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Mesothelioma

mesothelioma

Mesothelioma is a type of cancer that occurs in the tissues which cover the lungs or abdomen. The lining around the lungs is the pleura and in the abdomen it is called the peritoneum. Mesothelioma most commonly occurs in the pleura - the linings of the lungs.

What causes mesothelioma?

A cancerous tumour starts from one abnormal cell. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'.
The most important risk factor for getting mesothelioma is being exposed to asbestos in the past. Around nine out of ten people with a mesothelioma have been exposed to asbestos in the past. A mesothelioma may occur 15-20 years after you have been exposed to asbestos.

What is asbestos?

Asbestos is a material that was used in buildings in the past. It is an insulating material that is both heat and fire resistant. There are different types of asbestos: white, brown and blue. Although they are all harmful, blue and brown asbestos are the most strongly linked with mesotheliomas.

What are the symptoms of mesothelioma?

The symptoms depend on the site of the mesothelioma. It often takes many years after being exposed to asbestos for mesothelioma to occur. In the early stages, there may be no symptoms at all. When mesothelioma develops in the pleura, this causes the pleura to thicken and it may press inwards on the lung.

Symptoms may then include:

  • Shortness of breath.
  • Chest pain.
  • Cough.
  • Hoarse voice.
  • Abdominal swelling may occur if you have mesothelioma in your peritoneum. The lining of the abdomen becomes thickened and fluid can collect in the abdomen (ascites).
  • If the cancer spreads to other parts of the body then various other symptoms can develop.

How is mesothelioma diagnosed?

The most common initial investigation for a pleural mesothelioma is a chest X-ray. Other scans - for example, CT or MRI scans - are often performed for both types of mesothelioma.

As for all suspected cancers, the diagnosis is usually confirmed by obtaining a small sample or 'biopsy'.

  • Fine-needle biopsy. This is where a doctor inserts a thin needle through the chest or abdominal wall to obtain a small sample of tissue.
  • Pleural tap. If you have an accumulation of fluid between the pleura, some fluid can be drained with a fine needle. The fluid is examined for cancer cells.
  • Ascitic tap. If you have an accumulation of fluid between the peritoneum, some fluid can be drained with a fine needle.

Assessing the extent and spread

If you are confirmed as having mesothelioma, further tests such as CT scan and MRI scan may be done to assess if it has spread. This assessment is called 'staging' of the cancer. The aim of staging is to find out:

  • How much the cancer has grown into the lung.
  • Whether the cancer has spread to local lymph nodes or to other areas of the lungs.
  • Whether the cancer has spread to other areas of the body (metastasised).

By finding out the stage of the cancer it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What are the treatment options for mesothelioma?

The treatment for mesothelioma depends on whether or not it has spread. Unfortunately, when mesothelioma is diagnosed, it has usually already spread beyond the point where it could be removed.

Surgery

An operation may be an option if your mesothelioma is only in one area of your pleura. This operation may involve removing part, or all, of your pleura and part of your lung that is close to it. This type of operation is called a pleurectomy.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.
Radiotherapy is often used to improve symptoms such as pain or shortness of breath and also to reduce the size of any nodules that may have formed. Radiotherapy may also be given to your chest wall at the place where you have had a biopsy or a drainage tube has been inserted. This can be effective at preventing any mesothelioma from growing out through your chest wall.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Chemotherapy is sometimes given and can slow the growth of mesothelioma and also improve symptoms you may have.

Other treatments

If you have recurrent effusions, where the fluid keeps building up between the linings of your lungs, then it is possible to have a procedure to reduce the risk of this happening in the future. This is called a pleurodesis

What is the prognosis (outlook)?

In general, the outlook is poor. The outlook is best in those who are diagnosed at an early stage when the mesothelioma is still small. An operation may then give a good chance of cure. However, for most people, mesothelioma is diagnosed when it is at a later stage which means that a cure is less likely. For most people with mesothelioma, the expected lifespan after diagnosis is made is usually not more than 1-2 years.


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