Mesothelioma Treatment Options: Surgery, Chemo and Radiation

Author: Ian C. Langtree - Writer/Editor for Disabled World (DW)
Published: 30 Dec 2008 - Updated: 1 Oct 2026
Publication Type: Informative

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This information gives patients, families and caregivers a plain-language look at how malignant mesothelioma is treated today, covering the three main approaches - surgery, chemotherapy and radiation therapy - along with the complementary therapies many people add for pain relief and comfort. It explains why this cancer is so hard to treat: symptoms can stay hidden for decades after exposure, the disease is often misdiagnosed, and by the time it is found it has usually reached an advanced stage. It also walks through the four stages of the disease and shows how the stage at diagnosis shapes which treatments a doctor will recommend. Because mesothelioma mostly affects men over 50, whose overall health may rule out the most aggressive treatments, the guide is especially useful for older adults and their caregivers who need to weigh the benefits of each option against its side effects and the toll it can take on quality of life.

At a Glance

• 1 - Scientist Stephen Jay Gould lived with peritoneal mesothelioma for almost twenty years and eventually died of an unrelated cancer.
• 2 - British estimates suggest about 10% of newly diagnosed patients live at least three years, while roughly 5% survive five years or more.
• 3 - An extra-pleural pneumonectomy is the most radical pleural surgery, removing parts of a lung, the pleura, the diaphragm and the lining of the heart.
• 4 - Peritoneal patients may be offered cytoreductive surgery or a full peritonectomy, though pericardial mesothelioma patients are generally not offered surgery.

Topic Definition

Mesothelioma Treatment

Mesothelioma treatment is the medical care used to control malignant mesothelioma, a rare cancer that forms in the thin membranes lining the lungs, abdomen or heart. Because there is no known cure, the goals are to remove or shrink tumors, slow the spread of the disease, ease symptoms such as breathlessness and pain, and extend survival while protecting quality of life. Standard care relies on surgery, chemotherapy and radiation therapy, often used together in a multimodal plan, while newer immunotherapy drugs and clinical trials offer more options for some patients. The plan a care team recommends depends on the cancer's stage, its location and cell type, and the patient's age, overall health and personal goals.

Overview

While there is currently no cure available for malignant mesothelioma, there are treatments available. Some are recommended more frequently than others. The most commonly used treatments are surgery, chemotherapy, and radiation therapy.

Malignant mesothelioma is difficult to treat for several reasons. Like all cancers, it becomes more difficult to treat after the disease progresses.

Because mesothelioma doesn't show its symptoms until decades after the patient is exposed, it is often not found until it has reached advanced stages. Unfortunately, mesothelioma is also easily misdiagnosed, further delaying treatment. When the disease is found, it frequently doesn't respond well to conventional cancer treatments.

The nature of mesothelioma which affects tissues that line some of the major organs of the body means that it cannot easily be removed with surgery. And treatment can also be complicated by the demographics of its victims - generally, men over the age of 50 - whose health may not allow very radical treatments.

All of this means that even newly diagnosed mesothelioma patients sometimes are given a very bad chance of recovery by their doctors.

Statistics are hard to come by, but British scientists suggest that 10% of newly diagnosed mesothelioma patients will live for at least three more years; 5% will live five years or more. For patients in the first stage, 50% live for at least two more years. However doctors can be mistaken, and a diagnosis of mesothelioma is in no way always tantamount to a death sentence. In one famous case, scientist Stephen Jay Gould survived with peritoneal mesothelioma for almost twenty years. He eventually died from a different type of cancer.

There are four stages of malignant mesothelioma, which measure how far the disease has progressed. How a patient's mesothelioma is treated depends largely on which stage he or she is in when the disease is found.

• Stage I: Localized mesothelioma that exists only in the lungs, the diaphragm or the pericardial lining.
• Stage II: Advanced mesothelioma that has spread into the lymph nodes of the chest.
• Stage III: Advanced mesothelioma that has spread into the wall of the chest, the center of the chest, the lining of the heart and the diaphragm. Stage III malignant mesothelioma may or may not have spread to the lymph nodes.
• Stage IV: Advanced mesothelioma that has spread far from the chest and abdomen into other organs.

Treatment Options

Surgery

Patients with Stage I or milder Stage II mesothelioma are generally offered one or more of the conventional cancer treatments: surgery, radiation and chemotherapy.

For early-stage patients, surgery for mesothelioma aims to cure the disease by literally cutting the cancer out of the patient's body. The most common type of surgery for pleural mesothelioma is a pleurectomy/decortication, which is where doctors remove all or part of the tissues lining the lungs and chest cavity.

If doctors find that they can't remove the cancer without removing the lung underneath those tissues, they may remove one lung as well; this is called a pneumonectomy. A more radical type of surgery for pleural mesothelioma is called an extra-pleural pneumonectomy (EPP). In the case of an EPP, surgeons will remove parts of one lung, the pleura, the diaphragm, and the lining of the heart. These are difficult and dangerous surgeries that doctors won't recommend lightly.

Patients with peritoneal mesothelioma - the kind that affects the abdomen - may be offered cytoreductive surgery. In this surgery, doctors are trying to remove all of the cancerous tissue they can find in the abdomen and gut. They may also choose to do a peritonectomy -removal of the entire lining of the abdomen. Again, this is not an easy surgery and may not be possible for everyone, but it has been successful in some patients. Patients with pericardial mesothelioma are not generally offered surgery.

