Mesothelioma Treatment and Survival Rate

January 24, 2025

This page was reviewed under our medical and editorial policy by Jyoti Malhotra, M.D., M.P.H., associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Orange County Lennar Foundation Cancer Center; and Jae Y. Kim, M.D., associate professor, Division of Thoracic Surgery, Department of Surgery, City of Hope Cancer Center Duarte

Mesothelioma is a cancer that develops in the mesothelial cells that line the internal organs of the abdomen, chest, heart or testicles. It is sometimes called malignant mesothelioma.

Treatment options for the disease may vary based on:

• Cancer type and stage
• Tumor size
• Location of the cancer
• If the tumor is completely removable (resectable) with surgery
• The amount of fluid present in the chest or abdomen
• Blood levels of white blood cells and hemoglobin (an oxygen-carrying protein in red blood cells)
• The patient’s age, activity levels and overall health
• The patient’s treatment preferences

Who Treats Mesothelioma?

The patient’s health care team for mesothelioma cancer treatment may include:

• Thoracic surgeons, doctors trained to operate on lung and chest diseases
• Surgical oncologists, doctors trained to operate on cancer
• Pulmonologists, doctors trained to treat lung diseases
• Medical oncologists, doctors specializing in the use of medicine to treat cancer, such as chemotherapy drugs
• Radiation oncologists, doctors specializing in the use of radiation to treat cancer

Mesothelioma Treatments

The types of mesotheliomas are categorized by where they first form in the body.

Pleural mesothelioma: This type forms in the pleura tissue that covers the lungs and the chest area that holds the lungs.

Pericardial mesothelioma: This type forms in the pericardium tissue that surrounds the heart and the tissue lining the chest space that holds the heart.

Peritoneal mesothelioma: This type forms in the peritoneum tissue that lines both the abdomen (belly) and most of the organs of the abdomen.

Tunica vaginalis mesothelioma: This type forms in the tissues that cover the testicles. Doctors formulate treatment plans based on the location in the body and other factors. These treatments may include:

• Surgery to remove the cancer tumor
• Chemotherapy drugs that help destroy cancer cells
• Radiation therapy to destroy cancer cells using high-energy particles like X-rays
• Immunotherapy to help the body’s immune system fight cancer
• Targeted drug therapy to target and inhibit certain cancer-promoting proteins and genes in cancer cells
• Tumor treating fields, which use alternating electric fields to disrupt the cancer cells, which may reduce their ability to multiply and metastasize

These treatments may also be used to help ease the symptoms of mesothelioma or the side effects of cancer treatments.

Pleural Mesothelioma Treatment

Surgery is a main treatment for pleural mesothelioma when it is in Stage 1, Stage 2 or Stage 3 and the cancer is considered resectable, meaning it is able to be completely removed.

Pleural mesothelioma resection surgeries include the following.

Extrapleural pneumonectomy (EPP): On the side of the body that contains cancer, the surgeon removes the lung, the diaphragm and the pleura tissue lining the chest. The surgeon may also remove area lymph nodes and the pericardium, which is the sac surrounding the heart. The diaphragm and (if removed) the pericardium are resculpted using synthetic materials.

Pleurectomy/decortication (P/D): On the side of the body that contains cancer, the surgeon removes the pleural tissue lining the chest wall, lung, mediastinum (area between the lungs) and diaphragm. In a radical pleurectomy, the diaphragm on the side with cancer and/or the pericardium may also be removed.

Partial pleurectomy (debulking surgery): The surgeon removes as much of the mesothelioma tumor as possible with treatments such as chemotherapy and radiation therapy.

Chemotherapy may be given before surgery to help shrink the cancer cells, and it may also be given after surgery to help ensure all the cancer has been destroyed. Doctors may also recommend chemotherapy as a main treatment instead of surgery if the cancer is unresectable, meaning surgeons are not able to completely remove it.

