Mesothelioma Treatment
Surgery
Mesothelioma surgery alone usually does not cure patients of the disease. Instead, it is meant to reduce the amount of cancer to minimal levels. At the end of the procedure, the surgeon should not be able to see or feel any tumor in the chest or abdomen. However, it is usually not possible to remove every microscopic tumor cell.
By reducing the amount of cancer in the body, though, the disease’s progression can be slowed. This allows patients to receive additional therapies, such as radiation, chemotherapy and immunotherapy.
Mesothelioma surgery can also be used to relieve symptoms like pain and shortness of breath.
Two main types of mesothelioma surgery are performed at MD Anderson. Your surgeon will discuss which is best for you. This decision depends on many factors, including:
- Age
- Physical fitness
- Lung health
- Extent of the tumor
- Type of mesothelioma (epithelioid vs. non-epithelioid)
- Whether the tumor has travelled to the lymph glands
The types of mesothelioma surgery are:
Extrapleural pneumonectomy (EPP): This is an extensive surgery that involves removal of the entire pleura (lining of the lung and chest wall) as well as the affected lung, diaphragm and pericardium (the membrane surrounding the heart). Lymph nodes are also removed from the chest. The diaphragm and pericardium are rebuilt with a sheet of artificial material.
Patients must be in good physical shape to undergo EPP. It has a higher risk of mortality and complications, but it provides a more complete removal of the tumor than pleurectomy/decortication.
Pleurectomy/decortication (P/D): P/D involves removal of the affected areas of the pleura, lymph glands, diaphragm and pericardium. Unlike EPP, the lung is not removed. The diaphragm is reconstructed with an artificial membrane. Because the lung remains in place, this surgery has fewer major complications than EPP. It is also safer for older patients and usually offers a higher quality of life. However, the tumor is more likely to return in the chest than with EPP.
Radiation therapy
Radiation therapy uses high energy beams to kill cancer cells. By itself, radiation therapy does not cure mesothelioma. It is typically used after surgery to kill any cancer cells the surgeon could not see with the naked eye. These cells are called microscopic residual disease.
Patients who get radiation after surgery usually receive intensity-modulated radiation therapy (IMRT). IMRT focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose.
In some cases, radiation may help relieve pain or discomfort. This is known as palliative radiation. Patients getting palliative radiation often undergo 3D conformal radiation therapy. This uses three-dimensional scans to determine the exact shape and size of the tumor. The radiation beams are shaped by tiny metal leaves that are arranged to fit the tumor dimensions, minimizing the side effects to healthy tissue. Learn more about radiation therapy.
Chemotherapy
Chemotherapy works by directly killing cancer cells. Chemotherapy is proven to prolong life in mesothelioma patients. It is the main treatment for mesothelioma patients who are not good candidates for surgery. For patients who are good surgical candidates, it is given before their procedure. Learn more about chemotherapy.
Targeted therapy
Targeted therapy works by stopping or slowing the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. Learn more about targeted therapy.
Immunotherapy
Cancer immunotherapy improves the immune system’s ability to eliminate cancer. There are several types of immunotherapies, and each helps the immune system in a different way.
Immune checkpoint therapy is an option for some patients with mesothelioma. This treatment helps cancer-fighting immune cells, called T cells, mount a longer-lasting response against the disease. Learn more about immunotherapy.
Clinical trials
As a top-ranked cancer center, MD Anderson conducts multiple mesothelioma clinical trials, many of which may not be offered anywhere else. Doctors only suggest a clinical trial if they believe it is the best treatment for the patient. MD Anderson's mesothelioma clinical trials cover all stages of the disease, including treatments for early-stage disease, mesothelioma that has spread to other parts of the body, and mesothelioma that has returned or recurred Learn more about clinical trials.
Our treatment approach
MD Anderson offers pioneering treatments for mesothelioma, some of which are available at only a few cancer centers in the nation. When we treat mesothelioma, we also focus on lung function and quality of life.
Doctors often suggest a clinical trial for mesothelioma treatment. Some of these are available only at MD Anderson. A clinical trial may include surgery, radiation therapy, immunotherapy, chemotherapy or a combination of different treatments.
If you have mesothelioma, your doctors will discuss the best treatment options based on your specific condition. This depends on several things, including:
- Type of mesothelioma
- Stage of disease
- Location of cancer
- Your age and general health
Mesothelioma treatment plans
Doctors consider two main factors when developing a mesothelioma treatment plan: The extent of the disease, including whether it has spread to other parts of the body, and the patient’s age and overall health.