Because of the fact that the symptoms of mesothelioma lung cancer can remain latent for many years, the detection of this disease can be very difficult. For the detection and treatment of this disease, it is important for individuals to seek the services of a professional mesothelioma doctor.

The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope and the patient's age and desires.

Radiotherapy

This involves using high energy radiation beams to destroy the cancerous cells. Radiotherapy is often used to relieve any undesirable symptoms but can sometimes prove an effective treatment for mesothelioma. It can also be used to shrink the tumor before surgery and to reduce the risk of the cancer returning after surgery.

Radiotherapy treatment also comes with some unwanted side effects. These include nausea, vomiting and tiredness. However, these side effects and their severity varies depending upon the strength of the radiation used and the length of the radiotherapy treatment.

Chemotherapy

This mesothelioma treatment involves using anti-cancer medications to slow the growth of the tumor. It can also help reduce any undesirable symptoms. Unfortunately, in most cases chemotherapy alone is not enough to cure mesothelioma and instead helps provide sufferers with a better quality of life. However, it can be effective after surgery for killing off any remaining cancer cells and reducing the risk of recurrence.

Chemotherapy treatment does come with some undesirable side effects. The main side effect is that the drugs used often kill some non-cancerous cells too which makes you more susceptible to infections and can make you tire more easily. There are other associated side effects which include hair loss, nausea and diarrhea. However, these depend upon the type of chemotherapy drug being used.

Alternative Mesothelioma Treatment

A number of alternative therapies can also be combined with traditional treatment options. Many patients choose to add alternative therapies such as massage, acupuncture, or TENS therapy to their conventional treatment approach in an effort to enhance or complement the treatment process. A variety of alternative therapies, including aromatherapy, meditation, or yoga, are often added to a treatment regimen to provide pain relief and foster relaxation.

In the process of killing cancer cells, some healthy cells will also be damaged. It is these damaged cells that cause the often difficult side effects of treating mesothelioma.

Frequently Asked Questions

What causes mesothelioma?

Most cases are linked to breathing in or swallowing asbestos fibers, which lodge in the lining of the lungs or abdomen and can trigger cancer 20 to 50 years later. Many patients were exposed at work in construction, shipbuilding, manufacturing or the military.

Is immunotherapy approved for mesothelioma?

Yes. In 2020 the U.S. FDA approved the combination of nivolumab and ipilimumab as a first-line treatment for unresectable pleural mesothelioma, and it has shown longer survival than standard chemotherapy for many patients.

What is HIPEC treatment for peritoneal mesothelioma?

HIPEC stands for hyperthermic intraperitoneal chemotherapy. Right after cytoreductive surgery, heated chemotherapy is circulated through the abdomen to kill remaining cancer cells, and the combination has extended survival for some peritoneal patients.

How is fluid buildup around the lungs managed?

Doctors may drain the fluid with a procedure called thoracentesis, place an indwelling pleural catheter for drainage at home, or perform pleurodesis, which seals the space between the lung and chest wall so fluid cannot return.

Should mesothelioma patients consider clinical trials?

Clinical trials can offer access to new drugs, gene therapies and treatment combinations not yet widely available. Patients can ask their oncologist or search ClinicalTrials.gov to find studies that match their cancer type and stage.

How is mesothelioma diagnosed?

Diagnosis usually starts with imaging such as a CT or PET scan, but a biopsy is needed to confirm it. A pathologist examines the tissue to identify the cell type, which helps predict how the cancer will respond to treatment.

Does mesothelioma cell type affect treatment outcomes?

Yes. Epithelioid mesothelioma generally responds best to treatment and has the longest survival, while sarcomatoid tumors are more aggressive. Biphasic tumors contain both cell types and fall in between.

What role does palliative care play in mesothelioma?

Palliative care focuses on easing pain, breathlessness and fatigue at any stage of the disease. It can be provided alongside active treatment and helps patients and families manage both physical symptoms and emotional stress.

Insights, Analysis, and Developments

Editorial Note: Treatment for mesothelioma is rarely a single decision. It is usually a series of trade-offs between how aggressive the care is and how well a person can tolerate it. Radiotherapy can shrink a tumor before surgery or lower the chance of recurrence afterward, but it often brings nausea and fatigue. Chemotherapy can mop up cancer cells left behind after an operation, but it also weakens the immune system and raises the risk of infection. The tumor's location, how the cells look under the microscope, and the patient's own wishes all matter as much as the stage. For anyone facing this diagnosis, the practical takeaway is to see a doctor who specializes in mesothelioma, ask about combining treatments, and get a second opinion before committing to a major surgery, since experienced specialists can sometimes offer options and outcomes that a general oncologist may not.

Author Credentials: Ian is the founder and Editor-in-Chief of Disabled World, a leading resource for news and information on disability issues. With a global perspective shaped by years of travel and lived experience, Ian is a committed proponent of the Social Model of Disability, a transformative framework developed by disabled activists in the 1970s that emphasizes dismantling societal barriers rather than focusing solely on individual impairments. His work reflects a deep commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.