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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65721_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65721_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65721_"><span class="title" itemprop="name">Malignant Mesothelioma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: May 21, 2021.</p><p class="small">Created: <span itemprop="datePublished">April 23, 2005</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000269299__217">This PDQ cancer information summary has current information about the treatment of adult malignant mesothelioma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000269299__218">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000269299__1"><h2 id="_CDR0000269299__1_">General Information About Malignant Mesothelioma</h2><div id="CDR0000269299__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000269299__2">Malignant mesothelioma is a disease in which malignant (cancer) cells form in
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the lining of the chest or abdomen.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__7">Being exposed to asbestos can affect the risk of malignant mesothelioma. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__15">Signs and symptoms of malignant mesothelioma include shortness of breath and pain under the rib cage. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__19">Tests that examine the inside of the chest and abdomen are used to diagnose malignant mesothelioma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__134">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000269299__2"><h3>Malignant mesothelioma is a disease in which malignant (cancer) cells form in
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the lining of the chest or abdomen.</h3><p id="CDR0000269299__114">Malignant mesothelioma is a disease in which <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> cells are found in the pleura (the thin layer of tissue that lines the chest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> and covers the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>) or the peritoneum (the thin layer of tissue that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and covers most of the organs in the abdomen). Malignant mesothelioma may also form in the heart or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>, but this is rare.<div id="CDR0000269299__211" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Malignant%20mesothelioma%20forms%20in%20the%20tissue%20that%20lines%20the%20chest%20or%20abdomen%2C%20including%20the%20pleura%20(the%20tissue%20that%20lines%20the%20chest%20cavity%20and%20covers%20the%20lungs)%20and%20the%20peritoneum%20(the%20tissue%20that%20lines%20the%20abdomen%20and%20covers%20most%20of%20the%20organs%20in%20the%20abdomen)&p=BOOKS&id=570648_CDR0000770045.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65721.10/bin/CDR0000770045.jpg" alt="Drawing shows parts of the body where malignant mesothelioma may form, including the pleura (the tissue that lines the chest cavity and covers the lungs), the pericardium (the tissue that surrounds the heart), the peritoneum (the tissue that lines the abdomen and covers most of the organs in the abdomen), and the testicles. The heart and lungs are also shown." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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.</p></div></div></p></div><div id="CDR0000269299__7"><h3>Being exposed to asbestos can affect the risk of malignant mesothelioma. </h3><p id="CDR0000269299__155">Anything that increases the chance of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Not every person with one or more of these risk factors will develop malignant mesothelioma, and it can develop in people who don't have any known risk factors. Talk to your doctor if you think you may be at risk.</p><p id="CDR0000269299__9">Most people with malignant mesothelioma have worked or lived in places where they <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044600/" class="def">inhaled</a> or swallowed <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046528/" class="def">asbestos</a>. 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.</p></div><div id="CDR0000269299__15"><h3>Signs and symptoms of malignant mesothelioma include shortness of breath and pain under the rib cage. </h3><p id="CDR0000269299__17">Sometimes the cancer causes fluid to collect in the chest or in the abdomen. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">Signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by the fluid, malignant mesothelioma, or other conditions. Check with your doctor if you have any of the following:</p><ul id="CDR0000269299__18"><li class="half_rhythm"><div>Trouble breathing.</div></li><li class="half_rhythm"><div>Cough.</div></li><li class="half_rhythm"><div>Pain under the rib cage.</div></li><li class="half_rhythm"><div>Pain or swelling in the abdomen.</div></li><li class="half_rhythm"><div>Lumps in the abdomen.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">Constipation</a>.</div></li><li class="half_rhythm"><div> Problems with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476017/" class="def">blood clots</a> (clots form when they shouldn’t).</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li></ul></div><div id="CDR0000269299__19"><h3>Tests that examine the inside of the chest and abdomen are used to diagnose malignant mesothelioma.</h3><p id="CDR0000269299__21">Sometimes it is hard to tell the difference between malignant mesothelioma in the chest and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">lung cancer</a>. </p><p id="CDR0000269299__380">In addition to asking about your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">personal</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642015/" class="def">family health history</a> and doing a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a>, your doctor may perform the following tests and procedures:</p><ul id="CDR0000269299__22"><li class="half_rhythm"><div class="half_rhythm"><b>Chest x-ray</b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.<div id="CDR0000269299__145" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=X-ray%20of%20the%20chest&p=BOOKS&id=570648_CDR0000428438.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65721.10/bin/CDR0000428438.jpg" alt="Chest x-ray; drawing shows the patient standing with her back to the x-ray machine. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film. </p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> 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.