Mesothelioma: Statistics, Symptoms, Treatment and Prognosis – a complete 2017 Guide
What is Mesothelioma Cancer?
Mesothelioma is an aggressive and rare type of cancer that mostly occurs in the lining of the lungs or chest wall, heart and abdomen as a result of exposure to asbestos. This disease attacks the mesothelium, which is a layer that lines body cavities hence its name “Mesothelioma Cancer.”
Mesothelioma affects just thousands of people all over the world. This figure is expected to reduce in future with the ban and significant reduction of use of asbestos. The Centers for Disease Control (CDC) reports that more than 3000 people in the United States are diagnosed with mesothelioma cancer every year. Australia is one of the countries with highest mesothelioma cancer cases in the world due to asbestos mining.
Who is at risk of developing mesothelioma cancer?
More than 80% of mesothelioma cases are attributed to exposure to asbestos.
Other risk factors include
• Zeolites (erionite) a mineral type commonly found in Turkey.
• Radiation exposure especially in cancer treatment and use of a chemical known as thorium dioxide (Thorotrast) in X-ray tests.
• SV40 (Simian Virus) increases the risk when one is already exposed to asbestos
Military Personnel affected by Mesothelioma Cancer
Mesothelioma cancer is mostly seen in military personnel (30%) due to asbestos exposure in the World War I, World War II and the Vietnam war. Mesothelioma cases are also significant in manufacturing, construction, and engineering industries using asbestos products.
Men are at a higher risk as compared to women and the risk increases with age, probably because men are more likely to work in asbestos industries.
Types of mesothelioma cancer
Classification of mesothelioma cancer is based on the area of the body that it develops. Mesothelioma typically develops in the heart, lungs or abdomen.
Pleural Mesothelioma occurs in the lining of the lungs and chest wall, and it develops as a result of inhalation of asbestos. It accounts for 80% cases of mesothelioma, making it the most common type.
Peritoneal Mesothelioma is extremely rare and occurs along the lining of the abdomen as a result of inhalation or ingestion of asbestos. This type of mesothelioma accounts for about 20% of the cases. Patients with peritoneal mesothelioma have a better outcome than other types of mesothelioma cases.
Pericardial Mesothelioma is the least common and occurs on the lining of the heart cavity. It is the least common type of mesothelioma as it accounts for less than 1% of the cases.If it occurs, it is usually accompanied by serious cardiac complications.
Common signs and symptoms of Mesothelioma cancer
It may take 10 to 50 years for symptoms of mesothelioma cancer to appear. The symptoms occur as a result of tumor growth and compression of the nearby organs. Mesothelioma symptoms are similar to symptoms of other diseases, and that is why the diagnosis of mesothelioma is delayed in most cases.
Signs and symptoms of mesothelioma differ depending on the type of cancer. However, the most common symptoms are difficulty in breathing and shortness of breath due to pleural effusion (buildup of fluid around the lungs), swollen abdomen (ascites), chest pain, dry cough, fatigue and unintended weight loss.
• Chest pain under the ribcage
• Shortness of breath
• Blood in sputum
• Painful cough
• Unusual swelling or lumps in the chest
• Pleural effusion (Fluid accumulation in the area surrounding the lung affected)
• Pneumothorax (collapse of the lung)
• Abdominal pain
• Night sweats
• Weight loss
• Loss of appetite
• Lumps under the skin of the abdomen
• Ascites (abdominal swelling due to fluid accumulation in the abdominal cavity)
If mesothelioma has spread to other parts of the digestive tract, one may experience
• Difficulty in swallowing
• Swelling of the neck or face
• Chest pain
• Shortness of breath when lying flat
• Dry cough
• Pericardial effusion (fluid buildup in the pericardium)
Since pericardial mesothelioma involves the heart, there is a high chance of other cardiac complications such as heart failure, pulmonary embolism, pericarditis and cardiac tamponade.
