What to know about mesothelioma

Mesothelioma is a rare cancer that’s most commonly found in the lining of the lungs or abdomen, but it can also start in the lining of the heart or testicles in rare cases.

Mesothelioma is most common in men ages 45 to 85. Typically, it occurs in those who’ve been exposed to asbestos, a fibrous mineral used in construction and manufacturing until it was banned by the Environmental Protection Agency in 1989. But not everyone who’s been exposed to asbestos will get mesothelioma.

In rare cases, mesothelioma can be passed down in families through the BAP1 gene, or BRCA1-associated protein 1.

Not everyone who’s been exposed to asbestos will get mesothelioma, but if you’ve been exposed, you could be at risk. To learn about mesothelioma symptoms, diagnosis and treatment options, we spoke with Anne Tsao, M.D. Here’s what she shared.

What are common mesothelioma symptoms?

Mesothelioma symptoms often don’t appear until it’s advanced. It may be 20-30 years or more after you’ve been exposed to asbestos.

When it begins in the lungs, it’s called pleural mesothelioma. Shortness of breath is one of the first symptoms, but fluid in your lungs may also cause constant coughing or wheezing. As the tumor grows, it may press against other parts of your body, causing chest pain.

Peritoneal mesothelioma begins in the lining of the abdomen; its first sign is usually abdominal bloating.

You should tell your doctor if you experience any of these symptoms.

How is mesothelioma diagnosed?

If you’re experiencing shortness of breath, your doctor will most likely perform a chest X-ray. This would show any fluid in your lungs.

If the X-ray shows fluid in your lungs, your doctor may perform a procedure called a thoracentesis. During this procedure, your doctor will insert a needle into the space between the lungs and chest wall to remove fluid. Once the fluid is drained, it will be examined for cancer cells.

Unfortunately, cancer cells only show up 30% of the time, so your doctor may have to do more than one thoracentesis to find cancer cells.  

How is mesothelioma typically treated?

The type of treatment your doctor recommends depends on the stage and location of the tumor, as well as your age and overall health.

There are two different types of surgery your doctor may recommend:

• Extrapleural pneumonectomy removes all organs where mesothelioma has spread. This may include the lung, lymph nodes, diaphragm or lining of the heart. The diaphragm and heart lining are then rebuilt with a sheet of artificial material. 
• Pleurectomy/decortication involves peeling the tumor away from the lung, diaphragm and chest wall.
  

Radiation therapy after surgery can reduce the chances of cancer coming back. In some cases, it may also help relieve pain or discomfort. Your doctor may recommend a technique called intensity modulated radiation therapy, or IMRT. It focuses multiple radiation beams of different intensities directly on the tumor using the highest possible dose. IMRT may lead to better results and fewer side effects than other types of radiotherapy.

Chemotherapy, immunotherapy, or targeted therapy may also be used to slow tumor growth and prevent organ damage.

Which treatment options are best for which patients?

Your doctor may recommend extrapleural pneumonectomy if the mesothelioma is diagnosed early, before it has spread or caused serious damage to your organs. Because this complex surgery involves removing a lung, it’s only an option if you’re in good physical shape.

Pleurectomy/decortication may be a surgical option if you’re not eligible for an extrapleural pneumonectomy. Since the tumor usually can’t be removed entirely, there’s a risk of recurrence.  But this procedure relieves pain and shortness of breath, so your quality of life may improve.

Unfortunately, many mesothelioma patients aren’t diagnosed until the disease is more advanced. In these cases, surgery is not an option. When this happens, our goal is to give you more time with your family, improve your quality of life and relieve any cancer pain you have.

Anything else you want mesothelioma patients to know about treatment?

No matter when you’re diagnosed or what type of treatment your doctor recommends, it’s important to be as physically active as possible and maintain a balanced diet. This can help your body stay healthy enough for treatment and its side effects. If you’re an MD Anderson patient, ask your care team for a referral to one of our dietitians and the Integrative Medicine Center.

It’s also important to keep in mind that we have new ways to treat mesothelioma that weren’t options even two or three years ago, thanks to research and clinical trials.

Finally, there’s always hope. As long as you’re healthy enough to undergo treatment, there are options for you. If you have mesothelioma, you can have a good quality of life.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.