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Biopsy</b>: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer. </div><div class="half_rhythm">Procedures used to collect the cells or tissues include the following:<dl id="CDR0000269299__140" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b>Fine-needle (FNA) aspiration biopsy of the lung</b>: The removal of tissue or fluid using a thin needle. An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045720/" class="def">imaging procedure</a> is used to locate the abnormal tissue or fluid in the lung. A small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.<div id="CDR0000269299__148" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Fine-needle%20aspiration%20biopsy%20of%20the%20lung&p=BOOKS&id=570648_CDR0000531057.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65721.10/bin/CDR0000531057.jpg" alt="Fine-needle aspiration biopsy of the lung; drawing shows a patient lying on a table that slides through the computed tomography (CT) machine with an x-ray picture of a cross-section of the lung on a monitor above the patient. Drawing also shows a doctor using the x-ray picture to help place the biopsy needle through the chest wall and into the area of abnormal lung tissue. Inset shows a side view of the chest cavity and lungs with the biopsy needle inserted into the area of abnormal tissue." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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. </p></div></div></p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046119/" class="def">Thoracoscopy</a></b>: An incision (cut) is made between two ribs and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476929/" class="def">thoracoscope</a> (a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing) is inserted into the chest.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b>Thoracotomy</b>: An incision (cut) is made between two ribs to check inside the chest for signs of disease.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b>Peritoneoscopy</b>: An incision (cut) is made in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335492/" class="def">Open biopsy</a></b>: A procedure in which an incision (cut) is made through the skin to expose and remove tissues to check for signs of disease. </p></dd></dl></div><div class="half_rhythm">The following tests may be done on the cells and tissue samples that are taken:<dl id="CDR0000269299__200" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b>Cytologic exam</b>: An exam of 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.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b>Immunohistochemistry</b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> to check for certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a>) in a sample of a patient’s tissue. The antibodies are usually linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> 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.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b>Electron microscopy</b>: 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.</p></dd></dl></div></li></ul></div><div id="CDR0000269299__134"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000269299__136">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> and treatment options depend on the following: </p><ul id="CDR0000269299__137"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer. </div></li><li class="half_rhythm"><div>The size of the tumor.</div></li><li class="half_rhythm"><div>Whether the tumor can be removed completely by surgery.</div></li><li class="half_rhythm"><div>The amount of fluid in the chest or abdomen.</div></li><li class="half_rhythm"><div>The patient's age.</div></li><li class="half_rhythm"><div>The patient's activity level.</div></li><li class="half_rhythm"><div>The patient's general health, including lung and heart health.</div></li><li class="half_rhythm"><div>The type of mesothelioma cells and how they look under a microscope.</div></li><li class="half_rhythm"><div>The number of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> and how much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> is in the blood.</div></li><li class="half_rhythm"><div>Whether the patient is male or female.</div></li><li class="half_rhythm"><div>Whether the cancer has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back).</div></li></ul></div></div><div id="CDR0000269299__26"><h2 id="_CDR0000269299__26_">Stages of Malignant Mesothelioma</h2><div id="CDR0000269299__26.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000269299__27">After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__157">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__195">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__31">The following stages are used for malignant mesothelioma of the lung:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000269299__167">Stage I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__171">Stage II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__174">Stage III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__180">Stage IV</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000269299__252">Malignant mesothelioma can recur (come back) after it has been treated.</a></div></li></ul></div><div id="CDR0000269299__27"><h3>After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. </h3><p id="CDR0000269299__29">The process used to find out if cancer has spread outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045842/" class="def">pleura</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The gathered from the
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staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the disease. It is important to know whether the cancer has spread in order to plan treatment. </p><p id="CDR0000269299__199">The following tests and procedures may be used in the staging process:</p><ul id="CDR0000269299__142"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of the chest and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> 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.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find cancer cells in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> glucose (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, 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).</div></li><li class="half_rhythm"><div><b>Endoscopic ultrasound (EUS)</b>: A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>) 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045691/" class="def">fine-needle aspiration (FNA) biopsy</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or other areas.
