Mesothelioma – A Comprehensive Guide

What is Mesothelioma?

Mesothelioma is a rare form of cancer that develops on the cells of the mesothelium – the lining that covers some of the internal organs in your body. Around 2,500 people are currently diagnosed with mesothelioma each year in the UK – and nearly half of those are over the age of 75.

There are two main types of the condition: pleural mesothelioma (which occurs in the lungs) and peritoneal mesothelioma (which occurs in the abdomen). In this article, you’ll find out more about the disease, what causes it and what treatment is available.

Understanding Mesothelioma

Pleural Mesothelioma:

Pleural mesothelioma occurs in the pleura of the lungs. This is the smooth membrane covering each of your lungs and it is made up of two layers; an inner layer which is next to your lung and an outer layer, which is against the chest wall.

Normally, these two layers slide easily across one another as you inhale and exhale. However, when mesothelioma develops in this location, these layers thicken and may press against the lung. This thickening can also cause fluid to accumulate between the layers.

Pleural mesothelioma causes a variety of symptoms, including:

• Breathlessness
• Pain or discomfort in the chest
• Persistent coughing
• Sweating (often at night)
• Loss of appetite
• Unexplained weight loss
• Excessive fatigue

 

Peritoneal Mesothelioma:

Like your lungs, your peritoneum also has two layers of lining. The inner layer lies against your abdominal organs and the outer lines the abdominal wall. In exactly the same manner as pleural mesothelioma, peritoneal mesothelioma causes these layers to thicken; and in this instance, it causes fluid to accumulate in the abdomen. We call this fluid ascites – and it causes the abdomen to become swollen.

Symptoms of peritoneal mesothelioma differ from the pleural form, and include:

• Pain or discomfort in the abdomen
• Swelling or bloating in the area
• Changes to bowel movements (constipation or diarrhoea)
• Nausea or vomiting
• Fatigue
• Loss of appetite
• Unexplained weight loss

Other Types

Pleural mesothelioma is the most common form of the disease and affects approximately 75%-90% of sufferers.

It’s also possible to develop mesothelioma in the lining of the heart or the testes – but this is incredibly rare.

What Causes Mesothelioma?

Some researchers have identified an ‘indisputable’ link between mesothelioma and exposure to asbestos – most notably in this 2009 U.S study. In the vast majority of cases to date, strong links between asbestos and the illness have been identified – which further reinforces this claim.

The most common root cause is occupational exposure – being exposed to asbestos whilst working. Asbestos was widely used in a variety of industries from the 1940s to the 1970s; in mining, construction, manufacturing and the motor industry. Additionally, families of those who worked in these industries were also at risk – as the family member may have brought home asbestos fibres on their clothing.

However, environmental exposure is also possible, though less common. This includes those who live near areas where asbestos naturally occurs – though this tends to happen in other countries; notably Turkey, Greece and China.

How Does Asbestos Cause the Disease?

Asbestos is actually a natural mineral that comes in three types: blue (crocidolite), brown (amosite) and white (chrysotile). All three are now recognised as harmful. They were used in the UK until the 1980s, when blue and brown asbestos was banned. White asbestos wasn’t banned until 1999.

When asbestos is damaged or broken apart, it releases minute fibres into the air, which can either be breathed in or accidentally swallowed. When inhaled, asbestos fibres may settle themselves on the lining of the lungs, which over time, causes the cells to mutate. Likewise, when accidentally consumed, the fibres adhere to the digestive tract and then may move to the lining of the peritoneum.

The damage is not immediate. Indeed, it can take as long as 60 years for symptoms of mesothelioma to become apparent. However, most commonly, symptoms start manifesting themselves within 30-40 years after initial exposure.

Getting a Diagnosis

You should see a GP immediately if you have a cough that lasts for longer than two weeks, or experience any abdominal or chest discomfort for two weeks or more. This is especially the case if you know you’ve worked with asbestos in the past. It’s unlikely that you’ll have mesothelioma as it’s a relatively rare condition – but it’s important to receive formal diagnosis as swiftly as possible.

Seeing your GP:

When you see your doctor, make sure you let them know that you’ve been exposed to asbestos in the past. Depending on your symptoms, you’ll then be referred for a variety of medical tests to ascertain whether or not you have mesothelioma.

Testing for pleural mesothelioma:

Initially, you’ll probably be referred for a chest x-ray, to identify any thickening in the lining around your lungs. The radiologist will also look for any evidence of fluid build-up – another tell-tale sign of mesothelioma.

If the x-ray suggests that mesothelioma might be present, the next step is to have a CT scan. This is a completely painless procedure and enables the doctor to generate a 3D x-ray image of your lungs, in order to perform a better diagnosis.

Further testing:

If your doctor suspects that you may have pleural mesothelioma, it’s likely that they’ll want to drain some of the fluid from the pleura. This process is called pleural aspiration. You’ll be given local anaesthetic, then a needle will be inserted to remove a sample of the fluid for testing.

You may also be required to have a biopsy, where cells are removed from the affected area and tested. A biopsy enables your doctor to provide a more conclusive diagnosis. These cells can be gathered in a variety of ways:

• CT-guided biopsy. Using local anaesthetic, your doctor will pass a needle into the affected area, using a CT scanner to guide them.
• In another procedure, a small incision is made in the chest, and a thin tube inserted into the affected area. The doctor can then use a camera to observe the lungs, and to remove cells for testing. You’ll either be given a general or local anaesthetic for this procedure.
• Generally, you’ll only have a mediastinoscopy if your doctor believes the mesothelioma has spread to your lymph nodes. In this instance, the small incision is made at the base of the neck instead.

