Also known as asbestos lung cancer, asbestosis. Commonly misspelled as Mesothilioma, Mesotheliema, Mesothiliema, Mesotheleoma, Mesothileoma. Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum).
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos.
A doctor should be seen if a person has shortness of breath, pain in the chest, or pain or swelling in the abdomen. If there are symptoms, the doctor may order an x-ray of the chest or abdomen.
The doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time). Some pressure may be felt, but usually there is no pain.
The doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, a local anesthetic will be given. If tissue that is not normal is found, the doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.
The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient’s age.
Diagnosis Mesothelioma: Common Questions
- What is mesothelioma?
- How do you get mesothelioma?
- How much exposure does it take to get mesothelioma?
- How long does it take after exposure for mesothelioma to show up?
- How is mesothelioma diagnosed?
- What is the prognosis for mesothelioma?
- Is there any promising research or are there promising drugs for mesothelioma?
- What kinds of resources are available for people with mesothelioma?
- Mesothelioma At A Glance
What is mesothelioma?
Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum)
How do you get mesothelioma?
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Others have been exposed to asbestos in a household environment, often without knowing it.
How much exposure does it take to get mesothelioma?
An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later.
How long does it take after exposure for mesothelioma to show up?
People exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.
How is mesothelioma diagnosed?
Mesothelioma is diagnosed by pathological examination from a biopsy. Tissue is removed, placed under the microscope, and a pathologist makes a definitive diagnosis, and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid build-up around the lungs (pleural effusions), shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an x-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:
If fluid has collected in your chest, your doctor may drain the fluid out of your body by putting a needle into your chest and use gentle suction to remove the fluid. This is called thoracentesis.
For peritoneal mesothelioma the doctor may also look inside the abdomen with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is usually done in the hospital under a local anesthetic. If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.
Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated.
Mesothelioma Treatment Options (Traditional & New Treatments Being Studied)
Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use and each one measures somewhat different variables. The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages. The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis.
The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.
There are three traditional kinds of treatment for patients with malignant mesothelioma:
- Surgery (taking out the cancer)
- Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
- Chemotherapy (using drugs to fight the cancer)
NOTE: Often two or more of these are combined in the course of treatment. New Approaches Being Studied
New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include:
- L-NDDP or Platar. Intrapleural administration of this platinum product is designed to overcome the toxicity and drug resistance currently limiting the usefulness of platinum drugs like Cisplatin. NOTE: A recent trial produced remission in two patients.
- Endostatin, shown to work with angiostatin in destroying a tumors’ ability to grow blood vessels without harming normal cells.
- Lovastatin is a cholesterol drug shown in a recent study to potentially inhibit mesothelioma cancer cell growth.
- Intrapleural interferon gamma is the direct administration of the anti-cancer drug Interferon Gamma.
- Photodynamic therapy kills cancer cells using the energy of light
- Immunotherapy treats cancer by helping the immune system fight the disease.
- Gene therapy treats cancer by correcting the genetic deficits that allow tumors to develop. A September 1999 study found that Interferon interleukin prevented the growth of mesothelioma cells in mice.
Surgery: There are several types of surgery used in treating mesothelioma.
- A pleurectomy is the removal of part of the chest or abdomen lining and some of the tissue around it.
- Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy.
- In an extrapleural pneumonectomy, the lung is removed along with the lining and diaphragm (the muscle that helps you breathe) on the affected side. In this surgery, the lining around the heart is also removed.
- Sometimes a pleurectomy/decortication is performed. In this surgery, the lining of the lung is removed along with as much of the tumor as possible.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and use gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating. Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be administered by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapeutic agents can be administered either systemically (through the blood stream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.
- Butchart System extent of primary tumor mass
- Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
- Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
- Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
- Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.
TNM System — variables of T (tumor), N (lymph nodes), M (metastasis)
- Stage I:Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
- Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
- Stage III:Mesotheliomas is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
- Stage IV:Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal al cavity or neck. Any distant metastases is included in this stage.
