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Mesothelioma is a rare cancer that originates in the lining of many internal organs.
Approximately 75 to 80 percent of mesotheliomas start in the lining of the lungs. This is known as pleural mesothelioma. Pleural mesothelioma is a cancer that originates in the chest cavity. It does not begin in the lungs and is frequently mislabeled as lung cancer.
Peritoneal mesothelioma develops in the peritoneum, the tissue that surrounds the abdominal cavity. Peritoneal mesothelioma accounts for approximately 8% of all mesotheliomas.
Rare kinds of mesothelioma can also start in the pericardium, the lining surrounding the heart, or the tunica vaginalis, the lining around the testicles.
WHAT ARE THE TYPES OF MESOTHELIOMA?
Mesothelioma is classified into three types:
- Epithelioid type: The epithelioid form accounts for roughly 70% of mesothelioma cases. Epithelioid mesothelioma grows more slowly and often responds better to chemotherapy.
- Sarcomatoid type: Sarcomatoid mesothelioma affects between 7% and 15% of persons diagnosed with the disease. When compared to the other two kinds of mesothelioma, sarcomatoid mesothelioma may be more resistant to treatment. Standard treatment is frequently ineffective for this kind of mesothelioma.
- The mixed or biphasic type: The mixed kind affects between 10% and 20% of those diagnosed with mesothelioma. The word “mixed” or “biphasic” refers to cancer that is composed of both epithelioid and sarcomatoid cells. When compared to the epithelioid kind, treatment does not function as effectively for this type. However, treatment for this type is frequently more effective than treatment for the sarcomatoid type.
WHAT ARE THE SIGNS AND SYMPTOMS OF MESOTHELIOMA?
The following symptoms or indicators may be experienced by those who have mesothelioma. Some persons with mesothelioma do not experience any of these symptoms. Alternatively, the origin of a symptom could be a medical disease other than cancer. Symptoms of mesothelioma can arise years, if not decades, after asbestos exposure.
The symptoms of mesothelioma in the chest, known as pleural mesothelioma, may include:
- Shortness of breath caused by a thickening of the lining around the lung, which limits the amount the lungs can expand.
- Fluid build-up in the chest, called a pleural effusion
- Chest pain
The symptoms of mesothelioma in the abdomen area, known as peritoneal mesothelioma, may include:
- Pain in the abdomen
- Ascites, which is an abdominal enlargement caused by a fluid buildup.
- Obstruction of the bowel
Mesothelioma symptoms in general may include:
- Loss of weight
- Fatigue
- Blood clotting problems
- Fever
- Sweating at night
Please consult your doctor if you are concerned about any changes you are experiencing. In addition to other questions, your doctor will inquire as to how long and how frequently you have been experiencing the symptom(s). This is done to assist in determining the cause of the condition, which is referred to as a diagnostic.
If cancer is discovered, symptom relief is an important element of cancer care and treatment. This is known as palliative care or supportive care. Make an appointment with your health care provider to discuss your symptoms, especially any new or changing symptoms.
WHAT ARE THE STAGES OF MESOTHELIOMA?
Staging describes where the cancer is present, whether or not it has spread, and whether or not it is impacting other sections of the body.
Doctors utilize diagnostic tests to determine the stage of cancer, therefore staging may not be complete until all tests are completed. Knowing the stage assists the doctor in determining the best course of treatment and can help estimate a patient’s prognosis, or possibility of recovery. Distinct forms of cancer have different stage descriptions.
This section discusses the pleural mesothelioma staging system. There is no conventional staging approach for peritoneal mesothelioma at the moment. Your doctor will explain the extent of the sickness and what it implies to you.
TNM system of staging
The TNM system is one technique that clinicians use to describe the stage. Doctors use diagnostic test and scan results to address the following questions:
Tumor(T): What is the size of the primary tumor? Where can I find it?
Node(N): Has the cancer spread to your lymph nodes? If so, where are they and how many are there?
Metastasis(M): Is the cancer in other parts of the body? If so, where and how much?
The results are aggregated to establish each person’s cancer stage. There are four stages: I, II, III, and IV (1 through 4). The stage provides a common language for doctors to describe the cancer so that they can collaborate to determine the best treatments.
Clinical and pathological staging are both possible. Clinical staging is determined by the results of pre-surgery diagnostics, which may include physical examinations and imaging tests. Pathological staging is determined on what is discovered during surgery. Pathological staging, in general, provides the most information for determining a patient’s prognosis.
