The best way to prevent mesothelioma is to prevent or limit your exposure to asbestos in homes, in public buildings, and at work. People who may be exposed to asbestos at work include miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with insulation. If there is a possibility of on-the-job exposure, such as renovating old buildings, then you should use all protective equipment, work practices, and safety procedures designed for working around asbestos.

If you live in an older home, there may be asbestos-containing insulation or other materials. A knowledgeable expert can check your home to determine if there is any asbestos and if it poses any risk of exposure. This may involve testing the air for asbestos levels. It is often more dangerous to remove the materials containing asbestos than to leave them alone. You may then decide to have the asbestos removed from your home. You should hire a qualified contractor to perform this job, to avoid contaminating your home further or causing any exposure to the workers. You should not attempt to remove asbestos-containing material yourself.

Chemotherapy is the use of drugs for treating cancer. The drugs can be swallowed in pill form or they can be injected by needle into a vein or muscle. Chemotherapy is systemic therapy. This means that the drug enters the bloodstream and circulates throughout the body (through the whole system) to reach and destroy the cancer cells.

To treat mesothelioma, these drugs may also be given intrapleurally (directly into the chest cavity) or intraperitoneally (into the abdominal cavity). Based on the type and stage of mesothelioma, chemotherapy may be given as the primary (main) treatment or as an adjuvant treatment (treatment given in addition to the primary treatment) to surgery. Chemotherapy for this disease is palliative and not curative.

Several chemotherapy drugs have been used to treat mesothelioma. The preferred combination of drugs for now is pemetrexed (Alimta), which is combined with cisplatin. Because pemetrexed interferes with normal metabolism of folic acid and vitamin B12, these must also be given to avoid side effects. Another combination that has a good response rate is cisplatin and gemcitabine. Another option substitutes cisplatin with carboplatin, which causes much less nausea and vomiting.

Other combinations of drugs used to treat mesothelioma include:

• methotrexate and vincristine
• cisplatin, vinblastine and mitomycin
• cisplatin and doxorubicin
• doxorubicin, cyclophosphamide (or ifosfamide), and cisplatin

All the drugs above can be given alone in people who may not be able to tolerate two drugs. Other drugs such as paclitaxel and irinotecan are being studied to determine their effectiveness in treating mesothelioma.

A new, related drug called raltitrexed has also been shown to help patients with mesothelioma when given with cisplatin. Patients who received these drugs lived longer than those who received cisplatin alone.

Chemotherapy drugs kill cancer cells but also damage some normal cells. Therefore, your doctor will pay careful attention to avoiding or minimizing side effects, which depend on the specific drugs, the amount taken, and the length of treatment. Temporary side effects might include nausea and vomiting, loss of appetite, loss of hair, and mouth sores.

Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in an increased risk of infection (due to a shortage of white blood cells); bleeding or bruising after minor cuts or injuries (due to a shortage of blood; platelets); or fatigue or shortness of breath (due to low red blood cell counts).

Most side effects disappear once treatment is stopped. There are remedies for many of the temporary side effects of chemotherapy. For example, you can be given drugs to prevent or reduce nausea and vomiting. If you experience any side effects, be sure to talk with your doctor.

A treatment plan is devised depending upon the mesothelioma type, aggressiveness, primary location, and degree of local (rarely, distant) spread. The treatment of pleural mesothelioma is difficult. Treatment with surgery, radiation therapy or chemotherapy used alone or in combination may be proposed, depending upon the potential benefits and risks of each modality. Surgery is rarely used alone, but sometimes suffices when only a small pleural patch of mesothelioma is detected, thus allowing visually complete removal of the tumor. More often, mesotheliomas of the left or right pleural cavity cannot be completely removed without taking the entire lung (pneumonectomy) on the same side as well. In such cases, radiation therapy and/or chemotherapy is given postoperatively to help eradicate any residual mesothelioma that may have escaped the surgeon.

The treatment of peritoneal mesotheliomas is even more problematic; until recently no consistent treatment was available. At our institution, peritoneal mesotheliomas have been managed in the experimental setting with combined modality treatment consisting of extensive (usually not complete) debulking surgery, followed by intraperitoneal and systemic chemotherapy followed in turn by whole abdominal radiation therapy.

Because mesotheliomas now represent less than one percent of cancers and and are infrequently seen in the practice of most community oncologists, finding the correct treatment can be very difficult. Proper management of mesotheliomas often requires evaluation at larger tertiary hospitals or Comprehensive Cancer Centers by specialists in medical, surgical and radiation oncology with experience in all aspects of the clinical care of mesothelioma patients, including the newest experimental treatments.