A diagnosis of mesothelioma feels gut-wrenching for anyone who has ever experienced it. For the uninitiated, mesothelioma is an often fatal type of cancer caused by prolonged exposure to asbestos.
It takes decades for symptoms to appear, but, once they do, the disease has usually spread too far for any curative treatments to be viable. Still, there is a cavalcade of mesothelioma treatments and more are being developed by the day.
In general, however, treatment options are palliative. Mesothelioma life expectancy is short with most patients surviving just a year or two after diagnosis. With no treatment whatsoever, most patients survive between 4 and 6 months. There is no known cure for mesothelioma, but certain treatments can slow down the progression of the disease.
- Radiation therapy
Patients have the best outcomes when they opt for a mix of all three of these treatments. When the disease is caught in its early stages, the prognoses are even better. This three-pronged approach is known as multimodal therapy.
It usually involves subsets of treatment options:
- Neoadjuvant – treatment (often chemotherapy or radiation therapy) delivered prior to primary treatment to reduce the size of the tumor or make later treatments easier
- Primary – treatment (usually surgery) administered as the main method for combating mesothelioma
- Adjuvant – treatment (commonly chemotherapy) applied to reduce symptoms and ward off recurrence
Treatment options differ depending on the location type of the disease. The types are pleural (found in the lining of the lungs), peritoneal (found in the lining of the abdominal cavity), and pericardial (found in the lining of the heart).
Let’s delve a little more into the treatment methods for mesothelioma.
Surgery is by far the most effective curative treatment available for mesothelioma, particularly if the disease is caught in the early stages. Even so, some surgical options are merely palliative to provide patients with a better quality of life.
Other surgeries are diagnostic and performed in order to examine an area of the body or retrieve tissue samples for a biopsy. A thoracoscopy, for example, is used to examine the lining of the lungs or abdomen to look for signs of possible mesothelioma. This particular procedure uses a fiber optic camera to help doctors identify issues like inflammation or fluid buildup.
There are numerous other types of surgery available to patients, as well. The most invasive often include the removal of one or more organs, tumors, and/or tissues.
These surgeries include:
- Pneumonectomy (involves the removal of a cancerous lung)
- Extrapleural pneumonectomy (involves the removal of a lung along with portions of the chest and heart lining and, sometimes, the diaphragm and lymph nodes)
- Pleurectomy / Decortication (involves the removal of the lung lining and nearby tumors but not the lung itself)
- Peritonectomy and cytoreductive surgery (involves the removal of a portion of the abdominal lining while also reducing cancerous growths throughout the abdomen)
- Pericardiectomy (involves the removal of the lining of the heart, known as the pericardium)
Not all of these surgeries will be performed with curative intentions. For instance, a pericardiectomy can often be performed to reduce symptoms like pericarditis, fluid buildup, difficulty breathing, and heart palpitations. This is sometimes a palliative measure meant only to improve the patient’s quality of life.
Even so, all of these “removal” surgeries can be performed with curative goals in mind given the right circumstances. Not every mesothelioma patient is a good candidate for a major surgery of this variety. In some cases, a surgery like this could actually do more harm than good. It is also sometimes difficult for doctors to accurately identify which patients qualify for these surgeries.
A newer method, known as robotic surgery, has come into play in recent years that allows doctors and surgeons to make a more informed judgment on which patients a major surgery will help. Robotic surgery is essentially an upgraded version of a thoracoscopy (more specifically, a video-assisted thoracoscopic surgery, or VATS).
It allows surgeons to view the interior of the patient’s body with a magnified 3-dimensional view, while also making more precise incisions and movements with the use of small-scale robotic “hands.” Unfortunately, this option isn’t widely available at the moment, but it’s only a matter of time before it becomes the new standard in mesothelioma surgeries.
