What Is Mesothelioma?
Mesothelioma is a severe form of cancer, but many treatment options exist for patients. Treatment options like chemotherapy and radiation can stop cancer cells from spreading to other parts of the body. These cancer treatments can increase life expectancy after diagnosis. Medication and surgery are pain management options that can improve a patient’s quality of life.
All cancers, including malignant mesothelioma, are caused by genetic mutations in the body’s cells. These mutations affect more and more cells until the cancer grows and spreads.
If cancerous cells spread too much, they can damage organs by preventing them from functioning properly. Left untreated, mesothelioma cancer cells can also affect the lymphatic system which is responsible for “cleaning” the body.
Normally, the lymphatic system traps harmful organisms like cancer cells and bacteria to protect the body from infection and disease. The lymph fluid containing these harmful organisms is then filtered by lymph nodes. Lymph nodes are glands located throughout the body, including in the armpits, groin, and neck.
When cancer cells spread too much, they can become trapped in the lymph nodes. In these cases, the cancer cells spread so quickly that the lymph nodes cannot destroy them quickly enough. When the lymph nodes become overrun with cancer cells, they can no longer protect the body.
When the lymphatic system is not able to destroy the cancer cells, the mesothelioma can spread freely.
Because the lymphatic system is vital for proper human function, doctors will first check lymph nodes for signs of cancer. From there, doctors can make a diagnosis and determine how far the cancer has spread into the body. This helps doctors provide targeted treatments that control and potentially stop the spread of cancerous cells.
Mesothelioma is caused by genetic mutations that are primarily linked to asbestos exposure. This makes asbestos the number one risk factor for developing mesothelioma.
Other risk factors or “triggers” for malignant mesothelioma include:
- Hereditary medical conditions
- Environmental exposure to toxins
- Personal health history, such as a history of cancer
- Personal lifestyle, such as poor diet, lack of exercise, smoking, drug use and more
Depending on the case, there could be one or more risk factors at play. Regardless of the risk factors, treatment options are available to patients of any background.
Asbestos exposure is the most common underlying risk factor among mesothelioma patients. Most patients with mesothelioma have been exposed to asbestos at work, home or school. Mesothelioma can eventually form in those who inhaled asbestos particles 20 to 40 years prior.
Asbestos is a naturally occurring material composed of incredibly fine and flexible particles. These particles are strong enough to resist corrosion, water and heat damage. Because of its durability and resistance to damage, asbestos is used in countless industrial and construction capacities. These microscopic asbestos particles become airborne when disturbed. Airborne asbestos particles are susceptible to human inhalation and ingestion.
When inhaled, asbestos particles can settle deep into the lungs, causing irritation and damage. This continued irritation scars the lung tissue. If the asbestos particles remain trapped inside the body, the scarring and damage leads to cellular mutation. Cellular mutation caused by asbestos may create tumors. When these tumors grow and spread, malignant mesothelioma develops.
Mesothelioma can impact different areas of the body depending on how it was formed and how it spread. Doctors can diagnose a particular type of mesothelioma based on where the cancer developed. Each mesothelioma type has its own prognosis and options for treatment and pain management.
There are three main types of mesothelioma types based on location.
Pleural mesothelioma occurs when cancer cells form and spread within the lining of the lungs (pleura). 65% of mesothelioma cases are pleural. It is the most common type of mesothelioma because inhalation is the most common way to be exposed to asbestos. Inhaled asbestos fibers become lodged within the lung linings. They eventually cause enough damage that cancer cells grow.
Pleural mesothelioma can cause difficult and painful breathing, persistent coughing, and chest pain and lumps. Diagnosing pleural mesothelioma requires a combination of chest X-rays and tissue-testing. This is also known as a biopsy.
After diagnosing pleural mesothelioma, doctors will recommend treatments, such as radiation and chemotherapy. These treatments control and stop the spread of cancer cells in the lungs. Pain management treatments, such as palliative surgery and pain-relieving drugs, are also used to control symptoms and improve quality of life.
