What is mesothelioma?

Mesothelioma is a form of cancer affecting the abdominal cavity, chest cavity, and the region surrounding the heart. Due to its uncommon nature, mesothelioma is typically difficult to diagnose and treat. It has been connected with exposure to asbestos, a material formerly present in many work environments. Only about 3,000 individuals are diagnosed annually.

Individuals with a history of extended asbestos exposure are at the highest risk for developing malignant mesothelioma. Even a small exposure to this cancer-causing material can result in malignant mesothelioma. However, mesothelioma has a latency of up to thirty-forty years, and many individuals previously exposed to asbestos are now displaying symptoms. This means the average age of mesothelioma patients is between 50 and 70 years. Men are typically affected more, due to the common presence of asbestos in industrial settings. There are three major types of malignant mesothelioma . epithelial, sarcomatoid, and mixed. Epithelial mesothelioma is most common. Symptoms may include, but are not limited to respiratory distress, a lasting cough, and pneumonia. In addition, symptoms are often mistaken for less serious ailments, and many patients do not show any signs at all.

Individuals with pleural mesothelioma may accumulate some fluid between the lung lining and chest cavity. This can be detected through a chest x-ray, as well as CT scans.

Diagnosis of Mesothelioma is based on a pathological exam, more commonly referred to as a biopsy. This exam will test a tissue sample for the presence of malignant and/or pleural mesothelioma.

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Asbestos as the Primary Cause of Mesothelioma

Asbestos is a type of insulation material, which was used widely in the past in the following industries:

• Construction industry
• Ship building industry
• Automotive industry
• Other manufacturing industries

Mesothelioma occurred most often in persons who worked in the above industries and were exposed to asbestos in their workplace. The use of asbestos was very widespread after 1945. However, first symptoms of mesothelioma may not become apparent 10-40 years after the initial exposure, which makes it very hard to diagnose. The peak in mesothelioma cases is expected to be reached around 2010 according to some studies. There are three most commonly used types of asbestos: white, brown, and blue. Brown and blue asbestos are most commonly associated with mesothelioma. These types of asbestos have been banned by most countries in the 1990s.

Asbestos is a very dangerous substance and can cause a lot of damage to your health. It is made up of very small fibers, which can find their way to pleura (outside lining of the lung) and damage the cells pleura is made of. These fibers can also be carried on clothing, which makes them dangerous not only to the person exposed to asbestos, but to their family members as well.

How Do Doctor's Diagnose Mesothelioma?

The first step to diagnosing mesothelioma is a complete evaluation of a patient's medical history to determine symptoms and any past asbestos exposure, as well as a complete physical. In addition, physicians may request an MRI (magnetic resonance imaging) scan or an X-ray of the abdomen or chest region to help determine the location and size of the tumor.

In cases of pleural and peritoneal mesothelioma, fluid (effusion) may collect in the chest or abdominal region. Physicians may use a procedure known as fine needle aspiration to obtain a sample of this fluid for further testing. In addition, this procedure can be used to drain the effusion to temporarily relieve chest pain or other symptoms.

Usually, a biopsy of the tumor is required to make a diagnosis, however, sometimes only a fluid sample is needed. Below are a number of procedures commonly used.

Peritoneoscopy

In a case of peritoneal mesothelioma the doctor will use a tool called a peritoneoscope, which will be placed inside an opening made in the patient's abdomen. If fluid is found in the abdomen it will be drained through a process called paracentesis, which requires a needle to be placed inside the abdomen in order to extract the fluid.

Thoracoscopy

In diagnosing pleural mesothelioma a doctor may use a special instrument called a thoracoscope in order to examine the patient's chest cavity. This test requires an incision to be made in the chest wall, which will be used to place the thoracoscope between the patient's ribs. If the doctor finds fluid collected in a patient's chest, it will be drained out of the chest cavity through a needle. This test commonly requires anesthetic or another form of pain suppression.

Biopsy

If cancerous tissue is found in the patient's lungs or abdomen it will be extracted and examined by the doctor. This process helps the doctor determine potential ways of treatment and is usually done during the above two processes or may require additional surgery.

Mesothelioma Symptoms

In early stages of the disease, mesothelioma may not have any visible symptoms and is very hard to detect. In later stages of development, certain symptoms begin to develop and are usually caused by the growth of cancer and its pressure on certain nerves.