Chemotherapy for pleural mesothelioma includes:

• Systemic chemotherapy, in which chemotherapy drugs are injected into a vein so that they travel throughout the body
• Intrapleural chemotherapy, in which chemotherapy is placed directly into the pleura tissue in the chest where the cancer cells are located

Radiation therapy is sometimes recommended after surgery to help treat pleural mesothelioma, either alone or alongside chemotherapy.

Immunotherapy that targets the PD-1 and CTLA-4 proteins may be used for newly diagnosed advanced pleural mesothelioma.

Immunotherapy and targeted drug therapy may be combined to fight the disease. For example, combining chemotherapy with a drug called Avastin® (bevacizumab) that helps stop blood flow to cancer cells may help patients with pleural mesothelioma live longer than if they only had chemotherapy treatments.

Pericardial Mesothelioma Treatment

While there are no standard or universal treatment protocols for pericardial mesothelioma, a combination of surgery, radiation therapy and chemotherapy after surgery may help improve patients’ outcomes.

Surgery for pericardial mesothelioma includes removal of the tumor from the pericardium (sac around the heart). It may also include pericardiectomy, which is the removal of part or all of the pericardium. Sometimes an operation called a pericardial window is used to create a hole in the pericardium, through which chemotherapy drugs may be placed to help destroy the cancer cells.

In addition to these treatments, immunotherapy is sometimes used to treat the disease.

Since pericardial mesothelioma is often first diagnosed at a more advanced stage, treatment may be palliative, meaning it is used to ease the patient’s cancer symptoms and help improve their quality of life.

Treating Peritoneal Mesothelioma

Similar to other types of mesotheliomas, surgery may be used to treat resectable (removable) peritoneal mesothelioma, including:

• Debulking surgery, during which the surgeon removes as much of the mesothelioma cancer as possible and sometimes parts of the intestine
• Omentectomy, in which the surgeon removes the omentum, a layer of fatty tissue in the abdomen to which peritoneal cancer often spreads

During surgery, chemotherapy treatments may be placed inside the peritoneum tissue where the cancer cells are located. This is called intraperitoneal chemotherapy. Heating these chemotherapy drugs may increase their success rates, so doctors sometimes administer hyperthermic (heated) intraperitoneal chemotherapy (HIPEC).

Chemotherapy may also be used both before surgery to help shrink the cancer cells and after surgery either by itself or in combination with radiation therapy to help ensure that all cancer is eliminated.

Immunotherapy drugs, along with targeted drug therapy and chemotherapy, are often used for tumors that cannot be removed surgically (unresectable mesotheliomas). For instance, a tumor-expressing protein called PD-L1 may be found in people diagnosed with malignant peritoneal mesothelioma (MPM). Immunotherapy that targets the PD-1 proteins that bind to PD-L1 may help the immune system better fight the disease, especially for patients diagnosed with recurring MPM.

Tunica Vaginalis Mesothelioma Treatment

Surgery to remove mesothelioma from the tunica vaginalis tissue that surrounds the testicles rarely eliminates all the cancer. Instead, treatment may include radical orchiectomy surgery, during which the surgeon removes either one testicle or both. Other nearby structures may be removed as well, such as the spermatic cord.

Blood vessels and the vas deferens that carry sperm from the testicles are then tied off to help prevent cancer spread.

Radiation therapy and chemotherapy, either in combination or alone, may also be recommended after radical orchiectomy surgery to help ensure that all the cancer cells are destroyed.

If the cancer has already spread beyond the testicles to other parts of the body, the doctor may recommend chemotherapy, immunotherapy and targeted drug therapy, either by themselves or in combination, to treat tunica vaginalis mesothelioma.

Supportive Care Options

Supportive care, or palliative care, for mesothelioma includes procedures, surgeries and therapies to help patients feel more comfortable by easing their cancer symptoms and treatment side effects. These options may be used to help improve the patient’s quality of life if the cancer is not able to be completely controlled and destroyed, or while treatment is in progress for cancer that is controllable.

For instance, sometimes radiation therapy is used to help shrink cancer tumors in order to ease certain symptoms of mesothelioma, such as swallowing problems, shortness of breath and chest pain. Doctors may also perform the following procedures and surgeries for mesothelioma supportive care.

