Mesothelioma Treatment Side Effects
Mesothelioma is a type of cancer that arises in the membranes around certain organs, such as the lungs or digestive tract. While this is an aggressive cancer, treatments are available that can extend a patient’s lifespan. Mesothelioma treatment side effects can be serious, but there are ways to manage them to help maintain a patient’s quality of life.
Mesothelioma is a highly aggressive cancer. Without treatment, most patients survive for only a few months. The average life expectancy for pleural mesothelioma patients who don’t get treatment is about ten months; for peritoneal mesothelioma patients, it’s about four months.
There are treatments available that can extend a patient’s lifespan, including surgery, chemotherapy, radiation therapy, and immunotherapy. Most commonly, a combination of different treatment modalities is used in order to extend life as much as possible, called multimodal therapy.
These treatment modalities are effective but can lead to unwanted side effects. Although side effects can often be unpleasant, they can be managed. Make sure you tell your treatment team about any mesothelioma treatment side effects you may be experiencing, as they may be able to help.
Side Effects of Mesothelioma Surgery
The surgical procedures used to treat mesothelioma are highly invasive. Mesothelioma surgery is usually only an option for those who are diagnosed in a relatively early stage when the cancer has not spread to other parts of the body.
There are risks associated with any surgical procedure that requires general anesthesia. These include:
Bleeding
Infections
Blood clots
Cardiac arrest
Surgeons can reduce these risks through careful surgical techniques. They also carefully select which patients will be offered surgery. If a patient is not in good general health or has other major medical conditions, the risk of complications is greater, and surgery may not be recommended for these patients.
There are specific side effects related to the particular procedure a patient has, which depend on the type of mesothelioma they have.
Pleural Mesothelioma Surgery Side Effects
For pleural mesothelioma, two main types of surgery can be used to extend life expectancy. In extrapleural pneumonectomy (EPP), the diseased lung is removed, along with adjacent tissues. In pleurectomy/decortication (P/D), the lung is left in place, but the pleura (the membrane around the lung) is removed, along with other tissues.
Complications of these surgical procedures may include:
- Irregular heartbeat
- Accumulation of fluid in the lungs
- Collapse of all or part of a lung
- Pneumonia
- Pleural empyema (infection in the chest cavity)
- Cardiac herniation (in which part of the heart is squeezed through a sac around the heart, interfering with its function)
- Accumulation of blood or lymphatic fluid in the chest cavity
- Formation of an abnormal connection between the esophagus and other organs in the chest, which can allow swallowed food to leak into the chest cavity
- Persistent air leak (in which air leaks from the lung into the chest cavity, making breathing difficult)
Additional procedures may be needed to manage these side effects. For example, a patient with an air leak may need a chest tube to suction air out of the chest cavity.
Annals of Translational Medicine states that EPP generally causes more side effects because it is an invasive procedure, and the risk of dying from the procedure is higher. This is why many surgeons recommend P/D to most patients, although the choice of procedure must be individualized for each patient. You can ask your mesothelioma doctor to explain why they recommend a particular procedure in your case.
Peritoneal Mesothelioma Surgery Side Effects
For peritoneal mesothelioma, almost all patients who are eligible for surgery undergo cytoreductive surgery (CRS). The specifics of the procedure can vary depending on where cancer tissue is found. This means that the side effects will vary among patients.
The Indian Journal of Surgical Oncology shares possible side effects of CRS:
- Intestinal perforation (a hole in the wall of the intestine), which can allow material inside to leak out, potentially leading to severe infection
- Fistula, which is an abnormal connection between the intestine and another organ or the outside of the body, allowing leakage of material from inside the digestive tract
- Leakage of bile into the abdominal cavity
- Prolonged ileus, or paralysis of the muscles of the intestines, which prevents them from functioning
- Gastric stasis, in which the stomach muscles are paralyzed so that the stomach does not empty
Ileus is normal for a short period after any type of abdominal surgery, but it can sometimes last for a longer period. It usually gets better by giving IV fluids and nutrition, helping the patient walk as much as possible, and avoiding giving too much pain medication.
