Mesothelioma

Malignant mesothelioma is a serious and often fatal cancer that occurs in mesothelium, the thin layer that lines most of the internal organs of your body. In most cases, mesothelioma cannot be cured. Mesothelioma is classified into different types depending upon the part of the mesothelium that is affected. Most common form of mesothelioma is pleural mesothelioma that begins in the lining of the lungs (pleura). Other less common forms of mesothelioma are:

• Peritoneal mesothelioma (cancer develops in the lining of the abdomen)
• Pericardial mesothelioma (affects tissue surrounding the heart) and
• Testicular mesothelioma (affects tissue around the testicles).

The term Mesothelioma does not include benign mesothelioma or solitary fibrous tumor (a non-cancerous tumor in the chest).

Signs and symptoms of mesothelioma vary depending upon which part of your body is affected.

Signs and symptoms of pleural mesothelioma are:

• Chest pain under the rib cage
• Pain while coughing
• Shortness of breath
• Unusual mass of tissue on your chest
• Weight loss without trying

Signs and symptoms of peritoneal mesothelioma include:

• Abdominal pain
• Abdominal swelling
• Mass of tissue in the abdomen
• Weight loss without trying

Since mesothelioma of other tissues is very rare, their signs and symptoms are non-specific. People with pericardial mesothelioma may experience breathing difficulty and chest pains. Testicular mesothelioma may be associated with swelling or a mass on a testicle.

When to see a Doctor

Visit your doctor if you have signs and symptoms that worry you. Remember that the signs and symptoms of mesothelioma are not specific and may be caused due to other conditions. During your visit, DO NOT forget to mention if you've been exposed to asbestos.

The exact cause that lead to mesothelioma is not identified.

Generally, cancer develops when abnormalities in DNA (genetic mutations) of the cells lead to uncontrolled growth and multiplication of the cells. But the cause of genetic mutations, which leads to mesothelioma, has not been explained yet.

The cancer is believed to develop due to a combined effect of inherited conditions, your environment, your health condition and your lifestyle choices.

If you are suspected to have mesothelioma, you may be referred to pulmonologist for lung symptoms or a gastroenterologist for abdominal symptoms to receive a diagnosis.

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. You may:

List out all the symptoms.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor. Some typical questions can be:

• What is the probable cause of my symptoms?
• Do I need any kind of tests?
• Is my condition likely temporary or chronic?
• What are the treatment options and side effects of each treatment?
• Will there be a follow-up visit?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did start noticing the symptoms?
• Are your symptoms continuous or occasional?
• How severe are your symptoms?
• Does any factor improve or exacerbate your symptoms?
• Does it hurt when you take a deep breath?
• Are you able to perform your daily activities?
• Have you ever been exposed to asbestos?

You are likely to undergo following tests if you are suspected to have mesothelioma:

• Physical exam: Your diagnosis will begin with physical examination to confirm whether there are any lumps or unusual signs.
• Imaging tests: Imaging tests, such as X-ray and CT scan of your chest or abdomen may also be required to look for abnormalities. You are also likely to take further tests to determine whether your symptoms are associated to mesothelioma or any other disease.
• Biopsy: A sample of tissue is removed from the affected part and is sent for analysis to determine if you have mesothelioma. Selection of biopsy procedure is guided by the location of the cancer. The options for biopsy procedure include:

 Fine-needle aspiration: A small thin needle is inserted into your chest or abdomen to remove fluid or small portion of tissue.

 Thoracoscopy: Thoracoscopy is done to examine pleural and thoracic cavity. A small tube with a tiny video camera is inserted into your chest cavity though small incisions made between your ribs. This procedure is sometimes called video-assisted thoracoscopic surgery (VATS). With the help of special surgical tools, your surgeon removes small pieces of tissue for testing.

 Laparoscopy: Laparoscopy is done to view interior of your abdomen. A tiny camera and special surgical tools are inserted through small incisions made on your abdomen and a small sample of tissues is removed.

 Thoracotomy: Thoracotomy involves surgical opening of the chest to look for signs of disease. A sample of tissue may be removed for testing.

 Laparotomy: In laparotomy, incision is made through abdominal wall to check for signs of disease. A portion of tissue may be obtained for testing.

Further analysis of the sample tissue is required to determine if mesothelioma has occurred and which types of cells are involved. Your treatment plan is based on the type of mesothelioma you have.

Staging

When the diagnosis confirmed, your doctor moves further to stage the cancer. S/he can recommend imaging tests like CT scans of the chest and abdomen, magnetic resonance imaging (MRI) and positron emission tomography (PET). You may not require all these tests. Your doctor will decide which test suits your condition the best.

Stage I: Mesothelioma is localized to one portion of the lining of the chest.

Stage II: Mesothelioma has extended to the diaphragm or to a lung.

Stage III: Mesothelioma has spread to other structures within the chest and nearby lymph nodes.

Stage IV: Mesothelioma has spread to most parts of the chest or to distant areas of the body, such as the brain, liver and surrounding lymph. It’s an advanced form of the cancer.

Staging for other types of mesothelioma is not done because of their rare occurrence and lack of extensive study.

