Treatment options

Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.  

Mesothelioma can be difficult to treat because the disease is often at  an advanced stage by the time it is diagnosed. As well, it typically does not grow as a single tumour mass but tends to spread along surfaces, nerves and blood vessels. 

Treatment depends on the extent of the cancer, whether it has spread to lymph nodes or other organs, the type of mesothelioma cell and your other health needs. 

The four main types of treatment for mesothelioma are: 

• surgery 
• radiotherapy 
• chemotherapy 
• targeted therapy 
• immunotherapy 

Surgery 

Surgery is the main treatment used for mesothelioma if the entire tumour can be removed.  
 
During surgery, lymph nodes will be removed from different areas to be examined for the presence of cancer. 
 
Apart from using surgery to try to cure the cancer, palliative surgery might be used to relieve pain and other symptoms caused by the tumour. For example, the P/D procedure (described below) can help control fluid buildup, improve breathing and reduce pain.  
 
The types of surgery that might be used are as follows. 

Wide local excision 

This surgery removes the tumour and some of the healthy tissue around it. 

Pleurectomy and decortication (P/D) 

This type of surgery removes the tumour and the affected pleura. It can be used to try to cure some early-stage mesotheliomas. 
 
Partial pleurectomy (debulking) aims to remove as much of the tumour as possible – it removes less tissue than a P/D procedure. 

Extrapleural pneumonectomy (EPP) 

This type of surgery removes both pleural layers, the lung and the diaphragm on the side of the chest where the tumour is located, and often the pericardium (the mesothelium surrounding the heart). The diaphragm and the pericardium are then reconstructed using artificial materials. 
 
EPP is a complex operation, which is only used in people who are in good overall health with good lung function. It can have major complications, such as bleeding, blood clots, changes in heart rhythm, pneumonia, fluid buildup in the chest and loss of lung function. 

Pleurodesis 

Pleurodesis uses chemicals to make a scar in the pleural cavity and cause the 2 layers of pleura to stick together. The scarring stops fluid from building up in the pleural cavity. This procedure is used to relieve symptoms resulting from buildup of fluid, rather than as a cure. 

Chemotherapy 

Along with surgery, some people may receive chemotherapy. 

Chemotherapy might also be used before surgery to try to shrink the tumour and reduce the risk of its spread, or after surgery to kill any cancer cells that are left. 

Most cases of mesothelioma are not able to be treated by surgery. Chemotherapy is used if the whole tumour can’t be removed using surgery; however, although it might shrink the tumour or slow its growth, chemotherapy is unlikely to make the tumour go away completely.  

Immunotherapy

Immunotherapy involves treatment with medicines that boost the ability of the immune system to attack cancer cells. Immunotherapy can be used to treat some people with advanced mesothelioma, including cancer that cannot be removed using surgery, cancer that has come back after treatment or cancer that has spread to other parts of the body. 

Medicines used in immunotherapy for mesothelioma include nivolumab and ipilimumab. 

For further information on immunotherapy, see immunotherapy 

Radiation therapy  

Along with surgery, some people may receive radiation therapy (also known as radiotherapy) . Radiation therapy can be used after surgery to try to kill any cancer cells that are left. 
 
As well as being used for treatment of mesothelioma, radiation therapy may be used as palliative therapy to relieve pain and pressure symptoms and improve quality of life. 

Targeted therapy 

Targeted therapy uses medicines to specifically attack cancer cells. Bevacizumab is a medicine that is used to target advanced mesothelioma. It is a type of monoclonal antibody, a protein which attacks the growth of new blood vessels that the tumour needs for a supply of nutrients in order to grow.. 

Follow-up 

After treatment for mesothelioma, you will need regular follow-up examinations and tests to look for return of the cancer or side effects from treatment. These might include blood tests and imaging tests. 

Metastatic mesothelioma 

Stage IV mesotheliomas and some earlier-stage mesotheliomas can’t be removed completely by surgery. The main treatment for these cancers is chemotherapy, targeted therapy and/or immunotherapy, which can improve symptoms and shrink the tumour, or slow its growth. 

Palliative treatments aim to relieve symptoms. They can include surgical procedures to remove fluid buildup (which can cause breathing problems), radiotherapy, chemotherapy and use of pain-relieving medicines. 

Recurrent mesothelioma 

Recurrent cancer is cancer that comes back (recurs) after treatment. The cancer can come back in the same place or in another part of the body. Mesotheliomas often come back after the initial treatment, and can be hard to treat. Treatment depends on where the cancer is, which treatments have already been used and the person’s general health. The options will usually be similar to those for advanced mesothelioma.