Mesothelioma treatment

If you are diagnosed with mesothelioma, your multidisciplinary team will study your case to consider what treatment is best for you. You will then have an appointment to discuss treatment options. The choice of treatment will depend on: 

• the stage of cancer
• where the cancer is and the type of cancer
• your age 
• your general health and other conditions you may have
• your personal situation.

Treatment for mesothelioma can include: 

• chemotherapy
• immunotherapy
• surgery
• radiotherapy
• palliative care

You may also need treatment for pleural effusion.

According to NHS targets, in England, Scotland and Northern Ireland, you should wait no more than one month between the decision to treat and the start of your treatment.  Treatment should begin no more than two months after your urgent referral. 

In Wales, the target is to confirm diagnosis and start treatment within two months of your referral.  

Waiting for treatment can be stressful. You can call your clinical nurse specialist for support. You can also call our helpline on 0300 222 5800 or call the Mesothelioma UK helpline on 0800 169 2409 to talk to a specialist nurse. 

Mesothelioma UK also have a care record to help you keep up to date with your care.

Mesothelioma usually only causes symptoms when it is already advanced, and it tends to progress quickly. Treatments are usually given to ease pain and improve your quality of life, as well as to try and give you as much time as possible.  

Your outlook will depend on things like age, other medical conditions, the type of mesothelioma, and the stage of the cancer. About 45 out of 100 people diagnosed with mesothelioma live for a year after their diagnosis. This number increases to 60 out of 100 for people diagnosed with stage 1 mesothelioma. 7 in 100 people live for five years or more after their diagnosis. 

Asthma + Lung UK set up a mesothelioma research network (MRN) to bring together researchers working on mesothelioma. It aims to help improve the treatments for this type of cancer.

What is chemotherapy?

Chemotherapy uses drugs to destroy cancer cells. It’s used in mesothelioma treatment to try to shrink the cancer tumour and relieve some of the symptoms. It can help some people live longer after their diagnosis. 

Mesothelioma is usually treated with a combination of pemetrexed and cisplatin or carboplatin. Sometimes, raltitrexed is used instead of pemetrexed.  

How is it given?

Chemotherapy for mesothelioma is usually given through a drip into your arm or hand. The nurse will put a small tube into your vein which the medicine will travel through.  

Most people have chemotherapy as an outpatient, meaning you only have to attend the hospital for part of a day to have the treatment. 

You’ll have chemotherapy either every week or every two to three weeks. You may have up to six courses (cycles) of chemotherapy. You’ll have regular scans to see how the tumour is responding to the treatment. 

What are the side effects?

Chemotherapy drugs can also damage healthy cells. This can cause side effects. These differ, depending on which drug you are given. Side effects for chemotherapy drugs used to treat mesothelioma include: 

• feeling or being sick
• feeling tired
• bruising, bleeding gums and nosebleeds
• shortness of breath
• diarrhoea
• constipation
• skin rashes or dry and itchy skin
• hair loss. 

Because your white blood cell level drops during chemotherapy, you can be at a higher risk of getting an infection. Symptoms of an infection can include:

• a high temperature
• muscle aches
• headaches
• feeling cold. 

If you have any side effects, tell your treatment team. Your doctor will give you medication to help reduce the side effects of treatment. 

Cancer Research UK have a lot of information about chemotherapy and dealing with side effects.

What is radiotherapy?

Radiotherapy uses radiation to destroy cancer cells. In mesothelioma treatment, radiotherapy is sometimes used to relieve symptoms like pain and breathlessness. 

How is it given

Radiotherapy for mesothelioma involves lying down in a special machine, which aims beams of radiation at the cancer cells. You have to lie very still while the machine is working. You won’t feel anything during the treatment. 

You’ll be able to talk to the radiographer during the procedure and ask them to stop if you need to. 

What are the side effects?

