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malignant pleural mesothelioma

Mesothelioma Treatment by Stage

surgery tableSome treatments come into play in nearly all cases of malignant pleural mesothelioma (MPM), while others are used much more sparingly. If you or a loved one has been diagnosed with the disease, you’re almost certainly curious to know: Which treatments will be available? Does the regimen vary by stage of illness? Will I have a choice of treatments?

These are important questions, and at Kazan, McClain, Lyons, Greenwood and Harley, we encourage you to ask them. Your doctors and legal counsel will be able to fill you in on the treatments available for each stage of mesothelioma.

MPM is measured in four stages, with the first being considered local, and the other three categorized as advanced. If mesothelioma is caught in its early stage, it is usually by accident. However, a history of asbestos exposure can help contribute to early diagnosis, since doctors know that the mineral is the sole proven cause of mesothelioma.

Many MPM patients receive chemotherapy and radiation. These modes of treatment help shrink tumors and slow malignant growth. Surgeries, on the other hand, are more dependent on MPM stage.

As a rule of thumb, the less invasive a procedure is, the more often it is used. For example, fluid draining is a very common minor surgery for MPM, one that nearly all patients will undergo. All draining surgeries end in the suffix –centesis (e.g. thoracentesis, paracentesis and pericardiocentesis). In each case, surgeons insert a needle into the chest cavity to drain built-up fluid and relieve pressure.

Surgical resections (that is, removal of tissue) are also quite common, but the extent depends on disease stage. In debulking and pleurectomy/decortication, doctors remove as much tumor mass as they can while leaving the organs mostly intact. The operations are usually utilized for stages I, II and sometimes III.

A more radical surgery, known as extrapleural pneumonectomy (EPP), comes into play when MPM is more advanced, as in stages II and III. In an EPP, surgeons take out the diaphragm muscle, the chest cavity lining, the sac surrounding the heart and one lung.

Stage IV mesothelioma is typically considered “unresectable,” meaning it is so advanced and a patient is so weak that surgery is not an option.

Two things to keep in mind:

1. There is no one-size-fits-all treatment for MPM. Every case of mesothelioma is different, and doctors take many wellness factors into account before recommending certain procedures.

2. All treatments for MPM, surgical or otherwise, are considered palliative. This is because, for now, none is curative. However, treatments ease the tumor burden and improve comfort level, two very important benefits for people living with mesothelioma.

Current Mesothelioma Treatment Research and Studies

medical recordMalignant pleural mesothelioma (MPM) can be a difficult disease to treat. For this reason, scientists are constantly testing new and innovative therapies for the illness. At Kazan, McClain, Lyons, Greenwood and Harley, we believe that patients who know about current research and studies on MPM can make more informed decisions about their medical and legal options.

In fact, one of the busiest areas of mesothelioma research is the study of the condition’s relationship to asbestos exposure. Researchers have known for some time that the fiber is the sole proven cause of MPM. However, there has been a flurry of activity lately surrounding the mechanism by which asbestos causes mesothelioma.

Scientists are currently running dozens of cellular experiments to determine how asbestos damages cells. Many theorize that the fibers get stuck in lung cell membranes, damaging DNA, encouraging further oxidative damage and causing profound scarring. Causes aside, a central question among oncologists is whether there might be an as-yet-undiscovered treatment for MPM, one that might outdistance current therapies. Several new methods are currently being explored.

Current Mesothelioma Research Studies:

The first is based in chemotherapy. According to the American Cancer Society (ACS), researchers are testing the effects of dozens of new drugs on mesothelioma growth. Many of these substances already inhibit the the growth of other cancers – like raltitrexed, an antimetabolite that blocks rapid cellular growth, which has been used for colon cancer since 1998, according to the Mayo Clinic.

Likewise, new chemo administration methods are giving cause for optimism. The ACS notes that scientists are now trying injecting drugs (some of which are heated first) directly into mesothelioma tumors. This direct application has the potential to target carcinomas more directly and limit side effects.

