Mesothelioma Diagnosis and Treatment Options
Mesothelioma is a very rare type of cancer that can affect the thin membrane lining of different organs in the body, most commonly the lungs, but the chest, abdomen or heart may also be involved. This thin membrane on the lung is known as the pleura.
These tumors can be non-cancerous (benign) or cancerous (malignant). Benign mesotheliomas are usually removed by surgery and don’t require further treatment.
Malignant mesothelioma is often caused by exposure to asbestos, a mineral from rocks and soil and used prior to the 1970’s in industry and manufacturing. Exposure results in an aggressive and usually deadly form of cancer where cells making up these tissues grow out of control. In the United States, about 2,000-3,000 new cases of mesothelioma are diagnosed each year.
There are three conditions that may occur due to asbestos exposure:
- Lung cancer
- Mesothelioma: a rare cancer found in the thin lining of the lung, chest, abdomen and heart
- Asbestosis: a serious progressive, long-term, non-cancerous disease of the lungs.
What is asbestos?
Because of its fiber strength and heat resistance, asbestos was used in a variety of building construction materials for insulation, flooring and as a fire retardant, among other uses. The federal government began regulating the use of asbestos and asbestos products in the 1970s.
Today, asbestos handling is strictly regulated to contain airborne fibers that can get into the lungs, which leads to disease. In general, exposure may occur only when the asbestos-containing material is disturbed or damaged in some way to release particles and fibers into the air, according to the EPA.
There are four different types of mesothelioma. The early symptoms are tied with disease progression. Symptoms can be caused by pain from nerve irritation or fluid build-up. Usually, by the time a patient presents with symptoms, the disease is in a more advanced stage.
- Pleural Mesothelioma - The most common area where malignant mesothelioma occurs is in the lungs, chest cavity and the pleural membrane surrounding the chest cavity; this is known as pleural mesothelioma. Pleural mesothelioma occurs in about 75% of all cases.
- Peritoneal Mesothelioma - Peritoneal mesothelioma cancer can occur in the abdomen and stomach area, and may spread to other nearby organs such as the liver, spleen, and intestines.
- Pericardial Mesothelioma - If the disease occurs in the lining of the heart, called the pericardium, this can lead to pericardial mesothelioma. This type is very uncommon and only occurs in about 1 out of every 100 cases (equal to 1% of all cases).
- Testicular Mesothelioma - Testicular mesothelioma is the most rare form, and occurs in the testicle lining known as tunica vaginalis. Very few cases have been diagnosed around the world.
Frequent symptoms of pleural (lung) mesothelioma include:
- shortness of breath (dyspnea)
- chest pain
- unintentional weight loss
- fluid accumulation between the lungs and chest, known as mesothelioma pleural effusion.
Peritoneal (abdomen) mesothelioma symptoms can include:
- severe abdominal (stomach area) pain
- swelling due to fluid accumulation
Common symptoms of pericardial (heart) mesothelioma include:
- chest pain
- shortness of breath
Mesothelioma is almost always caused by having worked in an industry or being in areas where asbestos, a type of mineral, has been present in the air and inhaled. Most people who get this disease today may have had exposure to asbestos in the past.
Asbestos exposure prior to 1970 resulted from industrial products such as:
- ceiling tiles
- automobile brake linings
- fireproofing materials
- flooring tiles
Asbestos fibers are useful in industry because they are strong, heat resistant, chemically resistant, and do not conduct electricity. People working in industries such as shipbuilding or automotive, particularly prior to the 1970’s, were at greater risk. Family members were also at risk due to inhaling particles if workers brought asbestos home on their clothing. Typically, it can take 20 to 30 years to develop this condition after inhaling the fiber particles.
In general, exposure may occur when the asbestos-containing material is disturbed or damaged in some way to release particles and fibers into the air. Asbestos fibers may be released into the air by the disturbance of asbestos-containing material during product use, demolition work, building or home maintenance, repair, and remodeling.
As published by the Environmental Protection Agency (EPA), other products where asbestos may be found include:
- attic and wall insulation containing vermiculite
- vinyl floor tiles and the backing on vinyl sheet flooring and adhesives
- roofing and siding shingles
- textured paint and patching compounds used on wall and ceilings
- walls and floors around wood-burning stoves protected with asbestos paper, millboard, or cement sheets
- hot water and steam pipes coated with asbestos material or covered with an asbestos blanket or tape
- oil and coal furnaces and door gaskets with asbestos insulation
- heat-resistant fabrics
- automobile clutches and brakes
Older homes or other buildings may still contain asbestos. Testing may be required to determine if asbestos is present in older buildings, especially if remodeling or other construction occurs. If it is found, it will need to be sealed off and removed with special procedures by a certified company. Asbestos abatement workers are trained to properly use protective equipment to minimize exposure.
What else causes mesothelioma?
Other than asbestos, these may lead to mesothelioma:
- erionite, a non-asbestos mineral fiber, has lead to this condition in regions such as Turkey where exposure is highly prevalent.
