Mesothelioma

Overview and Facts about Mesothelioma

Malignant mesothelioma is a type of cancer that occurs in the tissue that lines the body (usually the chest and abdomen) and the internal organs, including the lungs and heart. Tumors form in the mesothelium, a protective membrane covering internal organs. This is a very serious and aggressive form of cancer, but very rare, affecting one in 150,000 people per year. When it is benign (noncancerous), it is called benign mesothelioma or solitary fibrous tumor and occurs most often in the chest. Benign mesothelioma is very uncommon, occurring in only 10 percent of all mesothelioma cases. This disease takes decades to develop in the mesothelium; most patients are age 60 and older.

• When mesothelioma is found in the area around the lungs (pleura), it is called pleural mesothelioma. This is the most common type of mesothelioma.
• Peritoneal mesothelioma occurs in the lining of the abdominal organs. It is less common than pleural mesothelioma, accounting for 10 to 20 percent of this type of cancer. 
• Pericardial mesothelioma is a very rare type of cancer that occurs in the lining of the pericardium, the covering around the heart.

Why Loyola?

We are proud to offer a one visit, one location approach for lung and thoracic cancers, such as mesothelioma. Loyola provides patients access to a multidisciplinary team of surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists and nurses at one convenient location. Our clinically integrated program means you receive a comprehensive evaluation, diagnosis and treatment plan designed specifically for your individual case.

The multidisciplinary thoracic oncology team at Loyola Medicine treats all major types of thoracic malignancies, including mesothelioma of pleural, peritoneal and pericardial sources. Working together with the medical oncology team, we provide our patients with a robust, collaborative approach to ensure comprehensive treatment.

Symptoms and Signs of Mesothelioma

Signs of mesothelioma are usually mild and easy to confuse with other conditions in its earlier stages. As the disease progresses, symptoms will be more severe, and will also vary according to where the tumor is located in the body.

Symptoms of a pleural (lung) mesothelioma:

• Shortness of breath
• Chest pain
• Fatigue
• Night sweats
• Unexplained weight loss

Symptoms of a peritoneal (abdomen) mesothelioma:

• Abdominal pain or bloating
• Constipation or diarrhea
• Nausea and vomiting

A pericardial mesothelioma may also have the following associated symptoms:

• Difficulty breathing, especially when lying down
• Heart palpitations or irregular heartbeat
• Murmurs

Causes and Risk Factors of Mesothelioma

While the cause is unknown, there is a proven link between exposure to asbestos and pleural mesothelioma. Direct exposure involves the inhalation of asbestos fibers that are not expelled by coughing or swallowing. You are also at risk if someone you live with has been exposed to asbestos or if there is exposure in your family history. Other minerals are also implicated in this disease, as well as genetic predisposition.

Other risk factors include:

• Previous radiation treatment
• Chronic inflammation
• Smoking is not a risk factor, but it is in small cell lung cancer and non-small cell lung cancer, which are found frequently in patients who have been exposed to asbestos.

Mesothelioma is more common in men than women, and usually occurs after the age of 65 because it takes 20 to 50 years to develop following asbestos exposure.

Industries that may have unsafe levels of asbestos include:

Tests and Diagnosis of Mesothelioma

A medical history (including potential asbestos exposure) and physical exam are the first steps to diagnosing mesothelioma. The first sign of the disease may be a   collection of fluid in your chest or abdominal cavity.

Your doctor will then likely order imaging tests to see inside the area of your body where you are experiencing symptoms. These tests include:

• Chest X-ray
• CT Scan
• MRI
• PET Scan

Your doctor may also want to remove a sample of pleural fluids and tissue  for a biopsy, so that cells in the affected area can be examined in a lab to look for specific signs, or markers, of mesothelioma. Tests used to remove fluid or tissue for analysis of mesothelioma include:

• Thoracoscopy: In this procedure, your surgeon makes one or more small incisions between your ribs to see inside your chest. This may be performed as an open procedure or a less invasive alternative called video-assisted thoracic surgery (VATS). In VATS, small tools are passed through small incisions in the chest cavity to perform the surgery.
• Thoracotomy: Your surgeon makes a long incision to open your chest between the ribs to check for signs of disease.
• Fine-needle aspiration: your physician removes tissue or fluid using a thin needle inserted into your chest or abdomen. This test is also performed to diagnose peritoneal mesothelioma.

These tests are best done in specialist centers that treat or have experience with mesothelioma, as special testing may be necessary to establish diagnosis. After diagnosis is performed, your doctor will stage the mesothelioma, determining the extent of the disease. This helps predict the outcome and find the best course for treatment. 

Treatment and Care for Mesothelioma

Treatment for mesothelioma varies depending on where it is located in the body and whether or not the cancer has spread. Most often, it is not found until its later or advanced stages. A combination of surgery, chemotherapy and/or radiation therapy is the usual course of treatment. Surgery is used to remove as much of the tumor as possible (macroscopic complete resection), and chemotherapy and radiation therapy are used to kill cancer cells and stop them from growing/spreading.

The following surgical options are available for mesothelioma treatment:

Pleural mesothelioma:

• Macroscopic complete resection: Removes as much of the disease as possible:
  • Pleurectomy/decortication: Removal of the tissue lining the ribs and lungs, as well as any tumor masses growing inside the chest cavity that may involve your breathing muscle (diaphragm and the sac around the heart (pericardium))
  • Extrapleural pneumonectomy: Removal of an entire lung and the surrounding tissues
• Pleurodesis: Insertion of a tube or catheter to drain fluid backup in your chest and inject medicine to prevent fluid form returning. This procedure is performed for symptom management only, to help make breathing easier.

Peritoneal mesothelioma:

• Peritonectomy/cytoreduction: Removal of the cancerous part of the lining of the abdomen (peritoneum)

Pericardial mesothelioma:

Pericardial mesothelioma is very rare. In selected cases, surgery is recommended to remove the restrictive effects of the tumor on the function of the heart.

• Surgery used to treat pericardial cancer is called a pericardiectomy. In this procedure, your surgeon removes all or part of the pericardium to help relieve  the constriction and minimize fluid buildup.

Loyola is committed to developing new and effective therapies for lung and thoracic cancer.  Our team’s efforts include designing clinical trials that bring new drug therapies to our patients, laboratory research on the biology of lung cancer and the exploration of new strategies to prevent, diagnose and cure lung cancer. In addition, highly targeted drugs that act more selectively on cancer cells and have a less toxic effect on normal cells are available in our clinic.

Prevention and Screening of Mesothelioma

Avoiding exposure to asbestos is the most important way to reduce your risk of mesothelioma. It is important to follow all safety precautions in the workplace, especially if you work in the mining, factory, insulation manufacturing, auto mechanics, construction or ship building fields.

Older homes and buildings may also contain asbestos. If you know or suspect you have asbestos in your home, hire a professional to advise whether it is safe to remove it. In many cases, it may be more dangerous to remove the asbestos as breaking it up causes fibers to become airborne and inhaled.

Medical Research in Action 

Over the past several years, lung and thoracic physicians at Loyola have published and presented numerous important findings in the study of mesothelioma. Topics range from tumor volume as an independent predictor of patient survival to how quality of life is affected by histological differentiation and procedures such as pleurectomy and decortication. By sharing such innovative studies in printed publications, national and international conferences and surgical society meetings, Loyola is advancing knowledge in the field, leading to more accurate diagnosis, prognosis and recovery of patients with lung and thoracic cancers. We also design and offer clinical trials that bring new drug therapies to our mesothelioma patients and explore new strategies to prevent, diagnose and treat lung and thoracic disease.