You’ve probably noticed an increase in TV commercials talking about mesothelioma, but don’t know what it is. Although it’s not a well-known disease, mesothelioma is a frequent subject of ads on TV, radio and elsewhere. There’s a reason for it.
In short, mesothelioma is a form of cancer that’s primarily found in the lungs and caused by exposure to asbestos. It forms primarily in the lining of the lungs, heart and stomach with a long period of dormancy—from 20 to 50 years—before the symptoms are apparent.
What Causes Mesothelioma?
Mesothelioma is considered “rare,” and the primary documented cause is asbestos exposure. There are a number of risk factors, including smoking, that can contribute to the development and advancement of the disease.
Asbestos is a naturally occurring mineral that was used throughout construction and other industries because of its fire-retardant capabilities. Because it was so prevalent in multiple industries, workplace exposure was common, and the reason why the disease is common in later years for most people.
Generally, exposure is due to the ingestion and/or inhalation of the asbestos fibers. These fibers then become wedged in the lining of the lungs, heart, abdomen, and other organs, causing irritation that then leads to inflammation, and eventually the development of the cancerous tumors.
Risk factors that can impact the possibility of developing mesothelioma include:
- Duration, or how long a patient had regular exposure to asbestos
- Quantity, the amount of asbestos fibers that a patient ingested or inhaled
- Type, one of six different types of asbestos fibers, the most dangerous of which is called “crocidolite.”
Workers are primarily exposed to asbestos on their jobsites, whether on a construction site, inside a building, or in a shipyard. Long-term exposure to considerable amounts of asbestos was commonplace many years ago, drastically increasing their risk factors and vulnerability to developing mesothelioma. Exposure is most common in vocations such as:
- Construction workers
- Industrial workers
- Automotive mechanics
- Oil refinery employees
- Shipyard workers
- Power plant workers
However, exposure to asbestos can happen in a number of places outside of work. Older homes, office buildings, schools and other places you may not expect may still contain asbestos in building materials such as paint, electrical wiring and insulations.
Most of this asbestos is safely fixed in place. But if the asbestos-containing building is renovated, demolished, or otherwise disturbed, asbestos exposure is a serious possibility.
Another type of exposure is secondhand, which happens when someone is in close contact with another individual who works with asbestos on a regular basis, or lives near a facility that produces a significant amount of asbestos (i.e., an oil refinery.)
Your Prognosis with Mesothelioma
Mesothelioma is a highly damaging disease that develops slowly and over such a long period of time that it is seldom caught early enough in its development to matter for patients.
The prognosis for most patients is doubtful, since many only survive a year, maybe two, after they are diagnosed. About 9% of patients with mesothelioma live five or more years following their diagnosis. However, multiple factors will determine each patient’s life expectancy and rate of survival once they are diagnosed, including:
- Stage of disease
- Where the disease develops in the body
- Cell type
- Lifestyle and general health
- Blood counts
The most significant predictors of a patient’s outcome are their gender and age. A younger patient is more likely to survive longer than someone older, and studies on the subject have demonstrated that female patients frequently survive an average of 5-6 months longer than male patients.
Patients whose mesothelioma is caught during the initial stages of the disease will likely have a longer life expectancy than patients who are diagnosed during a later stage.
There are several types and locations of mesothelioma, but the two main types are:
- Pleural, that forms in the lining of the lungs
- Peritoneal, forming in the lining of the abdomen
The type of mesothelioma can also determine a patient’s rate of survival. Patients with pleural mesothelioma experience rates of survival of 73% after one year, and 23% after three years. But patients with peritoneal mesothelioma experience rates of survival of 92% after one year and 74% after three.
Long-term survival following a diagnosis of mesothelioma is rare, but not impossible. While there are a few patients who have experienced a complete remission, there is no cure for mesothelioma. However, with the number of new and emergent treatment options that are being researched and becoming available, no case is a complete lost cause.
