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What is mesothelioma?
Mesothelioma is caused by exposure to asbestos and symptoms may not appear for as long as 20 to 40 years after exposure. Mesothelioma is a cancerous tumor of the mesothelium. The mesothelium is the tissue made up of specialized cells called mesothelial cells which line the chest cavity, abdominal cavity, and the cavity around the heart. These cells also cover the outer surface of most internal organs.
The mesothelium produces a special lubricating fluid that allows organs to move around within the body with less friction. For example, this fluid makes it easier for the lungs to move inside the chest during breathing.
The mesothelium of the chest is known as the pleura. The mesothelium of the abdomen is called the peritoneum. The mesothelium of the pericardial cavity, which is the space around the heart, is called the pericardium.
Mesothelioma is a cancer that attacks any of these mesothelial regions.
What is the difference between mesothelioma and malignant mesothelioma?
Tumors of the mesothelium can either be benign or malignant. A benign tumor is non-cancerous. A malignant tumor is cancerous, and one occurring on the mesothelium is called malignant mesothelioma. Because most mesothelial tumors are cancerous, malignant mesothelioma is commonly referred to as simply mesothelioma, or in casual conversation meso.
What are the causes of mesothelioma?
Asbestos exposure is the primary cause of mesothelioma. After asbestos fibers are breathed in, they travel to the ends of small air passages and reach the pleura where they cause physical damage to mesothelial cells that may result in cancer. They also cause injury to lung cells that can result in lung cancer and/or asbestosis (replacement of lung tissue by scar tissue). If ingested, these fibers can travel to the abdominal cavity and cause peritoneal mesothelioma.
While exposure to asbestos is mostly occupational, it can also be environmental. Exposure to asbestos can also occur from being in close contact with an asbestos worker. For example, the work clothes of an asbestos worker can expose a family member to asbestos fibers while doing laundry.
What is asbestos? The main risk factor for developing mesothelioma is exposure to asbestos. The term asbestos refers to a family of magnesium-silicate mineral fibers. In the past, asbestos was used widely for insulation because it does not conduct heat well and is resistant to burning. As the link between asbestos and mesothelioma has become more well known, the use of this material has decreased. However, up to 8 million Americans may already have been exposed to asbestos. Although asbestos has not been used in construction since approximately 1975, the products already in place present a danger to individuals involved in repair work and the demolition of structures containing asbestos products.
It is possible that asbestos causes cancer by physically irritating cells rather than by a chemical effect. When asbestos fibers are inhaled, the long, thin fibers may reach the ends of the small airways and penetrate into the pleural lining of the lung and chest wall. These fibers may then directly injure mesothelial cells of the pleura, and eventually cause mesothelioma.
People exposed to asbestos at an early age, for a long period of time, are most likely to develop this cancer. Mesothelioma, however, takes a very long time to develop. The time between exposure and diagnosis of mesothelioma is usually between 20 and 40 years.
What are the symptoms of mesothelioma?
It is important to note that symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. The early symptoms of malignant mesothelioma are common symptoms that are not specific to the disease itself. People often mistake the symptoms for everyday sicknesses and ailments such as the common cold. Many people with mesothelioma have symptoms for only a few months before they are diagnosed.
Over half of the patients with pleural mesothelioma have pain at the side of the chest or in the lower back. Shortness of breath is almost always a symptom shared by patients. Some report coughing, fever, sweating, fatigue, difficulty swallowing, and weight loss. Extreme symptoms include coughing up blood, swelling of the face and arms, muscle weakness, and sensory loss.
Symptoms of peritoneal mesothelioma include abdominal pain, weight loss, nausea, and vomiting. Some patients also suffer from hernias, fluid in the abdominal cavity, or the presence of a mass or bulge in the abdomen.
Anyone experiencing any of these symptoms who believes he or she has been exposed to asbestos should see a doctor immediately for diagnosis.
How is a person diagnosed with mesothelioma?
One reason why mesothelioma is such a dangerous form of cancer is because it is difficult to diagnose. Mesothelioma usually progresses to a dangerous stage by the time it is finally diagnosed. For these reasons it is incredibly important to see a doctor as soon as you experience any of the aforementioned symptoms.
It is essential that you give your doctor a complete medical history. Be sure to inform your doctor if you have been exposed to asbestos at work or through a family member. It is important to also tell your doctor when and for how long your exposure to asbestos occurred. Your medical history will help your doctor assess the risk factors associated with mesothelioma, as well as your symptoms.
A physical exam will provide your doctor with information about signs of mesothelioma and other health problems you may be experiencing. Patients with pleural mesothelioma often have fluid in their chest cavity, which is called pleural effusion. A physical exam can also detect the presence of ascites (fluid in the abdominal cavity) in patients with peritoneal mesothelioma. In patients with pericardial mesothelioma, pericardial effusion (fluid in the pericardium) can also be detected during a physical exam by a doctor.
