Mesothelioma Cancer

Mesothelioma is an aggressive cancer affecting the membrane lining of the lungs and abdomen.

Malignant mesothelioma is the most serious of all asbestos-related diseases. Although uncommon, mesothelioma cancer is no longer considered rare. The primary cause and risk factor for mesothelioma is exposure to asbestos.

Listen to an audio summary on Mesothelioma Cancer.

      

Making a correct mesothelioma diagnosis is particularly difficult for doctors because the disease often presents with symptoms that mimic other common ailments. There is no known cure for mesothelioma, but treatments such as surgery and chemotherapy have helped to improve the typical mesothelioma prognosis.

Pleural mesothelioma (affecting the lung’s protective lining in the chest cavity) represents about three quarters of all mesothelioma incidence. Peritoneal mesothelioma which affects the abdominal cavity and pericardial mesothelioma, which affects the cardiac cavity, comprise the remainder. Testicular mesothelioma is extremely rare and is typically presents with metastases of the peritoneal variety. There are three recognized mesothelioma cell-types. Between 50 and 70% of all mesotheliomas are of the epithelial variety. While prognosis is generally poor, it is considered less aggressive than sarcomatoid mesothelioma and biphasic mesothelioma, which comprise the remainder of cell type diagnoses.

encompassing the chest, abdomen, and heart are surround by a membrane of cells known as the mesothelium. Mesothelial cells assist in general organ functions. The mesothelium is particularly important to organs that are commonly in motion, such as expansion or contraction of the lungs, stomach, or heart. Lubrication from the mesothelial cells allows free range of motion within the body. The mesothelium of the chest, abdomen, and cardiac cavity are called the pleura, the peritoneum, and the pericardium, respectively. Each of these groupings of mesothelial cells are extremely critical to the functions of the body structures which they encompass.

Malignancies (cancerous tumors) occurring within the mesothelial membranes are known as malignant mesothelioma, or simply mesothelioma. Benign tumors of the mesothelium are known to occur, but are much rarer than the more common malignant cancer.

While tumors of the mesothelium were first recognized in the late 18th century, it was not until the middle of the 20th century that this particular cancer was studied and examined with more detail. It was at this time where suspicions of the cancer’s causal relationship with asbestos exposure became more substantiated. A joint research venture through the Department of Thoracic Surgery at the University of the Witswater and/Johannesburg General Hospital in South Africa provided the most compelling evidence of the nexus between asbestos exposure and the development of pleural mesothelioma.

Incidence of mesothelioma is still quite rare, with only 2,500-3000 diagnoses in the United States each year. There was a spike in reported diagnoses between 1970 and 1984, which has been attributed to the latency period between diagnosis and the height of industrial exposures, which occurred roughly 40-60 years prior to this time. Exposure was common in nearly all industries but was particularly common in the WWII-era military industrial cycle, including Navy Shipyards.

Although this cancer is much more common in men over the age of 60 (largely attributed to the industrial exposures within male-dominated industries), mesothelioma in women and children has been described as well. Mesothelioma causes for diagnosis in women and children are mainly attributed to secondary exposure to asbestos, as it was not uncommon for men to bring asbestos back into the home on their body or clothing if proper cleaning facilities were not available on site.

Mesothelioma is diagnosed through a comprehensive combination of biopsy and imaging scans.

Mesothelioma can be a difficult malignancy to diagnose because the symptoms and pathology of the disease closely resemble other respiratory conditions. For this reason, misdiagnosis is not uncommon in mesothelioma patients. Symptoms of mesothelioma include chest pain, chronic cough, effusions of the chest and abdomen, and the presence of blood in lung fluid.

Diagnostic surgeries, including a biopsy, will typically be required to determine the type of malignant cells that are present in the body. Typically a body imaging scan, including a magnetic resonance image (MRI) or computer topography (CT scan) will be required to determine the extent and location of the disease.

Mesothelioma patients are generally referred by their personal physicians to one of the many renowned mesothelioma doctors in the United States. These oncologists are well versed in the disease behavior and pathology and are the most familiar with cutting-edge mesothelioma treatment options. Dr. David Sugarbaker of the Brigham and Women's Hospital, an extension of Harvard University and the Dana Farber Cancer Institute in Boston, MA, is at the forefront of mesothelioma treatment through the International Mesothelioma Program.

While mesothelioma is typically advanced at diagnosis, treatment options are available.

