Mesothelioma
Mesothelioma is a rare and aggressive cancer that develops in the thin layer of tissue covering many internal organs. Most cases are linked to asbestos exposure, and symptoms may not appear until decades after contact with this harmful mineral.
Table of contents
- What is Mesothelioma?
- Where Mesothelioma Develops
- Causes and Risk Factors
- Signs and Symptoms
- Diagnosis
- Treatment Options
- Prognosis and Life Expectancy
- Living with Mesothelioma
What is Mesothelioma?
Mesothelioma is a type of cancer that forms in the mesothelium, a thin layer of tissue that covers many of your internal organs[1]. This protective lining is found in different parts of your body, and the cancer can develop in any of these locations.
This disease is sometimes called malignant mesothelioma because it is a fast-growing and deadly form of cancer[1]. Mesothelioma is uncommon but aggressive. In the United States, approximately 3,300 new cases are diagnosed each year[4].
Most people who develop mesothelioma have worked or lived in places where they breathed in or swallowed asbestos particles[2]. After being exposed to asbestos, it usually takes a long time for the disease to form. The time between exposure and diagnosis can be up to 40 or even 50 years[3][4].
Where Mesothelioma Develops
- Lungs and chest cavity (pleura)
- Abdomen (peritoneum)
- Heart (pericardium)
- Testicles (tunica vaginalis)
The most common type of mesothelioma affects the tissue around the lungs. This is called pleural mesothelioma, and it accounts for about 75 to 80 percent of all mesothelioma cases[2][9]. The pleura is a thin layer of tissue that lines the chest cavity and covers the lungs.
Mesothelioma can also develop in the tissue lining the belly, which is called peritoneal mesothelioma[1]. Less commonly, it can form in the tissue around the heart, known as pericardial mesothelioma, or around the testicles, called mesothelioma of the tunica vaginalis[1][8].
Causes and Risk Factors
More than 80% of mesothelioma cases are caused by exposure to asbestos[3]. Asbestos is a group of minerals naturally found in rocks and soil that form long, thin, very strong fibers[2]. These fibers do not evaporate or dissolve in water, and they resist heat and fire.
In the 20th century, before scientists learned about its health dangers, asbestos was used in many consumer products, automobile parts, and building materials[2]. Working with materials that contain asbestos can release tiny asbestos fibers, too small to see, into the air. When people breathe in or swallow these fibers over many years, they can develop mesothelioma and other diseases[2].
The greater the exposure to asbestos, the greater the risk of developing mesothelioma[3]. As of 2013, about 125 million people worldwide had been exposed to asbestos at work[3]. High rates of disease occur in people who mine asbestos, produce products from asbestos, or work with asbestos products. People who live with asbestos workers or work in buildings containing asbestos are also at risk[3].
Risk factors for mesothelioma include[2]:
- Being exposed to asbestos at work
- Living with someone who works with asbestos
- Living or working in a building where materials containing asbestos have been disturbed
- Living in an area with natural asbestos deposits or asbestos mines or factories
Not everyone who is exposed to asbestos will develop mesothelioma. However, asbestos exposure remains the most important cause of this cancer[2].
Signs and Symptoms
The signs and symptoms of mesothelioma depend on where the cancer develops in the body. Symptoms typically come on slowly[8].
Pleural Mesothelioma Symptoms
Pleural mesothelioma, which affects the tissue around the lungs, may cause[1][2]:
- Chest pain
- Painful coughing or persistent cough
- Shortness of breath
- Lumps under the skin on the chest
- Tiredness
- Weight loss without trying
Peritoneal Mesothelioma Symptoms
Peritoneal mesothelioma, which affects tissue in the belly, may cause[1][2]:
- Belly pain
- Belly swelling
- Nausea
- Tiredness
- Weight loss without trying
Other Types
Pericardial mesothelioma, which affects tissue around the heart, may cause trouble breathing and chest pains[1]. Mesothelioma of the tunica vaginalis, which affects tissue around the testicles, may first appear as swelling or a mass on a testicle[1].
If you have any symptoms that worry you, make an appointment with a doctor or other healthcare professional[1]. These symptoms may be caused by something other than cancer, but the only way to know what is causing them is to see your doctor[2].
Diagnosis
Diagnosing mesothelioma can be difficult because it is rare and its symptoms are similar to those of other common conditions[9]. Sometimes it is hard to tell the difference between mesothelioma and other cancers, such as lung cancer[2][8].
To diagnose mesothelioma, your healthcare professional will start with a physical exam to check for lumps or other signs[10]. The doctor will ask when the symptoms started and how often you experience them[8].
You may need several tests, including[2][10]:
- Imaging tests, such as chest X-rays, CT scans, or MRI, to look for mesothelioma and see where it is located
- Blood tests to check for certain proteins released when cancer is present
- A biopsy, which is a procedure to remove a sample of tissue or fluid for testing in a lab
A biopsy is the only way to confirm or rule out mesothelioma[10]. During a biopsy, a healthcare professional might remove fluid or tissue using a thin needle inserted through the skin of the chest or belly. Sometimes, a surgeon will take a tissue sample during surgery by making a small cut and inserting a tube with a video camera to see inside your chest or belly[10].
Once mesothelioma is confirmed, you may have additional tests to find out if the cancer has spread to your lymph nodes or to other areas of your body[10]. These results help your healthcare professional give your cancer a stage, which helps determine the best treatment options.