Treatment plan for mesothelioma depends on your health, stage of the disease and site of your cancer. Mesothelioma, mostly, is an aggressive disease which makes it difficult to cure. Most of the time, mesothelioma is diagnosed at an advanced stage. Hence, it isn't possible to remove the cancer through operation. So, the treatment is aimed at controlling your cancer and comforting you. The treatment options include:

• Surgery: Surgery is a choice if your cancer is diagnosed at an early stage. A surgery may not remove all of the cancer but it can help to reduce signs and symptoms caused by spreading of mesothelioma in your body. Surgical options may include:

1. Surgery to decrease fluid accumulation: Fluid may accumulate in your chest due to pleural mesothelioma, causing breathing problems. Surgery involves inserting a tube or catheter into your chest to evacuate the cavity. After the surgery, medicine may be injected into your chest to prevent fluid from accumulating again in a process called pleurodesis.
2. Surgery to remove the tissue around the lungs or abdomen: This surgery does not provide a cure but may relieve signs and symptoms. It involves removing affected lining of the ribs and the lungs (pleurectomy) or lining of the abdominal cavity (peritonectomy).
3. Surgery to remove the biggest possible portion of the cancer (debulking): In an attempt to remove the biggest possible portion of the cancer, if not all of the cancer, surgeons perform this type of surgery. Following debulking, you may be given radiation to relieve pain and fluid accumulation.
4. Surgery to remove a lung and the surrounding tissue: The affected lung and nearby tissues may be removed to reduce signs and symptoms. This surgery allows your doctor to use higher doses of radiation after the surgery because they are not concerned about lung damages caused by high doses of radiation.

• Chemotherapy: Chemotherapy uses drugs to destroy cancer cells. This treatment is useful in cases when surgery is unable to remove the cancer. Neoadjuvant chemotherapy (chemotherapy before surgery) may be used to shrink the cancer before surgery and make the operation easier while adjuvant chemotherapy (chemotherapy after surgery) may be used to minimize chances of recurrence. Chemotherapy drugs, after being heated, may be directly given into abdominal cavity (intraperitoneal chemotherapy) for peritoneal mesothelioma. This approach avoids the injury to healthy cells and allows administration of higher doses of drugs.
• Radiation therapy: It uses ionizing radiations like X-rays to kill cancer cells that have survived surgery or to reduce signs and symptoms of advanced cancer where surgery isn't a choice.
• Clinical trials: Clinical studies evaluate potential new treatment options for cancer. You may be a part of it after a thorough discussion with your doctor.Some new treatments approaches for mesothelioma include:

1. Targeted therapy, which targets specific “chemical targets” within cancer cells.
2. Biological therapy, which stimulates your body's immune system to fight cancer.
3. Gene therapy, which involves correcting the genetic mutation in order to stop disease.

Other types of mesothelioma, like pericardial mesothelioma and mesothelioma of testicles, are rare and so are their treatments. If a cancer is detected at an early-stage, surgery may be used to remove it but advanced stage cancers do not provide much possibilities of cure. Hence, treatments are aimed at improving quality of life.

The best way to prevent mesothelioma is to avoid being near asbestos.

Studies have found a clear link between exposure to asbestos and mesothelioma. People who work in mine factory, ship building industries, construction companies and automobile repairing facilities are more likely to be exposed to asbestos. Follow safety precautions if you are one of these people.

Older homes and buildings are more likely to contain asbestos. If you need to remove asbestos from your house, don’t do it yourself because breaking asbestos will only make it more dangerous. Instead, consult a qualified expert to remove asbestos from your home.

No alternative remedies have yet been proven to cure mesothelioma but they may be used to control signs and symptoms. Breathing problems, common in pleural mesothelioma may be relieved by alternative therapies such as:

• Acupuncture: In acupuncture, thin needles are inserted at specific points into your skin.
• Breath training: You can learn breathing techniques from a nurse or physical therapist to cope up with breathlessness.
• Relaxation exercises: Relaxation of different muscle groups may relieve your breathlessness making it easier to breathe.
• Sitting near a fan: Directing a fan to your face may help ease the sensation of breathlessness.

Lifestyle modifications are necessary in order to cope with Mesothelioma.

Cancer diagnosis is a devastating news for you and your family and friends. Following measures may be help you cope better with the stress:

• Learn enough about mesothelioma: Learn as much as you can about your condition. Doing so can boost your confidence and help you choose proper treatment option.
• Stay close to family and friend: Having someone to talk to is a great relief during stressful moments. Talk to someone you are comfortable with.
• Join support group: Find a support group near you or you may find it online. Get involved in some activities in your support group.

There are several risks and complications associated with mesothelioma.

Asbestos is a naturally occurring mineral that is used in insulation, brakes, shingles, flooring and many other products. Asbestos dust created during various processes can cause mesothelioma if inhaled or swallowed. Remember that asbestos alone is not the ultimate cause of mesothelioma rather a combination of genetic and environmental factors increase your risk of developing the condition.

Risks

• Personal history of asbestos exposure: You are at increased increase of having mesothelioma if you've been directly exposed to asbestos fibers at work or at home.
• Living with someone who works with asbestos: People who work in asbestos related industries can carry the asbestos fibers to their home. Exposure to these fibers can increase risk of mesothelioma. This risk can be reduced if people, who work with high level of asbestos, shower and change clothes before they leave for home.
• A family history of mesothelioma: You are more likely to develop mesothelioma, if anyone from your family has mesothelioma.

Complications

The pressure in the chest due to pleural mesothelioma can cause complications, such as:

• Breathing problems
• Chest pain
• Difficulty swallowing
• Pain due to pressure on the nerves and spinal cord
• Build-up of fluid in the chest (pleural effusion), which can compress the lung nearby and cause breathing difficulty