You can increase your chances of an improved prognosis of mesothelioma by:
- Seeking out a specialist who knowns and understands mesothelioma
- Using and expending all of your treatment options
- Join clinical trials to increase your chances of trying out new treatments
- Making healthy lifestyle choices
- Seeking out second opinions from specialists in mesothelioma
Despite the odds, it is possible to fight back against mesothelioma.
Types Of Mesothelioma
Mesothelioma comes in different forms, classified by both the cell type and its location in the body:
- Pleural, which affects the lining of the lungs
- Peritoneal, which affects the lining of the abdominal cavity
- Pericardial, which affects the lining of the heart
- Testicular, which affects the membrane surrounding the testes
Pleural and peritoneal are the most common forms, with pleural accounting for 70% to 90% of cases. The remainder of cases are peritoneal, with 1% of cases being pericardial, and a tiny fraction being testicular.
Even though pleural mesothelioma is the most frequent form, diagnosis is still very difficult, and isn’t discovered until it’s in the later stages. Fever and a chronic chest pain are the most common symptoms. The average survival rate after diagnosis averages about 17 months.
The less-frequent peritoneal mesothelioma disseminates into abdominal cavity organs, such as the spleen, liver, intestines, pancreas, etc. Abdominal pain and persistent nausea are the early symptoms, but new treatment options give this form a somewhat better prognosis than pleural.
Pericardial and testicular mesothelioma are extremely rare. The symptoms are usually signs of a heart attack, but the diagnosis is frequently not made until the patient passes. There are only 100 recorded diagnoses of the testicular form, so very little is known about it.
Additionally, mesothelioma is also classified by the type of cell, determined with a biopsy of the tissue affected with the disease.
Commonly found in patients with pleural mesothelioma, offering the best prognosis
Found in patients with pleural and peritoneal mesothelioma alike, considered the most aggressive, giving the worst prognosis.
Biphasic cells are a combination of epitheliod and sarcomatoid, and the least common. The prognosis depends on the amount of each of these cells that are present in the patient’s mesothelioma. A higher concentration of sarcomatoid indicates more of a negative prognosis.
Chances are that if you are diagnosed with mesothelioma, the first thing you’ll likely think of is how you got it in the first place.
Mesothelioma develops silently until you begin experiencing symptoms. From the first exposure to asbestos, it usually takes 30 to 40 years for symptoms to appear and manifest. This is known as the “latency period,” and can be as long as 50 years.
Once you begin experiencing symptoms, doctors usually use these tools to find a diagnosis:
- Imaging scans
- Blood tests and biomarkers
Because they are non-invasive, doctors usually use imaging scans first. They are an important first step in determining mesothelioma, although they do not provide a definitive diagnosis of mesothelioma. Other diagnostic testing will include:
- PET Scan
Blood testing is the next option, and specific blood tests can show an abnormal amount of substances that indicate the possibility of mesothelioma through biomarkers. One biomarker is the presence of a large amount of mesothelin in the blood, far beyond the normal amount produced by healthy mesothelial cells.
These biomarker tests are known as “assays,” but do not give a definitive diagnosis of mesothelioma. They can be used to rule out other specific diseases. These common biomarker assays may include:
- Mesomark (a test that checks mesothelin levels and, specifically, soluble mesothelin-related peptides)
Biopsies are the third option that can prove that a patient has mesothelioma. This involves getting a sample of affected tissue so that it can be tested for abnormal cell activity. The tissue is examined by a pathologist, who determines the active cell type in the sample. Once determined, an accurate life expectancy is provided, along with suggested treatments.
Doctors use one of three different methods for obtaining biopsy samples:
Biopsies with needles are actually the least invasive, drawing fluid out of the diseased tissue. However, in some cases it’s difficult to obtain enough fluid for a correct diagnosis, so a doctor may decide to do a camera assisted biopsy. It is also minimally invasive, using a small surgical incision to insert a tube with a camera to acquire a sample for testing. The most invasive biopsy is a surgical, used when a tumor is located in a difficult area where the other two biopsy types aren’t suitable.
