Definition
Mesothelioma is a rare type of aggressive cancer that is formed in the mesothelium, which is the protective lining around many of the internal organs. It is often labelled as ‘asbestos cancer’. A normal and healthy mesothelium cell can only reproduce a certain number of times which keeps certain cells from invading others. It is when these cells become mutated that cancer occurs and the cells reproduce uncontrollably. A lump is then formed by the large amount of mutated cells and is known as a tumor. There are two types of tumors; benign and malignant tumors. A benign tumor doesn’t allow the abnormal cells to spread to the area around it whereas a malignant tumor can spread to the cells around it. If a malignant tumor is left untreated it could spread and destroy healthy tissue and cells surrounding it. Cells off of the tumor can sometimes break off and spread through the bloodstream to other organs and tissue. It can also spread through the lymphatic system which is part of the body’s immune system. It includes bone marrow, the spleen and thymus, and lymph nodes found in the body that are all connected through lymphatic vessels. A new tumor that is formed is called a secondary tumor or a metastasis. Cancer is so dangerous for our bodies because of it’s ability to multiply and spread so quickly. Therefore, the sooner it is diagnosed, the better the chance one has of killing the cancerous cells and being cancer-free.
There are several different types of mesothelioma. The most common type develops along the pleura, which is the outer lining of the lungs and chest wall. This is known as pleural mesothelioma. It can also form along the pericardium, which is the protective sac around the heart. This type of mesothelioma is known as pericardial mesothelioma. The cancer can also form along the peritoneum, which is the lining of the abdominal cavity, and is known as peritoneal mesothelioma. Less commonly, mesothelioma can also develop along the tunica vaginalis, which is the protective sac around the testis. During the later stages of any type of mesothelioma, the cancer may spread to surrounding tissues in which it becomes more dangerous to the individual.
Cause
Mesothelioma is caused by a direct exposure to asbestos and/or when particles of asbestos are inhaled or ingested. Cases of second-hand exposure to asbestos has led to more diagnoses due to those handling the clothing, etc of those in contact with the asbestos. Most cases of mesothelioma are found in men however, women can be affected as well due to second-hand exposure. The disease can be dormant for 10-60 years after being exposed to asbestos. Therefore, it can be difficult to initially pin-point what the issue is and what it is caused by. Most individuals diagnosed with mesothelioma worked in shipyards, aluminum plants, steel mills, and power plants or worked as plumbers, electricians, pipe-fitters, contraction workers, boilermakers, and any other occupation where one would be exposed to airborne asbestos. In communities where asbestos factories or mines were located, many people have been diagnosed with mesothelioma. In some cases, entire towns have been affected by the dangerous airborne asbestos particles. For example, in Libby, Montana there was once a vermiculite asbestos mine and hundreds of people there have been diagnosed with mesothelioma and died from the disease. Smoking can greatly increase the change of developing mesothelioma after being exposed to asbestos. Therefore, it is important for an individual who has been exposed to stop smoking if they are a smoker and/or to not smoke at all. Overall, mesothelioma is known as the ‘asbestos cancer’ and is caused from direct or second-hand exposure to asbestos.
Signs and Symptoms
As mentioned above, often the signs symptoms of mesothelioma do not occur for several years after being exposed to asbestos. But once the signs and symptoms appear they become chronic very quickly. Typically the disease affects men aged 50-70. Signs and symptoms may depend on the type of mesothelioma the individual has. Below are signs and symptoms for each type of mesothelioma; pleura mesothelioma, pericardial mesothelioma, and peritoneal mesothelioma.
An individual with pleural mesothelioma, which affects the chest cavity and lungs, may experience all or some of the following signs and symptoms:
-shortness of breath
-fluid surrounding the lung(s)
-difficulty swallowing
-chest pain
-fatigue
-coughing, wheezing, or hoarseness
-anemia
-coughing up blood
-excessive sweating during the night
-fever
Pericardial mesothelioma, which affects the heart, causes signs and symptoms such as:
-heart palpations and/or a irregular heartbeat, also known as arrhythmia
-heart murmurs
-chest pain
-coughing
-difficulty breathing, even when resting
-fatigue
-fever and/or night sweats
An individual with peritoneal mesothelioma, which affects the abdominal cavity, may experience signs and symptoms such as:
-abdominal pain
-a mass (tumour) in the abdomen
-a buildup of fluid in the abdomen
-sudden unexplained weight loss
-issues with bowel movements
More severe and chronic signs and symptoms for any/all types of mesothelioma are:
-jaundice or yellowing of the skin and eyes
-blood clots in veins
-severe bleeding in several body organs
-low blood sugar
-blood clots in the lungs (in the arteries)
-buildup of fluid along the tissue of the lining of the lungs and chest wall (pleural effusion)
-buildup of fluid in the space between the tissues surrounding the abdomen and abdominal organs
Diagnosis
If an individual is experiencing any of the above symptoms, they should see their doctor as soon as possible. An early diagnosis allows for a better chance of recovery and relief due to the cancer being caught at an early stage and more treatment options being available. Typically, a diagnosis is made within 3-6 months of the patient’s first visit with their family doctor after which they are transferred to an oncologist or a pulmonolgist and, at times, an oncologist who specializes in mesothelioma types of cancer. Before a diagnosis is made, the family physician will examine the patient’s medical history, looking at past and present health concerns, such as respiratory issues, and the family history of cancer. A physical examination will also be performed where the doctor will look for signs or tumors, listen to the individuals breathing, check for localized tenderness upon palpation, and any reduced chest expansion with breathing. Prior asbestos exposure is a major factor the doctor will consider upon examination as well.