Other, less invasive surgical options are also available for some patients. These involve the removal of built-up fluid (or, effusion) using a hollow needle and include:
- Pleurodesis (removes fluid buildup in the pleura or lining of the lungs and prevents more fluid from building up in the future)
- Thoracentesis or Pleurocentesis (removes fluid buildup in the pleura)
- Paracentesis (removes excess fluid from the abdominal cavity)
- Pericardiocentesis (removes fluid buildup in the heart sac)
These procedures serve a dual purpose as they can be used both for symptom relief and as a diagnostic tool. Obviously, removing built-up fluid can alleviate symptoms like difficulty breathing and chest or abdominal pain. Pathologists can also use the fluid to identify why the buildup is occurring.
Unfortunately, these “fluid removal” surgeries are usually palliative treatments for mesothelioma. They are performed as a way to alleviate pain and improve the patient’s quality of life.
Pleurodesis is the most prominent example of palliative treatment, because it not only drains fluid buildup, it also gets rid of the pleural space to ensure that the buildup won’t return. Some patients who only have months to live opt for these palliative treatments to avoid the discomfort and long recovery times of more invasive procedures.
Recovery times are obviously different for major organ or tumor removal surgeries than they are for procedures that remove fluid buildup. You can usually expect several weeks of recovery time in a hospital after completion of major surgery. Recovery after an extrapleural pneumonectomy averages about 6 to 8 weeks and can sometimes last for months, however.
For surgeries that remove fluid buildup, hospital stays are generally no more than a day or two. The only outlier to this is the pleurodesis, which can take as long as a week to recover from.
Chemotherapy treatment for mesothelioma involves taking medications that can help attack cancer cells and mitigate the growth of tumors in the body. It is one of the most common mesothelioma treatments, with 70% of patients opting to engage in some form of therapy. Chemotherapy is often used in conjunction with other therapies like surgery and radiation. It can be used as neoadjuvant therapy to reduce tumor size prior to surgery and as an adjuvant therapy to avoid recurrence of the disease.
There are two primary ways that chemotherapy is administered: systemic and intraoperative. Systemic chemotherapy is the most common method and involves medication entering the bloodstream and traveling throughout the body. Patients are either given drugs intravenously through an IV or through a pill. Pills, however, are usually only administered during clinical trials and not during regular hospital treatment sessions.
For IV treatments, patients typically go to a hospital every few weeks to get a new round of medication injected into their bloodstream. More often than not, a “cocktail” of drugs is used to produce the best results. Multiple cycles of different chemotherapeutic combinations are often used to attack cancerous cells aggressively. This is referred to as first-line, second-line, and third-line (and so forth) chemotherapy.
The most common drugs include:
- Pemetrexed (Alimta) – This is the most common mesothelioma chemotherapy medication. It is frequently used with cisplatin and often requires corticosteroids and vitamin supplements to avoid negative side effects.
- Cisplatin – Another common mesothelioma drug, cisplatin is platinum-based and often used with pemetrexed. Doctors often prescribe it when tumors cannot be surgically removed.
- Carboplatin – This is similar to cisplatin, but it has fewer side effects. It can, however, obstruct blood cell production which can lead to excessive tiredness and a higher risk of infection.
- Gemcitabine (Gemzar) – Often used as a second-line treatment in conjunction with carboplatin, gemcitabine was originally used to treat bladder, ovarian, and lung cancers.
- Vinorelbine (Navelbine) – This medication is known to produce cell death in cancer cells and has had moderate effectiveness in treating mesothelioma.
- Ranpirnase (Onconase) – This breaks down the RNA in mesothelioma cells while also avoiding the elimination of healthy cells and thereby producing fewer side effects.
- Raltitrexed (Tomoduex) – Typically used to treat colorectal cancer, raltitrexed works by attacking the cancer cell’s DNA. It has shown some efficacy with mesothelioma when other drugs didn’t work.
Some of these drugs prove effective for certain patients while others show limited results. It all depends on the patient’s individual immune response.
The other method for receiving chemotherapy drugs, intraoperative, involves heating medications to up to 105 degrees Fahrenheit and injecting them straight into the tumor site. The two types of this therapy are Heated Intraperitoneal Chemotherapy (HIPEC) for peritoneal mesothelioma and Hyperthermic Intrathoracic Chemotherapy (HITHOC) for pleural mesothelioma.
