Mesothelioma

Mesothelioma is a rare and aggressive cancer. It is caused by asbestos and forms on the protective tissues covering the lungs, abdomen and heart. Symptoms include coughing, chest pain and shortness of breath. Treatments combining surgery, radiation and chemotherapy improve survival and life expectancy.The American Cancer Society records about 3,000 new cases of mesothelioma each year in the U.S. Doctors divide mesothelioma into different types based on what part of the mesothelium is affected. Mesothelioma most often affects the tissue that surrounds the lungs (pleura). This type is called pleural mesothelioma. Other, rarer types of mesothelioma affect tissue in the abdomen (peritoneal mesothelioma), around the heart and around the testicles.

It’s a disease that mostly affects people who worked with asbestos and products containing asbestos. Mesothelioma is an aggressive cancer that affects the lining of the lungs, heart, or abdomen. Caused by the inhalation of asbestos fibers, mesothelioma is often diagnosed in older individuals who worked with asbestos products. Prognosis for mesothelioma is poor, but early detection and new treatment provide hope for many patients. Mesothelioma is an aggressive and deadly form of cancer. Mesothelioma treatments are available, but for many people with mesothelioma, a cure is not possible.

While there are treatments that control tumor growth, researchers have not found a definitive cure for the cancer. Malignant mesothelioma (me-zoe-thee-lee-O-muh) is a type of cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium). Mesothelioma doesn't include a form of noncancerous (benign) tumor that occurs in the chest and is sometimes called benign mesothelioma or solitary fibrous tumor.

Causes

Mesothelioma is a rare cancer caused by exposure to asbestos. Our genes, which are made of DNA, control how cells grow, multiply and die. Changes in our genes may cause cells to divide out of control and may lead to cancer. The cancer develops when a person ingests asbestos, and it causes changes to a person’s DNA. In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control. It isn't clear what causes the initial genetic mutations that lead to mesothelioma, though researchers have identified factors that may increase the risk. It's likely that cancers form because of an interaction between many factors, such as inherited conditions, your environment, your health conditions and your lifestyle choices.

Symptoms

Patients begin to show signs of cancer around 10 to 50 years after their initial exposure to asbestos. Symptoms will differ by the type of mesothelioma, but these early symptoms are often mistaken for more common ailments, like the flu, pneumonia or lung cancer. Recognizing the signs and symptoms of mesothelioma early will increase treatment options and improve overall prognosis.It can take many years after being exposed to asbestos for mesothelioma to occur. The length of time taken is referred to as the latency period and is usually between 15-45 years.

In the early stages when the mesothelioma is present as very small nodules it will not show up on any scans or x-rays and is unlikely to cause any symptoms. As it progresses pleural and peritoneal mesothelioma can both cause general symptoms such as sweating, tiredness, loss of appetite and weight loss. As the disease advances pleural mesothelioma typically causes patients to feel breathless and/or experience chest pain.

Breathlessness may be due to a combination of factors. The pleura being thickened can act like a rind around the lung restricting its movement and preventing the lung from expanding.

Pain can be quite severe as the mesothelioma can extend into the tissues surrounding the pleura including nerves and bone. A variety of medication is available to control any pain experienced. Fluid may also accumulate in the space between the two layers of the pleura occupying space and again this restricts lung expansion. A cough or altered voice is also sometimes experienced. Peritoneal mesothelioma often causes swelling and pain in the abdomen.

This section describes symptoms that may be experienced by people with mesothelioma. It will include how these symptoms can be managed, based on medical evidence wherever possible. With care, much can be done to lessen the impact of most symptoms. In complex cases this requires the involvement of a variety of professionals - the multidisciplinary approach - such as doctors from palliative medicine and pain specialists, oncologists (cancer specialists), specialist nurses, physiotherapists, complementary therapists, psychologists and others. UK trade names for medicines are placed in brackets when used.

Irrespective of which anti-cancer treatment you have it is likely the mesothelioma will cause you to have some symptoms such as breathlessness, cough, pain or sweating. For this reason working with doctors and nurses who specialise in symptom management (Palliative Care Teams) is recommended for all patients.

These mesothelioma symptoms usually do not show until tumors have grown and spread. Mesothelioma latency is 20-50 years. That’s how long it takes from initial exposure to accurate diagnosis. For that reason, many people with mesothelioma are in their 60s or 70s.

You should talk to a mesothelioma specialist soon if you have a history of asbestos exposure and experience these symptoms. An early diagnosis may improve your prognosis and life expectancy.

How is Mesothelioma Diagnosed?

Malignant mesothelioma is difficult to diagnose because of its long latency period and nonspecific symptoms. Doctors will use a series of tests (blood tests, imaging, biopsies) to diagnose the cancer and determine its stage. The stage and other diagnostic details will provide information about your prognosis – that is, how the disease is likely to progress and what your life expectancy may be.

