Treatment of Mesothelioma by Stage

Stage I: Many patients with stage I pleural mesothelioma have their cancer removed by pleurectomy/decortication or extrapleural pneumonectomy, as described in the section How Is Mesothelioma Treated. Patients with peritoneal mesotheliomas in an early stage might also benefit from surgery. The value of adjuvant chemotherapy or radiation therapy (treatments given after surgery) for stage I mesothelioma is being studied. Radiation therapy may be used if your general health is too poor to tolerate a major operation. Some doctors have had success with putting cisplatin into the thoracic space after the surgery. This can also be used in the abdomen for peritoneal mesothelioma.

Stages II, III: Treatment options include palliative and supportive care providing relief of symptoms, such as thoracentesis (to remove fluid accumulation in the chest cavity) along with pleurodesis, paracentesis (removing fluid from the abdomen), operations to remove as much of the tumor as possible in some cases, and radiation therapy or chemotherapy aimed at easing symptoms. Cure is usually not possible for patients in these stages. Enrollment in clinical trials evaluating the newest treatment possibilities in large medical centers should be considered. Some patients can have long remissions after extensive surgery by experts.

Other approaches include putting chemotherapy or radioactive drugs directly into the pleural space or abdominal cavity. This can be done simply with the doctor placing a needle into the pleural space or abdomen after numbing the skin with local anesthetic. Although this only kills some of the cancer cells, it often helps slow down fluid collection.

Stage IV: Because stage IV mesothelioma has spread to distant organs, a cure is not possible. The goals of using any aggressive therapy such as chemotherapy and radiation therapy should be clear to you and your family. You might want to consider enrolling in a clinical trial in a large medical center. These studies evaluate the newest treatment possibilities.

Supportive care may be the best choice, perhaps in the setting of a good hospice program. Pain management is an important aspect of your care. It is important for you to know that drugs are available to effectively treat pain due to mesothelioma. You should not hesitate to request pain medicines or discuss pain control problems with your cancer care team.