Overview of Mesothelioma
Mesothelioma cancer develops decades after asbestos fibers are inhaled or ingested. The fibers cause inflammation and abnormal cell growth. The abnormal cells grow uncontrollably and form tumors, blocking normal cell growth and impeding normal bodily functions. Over time, cancerous cells spread throughout the body, called metastasis.
Mesothelioma is a form of cancer that develops in the thin layers of tissue that surround the internal organs, called the mesothelium. The types of mesothelioma are named for the area impacted:
- Pleural mesothelioma attacks the pleura (the thin layer of tissue around the lungs).
- Pericardial mesothelioma attacks the pericardium (the tissue around the heart).
- Peritoneal mesothelioma attacks the peritoneum (the tissue surrounding the abdomen).
Mesothelioma cancer is aggressive. Treatments can be productive if the disease is caught in the early stages. However, most people are not diagnosed until the late disease stages due to a long latency period.
How many people are diagnosed with mesothelioma each year?
What is malignant mesothelioma?
How are the stages of mesothelioma determined?
What do the mesothelioma stages mean?
Using information from TNM, doctors identify the stage of the disease. Patients diagnosed with mesothelioma in Stage I, Stage II or early Stage III have treatment options that can include surgery, radiation and chemotherapy. Patients in late Stage III or Stage IV mesothelioma have fewer treatment options, but may be eligible for clinical trials.
What are the different types of mesothelioma?
- Pleural mesothelioma (most common) — lungs
- Peritoneal mesothelioma — abdominal area
- Pericardial mesothelioma — heart
- Testicular mesothelioma — testes
Mesothelioma is also classified based on the cell types involved in the tumors. The cell types help doctors determine how the cancer will react to treatment:
- Epithelioid cells — most common and easiest to treat
- Sarcomatoid — aggressive with limited treatment options
- Biphasic — treatment options depend on dominate cell type (either epithelioid or sarcomatoid)
Asbestos Exposure and Risks
Asbestos has been used for centuries because it was easy to find (it is a naturally occurring mineral), inexpensive (easily dug from asbestos mines) and effective (superior insulating properties).
During World War II, military leaders used the fiber extensively on all vehicles and vessels. After the war and through the early 1980s, asbestos was used in scores of applications, from flooring to faux Christmas tree snow.
During the widespread use, companies that used or mined asbestos knew about the dangers and to great lengths to hide the information.
What causes mesothelioma?
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Most of the people diagnosed with mesothelioma are exposed to asbestos in the workplace or during military service. Over 3,000 U.S. workers, military veterans and their families are diagnosed with mesothelioma each year.
For mesothelioma victims and their families, getting complete and accurate information about the disease is vital to treatment. Mesothelioma prognosis and survival rates depend on several factors, including the patient’s age, stage of the disease, cell type involved and location of the cancer.
What is the life expectancy of a mesothelioma patient?
There are exceptional cases of patients who have lived longer than five years following diagnosis. Often, those patients are younger, so they can withstand rigorous treatment protocols.
What is the survival rate for mesothelioma?
A 2019 study that followed Italian shipyard workers for 55 years found asbestos exposure caused a 475% increased mortality from pleural cancer. The researchers said the study conclusion underscored a “urgent need for the prevention of asbestos related diseases through the implementation of an asbestos ban worldwide, including those countries where asbestos is still mined, manufactured and used.”
In general, survival rates are highly individualized due to disparities in the patient’s ages, health and disease metastasis. Recent studies show that advances in treatments, such as cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), can increase survival rates.
What factors affect a prognosis?
- Gender: Between women and men with similar disease patterns, women generally have better outcomes.
- Disease stage: Patients with early stage mesothelioma (Stage I and Stage II) respond better to treatment when compared to patients with late Stage III and Stage IV disease.
- Age: Younger and healthier patients respond better to treatment than older patients.
- Cell type: Of the three cell types (epithelioid, sarcomatoid and biphasic), epithelioid cells are generally easier to treat
- Mesothelioma location: Pleural mesothelioma (lungs) is the most common type of asbestos cancer.
- General health: Patients who are physically and mentally sound can better withstand treatment.
