Mesothelioma

Blood tests

Blood tests can check your overall health and how your blood cells, liver and kidneys are working.

X-rays

X-rays can help identify any abnormalities in the lungs, thickening of the pleura or fluid in the space between the lungs and the chest wall. X-rays will also help identify fluid in the abdomen.

CT scan

CT (computerised tomography) scans produce three-dimensional pictures of several organs at the same time and can also scan chest lymph nodes. CT scans may also be used to see if the mesothelioma has spread to other locations.

Biopsy

A biopsy is when a sample of pleural or abdominal tissue is removed for examination under a microscope. It is the main procedure used to diagnose pleural mesothelioma, and can be taken in two ways: via VATS (Video-assisted thoracoscopic surgery), a type of keyhole surgery; or via CT-guided core biopsy, which is done under a local anaesthetic using a needle guided by a CT scan.

Draining fluid from the pleura

This can be done to relieve symptoms of breathlessness caused by pleura leaking into the pleural cavity (called pleural effusion), and in some instances, to diagnose pleural mesothelioma. People with peritoneal mesothelioma may have fluid in the abdomen (called peritoneal effusion), causing swelling and pain.

Using an ultrasound scan to guide the doctor, the fluid is drained via a needle inserted through the chest wall into the pleural cavity or into the abdomen. A sample of the fluid is then sent to a pathologist for testing.

Mesothelioma can be difficult to diagnose as the cells can look similar to other types of cancer cells. Combining results from fluid samples with information from an x-ray and CT scan can provide an acceptable level of certainty of a diagnosis.

If mesothelioma is diagnosed, further tests are usually done to find out if the disease has spread to other parts of the body, such as CT scans; FDG-positron emission tomography (FDG-PET); mediastinoscopy (used to examine and sample lymph nodes at the centre of the chest); or endobronchial ultrasound (EBUS).

Chemotherapy

Chemotherapy drugs aim to destroy cancer cells while causing the least possible damage to healthy cells. The most commonly used chemotherapy drugs for treating pleural mesothelioma include pemetrexed with cisplatin or carboplatin. Chemotherapy for pleural mesothelioma aims to prolong life and shrink the cancer as well as improving quality of life. 

Chemotherapy is sometimes used for peritoneal mesothelioma either on its own or before or after surgery. Chemotherapy is given directly into the abdomen for people with peritoneal mesothelioma. 

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy), the use of x-rays to kill or damage cancer cells, can be used at different stages of pleural mesothelioma and in different ways. For example, it can relieve symptoms such as pain caused by tumours, and it can be given after chemotherapy or surgery, to help kill remaining cancer cells.

Radiation therapy is rarely used to treat peritoneal mesothelioma but may be used to relieve pain or kill any cancer cells that remain after surgery or chemotherapy.

Surgery

There are two main types of operations considered for actively treating pleural mesothelioma: extrapleural pneumonectomy (EPP), which removes the tumour and the pleura, the affected lung, the diaphragm and a portion of the lining of the heart; or a pleurectomy with pulmonary decortication (PD), which removes the pleura and as much disease as possible.

Surgery for peritoneal mesothelioma may be possible if the cancer has not spread. In this operation, called a peritonectomy, the surgeon removes parts of the peritoneum where the mesothelioma is growing. 

Trimodality therapy

Trimodality therapy uses a combination of chemotherapy, radiotherapy and major surgery. It is used to treat some people with mesothelioma.

Treating symptoms

When mesothelioma is diagnosed at an advanced stage, the main goal of treatment is to manage the symptoms and keep them under control as long as possible.

Treatments can include surgery to improve breathlessness caused by fluid build-up. VATS (video-assisted thoracoscopic surgery) involves removing some of the lining of the chest wall and lung. During the procedure, sterile talcum powder is injected into the pleural cavity, causing inflammation that closes the pleural cavity and helps prevent fluid from building up again.

More extensive open surgery can also be undertaken to drain fluid build-up in the lungs, or to relieve pain in the chest. For people not suitable for VATS or open surgery, an indwelling pleural drain may be used, which allows fluid to be drained 1-2 times a week, depending on how quickly the fluid builds up again.

The treatment team will discuss with the person, suitable treatment options to assist with other symptoms such as sleeplessness, pain, fatigue, loss of appetite and weight loss.

Palliative care

In some cases of mesothelioma, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of mesothelioma, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.