Malignant mesothelioma is an aggressive type of cancer that requires a team of experts to treat. The OHSU Knight Cancer Institute has a wealth of experience in caring for patients with this complex condition. Here’s what we have to offer:

• A team approach, with experts from different specialties looking at your case together.
• Promising new treatments, including immunotherapy, HIPEC and TTFields.
• On-campus lodging at the Rood Family Pavilion for out-of-town patients making a longer visit.
• A full range of support services for you and your family.

What is mesothelioma?

Mesothelioma is a condition that develops in the mesothelium, the membrane that surrounds your organs and that lines your body cavities.

The mesothelium is a tough layer of cells that protects your organs the way an orange peel protects the fruit inside. It covers the lungs, heart, stomach and other internal organs. It also lines the cavities inside your body where your organs dwell.

Sometimes these cells multiply out of control, forming tumors. This condition is mesothelioma.

• Benign mesothelioma may grow but does not spread.
• Malignant mesothelioma grows and spreads. It is an aggressive cancer.

Who gets mesothelioma?

Mesothelioma is rare. In the United States, roughly 3,000 people are diagnosed every year. Risk factors include:

• Exposure to asbestos: Asbestos is a fibrous mineral that was used for insulation in buildings and household products until the 1970s. Although asbestos has been banned in the United States, people can be exposed when buildings are demolished or renovated. People who inhale asbestos fibers are at higher risk for mesothelioma many decades later. But only a tiny fraction of those exposed get the disease.
• Age: The average age at diagnosis is 72.
• Gender: Men are three times more likely to get mesothelioma than women.

Survival rates

Malignant mesothelioma is an aggressive form of cancer. The survival rates are discouraging. But there are signs of hope. The Knight Cancer Institute offers several innovative therapies. We are also working hard to catch cancer earlier when it’s easier to treat, and to find more ways to treat this condition.

Diagnosing mesothelioma

Mesothelioma symptoms are often vague. They can be caused by many disorders. This makes the condition difficult to diagnose. Doctors may use these tests:

• Blood tests
• X-ray: Chest X-rays may show thickening of the membrane around your lungs or other organs.
• CT (computed tomography): CT scans use X-rays to create cross-sectional scans to show details of the size and shape of tumors.
• MRI (magnetic resonance imaging): MRI scans use magnets and radio waves to create images. They are useful for looking at soft tissues.
• PET (positron emission tomography): PET scans use a slightly radioactive dye that is injected into a vein. The dye shows the location of cancer cells.
• Biopsy: Your care team removes a small sample of fluid or tissue to check for cancer cells. They may use:
  • A long, hollow needle
  • An endoscope, a long, flexible tube with a tiny camera and cutting tool placed through a small incision
  • A bronchoscope, a long, flexible tube with a tiny camera and cutting tool threaded through the mouth

Mesothelioma stages

Your doctors will assign a stage to your mesothelioma. The stage indicates how advanced your cancer is and whether it’s likely to grow slowly or quickly.

These stages apply to malignant pleural mesothelioma, the most common type.

• Stage IA: Tumors are small and confined to the mesothelium.
• Stage IB: Tumors have invaded more tissue. They are bigger but can be surgically removed.
• Stage II: Tumors may be bigger or smaller, and cancer has spread to nearby lymph nodes.
• Stage IIIA: Tumors are bigger but can be surgically removed. Cancer has spread to nearby lymph nodes.
• Stage IIIB: Tumors cannot be surgically removed. Cancer has spread to nearby lymph nodes; or tumors can be surgically removed but cancer has spread to more distant lymph nodes.
• Stage IV: Cancer has spread to another part of the body.

Mesothelioma treatment

Mesothelioma can be hard to treat because the tumors do not always grow in a single mass. They often spread and invade multiple organs.

The best course of treatment often depends on what is most important to you. At the Knight Cancer Institute, we use a team model to treat our patients. Experts in surgery, chemotherapy, immunotherapy and other fields look at your case together to recommend a plan. We take the time to make sure you understand the benefits and drawbacks of each treatment.

New therapies have recently become available, and more are on the way. Patients who get treatment at research hospitals like the Knight Cancer Institute have better outcomes, according to a study in the Journal of Gastrointestinal Surgery.

Surgery

Our surgeons use advanced techniques to remove mesothelioma tumors when possible. It depends on how big the tumors are, where they are, and how deeply they have invaded your tissues and organs.

In some cases, doctors may do cytoreductive surgery. In this procedure, surgeons remove tumors from inside your abdomen. They may also remove organs where the cancer has spread.

Chemotherapy

Chemotherapy is medication that kills cancer cells. It is often used to treat patients with mesothelioma, especially along with surgery. Some chemotherapy medications work differently than others, but the main idea is the same: The drug attacks cells that divide rapidly, like cancer cells.

HIPEC surgery

HIPEC (hyperthermic intraperitoneal chemotherapy) is an innovative technique that combines surgery and chemotherapy. First surgeons remove tumors from the abdominal cavity. Then they flood it with a powerful dose of chemotherapy to kill any cancer cells that remain.

Radiation therapy

Radiation therapy uses beams of high-energy particles to destroy cancer cells. It's not always used in mesothelioma because the tumors usually don’t grow in a single mass. However, advances in technology may soon give doctors more leeway in using radiation therapy for this condition.

Immunotherapy

Immunotherapy is a promising new treatment for mesothelioma. In immunotherapy, doctors harness your immune system to destroy cancer cells. In 2020, the FDA approved two new immunotherapy medications, the first new treatment for mesothelioma in 16 years. The medications, nivolumab and ipilimumab, are a type known as immune checkpoint inhibitors. Knight researcher Lisa Coussens is a leading expert on the use of immunotherapy for mesothelioma, and is investigating new targets for therapy.

Tumor-treating fields (TTFields)

TTFields uses electricity to kill cancer cells. A portable device generates a low-intensity electric field focused on the tumors. The field disrupts rapidly dividing cells, like cancer cells. The FDA approved this treatment in 2019.

Learn more

• Malignant Mesothelioma, American Cancer Society
• Learn about Mesothelioma, American Lung Association