In most cases, mesothelioma is not diagnosed until the disease has been active for a while. Mesothelioma symptoms do not appear until the malignancy development has begun to cause inflammation in the mesothelium and often, the accumulation of fluid in the form of pleural effusion. However if the cancer is in stage one, the patient (if personal health allows) is a candidate for an extrapleural pneumonectomy, which involves removal of the pleura, diaphragm and lung on the side of the body where the mesothelioma is located.
Other surgical options include a partial resection, or "debulking" of the diseased pleura in order to remove as much malignant tissue as possible. In some cases a stage 2 patient in good health will undergo this surgery if physicians believe they can remove the impacted lymph nodes. In all cases a combination of chemotherapy and radiotherapy will be employed to treat pleural mesothelioma.
Some physicians that are employing aggressive chemotherapy techniques are reporting improved survival times for patients who are eligible for surgery. A treatment program for epithelial peritoneal mesothelioma has yielded remarkable resorts at four different medical centers. The surgical component ranges from removal of the peritoneum to removal of the peritoneum plus malignant nodes plus any impacted section of the lower intestine. Surgery is followed by the use of hyperthermic (heated) intraperitoneal chemotherapy, which is delivery of the chemotherapy medication directly to the targeted area with a shunt, followed by ongoing chemotherapy and radiotherapy treatments. Over 300 cases were reviewed using this protocol showing over a 75% survival rate at one year and over 50% at five years.