Patients who are diagnosed with malignant mesothelioma are generally treated by a multidisciplinary team that includes medical oncologists, surgical oncologists, and radiation oncologists. This group of cancer specialists collaborates to provide the best possible outcome based on the patient’s specific condition and goals. Medical oncologists are internal medicine specialists. They treat mesothelioma using special cancer-fighting medications including chemotherapy, targeted therapy, and immunotherapy.
What is a Medical Oncologist?
A medical oncologist, sometimes known as a hematologist/oncologist, is an internal medicine specialist who is trained in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. They are frequently the lead specialist involved in a mesothelioma patient’s care, coordinating the treatment provided by the patient’s internal medicine physician, radiation oncologists, and surgical oncologists.[1]
As members of a multidisciplinary cancer treatment team, medical oncologists help to create the medication plan based on the type of mesothelioma the patient has, the size and spread of the tumor, and its location. The plans also consider the patient’s age, general health, personal goals, and other factors. The medical oncologist oversees and monitors the patient’s condition, focusing on systemic treatments and offering solutions for adverse side effects.
How Does a Doctor Become a Medical Oncologist?
All physicians begin their educational journey with a bachelor’s degree and graduation from an accredited medical school. Those who wish to become medical oncologists then complete a basic internal medicine residency followed by two years of medical oncology fellowship training. Dual certification in hematology and medical oncology requires three years of combined fellowship training. Following completion of this training, candidates are eligible for certification in oncology by the American Board of Internal Medicine.
Medical Oncologists and Diagnosing Malignant Mesothelioma
Though many patients who seek treatment for malignant mesothelioma have already had their illness diagnosed, others present to medical oncologists seeking answers or treatment for the symptoms they are experiencing.
For malignant pleural mesothelioma, these symptoms may include:
- Chest pain
- Coughing
- Coughing up blood
- Difficulty swallowing
- Fatigue and muscle weakness
- Night sweats and fever
- Shortness of breath
- Weight loss
- Wheezing
For malignant peritoneal mesothelioma, these symptoms may include:
- Abdominal pain
- Buildup of fluids
- Decreased appetite and weight loss
- Gastrointestinal symptoms
- Fatigue
A medical oncologist will conduct a physical exam to check for lumps and unusual signs and, if mesothelioma is suspected, will ask you about your history of asbestos exposure. They will then order a series of diagnostic tests, including imaging scans such as a chest X-ray or a computerized tomography (CT) scan of your chest or abdomen. Based on these findings, they will order further testing, including bloodwork or biopsies to determine whether mesothelioma or another disease is causing your symptoms.
How Medical Oncologists Treat Mesothelioma
Once malignant mesothelioma has been diagnosed and staging has been completed to assess how far the disease has progressed, a medical oncologist will work with other cancer specialists to design the optimal treatment plan for the patient’s cancer, condition, and the patient’s personal goals. The medical oncologist’s role in the patient’s care will involve prescribing medication-based therapies. These may include:
- Standard systemic therapy such as combination chemotherapy with platinum and pemetrexed
- Combination immunotherapy with ipilimumab and nivolumab
- Chemoimmunotherapy using first-line dual checkpoint blockade followed by chemotherapy
- Single-agent immunotherapy following chemotherapy
- Vaccine and immunologic therapies
- Targeted molecular therapies that use drugs to target and interfere with molecules linked to mesothelioma cell growth
The use of these protocols is dispensed in coordination with radiation oncologists and surgical oncologists to identify those who might benefit from a multimodality approach, including procedures for symptom management and palliative care.[2]
Medical Oncologists and Palliative Care for Mesothelioma
Malignant mesothelioma is an extremely aggressive form of cancer that has a generally poor prognosis. In addition to trying to extend mesothelioma patients’ lives, medical oncologists work proactively to reduce physical symptoms and maintain or improve quality of life. Palliative care provided by medical oncologists may include pharmacologic management of pain including the use of benzodiazepines and opioids as well as ordering palliative radiotherapy to manage localized disease causing pain or obstructive symptoms.
Medical oncologists can address the discomfort of malignant pleural effusions by ordering thoracocentesis, a process that drains excess fluid from the pleural space and can significantly improve the patient’s ability to breathe and function.
Finding a Medical Oncologist Who Treats Malignant Mesothelioma
Though malignant mesothelioma is an extremely rare form of cancer, many medical oncologists specialize in its treatment. Most work for academic teaching hospitals or specialized cancer centers located in major metropolitan areas, though many also work at veterans’ centers.