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<div id="CDR0000269299__156" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Endoscopic%20ultrasound-guided%20fine-needle%20aspiration%20biopsy&p=BOOKS&id=570648_CDR0000466552.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65721.10/bin/CDR0000466552.jpg" alt="Endoscopic ultrasound-guided fine-needle aspiration biopsy; drawing shows an endoscope with an ultrasound probe and biopsy needle inserted through the mouth and into the esophagus. Also shown are the lymph nodes near the esophagus and cancer in one lung. An inset shows the ultrasound probe locating the lymph nodes with cancer and the biopsy needle removing tissue from one of the lymph nodes near the esophagus." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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. </p></div></div></div></li><li class="half_rhythm"><div><b>Laparoscopy</b>: A surgical procedure 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.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000793499/" class="def">Lymph node biopsy</a></b>: The removal of all or part of a lymph node. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the lymph node tissue under a microscope to check for cancer cells.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046287/" class="def">Mediastinoscopy</a></b>: A surgical procedure 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a> 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.</div></li></ul></div><div id="CDR0000269299__157"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000269299__157_md_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000269299__157_md_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000269299__195"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000269299__195_md_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000269299__195_md_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000269299__197">The metastatic tumor is the same type of cancer as the primary tumor. For example, if malignant mesothelioma spreads to the brain, the cancer cells in the brain are actually malignant mesothelioma cells. The disease is metastatic malignant mesothelioma, not brain cancer.</p><div id="CDR0000269299__226" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000269299__31"><h3>The following stages are used for malignant mesothelioma of the lung:</h3><div id="CDR0000269299__167"><h4>Stage I</h4><p id="CDR0000269299__169"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046726/" class="def">Stage I</a> is divided into stages IA and IB:</p><ul id="CDR0000269299__231"><li class="half_rhythm"><div>In stage IA, cancer is found in the inside lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a> 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:<ul id="CDR0000269299__232"><li class="half_rhythm"><div>The thin layer of tissue that covers the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>.</div></li><li class="half_rhythm"><div>The thin layer of tissue that covers the organs between the lungs.</div></li><li class="half_rhythm"><div>The thin layer of tissue that covers the top of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>.</div></li></ul></div></li><li class="half_rhythm"><div>In stage IB, cancer is found in the inside lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a>, and in each of the thin layers of tissue that cover the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the organs between the lungs, and the top of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> on one side of the chest. On the same side of the chest, cancer has also spread into one or more of the following:<ul id="CDR0000269299__233"><li class="half_rhythm"><div>Diaphragm.</div></li><li class="half_rhythm"><div>Lung tissue.</div></li><li class="half_rhythm"><div>Tissue between the ribs and the inside lining of the chest wall.</div></li><li class="half_rhythm"><div>Fat in the area between the lungs.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">Soft tissues</a> of the chest wall.</div></li><li class="half_rhythm"><div>Sac around the heart.</div></li></ul></div></li></ul></div><div id="CDR0000269299__171"><h4>Stage II</h4><p id="CDR0000269299__234">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046727/" class="def">stage II</a>, cancer is found in the inside lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a> 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:</p><ul id="CDR0000269299__235"><li class="half_rhythm"><div>The thin layer of tissue that covers the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>.</div></li><li class="half_rhythm"><div>The thin layer of tissue that covers the organs between the lungs.</div></li><li class="half_rhythm"><div>The thin layer of tissue that covers the top of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>.</div></li></ul><p id="CDR0000269299__236">Cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> along the center of the chest on the same side of the chest as the tumor.</p><p id="CDR0000269299__237">
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<i>
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<b>or</b>
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</i>
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</p><p id="CDR0000269299__238">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:</p><ul id="CDR0000269299__239"><li class="half_rhythm"><div>Diaphragm.</div></li><li class="half_rhythm"><div>Lung tissue.</div></li></ul><p id="CDR0000269299__240">Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.</p></div><div id="CDR0000269299__174"><h4>Stage III</h4><p id="CDR0000269299__241"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046728/" class="def">Stage III</a> is divided into stages IIIA and IIIB.</p><ul id="CDR0000269299__242"><li class="half_rhythm"><div class="half_rhythm">In stage IIIA, cancer is found in the inside lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a>, and in each of the thin layers of tissue that cover the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the organs between the lungs, and the top of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> on one side of the chest. On the same side of the chest, cancer has also spread into one or more of the following:<ul id="CDR0000269299__243"><li class="half_rhythm"><div>Tissue between the ribs and the inside lining of the chest wall.</div></li><li class="half_rhythm"><div>Fat in the area between the lungs.