Mesothelioma

Mesothelioma (me-zoe-thee-lee-O-muh) is a type of cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).

Mesothelioma is a malignant tumor that is caused by inhaled asbestos fibers and forms in the lining of the lungs, abdomen or heart. Symptoms can include shortness of breath and chest pain. The life expectancy for most mesothelioma patients is approximately 12 months after diagnosis. Treatments are available, but for many people with mesothelioma, a cure isn't possible. Treatment may improve prognosis and can include surgery, chemotherapy or radiation.

History

The connection between asbestos exposure and mesothelioma was discovered in the 1970s. In the United States, asbestos manufacture stopped in 2002. Asbestos exposure thus shifted from workers in asbestos textile mills, friction product manufacturing, cement pipe fabrication, and insulation manufacture and installation to maintenance workers in asbestos-containing buildings

Symptoms

• Signs and symptoms of mesothelioma vary depending on where the cancer occurs.
• Symptoms of mesothelioma appear when tumors spread, grow and press against the chest wall and the abdominal cavity.
• 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, ask your doctor to evaluate them. Tell your doctor if you've been exposed to asbestos.
• Pleural mesothelioma, which affects the tissue that surrounds the lungs, causes signs and symptoms that may include:
  • Chest pain
  • Dry painful coughing
  • Shortness of breath
  • Respiratory complications
  • Unusual lumps of tissue under the skin on the chest
  • Unexplained weight loss
  • Pleural effusion (fluid around the lungs)
• Peritoneal mesothelioma, which occurs in tissue in the abdomen, causes signs and symptoms that may include:
  • Abdominal pain
  • Abdominal swelling
  • Nausea
• Other forms of mesothelioma
  • Signs and symptoms of other types of mesothelioma are unclear, since these forms of the disease are very rare.
  • Pericardial mesothelioma, which affects tissue that surrounds the heart, can cause signs and symptoms such as breathing difficulty and chest pains.
  • Mesothelioma of tunica vaginalis, which affects tissue surrounding the testicles, may be first detected as swelling or a mass on a testicle.

Diagnosing Mesothelioma

• A biopsy is the only mesothelioma test that confirms a diagnosis.
• Blood tests
• Imaging scans (MRI (Magnetic resonance), PET (Positron emission tomography), CT scans)

Causes

• Asbestos exposure is the primary cause of mesothelioma. People exposed to asbestos at home, work or in the military have a higher risk of developing the cancerous disease.
• Asbestos is a group of minerals that occur naturally as bundles of tiny fibers. These fibers are found in soil and rocks in many parts of the world.
• When asbestos fibers in the air are inhaled, they can get into the lungs. Fibers that stay in the lungs can travel to the ends of the small airways and enter the pleural lining of the lung and chest wall. These fibers can then injure the cells of the pleura, and, over time, cause mesothelioma.
• Asbestos fibers can also damage cells of the lung and result in asbestosis (scar tissue in the lung) and/or lung cancer.
• In the past, asbestos was used in many products because it was heat and fire-resistant. Even though the link to mesothelioma is now well known, it is still used in some products.

People Most at Risk of Developing Mesothelioma

• People most at risk of developing mesothelioma handled asbestos for a prolonged period of time or were exposed to large amounts of asbestos as part of their career.
• Secondhand exposure is also common, especially among the spouses and children of people who worked with asbestos.
  • Blue-Collar Workers
    • Asbestos miners, firefighters, construction workers, power plant workers, shipyard workers, electricians, plumbers, demolition workers, railroad and automotive workers, and others are among these types of workers.
  • Veterans
    • U.S. Navy veterans are most at risk. Army, Marine Corps, Air Force and Coast Guard veterans also face health risks.
  • Family Members
    • Spouses, children and others who lived with a person who was regularly exposed to asbestos fibers are at risk. People who are exposed to asbestos may carry the fibers home on their skin and clothing. Exposure to these stray fibers over many years can put others in the home at risk of mesothelioma.
    • If parent, sibling or child has mesothelioma, there is an increased risk of this disease.
  • Radiation therapy to the chest. If you had radiation therapy for cancer in your chest, you might have an increased risk of mesothelioma.

