Learn About Mesothelioma
If you or a loved one has mesothelioma, you’ll likely want to understand the science behind it.
Mesothelioma is a rare and aggressive cancer affecting between 3,000 and 3,300 people in the U.S. each year. This disease develops in the linings of the lungs, abdomen or heart. Mesothelioma is caused by asbestos exposure, and the cancer usually forms 20 to 50 years after the patient was exposed.
Types of Mesothelioma
There are three primary types of mesothelioma based on tumor location: pleural, peritoneal and pericardial.
This cancer forms in the pleura, which is a thin lining that separates your chest wall and lung cavity.
This cancer originates in the peritoneum, which is a membrane that wraps around your abdominal cavity.
This cancer develops in the pericardium, the membrane which encloses your heart.
Treatment Options for Mesothelioma
Surgery, chemotherapy and radiation are the three most often-used treatment options for mesothelioma. There are multiple types of each method and some are only used for one specific type of mesothelioma.
Mesothelioma experts believe a multimodal approach is the most effective way of attacking this cancer. A multimodal approach involves two, or even three, of the main treatment methods.
Surgery is the most effective treatment for mesothelioma patients. Surgeons try to remove most, if not all, of the tumors from the body during an operation.
Pleural Mesothelioma Surgery
Extrapleural pneumonectomy — This operation involves the removal of the pleura, affected lung, diaphragm and the lining around the heart (pericardium). Extrapleural pneumonectomy is the more invasive of the two pleural mesothelioma surgeries and is recommended when the cancer has spread beyond the pleura.
Pleurectomy with decortication — This procedure spares the lung while removing the cancer’s point of origin, the pleura. Pleurectomy with decortication is less invasive and requires less recovery time, but it may only be beneficial in early stage mesotheliomas. Some doctors may use this surgery for late-stage patients in an extended form, with the diaphragm and other areas removed along with the pleura.
Peritoneal Mesothelioma Surgery
For peritoneal mesothelioma patients, the primary surgery is cytoreduction with heated intraperitoneal chemotherapy (HIPEC). The procedure involves removing the lining of the abdomen, called the peritoneum, and any visible tumors in the abdominal cavity. The abdomen is then bathed with heated chemotherapy to target any remaining cancer cells.
Pericardial Mesothelioma Surgery
Pericardial mesothelioma patients can undergo a pericardiectomy. This operation involves the removal of your pericardium, which is the lining surrounding your heart. Doctors usually recommend this procedure for patients who experience constrictive pericarditis (inflammation and stiffening of the pericardium).
While there are specific surgeries for each type of mesothelioma, chemotherapy is the only Federal Drug Administration-approved treatment for all forms of the cancer. The drugs can be used as a secondary option, paired with surgery, or as the first treatment.
The goals of chemotherapy include:
- Killing or shrinking mesothelioma tumors
- Preventing the spread of cancerous cells
- Relieving symptoms
- Improving the effectiveness of surgery or other treatments
Mesothelioma Chemotherapy Drugs
Pemetrexed and cisplatin are the two FDA-approved chemotherapy drugs for mesothelioma. They are often paired together to contain and attack the cancer. Other medications are used in an experimental setting or if pemetrexed and cisplatin are ineffective. Additional chemotherapy drugs include:
Mesothelioma chemotherapy usually produces uncomfortable side effects. Patients often report nausea, fatigue and a phenomenon known as “chemo brain,” which involves memory loss and concentration issues.
Radiation is another treatment method, usually used as a secondary option before or after surgery. Radiation also is paired at times with chemotherapy and is used for pain-relief purposes in late-stage patients.
Radiation therapy involves sending high-energy beams into the area where the mesothelioma tumors exist. Treatment is painless, making radiation one of the least-invasive options for patients.
Radiation sessionsUsually last around 15 minutes and occur five days per week
Emerging Treatments for Mesothelioma
Aside from surgery, chemotherapy and radiation, researchers are constantly uncovering new and promising ways of treating mesothelioma.
Virotherapy involves injecting the body with diseases that could attack and kill cancerous cells. Experts modify the viruses so that they ignore healthy cells.
Immunotherapy involves using drugs that specifically target cancerous proteins found in tumors. These drugs boost the immune system, which protects the body from diseases.
Gene therapy involves inserting healthy genetic material into the body. This therapy either aims to restructure flawed cells or kill ones which can't be fixed.
Clinical trials offer patients an opportunity to receive treatments not yet approved by the FDA. With patients' participation, researchers could discover a therapy or another form of care that saves thousands of lives.
Humanitarian Use Devices
In 2019, the FDA approved a medical device for pleural mesothelioma treatment. The NovoTTF-100L sends electrical currents into the body. These currents attack the mesothelioma cells.
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Mesothelioma has a latency period of between 20 and 50 years, which makes early detection and diagnosis difficult. When early diagnosis is achieved, mesothelioma is much easier to treat as the tumors likely haven’t spread beyond their origin location.
The process for learning if you have mesothelioma involves multiple tests. However, the only scientifically approved way of diagnosing the disease is a biopsy.
There are four main imaging tests involved in diagnosing mesothelioma:
- 1X-Ray — Provides a two-dimensional image of the abdomen and chest.
- 2CT scan — Shows a three-dimensional image of the abdomen and chest.
- 3PET scan — Involves radioactive sugar inserted into the blood. Cancerous cells will absorb the sugar, indicating their presence.
- 4MRI scan — Inspects tissue to check for any damage or cellular mutation.
Tissue biopsies are the most conclusive type and they require a minor surgery to perform. Fluid samples are less invasive than a tissue biopsy but not as surefire of a diagnostic option since the tissue is where the tumors form and grow.
In addition to learning if mesothelioma is present, biopsies also help the treatment team discover the histological makeup of the disease and the patient’s prognosis. Mesothelioma cells can be epithelioid, sarcomatoid or a combination of the two (called “biphasic”).
A biopsy is the extraction and examination of tissue or fluid from the patient.
Symptoms of Mesothelioma
Early detection is key to stopping the spread of mesothelioma and treating the disease with surgery and chemotherapy. Patients should know the common symptoms associated with mesothelioma. The symptoms vary for each type of mesothelioma.
- Chest and lower back pain
- Persistent coughing
- Pleural effusions (fluid buildup)
- Difficulty breathing
- Night sweats
- Abdomen and lower back pain
- Abdominal swelling due to peritoneal effusions (fluid buildup)
- Bowel issues
- Loss of appetite
- Irregular heartbeats
- Difficulty breathing
- Chest pain
- Arm or facial swelling
- Pericardial effusions (fluid buildup)
Mesothelioma Prognosis and Life Expectancy
The prognosis and life expectancy for mesothelioma depends on numerous factors: one’s overall health, age, cell type and stage of the cancer. Other elements include the treatment used following each patient’s diagnosis, as surgery often carries the best results for prolonged survival.
Stages of Mesothelioma
The four stages of mesothelioma are based on tumor size and location. According to a study published on UpToDate, the average life expectancy for pleural mesothelioma patients by stage is as follows:
Stage 1average survival time is 20 months.
Stage 2average time is 19 months.
Stage 3average time is 16 months.
Stage 4average time is 11 months.
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