Both are used during and in conjunction with major surgery. HIPEC is used with cytoreductive surgery while HITHOC is used with most tumor-removal surgeries. HIPEC has shown great efficacy for improving survival rates.
Of course, chemotherapy is not without its cons. Most people know that undergoing a chemotherapy treatment regimen is sure way to experience nausea, vomiting, hair loss, and other unfortunate side effects as a result of the treatment targeting all cells, including healthy ones.
Another side effect is known as “chemo brain” that impairs memory, concentration, and the patient’s ability to multitask. Leading a healthy lifestyle with a good diet and moderate exercise can help improve these symptoms.
Radiation therapy has been a staple of cancer treatments for decades. It works particularly well with mesothelioma because of its ability to target cells that replicate quickly. Of course, radiation does not provide a cure for mesothelioma, but it can help in a variety of ways.
It is typically used for:
- Seeding prevention – Cancer cells can be displaced during surgical procedures. Radiation therapy prevents those cells from “seeding” and proliferating in new areas.
- Improving life expectancy – A combination of surgery, chemotherapy, and radiation therapy can help extend life spans by 3 to 5 years.
- Relieving pain – Radiation therapy can also be used a palliative measure to decrease tumor size which will reduce pain.
There are two basic types of radiation therapy: external and internal. The most common type is external and, more specifically, external beam radiation. This therapy works by essentially sending a beam of radiation through the skin to the affected area. Doctors can control where the beam is focused so as to limit damage to healthy cells. Despite this, patients do receive some radiation on their skin and muscles.
Other types of external radiation include three-dimensional conformal radiation therapy (3D-CRT), and intensity modulated radiation therapy (IMRT). With 3D-CRT radiation, doctors can look at a three-dimensional representation of the body rather than the standard 2D of external beam radiation. Higher doses of radiation can be utilized with this method because the beam is more precise.
IMRT is similar to 3D-CRT in that it is more precise and can send higher doses of radiation to the affected area. It can also send different doses of radiation to different locations on the body at the same time. For instance, a large tumor can receive an intense beam of ionizing radiation while a minor cluster of mesothelioma cells gets a beam of lower intensity.
Internal radiation therapy, or brachytherapy, takes a different approach. Rather than beaming the radiation in from the outside, doctors implant irradiated seeds or pellets into the mesothelioma tissue. This option is generally reserved for patients whose tumors are located in a position that external radiation can’t reach. It can also be either temporary or permanent.
Side effects are similar to those of chemotherapy because of possible damage to healthy tissue and cells. In general, however, the negative aspects of radiation are far better than those of chemotherapy.
Side effects include:
- Decrease in white blood cells, leading to increased risk of infection
- Appetite loss
- Dry mouth
Finding a Cure
Long-term mesothelioma life expectancy is still not great. After decades of research, patients are considered fairly lucky if they make it two years after their original diagnosis. Even so, doctors and researchers are always looking for better mesothelioma treatment options that will eventually lead to a cure.
At present, researchers are working toward refining current treatments and introducing new ones. For instance, new chemotherapy drugs are always in the works, and surgical procedures and methods are always being updated and enhanced.
Newer treatment options like immunotherapy (drugs or other treatments that activate or suppress an immune response) and gene therapy (the practice of manipulating genes to treat or even prevent disease) are also showing promising results.
Clinical trials represent the best hope for finding a cure for mesothelioma. These trials offer patients new and experimental medications and treatments that could ultimately end the suffering caused by mesothelioma as we know it.
Still, there are always obstacles. Mesothelioma is a difficult disease to understand because it mimics so many other common diseases. It’s rarely caught in the early stages when it would be most advantageous for researchers to study it.
Patients are regularly diagnosed with stage 3 or stage 4 mesothelioma, usually making them unfit for clinical studies. Despite this, it’s only a matter of time before mesothelioma is a thing of the past.
One of the best hopes for finding a mesothelioma cure comes from emerging treatments. In some cases, these treatment options aren’t explicitly being researched or designed for mesothelioma, but their efficacy could extend to the disease. Many different types of cancer share the same characteristics, so it is not out of the question for certain treatments to apply to a wide range of the disease’s forms.