If the cancer has not spread and the patient is fit enough, he or she may be a good candidate for surgery. Surgical candidates may undergo chemotherapy before the procedure to help shrink the tumor. After surgery, patients may receive radiation therapy to kill any cells that were not visible to the naked eye.
Because the disease is usually diagnosed in older individuals or can present in more advanced stages, many mesothelioma patients are not able to undergo surgery. Instead, they receive systemic therapies, such as chemotherapy or immunotherapy.
For other treatments, the care teams may recommend targeted therapies or clinical trials with new novel therapies.
Learn more about mesothelioma:
MD Anderson mesothelioma patients can get treatment at the following locations.
Asbestos exposure and cancer: 8 things to know
Most cases of mesothelioma are caused by exposure to a substance called asbestos. This rare cancer develops in the mesothelial cells, the thin layer of tissue that lines the chest cavity and is also known as the pleura.
But what is asbestos? How might you be exposed to it? And, is there anything you should do to lower your risk of developing asbestos-related cancers?
We spoke with Ernest Hawk, M.D., vice president and head of Cancer Prevention and Population Sciences. He’s what he shared.
What is asbestos, and how might the average person be exposed to it?
Asbestos is a group of six naturally occurring mineral fibers that have special properties, such as being fire resistant and good insulators. They are found in certain types of rock and extracted through mining. Their names are:
- Actinolite
- Amosite
- Anthophyllite
- Chrysotile
- Crocidolite
- Tremolite
Until the 1970s, asbestos was used a lot in manufacturing. It could be found in everything from roof shingles and brake pads to flooring and insulation. Once asbestos was identified as a carcinogen, though, government agencies stepped in to start limiting its use. They also developed strict protocols on how materials containing asbestos could be handled, removed and disposed of.
Asbestos exposure is not considered as much of an issue today because its use has declined so much in the past 50 years.
Is there anything I should do to reduce my risk of asbestos exposure?
For the most part, no. Asbestos finds its way inside our bodies primarily through respiration. In other words, we breathe in the fibers and dust when we’re exposed to ore or other materials containing asbestos, and they get caught inside our lungs.
Small amounts of asbestos are still used in some products and industries today. But the average person probably won’t encounter it in high enough concentrations to increase their risk of developing a related cancer.
Prolonged, repeated exposure to asbestos is required for cancer to become an issue. That’s why people who lived or worked close to Ground Zero after the 9/11 World Trade Center attacks are at increased risk. And, anyone involved in the renovation or demolition of older residential or commercial structures could also be exposed to asbestos.
But unless you’re a miner, auto mechanic, roofer or construction laborer who worked in those industries mostly before about 1970, your risk is pretty low.
Which cancers are caused by asbestos exposure?
Mesothelioma is by far the most common. But asbestos exposure has also been linked to lung cancer, laryngeal cancer, ovarian cancer and even some gastrointestinal cancers.
Interestingly, asbestos was a factor in the recent lawsuits linking talcum powder to ovarian cancer, too. I’ve often wondered how something that's primarily inhaled can get so far inside the body. Maybe that connection will someday become clearer.
Are there any warning signs or symptoms of asbestos exposure?
No. That’s one of the challenges. There weren’t any screening tests to look for asbestos-related cancers in otherwise healthy individuals back in the 1970s. There still aren’t today. That’s why these cancers tend to be found in more advanced stages.
How are asbestos-related cancers usually diagnosed?
Mesothelioma and lung cancers caused by asbestos exposure are normally diagnosed with a chest X-ray in someone who complains of shortness of breath, trouble breathing, persistent coughing or other symptoms.
Why does asbestos exposure cause cancer?
There are currently three theories:
- Chronic inflammation
- Changes in cell signaling, or how our cells communicate with one another
- Free radicals, or highly unstable oxygen molecules that can damage cell DNA
But none of these offers a really satisfying explanation. So, it’s still a bit of a mystery.
Are there any unique features to help identify asbestos-related cancers?
No. I’ve seen reports that researchers are exploring potential blood markers. But it’s all still very experimental, so there’s nothing definitive yet. And, there are no distinctive, signature mutations related to asbestos exposure that I know of.
Even when we find actual asbestos particles in a biopsy specimen and can infer that it played a major part in causing a cancer, it doesn’t really influence treatment, as there is no treatment tailored to it.
What’s the most important thing to know about asbestos and cancer?
This is one instance in which government regulation has been really helpful. There’s always a bit of second-guessing involved at the beginning of that process, when you wonder, “Are we overdoing this?”
