Treatment of malignant mesothelioma (PDQ®) -Version for patients

General information about Treatment of malignant mesothelioma (PDQ®) -Version for patients

IMPORTANT POINTS

  • Malignant mesothelioma is a disease in which malignant (cancerous) cells form in the lining of the chest or abdomen.
  • Exposure to asbestos (asbestos) influences the risk of malignant mesothelioma.
  • The signs and symptoms of malignant mesothelioma include shortness of breath and pain below the ribs.
  • To detect and diagnose malignant mesothelioma, to examine the inside of the chest and abdomen.
  • Certain factors affect the prognosis (probability of recovery) and treatment options.

The Malignant mesothelioma is a disease in which malignant (cancerous) cells form in the lining of the chest or abdomen.

In Malignant mesothelioma disease in which malignant cells found in the pleura (a thin layer of tissue that lines the chest cavity and lines the lungs) or the peritoneum (thin layer of tissue that lines the abdomen and covers most of their organs). Malignant mesothelioma formed in the heart or testicles, but this is very rare.

Image result for malignant mesothelioma

Exposure to asbestos (asbestos) influences the risk of malignant mesothelioma.

Risk factor is Anything which increases the likelihood of having a disease. The presence of a risk factor does not mean that you will get cancer, But the absence of risk factors does not mean that you will not get cancer. Check with your doctor if you think you are at risk.

But the absence of risk factors does not mean that you will not get cancer. Check with your doctor if you think you are at risk.

Most people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After exposure to asbestos, it usually takes a long time for malignant mesothelioma to form. Living next to a person who works near asbestos is also a risk factor for malignant mesothelioma.

The signs and symptoms of malignant mesothelioma include shortness of breath and pain below the ribs.
Sometimes cancer causes fluid to build up in the chest or abdomen. Signs and symptoms occur because of fluid, malignant mesothelioma or other conditions. Check with your doctor if you have any of the following signs or symptoms:

  • Difficulty breathing.
  • Cough.
  • Pain under the ribs.
  • Pain or swelling in the abdomen.
  • Masses in the abdomen.
  • Constipation.
  • Problems with blood clots (unexpected clots)
  • Weight loss without known reason.
  • Feeling very tired.

To detect and diagnose malignant mesothelioma, to examine the inside of the chest and abdomen.

It is difficult to differentiate a malignant mesothelioma found in the thorax of a lung cancer in some cases.

Diagnose a malignant mesothelioma of the thorax or peritoneum,

Use the following tests and procedures:

  • Physical examination and history: body exam to check the general state of health and identify any signs of disease, such as masses or anything else that seems abnormal. Collected Data are also on health habits, exposure to asbestos, history of diseases and previous treatments.
  • The X-ray of the thorax: X-ray of the organs and bones inside the thorax. X-ray is type of energy beam that pass through the body and reflected in a film that shows an image of areas inside the body.
  • Computed tomography (CT) scan: a procedure that takes a series of detailed images of the chest and abdomen, from different angles. Images created with a computer connected to an x-ray machine. Dye injected into a vein or swallowed so that the organs or tissues stand out more clearly. The procedure called computed tomography, computerized axial tomography (CAT) or CT scan.
  • Biopsy: removal of cells or tissues from the pleura or peritoneum for a pathologist to observe under a microscope and determine if there are signs of cancer.

The procedures used to collect cells or tissues are the following:

  • Lung biopsy by fine needle aspiration (FNA): removal of tissue or fluid using a fine needle. Imaging procedure used to find abnormal tissue or fluid in the lung.
  • Thoracoscopy: A procedure in which an incision (cut) is made between two ribs and a thoracoscope is inserted into the thorax (a thin tube-shaped instrument with a light and a lens to observe).
  • Thoracotomy: A procedure in which an incision (cut) is made between two ribs to determine if there are signs of disease inside the chest.
  • Peritoneoscopy: a procedure in which an incision (cut) is made in the wall of the abdomen and a peritoneoscope (a thin tube-shaped instrument with a light and a lens to be observed) is inserted into the abdomen.
  • Open biopsy: A procedure in which an incision (cut) is made in the skin that allows you to see and remove tissues to determine if there are signs of disease.
The following tests may be done on cell and tissue samples:
  • Cytological examination: examination of the cells under a microscope to determine if something is abnormal. For mesothelioma, fluid is removed from the chest or abdomen. A pathologist examines the fluid to determine if there are signs of cancer.
  • Immunohistochemical test: test to identify certain antigens in a tissue sample by the use of antibodies. Usually, the antibody binds to a radioactive substance or a dye so that the cells light up under the microscope. This type of study is used to determine the difference between different types of cancer.
  • Electron microscopy: laboratory test by which the cells of a tissue sample are observed with a high power microscope to detect certain changes in the cells. With an electron microscope, small details are better than when using another type of microscope.