In the end stages of mesothelioma, a patient may have
• Blood clots in the veins (Deep Venous Thrombosis)
• Thrombophlebitis (vein inflammation as a result of blood clots)
• Jaundice (yellowing of the skin and eyes)
• Hypoglycemia (low blood sugar)
• Severe abdominal swelling
Diagnosing Mesothelioma Cancer: Imaging Tests and Biopsies
Diagnosing mesothelioma cancer is usually difficult as the disease presents itself in similar ways to other diseases. Before a diagnosis of mesothelioma cancer is made, the patient usually has gone through a series of tests that only end up in misdiagnosis. Sometimes it may take weeks to months to arrive at the correct diagnosis. For these reasons, diagnosis of mesothelioma cancer is mostly made in the advanced stages.
Diagnosis of mesothelioma cancer begins with taking history of any exposure to asbestos then a comprehensive physical examination follows and later, a series of tests.
A diagnosis is made using imaging tests and confirmed with a biopsy.
Imaging Tests for Diagnosing Early Stages of Mesothelioma Cancer
Chest X-ray is commonly the first test alongside lung function tests. An X-ray may reveal a thickening of the pleura (lining of the lung) which is a high suspicion of mesothelioma.
Other imaging tests are CT- Scan, MRI and Positron Emission Tomography (PET)
Cytopathology: Detecting Abnormal Cells
Cytopathology is done to detect any abnormal cells in the fluid that accumulates in the lungs, abdomen or heart cavity.
Thoracentesis is performed to obtain pleural fluid around the lung by passing a chest tube between the ribs.
Paracentesis is done if there is an abdominal swelling, by using a syringe to aspirate abdominal fluid.
Pericardiocentesis is done to obtain fluid in the pericardial cavity using a needle, under ultrasound guidance.
Biopsy: Obtaining a sample of tissue
A biopsy is the only test that confirms a diagnosis of mesothelioma cancer. It is done by obtaining a sample of tissue from an area with suspected mesothelioma cells. To get the tissue, a doctor may perform the following procedures.
Thoracoscopy– involves making a small cut through the chest wall and passing a thoracoscope ( a special which enables visualization of the thoracic wall) then collecting tissue.
Thoracotomy– which is done by a chest surgeon by opening the chest wall
Laparoscopy– a doctor makes a small opening is made in the abdomen then inserts a laparoscope and collects a tissue sample in the abdominal cavity.
Laparotomy and thoracotomy may also be done to explore the abdomen and chest respectively, to check for signs of mesothelioma or any other related disease.
The tissues obtained are then examined histologically under a microscope.
Staging of mesothelioma cancer
Once a diagnosis is made, mesothelioma is then categorized into four stages (I to IV), using the Tumor, Lymph Nodes and Metastasis (TNM) system. The TNM system describes:
• T (Tumor)- the size and position of the tumor
• N (Lymph Nodes)- whether mesothelioma has spread to the lymph nodes
• M (Metastasis)- whether the tumor has spread to other areas of the body
The Stages of Mesothelioma Cancer
Stage I- The mesothelioma is located only in one area of the body.
Stage II- The tumor has spread to nearby areas or nearby lymph nodes but has not gone far.
Stage III- Mesothelioma tumor has spread to nearby structures, and the lymph nodes are involved.
Stage IV- The tumors are extensive and have metastasized to distant body areas through the lymphatic system. Metastasis of mesothelioma commonly affects the liver, suprarenal glands, kidneys, brain, and lungs.
Stage I and Stage II may be successfully treated with surgery and chemotherapy while Stage III and IV are treated palliatively.
Treatment options for Mesothelioma Cancer
Treatment options for mesothelioma cancer are available, but a total cure is not possible in many cases. Surgery, chemotherapy and radiotherapy are the most common treatment options for mesothelioma cancer. Treatment significantly improves the outcome of the disease with about one year.
The course of treatment is influenced by the type and stage of the disease. Stage I and II may include surgery while symptomatic control is the most viable option for the end stages.
Is Surgery an Option for Mesothelioma Cancer?
Surgery is an option when mesothelioma is in its early stages. In the late stages, it may also be done to lower the risk of metastasis and reduce the signs and symptoms caused by tumor growth.
Surgical options include:
Pleurectomy – to remove the affected tissue lining the ribs and lungs. This procedure is beneficial in early cancer.