Needle fluid removal: Fluid may build up in between certain layers of tissue when people have mesothelioma, causing breathing problems or other issues. Doctors use a thin, hollowed-out needle to remove this fluid from the chest (thoracentesis), heart (pericardiocentesis) or abdomen (paracentesis).

Pleurodesis: A doctor makes a small cut in the chest wall and inserts a tube into it to drain out the fluid. Then a substance, such as an antibiotic or chemotherapy drug, is inserted into the tube. This substance helps seal linings of the chest wall and lungs together to prevent fluid buildup in these spaces.

Catheter placement: A tube is placed into the chest, abdomen or peritoneal mesothelioma through a small cut made by the doctor. The other end of the tube (catheter) is left outside the body and attached to a bottle or other device that holds the drained fluid.

Shunt placement: A thin, flexible tube with an attached pump, known as a shunt, is placed in the body to allow fluid to drain from one area of the body to another. For example, a pleuroperitoneal shunt drains extra fluid from the chest into the abdomen, which tends to absorb it better. Doctors may use a shunt if pleurodesis is not successful.

Surgery: Pleurectomy/decortication surgery may be used to help with pain management, fluid buildup and breathing problems for those with pleural mesothelioma. Patients diagnosed with pericardial mesothelioma may benefit from pericardiectomy surgery to help ease the pressure on their heart.

Mesothelioma Survival Rate

The survival rate for people diagnosed with mesothelioma may vary based on where the cancer is located in the body.

Pleural Mesothelioma Survival Rate

The five-year relative survival rate is the portion of people who survive for five years or more after a diagnosis of pleural mesothelioma, compared to people without this cancer type. People diagnosed with pleural mesothelioma had an overall five-year relative survival rate of 12% between 2012 and 2018, according to the American Cancer Society.

This survival rate varied by cancer stage (the extent of the cancer’s spread), as follows.

Localized cancer (that had not spread beyond pleura tissue): 24%.

Regional cancer (that had spread to area lymph nodes or structures): 16%.

Distant cancer (that had spread to distant sites in the body): 7%.

Newly approved treatments have shown promise for increasing survival rates for pleural mesothelioma, including two types of immunotherapy used when surgeons are not able to completely remove the cancer with surgery.

Peritoneal Mesothelioma Survival Rate

Peritoneal mesothelioma is rare, and one of the main systems for staging cancer has not established criteria to stage the disease.

While survival rates by stage are not available for this type of cancer, data published in F1000 Research across U.S. patients enrolled in the National Mesothelioma Virtual Bank revealed that the median survival period was 28 months for patients with peritoneal mesothelioma who underwent surgery and chemotherapy treatments. (Median means half lived longer, half lived a shorter time.) This median survival was significantly better than for patients diagnosed with pleural mesothelioma. And, some patients in the study with peritoneal mesothelioma survived up to 60 months after their initial diagnosis.

Pericardial Mesothelioma Survival Rate

Like peritoneal mesothelioma, pericardial mesothelioma is rare, and data on patient survival rates is limited. In 2018, researchers reviewed 103 cases of patients diagnosed with the disease. The median overall survival was six months. This survival period increased significantly — to 13 months — for patients undergoing chemotherapy treatments, the review found.

Tunica Vaginalis Mesothelioma Survival Rate

Tunica vaginalis mesothelioma is considered very rare, making the study of survival a challenge. In a recent case series of seven U.S. patients with tunica vaginalis mesothelioma in Clinical Genitourinary Cancer, all of the patients underwent testicle-removal surgery (radical orchiectomy) with limited chemotherapy and/or radiation therapy after surgery. Most patients survived at least four years or more, which is longer than previously reported in studies. Only one of the seven patients had a recurrence of the disease and died five years after initial diagnosis.

Mesothelioma care at City of Hope^® focuses on advanced, personalized treatments delivered by a multidisciplinary team of experts who understand the complexity of the disease and the importance of whole-person care. Services include fast appointment scheduling, quickly developed treatment plans, tailored therapies and access to clinical trials aimed at improving patients’ survival rates and quality of life.