Mesothelioma treatment options are improving with research and the program of treatment depends on factors such as where the cancer is situated, the stage of the cancer, how far it has spread, the patients age and needs and how the cancer cells appear under a microscope.
There are three main types of traditional treatment for people with mesothelioma lung cancer, namely, surgery to remove the cancer, chemotherapy which is the use of drugs to eradicate cancer cells and radiation therapy which uses x-rays in high dose or other energy rays to destroy cancer cells. Usually, these therapies are combined.
The mesothelioma cancer prognosis is usually only eight to twelve months. However, time is of the essence when treating this disease and the earlier it is diagnosed, the better.
In the case of surgery, sometimes diagnostic surgery is needed as a very necessary step, as mesothelioma diagnosis through fluid is sometimes inconclusive. Sometimes a thoracoscopy (like an open biopsy but less invasive) is done to carry out multiple tissue biopsies and for assessment of the pleural cavity. A conclusive diagnosis is obtained in up to 98% of cases. Fluid can be drained from the intrapleural space at the same time and the extent of the tumor assessed to determine the possibilities of resection.
An alternative to thoracoscopy is video assisted thoracic surgery (VATS) which is more invasive but the physician is able to see the pleural space using a camera while collecting tumor samples for examination by a pathologist. The physician can also determine the extent of tumor invasion for example in the chest wall or pleural involvement.
A laproscopy or mediastinoscopy are also sometimes used as other ways of gaging the extent of disease.
Palliative procedures are used to treat symptoms of mesothelioma but do not treat the disease itself. Such procedures include chest tube drainage and pleurodesis which are the most common palliative treatments. Thoracoscopy and pleurodesis are done with VATS. A pleuroperitoneal shunt is sometimes used, but in limited capacity due to tumor seeding concerns. Lastly a pleurectomy is sometimes carried out in cases where more extensive surgery is not possible.
Along with diagnostic and palliative treatments, surgery with potentially curative intent is carried out where the aim is to remove all of the disease with the awareness that some microscopic elements will probably remain.
For malignant pleural mesothelioma two surgical treatments are available namely, a pleurectomy/decortication which is carried out on early stage tumors (Stage I and sometimes Stage II) and secondly, an extrapleural pneumonectomy which is only executed by surgeons with much expertise and where previous surgery has failed to cure or prolong life.
For peritoneal mesothelioma, cytoreductive surgery aims at removing all of the visible or gross tumor within the peritoneal cavity. Cancer cells left are treated with chemotherapy and focused in the abdominal cavity.
Chemotherapy is the treatment of cancer with anticancer chemical substances to control the division of cancerous cells by destroying them. It is not considered curative but seeks to control the spread, shrink tumors, to relieve symptoms like pain and to destroy microscopic cells remaining post surgery (adjuvant chemotherapy).
Radiation therapy or radiotherapy is included in the range of mesothelioma treatment options and treats the tumor with the use of penetrative beams of high energy radiation and can be used in conjunction with surgery and palliatively.