From here, the family doctor will refer the patient to an oncologist or pulmonologist for further investigation. The specialist may prescribe a chest x-ray, CT scan, MRI, and or PET scans. Blood tests can also detect any signs of mesothelioma and assist in diagnosing the cancer at an earlier stage, even before symptoms arise. The hope is that some day blood tests will be perfected to assist in diagnosing cancer in the earliest stages of development. If their are any concerns from any of these results, the doctor will most likely perform a biopsy or serous effusion cytology for further examination. Biopsy’s are the most effective way to diagnose mesothelioma. Essentially, a needle is inserted into the area and tissue samples are removed and tested for cancerous cells. A diagnosis may be confirmed after these results are reviewed by the doctor. From here, treatment options will be discussed with the patient based on the type of mesothelioma is present.
Treatment
Once mesothelioma is diagnosed, treatment options will be discussed between the patient and the doctor. There is no known cure for mesothelioma and the prognosis for patients is poor. However, there are several treatment options such as chemotherapy, radiation therapy, and, at times, surgery which can attempt to remove the cancer and/or assist in treating the signs and symptoms. Certain alternative therapies can also be beneficial and provide assistance to patients.
For those suffering from pleural mesothelioma, the treatment options depend on what stage the cancer is at and the individuals’ overall physical health. Treatment options for pleural mesothelioma are surgery along with chemotherapy or surgery, chemotherapy, and radiation therapy. Some more recent experimental treatment options are photodynamic therapy and immunotherapy which can be used if the cancer is more localized.
Pericardial mesothelioma is a rare form of mesothelioma cancer and difficult to treat due to the proximity to the heart. Most people diagnosed with pericardial mesothelioma are not good candidates for cancer surgery because of the risk or performing surgery on a cancer that is surrounding the heart. That being said, there have been some cases where the cancer is caught early and the individual has surgery to remove the small and localized tumors from the area. Typically someone diagnosed with pericardial mesothelioma does not have a very good chance of beating the cancer and palliative treatment is sometimes the only option. Palliative care treatment would aim to improve the patients quality of life and help to make the inevitable symptoms they experience less severe. A fine needle can remove excess fluid from around the heart to decrease discomfort as well. Radiation is an option but not readily used due to the close proximity of the heart and lungs. Typical survival rate of this type of cancer is slim and roughly 50-60 percent of patients pass away within 6 months.
Peritoneal mesothelioma is no exception when it comes to effectiveness of treatment. Most treatment options are palliative and include methods such as chemotherapy and radiation therapy. If caught early, surgery can be performed in an attempt to remove any tumors which can dramatically add years to their initial prognosis. After surgery is performed, the individual will also undergo chemotherapy and/or radiation in an attempt to kill any remaining cancer cells.
Overall the prognosis for one diagnosed with mesothelioma is poor. Although doctors perform surges and prescribe medications to remove the cancer, it is often unsuccessful especially since mesothelioma is typically diagnosed in the later stages. Studies and trials for new drugs are constantly being tested and hopefully, one day, we will have a cure for mesothelioma cancer.
Prevention
Mesothelioma is caused by an exposure to asbestos due to the lack of proper protection to those working with the product. Despite the knowledge of the dangers of asbestos, many employers have neglected to provide the proper protection to their employees. Recently, public awareness of the dangers has improved job sites and employees are now offered protective gear such as respirators, aprons, gloves, and other items to assist in avoiding unnecessary exposure to such a dangerous product. For those who do suffer the consequences of asbestos exposure, lawyers are involved and companies are paying millions of dollars as compensation.
Many people who have been directly exposed to asbestos believe that it’s already too late and the discussion of the prevention of mesothelioma is not a factor to them. However, direct known exposure is not the only reason for one to be concerned. During the 20th century, asbestos was used in many products that can be found in our homes, offices, and factories all across North America. Asbestos is still encountered today, often during renovations and/or expansions in homes, shipyards, power plants, chemical plants, on the railroad, and in the automotive industry.
Precautions in the home should be taken during renovations, especially in older homes. Products such as attic insulation, roof shingles and tar, drywall and drywall glue, popcorn ceilings, floor tiles, wrapping on pipes and electrical wires, and joint compounds should all be removed with care. As a general rule, in any home built prior to 1980, protective gear should always be worn.
Similarily, precautions should be taken on job-sites where asbestos is suspected. Wearing proper gear to avoid inhalation of the chemical is important and is mandated. If an individual has been exposed to asbestos but has not developed any signs or symptoms yet, they should follow some general guidelines. Firstly, they should inform their family doctor of their exposure so they can monitor them during regular checkups. It is also important to have regular chest x-rays done and pulmonary function tests completed, whether there are symptoms or not. Also, quitting and/or not smoking will significantly reduce the emergence of the disease. Regular healthy checks are important to allow for early detection and early treatment which can greatly improve the individuals prognosis.
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