The symptoms of the two main types of mesothelioma (Pleural and Peritoneal) are described below:

Peritoneal Mesothelioma:

• Abdominal pain (stomach)
• Abdomen swelling
• Feeling sick
• Loss of appetite
• Losing over 10% of your body weight while not dieting
• Constipation and diarrhea

Pleural Mesothelioma:

• Lower back of chest pain
• Continual Cough
• Breath shortness
• Husky voice
• Losing over 10% of your body weight while not dieting
• Fever or sweating
• Trouble swallowing

The above symptoms may be caused by other illnesses not related to mesothelioma, however, if you have been exposed to asbestos in the past or if the symptoms persist, it is very important that you consult with your physician or health care provider immediately.

Pleural Mesothelioma - Cancer of the Lung Lining

Pleural Mesothelioma affects the chest cavity, sometimes including the lungs. Metastates, or the spreading of the cancer, can occur in any other organs, and is much more common than originally thought. This form of mesothelioma usually has a slow onset, with the most common symptoms is localized chest pain. This can be accompanied by trouble breathing, caused by pleural effusion, or a buildup of liquid in the pleural space (chest cavity). Additional symptoms include cough, weight loss, and fever. The best test for determining the extent of Pleural Mesothelioma is a computed chest tomograph (CT-scan). Median survival time for this form of Mesothelioma is approximately 17 months from the onset of symptoms. This is the most common form of mesothelioma, accounting for 80-90% of cases.

The pleura are the tissues lining or covering surrounding the actual lungs. There are 2 pleural membranes, separated by the pleural space. These membranes are fibrous sheets, protecting the lungs by producing a lubricating fluid to assist in lung operation.

Peritoneal Mesothelioma

Peritoneal Mesothelioma affects the abdomincal cavity and organs, including the liver, spleen and bowels. Pain is the most common symptom in cases of Peritoneal Mesothelioma. However, the accumulation of fluid can often cause the abdominal region to appear enlarged. Other common symptoms include vomiting, nausea, foot swelling, increased body temperature or fever, and difficulty in moving bowels. The survival time is poorer than pleural mesothelioma, with most patients averaging 10 months from the first display of symptoms. Peritoneal Mesothelioma accounts for approx. 10 percent of mesothelioma cases

Pericardial Mesothelioma and Desmoplastic Malignant Mesothelioma

Pericardial Mesothelioma is affects the thin lining of tissue that surrounds the heart, or the pericardium. This cancer can occur at any age, although the mean age of presentation is 46. Symptoms include chest pain, cough, dyspnea, and palpitations. As with the other forms of Mesothelioma, a strong link to asbestos exposure seems evident. Surgery and radiation therapy can provide some palliation, however the prognosis is extremely poor.

A common sign of pericardial mesothelioma is pericardial effusion, or a collection of fluid in the sac that surrounds the heart. If caused by cancer, this symptom can be caused by the direct spread of cancer, or the result of cancer metastasized from other parts of the body.

Desmoplastic Malignant Mesothelioma

Desmoplastic malignant mesothelioma is the growth of fibrous or connective tissues around the tumor of the lining of the lung or chest cavity. The term .desmoplastic. refers to the growth of fibrous or connective tissue. "Desmo-" comes from the Greek "desmos" meaning "a fetter or band" and "-plastic" is also borrowed from the Greek, from "plassein" meaning "to form" = to form a band or fetter.

Stages of Mesothelioma - Severity

Upon confirmation of a diagnosis of malignant mesothelioma, the next step is evaluating the stage of the disease. Physicians may conduct imaging studies, such as CT (computed topography) or MRI (magnetic resonance imaging) scans to assess the progression and appropriate treatment. The four stages of mesothelioma are as follows:

Stage 1

The tumor is found in the pleura with or without some involvement of the lung, pericardium (lining of the heart) or diaphragm.

Stage 2

The tumor is found in a stage I location, plus there is involvement of some lymph nodes in the chest.

Stage 3

The tumor has extended into the chest wall, ribs or heart, through the diaphragm or into the peritoneum (the abdominal lining). There also may be involvement of the lymph nodes.

Stage 4

The tumor has spread through the bloodstream to distant sites (it has metastasized).

Causes of Mesothelioma Asbestos Cancer

The primary cause of mesothelioma is exposure to Chrysotile asbestos fibers. These are the most common asbestos fibers, followed by amosite and crocidolite. Chrysotile asbestos makes up for about 95% of the asbestos produced in the United States, and is commonly referred to as white asbestos. Individuals commonly exposed to this form include those who worked in asbestos mines, mills, and factories, as well as insulation factories and shipyards. Any exposure to asbestos can potentially increase future risk of mesothelioma.

Mesothelioma Treatment Options

The three main types of mesothelioma treatment include radiation therapy, chemotherapy and surgery.

