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Mesothelioma

Medically reviewed on Nov 14, 2016 by L. Anderson, PharmD

What is Mesothelioma?

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. This thin membrane is known as the pleura. These tumors can be noncancerous (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. Mesothelioma is a very rare cancer in the United States, with about 3,000 new cases being diagnosed each year.

Standard and accepted mesothelioma treatment guidelines are not available. Treatment should be individualized based on symptoms, stage at presentation, and outcome goals. The following review primarily focuses on malignant pleural mesothelioma (MPM). However, 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 and as a fire retardant. The federal government began regulating the use of asbestos and asbestos products in the 1970s. Today, asbestos handling is strictly regulated; however, in general, it's safe to be around asbestos as long as the fibers are contained. This prevents them from getting airborne and into the lungs, which leads to disease.

Mesothelioma Facts

  1. There is no cure for mesothelioma, but treatment can lessen symptoms.
  2. Pleural mesothelioma, in the lungs, usually occurs in people older than 50 years of age.
  3. Malignant pleural mesothelioma is the most common form and is responsible for about 80 percent of all new mesothelioma cases.
  4. Pleural mesothelioma symptoms can include a cough, shortness of breath (dyspnea), chest pain, fatigue, and weakness.
  5. Testing for mesothelioma may involve a chest x-ray, breathing tests, a bronchoscopy (inserting a thin tube to look down your airways), or a lung biopsy (a piece of tissue may be taken to examine), if your doctor suspects the pleural type. Other types of mesothelioma tests may be used, too.
  6. Mesothelioma treatment options may involve surgery, radiation, and chemotherapy (cancer drugs).
  7. How do I pronounce mesothelioma? mez'o-the'le-o'ma

Mesothelioma Statistics

  • New cases of mesothelioma increased from the 1970s to the 1990s, but the incidence has leveled off since then.
  • The average age at diagnosis is roughly 70 years. Men, due to workplace exposure, historically were at a greater risk of developing this disease than women.
  • The incidence of mesothelioma is more frequently seen in Caucasians and Hispanics/Latinos than in African Americans or Asian Americans.
  • Mesothelioma rates are very low in the United States, with only about 3,000 new cases annually.

Mesothelioma Types

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.

  1. Pleural Mesothelioma (Lung) - 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.
  2. 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.
  3. 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 (1%) cases.
  4. Testicular Mesothelioma - Testicular mesothelioma is the most rare form, and occurs in the testicle lining known as tunica vaginalis. In fact, only about 100 cases total have been diagnosed around the world. Little is known about the testicular form, what causes it or how to treat it.

Mesothelioma Symptoms

Frequent symptoms of pleural mesothelioma include:

  • Shortness of breath (dyspnea)
  • Cough
  • Fatigue
  • Weight loss
  • Fluid accumulation between the lungs and chest, known as mesothelioma pleural effusion

Peritoneal mesothelioma symptoms can include:

  • Severe abdominal pain
  • Swelling due to fluid accumulation

Common symptoms of pericardial mesothelioma include:

  • Chest pain
  • Shortness of breath

Mesothelioma Cell Type

Mesothelioma types are classified based upon the type of cells that makes up the cancer:

  • Roughly 50% are malignant epithelioid mesothelioma (epithelial cells) which has a better prognosis (outlook) than other cell types.
  • Only about 10% are malignant sarcomatoid mesothelioma (fibrous).
  • The remaining can be mixed, known as biphasic mesothelioma, meaning the cancer has characteristics of both epithelioid and sarcomatoid cell types.

What Causes Mesothelioma?

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 are diagnosed between the ages of 50 and 70, and may have had exposure to asbestos in the past.

How do you get asbestos mesothelioma?

Asbestos exposure prior to 1970 resulted from industrial products such as:

  • Insulation
  • Ceiling tiles
  • Automobile brake linings
  • Cement
  • 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.

According to the Environmental Protection Agency (EPA), most uses of asbestos in the U.S. are not banned; only a few are banned under existing regulations. 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. However, 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 EPA, other products where asbestos may be found include:

  • Attic and wall insulation produced 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.

Causes of Mesothelioma Other Than Asbestos

  • Erionite, another mineral fiber, is a non-asbestos cause that leads to this condition in regions such as Turkey where exposure is highly prevalent.
  • Irradiation
  • Carbon nanotubes
  • Certain viruses

Mesothelioma Risk Factors

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:

  • Miners
  • Construction workers
  • Shipyard workers
  • Aircraft and auto mechanics
  • Boiler operators
  • Building construction workers
  • Electricians
  • 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 high risk of developing lung cancer and mesothelioma; however, this disease has no direct association with smoking like lung cancer.