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">Soft tissues</a> of the chest wall.</div></li><li class="half_rhythm"><div>Sac around the heart.</div></li></ul></div><div class="half_rhythm">Cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> along the center of the chest on the same side of the chest as the tumor.</div></li><li class="half_rhythm"><div class="half_rhythm">In stage IIIB, cancer is found in the inside lining of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044996/" class="def">chest wall</a>, and may also be found in the thin layers of tissue that cover the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the organs between the lungs, and/or the top of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a> 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:<ul id="CDR0000269299__245"><li class="half_rhythm"><div>Diaphragm.</div></li><li class="half_rhythm"><div>Lung tissue.</div></li><li class="half_rhythm"><div>Tissue between the ribs and the inside lining of the chest wall.</div></li><li class="half_rhythm"><div>Fat in the area between the lungs.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">Soft tissues</a> of the chest wall.</div></li><li class="half_rhythm"><div>Sac around the heart.</div></li></ul></div><div class="half_rhythm">Cancer has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> above the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000639993/" class="def">collarbone</a> 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.</div><div class="half_rhythm"><b><i>or</i></b></div><div class="half_rhythm">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:<ul id="CDR0000269299__249"><li class="half_rhythm"><div>The chest wall and may be found in the rib.</div></li><li class="half_rhythm"><div>Through the diaphragm into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a>.</div></li><li class="half_rhythm"><div>The tissue lining the chest on the opposite side of the body as the tumor.</div></li><li class="half_rhythm"><div>The organs in the area between the lungs (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046623/" class="def">trachea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046616/" class="def">thymus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>).</div></li><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>.</div></li><li class="half_rhythm"><div>Through the sac around the heart or into the heart muscle.</div></li></ul></div><div class="half_rhythm">Cancer may have spread to lymph nodes.</div></li></ul></div><div id="CDR0000269299__180"><h4>Stage IV</h4><p id="CDR0000269299__251">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046729/" class="def">stage IV</a>, cancer has spread to the tissue covering the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> or the lung on the opposite side of the chest, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a>, bones, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> outside the chest, or to other parts of the body.</p></div></div><div id="CDR0000269299__252"><h3>Malignant mesothelioma can recur (come back) after it has been treated.</h3><p id="CDR0000269299__254">The cancer may come back in the chest or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> or in other parts of the body.</p></div></div><div id="CDR0000269299__50"><h2 id="_CDR0000269299__50_">Treatment Option Overview</h2><div id="CDR0000269299__50.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000269299__51">There are different types of treatment for patients with malignant mesothelioma.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__59">The following types of treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000269299__61">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__65">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__68">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__375">Immunotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__221">Targeted therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000269299__83">New types of treatment are being tested in clinical trials. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__227">Treatment for malignant mesothelioma may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__159">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__161">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000269299__163">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000269299__51"><h3>There are different types of treatment for patients with malignant mesothelioma.</h3><p id="CDR0000269299__53">Different types of treatments are available for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044992/" class="def">malignant mesothelioma</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current treatments or obtain on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000269299__59"><h3>The following types of treatment are used:</h3><div id="CDR0000269299__61"><h4>Surgery</h4><p id="CDR0000269299__63"> The following surgical treatments may be used for malignant mesothelioma in the chest:</p><ul id="CDR0000269299__113"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446983/" class="def">Wide local excision</a>: Surgery to remove the cancer and some of the healthy tissue around it. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476760/" class="def">Pleurectomy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044275/" class="def">decortication</a>: Surgery to remove part of the covering of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a> and lining of the chest and part of the outside surface of the lungs.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367446/" class="def">Extrapleural pneumonectomy</a>: Surgery to remove one whole lung and part of the lining of the chest, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>, and the lining of the sac around the heart.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044294/" class="def">Pleurodesis</a>: A surgical procedure that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643008/" class="def">chemicals</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to make a scar in the space between the layers of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045842/" class="def">pleura</a>. Fluid is first drained from the space using a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheter</a> or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046222/" class="def">pleural cavity</a>.