More information on each component of the TNM system for pleural mesothelioma can be found below.
Tumor (T)
The “T” plus a letter and/or number (0 to 4) is used to describe the stage of the tumor in the TNM system. The size of a tumor is measured in millimeters (cm). A centimeter is approximately the width of a normal pen or pencil.
Stages can also be subdivided into smaller groups to assist define the tumor in greater depth. This enables the doctor to devise the most effective treatment strategy for each patient. The following information about tumor stages is provided:
TX: There is no way to analyze the original tumor.
T0: indicates that there is no evidence of a primary tumor.
T1: The tumor is only found on one side of the body in the pleura, a thin membrane that lines the lung and inner chest walls. It could have developed into visceral pleura, mediastinal pleura, or diaphragmatic pleura. These are the thin membranes that line the lungs, chest, and the diaphragm muscle, which separates the chest cavity from the belly.
T2: The tumor has invaded all of the pleural surfaces on one side of the body and has spread to the lung or diaphragm.
T3: The tumor has spread across all of the pleural surfaces on one side of the body, causing at least one of the following symptoms:
- Endothoracic fascia growth, which refers to growth of the membrane that surrounds the thorax.
- The mediastinum, which is the portion of the chest between the lungs, grows.
- Muscle growth in a specific region of the chest wall
- Minimal expansion of the pericardium, the lining that surrounds the heart.
T4: The tumor has invaded all of the pleural surfaces on one side of the body and has spread to at least one of the following locations:
- Several sections of the chest wall, with or without rib growth
- Through the diaphragm into the abdominal cavity
- Any organ(s) of the mediastinum, such as big blood arteries
- The opposite side of the chest’s pleura
- The backbone
- Through the pericardium, which may result in fluid buildup or heart growth
Node (N)
The letter “N” in the TNM staging system denotes lymph nodes. These little, bean-shaped organs aid in the battle against infection. Regional lymph nodes are lymph nodes located around the chest. Lymph nodes located in other sections of the body are referred to as distant lymph nodes.
NX: The lymph nodes in the region cannot be examined.
N0: The cancer has not spread to the regional lymph nodes.
N1: Cancer has spread to bronchopulmonary lymph nodes within the lungs on one side of the body and/or hilar lymph node(s) near the bigger airways of the lungs. It may also have migrated to lymph nodes in the chest on one side of the body, such as the internal mammary lymph nodes near the breast bone, the peridiaphragmatic lymph nodes encircling the diaphragm, the intercostal lymph nodes between the ribs, or the fat surrounding the heart.
N2: Cancer has spread to both sides’ mediastinal lymph nodes, internal mammary lymph nodes, and/or supraclavicular lymph node(s) above the collar bone on one or both sides of the body.
Metastasis (M)
The letter “M” in the TNM system denotes if the cancer has moved to other parts of the body, a condition known as distant metastasis.
M0: The cancer has not spread to any other places of the body.
M1: Other regions of the body have been infected with cancer.
Cancer stage grouping
Doctors determine the cancer stage by integrating the T, N, and M classifications.
Stage IA: The tumor has spread to one side of the body’s pleura and may or may not have spread to the visceral pleura, mediastinal pleura, or diaphragmatic pleura. It hasn’t spread to the lymph nodes or any other sections of the body (T1, N0, M0).
Stage IB: The tumor is classified as T2 or T3. It hasn’t spread to the lymph nodes or any other sections of the body (T2 or T3, N0, M0).
Stage II: The tumor is classified as T1 or T2. It has not spread to the lymph nodes or elsewhere in the body (T1 or T2, N0, M0).
Stage IIIA: The tumor is classified as T3. Cancer has spread to the lymph nodes denoted as N1 above, but not to other regions of the body (T3, N1, M0).
Stage IIIB: Any of the conditions listed below:
- T1, T2, or T3 tumors are classified. Cancer has spread to the N2 lymph nodes but not to other regions of the body (T1, T2, or T3, N2, M0).
- T4 refers to the tumor. The cancer may or may not have gone to the lymph nodes, but it has not moved to any other parts of the body (T4, any N, M0).
Stage IV: Cancer has spread to the lymph nodes and may or may not have spread to other regions of the body (any T, any N, M1).
Recurrent: Cancer that recurs after therapy is referred to as recurrent cancer. It may reappear in the chest or elsewhere in the body. If the cancer returns, more tests will be performed to determine the degree of the recurrence. These tests and scans are frequently identical to those performed at the time of the first diagnosis.