Radiation Therapy

It is extremely difficult to deliver adequate doses of radiation necessary to kill the tumor without harming the surrounding organs due to the location of mesothelioma cells. There is an option of lowering the radiation dose, however, it is hard to determine whether low doses of radiation are significant in reducing the survival rate among patients. Unfortunately, using radiation therapy after surgery has not been very successful in terms of increasing the rate of survival, however, since surgery does not always remove the entire tumor, radiation therapy can help kill the remaining cancer cells and relieve certain symptoms of the disease such as chest pain.

Surgery

Before considering surgery as a treatment option a patient should always contact their doctor or primary healthcare provider to go over other options of treatment and examine the overall condition of the patient. Various tests should be performed to determine how safe the option of surgery is depending on the patient.s condition and the spread of the tumor. There are a number of reasons why a patient.s lung and heart function can decrease such as exposure to asbestos, smoking and age, all of which must be considered before surgery is performed.

There are two types of surgical procedures performed in most mesothelioma cases: aggressive surgery, which can prove to be a long-term solution and palliative procedures usually performed as a means of symptom relief.

Aggressive surgery can be performed in order to remove the affected organs such as a lung, pleura, or a diaphragm with the purpose of removing as much of the cancer as possible. Such procedures are extremely complicated and not hospitals will be willing to perform them. This type of operation is usually only performed on younger patients with good overall health and the consequences of such operation are evaluated thoroughly. Please check with your doctor or healthcare professional in order to determine your eligibility.

Pallative procedures are usually performed in order to alleviate some of the symptoms of mesothelioma and are performed in later stages of the disease. These procedures are performed in order to remove the collected fluid in a patient.s lungs in order to relieve loss of breath and are not aimed at curing mesothelioma. During such procedures a needle is usually inserted into the chest and the fluid is drained therefore easing the pain and shortness of breath.

Chemotherapy and Drugs

Chemotherapy as another common method of treating mesothelioma generally has mixed results due to the variety of patients. conditions and their overall health. Combination of chemotherapy and mesothelioma drugs is usually more effective in treating the disease especially as more and more new drugs are being developed. Similarly to radiation therapy, chemotherapy can be used in addition to surgery in order to remove cancer cells missed by surgical operations

Which drugs you might have

There is no standard treatment used to treat mesothelioma and many different combinations of drugs are used. These combinations are sometimes called chemotherapy regimes or regimens. The chemotherapy drugs used include

• Mitomycin c
• cisplatin
• carboplatin
• vinorelbine
• gemcitabine
• pemetrexed
  

A drug called raltitrexed (Tomudex) has also been tested for mesothelioma. Like pemetrexed, you usually have this in combination with cisplatin.

Side effects

All chemotherapy drugs have side effects. Drugs affect people in different ways. Not everyone has the same side effects with the same drug. Some people have very few side effects at all. It is not possible to tell how you will react until you have had that particular drug. It is important to remember that these effects are temporary. They will go away when your treatment is finished. All the drugs have different side effects. Ask your doctor or nurse which side effects are most common with the chemotherapy drugs you will be having.

There are some side effects that are quite common with many chemotherapy drugs. These are
a fall in the no of blood cells

• Feeling and being sick feeling and being back
• diarrhoea
• sore mouth and mouth ulcers
  
• hair loss or thinning
  
• feeling tired and run down
  

These links will take you to information about coping with these side effects in the main chemotheraphy section of CancerHelp UK.

Pemetrexed

Pemetrexed is a new drug that has shown good results in trials for mesothelioma. It is also called Alimta. Pemetrexed has now been licensed in the UK for use in combination with cisplatin to treat mesothelioma. In January 2008 NICE (National institute for health and clinical excellence) recommended its use in England, for people with advanced mesothelioma which is not suitable for surgery, who are fit enough to look after themselves. Others who are already receiving pemetrexed will be able to continue their treatment while they and their doctors agree that it is helpful.

There is more about pemetrexed in the question and answersection of CancerHelp UK.

Side effects of pemetrexed

The commonest side effects of pemetrexed include

• A drop in the no of blood cells
  
• Feeling or being sick
  
• sore mouth and mouth ulcers
  

Pemetrexed is a type of drug known as an anti-folate. To help control the side effects, you should be given this drug with extra folic acid and vitamin B12.

A fall in the number of blood cells will increase your risk of picking up a serious infection. Because of this risk, you should make sure you know exactly how to contact the hospital or your chemotherapy nurse. You should phone the hospital or go straight to casualty if you develop any signs of infection and especially if you get a temperature of 38 degrees C (100.5 degrees F) or higher.

Stages of Treatment

Stage 1: Localized mesothelioma

This stage usually allows aggressive surgery to be performed in order by removing the affected organs in order to cure the disease. Additionally, other surgical operations may be beneficial in order to alleviate certain symptoms of mesothelioma such as breathlessness. Please contact your doctor or healthcare provider in order to determine if such options would be beneficial to your condition and for more information on hospitals performing the above surgical operations.