However, some of these complications may require additional surgical procedures to address them. For example, a surgeon may need to repair an intestinal perforation or fistula.
Mesothelioma Chemotherapy Side Effects
Chemotherapy targets cancer cells directly. The most common chemotherapy regimen for mesothelioma consists of pemetrexed combined with platinum-based chemotherapy (either cisplatin or carboplatin). Pemetrexed works by blocking enzymes that cancer cells need to divide so that no new cancer cells can grow. Cisplatin and carboplatin act to damage the DNA of cancer cells so they can no longer grow and divide.
Both drugs can cause serious side effects for patients. The side effects occur because chemotherapy drugs don’t only affect cancer cells; they also affect healthy cells. Cells that grow and divide more often tend to be affected the most, but all cells in your body could potentially experience toxicity from chemotherapy.
According to Seminars in Oncology, common side effects of pemetrexed include:
- Nausea and vomiting
- Diarrhea
- Loss of appetite
- Swelling of the hands and feet
- Low energy
- Mucositis, which causes painful skin sores, blisters, ulcers, or skin peeling inside or around the mouth or in the genital area
- Weight loss
- Low white blood cell count leading to an increased risk of infections
- Low red blood cell count, leading to severe fatigue, weakness, and pale skin
- Low platelet count, leading to unusual bleeding or bruising
Your medical team can use various strategies to help manage side effects of pemetrexed. If necessary, your dose may be adjusted in order to reduce the side effects. Supplementation with certain vitamins, such as folic acid and vitamin B12, helps minimize side effects and is generally recommended as a standard part of care.
Medications can be given to reduce nausea. A steroid such as dexamethasone can also be prescribed to help with certain symptoms. For patients experiencing an extremely low white blood cell count, a medication called granulocyte colony-stimulating factor (G-CSF) may be used to help stimulate the immune system.
From the Journal of Dalton Transactions, side effects of platinum-based chemotherapy (cisplatin or carboplatin) include:
- Alopecia
- Nausea and vomiting
- Diarrhea
- Loss of appetite
- Weight loss
- Muscle weakness
- Kidney damage
- Low white blood cell count
- Low red blood cell count
- Low platelet count
- Liver damage
- Hearing loss
- Mucositis
- Anaphylaxis (severe allergic reaction)
While cisplatin and carboplatin are similar, they’re not exactly the same, and their side effects can differ. Cisplatin is more likely to cause kidney damage, while carboplatin is more likely to suppress the immune system.
As with pemetrexed, there are ways for your medical team to manage these side effects. Medications can be used to reduce nausea. Growth factors can be given to help stimulate the immune system. Supplements of antioxidants can be used to reduce damage to the nervous system caused by these medications. Other supplements, such as magnesium, can also be helpful. A medication called propafenone can be used to treat an irregular heartbeat. In addition to these measures, the team will monitor your dose and adjust it as necessary.
Patients with severe kidney damage may need to go on dialysis, and it’s possible that the kidneys won’t fully recover after chemotherapy is finished.
Methods of Chemotherapy Administration
Chemotherapy can be given to the whole body through an IV. This is commonly used for pleural mesothelioma, either as the main form of treatment or before or after a surgical procedure. Peritoneal mesothelioma patients who are not candidates for surgery may also receive chemotherapy in this manner.
Peritoneal mesothelioma patients commonly receive chemotherapy during surgery. After the surgical procedure is finished, a warmed chemotherapy drug is infused into the abdominal cavity and left for some time before being washed out. This is known as hyperthermic intraperitoneal chemotherapy, or HIPEC. For pleural mesothelioma, a similar procedure known as hyperthermic intrathoracic chemotherapy, or HITHOC, has been gaining popularity.