Another intriguing new treatment is photodynamic therapy (PDT). In this mode of therapy, a specially formulated drug is given intravenously. Doctors allow several days to pass, giving the compound time to settle into tumor cells. Then, surgeons insert a light-emitting tube into the chest. The wavelength of light activates the drug (called a “photsensitizer”), which emits charged oxygen molecules, killing tumor cells. Though still in the trial phase, PDT is getting quite positive results.

Other targeted treatments are also being studied. For example, scientists are testing specially formulated compounds that precisely attack one step in the MPM growth cycle. A good example is the angiogenesis inhibitor, which prevents tumor cells from getting a good blood supply.

And even more futuristic treatments are in the works. In this vein, the ACS points to gene therapy, which might one day allow doctors to repair damaged lung cell DNA using specially modified viruses.

Mesothelioma Treatment Options and Clinical Trials

doctor in laboratoryThe news that you or a loved one has malignant pleural mesothelioma (MPM) can be totally overwhelming. Until you’ve begun to come to terms with the diagnosis, you may have a hard time focusing your thoughts and feelings. For this reason, we at Kazan, McClain, Lyons, Greenwood and Harley recommend that you talk to family, friends, physicians and legal counsel about what your options are and what comes next.

One way to cope with a mesothelioma diagnosis is to begin exploring the available treatments. Fortunately for anyone with the disease, there are usually a number of different options to weigh and discuss.

Here’s a quick overview, including some of the newest, cutting-edge clinical trials.

Mesothelioma surgeries

Pleurectomy/decortication (P/D): Currently, all procedures for mesothelioma are considered palliative. Most people with the disease will undergo at least one operation to remove tumor tissue and relieve pressure in the chest. The P/D is a fairly conservative surgery, in that it removes only the affected lung covering and part of the chest cavity lining.

Debulking: This is an even more conservative surgery, one that just focuses on removing the main mass of mesothelioma tumors.

Extrapleural pneumonectomy (EPP): Of the procedures used to treat mesothelioma, EPP is one of the most radical, since it removes the lining of the chest, the sac surrounding the heart, the diaphragm muscle and one lung. It is often used for more advanced cases of the disease.

Fluid removal: To ease pressure and increase comfort, doctors can perform fairly minor procedures like the thoracentesis, pleurodesis or pericardiocentesis, which use small tubes to drain excess fluid from the chest.


Pemetrexed: Many patients with MPM are given this chemotherapeutic agent, often in combination with cisplatin. Whether it’s taken orally, injected or applied directly to a tumor site depends on the disease’s stage.

ACisplatin: Another common chemo treatment.

Pazopanib: Though not yet approved for use on MPM, tests have shown that this chemo agent (which is used for kidney cancer) may double as a mesothelioma treatment.


External beam: As part of a multi-pronged approach to treatment, some patients may receive radiation therapy from an external source, like an X-ray machine.

Brachytherapy: Also known as internal radiation therapy, this treatment involves the injection or implantation of radioactive iodine as a way to kill MPM cells.

Clinical trials

Biologic therapy: This form of treatment, also called immunotherapy, uses your own immune system to fight tumor growth. It is being tested in multiple clinical trials.

MV-NIS: Short for “measles virus vector with the human thyroidal sodium iodide symporter,” this experimental treatment uses specially modified measles viruses to deliver radioactive iodine to MPM tumors in a targeted way.

Related articles:

Mesothelioma and Pain: What to Expect and How to Manage It

The Stages of Mesothelioma: What Can I Expect After My Diagnosis?

Recent Mesothelioma Medical Breakthroughs

doctors conferringIf you’ve read about malignant pleural mesothelioma online, then at first glance, it may have seemed as though there are just a few treatment options for MPM patients. However, researchers in dozens of U.S. laboratories are working diligently to develop new and more effective diagnostic tests, chemotherapies, surgeries and biological tools for attacking the disease.

After nearly four decades of helping patients make informed legal and medical choices, we at Kazan, McClain, Satterley & Greenwood have learned to keep this principle in mind: Every time you think that you’ve exhausted all available mesothelioma treatments, a new one might just appear on the horizon.

Here are a few good examples of recent mesothelioma medical breakthroughs, many of which are in the later stages of clinical trial.