After your medical history and physical exam, you should expect to undergo some medical tests. The tests performed by your doctor can range from basic imaging tests to tests of fluid and tissue samples.
The most basic test is a chest x-ray. The x-ray will show abnormalities involving the lungs, such as irregular thickening of the pleura, lowering of the space between the lungs, abnormal mineral deposits, and fluid build up inside of the lungs. A doctor will either take a CT scan (computed tomography scan) or an MRI (magnetic resonance imaging scan) to try and determine the location, size and mass of a possible cancerous growth. The CT scan uses a rotating x-ray beam to create a series of pictures of the body from many different angles. A computer then combines these pictures to produce cross-sectional images of a part of the body. A doctor may need to inject a dye into a vein in order to highlight details on the CT scan. An MRI uses magnetic fields instead of x-rays to create its images. After the magnetic fields capture the information, a computer generates a detailed cross-sectional image.
If pleural mesothelioma is suspected, the doctor may look inside the chest cavity with a special instrument called a thoracoscope. A peritoneoscope can be used in a similar procedure to look at the abdomen. In this procedure the doctor is looking for abnormal cell growths, which will usually be referred to as tumors. The thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision in the chest. The doctor can see the tumor through the thoracoscope, and can use special forceps to take a tissue biopsy.
After looking at the piece of the tumor under a microscope, the doctor may decide whether the tumor is benign, which means that it is not cancerous, or malignant, which means that it is cancerous.
If the doctor can't tell from the biopsy if the growth is cancerous, there are several other options. The doctor may take a sample of any fluid that has built up around the lungs, stomach or heart, or he may take a blood sample to see if your blood cell levels are what they are supposed to be.
In patients with a pleural effusion, a sample of this fluid can be removed by inserting a needle into the chest cavity. The fluid is then tested and its chemical make-up is then viewed under a microscope to determine whether cancer cells are present. A similar technique can also be used to obtain abdominal fluid and pericardial fluid.
It is often difficult to simply diagnose mesothelioma by looking at the cells from the fluid around the lungs, abdomen or heart. It is even hard to accurately diagnose mesothelioma solely with tissue from biopsies. Mesothelioma can look like several other types of cancer under a microscope. Special laboratory tests are often done to help distinguish mesothelioma from some other types of cancer. These tests often use special techniques to recognize certain markers (various types of chemicals) known to be present in mesotheliomas.
What are the different types of mesothelioma?
About 75% of mesothelioma occurrences start in the chest cavity. This is known as pleural mesothelioma. Another 10% to 20% is peritoneal mesothelioma which begins in the abdomen. Pericardial mesothelioma, found in the cavity around the heart, is very rare.
Pleural Mesothelioma
Pleural mesothelioma spreads within the chest cavity, sometimes involving the lungs.
The onset of mesothelioma is usually very slow, the most common symptom is persistent pain localized in the chest. Sometimes the pain is accompanied by severe difficulty breathing, which is caused by an accumulation of fluid in the pleural space.
Peritoneal Mesothelioma
Peritoneal mesothelioma involves the abdominal cavity, infiltrating the liver, spleen or bowels. Due to fluid accumulation in the abdominal cavity (ascites), the abdomen appears enlarged. The patients experience nausea, vomiting, fever and difficulty in moving their bowels.
The prognosis is poorer for peritoneal mesothelioma with a median survival time of about 10 months from the onset of symptoms.
Rare Forms of Mesothelioma
Mesothelioma of the pericardium is a very seldom seen cardiac cancer. The mass is usually detected at a late stage and the prognosis is very poor, with or without therapy. Mesotheliomas of the ovaries and the scrotum have also been reported.
Benign Forms of Mesothelioma
A rare form of mesothelioma is the cystic mesothelioma of the peritoneum. Its prognosis is benign. Its occurrence has been discovered primarily in young women.
What are the stages of malignant mesothelioma?
Once a person has been diagnosed with malignant mesothelioma, more tests will have to be done in order to determine whether or not the cancer has spread to other parts of the body. This process is called staging. The stage of the cancer must be determined in order to plan treatment. The following stages are used to describle malignant mesothelioma:
Localized Malignant Mesothelioma
Stage 1: The cancer is present in the lining of the chest cavity near the lungs and heart or in the diaphragm of the lung.
Advanced Malignant Mesothelioma
Stage II: The cancer has spread beyond the lining of the chest to the lymph nodes of the chest. Lymph nodes are collections of immune system cells that help the body fight off infections.
Stage III: The cancer has spread through the diaphragm or abdominal lining and into the chest wall, center of the chest, the heart, or nearby lymph nodes.
Stage IV: The cancer has spread to distant organs or tissues.
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