A 2019 study by the University of Pittsburgh found six factors associated with an improved mesothelioma prognosis:
- Female
- Under age 45
- Epithelioid cell type
- Peritoneal mesothelioma
- Stage I
- Treatment with surgery and chemotherapy
Mesothelioma victims also improve their prognosis when they consult with an asbestos-cancer expert. The leading mesothelioma specialists in the nation have the training, skills, education and experience to provide the best treatments available.
Developing a Treatment Plan
Together, patients and doctors are able to make treatment plans that best suit the patient’s needs. In some cases, the treatments are aggressive to include surgery, chemotherapy and possibly immunotherapy. In other cases, treatment plans include palliative care that reduces or eliminates pain. No matter the path, treatment plans should be customized to the patient’s needs.
When the American Society of Clinical Oncology (ASCO) recently updated its recommendations for mesothelioma treatments, the organization took into consideration all factors that are pertinent to treatment success. In many cases, multimodal treatment (surgery, chemotherapy and radiation or a combination of the three choices) is a good option.
What are the treatment options for a mesothelioma patient?
Some of the leading aggressive treatments include:
- Extrapleural Pneumonectomy (EPP)
In the EPP, physicians strip away the tumor-fill mesothelium (the tissue layer around the organs) or remove an entire diseased lung. While the EPP is considered a potentially curative treatment, it is extreme and reserved for eligible candidates. - Heated Chemotherapy/ Hyperthermic intraperitoneal chemotherapy (HIPEC)
HIPEC has proven to be highly successful in treating pleural and peritoneal mesothelioma. When coupled with radiation treatment, the multimodal therapy shrinks and removes tumors and kills extraneous cancer cells. - Pleurectomy/Decortication (P/D)
As the less invasive alternative to the EPP, the P/D treatment removes the diseased tissue and tumor growth surrounding the lung and other areas of the chest cavity. The procedure is followed up with adjuvant therapy (either chemotherapy or radiation treatments). P/D is also called lung-sparing surgery.
Mesothelioma Diagnosis
Since mesothelioma is difficult to diagnose, specialists use a variety of procedures. However, the most accurate diagnostic tool is a biopsy. For the procedure, physicians remove a small tissue sample and examine it under a microscope. Common types of mesothelioma biopsies include:
- Needle biopsy
Using a fine needle inserted in the lungs or abdominal area, doctors remove tissue or fluid samples - Surgical biopsy
Doctors surgically remove a larger tissue sample (such as a tumor) through traditional surgery. - Camera-assisted biopsy
Using a thin, flexible tube with a camera attached, doctors take samples from precise locations.
With biopsy information, specialists determine if the disease is mesothelioma and which kind of cells are involved. Specialists then use other tests, including the following:
- Physical exams and medical history
Mesothelioma specialists typically perform a full physical on patients to understand more about the patient’s general health. They also inquire about the patient’s medical and occupational history to learn more about asbestos exposure. - Blood tests
Doctors look for biomarkers, or indicators, in the blood to detect cancer cells. Blood tests like MESOMARK, Fibulin-3 and SOMAmer are used to identify specific biomarkers. - Imaging tests
Imaging tests — X-rays, Echocardiograms, MRIs, CT scans and PET scans — are used to visualize mesothelioma tumors and pinpoint metastasis.
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- Mayo Clinic. “Mesothelioma.” Retrieved from
https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022 - Medscape. “Mesothelioma.” Retrieved from https://emedicine.medscape.com/article/280367-overview
- Agency for Toxic Substances and Disease Registry. “Epidemiology of Mesothelioma.” Retrieved from https://www.atsdr.cdc.gov/phs/phs.asp?id=28&tid=4#bookmark04
- Environmental Health. “Mortality among workers exposed to asbestos at the shipyard of Genoa, Italy: a 55 years follow-up.” Retrieved fromhttps://ehjournal.biomedcentral.com/articles/10.1186/s12940-018-0439-1
- Environmental Health. “Mortality among workers exposed to asbestos at the shipyard of Genoa, Italy: a 55 years follow-up.” Retrieved from
https://ehjournal.biomedcentral.com/articles/10.1186/s12940-018-0439-1 - The Lancet. “Pleural mesothelioma: tackling a deadly cancer.” Retrieved from
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30004-9/fulltext - Translational Lung Cancer Research. “Extended pleurectomy decortication: the current role.” Retrieved fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204414/