Mesothelioma
Mesothelioma is a type of cancer that begins in the tissue lining different organs and spaces inside the body. This tissue, called mesothelium, protects organs by making a special fluid that allows the organs to move.
There are three main types of mesotheliomas. The most common (50%-70%) is the epithelioid type.
Risk Factors:
The main risk factor for mesothelioma is contact with asbestos. In the past, asbestos was used in insulation as well as in other products such as floor tiles, door gaskets, roofing, patching compounds, and more. Since asbestos is a natural mineral, it can also be found in dust and rocks in certain parts of the United States. Most use stopped after 1989, but it is still used in some products.
When asbestos fibers are breathed in, some can travel to the ends of the small air passages and reach the lining of the lungs. There they can damage the cells lining the lungs, which can lead to pleural mesothelioma. If swallowed, these fibers can also reach the lining of the abdominal cavity where they play a part in causing peritoneal mesothelioma.
People who may be at risk for asbestos exposure include some miners, factory workers, makers of insulation, railroad workers, ship builders, gas mask makers, and construction workers. Several studies have shown that family members of people exposed to asbestos at work have an increased risk of mesothelioma because asbestos fibers are carried home on the clothes of the workers.
The risk of getting mesothelioma depends on how much asbestos a person was exposed to and for how long. Mesotheliomas take a long time to develop. The time between the first exposure and finding the disease is often between 20 and 50 years. Another important point about asbestos is that the risk of mesothelioma does not drop over time. The risk appears to be lifelong and it does not go down.
While tobacco smoke has not been shown to cause mesothelioma, smokers exposed to asbestos have a much higher risk of lung cancer. More asbestos workers die of lung cancer than of mesothelioma.
Prevention:
The best way to prevent this disease is to avoid contact with asbestos in homes, public buildings, and at work. People who could be exposed to asbestos at work include miners, factory workers, insulation workers, railroad workers, ship builders, makers of gas masks, and construction workers.
If there is a chance of exposure, say, in fixing up old buildings, then workers should take special measures to protect themselves. If you live in an older home, there may be asbestos in the insulation or in other materials. An expert can check your home to see if there is any danger. If so, you might decide to have the asbestos removed. You should hire a qualified person to do this job. You should not attempt to do it yourself.
As a rule, a chest x-ray is not useful in finding mesothelioma early. One test being studied is a blood test. This test measures the levels in the blood of a certain protein that is higher in people who have lung damage due to asbestos. It is even higher if the person has mesothelioma.
Early symptoms of mesothelioma can be very general. Thus, they are often ignored. Most people with this type of cancer have symptoms for only 2 to 3 months before the cancer is found.
Symptoms of pleural mesothelioma (lining of the chest) can include:
- pain in the lower back or at the side of the chest
- shortness of breath
- trouble swallowing
- hoarseness
- cough
- fever
- sweating
- tiredness
- weight loss
- swelling of the face and arms
- muscle weakness
Symptoms of peritoneal mesothelioma (lining of the abdominal cavity) include:
- belly pain
- weight loss
- nausea
- vomiting
- fluid or a lump in the abdomen
Of course, these same symptoms can also be caused by other minor ailments. But if you have worked with asbestos and you have any of these symptoms, you should see your doctor right away.
If there is reason to suspect you might have mesothelioma, the doctor will ask you questions about your health and do a complete physical exam. The exam can help tell if you have fluid in the chest, abdomen, or heart. This fluid can be a sign of mesothelioma. Then one or more of the methods below can be used to find out whether you really have cancer.
Imaging Tests
These tests allow the doctor to see a picture of the inside of your body. These could include x-rays, CT scans (computed tomography), MRI (magnetic resonance imaging), or PET scans.
Chest x-ray: The x-rays might show thickening of the lining of the lungs or other signs of asbestos exposure leading to mesothelioma.
CT scans: A CT scan (also known as a CAT scan) is like an x-ray but it produces detailed cross-sectional images of your body. Instead of taking one picture, as does a regular x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body.