When chemotherapy is given during surgery, the side effects may be reduced when compared to the side effects of giving the medication to the whole body through an IV. However, some medications will still be absorbed into the bloodstream, so patients often experience side effects. This method of administration should not be considered a way to avoid chemotherapy side effects.
Side Effects of Radiation Therapy for Mesothelioma
Radiation therapy uses energy to target and destroy cancer cells. In mesothelioma patients, this is usually accomplished by directing radiation beams toward the cancer cells from outside the body.
The side effects of radiation therapy are primarily related to damaged body tissues in the treated area. This damage is reduced by using multiple radiation beams directed at the tumor from different angles. At the tumor’s location, the beams cross, delivering a high dose of radiation directly to the cancer, while other tissues in the area receive less radiation.
According to the American Cancer Society, general side effects of radiation therapy include hair loss, fatigue, skin changes (swelling, redness, itching, and peeling of skin in the treated area), and low blood counts.
Side effects of radiation therapy to the chest may include:
- Cough
- Shortness of breath
- Sore throat
- Loss of appetite
- Trouble swallowing
- Damage to the heart, which increases the risk of later heart disease
Side effects of radiation therapy to the abdomen may include:
- Nausea and vomiting
- Diarrhea
- Problems with urination, such as blood in the urine, incontinence (inability to hold in urine), or needing to urinate very often
- Skin changes
- Constipation
The side effects of radiation therapy can often be managed. For example, steroid creams can be used on damaged skin. Oral steroids may help manage some of the other side effects. In some cases, your radiation therapy may need to be modified due to the side effects. This could include reducing the dose of radiation given at each appointment or spacing out the appointments.
Side Effects of Immunotherapy for
Mesothelioma
Immunotherapy is a treatment that stimulates the patient’s immune system to attack and destroy cancer cells. Like chemotherapy, it’s given to the whole body through an IV. However, the mechanism of action is different.
Patients are sometimes attracted to immunotherapy because they hope to avoid the side effects of chemotherapy. However, it’s important to understand that immunotherapy can also cause side effects, and they can be severe.
The side effects of immunotherapy are generally related to the strong inflammatory response these drugs induce, which can cause damage to a patient’s own healthy cells. The Cancer Research Institute reports these may include:
- Fever
- Chills
- Fatigue
- Muscle aches
- Joint pain
- Nausea and vomiting
- Diarrhea or constipation
- Rash
- Headache
- Loss of appetite
- Hormonal imbalances due to inflammation of the thyroid gland or pituitary gland
- Severe inflammation of one or more organs, including the liver, heart, lungs, or pancreas
Most patients on immunotherapy will feel like they have the flu. However, some patients experience more severe side effects. Doctors may use various methods of managing these side effects. Prescription medications may be helpful for some symptoms, such as nausea. Another way to manage side effects is with a medication that reduces the intensity of the immune response.
In cases of severe side effects, the dose may need to be reduced, or immunotherapy may need to be stopped altogether. However, death from these side effects is rare.
Discuss Your Mesothelioma Treatment Side Effects With Your Cancer Treatment Team
Cancer treatment is often associated with various side effects, many of which can be unpleasant. Don’t hesitate to discuss any challenges you may be experiencing with your treatment team. Some patients don’t want to seem as though they’re complaining, but your treatment team will be glad you brought up the issue so they can help make things better for you.
As mentioned, there are a variety of methods that can be useful for treating your side effects. In some cases, prescription medications can make a significant difference, and specific supplements can be helpful. Your team may also need to adjust your dose to reduce the side effects. Treatments like dialysis may be necessary in some cases.
It’s also important to let your mesothelioma treatment team know about any type of alternative medicine treatment you may want to try. Although these types of treatment can benefit patients, some may increase the side effects of your current cancer treatment. Before you start a new alternative medicine, especially if it involves taking a supplement, check with your team to ensure it’s safe for you.
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