But there’s no doubt now that asbestos regulation has significantly decreased the incidence of all exposure-related diseases, including cancer. Recognizing the link between asbestos and cancer — and then acting on it by removing the source of exposure — has proven to be a highly effective prevention strategy.
Request an appointment at MD Anderson online or call 1-877-632-6789.
Mesothelioma survivor: Why I support fecal transplant research
When I started immunotherapy for mesothelioma at MD Anderson last year, I wasn’t concerned about colitis as a possible side effect. I was just grateful to have access to the latest treatment option for my disease. I was also relieved that I wouldn’t have to worry about losing my hair due to chemotherapy.
But once I developed colitis, the fecal transplant procedure I had through a clinical trial at MD Anderson is what finally resolved it. And the mesothelioma treatment I received there put the cancer in remission. So, even if I’d known beforehand how hard colitis was going to be, I’d still do it all over again.
My mesothelioma diagnosis
I had no idea I had mesothelioma until I started getting frequent bellyaches in January 2022. I was an educational consultant at the time, so I just figured my job was giving me an ulcer.
When I finally saw a doctor about them, he confirmed that my bellyaches were caused by stress. But the CT scan he’d ordered also showed a cherry tomato-sized tumor on my pleura, the layer of tissue covering the outside of the lungs. There were several smaller tumors there, too. A biopsy of the largest one showed I had stage I mesothelioma. I was shocked.
My mesothelioma treatment
I’ve lived in Atlanta since 2005. But I lived in Houston for 15 years before that. So, there was never any question about where I would go for my mesothelioma treatment. MD Anderson had already treated me once successfully for breast cancer five years earlier. So, that’s where I was going.
I met first with thoracic oncologist Dr. Frank Fossella. He recommended six infusions of two immunotherapy drugs: ipilimumab and nivolumab. The first infusion went fine. But after the second one, I developed terrible colitis, which is inflammation of the digestive tract.
For me, that meant severe and chronic diarrhea. I had to switch to radiation therapy for the remainder of my mesothelioma treatment. I had three weeks of it under radiation oncologist Dr. Zhongxing Liao, five days a week.
Colitis made me afraid to leave the house
Colitis is terribly debilitating. I was running to the bathroom eight to 12 times a day and still wearing pantyliners as a precaution. I didn’t dare pass gas outside of a bathroom. And I certainly couldn’t go out to eat or to a play or a symphony. Everything I ate just ran right through me. I lost 30 pounds.
Fortunately, my friends were very understanding. They were really good about coming over and bringing lunch with them. But colitis still interfered tremendously with my life. I was always worried about it. Having colitis makes you agoraphobic, or afraid to leave the house.
Why I joined a fecal transplant clinical trial at MD Anderson
My first gastroenterologist at MD Anderson, Dr. Anam Khan, tried two immunosuppressive drugs plus steroids to cure my colitis. Neither of them worked long-term. So, she referred me to her colleague, Dr. Yinghong “Mimi” Wang.
At the time, the Food and Drug Administration (FDA) had already approved fecal transplants to treat patients with recurrent C. diff infection. But Dr. Wang was conducting a clinical trial especially for patients like me. Her goal was to see if fecal transplants could be equally effective in patients whose colitis was caused by immunotherapy.
I know the idea of a fecal transplant is kind of gross. But the prospect of getting a better gut biome was extremely appealing, especially since I’d had colitis for eight months by then. After dealing with unrelenting diarrhea for that long, I was more than willing to give it a try. Thank goodness I did. It turned out to be a game-changer.
Dr. Wang performed the fecal transplant on Oct. 5, 2022. It took about four weeks for things to settle down. But when I had my first normal bowel movement last year, I felt like a new parent when their toddler uses the potty for the first time. I was ecstatic. Even better was the news I got in December from Dr. Fossella. He told me that I was in remission.
Why I support research at MD Anderson
The optimism and positive attitude of MD Anderson’s faculty and staff help set the tone for its patients. And the care they provide there is truly second-to-none. That’s why I’m personally donating to support Dr. Wang’s fecal transplant research — so she can help other patients like me with immunotherapy-induced colitis.
Compared to what some people can donate, my contribution is pretty small. But I still want to honor Dr. Fossella, Dr. Wang, Dr. Liao and their wonderful assistants for all they’ve done to restore me to health.
Dr. Wang’s research assistant in particular has been remarkable. Krishna Varatharajalu called to check on me every day after the fecal transplant, then every week after my colitis resolved. She even calls me now from time to time, just to make sure I’m still doing well. So, it was important to me to acknowledge their care and expertise with more than just a “thank you.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.