Malignant Mesothelioma Treatment (PDQ®): Treatment - Patient Information [NCI]
General Information About Malignant Mesothelioma
Malignant mesothelioma is a type of cancer that forms in the thin layer of tissue that covers organs in the chest or abdomen.
Malignant mesothelioma may be found in one or more of the following:
- the pleura, a thin layer of tissue that lines the chest cavity and covers the lungs
- the peritoneum, a thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen
- the pericardium, a thin layer of tissue that surrounds the heart
Malignant mesothelioma may also form in the heart or testicles, but this is rare.
Malignant mesothelioma forms in the tissue that lines the chest or abdomen, including the pleura (the tissue that lines the chest cavity and covers the lungs) and the peritoneum (the tissue that lines the abdomen and covers most of the organs in the abdomen). Malignant mesothelioma may also form in the pericardium (the tissue that surrounds the heart) or the testicles, but this is rare.
Being exposed to asbestos can increase the risk of malignant mesothelioma.
Malignant mesothelioma is caused by certain changes to the way the cells that line the organs function, especially how they grow and divide into new cells. Often, the exact cause of the cell change is unknown. Learn more about how cancer develops at
A risk factor is anything that increases the chance of getting a disease. Most people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos, which has been used in the building and textile industries. 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. Not every person with one or more of these risk factors will develop malignant mesothelioma. And it can develop in some people who don't have any known risk factors.
Talk to your doctor if you think you may be at risk.
Signs and symptoms of malignant mesothelioma include shortness of breath and pain under the rib cage.
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:
- trouble breathing
- cough
- pain under the rib cage
- pain or swelling in the abdomen
- lumps in the abdomen
- constipation
- problems with blood clots (clots form when they shouldn't)
- weight loss for no known reason
- fatigue (feeling very tired)
Tests that examine the inside of the chest and abdomen are used to diagnose malignant mesothelioma.
Sometimes it is hard to tell the difference between malignant mesothelioma in the chest and lung cancer. If you have symptoms that suggest mesothelioma, the doctor will need to find out if these are due to cancer or to another problem. The doctor will ask when the symptoms started and how often you have been having them. They will also ask about your personal and family health history and do a physical exam. Depending on these results, they may recommend other tests. If you are diagnosed with mesothelioma, the results of these tests will help you and your doctor plan treatment.
The tests and procedures used to diagnose mesothelioma may include:
- Chest x-ray is a type of radiation that can go through the body and make pictures of the organs and bones inside the chest.
A chest x-ray is used to take pictures of the structures and organs inside the chest. X-rays pass through the patient's body onto film or a computer. - CT scan (CAT scan) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Learn more at
Computed Tomography (CT) Scans and CancerComputed Tomography (CT) Scans and Cancer . - Biopsy is the removal of cells or tissues from the pleura or peritoneum so that a pathologist can view it under a microscope to check for signs of cancer.
Procedures used to collect the cells or tissues include:
- Fine-needle (FNA) aspiration biopsy of the lung uses a thin needle to remove tissue or fluid. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.
Fine-needle aspiration biopsy of the lung. The patient lies on a table that slides through the computed tomography (CT) machine, which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer. - Thoracoscopy is surgery to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the chest.
- Thoracotomy is surgery to look inside the chest. An incision (cut) is made between two ribs to check inside the chest for signs of disease.
- Peritoneoscopy is surgery to look inside the abdomen. An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen to check for signs of disease.
- Open biopsy is surgery to remove abnormal tissues so a pathologist can check it under a microscope for signs of disease. An incision (cut) is made through the skin to expose and remove tissues.
The following tests may be done on the cells and tissue samples that are taken:
- A cytologic exam is a laboratory test to view cells under a microscope to check for anything abnormal. For mesothelioma, fluid is taken from the chest or from the abdomen. A pathologist checks the fluid for signs of cancer.
- Immunohistochemistry is a laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient's tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
- Electron microscopy is a laboratory test in which cells in a sample of tissue are viewed under a high-powered microscope to look for certain changes in the cells. An electron microscope shows tiny details better than other types of microscopes.
- Fine-needle (FNA) aspiration biopsy of the lung uses a thin needle to remove tissue or fluid. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.
After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.
The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The information 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:
- CT scan (CAT scan) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the chest and abdomen. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Learn more at
Computed Tomography (CT) Scans and CancerComputed Tomography (CT) Scans and Cancer . - PET scan (positron emission tomography scan) uses a small amount of radioactive sugar that is injected into a vein. The PET scanner rotates around the body to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body.
