Learn About Mesothelioma

Learn About Mesothelioma

If you have mesothelioma, you’ll likely want to understand the science behind it.

Mesothelioma is a rare and aggressive cancer affecting between 3,000 and 3,300 people each year. This disease develops in the linings of the lungs, heart or abdomen. Mesothelioma is linked to asbestos exposure, and the cancer usually forms between 20 and 50 years after exposure occurs.


Types of Mesothelioma

There are three primary types of mesothelioma based on tumor location: pleural, peritoneal and pericardial.

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Pleural Mesothelioma

This cancer forms in the pleura, which is a thin lining that separates your chest wall and lung cavity.

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Peritoneal Mesothelioma

This cancer originates in the peritoneum, which is a membrane that wraps around your abdominal cavity.

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Pericardial Mesothelioma

This cancer develops in the pericardium, the membrane which encloses your heart.


Treatment Options for Mesothelioma

Surgery, chemotherapy and radiation are the three most often-used treatment options for mesothelioma. There are multiple types of each method and some are only used for one specific type of mesothelioma.

Mesothelioma experts believe a multimodal approach is the most effective way of attacking this cancer. A multimodal approach involves two, or even three, of the main treatment methods.

Mesothelioma Surgery

Surgery is the most effective treatment for mesothelioma patients. Surgeons try to remove most, if not all, of the tumors from your body during an operation.

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Pleural Mesothelioma Surgery

Extrapleural pneumonectomy — This operation involves the removal of your pleura, affected lung, diaphragm and the lining around your heart (pericardium). Extrapleural pneumonectomy is the more invasive of the two pleural mesothelioma surgeries and is recommended when the cancer has spread beyond the pleura.

Pleurectomy with decortication — This procedure spares the lung while removing the cancer’s point of origin, the pleura. Pleurectomy with decortication is less invasive and requires less recovery time, but it may only be beneficial if you have an early stage mesothelioma. Some doctors may use this surgery for late-stage patients in an extended form, with the diaphragm and other areas removed along with the pleura.

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Peritoneal Mesothelioma Surgery

For peritoneal mesothelioma patients, the primary surgery is cytoreduction with heated intraperitoneal chemotherapy (HIPEC). The procedure involves removing the lining of the abdomen, called the peritoneum, and any visible tumors in the abdominal cavity. The abdomen is then bathed with heated chemotherapy to target any remaining cancer cells.

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Pericardial Mesothelioma Surgery

Pericardial mesothelioma patients can undergo a pericardiectomy. This operation involves the removal of your pericardium, which is the lining surrounding your heart. Doctors usually recommend this procedure for patients who experience constrictive pericarditis (inflammation and stiffening of the pericardium).

Mesothelioma Chemotherapy

While there are specific surgeries for each type of mesothelioma, chemotherapy is the only Federal Drug Administration-approved treatment for all forms of the cancer. The drugs can be used as a secondary option, paired with surgery, or as the first treatment.

The goals of chemotherapy include:

  • Killing or shrinking mesothelioma tumors
  • Preventing the spread of cancerous cells
  • Relieving symptoms
  • Improving the effectiveness of surgery or other treatments

Mesothelioma Chemotherapy Drugs

Pemetrexed and cisplatin are the two FDA-approved chemotherapy drugs for mesothelioma. They are often paired together to contain and attack the cancer. Other medications are used in an experimental setting or if pemetrexed and cisplatin are ineffective. Additional chemotherapy drugs include:

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Bevacizumab

Carboplatin Icon

Carboplatin

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Gemcitabine

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Vinorelbine

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Mesothelioma chemotherapy usually produces uncomfortable side effects. Patients often report nausea, fatigue and a phenomenon known as “chemo brain,” which involves memory loss and concentration issues.

Mesothelioma Radiation

Radiation is another treatment method, usually used as a secondary option before or after surgery. Radiation also is paired at times with chemotherapy and is used for pain-relief purposes in late-stage patients.

Radiation therapy involves sending high-energy beams into the area where the mesothelioma tumors exist. Treatment is painless, making radiation one of the least-invasive options for patients.

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Radiation sessionsUsually last around 15 minutes and occur five days per week

Emerging Treatments for Mesothelioma

Aside from surgery, chemotherapy and radiation, researchers are constantly uncovering new and promising ways of treating mesothelioma.

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Virotherapy

Virotherapy involves injecting the body with diseases that could attack and kill cancerous cells. Experts modify the viruses so that they ignore healthy cells.

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Immunotherapy

Immunotherapy involves using drugs that specifically target cancerous proteins found in tumors. These drugs boost the immune system, which protects the body from diseases.

