How is malignant mesothelioma treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society’s Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

 

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

 

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don’t hesitate to ask him or her questions about your treatment options. If you have mesothelioma, your cancer care team will recommend one or more treatment options for you to consider. This is an important decision and you should take time to think about all of your choices. 

Survival statistics for mesothelioma

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or even don’t want to know them. If you don’t want to read about the survival statistics for mesothelioma, stop here and skip to the next section.

To get survival rates, doctors have to look at people who were treated at least several years ago. Although the numbers below are among the most current we have available, improvements in treatment since then could result in a more favorable outcome for people now being diagnosed with mesothelioma.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot be used to predict what will happen in any particular person’s case. Knowing the type and the stage of a person’s cancer is important in estimating their outcome. But many other factors can affect survival, such as a person’s age and overall health, the treatment received, and how well the cancer responds to treatment. Even taking these other factors into account, survival rates are at best rough estimates. Your doctor can tell you if the numbers below apply, as he or she is familiar with your situation.

How is malignant mesothelioma staged?

Staging is the process of finding out how far a cancer has spread. Your treatment and prognosis (outlook) depend, to a large extent, on the cancer’s stage. 

Staging is based on the results of physical exams, biopsies, and imaging tests (CT scan, PET scan, etc.), which are described in the section, “How is malignant mesothelioma diagnosed?”

A staging system is a formal way for doctors and nurses to sum up the extent of a cancer. Pleural mesothelioma, the most common type, is the only mesothelioma for which a formal staging system exists.

The TNM staging system

The system most often used to describe the growth and spread of pleural mesothelioma is the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM system is based on 3 key pieces of information:

• T sums up the extent of spread of the main (primary) tumor.
• N describes how much the cancer has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread first.
• M indicates whether the cancer has spread (metastasized) to other organs of the body. (The most common sites are the pleura on the other side of the body, the lungs, and the peritoneum.

How is malignant mesothelioma diagnosed?

Mesothelioma is most often diagnosed after a person goes to a doctor because of symptoms. If there is a reason to suspect you might have mesothelioma, your doctor will use one or more tests to find out. Symptoms might suggest that the problem could be mesothelioma, but tests will be needed to confirm the diagnosis.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have mesothelioma, your doctor will want to take a complete medical history to learn about your symptoms and possible risk factors, especially asbestos exposure. You will also be asked about your general health.

A physical exam can provide information about possible signs of mesothelioma and other health problems. Pleural mesothelioma can cause fluid to build up around the lungs in the chest (called a pleural effusion). In cases of peritoneal mesothelioma, fluid can build up in the abdomen (called ascites). In pericardial mesothelioma, fluid builds up in the sac around the heart (called a pericardial effusion). Rarely, mesothelioma can develop in the groin and look like a hernia. All of these might be found during a physical exam, such as when the doctor listens to these areas with a stethoscope.

Signs and symptoms of mesothelioma

Early symptoms of mesothelioma are more often caused by other things, so at first people may ignore them or mistake them for common, minor ailments. Most people with mesothelioma have symptoms for at least a few months before they are diagnosed. 

Symptoms of pleural mesothelioma (mesothelioma of the chest) can include:

• Pain in the lower back or at the side of the chest
• Shortness of breath
• Fluid in the area around the lung
• Cough
• Fever
• Excessive sweating
• Fatigue
• Weight loss (without trying)
• Trouble swallowing (feeling like food gets stuck)
• Hoarseness
• Swelling of the face and arms

Symptoms of peritoneal mesothelioma can include:

• Abdominal (belly) pain
• Swelling or fluid in the abdomen
• Weight loss (without trying)
• Nausea and vomiting

The symptoms and signs above may be caused by mesothelioma, but more often they are caused by other conditions. Still, if you have any of these problems (especially if you have been exposed to asbestos), it's important to see your doctor right away so the cause can be found and treated, if needed.

Can malignant mesothelioma be found early?

Mesothelioma is uncommon, and there are no widely recommended screening tests for this cancer in people who are not at increased risk. (Screening is testing for cancer in people who don't have any symptoms.) 

For people with known exposure to asbestos, some doctors recommend imaging tests such as chest x-rays or computed tomography (CT) scans to look for changes in the lungs that might be signs of mesothelioma or lung cancer. But it is not clear how useful these tests are in finding mesotheliomas early.

In recent years, doctors have found that people with mesothelioma often have high levels of certain substances in their blood, including osteopontin and soluble mesothelin-related peptides (SMRPs). Blood tests for these substances may one day be useful in finding mesotheliomas early, and in monitoring the course of the disease in people who have mesothelioma.

Most mesotheliomas are found when a person goes to a doctor because of symptoms. People who have been exposed to asbestos should know the possible signs and symptoms of mesothelioma (discussed in the next section). Many of these symptoms are more likely to be caused by something other than mesothelioma, but it's important to report any new symptoms to your doctor right away so that the cause can be found and treated, if needed.