Unfortunately, mesothelioma is frequently misdiagnosed, even with all the available options. Since mesothelioma symptoms frequently mimic the symptoms of other conditions, it’s easy for the early signs of pleural mesothelioma to be diagnosed as the flu, pneumonia or asthma. If you believe you or a loved one may be afflicted with mesothelioma, you must act quickly and inform your doctor as well.
Stages of Mesothelioma
Like other cancers, mesothelioma is “staged” according to the severity of the patient’s case. Mesothelioma has four stages:
- Stage 1—the tumor is localized, and has not begun to spread elsewhere, such as tissues, organs and lymph nodes. At this stage, patients have the best prognosis, because treatments like surgery and other curative treatments are used.
- Stage 2—the tumor has begun to spread a little to tissues and possibly lymph nodes. Surgery and curative treatments are also available at this stage.
- Stage 3—mesothelioma has spread into one region or one side of the body, including the lymph nodes. Some curative treatments can be used, but surgery is no longer available as an option. Pallative care, aimed at improving quality of life, is also employed at this point.
- Stage 4—at this point, mesothelioma has spread throughout the entire body, and is affecting tissues, organs, blood vessels and the lymphatic system. At this stage, most care is palliative, and surgery is no longer an option. Treatment and care at this stage is primarily palliative, and offers the worst prognosis.
It’s important to note that a Stage 4 diagnosis is hopeless, nor that a Stage 1 diagnosis is nothing to worry about. Although rare, a patient diagnosed with Stage 4 mesothelioma can find themselves in remission. It’s also possible that a patient diagnosed with Stage 1 mesothelioma may find that it spreads despite receiving treatment.
Additionally, no matter what happens within the patient, the stage will remain the same. This means that a patient with a Stage 2 diagnosis that spreads out to a farther region of the body will still be called “Stage 2,” albeit with further metastasis, or spreading.
The only form of mesothelioma that uses a clinically accepted standard for staging is pleural mesothelioma. The International Mesothelioma Interest Group and the American Joint Committee on Cancer both approve the TNM Staging System, which takes into account the tumor, nodes and metastasis into account. This staging system is also used for other forms of mesothelioma, or to some degree, another general cancer staging system.
Most people feel like the symptoms are the biggest part of an overall mesothelioma condition. But since the disease’s symptoms are not exclusive to it, mesothelioma is frequently misdiagnosed. Furthermore, a patient can live with mesothelioma without symptoms for as long as 50 years before it appears.
Symptoms will differ depending on the tumor’s location, such as symptoms of pleural mesothelioma that are contained in the chest and lung areas. Peritoneal mesothelioma manifests and exhibits symptoms that are mostly confined to the abdominal area.
Pleural mesothelioma-specific symptoms can include:
- Shortness of breath
- Trouble with speaking or swallowing
- Chest pain
- Fluid buildup around the lungs
- Constant coughing (possibly with the appearance of blood)
- Lower back discomfort
Peritoneal mesothelioma is frequently misdiagnosed as a hernia, or as irritable bowels syndrome, since the symptoms are similar:
- A range of abdominal pain
- Fluid buildup that causes abdominal swelling
- Weight loss
- Appetite loss
- Difficulty breathing
- Fatigue and weakness
- Bowel obstruction
Pericardial mesothelioma is extremely rare, and it’s symptoms are frequently overlooked. But when a patient presents the symptoms, they are usually diagnosed as another illness, such as:
- Heart murmurs and other abnormal heart behaviors
- Chest pain
- High fever
- Fluid buildup around the heart
Patients usually experience these symptoms first, and frequently ignore them or assume that they are minor. However, these symptoms are critical during the early stages of the disease, which is the best time to diagnose it to begin treatment.
But as mesothelioma progresses, it becomes more difficult to ignore the obvious symptoms.
Patients are usually diagnosed at Stage 3. It is at this point when pain increases in intensity and they develop difficulty breathing. A patient may also find him or herself experiencing severe fatigue and chronic exhaustion, and find their way to a doctor’s office.
Nerve issues begin appearing in Stage 4, including Horner’s syndrome, a nerve condition that affects the eyes. Many will also show symptoms of laryngeal nerve palsy, which causes hoarseness and essentially paralyzes the voice box.
