Mesothelioma Frequently Asked Questions

What is mesothelioma?

What is mesothelioma?
Mesothelioma is a cancer of the mesothelial cells which form a lining around the lungs and the ribs (pleura), or around the abdominal organs (peritoneum). The only known cause of mesothelioma in the United States is previous exposure to asbestos fibers. This exposure is likely to have happened twenty or more years before the disease is diagnosed, due to the long latency period for the disease to develop. While mesothelioma has been observed largely in asbestos workers, individuals living in the same household as asbestos workers also have an increased risk of developing mesothelioma due to their exposure to asbestos which workers brought into the household on their dirty work clothes. Human studies have not demonstrated an association between cigarette smoking and the development of mesothelioma.

Malignant pleural mesotheliomais a cancer of the cells of the pleura, a lining around the surface of the lungs and ribs. The spread of the tumor over the pleura causes pleural thickening which can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as the tumor grows and compresses the lungs, he or she can become short of breath even while resting. In addition, as the tumor grows outward, it can invade the chest wall and ribs, becoming extremely painful.

Pleural mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms, such as when tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows an accumulation of fluid (a pleural effusion) in the pleural space - the area between the lungs and the chest wall.

The first step in detecting pleural mesothelioma is, typically, a chest x-ray, or a CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs. The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is usually not painful. The tissue sample is tested by a pathologist, who will use special lab stains to differentiate between mesothelioma, and other diseases, such as lung cancer.

As of yet, there is no known cure for malignant pleural mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, the extent of the tumor, the cell type, and whether or not the tumor responds to treatment.

Malignant peritoneal mesothelioma is a tumor of the thin membrane of mesothelial cells which cover many of the organs in the abdomen. As with pleural mesothelioma, the only known cause of peritoneal mesothelioma in the United States is previous exposure to asbestos. There are at least two explanations for how asbestos fibers can get into the peritoneum. The first is that fibers caught by the mucus of the trachea and bronchi end up being swallowed. Some of them lodge in the intestinal tract and from there they can move through the intestinal wall into the peritoneum. The second explanation is that fibers that lodge in the lungs can move into the lymphatic system and be transported to the peritoneum.

Peritoneal mesotheliomas account for about one-fifth of all mesotheliomas. The symptoms of peritoneal mesothelioma typically include abdominal pains, weakness, weight loss, loss of appetite, nausea, and abdominal swelling. Fluid often accumulates in the peritoneal space, a condition known as ascites. Over time the wasting symptoms can become more and more severe. The growing tumor can exert increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. If the tumor presses upward, it can impair breathing capacity. If the tumor pushes against areas with many nerve fibers, and the bowel distends, the amount of pain can increase.

Abdominal x-rays and CT scans are, typically, the first step toward detecting peritoneal mesothelioma. The actual diagnosis is typically achieved by obtaining a biopsy of the tissue during a peritoneoscopy, and having a pathologist examine the tissue, using microscopic analysis of specialized stains.

There is no known cure, for peritoneal mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, its extent, the cell type, and whether or not the tumor responds to treatment.

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