- carbon nanotubes
- certain viruses
A history of asbestos exposure greatly increases your asbestosis and mesothelioma risk factors. People who either live or work in buildings with asbestos-containing materials that are either under reconstruction or deteriorating are at a greater than normal risk. Workers at risk may include:
- construction workers
- shipyard workers
- aircraft and auto mechanics
- boiler operators
- railroad workers
- workers removing asbestos insulation around steam pipes in older buildings
Living with someone who is exposed to asbestos can increase a family’s risk due to passive inhalation if they bring it home on clothes. Those who smoke and are exposed to asbestos have an even higher risk of developing lung cancer and mesothelioma; however, this disease has no direct association with smoking like lung cancer.
A diagnosis of mesothelioma will involve several mesothelioma tests, because symptoms can be caused by other medical conditions, including other cancers. These tests might include:
- Imaging tests - Examples include a chest X-ray, CT scan, PET scan or an MRI. These tests will create images of your lungs or other areas where this condition is suspected. These studies help to locate and determine the size of any tumors, and if the cancer has spread.
- Electrocardiogram (ECG) - To check your heart’s rhythm
- Bronchoscopy - Your doctor will insert a bronchoscope into your airways to examine your airways.
- Spirometry - A test to check your breathing and lung function; you breath into tube for this test.
- Thoracentesis - Your doctor may use a thin needle to remove excess fluid from your chest or abdomen. The fluid sample may be analyzed. Removing fluid can also help relieve chest pain and shortness of breath.
- Biopsy - A small sample of tissue is removed from the space around the lung, or other area where disease is suspected, and it is examined. This is usually the gold standard for diagnosis of mesothelioma.
There are 4 mesothelioma stages with pleural mesothelioma. Determining the stage will allow the doctor to determine the tumor size and placement, progression, and help to guide the choice of therapy.
Stage 1 is considered localized disease, while stages 2, 3 and 4 are considered advanced mesothelioma. Initial staging will identify patients who are not candidates for surgery, and who may receive palliative therapy and drug treatment to lessen symptoms. Stages of mesothelioma are based on the recommendations of the International Mesothelioma Interest Group.
Stages of Pleural Mesothelioma
|Stage Level||Progression of Mesothelioma||Distant Spread|
|Stage I (localized)||Tumor only in pleural (lung) membrane lining on one side of chest or diaphragm.||No distant cancer spread (metastasis) and no lymph node involvement.|
|Stage II (advanced)||Involves one side of chest but has grown into lung, lung lining or diaphragm.||No distant cancer spread and no lymph node involvement.|
|Stage III (advanced)||Cancer involves one side of chest but has grown into chest wall or heart lining (pericardium).||Cancer may have spread to lymph nodes on same side of tumor; no distant spread.|
|Stage IV (advanced)||Cancer involves one or both sides of chest; has spread deep into the chest wall, through diaphragm, spine, heart lining, and possibly heart.||Cancer may have spread to distant lymph nodes and sites.|
Source: Table adapted from Mesothelioma Health Guide: Harvard Health Publications, November 2022.
There are three approaches to treatment for mesothelioma: surgery, radiation, and chemotherapy. Treatments can help patients breathe easier and have less pain. It is important to consult with a team of mesothelioma specialists. In some cases, multiple treatments will be sued.
- Surgery: May be aggressive or palliative with a goal of long-term control of the disease in appropriate candidates, or to relieve symptoms. Patients need to be healthy enough to have aggressive surgery.
- Aggressive surgery is used in Stage 1 patients only and may involve removal of a lung, pleura, diaphragm, and/or pericardium, removal of the mesothelioma tumor, and fluid drainage from around the lung. Aggressive surgery is high risk and complex, and few patients undergo this type of surgery.
- More palliative procedures may involve fluid removal and installation of talc in the pleural space to prevent fluid build-up, to help control pain and shortness of breath. For disease in the stomach area, treatment is usually palliative and aimed at relieving symptoms
- Radiation therapy: Used to kill cancer cells left from surgery, or cells that are present if surgery is not performed. Radiation may also relieve some symptoms like chest pain, but it is not clear if radiation prolongs survival.
- Chemotherapy: Delivery of medications to kill cancer cells, including those left behind after surgery, but chemotherapy cannot cure mesothelioma. Chemotherapy may be instilled into the chest cavity, abdomen, or given through the vein. Combination therapy, such as cisplatin (Platinol, Platinol-AQ) and pemetrexed (Alimta, Pemfexy), can be combined with surgery and/or radiation treatment to help prolong survival.
- Immunotherapy: Ipilimumab (Yervoy) + nivolumab (Opdivo) combination treatment is now approved for the first-line treatment of adults with malignant pleural mesothelioma that cannot be removed with surgery. Immunotherapy helps to stimulate your body's immune system to fight cancer.
- Experimental treatments: Other investigational treatments for mesothelioma are in process, including:
- combination chemotherapies
- gene therapies (helps to make cancer cells more likely to be killed by chemotherapy)
- intracavitary chemotherapy (when drugs are put directly into the chest or abdomen)
- brachytherapy (when radioactive agent is placed directly into the chest or stomach area).
To learn more about mesothelioma clinical trials, speak to your physician and visit the National Cancer Institute and search for “mesothelioma” on their website. There are many ongoing trials and your physician can provide more detailed information.