</div></li></ul><p id="CDR0000269299__64">After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> after surgery 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</p></div><div id="CDR0000269299__65"><h4>Radiation therapy</h4><p id="CDR0000269299__67">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of radiation to kill cancer cells or keep them from growing. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the area of the body with cancer. It may also be used as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</p></div><div id="CDR0000269299__68"><h4>Chemotherapy</h4><p id="CDR0000269299__70">Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an organ, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the chest or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). Combination chemotherapy is the use of more than one anticancer drug. </p><p id="CDR0000269299__203"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045716/" class="def">Hyperthermic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046331/" class="def">intraperitoneal chemotherapy</a> is used in the treatment of mesothelioma that has spread to the peritoneum (tissue that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> 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. </p><p id="CDR0000269299__204">The way the chemotherapy is given depends on the type and stage of the cancer being treated.</p><p id="CDR0000269299__184">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/mesothelioma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Malignant Mesothelioma</a> for more information.</p></div><div id="CDR0000269299__375"><h4>Immunotherapy</h4><p id="CDR0000269299__377"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. </p><p id="CDR0000269299__327">The following types of immunotherapy are being used in the treatment of malignant mesothelioma:</p><ul id="CDR0000269299__319"><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>: Some types of immune cells, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044928/" class="def">T cells</a>, and some cancer cells have certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a>, called checkpoint proteins, on their surface that keep <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045722/" class="def">immune responses</a> in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced</a> malignant melanoma.</div><div class="half_rhythm">There are two types of immune checkpoint inhibitor therapy:<ul id="CDR0000269299__328"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777030/" class="def">CTLA-4</a> inhibitor therapy: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">Ipilimumab</a> is a type of CTLA-4 inhibitor.<div id="CDR0000269299__374" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=570648_CDR0000776560.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65721.10/bin/CDR0000776560.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of the T-cell receptor (TCR) to antigen and MHC proteins on the antigen-presenting cell (APC) and the binding of CD28 on the T cell to B7-1/B7-2 on the APC. It also shows the binding of B7-1/B7-2 to CTLA-4 on the T cell, which keeps the T cells in the inactive state. The panel on the right shows immune checkpoint inhibitor (anti-CTLA antibody) blocking the binding of B7-1/B7-2 to CTLA-4, which allows the T cells to be active and to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as B7-1/B7-2 on antigen-presenting cells (APC) and CTLA-4 on T cells, help keep the body’s immune responses in check. When the T-cell receptor (TCR) binds to antigen and major histocompatibility complex (MHC) proteins on the APC and CD28 binds to B7-1/B7-2 on the APC, the T cell can be activated. However, the binding of B7-1/B7-2 to CTLA-4 keeps the T cells in the inactive state so they are not able to kill tumor cells in the body (left panel). Blocking the binding of B7-1/B7-2 to CTLA-4 with an immune checkpoint inhibitor (anti-CTLA-4 antibody) allows the T cells to be active and to kill tumor cells (right panel).</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000777027/" class="def">PD-1</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797389/" class="def">PD-L1</a> inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">Nivolumab</a> is a type of PD-1 inhibitor. </div></li></ul><div id="CDR0000269299__331" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Immune%20checkpoint%20inhibitor&p=BOOKS&id=570648_CDR0000774646.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65721.10/bin/CDR0000774646.jpg" alt="Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).</p></div></div><div id="CDR0000269299__369" class="box"><h3><span class="title">immune checkpoint inhibitors</span></h3><div class="caption"><p>Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.</p></div><p><a href="https://www.youtube.com/watch?v=GIUu239FWMg" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div></li><li class="half_rhythm"><div class="half_rhythm"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045324/" class="def">Interferon</a>: Interferon affects the division of cancer cells and can slow tumor growth. Gamma interferon is being studied in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> malignant mesothelioma.</div></li></ul></div><div id="CDR0000269299__221"><h4>Targeted therapy</h4><p id="CDR0000269299__223"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. </p><p id="CDR0000269299__224"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a> therapy is a type of targeted therapy. Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or radioactive material directly to cancer cells.</p><p id="CDR0000269299__220"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">Bevacizumab</a> is a monoclonal antibody used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced</a> malignant mesothelioma. It binds to a protein called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044222/" class="def">vascular endothelial growth factor</a> (VEGF). This may prevent the growth of new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> that tumors need to grow. Other monoclonal antibodies are being studied in malignant mesothelioma.