Certain factors affect the prognosis (probability of recovery) and treatment options.

The prognosis (probability of recovery) and treatment options depend on the following aspects:

  • The stage of cancer.
  • The size of the tumor
  • If it is possible to remove the tumor completely by surgery.
  • The amount of fluid in the chest or abdomen.
  • The age of the patient
  • The degree of activity of the patient.
  • The general state of health of the patient, such as the health of the lungs and the heart.
  • The type of mesothelioma cells and their appearance under a microscope.
  • The number of white blood cells and the amount of hemoglobin in the blood.
  • If the patient is male or female.
  • If the cancer was recently diagnosed or relapsed (returned).

Stages of malignant mesothelioma

IMPORTANT POINTS

  • After diagnosing malignant mesothelioma, tests are done to determine if cancer cells have spread to other parts of the body.
  • Cancer spreads in the body in three ways.
  • It is possible for the cancer to spread from where it started to other parts of the body.
  • The following stages are used for malignant lung mesothelioma:
  • one – Stage I
  • Two – Stage II
  • Three – Stage III
  • Four – Stage IV

After diagnosing malignant mesothelioma, tests are done to determine if cancer cells have spread to other parts of the body.

The process used to determine if the cancer has spread outside the pleura or peritoneum is called staging. The information obtained from the staging process determines the stage of the disease. It is important to know if the cancer has spread to plan the treatment.

The following tests and procedures may be used during the staging process:

  • Computed tomography (CT) scan: a procedure that takes a series of detailed images of the chest and abdomen, from different angles. The images are created with a computer connected to an x-ray machine. A dye is injected into a vein or swallowed so that the organs or tissues stand out more clearly. This procedure is also called computerized tomography, computerized axial tomography, or CT scan.
  • Positron emission tomography (PET) scan: procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and creates an image of the places in the body that use glucose. Malignant tumor cells look brighter in the image because they are more active and absorb more glucose than normal cells.
  • Magnetic resonance imaging (MRI): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed images of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI).
  • Endoscopic ultrasound (EE): procedure for which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens to observe. A probe placed at the end of the endoscope is used to bounce high-energy (ultrasonic) sound waves off tissues or internal organs, and create echoes The echoes form an image of the tissues of the body called an echogram. This procedure is also called endoechography. EE also serves to guide fine needle aspiration (FNA) biopsy in the lung, lymph nodes, or other areas.
  • Laparoscopy: surgical procedure to observe the organs inside the abdomen and determine if there are signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. It is possible to introduce other instruments in the same incision or in other incisions to perform procedures such as removing organs or extracting tissue samples for observation under a microscope and checking for signs of disease.
  • Lymph node biopsy: total or partial removal of a lymph node. A pathologist observes the tissue of the lymph node under a microscope to detect cancer cells.
  • Mediastinoscopy: surgical procedure to check for abnormal areas in the organs, tissues, and lymph nodes between the lungs. An incision (cut) is made in the upper part of the sternum and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens to observe. Sometimes you have a tool to remove tissue samples or lymph nodes, which are seen under a microscope to check for signs of cancer.

Cancer spreads in the body in three ways.

Cancer can spread through the tissue, lymph system and blood:
  • Tissue. Cancer spreads from where it started and extends into nearby areas.
  • Lymphatic system. Cancer spreads from where it started and enters the lymphatic system. The cancer travels through the lymphatic vessels to other parts of the body.
  • Blood. Cancer spreads from where it started and enters the blood. The cancer travels through the blood vessels to other parts of the body.
It is possible for the cancer to spread from where it started to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they originated (the primary tumor) and move through the lymphatic system or blood.

  • Lymphatic system. Cancer penetrates the lymphatic system, travels through the lymphatic vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. Cancer penetrates the blood, travels through blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if malignant mesothelioma spreads to the brain, the cancer cells in the brain are, in reality, malignant mesothelioma cells. The disease is malignant metastatic mesothelioma, not brain cancer.