HOW IS MESOTHELIOMA DIAGNOSED?
Many tests are used by doctors to detect or diagnose cancer. They also perform tests to see whether the cancer has spread to another place of the body from where it began. This is referred as as metastasis. Imaging tests, for example, can reveal whether or not the cancer has spread. Images of the inside of the body are produced via imaging tests. Doctors may also conduct tests to determine which treatments are most likely to be effective.
A biopsy is the only guaranteed way for a doctor to know if a part of the body has cancer in most cases of cancer. During a biopsy, the doctor extracts a small sample of tissue for laboratory testing. If a biopsy is not possible, the doctor may recommend alternative tests to aid in the diagnosis.
Not all of the tests described below will be administered to every individual. When selecting a diagnostic test, your doctor may take the following variables into account:
- The cancer type suspected
- Your symptoms and signs
- Your age and general well-being
- The outcomes of previous medical tests
Mesothelioma is difficult to diagnose and can be mistaken with other conditions such as lung cancer.
Many patients become aware of mesothelioma symptoms when they acquire fluid in the region surrounding their lungs or in their belly. Pleural effusion is fluid that collects around the lungs. Fluid in the abdomen is called ascites.
The following tests, in addition to a physical examination, may be performed to diagnose mesothelioma:
Fluid testing from the lungs or abdomen: After the skin has been numbed, a needle is introduced into the space between the lung and the chest wall or into the abdomen. When the fluid is extracted, it can be tested to see if it contains cancer cells. This is frequently one of the first steps in the diagnosis of mesothelioma. However, evaluating this fluid is rarely the only test required to detect the condition. Typically, a biopsy is required to diagnose mesothelioma.
Biopsy: A biopsy is the removal of a small sample of tissue for microscopic examination. Other tests can indicate the presence of cancer, but only a biopsy can provide a definitive diagnosis. The material is next examined by a pathologist. A pathologist is a medical professional who specializes in interpreting laboratory tests and assessing cells, tissues, and organs to identify disease. A sample is usually required to confirm a mesothelioma diagnosis. A needle can sometimes be used to obtain a sample of the lining. Typically, a tissue sample is removed by the doctor using a thin, illuminated tube placed through a small incision in the body. When utilized to obtain samples from inside the chest, this is referred to as a video thoracoscopy. When utilized to get tissue samples from inside the abdomen, it is referred to as a laparoscopy. Surgery is sometimes required to obtain a tissue sample.
The following procedures may be used to diagnose the stage of cancer and aid in the development of a treatment plan:
Physical exam and medical history: To understand more about your health history and your risk of mesothelioma, your doctor may perform a physical exam and ask you questions. This could include:
- Inquiring about your medical history and the ailments that have occurred in your family in the past
- Inquiring about your history of exposure to potential mesothelioma risk factors, such as asbestos exposure
- A physical exam is performed to seek for other indicators of cancer and to assess your current health.
Blood tests: Several blood tests may be recommended by your doctor to determine the health of your kidneys, liver, thyroid, and bone marrow.
Lung function tests: Lung function tests, often known as pulmonary function tests or PFTs, assess the following:
- The amount of air that the lungs can contain
- The rate at which air can enter and exit the lungs.
- How well the lungs provide oxygen to the blood and eliminate carbon dioxide.
X-ray: An x-ray is a technique that uses a small amount of radiation to create a picture of the structures inside the body. It is not the primary method of diagnosing mesothelioma. A chest x-ray, on the other hand, can occasionally assist doctors in determining whether a person has mesothelioma and where it is located.
Positron emission tomography (PET) or PET-CT scan: A PET scan is frequently coupled with a CT scan to form a PET-CT scan. However, your doctor may refer to this technique simply as a PET scan. A PET scan is a technique for creating images of organs and tissues within the body. A radiolabeled sugar compound is injected into the patient’s body in modest amounts. This sugar molecule is absorbed by the cells that consume the most energy. Cancer absorbs more radiolabeled material because it actively uses energy. The material is then detected by a scanner, which produces images of the inside of the body.
Magnetic resonance imaging (MRI): An MRI produces detailed images of the body by using magnetic fields rather than x-rays. The tumor’s size can be determined via an MRI. To provide a crisper image, a special dye known as a contrast medium is administered before to the scan. This dye can be injected into a patient’s vein or given to them in the form of a pill or liquid to consume.
