Malignant mesothelioma is a disease in which cancer cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) or the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen). Malignant mesothelioma may also form in the heart or testicles, but this is rare.
Anything that increases the chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop malignant mesothelioma, and it can develop in people who don't have any known risk factors. Talk to your doctor if you think you may be at risk.
Most people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After being exposed to asbestos, it usually takes a long time for malignant mesothelioma to form. Living with a person who works near asbestos is also a risk factor for malignant mesothelioma.
Sometimes the cancer causes fluid to collect in the chest or in the abdomen. Signs and symptoms may be caused by the fluid, malignant mesothelioma, or other conditions. Check with your doctor if you have any of the following:
Sometimes it is hard to tell the difference between malignant mesothelioma in the chest and lung cancer.
In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:
Procedures used to collect the cells or tissues include the following:
The following tests may be done on the cells and tissue samples that are taken:
The prognosis and treatment options depend on the following:
The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The gathered from the staging process determines the stage of the disease. It is important to know whether the cancer has spread in order to plan treatment.
The following tests and procedures may be used in the staging process:
Cancer can spread through tissue, the lymph system, and the blood:
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if malignant mesothelioma spreads to the brain, the cancer cells in the brain are actually malignant mesothelioma cells. The disease is metastatic malignant mesothelioma, not brain cancer.
Stage I is divided into stages IA and IB:
In stage II, cancer is found in the inside lining of the chest wall on one side of the chest. On the same side of the chest, cancer may also be found in one or more of the following:
Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.
or
Cancer is found in the inside lining of the chest wall, and in each of the thin layers of tissue that cover the lung, the organs between the lungs, and the top of the diaphragm on one side of the chest. On the same side of the chest, cancer has also spread into one or both of the following:
Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.
Stage III is divided into stages IIIA and IIIB.
Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.
Cancer has spread to lymph nodes above the collarbone on either side of the chest or cancer has spread to lymph nodes along the center of the chest on the opposite side of the chest as the tumor.
or
Cancer is found in the inside lining of the chest wall, and in each of the thin layers of tissue that cover the lung, the organs between the lungs, and the top of the diaphragm on one side of the chest. Cancer has also spread to one or more of the following:
Cancer may have spread to lymph nodes.
In stage IV, cancer has spread to the tissue covering the lung or the lung on the opposite side of the chest, peritoneum, bones, liver, lymph nodes outside the chest, or to other parts of the body.
The cancer may come back in the chest or abdomen or in other parts of the body.
Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
The following surgical treatments may be used for malignant mesothelioma in the chest:
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. It may also be used as palliative therapy to relieve symptoms and improve quality of life.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the chest or peritoneum, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug.
Hyperthermic intraperitoneal chemotherapy is used in the treatment of mesothelioma that has spread to the peritoneum (tissue that lines the abdomen and covers most of the organs in the abdomen). After the surgeon removes all the cancer that can be seen, a solution containing anticancer drugs is heated and pumped into and out of the abdomen to kill cancer cells that remain. Heating the anticancer drugs may kill more cancer cells.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Malignant Mesothelioma for more information.
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.
The following types of immunotherapy are being used in the treatment of malignant mesothelioma:
There are two types of immune checkpoint inhibitor therapy:
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.
Monoclonal antibody therapy is a type of targeted therapy. Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Bevacizumab is a monoclonal antibody used to treat advanced malignant mesothelioma. It binds to a protein called vascular endothelial growth factor (VEGF). This may prevent the growth of new blood vessels that tumors need to grow. Other monoclonal antibodies are being studied in malignant mesothelioma.
Kinase inhibitors are a type of targeted therapy being studied in the treatment of malignant mesothelioma. Kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow.
about clinical trials is available from the NCI website.
For information about side effects caused by treatment for cancer, visit our Side Effects page.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
For about the treatments listed below, see the Treatment Option Overview section.
If stage I malignant mesothelioma is in one part of the chest lining, treatment may be the following:
If stage I malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:
If stage I malignant mesothelioma is in the peritoneal lining, treatment may be the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For about the treatments listed below, see the Treatment Option Overview section.
If stage II, stage III, or stage IV malignant mesothelioma is found in the chest, treatment may be one of the following:
If stage II, stage III, or stage IV malignant mesothelioma is found in the peritoneum, treatment may be one of the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For about the treatments listed below, see the Treatment Option Overview section.
Treatment of recurrent malignant mesothelioma may be one of the following:
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For more from the National Cancer Institute about malignant mesothelioma, see the following:
For general cancer information and other resources from the National Cancer Institute, visit:
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PDQ® Adult Treatment Editorial Board. PDQ Malignant Mesothelioma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/mesothelioma/patient/mesothelioma-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389166]
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