Stages II, III, and IV: Advanced mesothelioma

Pallative procedures may be performed in order to drain excess fluid from the patient.s lungs in order to relieve certain symptoms of the disease. Other methods of treatment such as chemotherapy and/or mesothelioma drugs may be used as well in order to fight the disease.

Stage V: Recurrent Mesothelioma

Unfortunately there are currently no effective methods of treatment in this stage of the disease. However, treatment options not considered in the earlier stages can be considered and may be beneficial. Please contact your doctor in order to determine which treatment options are right for you.

Mesothelioma Clinical Trials

Clinical trials are currently ongoing in the effort to find a cure for malignant mesothelioma. These trials are made up of research studies that evaluate possible new treatments effectiveness. safely, in the hope that one day a cure will be found. Although clinical trials offer no guarantee of success and require some degree of risk, they often involve the newest technology and research. In addition, researchers do not undertake these trials without a belief that the results will have some value in treating mesothelioma. Below is a list of current treatment research.

Combination chemotherapy

Chemotherapy drugs have been combined with successful results in treating other forms of cancer, and show mixed results in treating mesothelioma. Recently, a study was conducted to evaluate the possible benefit of a combination of Cisplatin and Gemcitabine in treating malignant mesothelioma. This drug cocktail was tested on 21 advanced mesothelioma patients, and resulted in forty seven percent showing a partial response to the treatment.

Intracavitary chemotherapy

Research is being conducted on this form of chemotherapy, which instills chemotherapy drugs directly into the pleural or peritoneal spaces. This form may have advantages over traditional chemotherapy as it allows for much higher doses without severe side effects. Recent studies have shown that this treatment may have positive effects on reducing tumor size and controlling pleural effusions.

Brachytherapy

This form of treatment uses radiation therapy within the pleural or peritoneal space. A radioactive substance is typically placed within the cavity.

Multimodality therapy

Multimodality simply refers to a combination of treatments, such as surgery, chemotherapy, and radiation to maximize results.

Gene Therapy

This experimental form of treatment uses a genetically tailored virus to attack tumor cells in an effort to make them vulnerable to tumor drugs.

Immunotherapy

This form of treatment attempts to boost the body.s natural immune system in order to better fight cancer cells.

Photodynamic therapy

This treatment utilizes photosensitive drugs, or those which are sensitive to light to saturate tumor cells, which are then exposed to light.

Benefits of Participating in a Clinical Trial

• Best healthcare available
• Contribute to finding a cure
• New treatments may be more effective
• Treatment may be free of charge
• Careful monitoring by clinical trial team

Risks Involved in Clinical Trials

Although clinical trials are designed to maximize patients. safety, certain risks do remain. It is important to ask about these risks as well as discuss them with your health care provider. A common concern of patients. is that they will be .guinea pigs. of researchers by participating in a clinical trial. It is important to realize that in most trials done, the experimental treatment is compared to the standard mesothelioma treatment. Even if a test patient does not receive the experimental drug or treatment, they will still receive standard therapy, usually at little or no cost. If a placebo is used instead of another treatment, you will be informed of this before the trial begins.

Clinical trials are used as a research tool for future treatments, and are not guaranteed to work. However, they do offer another treatment option, and provide patients with an opportunity to contribute to a future cure. For these reasons, the good from these trials usually outweighs any risk involved.

Questions to Ask Before Committing to a Mesothelioma Clinical Trial

You may want to ask your doctor, nurse or researcher administering the mesothelioma clinical trial questions before committing oneself.

Ask questions such as:

• What does the mesothelioma trial hope to accomplish?
• What side effects might I experience? Are these worse than those I might experience with standard treatment?
• Who is sponsoring the mesothelioma trial?
• What should I expect if I am in the trial? What should I expect if I am not in the trial?
• What are the possible benefits to my family and me if I go into the mesothelioma trial?
• Will I have to pay for the treatment? Will any of the treatment be free?
• Will joining a trial keep me from being treated with other therapies, either now or later?
• Whom can I call if there are problems while I am in the mesothelioma trial? What phone number should I call in the evening or on weekends?

Some doctors are reluctant to have their patients participate in mesothelioma clinical trials. This may be due to any number of reasons, including:

• some healthcare providers may be generally concerned about their patients participating in medical research
• some may be concerned that their patient.s participation in a mesothelioma clinical trial will result in more work for the professionals and more demands on their already limited time
• others may worry that patients cannot withstand the more frequent office visits that might be required
• still others may believe that a standard treatment regimen will be best