- MRI (magnetic resonance imaging) uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Endoscopic ultrasound (EUS) is a procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
Endoscopic ultrasound-guided fine-needle aspiration biopsy. An endoscope that has an ultrasound probe and a biopsy needle is inserted through the mouth and into the esophagus. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the lymph nodes near the esophagus. The sonogram helps the doctor see where to place the biopsy needle to remove tissue from the lymph nodes. This tissue is checked under a microscope for signs of cancer. - Laparoscopy is surgery to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples to be checked under a microscope for signs of disease.
- Lymph node biopsy is the removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells.
- Mediastinoscopy is surgery to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
Some people decide to get a second opinion.
You may want to get a second opinion to confirm your cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.
Learn more about choosing a doctor and getting a second opinion at
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis and treatment options depend on:
- the stage of the cancer
- the size of the tumor
- whether the tumor can be removed completely by surgery
- the amount of fluid in the chest or abdomen
- the patient's age
- the patient's activity level
- the patient's general health, including lung and heart health
- the type of mesothelioma cells and how they look under a microscope
- the number of white blood cells and how much hemoglobin is in the blood
- whether the patient is male or female
- whether the cancer has just been diagnosed or has recurred (come back)
Stages of Malignant Mesothelioma
Cancer stage describes the extent of cancer in the body.
Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. It is important to know the stage of mesothelioma to plan the best treatment.
There are several staging systems for cancer that describe the extent of the cancer. Malignant mesothelioma staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to your cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.
Learn about
The following stages are used for malignant mesothelioma of the lung:
Stage I (also called stage 1) malignant mesothelioma
Stage I is divided into stages IA and IB:
- In stage IA, 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:
- the thin layer of tissue that covers the lung
- the thin layer of tissue that covers the organs between the lungs
- the thin layer of tissue that covers the top of the diaphragm
- In stage IB, 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 more of the following:
- diaphragm
- lung tissue
- tissue between the ribs and the inside lining of the chest wall
- fat in the area between the lungs
- soft tissues of the chest wall
- sac around the heart
Stage II (also called stage 2) malignant mesothelioma
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:
- the thin layer of tissue that covers the lung
- the thin layer of tissue that covers the organs between the lungs
- the thin layer of tissue that covers the top of the diaphragm
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:
- diaphragm
- lung tissue
Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.
Stage III (also called stage 3) malignant mesothelioma
Stage III is divided into stages IIIA and IIIB.
- In stage IIIA, 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 more of the following:
- tissue between the ribs and the inside lining of the chest wall
- fat in the area between the lungs
- soft tissues of the chest wall
- sac around the heart
Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.
- In stage IIIB, cancer is found in the inside lining of the chest wall, and may also be found in the thin layers of tissue that cover the lung, the organs between the lungs, and/or the top of the diaphragm on one side of the chest. On the same side of the chest, cancer may have also spread into one or more of the following:
- diaphragm
- lung tissue
- tissue between the ribs and the inside lining of the chest wall
- fat in the area between the lungs
- soft tissues of the chest wall
- sac around the heart
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:
- the chest wall and may be found in the rib
- through the diaphragm into the peritoneum
- the tissue lining the chest on the opposite side of the body as the tumor
- the organs in the area between the lungs (esophagus, trachea, thymus, blood vessels)
- the spine
- through the sac around the heart or into the heart muscle
Cancer may have spread to lymph nodes.
Stage IV (also called stage 4) malignant mesothelioma
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.
Stage IV malignant mesothelioma is also called metastatic mesothelioma. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if malignant mesothelioma spreads to the liver, the cancer cells in the liver are actually malignant mesothelioma cells. The disease is called metastatic mesothelioma, not liver cancer. Learn more in
Malignant mesothelioma can recur (come back) after it has been treated.
Recurrent malignant mesothelioma is cancer that has come back after it has been treated. If mesothelioma comes back, it may come back in the chest or in other parts of the body, such as the liver, lungs, or both. Tests will be done to help determine where the cancer has returned. The type of treatment for recurrent mesothelioma will depend on where it has come back.
Learn more in
Treatment Option Overview
There are different types of treatment for patients with malignant mesothelioma.
Different types of treatments are available for malignant mesothelioma. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.
Talking with your cancer care team before treatment begins about what to expect will be helpful. You'll want to learn what you need to do before treatment begins, how you'll feel while going through it, and what kind of help you will need. To learn more, visit
The following types of treatment are used:
Surgery
The following surgical treatments may be used for malignant mesothelioma in the chest:
- Wide local excision is surgery to remove the cancer and some of the healthy tissue around it. The amount of healthy tissue removed depends on how deep or how large the tumor being removed is.
- Pleurectomy and decortication is surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
- Extrapleural pneumonectomy is surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
- Pleurodesis is surgery that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.