Mesothelioma, while certainly an aggressive disease, is a manageable malignancy. While there is no cure for the cancer, mesothelioma treatment options including surgery, chemotherapy, and radiation therapy are available for many patients. While a combination of Alimta® and Cisplatin is currently the only FDA approved chemotherapy regimen, several clinical trials are currently in progress utilizing other drugs including Gemcitabine and Onconase, with many showing dramatically improved results in certain cancer patients.

Radiation therapy is also utilized, but typically in conjunction with other treatment methods like surgery and chemotherapy. Surgical resection of mesothelioma is possible in early-stage-diagnosed patients. Aggressive surgeries such as extrapleural pneumonectomy can extend survival rates far beyond previously-thought timeframes. Diagnostic and palliative surgeries such as pleurocentesis and pleurodesis are also common in patients of malignant mesothelioma cancer.

Alternative therapies have also been used effectively by many mesothelioma patients to assist in managing symptoms of the disease and conventional treatments. These treatments are mainly preferential but can be extremely valuable to many patients.

Mesothelioma is caused by exposure to asbestos.

Mesothelioma is only caused by exposure to asbestos, though cases have been documented in children or other individuals with no asbestos history. Asbestos is a microscopic and naturally-occurring mineral that lodges in the pleural lining of the lungs and the peritoneal lining of the abdominal cavity. In most cases, several years will pass (up to 60) before mesothelioma develops in those who had been exposed to asbestos.

In many cases, those individuals diagnosed with mesothelioma that have been known to be exposed to asbestos may be eligible for financial compensation from asbestos manufacturers for their illness. Those who have been diagnosed with mesothelioma and were exposed to asbestos should fill out the brief form on this page. We'll rush you a complimentary mesothelioma and asbestos exposure information kit detailing new mesothelioma treatments, active clinical trials, top doctors, as well as how to obtain compensation for asbestos-related health conditions like mesothelioma.

Topics in this Section

Mesothelioma Risk Factors

Asbestos exposure is the primary risk factor for mesothelioma. Others include Radiation, Zeolite and SV40. Read more in this section.

Mesothelioma Causes

The primary cause of mesothelioma is asbestos exposure. Learn more about direct occupational exposure as well as second hand exposure.

Mesothelioma Symptoms

Mesothelioma symptoms often mimic those of common respiratory ailments. Learn more about the signs and symptoms to be aware of.

Mesothelioma Diagnosis

Read about the diagnostic tests that doctors use to determine whether or not a patient has mesothelioma including imaging scans and biopsies.

Mesothelioma Types

Pleural mesothelioma, peritoneal mesothelioma and pericardial mesothelioma are the most common types of mesothelioma. Learn more.

Mesothelioma Stages

Learn about the different staging systems that medical experts use find out how far mesothelioma cancer has spread.

Mesothelioma Prognosis

Learn about the various factors that determine what the prognosis is for individuals that have been diagnosed with mesothelioma.

Mesothelioma Information

This section provides a wealth of information about mesothelioma including the disease itself, latency period, survival rates, prevention and more.

Mesothelioma Pictures

This section provides visual depictions of the types of mesothelioma that patients are most often diagnosed with, available treatment options, and the dangers associated with asbestos exposure.

Mesothelioma Charities

These organizations support the mesothelioma community through a variety of programs that serve to raise awareness, fund ongoing research and assist asbestos disease victims in their fight against cancer.

Sources:

National Cancer Institute – Malignant Mesothelioma

(http://www.cancer.gov/cancertopics/types/malignantmesothelioma)

Wagner, J.C., Sleggs, C.A., and Marchand, Paul. “Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province.” Department of Thoracic Surgery: University of The Witswatersrand. Johannesburg, South Africa. 1960.

Grondin, Sean C., Sugarbaker, David J. “Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma” Chest December 1999 116:suppl 3 450S-454S;

Rusch, Valerie W. “Indications for pneumoctomy. Extrapleural pneumonectomy”

Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT (2002). "Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases". Ultrastruct Pathol 26(2): 55–65.

Brigham and Women’s Hospital – International Mesothelioma Program

(http://www.brighamandwomens.org/Departments_and_Services/surgery/services/thoracicsurgery/services/mesothelioma/default.aspx)

Mesothelioma Treatment

If there’s one thing we know about mesothelioma treatment, it’s this: we’re still being challenged to arrive at efficacy.