Mesothelioma Diagnosis & Testing

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.
  • 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 help relieve chest pain and shortness of breath.
  • Mesothelioma 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.

Mesothelioma Staging

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 1 Tumor only in pleural membrane lining on one side of chest or diaphragm. No distant cancer spread (metastasis) and no lymph node involvement.
Stage 2 Involves one side of chest but has grown into lung lining or diaphragm. No distant cancer spread and no lymph node involvement.
Stage 3 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 4 Cancer involves one or both sides of chest; has spread deep into the chest wall, through diaphragm, 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 2016.

Mesothelioma Treatment

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.

  • Mesothelioma 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.
  • Mesothelioma radiation therapy: Used to kill cancer cells left from surgery or present if not surgery is performed. Radiation may also relieve some symptoms like chest pain, but it is not clear if radiation prolongs survival.
  • Mesothelioma chemotherapy: Delivery of medications to kill cancer cells, including those left behind after surgery. Chemotherapy cannot cure mesothelioma. Chemotherapy may be instilled into the chest cavity, abdomen, or given through the vein. Combination therapy, such as cisplatin and pemetrexed (Alimta), can be combined with surgery and/or radiation treatment to help prolong survival.

Mesothelioma Prognosis

The question may be asked by patients or family members “Is there a mesothelioma cure?” There is not a cure for mesothelioma unless surgery is 100% effective, which is highly unlikely in most patients. The prognosis for mesothelioma is usually poor due to an advanced stage at initial diagnosis.

Many factors play into the length of mesothelioma survival, including: age, gender, stage at diagnosis, mesothelioma cell type, tumor location, and treatment success. 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, as well.

Mesothelioma Life Expectancy

Staging is important to determine mesothelioma life expectancy after diagnosis. Although these timelines look grim, improved treatments and clinical trials offer newly diagnosed patients a reason to seek experienced medical care.

Mesothelioma Stage Median Life Expectancy
Stage 1 21 months
Stage 2 19 months
Stage 3 16 months
Stage 4 12 months

Mesothelioma Clinical Trials

To learn more about clinical trials for mesothelioma, speak to your physician and visit the National Cancer Institute and search for “mesothelioma” on their search engine.  There are many ongoing trials, including some with new immunotherapy cancer treatments. Your physician can provide more detailed information.

Mesothelioma and Asbestosis

Asbestosis vs. Mesothelioma: Asbestosis is a chronic lung disease that often occurs in textile mining, milling, or manufacturing workers who inhaled asbestos fibers over a prolonged period in their workplaces. Asbestosis leads to shortness of breath, lung tissue scarring, and severe fibrosis. It takes 10–20 years for the disease to develop after exposure. Patients should be medically monitored periodically for disease progression and closely observed for asbestos-associated malignancies such as lung cancer, mesothelioma, and other cancers.

Asbestosis signs and symptoms can include:

  • Shortness of breath
  • A persistent, dry cough
  • Loss of appetite with weight loss
  • Fingertips and toes that appear wider and rounder than normal (clubbing)
  • Chest tightness or pain

A chest X-ray, a CT scan, and a pulmonary function (breathing) test may be used to diagnose asbestosis. Treatment focuses on relieving your symptoms; oxygen therapy may be offered. In some cases, a lung transplant might be an option, as well. Today, asbestosis is unlikely if you follow your employer's safety procedures.

Learn more about Asbestosis...

Mesothelioma Lawsuits

Mesothelioma has been the subject of many injury lawsuits, and, in fact is the longest running series of civil liability in U.S. history. Many patients wonder what they can do legally if they are diagnosed with mesothelioma.

There are U.S. lawyers that specialize in handling these cases. An asbestos trust fund in the U.S. is said to hold over $30 billion, as well, for people who have mesothelioma. Here are a few frequently asked questions about mesothelioma lawsuits that may help to answer some questions; always seek reliable and licensed lawyers to help with your individual questions.

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. Mesothelioma claims are usually brought against the company that you worked for where your 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 is decided on a state-by-state case. Speak to a 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 can 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. Mesothelioma Guide reports that roughly 575,000 claims were paid out in 2008, helping families manage lost wages and treatment. Some cases may not go to trial because the suit settles before trial. 

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; however, that may still be an option. 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. Typically, your estate would act on your behalf to divide any mesothelioma payouts among your survivors. It is always best to consult an experienced mesothelioma lawyer to discuss mesothelioma facts on a case-by-case basis.

History of Mesothelioma and the Internet

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 was 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 $US100.00.

In addition, many commercials advertising for mesothelioma lawyers are often seen on TV in the U.S.

Mesothelioma cases are expected to rise at least through 2025.

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