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Gene Therapy

Gene therapy involves inserting healthy genetic material into the body. This therapy either aims to restructure flawed cells or kill ones which can't be fixed.

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Clinical Trials

Clinical trials offer patients an opportunity to receive treatments not yet approved by the FDA. With your participation, researchers could discover a therapy or another form of care that saves thousands of lives.

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Humanitarian Use Devices

In 2019, the FDA approved a medical device for pleural mesothelioma treatment. The NovoTTF-100L sends electrical currents into the body. These currents attack the mesothelioma cells.


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Diagnosing Mesothelioma

Mesothelioma has a latency period of between 20 and 50 years, which makes early detection and diagnosis difficult. When early diagnosis is achieved, mesothelioma is much easier to treat as the tumors likely haven’t spread beyond their origin location.

The process for learning if you have mesothelioma involves multiple tests. However, the only scientifically approved way of diagnosing the disease is a biopsy.

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Imaging Tests

There are four main imaging tests involved in diagnosing mesothelioma:

  • 1
    X-Ray — Provides a two-dimensional image of your abdomen and chest.
  • 2
    CT scan — Shows a three-dimensional image of your abdomen and chest.
  • 3
    PET scan — Involves radioactive sugar inserted into your blood. Cancerous cells will absorb the sugar, indicating their presence.
  • 4
    MRI scan — Inspects your tissue to check for any damage or cellular mutation.
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Biopsies

Tissue biopsies are the most conclusive type and they require a minor surgery to perform. Fluid samples are less invasive than a tissue biopsy but not as surefire of a diagnostic option since the tissue is where the tumors form and grow.

In addition to learning if mesothelioma is present, biopsies also help the treatment team discover the histological makeup of the disease and the patient’s prognosis. Mesothelioma cells can be epithelioid, sarcomatoid or a combination of the two (called “biphasic”).

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A biopsy is the extraction and examination of tissue or fluid from the patient.


Symptoms of Mesothelioma

Early detection is key to stopping the spread of mesothelioma and treating the disease with surgery and chemotherapy. Patients should know the common symptoms associated with mesothelioma. The symptoms vary for each type of mesothelioma.

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Pleural

  • Chest and lower back pain
  • Persistent coughing
  • Pleural effusions (fluid buildup)
  • Difficulty breathing
  • Night sweats
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Peritoneal

  • Abdomen and lower back pain
  • Abdominal swelling due to peritoneal effusions (fluid buildup)
  • Bowel issues
  • Loss of appetite
  • Fatigue
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Pericardial

  • Irregular heartbeats
  • Difficulty breathing
  • Chest pain
  • Arm or facial swelling
  • Pericardial effusions (fluid buildup)

Mesothelioma Prognosis and Life Expectancy

The prognosis and life expectancy for mesothelioma depends on numerous factors: one’s overall health, age, cell type and stage of the cancer. Other elements include the treatment used following each patient’s diagnosis, as surgery often carries the best results for prolonged survival.

Stages of Mesothelioma

The four stages of mesothelioma are based on tumor size and location. According to a study published on UpToDate, the average life expectancy for pleural mesothelioma patients by stage is as follows:

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Stage 1average survival time is 20 months.

Stage 2 Cirlce Icon

Stage 2average time is 19 months.

Stage 3 Cirlce Icon

Stage 3average time is 16 months.

Stage 4 Cirlce Icon

Stage 4average time is 11 months.

There is hope, though. Some pleural mesothelioma patients survive well beyond two years after their diagnosis, and peritoneal mesothelioma patients have reported reaching the five-year survival milestone. Finding a mesothelioma specialist is essential to improving your chances of a long and fulfilling life.


SOURCES
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Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-epidemiology-risk-factors-clinical-presentation-diagnosis-and-staging. Accessed: 06/28/19.

Life Expectancy in Pleural and Peritoneal Mesothelioma. US National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/.Accessed: 03/19/19.

Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-epidemiology-risk-factors-clinical-presentation-diagnosis-and-staging/. Accessed: 03/19/19.

Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/29792828/. Accessed: 03/19/19.

Surgery for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/treating/surgery.html. Accessed: 06/25/19.

Surgery for Peritoneal Mesothelioma. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21445576. Accessed: 06/25/19.

Risk Factors for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/causes-risks-prevention/risk-factors.html. Accessed: 06/26/19.

Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 04/10/19.

Signs and Symptoms of Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html. Accessed: 04/10/19.

Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/10/19.

Life Expectancy in Pleural and Peritoneal Mesothelioma. US National Library of Medicine. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma?topicRef=4625&source=see_link. Accessed: 03/19/19.