Mesothelioma (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, such as pleura, peritoneum and pericardium. Epidemiological data show most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or have been exposed to asbestos dust and fibre in other ways. Usual symptoms and signs include chest pain, cough, shortness of breath, abdominal pain, palpitation and oedema. Treatments include surgery, radiation therapy, chemotherapy, or a combination of them. The prognosis of mesothelioma is poor. The best way for prevention is to prevent or limit the exposure to asbestos.

What are the symptoms of Mesothelioma?
Early mesothelioma does not have any symptoms. As the tumor grows larger, people may notice one or more of the symptoms.

Mesothelioma that affects the pleura can cause:
 * Chest pain
 * Shortness of breath
 * Cough
 * Blood in sputum or hemoptysis
 * Fever
 * Sweating
 * Fatigue
 * Weight loss
 * Trouble swallowing

Mesothelioma that affects the peritoneum can cause:
 * Abdominal pain
 * Ascites or abdominal distension
 * A mass in the abdomen
 * Problems with bowel function
 * Fatigue
 * Weight loss

Mesothelioma that affects the pericardium can cause:
 * Palpitation
 * Cough or hemoptysis
 * dizziness or hypotension
 * oedema in legs
 * Fatigue

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes Mesothelioma?
Long-term exposure to asbestos -- a fire-resistant material -- is the biggest risk factor. Asbestos was once commonly found in insulation, ceiling and roofing vinyls, cement, and automotive brake materials. Although many asbestos workers smoked, experts do not believe smoking itself is a cause of this condition.

Malignant mesothelioma affects men more often than women. The average age at diagnosis is 60.

Who is at highest risk?
Clinical data has suggested that the development of kidney cancer is related to several factors.
 * Asbestos: Doctors found most cases of mesothelioma have been linked to asbestos exposure in the workplace.
 * Zeolites: Zeolites are silicate minerals chemically related to asbestos. Data suggest that they are related to the development of mesothelioma.
 * Radiation: During the past, thorotrast is found to invlove in the development of mesothelioma.
 * Simian virus 40 (SV40): Some lab studies reported that SV40 infection may cause mesothelioma.

When to seek urgent medical care?
Call your health care provider if symptoms of mesothelioma develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
 * Severe chest pain
 * A large amount of hemoptysis
 * Shortness of breath
 * Severe abdominal pain
 * Abdominal distension
 * Palpitation
 * Hypotension, even shock

Diagnosis

 * Chest x-ray: Chest x-ray is often the first test done if someone has symptoms such as a constant chest pain or cough. This may show some abnormal signs suggested pleural mesothelioma.


 * Heart Colored Doppler test: These are echocardiogram and colored doppler test which use sound waves to create a picture of the heart and flow. Because tumors generate different echoes of sound waves than normal tissue, the doctor can locate a mass on the pericardium.


 * Computed tomography (CT) scan and biopsy: CT scans are often used to diagnose mesothelioma. It can confirm the location of the cancer and show the organs nearby, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful in staging the cancer and in determining whether surgery is a good treatment option. And CT scans can also be used to guide biopsy and a biopsy sample is then removed and looked at under a microscope.


 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but which is a different imaging type from computed tomography (CT) to produce detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture. MRI scan takes longer time than CT scan.


 * Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy to accept to produce the images. PET can provide more helpful information than CT scan and MRI scan. It is useful to see if the cancer has spread to lymph nodes and also useful for your doctor to locate where the cancer has spread.

Treatment options
Patients with mesothelioma have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.
 * Surgery: The goal of surgery is to try to cure the cancer or to relieve pain and other symptoms caused by the tumor. But the result has proved disappointing.
 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.
 * Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. It concludes systemic therapy and intrapleurall chemotherapy or intraperitoneal chemotherapy. Usual drugs invlove pemetrexed (Alimta) and cisplatin.

Diseases with similar symptoms

 * Lung cancer
 * Mediastinum
 * Pulmonary tuberculosis
 * Colorectal Cancer
 * Peritoneal tuberculosis
 * Restrictive cardiomyopathy
 * Hypertrophic cardiomyopathy
 * Other causes of heart failure

Where to find medical care for Mesothelioma?
Directions to Hospitals Treating mesothelioma

What to expect (Outlook/Prognosis)?
In general, the prognosis of mesothelioma is poor and it depends on the following:


 * Whether or not the tumor can be removed by surgery
 * The stage of the cancer: the size of the tumor, whether the cancer has spread
 * The patient’s general health

Prevention
Because the main risk factor of developing mesothelioma is asbestos, the best way to reduce the risk is to prevent or limit your exposure to asbestos at work or anywhere around you.