</p><div id="CDR0000269299__258" class="box"><h3><span class="title">monoclonal antibodies: how monoclonal antibodies treat cancer</span></h3><div class="caption"><p>How do monoclonal antibodies work to treat cancer? This video shows how monoclonal antibodies, such as trastuzumab, pembrolizumab, and rituximab, block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful substances to cancer cells. </p></div><p><a href="https://www.youtube.com/watch?v=dxnjAc-rqz8" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div><p id="CDR0000269299__225"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750798/" class="def">Kinase inhibitors</a> are a type of targeted therapy being studied in the treatment of malignant mesothelioma. Kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. </p></div></div><div id="CDR0000269299__83"><h3>New types of treatment are being tested in clinical trials. </h3><p id="CDR0000269299__154"> about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000269299__227"><h3>Treatment for malignant mesothelioma may cause side effects.</h3><p id="CDR0000269299__227_md_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000269299__159"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000269299__159_md_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000269299__159_md_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000269299__159_md_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000269299__161"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000269299__161_md_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000269299__161_md_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000269299__163"><h3>Follow-up tests may be needed.</h3><p id="CDR0000269299__163_md_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order 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.</p><p id="CDR0000269299__163_md_34">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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000269299__255"><h2 id="_CDR0000269299__255_">Treatment of Localized Malignant Mesothelioma (Stage I)</h2><p id="CDR0000269299__229">For about the treatments listed below, see the <a href="#CDR0000269299__59">Treatment Option Overview</a> section.</p><p id="CDR0000269299__95">If <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046726/" class="def">stage I malignant mesothelioma</a> is in one part of the chest lining, treatment may be the following:</p><ul id="CDR0000269299__205"><li class="half_rhythm"><div>Surgery to remove the part of the chest lining with cancer and the tissue around it. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044682/" class="def">Intracavitary</a> mesotheliomas are treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367446/" class="def">extrapleural pneumonectomy</a>.</div></li></ul><p id="CDR0000269299__116">If stage I malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:
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</p><ul id="CDR0000269299__96"><li class="half_rhythm"><div>Pleurectomy and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044275/" class="def">decortication</a>, with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.
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</div></li><li class="half_rhythm"><div>Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of anticancer drugs placed directly into the chest after surgery to remove the tumor. </div></li><li class="half_rhythm"><div>A clinical trial of combinations of surgery, radiation therapy, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of a new treatment.</div></li></ul><p id="CDR0000269299__206">If stage I malignant mesothelioma is in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044993/" class="def">peritoneal</a> lining, treatment may be the following:</p><ul id="CDR0000269299__207"><li class="half_rhythm"><div>Surgery to remove the part of the peritoneal lining with cancer and the tissue around it.</div></li></ul><p id="CDR0000269299__TrialSearch_255_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000269299__256"><h2 id="_CDR0000269299__256_">Treatment of Advanced Malignant Mesothelioma (Stages II, III, and IV) </h2><p id="CDR0000269299__259">For about the treatments listed below, see the <a href="#CDR0000269299__59">Treatment Option Overview</a> section.</p><p id="CDR0000269299__99">If <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046727/" class="def">stage II</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046728/" class="def">stage III</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046729/" class="def">stage IV</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044992/" class="def">malignant mesothelioma</a> is found in the chest, treatment may be one of the following:</p><ul id="CDR0000269299__100"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407759/" class="def">Draining</a> fluid that has collected in the chest, to relieve chest discomfort and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044294/" class="def">Pleurodesis</a> may be done to stop more fluid from collecting in the chest. For more information, see <a href="/books/n/pdqcis/CDR0000352193/">Cardiopulmonary Syndromes</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">Palliative</a> surgery in certain patients.</div></li><li class="half_rhythm"><div>Palliative <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to relieve pain.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a> therapy (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000767747/" class="def">nivolumab</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000535555/" class="def">ipilimumab</a>).</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> with or without a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">bevacizumab</a>).</div></li><li class="half_rhythm"><div>A clinical trial of combinations of surgery, radiation therapy, and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>. </div></li><li class="half_rhythm"><div>Chemotherapy placed directly into the chest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> to shrink the tumors and keep fluid from building up.</div></li></ul><p id="CDR0000269299__208">If stage II, stage III, or stage IV malignant mesothelioma is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a>, treatment may be one of the following:</p><ul id="CDR0000269299__209"><li class="half_rhythm"><div>Surgery to remove the tumor followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045716/" class="def">hyperthermic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046331/" class="def">intraperitoneal chemotherapy</a>.</div></li><li class="half_rhythm"><div>Chemotherapy.