Blood tests

Blood tests can check your overall health and how your blood cells, liver and kidneys are working.

X-ray

X-rays can help identify any abnormalities in the lungs, thickening of the pleura or fluid in the space between the lungs and the chest wall. X-rays will also help identify fluid in the abdomen.

CT scan

CT scans produce three-dimensional pictures of several organs at the same time and can also scan chest lymph nodes. CT scans may also be used to see if the mesothelioma has spread to other locations.

Biopsy

A biopsy is when a sample of pleural or abdominal tissue is removed for examination under a microscope. It is the main procedure used to diagnose pleural mesothelioma, and can be taken in two ways: via VATS (Video-assisted thoracoscopic surgery), a type of keyhole surgery; or via CT-guided core biopsy, which is done under a local anaesthetic using a needle guided by a CT scan.

Draining fluid from the pleura

This can be done to relieve symptoms of breathlessness caused by pleura leaking into the pleural cavity (called pleural effusion), and in some instances, to diagnose pleural mesothelioma. People with peritoneal mesothelioma may have fluid in the abdomen (called peritoneal effusion), causing swelling and pain.

Using an ultrasound scan to guide the doctor, the fluid is drained via a needle inserted through the chest wall into the pleural cavity or into the abdomen. A sample of the fluid is then sent to a pathologist for testing.

Mesothelioma can be difficult to diagnose as the cells can look similar to other types of cancer cells. Combining results from fluid samples with information from an x-ray and CT scan can provide an acceptable level of certainty of a diagnosis.

If mesothelioma is diagnosed, further tests are usually done to find out if the disease has spread to other parts of the body, such as CT scans; FDG-positron emission tomorgraphy (FDG-PET); mediastinoscopy (used to examine and sample lymph nodes at the centre of the chest); or endobronchial ultrasound (EBUS).

Types of Mesothelioma

Oncologists name each type of mesothelioma by the location in the body where it develops. Once diagnosed, your doctor will tell you what type of mesothelioma you have, including the cell type. There are three main types of mesothelioma based on the location in the body where tumors originate.

The pleural and peritoneal types of mesothelioma are the most common. Pericardial accounts for 1 percent of cases. Another rare type is testicular mesothelioma. It represents less than 1 percent of all mesotheliomas.

Prognosis, symptoms and treatment options vary by type.

Pleural Mesothelioma

Most common type
Forms on soft tissue covering the lungs
Best treated with a multimodal approach

LEARN ABOUT PLEURAL MESOTHELIOMA

Peritoneal Mesothelioma

Less than 20 percent of all cases
Develops on lining surrounding the abdomen
Responds best to a combination of surgery and heated chemotherapy

LEARN ABOUT PERITONEAL MESOTHELIOMA

Pericardial Mesothelioma

Second-rarest type
Forms on soft tissue around the heart
Best treated with a multimodal approach

LEARN ABOUT PERICARDIAL MESOTHELIOMA

Who Is Most at Risk of Mesothelioma?

Personal history of asbestos exposure. If you've been directly exposed to asbestos fibers at work or at home, your risk of mesothelioma is greatly increased.

Living with someone who works with asbestos. People who are exposed to asbestos may carry the fibers home on their skin and clothing. Exposure to these stray fibers over many years can put others in the home at risk of mesothelioma. People who work with high levels of asbestos can reduce the risk of bringing home asbestos fibers by showering and changing clothes before leaving work.

A family history of mesothelioma. If your parent, sibling or child has mesothelioma, you may have an increased risk of this disease.

Veterans

Asbestos use in the military was widespread from 1940 to 1980. Veterans from all branches of the U.S. armed forces were at risk of exposure. Navy veterans are most at risk. This branch used the largest quantity of asbestos products.

Occupational Exposure

More than 75 occupations have exposed workers to asbestos. Auto mechanics, textile workers, steel mill workers, construction workers and firefighters are among the most at risk.

Secondary Exposure

Asbestos workers unknowingly carried asbestos fibers on their body and clothing. This resulted in secondary asbestos exposure among residents such as women and children.

Mesothelioma Treatment

Once an individual has been diagnosed by a qualified mesothelioma doctor, the next step is to discuss mesothelioma treatment options and to develop a treatment plan. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing mesothelioma and supporting improved quality of life.

Newly diagnosed mesothelioma patients often have many questions for their doctors about the treatment options that would be most effective for them. Conventional treatment options for mesothelioma include surgery, radiation and chemotherapy. Recently, chemotherapy drugs including Alimta® and Cisplatin have showed promising results in some patients.

Most often, mesothelioma is treated with a multimodal plan, or combination, of conventional cancer treatment methods including surgery and chemotherapy. Treatment will either focus on extending life expectancy or, at a late stage, focus on palliative care to relieve side effects. Research and clinical trials have found new hope for a potential cure with emerging treatments, like immunotherapy, to combat the disease and improve life expectancy.

