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). Pleural mesothelioma is the most common form, often presenting with symptoms in the chest area. Peritoneal mesothelioma is much less common. This can effect the organs in the abdomen, and its symptoms are related to this area of the body, that is, abdominal swelling, nausea, vomiting, and bowel obstruction. The rarest form of mesothelioma is pericardial mesothelioma, which involves the sac surrounding the heart. There are two major cell types of mesothelioma, epithelial and sarcomatoid. Sometimes both of these cell types can be present. The sarcomatoid type is rarer and occurs in only about 15% of cases; it portends a poorer prognosis. In very rare cases, mesothelioma can originate from benign, non-malignant cells. This so-called benign mesothelioma can be cured surgically. Most people present with complaints of shortness of breath. They also can have complaints of chest pain. Surprisingly, this pain is often not pleuritic; that is, it does not get worse with deep breathing. This is surprising in that the pleura (outer surface of the lung) is often involved in this disease, and most other diseases involving the pleura are often associated with pleuritic pain (pain that worsens with deep breathing). Patients may also be asymptomatic, with the disease discovered by physical exam or an abnormal chest X-ray. As the disease progresses, shortness of breath increases, and weight loss, decreased appetite, and night sweats can develop. Local invasion by the tumor can result in changing of voice, loss of function of the diaphragm, and symptoms specific to the area and involvement of adjacent structures. Most people with malignant mesothelioma have worked on jobs where they breathedasbestos. Usually, this involves men over 40 years of age. Others have been exposed to asbestos in a household environment, often without knowing it. Interestingly, the number of new cases of mesothelioma has been relatively stable since 1983, the same time that the restrictions on asbestos were instituted by the U.S. Occupational Safety and Health Administration (OSHA). In Europe, the number of new cases of mesothelioma continues to rise. An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later and in some cases, as much as 70 years later. People exposed in the 1940s, '50s, '60s, and '70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease. 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 buildup 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: Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated. Unfortunately, mesothelioma is often found at a stage in which a cure is unobtainable. Many will succumb to the disease within one year of diagnosis. Mesothelioma treatment options (traditional and new treatments being studied) Treatment options are determined by the stage of mesothelioma (the extent to which the tumor has spread in the body). 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. Butchart system extent of primary tumor mass The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis. TNM system: variables of T (tumor), N (lymph nodes), and M (metastasis) The Brigham system is the latest system and stages mesothelioma according to resectability (the ability to surgically remove the tumor) and lymph node involvement. Brigham system: variables of tumor resectability and nodal status There are three traditional kinds of treatment for patients with malignant mesothelioma. Often two or more of these are combined in the course of treatment: Additional information Surgery: There are several types of surgery used in treating mesothelioma. 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 using 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 bloodstream) 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. New approaches being studied Research is being conducted at various cancer centers all over the United States. A recent study involving L-NDDP produced two cases of remission in mesothelioma patients. Another study found that a drug known as Lovastatin may hold promise for mesothelioma patients.
What is mesothelioma?
What are the symptoms of mesothelioma?
What causes mesothelioma?
How much asbestos exposure does it take to get mesothelioma?
How long does it take after asbestos exposure for mesothelioma to show up?
How is mesothelioma diagnosed?
For pleural mesothelioma, 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 is usually done in a hospital using a local anesthetic or painkiller.
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 using 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.
If abnormal tissue is found, the doctor will need to cut out a small piece and have it looked at under a microscope. This is usually done during the thoracoscopy or peritoneoscopy, but can be done during surgery.
Unfortunately, in some cases, tumor cells can grow along the tract where the biopsy is taken. This can be minimized with the use of radiation to the area.What is the prognosis for mesothelioma?
What is the treatment for mesothelioma?
Is there any promising research or are there promising drugs for mesothelioma?
New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They includeMesothelioma At A Glance
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