Molecular testing of the tumor: Your doctor may advise you to do laboratory testing on a tumor to discover specific genes, proteins, and other components that are specific to the tumor. The results of these tests can help you decide on a treatment plan.
Computed tomography (CT) scan: A CT scan uses x-rays captured from various angles to create images of the inside of the body. These photos are combined by a computer to create a detailed, three-dimensional image that shows any anomalies or malignancies. A CT scan can be performed to determine the size of the tumor. To improve image detail, a specific dye known as a contrast medium is sometimes administered before to the scan. This dye can be injected into a patient’s vein or given as a tablet or liquid to consume, depending on the section of the body being examined.
WHAT ARE THE TREATMENTS FOR MESOTHELIOMA?
Different types of specialists frequently collaborate in cancer care to develop a patient’s overall treatment plan, which mixes many sorts of therapy. This is referred to as a multidisciplinary team. Other health care professionals on cancer care teams include physician assistants, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others.
The following are descriptions of the most prevalent types of therapies for pleural and peritoneal mesothelioma. Your treatment plan will also include treatment for symptoms and side effects, which is an important aspect of cancer care.
The type and stage of cancer, potential side effects, and the patient’s preferences and overall health all influence treatment options and recommendations. Take the time to read about all of your treatment options, and don’t be afraid to ask clarifying questions. Discuss the aims of each treatment with your doctor, as well as what you can expect during treatment. These discussions are known as “shared decision making.” When you and your doctors collaborate to choose therapies that meet the goals of your care, this is referred to as shared decision making. Because there are various treatment choices for mesothelioma, shared decision making is very vital.
Surgery
During a surgery, the tumor and some surrounding healthy tissue are removed. A surgical oncologist is a specialist who specializes in the surgical treatment of cancer. The type of surgery for mesothelioma is determined by the cancer’s stage and location.
- Pleural mesothelioma: A surgeon may remove the malignant lining around the lung in patients with pleural mesothelioma. This is known as a pleurectomy/decortication. In most cases, a pleurectomy/decortication cannot entirely remove the tumor. An extrapleural pneumonectomy is a more aggressive pleural mesothelioma surgery. This procedure involves removing the lining of the lung, the entire lung, a piece of the diaphragm, and, in some cases, a section of the lining around the heart. This is a complicated procedure that should only be performed after the doctor has considered a number of considerations, including the patient’s overall health and the stage of the disease. Following surgery, further treatments such as chemotherapy and/or radiation therapy are frequently indicated. Before surgery, chemo and/or radiation therapy may be administered.
- Peritoneal mesothelioma: Peritoneal mesothelioma patients are frequently subjected to a procedure known as an omentectomy. The lining around the abdominal organs is removed during an omentectomy. Because peritoneal mesothelioma patients frequently have tumors throughout their abdomen, it is difficult to remove all of them. The purpose of surgery is to remove tumors as small as feasible. Chemotherapy may be administered straight into the abdomen following surgery.
Before undergoing surgery, consult with your health care team about the potential adverse effects of the procedure.
Radiation therapy
The use of high-energy x-rays or other particles to eliminate cancer cells is known as radiation therapy. A radiation oncologist is a doctor who specializes in the use of radiation therapy to treat cancer. External-beam radiation, which is radiation delivered from a machine outside the body, is the most prevalent method of radiation treatment.
A radiation therapy regimen, or schedule, typically consists of a predetermined number of treatments administered over a predetermined time period.
- Pleural mesothelioma: Because of the potential of lung damage, treating pleural mesothelioma with radiation therapy is difficult. When one of the two lungs is surgically removed, radiation therapy to the chest cavity is frequently used to reduce the risk of the mesothelioma returning in the chest. This method, for example, could be utilized following an extrapleural pneumonectomy. Radiation therapy may be administered to a smaller area of some patients as supportive care to help relieve symptoms such as discomfort.
- Peritoneal mesothelioma: Radiation therapy to the entire abdomen generates severe side effects in persons with peritoneal mesothelioma and is not used. Radiation therapy may be a supportive care option for a patient who is experiencing discomfort in a specific area.
Tiredness, moderate skin responses, unsettled stomach, and loose bowel motions are all possible side effects of radiation therapy. The majority of negative effects fade quickly after treatment is completed.
Chemotherapy
Chemotherapy is the most commonly used systemic treatment for mesothelioma. It normally works by preventing cancer cells from growing, dividing, and proliferating.
