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Mesothelioma

Definition


Disease: Mesothelioma Mesothelioma
Category: Other Diseases
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Disease Definition:

The rare cancer that occurs in the thin layer of tissue that covers the majority of the internal organs (mesothelium) is called malignant mesothelioma.

Based on what part of the mesothelium is affected, mesothelioma is divided into different types that include the following:

Mesothelioma of the tunica vaginalis:
This type occurs in the lining around the testicles.

Peritoneal mesothelioma:
This type occurs in the tissue in the abdomen.

Pleural malignant mesothelioma:
It's the most common form of mesothelioma which affects the tissue surrounding the lungs.

Pericardial mesothelioma:
The tissue surrounding the heart is affected by this type.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Depending on where the cancer occurs, signs and symptoms of mesothelioma vary.

The following are included in the signs and symptoms of pleural mesothelioma:

 

  • Unusual lumps of tissue under the skin on the chest
  • Unexplained weight loss
  • Painful breathing (pleurisy)
  • Painful coughing
  • Shortness of breath
  • Dry (nonproductive) cough
  • Chest pain under the rib cage


The following are included in the signs and symptoms of peritoneal mesothelioma:
 

  • Unexplained weight loss
  • Abdominal pain
  • A change in the bowel habits of the patient, such as more frequent diarrhea or constipation
  • Abdominal swelling
  • Lumps of tissue in the abdomen



OTHER FORMS OF MESOTHERLIOMA:
It's not clear what the signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are. Not much information is available about these forms because they're so rare. Chest pains or difficulty breathing may be included in the signs and symptoms of pericardial mesothelioma. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle.

When someone experiences signs and symptoms that may indicate mesothelioma, he/she should see the doctor. The signs and symptoms of mesothelioma are more likely to be related to other conditions due to the rarity of mesothelioma, and they aren't specific to this disease. The patient should ask the doctor to evaluate any persistent signs and symptoms if they seem unusual or bothersome.

Causes:

When a series of genetic mutations occur within a cell causing it to grow and multiply out of control when healthy cells would normally die, cancer begins. The mass (tumor) is formed by the accumulating abnormal cells. The cancer cells can break off from an initial tumor to spread elsewhere in the body (metastasize), meaning that these cancer cells invade nearby tissues.

Though researchers have identified factors that may increase the risk of mesothelioma, what causes the initial genetic mutations that lead to this condition is still not clear. An interaction between many factors such as one's health conditions, inherited conditions, lifestyle choices and environment is probably the cause of cancer.

BENIGN PLEURAL MESOTHELIOMA:
Benign mesothelioma is what they call a form of noncancerous (benign) tumor that can occur in the chest. However, this name is misleading. This condition doesn't begin in the same cells where the cancerous forms of mesothelioma begin. This tumor is referred to now as solitary fibrous tumor because despite the term "benign", benign mesothelioma can be very aggressive in a minority of cases.

Usually, solitary fibrous tumor doesn’t cause signs and symptoms. Most cases of solitary fibrous tumor are usually discovered accidentally during procedures and tests for other conditions. Solitary fibrous tumors aren't linked to asbestos exposure; however, what causes them is still not clear. Surgery is typically included in the treatment of solitary fibrous tumor.

The primary risk factor for mesothelioma is asbestos exposure:
Asbestos is a mineral that's found naturally in the environment. The fibers of this mineral are useful in a wide variety of applications, such as in cement, shingles, flooring, insulation, brakes and many other products, as they are strong and resistant to heat. The greatest risk of mesothelioma may face people who work around asbestos fibers.

Dust may be created when removing asbestos insulation or when asbestos is broken up, such as during the mining process. Though it's not understood how exactly this happens, the asbestos fibers may settle in the lungs or in the stomach, where they can cause irritation that may lead to mesothelioma in case the dust is inhaled or swallowed.

The risk of mesothelioma is believed to increase in people exposed to asbestos at a young age, people who are exposed to asbestos over a long period of time and people who are exposed to high levels of asbestos. However, as a result of asbestos exposure, it can take 30 to 40 years or more for mesothelioma to develop.

In determining whether someone gets mesothelioma or doesn't, other factors may be involved; for example, one could inherit a predisposition to cancer or some other condition could increase the risk. So, some people with very brief asbestos exposure may develop mesothelioma, while others with years of exposure may never develop the disease.

The risk of mesothelioma may increase due to several factors:

Smoking:
In smokers who are exposed to asbestos, the risk of mesothelioma is increased greatly.

Family history:
Though more research is needed to understand this theory, the risk of mesothelioma may increase due to a family history of this condition.

Personal history of asbestos exposure:
The risk of mesothelioma is greatly increased if one has been directly exposed to asbestos fiber at home or at work.

SV40:
A link between mesothelioma and simian virus 40 (SV40) is indicated in some research. Polio vaccine between 1955 and 1963 was developed using monkey cells, so millions of people may have been exposed to SV40 when receiving the vaccinations. The virus was removed from the polio vaccine once it was discovered that SV40 was linked to certain cancers. It's still controversial whether the risk of mesothelioma is increased by SV40.

Living with someone who works with asbestos:
The fibers may be carried home on the clothing and skin of people who are exposed to asbestos. Before leaving work, people who work with asbestos should shower and change clothes as these stray fibers can put others in home at risk of mesothelioma.