Peritonectomy – to excise affected tissues of the abdominal cavity.
Debulking – to remove as much mesothelioma as possible, when it is not possible to remove all tumors.
Extrapleural pneumonectomy (EPP)– is extensive and involves removal of the affected lung, along with the pleura lining, chest wall, diaphragm, pericardium, and nearby lymph nodes of the affected side.
Surgical procedures to treat mesothelioma cancer may cause serious risks and adverse side effects depending on the extent of the procedure and the health of the patient. Possible side effects include:
• Bleeding at the incision site
• Wound infections
• Lung collapse
• Blood clots
Chemotherapy as a Treatment for Mesothelioma Cancer
Chemotherapy involves the use of certain medications to shrink, kill and slow down growth of mesothelioma tumors. Chemotherapy may also be done before and after surgery, to ensure that mesothelioma cancer does not relapse.
Chemotherapy drugs are taken as a pill or through intravenous administration. In these two ways, the drugs travel throughout the body and as a result, can damage other innocent cells.
In other cases, chemotherapy treatment may be administered directly to the affected area of the body, to lower the risk of injury to other body areas and achieve higher doses of treatment.
Drugs commonly used in mesothelioma chemotherapy include:
Pemetrexed (Alimta) is the most commonly used drug and is often administered together with Cisplatin. When given as an injection, corticosteroids, vitamin B12 and B9 are almost always administered concurrently to reduce side effects. The combination of Pemetrexed and
Cisplatin is frequently used when surgery is not an option. Carboplatin is a platinum-based drug obtained from Cisplatin. It has fewer side effects as compared to Cisplatin, but it inhibits production of blood cells, increasing the risk of anemia and infections.
Gemcitabine (Gemzar) is used in the treatment of ovarian, lung and urinary bladder cancers, together with Carboplatin. In mesothelioma treatment, it is generally used as a second line treatment.
Ranpirnase (Onconase) has also been proven to kill mesothelioma cells by destroying their RNA. Ranpirnase does not kill other healthy cells, thus has fewer side effects.
Vinorelbine (Navelbine) is primarily used in treating breast and non-small cell lung cancer (NSCLC) and has also shown to be effective in treating mesothelioma by causing programmed cell death.
Other drugs include Mitomycin (Mutamycin), Doxorubicin (Adriamycin) and Raltitrexed (Tomudex).
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is effectively used to treat peritoneal mesothelioma that has not spread beyond the abdomen. It is done after a procedure of peritonectomy (removal of the affected parts of the peritoneum). It involves infusing a hot and concentrated dose of chemotherapy into the abdominal cavity. This type of chemotherapy allows delivery of a high dose to the affected area without damaging other parts of the body. Mitomycin or a combination of cisplatin and doxorubicin are often used for HIPEC.
The Downside of Chemotherapy
The downside of chemotherapy is that it has many side and adverse effects which deteriorate the quality of life of mesothelioma patients. Experience with chemotherapy treatment differs from one patient to another. Most of the common side effects include:
• Memory loss
• Inability to focus
• Loss of hair
• Mouth sores
• Nausea and vomiting
• Easy bruising and bleeding
• Low white and red blood cell counts
Radiotherapy: The Pros and Cons for Treating Advanced Stages of Mesothelioma with Radiation
Radiation is usually used in advanced stages of mesothelioma cancer to relieve symptoms or after surgery to kill any mesothelioma cells that may have been left in the body. Radiation therapy works by killing mesothelioma cells through damaging their DNA. Radiotherapy can damage healthy cells. To prevent this, it is mainly directed to the affected cells.
There are two main types of mesothelioma cancer radiotherapy
External Beam Radiation is the most widely used method as it can highly target tumors. It significantly improves the survival rate when used together with chemotherapy. The radiation dosage depends on the type, stage and size of mesothelioma tumors. External Beam Radiation is usually administered several times a week and spread out for several weeks.
Brachytherapy uses a radiation source in the body that is directed to the location of mesothelioma. It involves either permanent implantation of radioactive seeds that emit radiation for 3 to 12 months or temporary implantation of radioactive seeds that stay in the body for a particular period then removed.
