Treatment for pleural mesothelioma
For most people, treatment is given to help control symptoms and to slow the growth of the pleural mesothelioma. Treatments may include chemotherapy, radiotherapy and other treatments, sometimes known as supportive therapies.
Very occasionally, if the mesothelioma is diagnosed before it has spread or it has spread to nearby tissues, surgery may be a treatment option.
Chemotherapy for pleural mesothelioma
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Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of the cancer cells. It’s used to help slow the growth of the mesothelioma and control its symptoms. It may not be suitable for some people as you need to be fit enough to have it. Your doctor will let you know if it’s a suitable treatment for you.
How chemotherapy is given
The drugs are usually given by injection into a vein (intravenously). Each session of chemotherapy may last between one and a few days, and is followed by a rest period of a few weeks. This is known as a cycle of treatment.
The number of cycles you have will depend on the stage of your cancer and how well it is responding to treatment.
The drugs that are used
The most commonly used drugs to treat pleural mesothelioma are pemetrexed (Alimta®) together with cisplatin (or sometimes carboplatin). You’ll usually be given these drugs on the same day as an outpatient. You’ll then have a rest with no chemotherapy for 20 days before starting your next cycle. If you have pemetrexed, you’ll be given the vitamins B12 and folic acid as these help to reduce side effects of treatment without reducing its effectiveness.
Other chemotherapy drugs may sometimes be used. These may be given as part of a clinical trial.
We have more information about chemotherapy available.
Side effects of chemotherapy
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Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more.
The most common side effects of pemetrexed and cisplatin are described here.
Feeling sick (nausea) and being sick (vomiting)
This is common and may begin soon after the treatment is given and last for a few days. Occasionally, it may last longer. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting.
Risk of infection
Pemetrexed and cisplatin chemotherapy can reduce the number of white blood cells in your body, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if:
you develop a high temperature - this may be over 37.5°C (99.5F) or over 38°C (100.4F) depending on the hospital’s policy. Follow the advice that you’ve been given by your chemotherapy team.
you suddenly feel unwell, even with a normal temperature
you feel shivery and shaky
you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection) or diarrhoea.
If necessary, you’ll be given antibiotics to treat any infection. You’ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered.
Occasionally, your treatment may need to be delayed if the number of your white blood cells is still low.
The number of red blood cells, which carry oxygen around the body, may also be reduced. A low red blood cell count is called anaemia. This may make you feel tired and breathless. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Your mouth may become sore or dry, or you may notice small ulcers during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
This can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It’s important to drink plenty of fluids if you have diarrhoea.
Numbness or tingling in hands or feet
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Let your doctor know if you develop these symptoms.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and balance rest with some gentle exercise.
Pemetrexed may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Your doctor can prescribe soothing eye drops to help with this.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Very occasionally, your sense of balance may be affected. Any hearing loss (and balance changes if they occur) may be permanent. However, tinnitus usually improves when treatment ends.
Although they may seem hard to bear at the time, most of the side effects are temporary and will disappear once your treatment is over. We have more detailed information on coping with the side effects of chemotherapy.
Chemotherapy affects different people in different ways. Some people are able to lead a normal life during their treatment; others find they become very tired and have to take things more slowly. Just do as much as you feel like doing and try not to overtire yourself.
Radiotherapy for pleural mesothelioma
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Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It’s usually given by aiming the high-energy x-rays at the lung from a radiotherapy machine. This is known as external beam radiotherapy. The treatment is given in the hospital radiotherapy department as an outpatient.
Radiotherapy can be given for different reasons:
It can be given to shrink or reduce the size of the mesothelioma - this can help relieve symptoms such as pain and breathlessness.
It’s sometimes given to the chest wall at the place where a biopsy has been done or a drainage tube has been inserted. In this situation, the radiotherapy may prevent the tumour from growing out through the scar.
It can also be used alongside surgery and chemotherapy (usually within a clinical trial).
Often, only one or two treatments are needed, but occasionally a course of treatment is given over two weeks or so. For single treatments, the planning discussed below isn’t needed.
Planning your radiotherapy
Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It’s planned by a cancer specialist (clinical oncologist) and it may take a few visits.
On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or to lie under a machine called a simulator, which takes x-rays of the area to be treated.
If you’re having radiotherapy to the place where a drainage tube has been, you won’t need a CT scan.
You may need some small marks made on your skin to help the radiographer (who gives you your treatment) position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) are usually used. These are extremely small, and will only be done with your permission. It may be a little uncomfortable while they are done.
At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch and make sure you’re comfortable. You’ll be alone in the room during your treatment but the radiographers will be able to see you. There may also be an intercom in the treatment room so that they can talk to you during your treatment. Radiotherapy isn’t painful, but you will have to lie still for a few minutes during the treatment.
Side effects of radiotherapy
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Radiotherapy can cause general side effects, such as feeling sick (nausea), being sick (vomiting) and tiredness. It can also make you temporarily more breathless.
These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your clinical oncologist and radiographer can advise you on what to expect.
Nausea and vomiting
This can usually be effectively treated with anti-sickness (anti-emetic) drugs, which your doctor can prescribe.
If you feel tired, get plenty of rest but balance this with some gentle exercise, such as short walks. This will give you more energy and help to keep your muscles working. Save some energy for doing the things you enjoy and ask others for help doing chores if these are tiring you out.
Discomfort when swallowing
This may start in the first week after your treatment and last a few days. Tell your doctors if you have problems swallowing as they can give you medicines to help. They can also prescribe you nutritious, high-calorie drinks if eating is difficult.
These side effects should disappear gradually once your course of treatment is over, but it’s important to let your doctor know if they continue. We have more detailed information on coping with these side effects.
Radiotherapy does not make you radioactive and it’s perfectly safe for you to be with other people, including children, throughout your treatment.
We have more detailed information about radiotherapy available.
Surgery is only suitable for a small number of people with pleural mesothelioma. The aim of surgery is usually to help with symptoms and to control the disease rather than to cure it. The operation will be done by a specialist chest surgeon who is experienced in the treatment of mesothelioma. An operation may be carried out as part of a clinical trial.
The type of surgery that may occasionally be used for pleural mesothelioma is called a pleurectomy. This involves removing the tumour and part, or all, of the pleura and the lung tissue close to it. It’s used to help stop the build-up of fluid in the lung and to help with breathlessness and pain.
Pleurectomy can also help a collapsed lung to reinflate with air, which will help reduce breathlessness. For some people, it may be possible to have a pleurectomy using keyhole surgery. With this type of surgery, only small openings are made instead of one large cut (incision).
Pleurectomy is only suitable for some people with mesothelioma. There are other treatments that don’t involve major surgery, which can be used to control the build-up of fluid in the lung, breathlessness and pain.