Mesothelioma is a cancer associated to asbestos exposure which can develop in various parts of the body but more specifically within the mesothelium which is a membrane lining found within the pleura (thoracic cavity), peritoneum (abdominal cavity), pericardium (heart) and testicles. Mesothelial cells produce a lubricating fluid to provide a slippery, non-adhesive and protective surface.
The type of mesothelioma diagnosed is determined where the cancer develops and most commonly is found in the linings of the lungs (pleura) which is referred to as pleural mesothelioma. Less common it is found within the linings of the tummy (peritoneal mesothelioma) and in very rare instances it can be found within the linings of the heart (pericardial mesothelioma) and within the linings of the testicles (testicular mesothelioma).
The UK has one of the highest rates of mesothelioma in the world due in part to the late introduction of asbestos regulations and because of its association to industrial workplace settings with the majority of people affected being men aged between 60 – 78 years of age.
Mesothelioma is caused by inhalation of asbestos fibres which become trapped in the linings of the lungs. Over time the fibres can cause inflammation, irritation and scarring to the lung tissue which leads to cancerous changes and development of mesothelioma or lung cancer. Other lung diseases associated to asbestos fibres include pleural plaques, pleural thickening, pleural effusion and asbestosis. Not everyone exposed to asbestos fibres will develop an illness which can take many years to develop until symptoms become apparent and which is referred to as the ‘latency period’. Mesothelioma can take up to 50 years or longer to develop and despite improved treatments is still regarded as an incurable disease with a poor prognosis.
Life expectancy in sufferers of mesothelioma is not an exact science with long term survivors attributing an improving trend to multimodal treatments, alternative medicines, clinical trials and nutritional changes. Other factors which affect survival periods include age, gender, race and overall state of health of the sufferer. Importantly the location, stage, cell type and type of cancer is also a factor. There are three main cell types for mesothelioma which include epithelial, sarcomatoid and biphasic which respond differently to treatments and whilst identification might take time it is nevertheless important to receive the most appropriate treatment than receiving quicker treatment.
Patients diagnosed with epithelioid mesothelioma are likely to live longer than those with either sarcomatoid or biphasic types which are considered more aggressive and harder to treat. Those diagnosed early potentially have the longest survival period and is particularly relevant if diagnosis can be made before the cancer has spread through the lymph nodes into other parts of the body.
Many people diagnosed with mesothelioma seek to improve their prognosis and quality of life by availing themselves, wherever appropriate, to the latest treatments and clinical trials. Other factors within their control which can improve a prognosis include taking steps to improve your overall health through healthy eating and remaining active balanced with plenty of rest. Even light activity such as walking and yoga can help alleviate fatigue from treatment. People in good health are more likely to be offered intensive treatments which might include chemotherapy or surgery and by remaining strong and active you are more likely to deal with side effects such as fatigue, pain and Stiffness brought about by treatments. If you are a smoker you will be advised to stop immediately on account of increasing lung complications, particularly if surgery is to be offered. Immediate benefits of quitting include lowering of blood pressure, heart rate and levels of carbon dioxide in the blood. You will be less prone to coughing and more likely to improve your sense of smell and taste.
Diagnosing mesothelioma can sometimes be difficult on account it is a complex and rare form of cancer which is often further complicated by symptoms resembling that of pneumonia. In most cases the first symptom noticed is a shortness of breath. Other common symptoms include pleural effusion (fluid build-up in the lungs), persistent cough, fatigue, loss of appetite, unexplained weight loss and clubbed fingertips. Pain or swelling in the stomach and changes to normal bowel pattern (constipation or diarrhoea) can be associated to peritoneal mesothelioma. Diagnosis of mesothelioma is usually made at an advanced stage, often when pain is commonplace caused by the impact of a tumour on the ribs and muscles lining the chest wall.
Following examination by your GP further tests will be arranged which could include blood tests, chest x-ray, CT scan and biopsy. Whilst chest x-rays and CT scans provide strong reliable evidence to support a diagnosis confirmation is normally made following a biopsy which involves examination of tissue and cancer cells obtained from the thickened pleura [chest] or peritoneum [tummy].
Treatment options for mesothelioma will vary according to several factors including the type of cancer diagnosed, the cell type and stage of the cancer, the extent to which the cancer might have spread and the general level of health of the patient. Following diagnosis it is important to consider all treatment options and wherever necessary consider seeking a second opinion which might offer wider treatment plans to better suit your lifestyle changes. People diagnosed with early stage mesothelioma, particularly those who are younger and in good health are likely to qualify for surgery which offers longer term survival. It is important to recognise that not all hospitals in the UK offer surgical treatment for mesothelioma and not all thoracic surgeons have experience in radical surgery. A patient might need to consider requesting a referral to a specialist centre.
Surgery for pleural mesothelioma involves two approaches, ‘radical surgical options’ and ‘palliative surgery’. Radical surgery is used to remove all visible tumours and is appropriate in instances where the cancer appears not to have spread. This form of surgery might involve removal of an entire lung and pleura together with the diaphragm and side of the pericardium and is considered to be the most aggressive surgical procedure [extrapleural pneumonectomy] perhaps only available to a small number of people who have previously demonstrated good heart and lung function. After the tumour has been removed reconstructive surgery is required.
Further radical surgery [extended pleurectomy & decortication] involves removal of the pleura from the chest wall and sometimes the pericardium, diaphragm and affected parts of the lung. Whilst also considered major surgery this procedure enables the lung to remain in place and provides for a faster recovery. Generally speaking recovery from aggressive mesothelioma surgery involves a stay in hospital for at least two weeks followed by up to a year recuperation at home.
Palliative surgery can be used in all stages of mesothelioma and is used to relieve pain by draining and/or preventing the build up of fluid around the lungs thereby allowing the lungs to expand and improve any shortness of breath. Once the fluid has been removed a procedure known as pleurodesis is often undertaken which involves insertion of sterile talc around the lung to close and seal the pleural space thereby limiting further effusions. Particularly in advanced stages and where a patient is considered too frail to have surgery, chemotherapy or radiotherapy treatments can be offered to help relieve symptoms and often involve the role of physiotherapists and dieticians. Side effects from chemotherapy include hair loss, tiredness, nausea and vomiting but medication can help. Following the last cycle of chemotherapy treatment any hair loss should grow back. Radiotherapy treatment can also cause tiredness with redness, irritation and hair loss around the affected area.
Surviving cancer is likely to be the greatest challenge anyone will ever face and it is important to remember you do not have to face it alone. Maintaining a positive attitude with a strong support system, family or otherwise can help in your recovery. There are ‘support groups’ you can join to share your feelings and experiences whilst others might seek benefit from spiritual groups or from one-to-one counselling.