Key Takeaways
- Malignant pleural mesothelioma is the most common form of mesothelioma, accounting for about 75% of all cases. It begins in the thoracic cavity — the lining surrounding the lungs.
- Extrapleural pneumonectomy (EPP) is a major surgery that removes a diseased lung along with portions of the heart membrane, diaphragm, and chest lining. It has been widely used in early-stage cases and can increase survival rates.
- Pleurectomy/decortication (P/D) removes part or all of the pleura and strips cancerous tissue from the lung surface. It’s a lung-sparing alternative to EPP, though cancer often returns quickly after either surgery.
- HITHOC (hyperthermic intrathoracic chemotherapy) delivers heated chemotherapy directly to the chest cavity after surgery. It can extend survival rates but is considered experimental and aggressive — not suitable for all patients.
- Chemotherapy may be used in early stages to shrink or control cancer spread. Radiation therapy is often used after surgery to slow regrowth and manage symptoms.
- Palliative care is used for patients in later stages to manage symptoms and improve quality of life when curative surgery is no longer an option.
- The treatment plan depends on multiple factors, including the stage of the cancer and the patient’s overall physical condition.
Malignant pleural mesothelioma is the most common form of mesothelioma, beginning in the thoracic cavity and affecting about 75% of mesothelioma patients. There are many different treatment options for those who have been diagnosed and the ones that are used are chosen based on stages of the cancer and other factors.
Different Ways of Treating Pleural Mesothelioma
Extrapleural pneumonectomy (EPP) has been widely used to treat patients with pleural mesothelioma in early stages and has been able to increase survival rates. An extrapleural pneumonectomy is a surgery to remove a diseased lung, in this case a lung that has been affected by mesothelioma, part of the membrane that covers the heart, a portion of the diaphragm and a portion of the parietal pleura, which is the membrane that lines the chest. Additionally, pleurectomy/decortication (P/D) has been used on pleural mesothelioma patients. A P/D involves taking out a portion of the pleura and then removing cancerous tissues and tumors from the surface of the lung. These forms of treatment are extremely helpful to patients, however, they usually result in the cancer coming back very quickly. Hyperthermic intrathoracic chemotherapy also known as HITHOC has been a relatively successful way of treating this type of mesothelioma, although it is not used as much as it is aggressive. This type of treatment involves local administration of cytotoxic therapy in the area where the pleura is located. HITHOC may be recommended for patients who have been through a pleurectomy/decortication as it tends to extend survival rates.
Most doctors consider HITHOC to be an experimental treatment. It can be utilized by patients who are able to undergo aggressive treatments, but may not be good for those who cannot. Other treatment options for those with pleural mesothelioma include radiation therapy, other surgeries, chemotherapy and other supportive treatments that are done to control the symptoms of advanced cancer. Normally, the type of treatment that is used is decided based on a variety of factors, such as the condition that the patient is in.
Chemotherapy
Chemotherapy might be used for patients who have early stage pleural mesothelioma and it is used to shrink or control the spread of the cancer. Radiation therapy may be used after surgery and is used to slow the growth of the cancer as well as to control symptoms. In order to have surgery, the patient is usually in relatively good physical condition in order to be able to recover well. A surgery that removes a part of the pleura, or the lining of the lung, is a partial pleurectomy. A surgery that removes all of the pleura is a pleurectomy, as mentioned earlier.
Removing part of the pleura is a really intense operation. This can be performed using keyhole surgery or making a large wound in the chest. After this surgery, patients typically remain in the hospital for about a week and it takes about a month or more to fully recover. As discussed earlier, a P/D is another operation that can be performed by a surgeon and it involves removing any mesothelioma that is visible, removing the pleura itself and removing the hardened outer layer of the surface of the lung.
Palliative care may also be utilized, specifically for patients that are in the later stages of mesothelioma in order to enhance their quality of life.
If you or a loved one has been diagnosed with an asbestos related disease, such as mesothelioma, fill out the form or call 800-505-6000 for a free case evaluation today.
Frequently Asked Questions
What are the main treatment options for pleural mesothelioma?
The primary treatment options include:
- Surgery — extrapleural pneumonectomy (EPP), pleurectomy/decortication (P/D), or partial pleurectomy
- Chemotherapy — used to shrink tumors or control cancer spread
- Radiation therapy — often used after surgery to slow regrowth
- HITHOC — heated chemotherapy delivered directly into the chest cavity
- Palliative care — symptom management for later-stage patients
Most patients receive a combination of these treatments. The specific plan depends on the stage of the cancer and the patient’s overall health.
What is an extrapleural pneumonectomy (EPP)?
An extrapleural pneumonectomy is a major surgery that removes the diseased lung along with part of the membrane covering the heart (pericardium), a portion of the diaphragm, and the parietal pleura (the membrane lining the chest). It has been widely used for early-stage pleural mesothelioma patients and has been shown to increase survival rates. However, it is a very aggressive procedure and requires the patient to be in relatively good physical condition.
What is the difference between EPP and pleurectomy/decortication (P/D)?
The key difference is that EPP removes the entire diseased lung, while P/D is a lung-sparing surgery that removes the pleura (lung lining) and strips visible cancerous tissue and tumors from the lung surface without removing the lung itself. P/D is a major operation — it can be performed through keyhole surgery or a large chest incision, typically requires about a week in the hospital, and takes a month or more to fully recover from. Both surgeries are effective but carry a significant risk of cancer recurrence.
What is HITHOC and how does it work?
HITHOC (hyperthermic intrathoracic chemotherapy) is a treatment that delivers heated chemotherapy drugs directly into the chest cavity where the pleura is located. It is typically administered after a pleurectomy/decortication to target any remaining cancer cells and has been shown to help extend survival rates. HITHOC is considered experimental by most doctors and is an aggressive treatment — it may be recommended for patients who can tolerate intensive therapy but is not suitable for everyone.
When is chemotherapy used to treat pleural mesothelioma?
Chemotherapy may be used for patients with early-stage pleural mesothelioma to shrink tumors or slow the spread of cancer. It can be administered before surgery (neoadjuvant chemotherapy) to reduce tumor size, or after surgery (adjuvant chemotherapy) to target any remaining cancer cells. For patients who are not candidates for surgery, chemotherapy may be used as a primary treatment to help control the disease.
What role does radiation therapy play in treating pleural mesothelioma?
Radiation therapy is most commonly used after surgery to slow the regrowth of cancer cells and control symptoms. It uses high-energy X-rays targeted at the area where the cancer was located. Radiation can also be used as part of palliative care for later-stage patients to help manage pain and other symptoms.
What is palliative care for pleural mesothelioma?
Palliative care focuses on managing symptoms and improving quality of life rather than curing the cancer. It is typically used for patients in later stages of mesothelioma when curative surgery is no longer an option. Palliative treatments can include procedures to drain fluid buildup from the chest (thoracentesis), pain management, and supportive therapies to help patients remain as comfortable as possible.
How do doctors decide which treatment to use?
Treatment decisions are based on several factors, including the stage of the cancer, the patient’s overall physical condition, the location and extent of the tumors, and whether the patient is strong enough to undergo aggressive treatments like surgery or HITHOC. A multidisciplinary team of oncologists, surgeons, and other specialists typically works together to determine the best plan for each patient.
What should I do if I’ve been diagnosed with pleural mesothelioma?
If you or a loved one has been diagnosed with pleural mesothelioma or another asbestos-related disease, understanding your treatment options and legal rights is essential. Your asbestos exposure history may play a critical role in pursuing compensation for medical expenses and other damages. Call (800) 505-6000 or fill out our contact form for a free case evaluation.