Brigham System: (variables of tumor resectability and nodal status)
- Stage I: Resectable mesothelioma and no lymph node involvement
- Stage II: Resectable mesothelioma but with lymph node involvement
- Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
- Stage IV: Distant metastatic disease
Is there any promising research or are there promising drugs for mesothelioma?
Research is being conducted at various cancer centers all over the United States. A recent study involving L-NDDP (brand name: Platar) produced two cases of remission in mesothelioma patients. Another study found that a drug known as Lovastatin may hold promise for mesothelioma patients.
To learn more about mesothelioma clinical studies and journal medical journal articles visit the Mesothelioma Web http://www.mesotheliomaweb.org. Mesothelioma At A Glance
- Mesothelioma is a cancer that arises from the cells lining the chest or abdominal cavities.
- Mesothelioma typically results from exposure to asbestos.
- When mesothelioma affects the chest the doctor may look inside the chest cavity with a special instrument called a thoracoscope.
- When mesothelioma affects the abdomen, the doctor may look inside the abdomen with a special tool called a peritoneoscope.
- Mesothelioma is diagnosed by a biopsy.
- The outlook for patients with mesothelioma depends on how early the disease is detected and how aggressively it is treated.
Diagnosis Mesothelioma: Diagnosis & Symptoms
The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.
PLEASE KEEP IN MIND THAT THESE SYMPTOMS MAY BE CAUSED BY MESOTHELIOMA OR BY OTHER LESS SERIOUS CONDITIONS. ONLY A DOCTOR CAN MAKE A DEFINITIVE DIAGNOSIS.
One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the lining of the lung and the chest cavity. As the volume of fluid increases, shortness of breath, known as “dyspnea”, and sometimes pain may occur. The primary goal in treating this effusion is to relieve shortness of breath, prevent recurrence and minimize discomfort.
Doctors use x-rays and CT scans to identify effusions and help determine a course of treatment. MRIs are used to a lesser extent in evaluating pleural effusions, but may be helpful in assessing the extent of chest wall involvement by tumor.
Diagnosis from Pleural Fluid
A diagnostic thoracentesis, in which cells are extracted from the pleural cavity is many times used as an aid in the diagnosis of mesothelioma. This is not usually considered a reliable test, however, since in up to 85% of the cases, the fluid tests negative or inconclusive even though cancer is present. It is ultimately a needle biopsy of the pleura (lining of the lung) or an open surgical tissue biopsy which confirms a mesothelioma diagnosis.
Treatment for Pleural Effusion
One way to treat the symptoms of difficult diseases is called palliative therapy. This approach is often considered for patients with malignant pleural effusions and is directed by evaluation of the symptoms, general health and functional status. Relief of dyspnea is a major consideration in mesothelioma. For patients who have large pleural effusions, doctors may recommend chest tube drainage and chemical pleurodesis. It is important to remember, however, that once patients have a talc treatment, they may be eliminated from certain chemotherapy treatments or clinical trials.
Chemical pleurodesis is a technique used to produce an adhesion inside the pleural cavity. It is used on patients who have significant relief of symptoms when pleural fluid is drained and show evidence of lung reexpansion. It is performed with a standard tube thoracostomy. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is admistered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution which forms a wet slurry that can roll around the pleural cavity.
Stages of malignant mesothelioma
Once malignant mesothelioma is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the cancer to plan treatment. The following stages are used for malignant mesothelioma.
Localized malignant mesothelioma
The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung.
Advanced malignant mesothelioma
The cancer has spread beyond the lining of the chest to lymph nodes in the chest.
Cancer has spread into the chest wall, center of the chest, heart, through the diaphragm, or abdominal lining, and in some cases into nearby lymph nodes.
Cancer has spread to distant organs or tissues.
Recurrent malignant mesothelioma
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lining of the chest or abdomen or in another part of the body.