Pleural Mesothelioma Treatment

Pleural mesothelioma is a rare cancer that originates in the lining of the lungs, with about 1,500 to 2,000 cases diagnosed in the United States each year. No cure has been discovered for pleural mesothelioma, but there are treatments to manage symptoms and extend life expectancy. Most patients live four to 18 months after diagnosis, but some patients may live five years or longer.
Pleural mesothelioma is a rare cancer that originates in the lining of the lungs, with about 1,500 to 2,000 cases diagnosed in the United States each year. No cure has been discovered for pleural mesothelioma, but there are treatments to manage symptoms and extend life expectancy. Most patients live four to 18 months after diagnosis, but some patients may live five years or longer.
Speaking with a pleural mesothelioma specialist can help patients understand which treatment options may be the best for their unique diagnosis. The Mesothelioma Center's free Doctor Match Program can pair you with the nation's top pleural mesothelioma doctors and help you find treatment facilities near you. Visit this page or call (800) 549-0544 to learn more about the program.

Treatment Options Vary

Treatment for malignant pleural mesothelioma (MPM) may be palliative (which aims to relieve symptoms) or potentially curative (which attempts to cure the disease or extend life expectancy). For most patients, surgery is performed to remove as much tumor growth as possible. After that, doctors recommend chemotherapy and/or radiation therapy to help kill as remaining cancer cells as possible. Some doctors may also suggest up-and-coming treatment options such as immunotherapy, photodynamic therapy and gene therapy. Patients can also consider alternative treatments, which can help alleviate pain and improve quality of life, or clinical trials, which can offer opportunities to use experimental new treatments.
Patients may be eligible for certain treatments based on a number of factors. For example, the most common candidates for potentially curative surgery are patients around 50 years old or younger who are in overall good health and whose pleural mesothelioma has not spread throughout the body. Older or less healthy patients are more susceptible to complications during treatment and longer recuperation times. Additionally, if the cancer is in later stages when the cancer has spread from its origin, treatments such as surgery will not be particularly effective because the growth and spread of pleural mesothelioma makes it nearly impossible to remove all the tumors and cancerous cells.

Surgery

Depending on each patient's unique situation, surgery can be potentially curative or strictly palliative. Patients who qualify for curative surgery usually undergo one of two potentially curative surgeries: extrapleural pneumonectomy or pleurectomy/decortication. These vastly different surgeries have both been shown to add months to life span, but they each come with a set of complications and risks. Other surgical options may include pleurodesis or pleurectomy.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) is a very serious, potentially curative procedure that removes the entire cancerous lung. The surgery aims to remove as much cancerous tissue as possible, so it may also include the removal of parts of the chest lining, heart sac lining and diaphragm. Naturally, the loss of a lung significantly impacts quality of life for most patients. It severely and often permanently restricts lung functioning and physical ability.
However, EPP is still favored by some surgeons because it has been found to extend life span and is associated with long-term survival. One 2008 study found that patients with Stage I MPM survived a median of 22 months after undergoing EPP. Stage IV patients, on the other hand, had predictably shorter life spans, surviving a median of four months after surgery. Still, some Stage IV patients in the study survived more than four years after receiving the same treatment.

Pleurectomy/Decortication

Pleurectomy/decortication (P/D) is a lung-sparing alternative to EPP that many surgeons now favor. Like EPP, P/D is a potentially curative procedure. However, P/D leaves the lung intact and removes the cancerous lining of the lung. It usually also removes parts of the chest lining and part of the surface of the lung.
The same 2008 study showed that P/D was a significantly better option than EPP for patients in Stage I. Stage I patients who underwent P/D lived a median of 46 months, just shy of four years. As patients entered later stages, the two procedures had somewhat comparable results. Patients in Stage IV who received the P/D surgery had a median survival of nine months.

Palliative Surgeries

Doctors may consider palliative surgeries if they believe P/D and EPP are too dangerous or will be ineffective. Some of the main palliative procedures are pleurodesis and pleurectomy.

Pleurodesis

- is used to drain built-up fluid in the chest cavity. It is designed to seal pleural spaces and prevent further fluid accumulation. This process relieves pressure, alleviates chest pain and eases breathing.

Pleurectomy

- removes the cancerous lining of the lung. Like pleurodesis, it is helpful for patients with fluid buildup. The procedure can relieve common symptoms such as chest pain and shortness of breath.