The following stages are used for malignant lung mesothelioma:

Stage I
Stage I is divided into stages IA and IB:
  • In stage IA, cancer is found in the inner lining of the chest wall on one side of the chest. On the same side of the thorax, cancer may also be found in one or more of the following sites:
    • The thin layer of tissue that lines the lung.
    • A thin layer of tissue that lines the organs between the lungs.
    • Thin layer of tissue that lines the upper part of the diaphragm.
  • In stage IB, the cancer is found in the inner lining of the chest wall and in each of the thin layers of tissue that line the lung, the organs that are between the lungs, and the upper part of the diaphragm on one side of the lung. chest. On the same side of the thorax, the cancer also spread to one or more of the following sites:
    • Diaphragm.
    • Lung tissue
    • The tissue between the ribs and the inner lining of the chest wall.
    • The fat between the lungs.
    • The soft tissues of the chest wall.
    • The bag that surrounds the heart.
Stage II

In stage II, cancer is found in the inner lining of the chest wall on one side of the chest. On the same side of the thorax, cancer may also be found in one or more of the following sites:

  • Some thin layer of tissue that lines the lung.
  • Your thin layer of tissue that lines the organs between the lungs.
  • And thin layer of tissue that lines the upper part of the diaphragm.

The cancer spread to the lymph nodes along the center of the chest on the same side as the tumor.

or

The cancer is found in the inner lining of the chest wall and in each of the thin layers of tissue lining the lung, the organs between the lungs, and the upper part of the diaphragm on one side of the chest. On the same side of the chest, the cancer also spread to one or both of the following sites:

  • Diaphragm.
  • Lung tissue

The cancer spread to the lymph nodes along the center of the chest on the same side as the tumor.

Stage III

Stage III is divided into stages IIIA and IIIB.
  • In stage IIIA, cancer is found in the inner lining of the chest wall and in each of the thin layers of tissue lining the lung, the organs between the lungs, and the upper part of the diaphragm on one side of the lung. chest. On the same side of the thorax, the cancer also spread to one or more of the following sites:
    • The tissue between the ribs and the inner lining of the chest wall.
    • The fat between the lungs.
    • The soft tissues of the chest wall.
    • The bag that surrounds the heart.

The cancer spread to the lymph nodes along the center of the chest on the same side as the tumor.

  • In stage IIIB, cancer is found in the inner lining of the chest wall and may also be found in the thin layers of tissue lining the lung, the organs between the lungs, or the upper part of the diaphragm. one side of the thorax On the same side of the chest, it is possible that the cancer has also spread to one or more of the following sites:
    • Diaphragm.
    • Lung tissue
    • The tissue between the ribs and the inner lining of the chest wall.
    • The fat between the lungs.
    • The soft tissues of the chest wall.
    • The bag that surrounds the heart.

The cancer has spread to the lymph nodes that are above the clavicle on either side of the chest, or the cancer has spread to the lymph nodes along the center of the thorax on the side opposite the tumor.

or

The cancer is found in the inner lining of the chest wall and in each of the thin layers of tissue lining the lung, the organs between the lungs, and the upper part of the diaphragm on one side of the chest. The cancer also spread to one or more of the following sites:

  • The chest wall and sometimes the ribs.
  • Through the diaphragm to the peritoneum.
  • The tissue that lines the thorax on the side of the body opposite the tumor.
  • The organs that are between the lungs (esophagus, trachea, thymus, blood vessels).
  • Spinal column.
  • For the bag that surrounds the heart to the heart muscle.

It is possible that the cancer has spread to the lymph nodes.

Stage IV

In stage IV, the cancer has spread to the tissue lining the lung or lung on the opposite side, the peritoneum, bones, liver, lymph nodes outside the chest, or to other parts of the body.

Recurrent Malignant Mesothelioma

Recurrent malignant mesothelioma is cancer that has recurred (come back) after treatment. Cancer returns to the chest, abdomen or other parts of the body.

General aspects of treatment options
IMPORTANT POINTS

  • There are different types of treatment for malignant mesothelioma patients.
  • Four types of standard treatment are used:
    • Surgery
    • Radiotherapy
    • Chemotherapy
    • Directed therapy
  • New types of treatment are being tested in clinical trials.
    • Biological therapy
  • Sometimes, the treatment of malignant mesothelioma causes side effects.
  • Patients could consider participation in a clinical trial.
  • Patients can enter clinical trials before, during or after beginning their treatment for cancer.
  • Sometimes follow-up tests are needed.
There are different types of treatment available for malignant mesothelioma patients.

Some treatments are standard (treatment currently used) and others are being tested in clinical trials. A clinical trial of treatment is a research study in order to improve current treatments or obtain information about new treatments for cancer patients. When clinical trials show that a new treatment is better than standard treatment, it is possible that the new treatment becomes the standard treatment. Patients could consider participation in a clinical trial. In some clinical trials only patients who have not received treatment are accepted.