After the doctor removes all the cancer that can be seen at the time of the surgery, some people may receive chemotherapy or radiation therapy 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
Radiation therapy 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 care to relieve symptoms and improve quality of life.
Chemotherapy
Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Combination chemotherapy is the use of more than one anticancer drug.
Systemic chemotherapy is when chemotherapy is taken by mouth or injected into a vein or muscle. When given this way, the drugs enter the bloodstream and can reach cancer cells throughout the body.
Regional chemotherapy is when chemotherapy is placed directly into an organ or a body cavity, such as the chest or peritoneum. When given this way, the drugs mainly affect cancer cells in those areas. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a type of regional chemotherapy used to treat malignant mesothelioma:
- HIPEC may be used to treat 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.
Learn more about how chemotherapy works, how it is given, common side effects, and more at
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Immunotherapy
Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about
Immunotherapy drugs used to treat advanced mesothelioma include:
- ipilimumab
- nivolumab
Other immunotherapy drugs, such as durvalumab, are being studied in malignant mesothelioma.
Learn more about
Targeted therapy
Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. Bevacizumab is a targeted therapy drug used to treat malignant mesothelioma.
Other targeted therapies, such as ramucirumab, are being studied in malignant mesothelioma.
Learn more about
New types of treatment are being tested in clinical trials.
Joining a clinical trial may be an option. There are different types of clinical trials for people with mesothelioma. For example, a treatment trial tests new treatments or new ways of using existing treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.
You can use the
Learn more about clinical trials at
Treatment for malignant mesothelioma may cause side effects.
For information about side effects caused by treatment for cancer, visit our
Follow-up care may be needed.
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).
Treatment of Localized Malignant Mesothelioma (Stage I)
If stage I malignant mesothelioma is in one part of the chest lining, treatment may include surgery to remove the cancer and the tissue around it.
Treatment of stage I intracavitary mesothelioma may include:
- a surgery called extrapleural pneumonectomy
- palliative surgery with pleurectomy and decortication, which may be followed by radiation therapy, to relieve symptoms and improve quality of life
- palliative radiation therapy to relieve symptoms and improve quality of life
Learn more about these treatments in the
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Treatment of Advanced Malignant Mesothelioma (Stages II, III, and IV)
If stage II, stage III, or stage IV malignant mesothelioma is found in the chest, treatment may include:
- immunotherapy (nivolumab and ipilimumab)
- combination chemotherapy with or without targeted therapy (bevacizumab)
- combination chemotherapy and palliative care, which may be followed by maintenance chemotherapy
- palliative care, which may include draining fluid from the chest, a procedure to prevent fluid from collecting in the chest (pleurodesis), surgery, or radiation therapy, to relieve symptoms and improve quality of life
- chemotherapy placed directly into the chest or abdominal cavity to shrink the tumors and keep fluid from building up
If stage II, stage III, or stage IV malignant mesothelioma is found in the peritoneum, treatment may include:
- surgery to remove the tumor followed by hyperthermic intraperitoneal chemotherapy
- chemotherapy
Learn more about these treatments in the
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Treatment of Recurrent Malignant Mesothelioma
When malignant mesothelioma recurs (comes back), the treatment strategy often involves options that weren't used in the initial treatment. If you haven't received systemic therapy before, treatment may include:
- chemotherapy
- a combination of chemotherapy and immunotherapy (nivolumab)
- immunotherapy alone
If you have received systemic therapy, treatment might include the following, given alone or in combination:
- chemotherapy
- immunotherapy
For certain people with locally recurrent cancer, surgery to remove the affected part of the chest wall may be an option.
Learn more about these treatments in the
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To Learn More About Malignant Mesothelioma
For more from the National Cancer Institute about malignant mesothelioma, see the following:
-
Malignant Mesothelioma Home PageMalignant Mesothelioma Home Page -
Drugs Approved for Malignant MesotheliomaDrugs Approved for Malignant Mesothelioma -
Asbestos Exposure and Cancer RiskAsbestos Exposure and Cancer Risk
For general cancer information and other resources from the National Cancer Institute, visit:
-
About CancerAbout Cancer -
Cancer StagingCancer Staging -
Chemotherapy and You: Support for People With CancerChemotherapy and You: Support for People With Cancer -
Radiation Therapy and You: Support for People With CancerRadiation Therapy and You: Support for People With Cancer -
Coping with CancerCoping with Cancer -
Questions to Ask Your Doctor about CancerQuestions to Ask Your Doctor about Cancer -
For Survivors, Caregivers, and AdvocatesFor Survivors, Caregivers, and Advocates
About This PDQ Summary
About PDQ
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in
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Clinical trials can be found online at
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PDQ® Adult Treatment Editorial Board. PDQ Malignant Mesothelioma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at:
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Last Revised: 2024-07-19
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