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What Is Mesothelioma? What Are The Options Once Diagnosed With Mesothelioma?

question_blue.pngAccording to the American Cancer Society, malignant mesothelioma is a cancer that starts in the cells that line certain parts of the body, most commonly the lungs and stomach. The lining formed by these cells is called mesothelium. These cells protect organs by making a special fluid that allows the organs to move. For instance, this fluid makes it easier for the lungs to expand and contract during breathing. Mesothelioma also can occur in the heart and testicles.

The mesothelium has different names in different parts of the body:
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  • In the chest it is called the pleura. Pleural mesothelioma typically occurs on only one side of the lung and rarely spreads to bone, brain or adrenal glands.
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  • In the belly or abdomen it is called the peritoneum. Peritoneal mesothelioma begins in the abdominal cavity and affects the entire digestive track. This is an uncommonly aggressive cancer that is more likely to spread to lymph nodes.
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  • In the space around the heart it is called the pericardium. Pericardial mesothelioma is the rarest, but the most lethal form of mesothelioma. Because of the heart’s involvement, it is rarely operable.

Tumors of the mesothelium can be benign or they can be cancer. A cancer tumor of the mesothelium is called a malignant mesothelioma, but this is often shortened to just mesothelioma.

There are 4 main types of mesotheliomas based on how the cells look under a microscope.

  1. Epithelioid: This is the most common type. It tends to have a better outlook (prognosis) than the other types.
  2. Sarcomatoid (fibrous): About 1 to 2 out of 10 mesotheliomas are of this type.
  3. Mixed (biphasic): This type has features of both Epithelioid and Sarcomatoid. About 3 to 4 out of 10 mesotheliomas are the mixed type.
  4. Desmoplastic: This is the rarest form of Mesothelioma.

What is Cancer? Now that a definition has been given for Mesothelioma that explains the specific regions of the body that may be affected by this cancer and the types that it can come in, one might be left wondering “what is cancer?” Cancer begins when cells in the body grow out of control. There are many types of cancer, but they all begin in this manner. During one’s youth, normal cells grow or divide at a rate to accommodate growth. After that, cells should only divide to replace damaged or dying cells. Unlike regular cells, cancer cells, instead of dying, grow and divide rapidly and can potentially invade other areas of the body; this is known as metastasis. Cancer usually manifests in tissue and forms tumors, but it can also be in the blood or in the marrow of bones.

Mesothelioma, like any type of cancer, can only be conclusively diagnosed with a biopsy. A biopsy is the removal of a sample of tissue or cells. These cells are then examined under a microscope to determine if they are cancer, and if so, what type. When a whole lump or targeted area is removed surgically, it is called an Excisional biopsy. When just a sample of tissue is removed, the procedure is called an Incisional biopsy (core biopsy). Because it is rare, Mesothelioma is often overlooked and misdiagnosed.

Symptoms of mesothelioma :

Symptoms of pleural mesothelioma include:

  • chest pain that is caused by a build-up fluid around the lungs.
  • Difficulty breathing and wheezing
  • Persistent cough, usually productive (a cough that produces fluid known as sputum)
  • Blood in the sputum
  • Hoarseness or a change in voice

Symptoms of peritoneal mesothelioma include:

  • Abdominal pain
  • Swollen or extended stomach caused by ascites which is a build-up of fluid in the abdomen
  • Abdominal masses
  • Loss of weight and appetite
  • Problems with bowel functions

Symptoms of pericardial mesothelioma include:

  • Heart palpitations or irregular heartbeat
  • Loss of weight
  • Persistent cough
  • Chest Pain
  • Shortness of breath

Causes of Mesothelioma: There is very little dispute as to what causes mesothelioma of any type. Asbestos. Asbestos is a set of six naturally occurring silicate minerals used commercially for their desirable physical properties. When asbestos fibers are inhaled or ingested most are expelled; however some become lodged in the lining of organs associated with the respiratory or digestive systems.