A chemotherapy regimen, or schedule, typically consists of a predetermined number of cycles administered over a predetermined time period. A patient may be administered one medicine at a time or a mixture of drugs at the same time.
Pleural mesothelioma: For patients who have not yet undergone treatment, a combination of pemetrexed (Alimta) and cisplatin (Platinol) or carboplatin is indicated (Paraplatin). These drugs are administered every three weeks. A cycle is a three-week period. People may be subjected to 4 to 6 treatment cycles. Following the treatment cycles, some people may undergo extra therapy known as maintenance therapy. This medicine combination has the potential for serious adverse effects. If providing both medications causes too many side effects, some people may be given a single drug. For some patients, bevacizumab may be combined with chemotherapy.
Peritoneal mesothelioma: As indicated in the Surgery section, chemotherapy is frequently administered straight into the belly following surgery. Chemotherapy can also be administered intravenously (via a vein). In the treatment of pleural mesothelioma, the medication combination pemetrexed with cisplatin or carboplatin is most commonly utilized.
Chemotherapy side effects vary depending on the individual and the dose used, but they can include exhaustion, infection risk, nausea and vomiting, hair loss, loss of appetite, and diarrhea. The most common side effects of mesothelioma medicines include renal damage, numbness and tingling in the fingers or toes, rash, an increased risk of infection due to a low white blood count, or anemia. Other negative effects are possible for patients. To reduce the likelihood of these side effects, patients receiving this kind of chemotherapy are given the vitamins B12 and folic acid. Many of these side effects can be alleviated with other drugs, such as those meant to reduce vomiting. These adverse effects normally fade away once the treatment is completed. Discuss with your doctor the potential side effects of your chemotherapy regimen and how to manage them.
Targeted therapy
Targeted therapy is a type of cancer treatment that targets specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This sort of treatment inhibits cancer cell growth and spread while causing minimal harm to healthy cells.
The targets of all cancers are not the same. Your doctor may order tests to determine the genes, proteins, and other variables in your tumor in order to find the most effective treatment. This enables clinicians to provide the most effective treatment to each patient whenever possible. Furthermore, research studies are continuing to learn more about specific molecular targets and new treatments aimed at them.
For patients with pleural mesothelioma who do not have any health concerns that would prohibit them from getting it, the medication bevacizumab (Avastin) may be administered to chemotherapy. Bevacizumab is classified as an anti-angiogenic targeted treatment. Anti-angiogenesis therapy aims to halt angiogenesis, or the process of forming new blood vessels. Because tumors require the nutrients given by blood vessels to develop and spread, anti-angiogenesis medicines aim to “starve” the tumor. Discuss with your doctor the potential side effects of a certain medicine and how to manage them.
Immunotherapy
Immunotherapy, also known as biologic therapy, is intended to increase the body’s natural defenses against cancer. It employs components created by the body or in a laboratory to enhance, target, or restore immune system activity.
The FDA has approved a combination of the immunotherapy medications ipilimumab (Yervoy) and nivolumab (Opdivo) as a first-line treatment for pleural mesothelioma that cannot be treated surgically. This combination is approved for treatment in all kinds of pleural mesothelioma, but people with biphasic or sarcomatoid mesothelioma improved more in research studies.
Pembrolizumab (Keytruda) and a combination of ipilimumab and nivolumab may be possibilities for people who have already had chemotherapy for mesothelioma.
Different forms of immunotherapy might result in a variety of adverse effects. Skin rashes, flu-like symptoms, diarrhea, and weight fluctuations are all common adverse effects. Consult your doctor about the potential adverse effects of the immunotherapy that has been prescribed for you.
Metastatic mesothelioma
Doctors refer to cancer that has spread to another place of the body from where it began as metastatic cancer. If this occurs, it is advisable to consult with specialists who have treated similar cases in the past. Different doctors may have differing views on the optimal conventional treatment strategy. Clinical trials are another possibility. Learn more about getting a second opinion before beginning treatment so that you are confident in your treatment plan.
Your treatment strategy may involve a combination of the above-mentioned procedures, such as surgery, radiation therapy, and systemic therapy with medication. Palliative treatment will also be essential in order to alleviate symptoms and negative effects.
A diagnosis of metastatic cancer is extremely stressful and, at times, difficult to bear for the majority of people. You and your family are encouraged to express your feelings to doctors, nurses, social workers, and other members of the health care team. It may also be beneficial to speak with other sufferers, such as through a support group.