Despite years of research since the disease was first identified, it’s still difficult to identify the best approach to treating the disease, says David Rice, MD, a cardiothoracic surgeon and nationally known mesothelioma expert who practices at the University of Texas MD Anderson Cancer Center in Houston, TX.

The very rareness of the cancer—only about 3,000 people a year are diagnosed in the United States—makes it difficult to run the kind of research studies needed to compare treatments and determine the ideal therapy at each stage of the disease. “There isn’t a lot of evidence-based science in this disease,” Dr. Rice admits. So when his patients ask him what the best treatment is for the disease, he tells them what we tell you in this section, adding that “we don’t have a reliable cure for this disease.”

Thus, a major goal of treatment is to reduce pain and suffering and prolong a patient’s life as long as possible while providing them with the highest quality of life possible.

Choosing the right mesothelioma doctor is an important first step in planning for treatment.

There are a number of mesothelioma experts, like Dr. Rice, practicing in specialized clinics throughout the country. Each of these cancer specialists has an acute knowledge of the behavior and pathology of malignant mesothelioma and its treatment. It is likely that if you are diagnosed with mesothelioma, you will be referred by your personal physician to a larger scale comprehensive cancer center.

The most important consideration in mesothelioma treatment is the cancer stage and type, said Dr. Rice. Treatment decisions also depend on whether the cancer is localized to the chest or has spread to the chest wall, diaphragm, or lymph nodes, your age and overall health, and the center where you’re being treated. Learn more about finding a doctor here.

Conventional treatments for mesothelioma involve surgery, chemotherapy, and radiation therapy.

As with most solid tumors, doctors turn to surgery, radiation and chemotherapy to manage mesothelioma. When exploring the various treatment options available with your doctor it is important to be informed about the risk and benefits of each one before making a final decision.

Listen to an audio summary on Mesothelioma Treatment.

Surgery

Only about 1 in 5 patients with metastatic pleural mesothelioma undergo surgery. There are two main surgeries: pleurectomy/decortication, in which the surgeon tries to remove as much of the tumor from around the lung as possible, and the more radical extrapleural pneumonectomy, in which the lung itself is removed.

There is a lot of debate as to which is “best,” said Dr. Rice, although studies find that most long-term survivors have had surgery. He personally believes that pneumonectomy is best for tumor control if followed with radiation. Studies find it prevents tumor recurrence in the chest in 80 to 85 percent of patients who have the surgery.

However, Dr. Rice noted, it is a long, intensive operation with a 55 percent complication rate and a 3 percent risk of death, higher in some institutions. “So you only want to perform that surgery if the patient has a reasonably good prognosis,” said Dr. Rice. Translation: it doesn’t appear that the cancer has spread outside the chest.

Patients best suited for pneumonectomy are younger, with the epithelial form of the disease, no obvious lymph gland involvement, and are otherwise healthy enough to withstand the rigor of the procedure. Dr. Rice actually waits until he has the patient’s chest open in the operating room and biopsies the lymph nodes before deciding which procedure to perform.

Pleurectomy/decortication has a higher failure rate, with the tumor recurring in the chest cavity 50 to 80 percent of the time. However, that rate may change with improved radiotherapy techniques, Dr. Rice said. The reason for the high recurrence is that it’s impossible to completely remove the tumor without removing the lung.

However, he noted, there is no difference in survival rates between the two surgeries. Part of the reason is that the cancer has often spread to other parts of the body by the time it is diagnosed even if it appears to be confined to the chest.

Chemotherapy

Chemotherapy, also known as systemic therapy, uses oral or infusion-based medications to kill cancer cells throughout your body. Chemotherapy is used both before and after surgery, as well as in people who can’t handle surgery. It is also used in the palliative setting to reduce pain and improve quality of life.

The most commonly used chemotherapy drugs for mesothelioma are cisplatin combined with pemetrexed (Alimta) or raltitrexed (Tomudex). Other combinations include gemcitabine, carboplatin or oxaliplatin.

If you can’t manage combination therapy, your doctor may start on just one drug. Sometimes, your doctor may infuse the medication directly into your chest cavity, a procedure called pleural chemotherapy, or, abdomen, called intraperitoneal chemotherapy. You may also get a second course of chemotherapy, called “second-line” chemotherapy, with pemetrexed or other drugs, raltitrexed plus oxaliplatin, or the triple drug combination of irinotecan, cisplatin and mitomycin.