Stages of Mesothelioma

• The stages of mesothelioma range from 1 to 4 and are based on tumor size and location.
• Early-stage mesothelioma is usually more confined to one site, while late-stage mesothelioma shows tumors spreading beyond the chest or abdominal cavity. Staging is an important part of determining treatment.

Mesothelioma Types

The four typed of mesothelioma cancer are identified by the location in the body where tumors develop. Pleural and peritoneal types of mesothelioma are the most common. Pericardial mesothelioma accounts for 1% of cases. Prognosis, symptoms and treatment options vary by mesothelioma type.

• Pleural
  • 80-90% of cases
  • Forms on soft tissue covering the lungs or in the lining of the lungs
  • Best treated with a multimodal approach
• Peritoneal
  • Less than 20% of cases
  • Develops on lining surrounding the abdomen
  • Responds best to a combination of surgery and heated chemotherapy
• Pericardial
  • 1% of cases
  • Forms on soft tissue around the heart
  • Best treated with a multimodal approach
• Testicular
  • Less than 1% of cases
  • Develops on the lining of the testes
  • Responds best to surgery

Treatment Options

• Treatment depends on the person’s general health and the stage and location of the mesothelioma.
• According to a 2018 American Society of Clinical Oncology study, mesothelioma cancer is treated with conventional therapies such as surgery, chemotherapy and radiation. But not every patient is eligible for each type of mesothelioma treatment. Some patients also opt for emerging cancer treatments, including clinical trials and alternative therapies

Prognosis

• The prognosis for mesothelioma is not good. The life expectancy for most patients is about 12 – 21 months after diagnosis with about 7.5% of people surviving for 5 years. Those who can undergo multimodal therapy, which is a combination of two or more treatments, have an improved prognosis.
• Factors that most affect mesothelioma prognosis are stage and cell type.
• Age, gender and exposure history also affect outlook.
• Younger patients and women have a better mesothelioma prognosis than older men.
• People diagnosed with the peritoneal mesothelioma type also have a higher chance of survival.
• Mesothelioma accounts for less than 1% of all cancers diagnosed in the UK, (around 2,600 people were diagnosed with the disease in 2011), and it is the seventeenth most common cause of cancer death (around 2,400 people died in 2012).

Notables

1. Wikipedia – Mesothelioma

• Malcolm McLaren, musician and manager of the punk rock band the Sex Pistols, was diagnosed with peritoneal mesothelioma in October 2009 and died on 8 April 2010 in Switzerland.
• Steve McQueen, American actor, was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen subsequently sought alternative treatments at clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in automobile racing suits (McQueen was an avid racing driver and fan).
• Mickie Most, record producer, died of peritoneal mesothelioma in May 2003; however, it has been questioned whether this was due to asbestos exposure.
• Warren Zevon, American musician, was diagnosed with pleural mesothelioma in 2002, and died roughly a year later. It is believed that this was caused through childhood exposure to asbestos insulation in the attic of his father's shop.
• David Martin, Australian sailor and politician, died on 10 August 1990 of pleural mesothelioma. It is believed that this was caused by his exposure to asbestos on military ships during his career in the Royal Australian Navy.

Although life expectancy with this disease is typically limited, there are notable survivors.

• Paul Kraus, diagnosed in 1997, is considered the longest currently living (as of 2017) mesothelioma survivor in the world.
• In July 1982, Stephen Jay Gould, a well-regarded paleontologist, was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote "The Median Isn't the Message", in which he argued that statistics such as median survival are useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to cancer not linked to his mesothelioma.

References & Additional Reading:

• Asbestos.com - Mesotheliom
• Mayo Clinic – Mesothelioma
• Mesothelioma.com – Mesothelioma Cancer
• Mesothelioma.com – Resources for Patients and Their Families
• American Cancer Society – Malignant Mesothelioma
• Wikipedia – Mesothelioma
• Mesothelioma Deaths Seem to be on the rise. By Jacob Maslow 3 Sept 2020
• YouTube- Mesothelioma
• Baron & Budd- Asbestos awareness month – There is more than one kind of Mesothelioma 20 Nov 2018

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