 

Occasionally, even after examining the cells taken at the biopsy, your doctor still won’t definitely know whether or not you have mesothelioma. This is because so many other illnesses are similar in nature to the condition. If this is the case, the biopsy sample will probably be sent to an alternative laboratory for a second opinion and you may need to have some of the tests repeated.

Testing for Peritoneal Mesothelioma:

Initially, the first stages of testing will be the same. Your doctor will book you in for an abdominal x-ray, to see whether or not there’s any evidence of cancerous cells or build-up of fluid. You’re likely to also have a CT scan of the area.

Further testing:

As with pleural mesothelioma, the next stage is to drain fluid from the abdomen for testing. This is called peritoneal aspiration. A local anaesthetic will be administered, then a needle passed through the skin to collect the fluid.

You may also require a biopsy. For peritoneal mesothelioma, the following biopsy techniques are used:

• Laparoscopy: You’ll be given a general or local anaesthetic, then your doctor will make a small incision in your stomach. They’ll then put a tube into your abdomen, to examine the area and remove a small sample of tissue.
• CT-guided biopsy – as with pleural mesothelioma, your doctor will insert a needle into your abdomen to gather the tissue, using CT imaging to guide the process.

When to Expect Results?

Results may take anything from a couple of days to a few weeks to arrive – depending on the procedure used for testing. Once your results are in, your doctor will ask you to come to the surgery or hospital to discuss things further.

Treatment and Rehabilitation

Staging:

The treatment you’ll be offered depends largely on the severity of your condition. As with any form of cancer, mesothelioma is staged – and each stage describes its size, plus whether it’s spread to any other parts of the body. Here’s a brief guide to each stage:

• Stage 1 – Cancerous cells are small and haven’t spread to any other part of the body. This is sometimes called early stage, or localised cancer.
• Stage 2 – Cancerous cells have started to spread regionally within the region, but not significantly to other parts of the body.
• Stage 3 – Evidence of more spreading within the body, but still regional to the area where the cancer started.
• Stage 4 – At this stage, the cancerous cells have spread significantly throughout the body. This is sometimes referred to as ‘distant spread’.

Treatment:

As with any form of cancer, there are three principal treatment options – surgery, radiotherapy and chemotherapy.

• Surgery – Surgery can be useful for removing the bulk of the cancerous cells and controlling symptoms. Not all hospitals will offer this type of treatment and it’s only suitable for certain people.
• Radiotherapy – Radiotherapy uses high levels of radiation to kill the cancerous cells. It cannot eradicate mesothelioma, but can reduce the size of the cells to improve quality of life.
• Chemotherapy – Chemotherapy uses anti-cancer drugs to kill the cancerous cells. Like radiotherapy, it cannot get rid of mesothelioma entirely, but can reduce the cancerous cells, which will make life more comfortable for the patient.

Rehabilitation:

There are a variety of techniques you can use after treatment to improve your symptoms. These include:

• Breathing techniques – Your doctor will demonstrate breathing techniques to help combat breathlessness, plus you may be offered oxygen at home, or medication to help with the problem, such as a low dose of morphine.

 

• Fluid drainage – A build-up of fluid on the lungs or abdomen can cause discomfort. A pleural effusion, which is a procedure undertaken at the hospital, drains the fluid, then if possible, the area is sealed to reduce fluid build-up in the future. Alternatively, the doctor may decide that you’d benefit more from a pleural catheter, which you can use to drain the fluid from home. In the case of peritoneal mesothelioma, a tablet called spironolactone is sometimes given – which is a diuretic designed to increase urination and reduce fluid on the abdomen.

 

• Pain relief medication – If you experience pain, your doctor will prescribe medication to make life more comfortable. This might include paracetamol, codeine, morphine, ibuprofen, diclofenac or gabapentin.

 

• Complementary therapies – Many hospitals offer complementary therapies to mesothelioma patients, which include acupuncture, relaxation techniques and aromatherapy. These can help combat some of the symptoms associated with the disease – such as fatigue, discomfort and depression.

Prognosis for Mesothelioma

Your prognosis will depend largely on how advanced the condition is. Regrettably, by the time symptoms become apparent, the disease is often in its more advanced stages; and as a result, the outlook might not be good. Generally speaking, pleural mesothelioma is easier to treat and offers better prognosis.

Mesothelioma cannot be cured, but cancerous cells can be reduced through treatment, depending on the stage of the disease. There’s a lot that can be done to improve quality of life after diagnosis – and you’ll be assigned a specialist team to assist you with this. You’re also entitled to benefits and a government compensation sum – which is currently capped at £123,000. Alternatively, you may want to file a legal claim against your former employer if you were exposed to asbestos in the workplace.

There are also a number of support groups in operation throughout the UK. You can find out more here.

The Future?

As increasing numbers of people are being diagnosed with mesothelioma, it’s becoming ever more important to understand the disease better – and to seek a cure. After your diagnosis, it’s possible that you’ll be asked to take part in a clinical trial, which will help doctors to develop new treatments for future patients.

Of course, you don’t have to take part in these trials if you don’t wish to – and your decision will be respected.

 

 

References:

https://www.mesothelioma.uk.com/information-and-support/about-mesothelioma/

https://www.macmillan.org.uk/cancer-information-and-support/mesothelioma

https://www.nhs.uk/conditions/mesothelioma/

http://www.tandfonline.com/doi/abs/10.1080/01913120252959227#.Vs2W9fmLSUk

https://www.macmillan.org.uk/cancer-information-and-support/mesothelioma