

Working With a Mesothelioma Oncologist

Mesothelioma patients meet with an oncologist to discuss their case and treatment options before chemotherapy begins. The oncologist determines which drugs to administer, including dosage and frequency. They also talk the patients through the entire chemotherapy process and answer their questions.

Who Administers Chemotherapy?

Chemotherapy treatments are typically administered by an oncology nurse. Oncology nurses specialize in patients with cancer, including aftercare and side effects.

Are There Chemotherapy Treatment Side Effects?

Most people are familiar with some of the common side effects of chemotherapy, including hair loss, nausea, vomiting and fatigue.

A more complete list of chemotherapy side effects include:

  • Stomach pain
  • Muscle pain
  • Headaches
  • Fatigue
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Appetite loss
  • Hair loss
  • Nerve damage such as tingling, numbness, burning or muscle weakness
  • Blood disorders
  • Sores on the mouth and throat
  • Reproductive/fertility issues
  • Heart problems
  • Organ damage

The list may seem long, but not every patient experiences every symptom. Chemotherapy also involves minimizing side effects as much as possible and balancing a patient’s physical response to chemotherapy with their need for treatment.

Mesothelioma patients should try to be open and honest about their side effects as they experience them so their health team can reduce them.

How Long Does Chemotherapy Take?

Chemotherapy is often administered every 3 weeks in sessions that last approximately 2 hours. After 3-4 rounds of chemotherapy, the oncologist will advise whether the chemotherapy is working and help determine whether the treatment should continue.

Radiation Therapy Treatment FAQs

What Should I Expect From Radiation Therapy?

Radiation therapy for mesothelioma uses external beams of radiation to target a tumor. The treatments are relatively quick but frequent, as patients usually receive radiation therapy every day of the week, Monday through Friday.

Before treatment, mesothelioma patients will meet with a radiation oncologist who will discuss the treatment plan, explain the details of how radiation therapy works, and answer any questions. Radiation therapy in itself isn’t painful, but some of the side effects may be.

Are There Radiation Therapy Side Effects?

Radiation therapy side effects depend on where the radiation is administered. Most patients don’t have many side effects.

When radiation is aimed at the abdomen, the following side effects may occur:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fatigue
  • Skin sensitivity at the radiation site

Radiation therapy aimed at the chest often has these side effects:

  • Shortness of breath
  • Sore breasts or nipples
  • Difficulty swallowing
  • Stiff shoulders
  • Skin sensitivity at the radiation site
  • Radiation pneumonitis – a cough, fever, and “full” feeling

Radiation pneumonitis can lead to permanent scarring of the lungs called radiation fibrosis if it isn’t treated properly. Mesothelioma patients who experience radiation pneumonitis should discuss the side effects with their oncologist immediately.

Who Administers Radiation Therapy?

Radiation therapy is administered by a radiation therapist, with the assistance of a radiation oncology nurse. In addition, a radiation oncologist will oversee the treatment from a planning and paperwork perspective.

They’ll also work with a dosimetrist to determine the right radiation dose, and a medical radiation physicist, who designs treatment plans for the specific radiation machines. Patients may also work with numerous other health care professionals during radiation therapy, ranging from social workers and nutritionists to dentists and physical therapists.

How Long Does Radiation Therapy Take?

Radiation therapy takes approximately 10 to 15 minutes to administer and is often repeated 5 days per week for 5 to 8 weeks. After the treatment course, the oncologist will work with the mesothelioma patient to plan the next steps.

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Other Treatment Type FAQs

What Other Treatment Options Are Available for Mesothelioma?

Although the trimodal approach is the only tried and true method for combating mesothelioma at this time, many additional therapies are being considered, including:

  • Targeted therapy
  • Immunotherapy
  • Proton therapy

Some of these therapies target mesothelioma cells, while others help the body fight the disease better. Many of these new mesothelioma treatments are currently in clinical trial.

What Is Targeted Therapy/Gene Therapy?

Targeted therapies and gene therapies will target specific genes or biological markers in an attempt to destroy cancer. Cancer is formed when the genes in healthy cells are mutated. These gene mutations then tell cancer cells how to grow and allow them to live longer than a healthy cell can.

How Targeted Therapy for Mesothelioma Works

Targeted and gene therapies use drugs to either reverse mutated cancer cell signals or destroy the cells that have the mutated genes.

What Is Immunotherapy?

Immunotherapy is a mesothelioma treatment that boosts the body’s natural ability to fight off diseases like mesothelioma by improving or adding antibodies. Antibodies tell the immune system which cells to fight and, in turn, immunotherapy can help the body fight harder and better identify dangerous cancer cells.

What is Proton Therapy?

Proton therapy is a radiation therapy innovation that uses protons to destroy cancer cells, including mesothelioma. When administered well, proton therapy only targets the tumor and doesn’t leak radiation to the surrounding organs and tissues. This is a significant advantage over traditional radiation and is why it is being explored as a mesothelioma treatment option.

If you have questions about undergoing mesothelioma treatment, contact our Patient Advocates today. Call us at (800) 584-4151 and receive a FREE Mesothelioma Help Guide to better understand your mesothelioma treatment options.

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Last modified: December 31, 2018