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- Mesothelioma facts
- 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?
- What is the prognosis for mesothelioma?
- What is the treatment for mesothelioma?
- Is there any promising research or are there promising drugs for mesothelioma?
- What other kinds of information is available for people with mesothelioma?
- 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.
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). Pleural mesothelioma is the most common form, often presenting with symptoms in the chest area. Peritoneal mesothelioma is much less common. This can affect 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.
Quick GuideLung Cancer Symptoms, Stages, Treatment
What are the symptoms of mesothelioma?
Most people present with complaints of shortness of breath. They also can have complaints of chest pain and cough. 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.
What causes mesothelioma?
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Usually, this involves men over 40 years of age. Others have been exposed to asbestos in a household environment, often without knowing it. 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.
How much asbestos 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 and in some cases, as much as 70 years later.
How long does it take after asbestos 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 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:
- Thoracoscopy: 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 an anesthetic. 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.
- Peritoneoscopy: 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 an 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.
- Biopsy: If abnormal tissue is found, the doctor will need to cutout 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?
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
- 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.
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)
- 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: Mesothelioma 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, extended to the pleura or lung on the opposite side, or directly extended into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.
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
- 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
What is the treatment for mesothelioma?
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:
- surgery (taking out the cancer),
- radiation therapy (using high-dose X-rays or other high-energy rays to kill cancer cells), and
- chemotherapy (using drugs to fight the cancer).
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 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.
Quick GuideLung Cancer Symptoms, Stages, Treatment
Is there any promising research or are there promising drugs for mesothelioma?
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 (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 has been 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.
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.
To learn more about mesothelioma clinical studies and journal medical journal articles, visit the Mesothelioma Web (http://www.mesotheliomaweb.org).
What other kinds of information is available for people with mesothelioma?
There are numerous cancer web sites, some specific to mesothelioma. Because they are often difficult to locate, we have listed some relevant medical web sites that have information about mesothelioma.
American Institute for Cancer Research
American Thoracic Society
Canadian Cancer Society
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"Malignant peritoneal mesothelioma: Treatment"
"Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging"
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Top Mesothelioma Related Articles
Asbestos is a mineral fiber that is found in soil and rock. Asbestos exposure occurs when asbestos fibers are disturbed and released into the air then and inhaled. Inhaling asbestos fibers causes three lung diseases; asbestosis, lung cancer, and noncancerous lung disease. In asbestosis, the asbestos fibers scar the lungs. Asbestosis and lung cancer have the same symptoms of cough and shortness of breath.
Asbestosis progresses slowly, frequently even 20 to 40 years after asbestos exposure. Asbestos exposure include can come from a variety of products, for example, drinking water due to the decay of asbestos cement in water mains and erosion of natural deposits (which increases your risk of developing benign intestinal polyps), insulation, vinyl floor tiles, some paints and patching compounds, oil and coal furnaces and doors, heat-resistant fabrics, and automobiles brakes and clutches. Some uses of asbestos are banned; however, most are not.
Examples of products banned from using asbestos are commercial, corrugated, and specialty paper, flooring felt, and artificial fireplace embers that contain asbestos. Examples of products not banned from using asbestos include vinyl flooring, clothing, roof and non-roof coatings, friction materials, and some car components.Cancers of the larynx, throat, kidney, esophagusand gallbladder have been linked to asbestos exposure. Treatment is dependent upon the type of condition related to asbestos exposure.
CancerCancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Cancer CausesThough it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Cancer DetectionCancer detection are methods used to find cancer in persons who may or may not have symptoms. Symptoms of cancer are abnormal sensations or conditions that persons can notice that are a result of the cancer. It is important to your doctor for regular checkups and not wait for problems to occur.
CAT ScanA CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
ChemotherapyChemotherapy is the treatment of cancer with drugs that can destroy cancer cells. These drugs often are called "anticancer" drugs. Chemotherapy is often used with other treatments. Coping with side effects (fatigue, nausea, vomiting, pain, hair loss, infection, diarrhea, constipation, fluid retention, mouth and throat problems) are important to understand when undergoing chemotherapy treatment. It is important to eat well during chemotherapy, and get the support you need both during and after treatment.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis.
Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Chest X-rayChest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalitites in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as:
- excessive fluid (fluid overload or pulmonary edema),
- fluid around the lung (pleural effusion),
- and cancers.
Lung CancerLung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due to tobacco smoke. Lung cancers are classified as either small cell or non-small cell cancers.
Lung Cancer SlideshowLearn about lung cancer symptoms and treatments. Get more information on small cell lung cancer, non-small cell lung cancer, and the diagnosis of lung cancer stages.
Lungs Design And PurposeThe lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. Eliminating carbon dioxide from the blood is important, because as it builds up in the blood, headaches, drowsiness, coma, and eventually death may occur. The air we breathe in (inhalation) is warmed, humidified, and cleaned by the nose and the lungs.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. The causes of night sweats in most people are not serious, like menopause in women, sleep apnea, medications, alcohol withdrawal, and thyroid problems. However, more serious diseases like cancer and HIV also can cause night sweats. Your doctor will treat your night sweats depending upon the cause.
You may experience other signs and symptoms that are associated with night sweats, which depend upon the cause, but may include:
- Fever, shaking, and chills with a fever caused by an infection like the flu or pneumonia.
- Unexplained weight loss due to lymphoma.
- Women in perimenopause or menopause may also have vaginal dryness, mood swings, and hot flashes during the day.
- Low blood sugar in people with diabetes.
Other causes of night sweats include:
- Medications like NSAIDs (aspirin, acetaminophen, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn), antidepressants, sildenafil (Viagra), and abuse of prescription or illegal drugs and drug withdrawal.
- Hormone disorders like pheochromocytoma and carcinoid syndrome
- Idiopathic hyperhidrosis
- Infections like endocarditis, AIDs, and abscesses.
- Alcoholism and alcohol withdrawal
- Drug abuse, addiction, and withdrawal
A doctor or other health care professional can treat your night sweats after the cause has been diagnosed.
Pleural Effusion (Fluid In the Chest or On Lung)Pleural effusion is a buildup of fluid in the chest or on the lungs. There are two types of pleural effusion, trandsudate and exudate. Causes of transudate pleural effusion include congestive heart failure, kidney failure, and cirrhosis. Exudate pleural effusion can be caused by malignancy (cancer) or lung infection. Typically, transudate pleural effusion is more easily treatable. Symptoms of pleural effusion include:
- chest pain,
- pain when breathing,
- difficulty breathing, and
PleurisyPleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Radiation TherapyRadiation therapy is a cancer-fighting technique. In radiation therapy, a radiation oncologist uses high-energy rays to kill cancer cells and stop them from growing and dividing. The two types of radiation therapy are external and internal. Potential side effects of radiation therapy include:
- skin redness,
- permanent pigmentation,
- diarrhea, and
- a reduction in white blood cells.