Four types of standard treatment are used:
Surgery
The following surgical procedures are used for malignant thoracic mesothelioma:
  • Pleurectomy and decortication: surgery to remove part of the tissue that lines the lungs, the lining of the chest and the part of the outer surface of the lungs.
  • Extrapleural pneumonectomy: surgery to remove an entire lung and part of the lining of the chest, the diaphragm, and the lining of the pouch that surrounds the heart.
  • Pleurodesis: surgical procedure for which chemical substances or drugs are used to form a scar in the space between the layers of the pleura. First the fluid is removed from the space with a catheter or chest tube and then the chemical or medication is placed in that space. The scarring stops the accumulation of fluid in the pleural cavity.

After the doctor removes all visible cancer at the time of surgery, some patients may receive chemotherapy or radiation therapy to kill any remaining cancer cells. The treatment that is given after surgery to decrease the risk of the cancer coming back is called adjuvant therapy.

Radiotherapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy.

  • External radiotherapy: type of radiation therapy for which a machine is used that sends radiation to the cancer from outside the body.
  • Internal radiation therapy: A type of radiation therapy that uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

How radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat malignant mesothelioma and is also sometimes used as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy

Chemotherapy is a cancer treatment in which drugs are used to stop the formation of cancer cells, either by destroying them or by preventing their multiplication. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the chest or peritoneum, the drugs mostly affect the cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one cancer drug.

Hyperthermic intraperitoneal chemotherapy is used to treat mesothelioma that has spread to the peritoneum (tissue that lines the abdomen and lines most organs of the abdomen). After the surgeon removes all visible cancer, a solution containing anticancer drugs is used that is heated and pumped into and out of the abdomen to kill the remaining cancer cells. When cancer medicines are heated, more cancer cells are destroyed.

How the chemotherapy is given depends on the type and stage of the cancer being treated.

For more information in English, see the link Drugs Approved for Malignant Mesothelioma (Medications approved for malignant mesothelioma).

Directed therapy

Targeted therapy is a type of treatment for which drugs or other substances are used to attack specific cancer cells. In general, targeted therapies produce less damage in normal cells than chemotherapy or radiation therapy.

Monoclonal antibody therapy is a cancer treatment for which antibodies produced in the laboratory are used from a single cell type of the immune system. These antibodies identify substances in cancer cells or normal substances that help cancer cells multiply. Antibodies adhere to these substances and destroy cancer cells, block their multiplication or prevent them from spreading. The monoclonal antibodies are administered by infusion. They are used alone or to carry medicines, toxins or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody that is used for the treatment of advanced mesothelioma. It binds to a protein called vascular endothelial growth factor (VEGF). It is possible that this antibody prevents the growth of new blood vessels that tumors need to grow. Other monoclonal antibodies are also studied to treat malignant mesothelioma.

Kinase inhibitors are a type of targeted therapy that is studied for the treatment of malignant mesothelioma. Kinase inhibitors are targeted therapy drugs that interrupt the signals that cause tumors to grow.

New types of treatment are being tested in clinical trials.
This section of the summary describes treatments that are being studied in clinical trials. All new treatments under study may not be mentioned. Information about clinical trials is available on the NCI website.

Biological therapy

Biologic therapy is a treatment in which the patient’s immune system is used to fight cancer. Substances made by the body or produced in a laboratory are used to boost, direct or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Sometimes, the treatment of malignant mesothelioma causes side effects.


For more information about side effects caused by cancer treatment, see our side effects page.

Patients could consider participation in a clinical trial.


For some patients, the best choice of treatment could be a clinical trial. Clinical trials are part of the cancer research process. Clinical trials are conducted to find out whether new treatments for cancer are safe (safe) and effective, or better than standard treatment.

Many of the current standard treatments are based on previous clinical trials. Patients who participate in a clinical trial receive standard treatment or are among the first to receive the new treatment.

Patients who participate in clinical trials also help improve the way cancer will be treated in the future. Although clinical trials do not always lead to effective treatments, they often answer important questions and help advance research.

Patients can enter clinical trials before, during or after beginning their treatment for cancer.


In some clinical trials only patients who have not received treatment are accepted. In other trials therapies are tested in cancer patients who did not improve. There are also clinical trials in which new ways of preventing cancer from recurring (coming back) or decreasing the side effects of cancer treatment are tried.

Clinical trials are conducted in many parts of the country. Information in English about clinical trials sponsored by the National Cancer Institute (NCI) can be found on the Internet clinical trials search page. For information in English on clinical trials sponsored by other organizations, see the ClinicalTrials.gov website.

Sometimes follow-up tests are needed.


Some tests may be repeated to diagnose the cancer or to determine the stage of the cancer. Other tests are repeated to ensure that the treatment is effective. Decisions about following, changing or suspending treatment can be based on the results of these tests.

Some of the tests are repeated every so often after finishing the treatment. The results of these tests show if the condition has changed or if the cancer has recurred (come back). These tests are also called follow-up medical exams.

Treatment options for malignant mesothelioma


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