</div></li></ul><p id="CDR0000269299__TrialSearch_256_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000269299__257"><h2 id="_CDR0000269299__257_">Treatment of Recurrent Malignant Mesothelioma</h2><p id="CDR0000269299__260">For about the treatments listed below, see the <a href="#CDR0000269299__59">Treatment Option Overview</a> section.</p><p id="CDR0000269299__103">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045861/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044992/" class="def">malignant mesothelioma</a> may be one of the following:</p><ul id="CDR0000269299__127"><li class="half_rhythm"><div>Surgery to remove part of the chest wall.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>, if it was not given as initial treatment.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of new therapies.</div></li></ul><p id="CDR0000269299__TrialSearch_257_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000269299__149"><h2 id="_CDR0000269299__149_">To Learn More About Malignant Mesothelioma</h2><p id="CDR0000269299__150">For more from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about malignant mesothelioma, see the following:</p><ul id="CDR0000269299__151"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/mesothelioma/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Malignant Mesothelioma Home Page</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/mesothelioma" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Malignant Mesothelioma</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Immunotherapy to Treat Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Therapy to Treat Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/asbestos/asbestos-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Asbestos Exposure and Cancer Risk</a>
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</div></li></ul><p id="CDR0000269299__149_md_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000269299__149_md_41"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000269299__AboutThis_1"><h2 id="_CDR0000269299__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000269299__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000269299__AboutThis_3">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 <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000269299__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000269299__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000269299__AboutThis_6">This PDQ cancer information summary has current information about the treatment of adult malignant mesothelioma. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000269299__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000269299__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000269299__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000269299__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000269299__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000269299__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000269299__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000269299__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000269299__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000269299__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Malignant Mesothelioma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/mesothelioma/patient/mesothelioma-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/mesothelioma/patient/mesothelioma-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389166]</p><p id="CDR0000269299__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000269299__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000269299__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000269299__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000269299__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65721.10/?report=reader">PubReader</a></li><li><a href="/books/NBK65721.10/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65721" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65721" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Malignant Mesothelioma Treatment (PDQ®): Patient Version. 2021 May 21. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65721.12/">NBK65721.12</a></span> July 19, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65721.11/">NBK65721.11</a></span> November 2, 2023</li><li><span class="bk_col_itm">NBK65721.10</span> May 21, 2021 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65721.9/">NBK65721.9</a></span> November 6, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65721.8/">NBK65721.8</a></span> October 15, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65721.7/">NBK65721.7</a></span> March 7, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65721.6/">NBK65721.6</a></span> July 30, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65721.5/">NBK65721.5</a></span> May 2, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65721.4/">NBK65721.4</a></span> November 9, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65721.3/">NBK65721.3</a></span> October 21, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65721.2/">NBK65721.2</a></span> August 9, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65721.1/">NBK65721.1</a></span> September 4, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000269299__1" ref="log$=inpage&link_id=inpage">General Information About Malignant Mesothelioma</a></li><li><a href="#CDR0000269299__26" ref="log$=inpage&link_id=inpage">Stages of Malignant Mesothelioma</a></li><li><a href="#CDR0000269299__50" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000269299__255" ref="log$=inpage&link_id=inpage">Treatment of Localized Malignant Mesothelioma (Stage I)</a></li><li><a href="#CDR0000269299__256" ref="log$=inpage&link_id=inpage">Treatment of Advanced Malignant Mesothelioma (Stages II, III, and IV) </a></li><li><a href="#CDR0000269299__257" ref="log$=inpage&link_id=inpage">Treatment of Recurrent Malignant Mesothelioma</a></li><li><a href="#CDR0000269299__149" ref="log$=inpage&link_id=inpage">To Learn More About Malignant Mesothelioma</a></li><li><a href="#CDR0000269299__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65983/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31593394" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Mesothelioma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Mesothelioma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389499" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pheochromocytoma and Paraganglioma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> 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