Most asbestos exposure is occupational. This is when someone is exposed to asbestos during, and as a result of, his daily work routine. Because of its resistance to heat and its inexpensive price tag, a variety of industries including construction, automotive and manufacturing made use of this potentially toxic mineral. Asbestos exposure can also take place when someone who has been occupationally exposed brings asbestos fibers home on their clothes or work gear. Family members who wash the asbestos covered clothes or clean up after and tend to the workers asbestos covered gear are also at risk. This is known as secondary exposure. Bystander exposure is when, although not working directly with an asbestos containing product, an individual is exposed because they are in close proximity to a situation where asbestos dust is being created. For example, in a building undergoing construction; in a building that is in a state of dis-repair where asbestos containing ceiling tiles or drywall are deteriorating and creating dust; in a warehouse or clerical or administrative setting where asbestos products are being opened and or used creating asbestos containing dust.

stethoscope blue.jpgTreatment Options – There are factors that must be taken into consideration when evaluating prognosis (chance of recovery) and treatment options:

  • The stage of the cancer. The stage of the cancer is determined by tumor size, the type of cancer it is and to what extent it has spread. Stages are numbered one through four.
  • The size and location of the tumor.
  • Whether the tumor can be removed completely by surgery.
  • The amount of fluid accumulated in the chest or abdomen.
  • The patient’s age and general health, including lung and heart health.
  • The type of mesothelioma cancer cells and how they look under a microscope.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Once all the diagnostic information is assessed, it can be determined what treatment options are available. Sometimes the approach is a combination of treatments, and sometimes, because mesothelioma is often diagnosed in its late stages, the only treatment is that which can aid in controlling the cancer and make the patient more comfortable.

Medicinal or chemical Treatment: Chemotherapy is the use of chemicals that kill cancer cells. Chemotherapy can be used before surgery to shrink the tumor and make the surgery easier, or after surgery to prevent the return of the cancer. Radiation therapy focuses high-energy beams, such as X-rays, to a specific spot or spots on your body. Radiation may reduce signs and symptoms in people with pleural mesothelioma. Radiation therapy is sometimes used after biopsy or surgery to prevent mesothelioma from spreading to the surgical incision.

Surgical Techniques: Surgery is an option in instances where mesothelioma is diagnosed at an early stage. Sometimes it isn’t possible to remove all of the cancer. In those cases, surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in your body. Surgery can decrease fluid buildup, be used to remove the tissue around the lungs or abdomen, remove as much of the cancer as possible – also known as debulking, or to remove a lung and the surrounding tissue which allows higher doses of radiation to be used.

Clinical Trials are experimental treatments that explore new methods of treating mesothelioma. These must be evaluated very carefully and discussed with your doctor.

Psychological Treatment: Dealing with the physical symptoms, which usually include loss of breath, the medical treatment and side effects thereof, the legal questions that arise from a diagnosis of mesothelioma as well as the personal and emotional trauma is all too often an insurmountable amount of stress. This often leads to severe depression, anxiety and feelings of isolation. The psychological ramifications of the disease must also be dealt with.

Legal Rights: Manufacturers were aware that asbestos was dangerous and potentially lethal if inhaled. They continued production of asbestos containing goods without advising of the hazards and with no regard for the safety of the end user. Someone who has been diagnosed with mesothelioma may have a legal right to compensation. It is important to have experienced, effective and aggressive legal representation to protect those rights and seek all recompense allowed by law and within the time-frame dictated by the applicable statute of limitations.

Nearly 3,000 people are diagnosed with mesothelioma every year. There are support groups and resources that can be used to determine what courses of action are right for you and your family. Being properly informed can help make difficult decisions a little easier
medical reference books.jpgREFERENCES:

Sugarbaker Oncology Associates: Specialty Section for the Treatment of Peritoneal Mesothelioma

Mesothelioma Applied Research Foundation

The May Clinic: Mesothelioma Treatments and Drugs