What is mesothelioma?
Malignant mesothelioma, a rare cancer, is characterized by malignant cells found in the pleura, the peritoneum or the pericardium


How is mesothelioma acquired?
Malignant mesothelioma is primarily an industrial disease, aquired by inhaling asbestos fibres. However, others have acquired the disease in the home - family memebers inhaling fibres brought home on clothing, for example.

How quickly does the disease show itself?
Mesothelioma has a latency period of up to 50 years, 35-40 years being common in construction workers. Periods of less than 20 years have been reported.

What are the symptoms?
Early symptoms are often non-specific, which may lead to a delay in diagnosis. Mesothelioma may resemble viral pneumonia, with shortness of breath, chest pain and/or persistent cough.

Occasional symptoms of pleural mesothelioma include fever, night sweats and weight loss. Peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

How is the diagnosis made?
Clinical and radiological findings may suggest the diagnosis, and a review of the medical and occupational history is taken.

A physical examination, x-rays of the chest or abdomen, and lung function tests are routine; a CT scan or MRI may also be requested.

A biopsy or examination of exudate from the affected area will be necessary to confirm this diagnosis.

How is the stage established?
The standard staging system is the the TNM System, used in most cancers; variables of T (tumor), N (lymph nodes), M (metastasis)

Stage I: Right or left pleura involved; spread to the lung, pericardium, or diaphragm on the same side is possible. Lymph nodes are not involved.

Stage II: Mesothelioma has spread from the pleura on one side to local lymph nodes near the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.

Stage III: Mesothelioma is found in the chest wall, muscle, ribs, heart, oesophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.

Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

What treatment is available?
The long latency of the disease, often without any knowledge of asbestos exposure, means that the disease may be quite advanced by the time the diagnosis is confirmed.

This can limit the options available; treatment should be commenced as soon as possible, for best results.

There are three treatment options, Surgery, Chemotherapy and Radiation Therapy.

Surgically, tumors that can be visualized can be resected; this can include removal of a complete lobe, even a complete lung. However, like many metastatic cancers, there are likely to be traces of the disease that cannot be visualized, even with the latest equipment, so surgery cannot be a complete solution.

Chemotherapy is based on platinum drug combinations, with varying success; chemotherapy can be a usful therapy in early mesothelioma, and working in combination with surgery or radiotherapy.

Radiotherapy has a role in shrinking tumours prior to surgery, also after surgery and as a paliative measure for late symptom control. as with all metastatic cancers, radiotherapy cannot provide a cure for mesothelioma, but can be effective in some patients, when combined with other approaches.

What is the prognosis for mesothelioma?
Historically, mesothelioma has had an appalling prognosis; but in recent years, with better and earlier diagnosis, this has improved. Patients whose disease is caught early can expect effective treatment, while many patients who cannot be offered curative therapy can hope for an extended period of palliative care, with effective symptom control.

Sources?
Mesothelioma Web
Mesothelioma: Questions and Answers
Mesothelioma

Andrew Heenan January 2005

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Andrew Heenan is a Nurse, Journalist and Web Editor.
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