After receiving a mesothelioma diagnosis, the most important step is finding a mesothelioma doctor who specializes in asbestos-related diseases. They will be the best person to determine the most effective treatment options for your individual case, and will also be aware of the latest treatment advancements or clinical trials available. Creating a custom treatment plan with a mesothelioma doctor is the most effective way to improve prognosis.

Mesothelioma clinical trials as well as experimental treatments are other options that certain mesothelioma patients may be eligible to participate in. Our site features a comprehensive mesothelioma cancer treatment section that includes important information for patients and families. We've included resources on top mesothelioma experts such as Dr. Raphael Bueno, as well as a comprehensive list of cancer centers where mesothelioma treatment takes place.

Beyond the conventional treatments for mesothelioma, certain alternative therapies may provide assistance to mesothelioma patients. Financial assistance is available to help offset mesothelioma treatment costs. We continually update this section of our site as new mesothelioma treatment information becomes available.

Learn More About Mesothelioma Treatments

Asbestos Exposure and Cancer

Asbestos exposure is the primary cause of mesothelioma cancer. Inhaled or ingested asbestos fibers may cause an inflammation of internal tissue and disrupt organ function which leads to the development of mesothelioma. Asbestos products were used extensively in the 20th century throughout the United States, in a wide variety of applications. Many workers were put at risk at commercial and industrial locations including refineries, power plants, steel mills, auto production facilities, and large construction sites. Some of the occupations of workers at risk include electricians, plumbers, boilermakers, carpenters, mechanics, machinists and more. Additionally, if you lived with someone who was regularly exposed to asbestos and washed their clothes, you could be at risk for second-hand asbestos exposure.

Asbestos companies continued to produce these products even after they were known to be hazardous to workers. These products were responsible for asbestos exposure sustained by the individuals who manufactured them as well as those who used them. Renovation and construction both at home and in schools also poses high-risk areas for exposure. People also may have been exposed to asbestos-contaminated talc in baby powder

Veterans and Mesothelioma

Although rare, mesothelioma affects veterans from all branches of service: Army, Navy, Air Force, Marines, and Coast Guard. As mesothelioma has a long latency period and can remain dormant for several decades, veterans who served our country from 1930 through 1980 are just now being diagnosed with the disease.

Navy veterans who worked in Navy shipyards and or served on our nation's aircraft carriers, battleships, destroyers, submarines and warship from WWII through the Vietnam War were exposed to high concentrations of deadly asbestos and are at a high risk for developing asbestos-related cancer. Boiler rooms, engine rooms, sleeping quarters, and other areas of naval vessels were the most common areas where asbestos was present.

Some prominent shipyards where asbestos was prevalent include Brooklyn Navy Yard, Norfolk Navy Shipyard, Long Beach Naval Shipyard, and Hunters Point Naval Shipyard. Financial assistance and help with VA Benefits are available to veterans diagnosed with mesothelioma.

Prognosis

Younger patients and women have a better mesothelioma prognosis than older men. People diagnosed with peritoneal mesothelioma also have a higher chance of survival.

Patients eligible to undergo multimodal therapy, which is a combination of two or more standard-of-care treatments, have a better life expectancy and improved prognosis.

A patient’s mesothelioma cell type also plays a significant role in prognosis and life expectancy.

The three types of cells include:

Epithelioid

These cells are the most responsive to treatment, which improves prognosis and life expectancy. They comprise 50 percent of mesothelioma diagnoses.

Sarcomatoid

These cells are the least responsive to treatment. Patients with this cell type have a poorer prognosis and shorter life expectancy. These cells comprise 10 percent of diagnoses.

Biphasic

A combination of epithelioid and sarcomatoid cells. This type is less responsive to treatment. But prognosis and life expectancy depends on the ratio of both types of cells. This type accounts for 30-40 percent of diagnoses.

The Four Stages of Mesothelioma

Stage 1 Mesothelioma

The cancer is localized. Surgery is most effective at this stage. Survival rate is higher. Median life expectancy at stage 1 is 22.2 months.

LEARN ABOUT STAGE 1

Stage 2 Mesothelioma

Tumors have started to spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 20 months.

LEARN ABOUT STAGE 2

Stage 3 Mesothelioma

Cancer has progressed to a more advanced stage with spread into the regional lymph nodes. Surgery may still be an option. Median life expectancy at stage 3 is 17.9 months.

LEARN ABOUT STAGE 3

Stage 4 Mesothelioma

Cancer has spread extensively in the area where it developed. Chemotherapy and immunotherapy control symptoms and prolong survival. Median life expectancy at stage 4 is 14.9 months or less.

LEARN ABOUT STAGE 4