Treatment Options
There is no cure for mesothelioma in most cases, but treatments are available that can help control the disease and improve quality of life[1][2]. Treatment depends on where the mesothelioma is located, whether it has spread to other parts of the body, your general health, and your personal wishes[13].
Unfortunately, mesothelioma can be difficult to treat. It is often diagnosed at an advanced stage, so nearly all treatments aim to control the cancer for as long as possible and keep symptoms under control[13].
Surgery
For early stage mesothelioma, you might have surgery if you are well enough[13]. Surgery is not a common treatment for mesothelioma because it can be difficult to remove all the cancer[13]. To have surgery, you need to be fairly fit and well so that you can recover without too many problems.
Types of surgery include removing part of the pleura, removing the whole pleura, or removing as much cancer as possible to relieve symptoms[13].
Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream[13]. You might have chemotherapy for early stage mesothelioma alongside surgery and radiation, or to shrink or control advanced mesothelioma[13].
Common chemotherapy drugs for mesothelioma are pemetrexed and cisplatin[13][4]. Chemotherapy with these medications is considered standard treatment, although cancer can return[4].
Radiation Therapy
Radiation therapy uses high-energy rays to destroy cancer cells[2][13]. You might have radiation after surgery for early stage mesothelioma or to control symptoms and slow down the growth of your cancer.
Immunotherapy
Immunotherapy uses your immune system to fight cancer. It works by helping the immune system recognize and attack cancer cells[13]. Immunotherapy is a treatment option for some people with pleural mesothelioma. You might have immunotherapy if you cannot have surgery. It helps to control the cancer and is given as your first treatment, before other treatments such as chemotherapy[13].
Other Treatments
Other treatment options may include[2]:
- Targeted therapy, which uses drugs to block the growth and spread of cancer cells
- Clinical trials, which test new treatment options
- A procedure called pleurodesis, which uses substances such as talc to scar together the pleura to prevent fluid from building up around the lungs[3]
Palliative Care
Some people might be too ill to cope with treatments like chemotherapy, radiation, or surgery. However, you can still have treatment to relieve symptoms such as pain or breathing problems. This is called palliative care[13].
Palliative care is managed by a team of doctors and nurses who are experts in controlling symptoms of advanced cancer. The team might also include a physiotherapist and dietician[13].
Prognosis and Life Expectancy
A mesothelioma prognosis estimates how long a patient with this cancer is expected to live. The average mesothelioma prognosis is a life expectancy of 12 to 21 months[25]. The 5-year survival rate is about 8 to 12 percent in the United States[3][25].
This means that only a small percentage of patients are still living 5 years after diagnosis. However, your prognosis could improve with treatment. Some mesothelioma patients have become long-term survivors, living for 15 years or more[25].
Several factors affect prognosis and treatment options[8]:
- Where the cancer is located
- How far it has grown or spread (the stage)
- The type of cancer cells
- Your general health and level of fitness
Treatment for early stage disease with surgery and radiation is potentially curative, but many patients either are too ill to undergo aggressive surgery or present with advanced disease[4]. Peak incidence occurs in the 5th and 6th decades of life, and males are three times more likely to be diagnosed than females[4].
Living with Mesothelioma
Living with mesothelioma presents many challenges. From coping with a difficult diagnosis to the stress of financial decisions and the uncomfortable symptoms and treatments of this cancer, quality of life can decrease. However, patients and their loved ones can take action and use resources to make this time easier.
Managing Symptoms and Side Effects
Mesothelioma symptoms can affect daily life, but managing them effectively can improve comfort and well-being. Common symptoms include shortness of breath, chest pain, fatigue, and lack of appetite. Doctors may recommend medications, oxygen therapy, or pulmonary rehabilitation to ease breathing difficulties. Pain management options, like physical therapy, can also be helpful. Nutritionists can offer guidance on maintaining a healthy diet.
It is vital to communicate openly with your doctors about symptoms and side effects so they can make adjustments to your treatment plan as needed. This can significantly improve the quality of your daily life.
Seeking Emotional Support
Receiving a mesothelioma diagnosis is emotionally overwhelming. Patients may experience fear, anger, anxiety, or depression. Family members often struggle with their own emotions while trying to support their loved ones. Seeking emotional support can make a significant difference in coping with the diagnosis.
Support groups provide a sense of community for both patients and caregivers. Speaking with others who understand the challenges of mesothelioma can be comforting. Many hospitals and cancer centers offer in-person and virtual support groups. Therapists and counselors can also help you and your family process emotions and develop coping strategies. You may benefit from meditation, relaxation exercises, or journaling to manage stress.
Accepting Your Diagnosis
Denial is a common reaction to such bad news as a mesothelioma diagnosis, but you cannot begin to move forward without acceptance. This type of cancer requires aggressive treatments, financial decisions, and essential planning. The sooner you accept a mesothelioma diagnosis, the sooner you can get the help you need to make the most of this challenging part of your life.
Relying on Family and Friends
A cancer diagnosis is tough to accept, but it is important to realize that you cannot do this alone. You need support and practical assistance from family now more than ever. Let your closest loved ones be there to listen, to drive you to appointments, to make dinner, and to help you make big decisions. Open and honest conversations with loved ones can help strengthen emotional bonds during this difficult time.
Improving Quality of Life
Research shows that patients who maintain a positive quality of life often have a better mesothelioma prognosis. Focusing on nutrition, seeking support, and effectively managing symptoms can enhance your quality of life and help you navigate the challenges of mesothelioma more effectively.