Often after the first set of pictures is taken, you will receive an intravenous injection of dye that helps better outline parts of your body. A second set of pictures is then taken. You will need an intravenous (IV) line through which the dye can be given. Some people are allergic to the dye and get hives, a flushed feeling, or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell your doctor if you have ever had a reaction to any dye used for x-rays.
CT scans take longer than regular x-rays, and you need to lie still on a table while they are being done. But they are getting faster and your scan might be pleasantly short.
CT scans are often used to first find the mesothelioma, and they are helpful in finding out how far it has spread.
PET scan: A PET scan uses glucose (a form of sugar) that contains a radioactive substance. Cancer cells in the body absorb large amounts of the radioactive sugar and a special camera can detect the radioactivity. This test, which is still being studied, can help tell whether a thickening of the tissues is cancer or just scar tissue. It can also spot the spread of cancer.
MRI scans: This test uses radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of your body.
A contrast material might be injected just as with CT scans. MRI scans provide the same kind of information that CT scans do, but sometimes they can provide a different and more helpful picture.
MRI scans are useful in looking at the diaphragm (the thin muscle at the bottom of the lung cage that goes up and down during breathing). The mesothelioma may have spread to the diaphragm.
MRI scans take longer than CT scans – often up to an hour. Also, you are placed inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. The machine makes a thumping noise, and some places will provide headphones with music to block out the noise.
While there is a blood test to track the progress of the disease during and after treatment, it is not really useful in telling whether a person has this cancer. But a high level of a certain protein (osteopontin) is a cause for concern.
Fluid or tissue samples may be taken from the chest, stomach, or heart area with a needle and sent to the lab to see if cancer cells are present.
Other methods of looking inside the body involve making a small cut (incision) in the chest or stomach area and then using a small tube with a video camera to allow the doctor to look directly at the area in question and take a tissue sample.
In another approach, the doctor can insert a lighted tube through the mouth and into the chest. This is called a bronchoscopy. If the tube is placed under the chest bone and then moved down into the chest, it is called a mediastinoscopy.
Surgery allows the doctor to remove a larger sample of tumor or, sometimes, the whole tumor.
It is often hard to identify mesothelioma by looking at the cells (or even tissue) from the fluid around the lungs, stomach, or heart. So your doctor may want to do other tests as well. Sometimes an electron microscope is used to look at cells in greater detail.
Treatment:
Because this is such a rare cancer, it has been hard for doctors to compare the value of different treatments. Treatment options include surgery, chemotherapy and radiation therapy. One problem with treating mesothelioma is that it does not grow as a single mass. Instead it tends to spread along surfaces, nerves, and blood vessels. This makes it hard for one or more types of treatment to get rid of all of the disease.
Surgery
Surgery for some types of mesothelioma might be done to try to bring about a cure or to relieve symptoms.
Chemotherapy
Depending on the type and stage of the cancer, chemotherapy may be given as the main treatment or along with surgery. Chemotherapy for this disease is given to relieve symptoms, not to cure the cancer.
Chemotherapy can have some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Side effects could include the following:
- nausea and vomiting
- loss of appetite
- hair loss
- mouth sores
- an increased risk of infection
- bleeding or bruising after minor cuts
- tiredness
- shortness of breath
Most side effects go away once treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.
Radiation Therapy
Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (internal or implant radiation). External radiation is the preferred type for mesothelioma. It is given in the same way as the type of x-ray used to find a broken bone, although it takes longer. Treatments are usually given daily (5 days a week) for 3 to 5 weeks.
As a rule, radiation treatment doesn't help much for mesothelioma, and the need to treat a large part of the lung leads to problems with lung damage. But radiation can be used along with surgery to kill small areas of cancer that cannot be seen and removed during surgery. It can also be used as a way to ease symptoms such as shortness of breath, pain, bleeding, or trouble with swallowing. If fluid builds up in the chest, radioactive drugs can be put into the space after the fluid is drawn out. This might help keep the fluid from coming back.
There can be side effects from radiation. Most of these will go away after a short while. The skin in the area treated may look sunburned and then become darker. You may also feel tired. Be sure to talk with your doctor about any side effects. Often there are medicines or other methods that will help.
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