Mesothelioma is not curable in most patients, as diagnosis often occurs in the later stages. The prognosis for mesothelioma is usually poor due to an advanced stage in most patients when they are first diagnosed. If you are diagnosed early and in good health your outcomes may be more favorable.
Many factors play into the length of mesothelioma survival, including: age, gender, overall health status, stage at diagnosis, mesothelioma type and tumor location, and treatment success. Non-smokers often have a better prognosis than patients who smoke. Your doctor will give you a prognosis based on these factors, and your treatment options and choices.
You might be able to enroll in mesothelioma clinical trials with investigational treatments, if you choose.
Mesothelioma Life Expectancy
- The current 5-year survival rate for mesothelioma is 10%, meaning that about 10 out of every 100 patients with mesothelioma will be alive 5 years after diagnosis. Speak to your doctor about your expected outcomes, which may be different.
- The average life expectancy after diagnosis ranges from 4 to 18 months, but some patients have lived as long as 10 years after a diagnosis.
- Your doctor may recommend other treatments to improve your quality of life.
Mesothelioma has been the subject of many injury lawsuits and is one of the longest running series of civil liability cases in U.S. history. There are lawyers that specialize in handling these cases, and these are services are frequently advertised on the Internet. An asbestos trust fund has been set up in the U.S.
Frequently Asked Questions about Mesothelioma
Always seek a reliable, experienced and licensed lawyer to help with your individual questions and latest information on mesothelioma and associated legal issues. These questions and answers do not serve as legal advice.
Q. How do I find a mesothelioma attorney?
A. There are many lawyers who are experts on lawsuits involving injury due to asbestos exposure. You might ask a trusted lawyer who deals with these types of litigation in your area, to start. It is important to find a trusted lawyer you feel comfortable with, and that has years of proven experience dealing with these cases. Beware of immediately selecting legal help from the Internet without some degree of investigation.
Your attorney should evaluate the facts of your case and guide you to your best options. Whether you can file a lawsuit will depend on many issues, such as when you were exposed, how the exposure to asbestos occurred, when you became ill, your medical history, and your medical complications.
Q. How do I file a lawsuit?
A. Always consult with your lawyer. Mesothelioma claims are usually brought against the company that you worked for where the asbestos exposure occurred. If you are a Veteran, you may also be eligible for assistance through the Department of Veterans Affairs.
Q. How can I get mesothelioma compensation? How much will my mesothelioma settlement be?
A. Beware of any mesothelioma law firm who guarantees you a specific award amount; there is no assurance that you will receive any settlement. However, the types of expenses and losses that may be sought in a lawsuit include: lost wages, medical expenses, pain and suffering. Your compensation may be impacted by your lawyer’s legal fees, as well.
Q. Is there a deadline (statute of limitations) for filing a mesothelioma case?
A. Yes, a deadline for filing a mesothelioma lawsuit may be decided on a state-by-state case. Speak to an experienced and reliable lawyer as soon as you can after your diagnosis.
Q. Is there a trust fund for mesothelioma compensation?
According to the Mesothelioma Guide, people with asbestos-related diseases may receive financial support from asbestos trust funds. Companies who went bankrupt organized these funds to provide funds for victims of asbestos exposure. Mesothelioma patients typically collect the highest compensation of all asbestos-related diseases. Some cases may not go to trial because the suit may settle out of court.
Q. Should I join a mesothelioma class action lawsuit?
A. A mesothelioma class action lawsuit would collectively bring a claim against a defendant for a group of people with similar injuries, circumstances, and legal issues due to mesothelioma. Class actions have not been widely used in asbestos cases. Before you agree to participate or exclude yourself from a class action lawsuit, you should consult with an experienced law firm.
Q. Can my family make claims if I die before my case goes to trial?
A. It is always best to consult with an experienced mesothelioma or estate lawyer to discuss mesothelioma claims on a case-by-case basis. Typically, your estate would act on your behalf to divide any mesothelioma payouts among your survivors, but this can vary.
Researchers found the connection between asbestos and lung cancer in the 1930’s. However, the link between asbestos exposure and mesothelioma lung cancer was not found until the 1970s.
Cancer can occur in people who worked for those companies that manufactured products that contain asbestos. These companies often knew asbestos was toxic to humans but purposely failed to warn employees. Due to this negligence, lawsuits with mesothelioma compensation claims in the billions of dollars have been filed.
Patients and families often seek information about mesothelioma on the Internet. Mesothelioma related keywords were once among the highest "pay per click" advertising topics on the Internet. Intense competition among mesothelioma attorneys trying to attract the attention of patients eligible for large compensation payouts led to related "cost-per-click" advertisements on Google skyrocketing above $100 to $300 per click.
In addition, many commercials advertising for mesothelioma lawyers are often seen on TV in the U.S. Always consult a reliable and experienced attorney to answer any questions you have about a mesothelioma legal case.
This is not all the information you need to know about mesothelioma and does not take the place of your doctor’s directions. Discuss any medical or treatment questions you have with your doctor or other health care provider.
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Symptoms and treatments
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