Possible side effects of radiotherapy
• Sunburn-like skin problems characterized by redness, peeling and darkening on the skin surface that was exposed to radiation.
• Hair loss
• Loss of appetite
The symptoms are usually worse when radiation is combined with chemotherapy but subsides when radiotherapy is treatment is complete.
Are there any alternative treatment options for mesothelioma cancer?
According to the mainstream medical establishment, there are no alternative options that have proved to treat mesothelioma. However, there are complementary methods that are helpful in controlling the signs and symptoms. They include supplemental oxygen, breathing techniques, and relaxation exercise. Some patients report an improvement when they incorporate a healthy diet and fitness into their lives.
Natural Cures for Mesothelioma Cancer Victims and Asbestos Cancer Victims
Natural healing techniques can be incorporated to ameliorate (lessen) and even possibly reverse the effects of mesothelioma cancer. Such natural health protocols include fasting (abstaining from eating food for periods of time, usually 3 days to 3 weeks, only drinking water) and also, the practice of urine therapy, wherein a person drinks his own urine, first thing in the morning. The benefits of urine therapy are enormous and effective immediately, according to practitioners throughout the world.
Can mesothelioma reoccur after successful treatment?
Mesothelioma cancer can reoccur after initial treatment. Mesothelioma cancer that reoccurs is referred to as recurrent mesothelioma. It can reoccur in or near where it started or in a distance organ such as the brain, liver or kidney. Chemotherapy and radiotherapy are the treatment options for recurrent mesothelioma.
Prognosis for Mesothelioma Cancer Victims
The outcome of mesothelioma cancer depends on its stage, tumor size, cell type, and gender and age of the patient. Generally, the prognosis of mesothelioma cancer is poor with an average survival of 6-12 months after diagnosis. This is because the cancer is aggressive and diagnosis is often made in the advanced stages. Women, young people and patients with stage I and II mesothelioma usually have a better prognosis.
Typically, about 5 to 10% of people have a survival rate of five years. Most of the survival cases are from 6 to 21 months.
Prevention of Asbestos Cancer
Elimination of asbestos exposure is the mainstay of prevention os mesothelioma cancer. Ways to lower the risk of exposure when working in a place with asbestos materials include
• Wearing personal protective equipment such as face masks, overall, gloves and boots
• Taking a bath before going home
• Change of clothes before leaving work
While at home;
• Consult trained and accredited asbestos professionals if you suspect that your home may contain asbestos-related material
• Avoid removing asbestos roofing or flooring as it breaks up asbestos fibers.
• If asbestos-containing material is damaged, it should be left intact. If significantly damaged, consult accredited professionals to get rid of it.
• Avoid by any means, damaging, sweeping, drilling, dusting, or vacuuming any asbestos material.
Compensation for patients with mesothelioma
Patients with mesothelioma are entitled to compensation. Entitlement to mesothelioma compensation depends on the state or territory of exposure to asbestos.
Legal Entitlements for Mesothelioma Cancer Victims
An individual who has mesothelioma cancer has two types of legal entitlements, either through a claim through the court or a government compensation scheme. There are expert lawyers who are specialized in handling mesothelioma legal cases.
Summary of mesothelioma cancer
Location: Lung and chest wall lining
Most commons symptoms: Chest pain, shortness of breath, pleural effusion, dry cough
Diagnosis: Chest x-rays, CT scan, MRI and PET Blood Test biopsies
Treatment options: Pleurectomy, Thoracotomy, chemotherapy, radiotherapy (radiation)
Prognosis: 6 to 12 months
Location: Abdominal lining
Most common symptoms: abdominal swelling, abdominal pain, loss of appetite, weight loss
Diagnosis: abdominal xray, CT scan, biopsy
Treatment options: Peritonectomy, HIPC, chemotherapy, radiotherapy, debulking
Prognosis: 6 to 12 months
Location: Heart lining
Most common symptoms: chest pain, pericardial effusion, arrhythmias,
Diagnosis: xray, CT scan, MRI
Treatment options: pericardiectomy, pericardiocentesis, chemotherapy, radiotherapy,
Prognosis: extremely poor, 6 months on average