What is Mesothelioma?

Malignant mesothelioma (me-zo-thee-le-O-muh) is a rare cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium). Doctors divide mesothelioma into different types based on what part of the mesothelium is affected, including:

• Pleural malignant mesothelioma, which affects the tissue that surrounds the lungs and is the most common form of mesothelioma.
• Peritoneal mesothelioma, which occurs in the tissue in your abdomen.
• Pericardial mesothelioma, which affects the tissue surrounding the heart.
• Mesothelioma of the tunica vaginalis, which occurs in the lining around the testicles.

Between 2,000 and 3,000 people are diagnosed with mesothelioma in the United States each year, according to the American Cancer Society.

Complications of Mesothelioma

Complications from Spreading Cancer

As pleural mesothelioma spreads in the chest, it puts pressure on the structures in that area. This can cause complications, such as:

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

Death

Mesothelioma that progresses can lead to death. People who die of mesothelioma usually die from related complications, such as lung failure, heart problems, stroke and other causes.

Treatments and Drugs

What treatment you undergo for mesothelioma depends on your health and certain aspects of your cancer, such as its stage and location. Unfortunately, mesothelioma often is an aggressive disease and for most people a cure isn't possible. Mesothelioma is usually diagnosed at an advanced stage — when it isn't possible to remove the cancer through an operation. Instead, your doctor may work to control your cancer to make you more comfortable.

Discuss treatment goals with your doctor. Some people want to do everything they can to treat their cancer, even if that means enduring side effects for a small chance of an improvement. Others prefer treatments that make them comfortable so that they can live their remaining months as symptom-free as possible.


Surgery

Surgeons work to remove mesothelioma in instances where it is diagnosed at an early stage. Sometimes it isn't possible to remove all of the cancer. In those cases, surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in your body. Surgical options may include:

• Surgery to decrease fluid buildup. Pleural mesothelioma may cause fluid to build up in your chest, causing difficulty breathing. Surgeons insert a tube or catheter into your chest to drain the fluid. Surgeons may also inject medicine into your chest to prevent fluid from returning (pleurodesis).
• Surgery to remove the tissue around the lung or abdomen. Surgeons may remove the tissue lining the ribs and the lungs (pleurectomy) or the tissue lining the abdominal cavity (peritonectomy) in order to relieve signs and symptoms of mesothelioma.
• Surgery to remove as much of the cancer as possible (debulking). If all of the cancer can't be removed, surgeons may attempt to remove as much as possible.
• Surgery to remove a lung and the surrounding tissue. Removing the affected lung and the tissue that surrounds it may relieve signs and symptoms of pleural mesothelioma. This procedure also allows doctors to use higher doses of radiation against any remaining mesothelioma, since they won't need to worry about protecting your lung from damaging radiation.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells. Systemic chemotherapy travels throughout the body and may shrink or slow the growth of a pleural mesothelioma that can't be removed using surgery. Chemotherapy may also be used before surgery (neoadjuvant chemotherapy) to make an operation easier or after surgery (adjuvant chemotherapy) to reduce the chance that cancer will return.

Chemotherapy drugs may also be heated and administered directly into the abdominal cavity (intraperitoneal chemotherapy), in the case of peritoneal mesothelioma, or into the chest cavity (intrapleural chemotherapy), in the case of pleural mesothelioma. Using this strategy, chemotherapy drugs can reach the mesothelioma directly without injuring healthy cells in other parts of the body. This allows doctors to administer higher doses of chemotherapy drugs.

Intraperitoneal chemotherapy may also be used to reduce the signs and symptoms of peritoneal mesothelioma that can't be removed through surgery.


Radiation Therapy

Radiation therapy focuses high-energy beams to a specific spot or spots on your body. Radiation may reduce signs and symptoms in people with pleural mesothelioma. Doctors aim radiation at the entire chest to obtain the best result. However, many sensitive organs are in the chest, such as the heart, lungs, esophagus and spinal cord, so doctors must use low doses of radiation to spare these organs. Radiation therapy is sometimes used after biopsy or surgery to prevent mesothelioma from spreading to the surgical incision.

Radiation therapy is used occasionally in people with peritoneal mesothelioma to reduce signs and symptoms caused by the cancer.


Combination Therapy

Surgery, chemotherapy and radiation therapy may be combined. This aggressive therapy can be grueling and may not be appropriate for everyone. Younger, healthier people and those with earlier stage mesothelioma may be more able to endure this treatment. Combination therapy has shown the most promise in treating mesothelioma. However, most people will eventually experience a recurrence of this cancer despite aggressive treatment. Combination therapy has been used in both pleural mesothelioma and peritoneal mesothelioma.


Clinical Trials

Clinical trials are studies of new mesothelioma treatment methods. People with mesothelioma may opt for a clinical trial for a chance to try new types of treatment. However, a cure isn't guaranteed. Carefully consider your treatment options and talk to your doctor about what clinical trials are open to you. Your participation in a clinical trial may help doctors better understand how to treat mesothelioma in the future.

Clinical trials are currently investigating a number of targeted drugs. Targeted drug therapy uses drugs to attack specific abnormalities within cancer cells. Targets being studied in mesothelioma include a substance that cancer cells make to attract new blood vessels to bring the cancer oxygen and nutrients. Another target is an enzyme that helps cancer cells develop resistance to chemotherapy drugs. Researchers hope drugs that target these areas can help kill mesothelioma cells.


Treatment for Other Types of Mesothelioma

Pericardial mesothelioma and mesothelioma of the tunica vaginalis are very rare and can be very aggressive. Early-stage cancer may be removed through surgery. Doctors have yet to determine the best way to treat later stage cancers, though. Your doctor may recommend other treatments to improve your quality of life.

Symptoms of Mesothelioma

Signs and symptoms of mesothelioma vary depending on where the cancer occurs.

Pleural mesothelioma signs and symptoms may include:

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

Peritoneal mesothelioma signs and symptoms may include:

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

Other Forms of Mesothelioma

Signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are unclear. These forms are so rare that not much information is available. Pericardial mesothelioma signs and symptoms may include difficulty breathing or chest pains. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle.


When to See a Doctor ?

See your doctor if you have signs and symptoms that may indicate mesothelioma. Signs and symptoms of mesothelioma aren't specific to this disease and, due to the rarity of mesothelioma, are more likely to be related to other conditions. If any persistent signs and symptoms seem unusual or bothersome to you, ask your doctor to evaluate them.

Preparing for Your Appointment

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a doctor who specializes in lung diseases (pulmonologist) or abdominal problems (gastroenterologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.


What You Can Do ?

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes. If you're worried about mesothelioma, make a list of all your occupations, even those you had for only a few months.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For mesothelioma, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will it cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.


What to Expect from Your Doctor?

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do your symptoms affect your ability to work?

What You Can Do in the Meantime?

Try to avoid anything that worsens your signs and symptoms. For instance, if you're experiencing shortness of breath, try to take it easy until you can meet with your doctor.