Mesothelioma: Comprehensive Cancer Information

Mesothelioma: A Comprehensive Guide

This information is intended to provide a general overview of mesothelioma. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.

General Information

Mesothelioma is a rare form of cancer that originates in the mesothelium, a protective layer of tissue that lines many of the body's internal organs. Most commonly, it starts in the pleura, the tissue lining the outside of the lungs and the inside of the chest wall, known as malignant pleural mesothelioma. A less common type, malignant peritoneal mesothelioma, starts in the abdomen.

Unlike many tumours with clear, defined edges, mesothelioma tends to surround organs and fill the chest and abdominal cavity, which can compress the lungs.

Causes and Risk Factors

The primary cause of mesothelioma is past exposure to asbestos, a fibrous mineral historically used across various sectors, including construction, automotive, military, marine, and manufacturing. When tiny asbestos particles are disturbed, they can be inhaled or swallowed. These fibres can remain in the body for decades, sometimes causing genetic changes to mesothelial cells that lead to cancer. The disease typically develops 30 to 50 years after the initial exposure, and patients are often unaware of this history.

Other risk factors include:

  • Gender: Mesothelioma is more common in men, likely due to a higher prevalence of men working in asbestos-using industries.
  • Genetic Changes: A small number of cases are linked to a mutation in the BAP1 gene, which is believed to increase the risk in individuals exposed to asbestos.
  • Radiation Exposure: Individuals who have received radiation treatment for other cancers may have a slightly increased risk later in life.

It is important to note that asbestos exposure can also cause other serious health issues, including cancers of the lung, larynx, and kidney, as well as asbestosis (a non-cancerous, chronic lung disease).

Mesothelioma Cell Types

Mesothelioma is also categorised by the type of cell involved, which influences the patient's outlook:

Epithelioid

Accounts for 60% to 70% of cases and generally has the best outcomes.

Sarcomatoid

Accounts for about 10% to 15% of cases and is a more aggressive type.

Biphasic or Mixed

Contains both epithelioid and sarcomatoid cells and is an extremely aggressive form of the disease, making up 10% to 15% of cases.

Symptoms

Because symptoms can resemble those of other illnesses, mesothelioma is often not diagnosed until it has advanced. The signs typically vary among individuals, with many symptoms caused by fluid accumulating in the chest (pleural effusion) or the tumour pressing on the lungs.

Common Symptoms may include:

  • Shortness of breath
  • Constant, uninterrupted chest or abdominal pain
  • Fatigue
  • Collapsed lung

Less Common Symptoms may include:

  • Persistent coughing
  • Unexplained weight loss
  • Blood in sputum (phlegm) coughed up from the lungs
  • Difficulty swallowing
  • Prolonged hoarseness
  • Nausea
  • Low oxygen levels

It is essential to discuss any new or concerning symptoms with your doctor, as they may indicate other underlying health problems.

Diagnosis

The overlapping symptoms with other diseases, such as lung cancer, heart failure, and pneumonia, can make mesothelioma challenging to diagnose. Early and precise diagnosis is crucial for effective treatment.

The diagnostic process involves a thorough examination and a discussion of your health history, lifestyle, and any past exposure to asbestos. One or more of the following tests may be used:

Biopsy

This is typically the only way to definitively diagnose mesothelioma and involves removing suspected tissue for microscopic study.

  • Needle biopsy: Doctors insert a needle to sample part of the tumour or drain fluid from the area, which is then examined for cancer cells.
  • Thoracoscopic surgical biopsy: A small incision is made in the chest to insert a tube with a camera, allowing for the removal of a tissue sample.

Imaging Exams

Used to help determine the extent of the disease and plan treatment.

  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • Chest X-ray

Lung Function Test

These are not used for diagnosis but help determine the condition of the patient's lungs, which is important for assessing suitability for surgery.

Pathologists at SSCHRC have special expertise in diagnosing mesothelioma and its subtypes, ensuring an accurate diagnosis from the start to inform the best possible treatment plan.

Treatment

Mesothelioma treatment is typically a multi-modal approach, combining different therapies to reduce the amount of cancer, slow its progression, and relieve symptoms. Treatment plans are highly personalised based on: the type and stage of mesothelioma, the cancer's location, and the patient's age and general health.

Surgical Procedures

Surgery alone rarely cures the disease but is intended to reduce the tumour burden to minimal levels. Two main types of surgery are performed:

Extrapleural Pneumonectomy (EPP)

An extensive procedure involving the removal of the entire pleura (lining of the lung and chest wall), the affected lung, the diaphragm, and the pericardium (the sac surrounding the heart). This provides a more complete tumour removal but has a higher risk of complications and is generally reserved for physically fit patients.

Pleurectomy/Decortication (P/D)

This involves removing the affected areas of the pleura, lymph glands, diaphragm, and pericardium, but the lung remains in place. P/D is a safer option for older patients and often offers a higher quality of life, though the tumour may be more likely to return compared to EPP.

Systemic and Local Therapies

Chemotherapy

Works by directly killing cancer cells. It is proven to prolong life and is often given before surgery to shrink the tumour, or as the main treatment for patients who are not suitable candidates for surgery.

Radiation Therapy

Uses high-energy beams to destroy cancer cells. It is commonly used after surgery to eliminate any microscopic residual disease, usually delivered as Intensity-Modulated Radiation Therapy (IMRT). It can also be used for palliative care, such as 3D conformal radiation therapy, to relieve pain or discomfort.

Immunotherapy

Improves the body's immune system to fight cancer. Immune checkpoint therapy is an option for some patients, helping cancer-fighting T cells mount a longer-lasting response against the disease.

Targeted Therapy

Designed to interfere with specific molecules or genes that cancer cells rely on to survive, multiply, and spread, thereby stopping or slowing the disease's progression.

Clinical Trials

As a leading cancer centre, SSCHRC conducts multiple mesothelioma clinical trials, offering patients access to pioneering and novel treatments. Doctors only recommend a clinical trial when they believe it offers the best treatment option for the patient's specific condition.

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