Using CT scanning for surgery-free tumor tracking

In this case, there was no need for a trial, since computed tomographic (CT) scans are already routinely used as part of the MPM diagnostic process. In a recent study supported by The Kazan, McClain, Abrams, Fernandez, Lyons, Greenwood, Oberman, Satterley & Bosl Foundation, Inc, a team of radiologists from the University of Chicago found that CT scanning may be used to non-invasively track the size of mesothelioma tumors.

Published in the journal Medical Physics, the group’s results indicated that this 3D imaging method may be as accurate as surgical biopsies in estimating the extent of MPM growth.

And what’s more, the technique might act as a stepping stone for the development of new treatments for MPM!

“[This] computerized method will be implemented in future studies to help evaluate novel therapies,” researchers concluded. “Further, we believe that these methods will be invaluable to researchers who attempt to create novel treatments for pleural-based diseases.”

What other advances in mesothelioma treatment are currently in development?

Plenty! Consider a report recently released by the Mayo Clinic, which explained that a drug used for kidney cancer may double as a chemotherapy for MPM.

Called pazopanib, the substance is typically administered to treat advanced renal carcinomas. However, as Dr. Julian Molina discovered, it may have other exciting applications.

“We…added it to mesothelioma cells that we had in the lab, and we noticed that pazopanib was very effective at killing these cancer cells,” he explained, quoted by the clinic’s magazine, Discovery’s Edge. “At the time, we were doing a Phase I study here in which we were testing pazopanib for patients who had all tumor types.”

In the same edition of the periodical, researchers from the University of Minnesota described their own cutting-edge, “biologic” treatment for MPM: a modified measles virus that can deliver radioactive iodine to mesothelioma tumors without actually infecting the patient.

Lab tests were encouraging. Compared to MPM-diagnosed mice given traditional therapies, those that were treated with this new approach lived twice as long on average. The team told the news source that some of the animals even appeared to have been cured!

The Stages of Mesothelioma: What Can I Expect After My Diagnosis?

doctor with patient in hospital roomIt’s numbing, in a way, to discover that you have malignant pleural mesothelioma, but this feeling doesn’t last. What comes next? With a little help from friends, family, doctors and legal counsel, your shock can quickly turn to concern, hope and even optimism.

At Kazan, McClain, Lyons, Greenwood and Harley, we’ve spent decades helping the victims of asbestos exposure come to terms with mesothelioma while navigating their legal and medical options. If you or a loved one has been diagnosed with mesothelioma, you may be wondering how to begin grappling with the illness.

While it is tempting to maintain some ignorance about mesothelioma, the knowledge of what’s to come can be genuinely helpful. It can help you work through your feelings. It can give you time to learn about your palliative care options. It might also calm you down to know more about the road ahead.

For these reasons, most physicians will begin by telling you what to expect from the disease itself. Here, then, is a brief summary of the stages of mesothelioma.

Mesothelioma Stage I

At this point, the disease is located on one side of the chest only. Though there are four stages of mesothelioma, only Stage I is considered “local.” Because the disease is very aggressive, all the rest are “advanced” by definition. For this reason – and because it can take years or even decades for mesothelioma to show symptoms – few cases of the illness are diagnosed at Stage I.

Mesothelioma Stage II

In Stage II, tumor has spread around the lung lining, into the diaphragm or has invaded the lung itself.

Mesothelioma Stage III

At this stage, mesothelioma may also be found in the tissue surrounding the heart, in the ribs and in the soft tissue and lymph nodes of the chest.

Mesothelioma Stage IV

In this stage of mesothelioma, it may spread nearly anywhere. Typically, it is found in both halves of the chest and in the lower abdomen. It may also involve the spine, the brain or more distant places.


  • You have plenty of palliative care options to choose from, some of which can greatly extend life expectancy and most of which will make you much more comfortable.
  • Ask your doctor all the questions you like. The more information you know, the better.
  • Know your legal and clinical options.

Related articles:

Mesothelioma and Pain: What to Expect and How to Manage It

Strategies for Coping with a Mesothelioma Diagnosis

Mesothelioma Treatment Options and Clinical Trials

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