Radiotherapy can also damage healthy cells in the body. This can cause side effects, such as: 

• feeling tired
• sore or itchy skin
• hair loss in the treatment area
• difficulty swallowing
• feeling sick. 

Let your doctor know if you are having any of these side effects. They may be able to prescribe you medication to help manage them. 

Cancer Research UK have more information on radiotherapy for mesothelioma.

What is immunotherapy?

Immunotherapy works by helping the body’s immune system destroy cancer cells.

The immunotherapy drugs nivolumab and ipilimumab are used to treat mesothelioma. They work by blocking proteins that stop your immune system from attacking cancer cells. 

How is it given?

Immunotherapy drugs are given through a drip. These drugs go into your bloodstream.  

• For nivolumab, the treatment will take 30 minutes every 3 weeks. 
• For ipilimumab, the treatment will take 30 minutes every 6 weeks. 

What are the side effects?

Immunotherapy can cause side effects, including: 

• feeling or being sick
• diarrhoea
• headaches
• feeling very tired 
• skin rashes, which are sometimes itchy
• loss of appetite
• feeling short of breath
• muscle or bone pain.

Let your doctor or nurse know if you have any of these side effects. They may be able to give you medication to help relieve them.

Current UK guidelines do not recommend surgery for mesothelioma, so it’s rarely done. Recently, a clinical trial was done to see whether an operation called a pleurectomy decortication could be useful in treating mesothelioma, when combined with chemotherapy. The results are expected in 2023. 

Palliative care focuses on: 

• managing your symptoms
• offering emotional support
• offering practical support, such as planning for the future
• helping you live as actively as possible.

Palliative care includes chemotherapy and radiotherapy given to relieve your symptoms. But it also includes many other kinds of medical, emotional, and practical support, such as: 

• prescribing medicine to help relieve symptoms and make you more comfortable
• checking how you’re feeling and providing care for your mental health
• providing help with personal care, such as bathing and dressing
• helping you get practical aids and equipment to make daily life easier 
• giving advice on benefits or claiming compensation.

Palliative care can also include support for your family and carers. 
Your palliative care team may include: 

• specialist doctors and nurses
• social workers
• a pharmacist
• a physiotherapist
• an occupational therapist
• a counsellor or psychologist
• a dietitian
• a social worker
• a benefits adviser.

Palliative care is not just for the end stages of mesothelioma – it can be helpful right from when you are first diagnosed. If you have not been offered palliative care, talk to your healthcare team.

Pleural tap (aspiration)

In this procedure, the doctor puts a thin needle through your skin and into the pleural space around your lungs. They use an ultrasound scan to find the best area to put the needle in, and they will give you an injection to make the area numb. Then they make a small cut and put the needle in to remove the fluid.

A pleural tap does not stop fluid building up again. For this reason, doctors will usually also use another procedure called pleurodesis.

Pleurodesis

Pleurodesis is a procedure to seal the space between your lung and chest wall. This stops fluid building up.

After fluid has been drained from your chest, the doctor injects sterile talc, either in liquid or powder form. You’ll have painkillers to help with any discomfort the procedure may cause.

Once the talc has been injected, the doctor will close the tube to hold the drug in place. After an hour, the doctor will reopen the tube, to allow air and fluid to drain. You may have to stay in hospital overnight if there’s a lot of fluid to drain.

Indwelling pleural catheter  

An indwelling pleural catheter (IPC) is a small, flexible tube put into your lung to drain the fluid. One end of the tube stays inside the chest and the other passes out through the skin.

The doctor uses an ultrasound scan to find the best area to put the IPC in, and they will give you an injection to make the area numb. They then make two small cuts and put the IPC into your chest. Once it’s inserted, they will seal the cuts with two small stitches, which a nurse will remove after one or two weeks.

If you have an IPC, you’ll be able to drain the fluid from your chest yourself. The nurse will teach you how to do this.

Pleurodesis and IPC are both effective ways of treating pleural effusion. Your doctor will discuss which is the best choice for you.