Cancer that has formed in the lining of the abdomen (peritoneum) is called peritoneal mesothelioma. It is the second most common type of mesothelioma. Roughly 10% to 20% of all mesothelioma cases are located in the peritoneum.
Peritoneal mesothelioma is caused by ingesting asbestos fibers trapped in the digestive system.
Common peritoneal symptoms include abdominal pain, diarrhea, constipation, nausea and vomiting. Doctors diagnose peritoneal mesothelioma using a combination of imaging scans and biopsies (tissue-testing).
Chemotherapy is the traditional treatment for peritoneal mesothelioma. It kills cancer cells to prevent the disease from spreading. Other pain management treatments, such as palliative abdominal surgery, can also help peritoneal mesothelioma patients improve their quality of life by reducing painful symptoms.
In extremely rare cases, mesothelioma forms in the lining of the heart (pericardium). This is called pericardial mesothelioma. It accounts for less than 1% of all cases. Unlike the abdominal and lung linings, it is not very well understood how asbestos fibers impact the heart’s lining.
Pericardial mesothelioma symptoms include heart palpitations, coughing and chest pain. Diagnosing pericardial mesothelioma involves a combination of X-rays, imaging scans and echocardiograms.
Pericardial mesothelioma treatments involve chemotherapy and radiation. They may also include surgically removing parts of the pericardium. This helps to relieve pressure, alleviate pain and allow the heart to continue to function.
Mesothelioma has different symptoms depending on where the disease has formed in the body.
Here are the common mesothelioma symptoms based on disease location.
Pleural Mesothelioma Symptoms
Because pleural mesothelioma affects the lungs, its symptoms are primarily respiratory.
Common pleural mesothelioma symptoms include:
- Painful coughing
- Chest pain found under the rib cage
- Difficulty breathing and shortness of breath
- Lumps of tissue under the skin around the chest
- Unexplained weight loss
Peritoneal Mesothelioma Symptoms
Peritoneal mesothelioma affects the stomach and digestive system, so its symptoms are primarily abdominal.
Peritoneal mesothelioma symptoms commonly include:
- Abdominal pain and swelling
- Lumps of tissue found around the stomach
- Digestive conditions such as diarrhea and constipation
- Unexplained weight loss
Pericardial Mesothelioma Symptoms
Pericardial mesothelioma affects the tissue lining in the heart causing cardiovascular symptoms.
Pericardial mesothelioma symptoms include:
- Difficulty breathing
- Chest pains
- Heart palpitations and murmurs
Many mesothelioma treatment options exist to help control, manage and reduce these symptoms.
To reach and confirm a diagnosis, doctors follow a specific process to determine the presence of mesothelioma and its stage.
The process for reaching a mesothelioma diagnosis is as follows:
1. Review Symptoms
Doctors will first review your symptoms to see if they are consistent with mesothelioma. The doctor can do this by performing a physical exam and looking for chest or abdominal lumps.
2. Perform X-Rays, Imaging Scans and Other Tests
The next step is to conduct X-rays or a CT scan to look for abnormalities in the chest, abdomen or heart. The area examined depends on the type of symptoms. X-rays and imaging scans help doctors find cancerous abnormalities and determine how far the disease may have spread. If pericardial mesothelioma is suspected, doctors may conduct an echocardiogram. This test checks for heart murmurs, thickness and other precursors of mesothelioma in the heart.
3. Conduct Blood Tests and Biopsies
If doctors suspect the presence of tumors based on the previous tests, they will order a biopsy and/or blood test. Biopsies and blood tests take tissue and fluid samples from the patient. These samples are then tested for malignancy.
There are different types of biopsies used in testing for cancer and mesothelioma in particular.
These biopsy types include:
- Endoscopic Biopsies: Endoscopic biopsies use thin tubes to look inside the body and pull out samples of tissue. Depending on the location of the tumor, different types of endoscopies are used. Endoscopic biopsies are the most commonly used method of testing for mesothelioma.