Common emerging therapies include:
- Gene therapy
- p53 gene therapy
- Photodynamic therapy
- Epigenetic therapy
Immunotherapy is probably the most well-known emerging treatment for many diseases. The most common immunotherapeutic treatments are in a class called “checkpoint inhibitors.” These medications help trigger an immune response so that immune cells will attack cancerous cells rather than ignore them. Both Keytruda and Opdivo are checkpoint inhibitors that have been approved for use in other cancers and are being tested with mesothelioma.
Gene therapy is another emerging treatment, although less is known about its effect on cancer. Gene therapy trials with cancer have been ongoing for less than 20 years, and gene therapy trials of any kind haven’t been around for much longer. Essentially, gene therapy’s goal is to introduce new, healthy genes to a body that are designed to fix cancerous mutations. One gene, p53, is known tumor-suppressant that researchers are trying to enhance for use in gene therapy.
Photodynamic therapy is a unique treatment option that combines a medication dubbed a “photosynthesizing agent” with a beam of light at a precise wavelength to produce a reaction in cancerous cells. It has already shown promise as a treatment for mesothelioma among other diseases.
Virotherapy is the practice of unleashing cancer-killing viruses in a patient’s system while cryotherapy employs the use of extremely cold temperatures to weaken cancer cells. Epigenetic theory looks to make alterations to an individual’s epigenome (or, their DNA’s log of chemical changes).
Most of these emerging treatments require patients to enroll in clinical trials. But, they can all prove to be quite valuable to the long-term mesothelioma prognosis.
Treatments that are outside of the mainstream medical world are often considered the alternative. Most doctors prefer the term “complementary treatments” to “alternative treatments,” however. This is because the word “alternative” implies that there are other, viable options outside of standard or emerging mesothelioma treatments. Unfortunately, this is not the case. Trying to beat mesothelioma without the help of modern medicine is a losing battle.
If, however, you think of alternative treatments as complementary to standard and emerging ones, then you can experience some benefits. There is a wide range of alternative treatments that provide many mesothelioma patients with emotional calm and relief from pain.
The most obvious “alternative” treatment is simply maintaining a healthy diet. Many oncologists advocate for specific diets for those with mesothelioma and other cancers. These diets can help alleviate nausea, pain, and difficulty swallowing. Herbal remedies can also be incorporated into your diet. Herbs have found their way into medicines for millennia. Medical cannabis is just one example.
When you’re going through cancer treatment, it’s important not to neglect your mental and emotional wellbeing. Activities that engage both your body and mind are particularly helpful.
Some of these include:
- Support groups
- Mental health counseling and therapy
- Music and sound therapy
- Pet therapy
There are also a variety of holistic treatments that focus not on the illness but on the individual as a whole. These methods often incorporate the whole body cleanses, healthy eating, herbal medicine, lifestyle changes, and a focus on natural rather than pharmaceutical treatments.
Some holistic health alternatives include:
- Traditional Chinese medicine
- Osteopathic medicine
- Naturopathic medicine
Again, none of these alternative treatments should be considered a substitute for scientifically proven modern medicine. But, when used in conjunction with standard treatments, these can prove to be uniquely helpful.
Pain is an unfortunate part of any mesothelioma diagnosis. The disease causes a variety of symptoms depending on the location. Fluid buildup in pleural mesothelioma produces chest pain and difficulty breathing. That same fluid buildup in peritoneal mesothelioma restricts the abdomen’s natural movement, causing bowel issues, nausea, and a lack of appetite. Tumors can also cause a great amount of pain just by being foreign objects in a place they shouldn’t be.
Palliative treatments are often administered to mitigate these symptoms. Doctors can prescribe surgery, chemotherapy, and/or radiation specifically to reduce pain and discomfort. Of course, these treatment options come with their own set of side effects. For instance, chemotherapy and radiation are known to cause nausea and fatigue because they can kill healthy cells as well as cancerous ones. To combat this, doctors will often prescribe vitamin B12, vitamin B9, and folic acid to rejuvenate the body.