But remember that symptoms of mesothelioma mimics those of a variety of other conditions and diseases, many of which are less serious. Even with these symptoms, it doesn’t necessarily indicate that you have it. That’s why it’s important to see a doctor to identify the root cause of the symptoms, whether or not you have mesothelioma.
Strictly speaking, the term metastasis describes any type of cancer that has spread beyond the original site or tumor and migrated into other areas of the body. However, mesothelioma is considered exceptionally aggressive because once it begins to metastasize, it can spread very rapidly. Unfortunately, when mesothelioma exhibits metastasis, fatality usually occurs within a year or so.
Metastasis can arise through multiple different paths within the body, including the:
- Newly created blood vessels
- Lymph nodes
- Lymphatic system
Mesothelioma in Stages 1 and 2 usually do not experience much metastatis, but the disease is capable of spreading to adjoining tissues. The extensive, aggressive metastasis is seen in Stages 3 and 4, when a patient sees a doctor for symptoms and the mesothelioma is finally diagnosed.
Although the cancerous cells of mesothelioma can literally spread anywhere in the body, they most commonly invade the
- Adrenal glands
But the disease’s trajectory also depends on where it began. Pleural mesothelioma begins spreading in the chest cavity, and affects local organs like the heart and the lungs. Peritoneal mesothelioma begins to metastasize in the abdominal area and will affect those localized organs such as the appendix, pancreas and spleen. However, both forms have the ability to spread out anywhere in the body at any time.
The types of cell that are contained in the body will also indicate the extent to which mesothelioma will metastasize. Pleural mesothelioma commonly contain epithelioid cells, which develop slower, but are also dangerous. Peritoneal mesothelioma commonly contain sarcomatoid cells, which are the most aggressive and metastasize much faster.
As we previously discussed, asbestos exposure is the primary risk factor for the development of mesothelioma, and is the only known and documented cause. The highest risk group of people are those who worked with large quantities of asbestos for long periods of time, although asbestos is also found outside of workplaces as well.
Statistics and Facts of Mesothelioma
Although mesothelioma is a very deadly form of cancer, medical researchers and doctors are still learning and understanding more about it every day.
In the US alone, between two and three thousand people are diagnosed with this illness every year, with an average of 2,500 fatalities attributed to mesothelioma every year. There were over 45,000 known deaths attributed to mesothelioma in the US alone between 1999 and 2015. Worldwide, mesothelioma deaths total about 43,000 every year.
The cause of mesothelioma, asbestos, is banned either partially or completely in 61 nations worldwide. The United States is one of the developed nations that has not yet completely banned asbestos, and it is still legal to import products that contain it. In 2016 alone, the US imported 680,000 pounds of it. Mining for asbestos has been illegal in the US since 2002, and there is asbestos still in place in many buildings.
Advancements in medicine and technology have improved the survival rates for patients with peritoneal mesothelioma, with the 10-year survival rate now at 39%. Unfortunately, the 10-year survival rate for the most common type, pleural mesothelioma, is only 4.7%. Survival rates have remained steady at 7% to 9% after five years through recent decades. This is because 75% of the cases are pleural mesothelioma, and patients generally have about a one-year life expectancy.
The highest rates of mesothelioma are in Belgium, the UK and Australia. However, since other nations don’t necessarily keep accurate counts of mesothelioma cases, the metric may not be completely accurate. Predicted increases in developed countries are between 5% and 10% by 2020.
There is hope for patients despite the numbers. Patients who opt for treatment combining radiation therapy, chemotherapy and surgery see better prognoses that patients who have only one or two of them. About 50% of mesothelioma patients decide to enroll in clinical trials, which allows them to acquire and benefit from new and updated treatments that may not be otherwise available.
Unfortunately, a mesothelioma diagnosis is generally not a positive experience, and once you’ve been diagnosed, you understand the dangers. However, new treatment options are offering patients better treatments and extending life expectancy, as well as working toward everyone’s ultimate goal of finding a cure for mesothelioma as soon as possible.