Some centers are beginning to provide intraperitoneal chemotherapy before surgery, followed by chemotherapy shortly after surgery. You can learn more about this approach here. There is also work underway to personalize chemotherapy based on the genetic characteristics of your tumor.

Radiation

Radiation can be an important part of mesothelioma treatment. The problem is that because the cancer is near the heart and lungs, it’s challenging to provide the kind of high-dose, intensive therapy needed to shrink the tumor. However, a newer option, intensity-modulated radiotherapy (IMRT), which can more accurately target cancer cells and avoid healthy tissue, may provide better results when performed by experienced clinicians.

Investigational therapies are being explored through clinical and surgical trials at many of the nation’s top cancer centers.

There are more than 50 studies on new therapies for mesothelioma in the U.S. that are looking for volunteers. Researchers are investigating new targeted drugs and chemotherapies, as well as new protocols for giving the medications; immunotherapy, which harnesses the power of the immune system to fight the disease; phototherapy, in which you are injected with a drug that bonds to cancer cells and is activated by high-intensity light; genetic therapies; and novel radiotherapy techniques like tomotherapy to treat the disease. Learn more about participating in a clinical trial here.

At some point, the management of the disease will shift from trying to cure the disease to trying to keep the patient as comfortable as possible for as long as possible.

This is the palliative care stage, when many people enter a hospice program. The primary goal at this stage is maximizing patient comfort. Medication to help with pain, difficulty breathing, and other symptoms that may be experienced is a mainstay. So is emotional and spiritual support for you and your family.

Alternative therapies for mesothelioma can be used to ease side effects of traditional cancer treatment.

Complementary and alternative medicine (CAM) includes such therapies as massage, acupuncture, and meditation. They can be a powerful part of your overall management plan, helping you better manage the stress and anxiety of the disease and conventional treatments.

Topics in this Section

Conventional Therapies

Conventional therapies for mesothelioma include surgery, radiation and chemotherapy.

Experimental Therapies

Several forms of mesothelioma treatment such gene therapy, immunotherapy, photodynamic therapy and multimodality therapy are still in their preliminary stages.

Alternative Treatments

These untraditional treatment approaches can complement conventional therapies and allow the patient to be more at peace and comfortable during this difficult time.

Treatment by Stage

This section lists typical treatment strategies based on the stage of the mesothelioma.

Mesothelioma Doctors

Medical doctors who specialize in aggressively treating mesothelioma cancer state by state.

Mesothelioma Experts

Medical doctors with a longstanding expertise in treating malignant mesothelioma.

Clinical Trials

Information about current studies of promising new or experimental mesothelioma treatments.

Mesothelioma Clinics

Top Cancer Centers for mesothelioma treatment have been listed alphabetically by state for your convenience.

Ask Your Doctor

We have listed some questions that you might want to ask your doctor in this section.

Treatment Side Effects

While undergoing treatment for mesothelioma, you should be prepared for the following treatment side effects.

Caregiver Resources

Resources for family members and loved ones responsible for caring for mesothelioma patients.

Mesothelioma Research

Selected abstracts relating to malignant mesothelioma from PubMed, the National Library of Medicine's search service.

Mesothelioma Treatment Alerts

Articles regarding the most recent advances in mesothelioma treatment that are helping to improve longevity and quality of life in patients.

Sources:

Campbell NP, Kindler HL. Update on malignant pleural mesothelioma. Semin Respir Crit Care Med. 2011;32(1):102-110.

Sugarbaker, David, Zellos, Lambros S. Multimodality treatment of diffuse malignant pleural mesothelioma. Seminars in Onology. 2002; 29 (1): 41-50.

Chua TC, Yan TD, Morris DL. Surgical biology for the clinician: peritoneal mesothelioma: current understanding and management. Can J Surg. 2009;52(1):59-64.

Dhalluin X, Scherpereel A. Treatment of malignant pleural mesothelioma: current status and future directions. Monaldi Arch Chest Dis. 2010;73(2):79-85.

Friedberg JS. Photodynamic therapy as an innovative treatment for malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg. 2009;21(2):177-87.

Garland LL. Chemotherapy for Malignant Pleural Mesothelioma. Current treatment options in oncology. 2011. epub

Stevens LM, Lynm C, Glass RM. JAMA patient page. Palliative care. JAMA. 2006;296(11):1428.

Rice, David M.D. Telephone Interview. April 29, 2011.