As the disease progresses and the pain becomes more extreme, doctors will likely begin prescribing stronger painkillers. In some cases, patients will be given anti-anxiety medications like Xanax to keep their minds calm. If you or a loved one is suffering from mesothelioma pain, consider seeking out some alternative treatments, as well.
The unfortunate thing about any major disease is that it’s going to cost money to get treatment. For mesothelioma, those costs can start to add up quickly. No one really wants to think about money after a mesothelioma diagnosis, because the diagnosis itself can be devastating. But, it’s not unheard of for treatment costs to rise as high as a million dollars or more.
Treatment costs are different for every patient, however. Not every patient is going to have the same treatments, and some hospitals may offer a different pricing structure than another. The primary cost of any mesothelioma treatment includes diagnostics and actual therapies to treat the disease.
Costs can include:
- CT scan ($400 to $800)
- MRI (up to $1,600)
- PET scan ($2000 to $2800)
- Needle biopsy ($500 to $700)
- Thoracoscopy/Laparoscopy ($3,500 to $5,000)
- HIPEC ($700 to $1,200)
- Radiation therapy ($7,000 to $12,000)
- Surgeries like pneumonectomy or peritonectomy ($13,000 to $30,000)
- Chemotherapy ($35,000 to $50,000 per course)
These are just the primary diagnostic and therapeutic costs for mesothelioma. It does not take into account the price tag for staying in the hospital for weeks after surgery, blood tests, palliative medications, other prescriptions, travel time, lost wages from lack of work, credit card interest, follow-up care, and numerous other secondary costs.
If you’re lucky enough to have a good health insurance plan, then your provider will cover at least a portion of these costs. Of course, each provider has different rules and restrictions on what they’ll cover. Before a diagnosis, you can also opt for something called “cancer insurance” that will cover many of your expenses if you do end up getting diagnosed. Another way to lower costs is by negotiating with medical institutions or asking for grants of some kind.
Some individuals may qualify for VA benefits or government-assisted programs like Medicaid or Medicare. You can also enroll in clinical trials and get some of your care covered by researchers. This option also allows you to test out new, potentially effective treatments.
Because mesothelioma is caused by exposure to asbestos and most producers of asbestos were negligent in their use of the substance, many mesothelioma patients can actually seek out a settlement to cover their medical expenses. While a settlement may not get all of your bills covered, it will still provide some financial relief.
Researchers are devising new drugs and treatment options all the time, but they need subjects to test those treatments on. Clinical trials essentially grant them that opportunity. They can also be a great way for mesothelioma patients to get free or low-cost medical care while also trying out new and experimental treatments for the disease.
Clinical trials are generally considered a win-win for both patients and researchers. The care you will receive is generally high-class as the sponsoring institutions are often well-funded government programs, universities, or pharmaceutical companies. In some cases, your insurance will cover all expenses associated with the clinical trial. The sponsoring institution may also cover some of those expenses.
To enroll in a clinical trial, talk to your doctor or local cancer center to see if any clinical trials are currently in the recruitment phase. Many trials have specific requirements for eligibility.
These often include:
- The patient’s overall health
- Type and stage of the disease
- The existence of any other medical conditions
- Past treatment history of the patient
If you are accepted, you will then be provided with treatment that will include the therapy being researched and other treatment options. As with anything, there are risks involved with this. Some new treatments have never been tested before. These are usually referred to as Phase I trials. Phase IV trials, on the other hand, have been tested thoroughly and are on the cusp of FDA approval.
Research into mesothelioma is always ongoing. A cure is always on the horizon even if we can’t quite see it yet. Mesothelioma was first identified in 1920, and the primary method of treatment involved complex surgeries to remove the lungs. In the 1960s, mesothelioma’s relationship to asbestos was first publicized.
In the 2000s, treatment options expanded to include radiation therapy and chemotherapy. The combination of pemetrexed and cisplatin (the most common chemotherapy treatment now) was introduced in 2004.
There are a variety of options available to patients with the disease and more are coming every day. Whether it’s early detection through biomarkers or the advent of immunotherapy treatments, mesothelioma research is at its most advanced now than ever before.