Radiation:
The radioactive substance thorium dioxide, which was used along with X-rays to diagnose various health conditions from the 1920s to 1950s, is linked to mesothelioma. Later, thorium dioxide was no longer used as it was found to cause cancer.

Complications

Complications:

COMPLICATIONS FROM SPREADING CANCER:
Many complications can result in case pleural mesothelioma spreads in the chest and puts pressure on the structures in that area:
 

  • Accumulation of fluid in the chest (pleural effusion), which can compress the nearby lung and make breathing difficult
  • Difficulty swallowing
  • Difficulty breathing
  • Pain caused by pressure on the nerves and spinal cord
  • Swelling caused by pressure on the large vein that leads from the upper body to the heart (superior vena cava syndrome)
  • Chest pain


Death:
Death may be the result of mesothelioma that progresses; it may result from complications such as heart problems, stroke, lung failure and other causes.

Treatments:

Depending on the health of the patient and certain aspects of his/her cancer such as its stage and location, the type of treatment the patient will undergo for mesothelioma can be decided. Unfortunately, a cure for mesothelioma isn't possible for most people, because it is often an aggressive disease. Mesothelioma is usually diagnosed at an advanced stage when it isn't possible to remove the cancer through an operation. As an alternative, to make the patient more comfortable, the doctor may work to control the cancer.

Some people prefer treatments that make them comfortable so that they can live their remaining months as symptom-free as possible, and others want to do everything they can to treat their cancer. So, treatment goals should be discussed with the doctor.

RADIATION THERAPY:
High-energy beams are focused to a specific spot or spots on the body in radiation therapy. In people with pleural mesothelioma, radiation may reduce signs and symptoms. To obtain the best result, radiation is aimed at the entire chest. However, low doses of radiation should be used because many sensitive organs are in the chest such as the spinal cord, esophagus, lungs and heart, in order to spare those organs. Sometimes after biopsy or surgery to prevent mesothelioma from spreading to the surgical incision, radiation therapy is used.
To reduce signs and symptoms caused by the cancer, radiation therapy is used occasionally in people with peritoneal mesothelioma.

CHEMOTHERAPY:
To kill cancer cells, chemotherapy uses chemicals. Systemic chemotherapy may shrink or slow the growth of a pleural mesothelioma that can't be removed using surgery because it travels through the body. To reduce the chance that cancer will return, chemotherapy may be used after surgery (adjuvant chemotherapy); or to make an operation easier, chemotherapy may be used before surgery (neoadjuvant chemotherapy).

In the case of pleural mesothelioma, chemotherapy drugs may be heated and administered directly into the chest cavity (intrapleural chemotherapy); and in the case of peritoneal mesothelioma, they can be heated and administered directly into the abdominal cavity (intraperitoneal chemotherapy). Without injuring healthy cells in other parts of the body, chemotherapy drugs can reach the mesothelioma directly when using this strategy. Higher doses of chemotherapy drugs may be administered in this way.

To reduce the signs and symptoms of peritoneal mesothelioma that can't be removed through surgery, intraperitoneal chemotherapy may be used as well.

SURGERY:
In instances where mesothelioma is diagnosed at an early stage, surgeons work to remove it. Surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in the patient's body in the cases where it isn't possible to remove all of the cancer. The following are included in the surgical options:

Surgery to remove as much of the cancer as possible (debulking):
Surgeons may attempt to remove as much or the cancer as possible if all of it can't be removed.

Surgery to decrease fluid buildup:
Difficulty breathing may result in case pleural mesothelioma causes fluid to build up in the chest. To drain the fluid, a tube or catheter is inserted into the chest of the patient, and to prevent fluids from returning (pleurodesis), medicine may also be injected into the chest of the patient.

Surgery to remove the tissue around the lung or abdomen:
In order to relieve signs and symptoms of mesothelioma, the tissue lining the abdominal cavity (peritonectomy) or the tissue lining the ribs and the lungs (pleurectomy), may be removed.

Surgery to remove a lung and the surrounding tissue:
The signs and symptoms of pleural mesothelioma may be relieved by removing the affected lung and the tissue that surrounds it. The doctors won't need to worry about protecting the lung of the patient from damaging radiation as this procedure allows them to use higher doses of radiation against any remaining mesothelioma.

COMBINATION THERAPY:
Radiation therapy, chemotherapy and surgery may be combined. This treatment may not be appropriate for everyone as it is aggressive therapy that can be exhausting. Healthier, younger people and those with earlier stage of mesothelioma may be more able to endure this treatment. The most promise in treating mesothelioma is shown in combination therapy. But in spite of aggressive treatment, most people will eventually experience a recurrence of this cancer. In both peritoneal mesothelioma and pleural mesothelioma, combination therapy has been used.

TREATMENT FOR OTHER TYPES OF MESOTHELIOMA:
Pericardial mesothelioma and mesothelioma of the tunica vaginalis can be very aggressive, but they are very rare. Surgery may remove early-stage cancer. Still, the best way to treat later stage cancers has yet to be determined. To improve the quality of life of the patient, other treatments may be recommended.

Prognosis:

Not Available

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