TreatmentMesothelioma treatment depends on several factors, including the stage of mesothelioma, the ******** of the tumor, and the age and overall health of the patient.Surgery – Removal of MesotheliomaSurgical removal of the tumor and surrounding tissue may be done depending on how far the mesothelioma has spread (the stage). The more advanced the stage, the less likely that surgery will be effective in treating mesothelioma.Surgery for malignant mesothelioma can be used in certain cases to try and cure the disease. This is aggressive surgery. It can be used to relieve pain and other symptoms. This is called palliative surgery.Aggressive surgeryAggressive mesothelioma surgery involves removal of the pleura lining the chest wall, the diaphragm, and pericardium, as well as the entire lung on the side with the mesothelioma This i is called extrapleural pneumonectomy. The goal is to remove as much of the mesothelioma tumor as possible. This type of surgery, typically is performed on younger patients in Stage 1 of mesothelioma. At least one out of four patients has serious complications after this surgery. It is usually followed by chemotherapy and/or radiation therapy.Because of the complexity and the high risks involved with this type of surgery, some mesothelioma hospitals do not perform the procedure. Also, different mesothelioma treatment centers may have different criteria for accepting patients for surgery. Therefore, it is important to check with a mesothelioma hospital to see if you meet its criteria.Palliative SurgeryPalliative surgery is typically used in the more advanced stages of mesothelioma. The goal is to relieve or control symptoms caused by fluid collection or by the tumor compressing the lung or other organs. It is not intended to cure mesothelioma.Pleurectomy/decortization is usually a palliative operation. It is used in situations where the entire tumor cannot be removed, so it is rarely thought of as a curative procendure. It is effective for controlling the accumulation of fluid in the pleural space (called a pleural effusion), decreasing the pain caused by mesothelioma, as well as decreasing the difficulty breatthing.Thoracentesis is also used to treat pleural effusions in pleural mesothelioma. This treatment involves inserting a needle into the chest, into the space between the two layers of pleura, in order to drain the fluid. Thoracentesis does not involve surgical removal of tumor cells.Other procedures are done for mesotheliomas of the peritoneun, pericardium, or tunica vaginalis testis.Read more about mesothelioma surgeryRadiation - RadiotherapyRadiation therapy uses high-energy x-rays to kill mesothelioma cancer cells and to shrink tumors. There are two types of radiation therapy.External radiation therapy uses a machine outside the body that beams x-rays to the ******** of the mesothelioma.Brachytherapy involves putting chemicals that produce radiation directly into the site of the mesothelioma cancer. This is done by inserting a thin plastic tube into the chest or abdomen.Because of the ******** of malignant mesothelioma, it is very difficult to deliver high-enough doses of radiation to kill the tumor without damaging surrounding organs. As a result, it is unclear whether radiation therapy is a successful method of treating mesothelioma. It has, however, been effective in killing remaining tumor cells after surgery has been performed.Radiation therapy is also used as a palliative therapy to relieve symptoms of mesothelioma, such as shortness of breath, chest pain, and internal bleeding.Radiation therapy has several side effects, such as fatigue, nausea, and vomiting. Although these side effects are sometimes temporary, you should let your doctor know, since they often can be controlled.Read more about radiation therapyChemotherapyChemotherapy is the use of drugs to treat cancer. Chemotherapy can be administeredorally (by mouth) or by injection into the muscles. However, for mesothelioma, as with other cancers chemotherapy agents are usually injected into the veins (intravenously). Sometimes the chemotherapy agents can be put directly into the chest cavity (intrapleurally)in the case of pleural mesothelioma or the abdominal cavity (intraperitoneally), in the case of peritoneal meothelioma. The goal of mesothelioma chemotherapy is for the drug destroy the cancer cells while sparing normal cells as much as possiible.Several drugs have been used, either individually or in combination with others, to treat mesothelioma. Some of the drugs include:a) Alimta (pemetrexed) - The FDA (in 2004) approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma along with cisplatin..This combination appears to be very effective for mesothelioma. Pemetrexed interferes with folic acid and vitamin B12 in the body, so these vitamins must be taken. This is now the most common chemotherapy regimen for mesothelioma. At the current time it may be considered the standard of care. For more information on Alimta, follow the links below.b) Tomudex (raltitrexed) - In October 2005,researchers reported that the combination of Tomudex (raltitrexed) and Platinol (cisplatin) improves survival of patients with malignant pleural mesothelioma more than Platinol alone.c) Vinorelbine - In one study, 29 patients were given vinorelbine alone. 7 (24%) patients had a partial response and 16 (55%) patients’ disease remained stable. The quality of life improved for patients, and there was low toxicity. Vinorelbine is useful as palliative therapy.d) Doxorubicin - Previously, oxorubicin has not been useful in treating mesothelioma, which is resistant to this agent. In 2006, researchersfound that statins, drugs commonly used to reduce cholesterol (such as mevastatin and simvastatin) can reverse the resistance of mesothelioma cells to doxorubicin in culture. Future research may be able to discover if this is clinically significant. .e) Onconase (ranpirnase) inhibits cell growth and causes cellular death. It is undergoing testing, comparing the results in treating mesothelioma with Onconase and Doxorubicin against Doxorubicin alone.It has not yet been approved for treatment of mesothelioma.f) Cisplatin, a platinum-based chemotherapy drug used to treat mesothelioma and other forms of cancer, slows or stops the growth of cancer cells in the body. It is usually given with pemetrexed.(Alimta). Sometimes carboplatin is used instead, but most regimens use cisplatin.g) Gemcitabine (difluorodeoxycytidine) is commonly used to treat pancreatic, bladder and breast cancer but is being studied for mesothelioma.Chemotherapy alone or with radiotherapy is the usual treatment for mesothelioma that cannot be surgically removed. While it is not curative, it can slow progression of the cancer. Chemotherapy can also be given before or after surgery.Because of the relatively low response rate of single-agent therapy in treating mesothelioma, combinations of these drugs have been used to increase their effectiveness. Researchers have reported good response rates to some of these therapies. Research continues to try and find the best types of chemotherapy for mesothelioma.Chemotherapy drugs are generally very toxic. Therefore, patients must be monitored very closely. Some of the more common side effects include nausea, vomiting, loss of appetite, hair loss, mouth sores, and fatigue. Chemotherapy can also result in low blood cell counts,. A reduced number of red cells is called anemia, and it may increase fatigue. Decreased level of white cells can lead to increased chance of infection. Decreased level of platelets can lead to bleeding..Side effects like these generally disappear after treatment is completed. There is also medication to help reduce many of the side effects. There are good drugs to reduce nausea and vomiting. There are also medications that can help treat anemia.Other side effects can be more long-lasting, or even permanent. The particular risks depend on which drugs are used.Depending on the stage of the mesothelioma, and the overall health of the patient, anyone with stage 2 or above mesothelioma should consider participating in a clinical trial. Encouraging results are coming from many clinical trials