- Needle Biopsies: Needle biopsies are used in the chest, making it a common test for pleural mesothelioma. A needle is inserted into the chest and sent down into the lining of the lungs. With guidance from imaging scans, the needle can pull out a tissue sample, which is then examined for malignancy.
- Open Surgical Biopsies: Open surgical biopsies are performed when other methods are not sufficient in obtaining a proper sample. This can be because doctors want to collect multiple samples from multiple locations. It can also be because needle biopsies do not collect large enough samples. Open biopsies allow surgeons to see right into the patient’s chest or abdomen, making it the surest method of collecting accurate samples. Sometimes, doctors will remove the tumor entirely during open surgical biopsies.
Though doctors work hard to ensure a proper diagnosis, a misdiagnosis can happen. Mesothelioma is considered a very rare disease, and its different forms aren’t fully understood. This makes diagnosing this disease more complicated than other forms of cancer. It’s important to always see a mesothelioma specialist. Mesothelioma is so rare that non-specialists don’t have the experience to properly diagnose and treat patients.
Once a mesothelioma diagnosis is reached, the doctor will order additional tests to determine which stage the cancer is at. The stage of cancer indicates how far the mesothelioma has spread. Because pleural mesothelioma is the most common type, it is the only form of mesothelioma that has established stages.
The established stages of pleural mesothelioma are:
- Stage 1: Localized cancer centered around one portion of the chest’s lining
- Stage 2: Cancer that has spread outside of the chest to the lungs or diaphragm
- Stage 3: Further spreading to other structures, such as the lymph nodes
- Stage 4: Extensive spreading well beyond the chest that may include the brain or liver
Currently, peritoneal and pericardial mesotheliomas do not have established stages. Doctors usually assess these conditions based on how localized the cancer is. They may also assess these other types of mesothelioma based on how much the cancer is metastasized (spread to surrounding areas or other systems).
Early detection of mesothelioma improves treatment success. However, it is vital to understand that treatment options are available regardless of which stage your mesothelioma has been diagnosed. Treatment can control the disease, maintain and improve quality of life and extend life expectancy.
After mesothelioma has been diagnosed and staged, doctors can make treatment recommendations. Understanding all available treatment options gives mesothelioma patients control over their disease. Pursuing recommended treatment is critical for patients to extend their life expectancy and improve lifestyle quality.
Treatment recommendations depend on several factors, including:
- The location of the mesothelioma (pleural, peritoneal, pericardial)
- How far the cancer has spread (the stage)
- The patient’s overall health status, including other pre-existing health conditions
Treatments for mesothelioma work to control the spread of cancer, kill existing cancer cells, remove cancerous tumors and manage painful symptoms.
The following are the main types of mesothelioma treatments:
- Chemotherapy: Chemotherapy is the process of injecting anticancer drugs into the veins on a regular basis (usually every two weeks). It is used to treat both pleural and peritoneal mesothelioma by slowing down the growth and spread of cancer.
- Radiotherapy: Radiotherapy or radiation therapy is the process of using X-rays to kill cancer cells. It is typically used to treat mesothelioma in stages 2, 3 and 4. Radiation therapy helps to control painful symptoms and may also slow down the growth of tumors.
- Surgery: Malignant mesothelioma tumors can be removed surgically. Depending on the location, doctors can surgically remove parts of the pleura, peritoneum or pericardium. In some cases, surgical procedures remove the tumor entirely. In other cases, they may remove as much of the tumor as possible.
- Palliative Care: Palliative care is a form of treatment often applied to those suffering from the late stages of mesothelioma. However, early stage patients can benefit from this treatment as well. Palliative care is way to reduce pain and other debilitating symptoms. A palliative care specialist helps patients feel comfortable by eliminating suffering.
Depending on your case, your health care team will offer one or more of these treatment options. They will work with you to determine the best course of therapy that will control mesothelioma growth and reduce pain and discomfort.