Mesothelioma

At Brown Cancer Center you can be sure you are being cared for by renowned physicians with the highest levels of experience and skill.

A team of medical oncologists, surgeons, radiation oncologists, pulmonologists and pathologists in our Multidisciplinary Lung Cancer Clinic work together closely to customize the best treatment for you. A specially trained support team is part of each group.

At Brown Cancer Center, you are surrounded by the strength of one of the region’s foremost comprehensive cancer centers. When we treat mesothelioma, we also focus on lung function and quality of life. To do this, we draw upon mesothelioma treatments that may include specialized, less-invasive surgical methods and highly focused radiation therapy.

Facts

Understanding a disease is the first step toward finding the right care. Get the facts about mesothelioma, including the different types, how it starts and who’s at risk.

According to the American Cancer Society, between 2,000 and 3,000 people in the United States are diagnosed each year with mesothelioma, a rare and dangerous cancer.

Mesothelioma starts in the mesothelium, which includes the:

Pleura, the thin layer of tissue that lines the lungs
Pericardium, the sac around the heart
Peritoneum, the membrane that lines the abdomen

Mesothelioma usually starts in the pleura. This type of mesothelioma also is called malignant pleural mesothelioma (MPM).

Mesothelioma almost always is caused by past exposure to fibers of asbestos. Asbestos is a fibrous mineral that in the past was used in the construction, automotive, military, marine and manufacturing industries.

When tiny particles of asbestos are made or disturbed, they can float in the air. People can breathe in the asbestos or swallow it. This may lead to serious health conditions such as cancers of the lung, larynx and kidney. It also can cause asbestosis, a non-cancerous, chronic lung disease.

In some people, asbestos fibers cause genetic changes in the pleura, the thin layer of tissue that lines the lungs. These changes may lead to mesothelioma. It can occur 20 to 50 years after a person has come in contact with asbestos.

Mesothelioma types

There are three types of mesothelioma

Epithelioid: 60% to 70% of cases, usually has the best outcome
Sarcomatoid: 10% to 15% of cases, more aggressive
Biphasic or mixed: 10% to 15% of cases, extremely aggressive

In rare cases, mesothelioma can be passed down from one generation to the next. Genetic counseling may be right for you.

Risk factors

Anything that increases your chance of getting mesothelioma is a risk factor. The only known risk factor for mesothelioma is contact with asbestos. It is more common in men, mainly those between 45 and 85 years old.

Not everyone with risk factors gets mesothelioma. However, if you have been exposed to asbestos, it’s a good idea to tell your doctor.

Symptoms

Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.

Because other diseases can cause similar symptoms, mesothelioma often is not diagnosed until it has spread. Symptoms vary from person to person and may include:

More common:

Shortness of breath
Chest or abdominal pain
Fatigue
Collapse of lung

Less common:

Cough that does not go away
Losing a lot of weight without trying
Blood in sputum (phlegm) coughed up from the lungs
Difficulty swallowing
Prolonged hoarseness
Nausea
Low oxygen levels

If you have one or more of these symptoms, it does not mean you have mesothelioma. However, it is important to discuss any symptoms with your doctor. They may indicate other health problems.

Diagnosis

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

The symptoms of mesothelioma often are the same as those of other diseases. This may make mesothelioma hard to diagnose. In particular, pleural effusion (fluid build-up in the chest cavity) may be found in several other diseases including lung cancer, heart failure and pneumonia. Early and precise diagnosis is important to successful mesothelioma treatment. However, doctors often are unsure if a person has mesothelioma, even after chest fluid has been removed and tested.

Choose a doctor experienced in mesothelioma.

If you have been exposed to asbestos and have symptoms, try to see a doctor who has experience in mesothelioma. If you have been diagnosed with mesothelioma, it is important that a doctor experienced in mesothelioma reviews your tests.

If you have symptoms that may signal mesothelioma, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your exposure to asbestos. One or more of the following tests may be used to find out if you have mesothelioma and if it has spread. These tests also may be used to find out if treatment is working.

Needle biopsy or drainage of lung fluid
Lung function test
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- Chest X-ray
Thoracoscopic surgical biopsy: A small incision (cut) is made in the chest. A tiny tube with a camera on the end is inserted, and a small amount of tissue is removed and looked at under a microscope.

Treatment

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select the treatment for mesothelioma based on your diagnosis and disease stage.

Brown Cancer Center offers pioneering treatments for mesothelioma, some of which are available at only a few cancer centers in the nation. When we treat mesothelioma, we also focus on lung function and quality of life. To do this, we draw upon mesothelioma treatments that may include specialized, less-invasive surgical methods and highly focused radiation therapy.

Doctors often suggest a clinical trial. This may include surgery, radiotherapy, chemotherapy and a targeted agent. If surgery is not possible, some patients may be treated with targeted agents.

Targeted agents are innovative drugs that offer new hope for some patients with mesothelioma.

If you have mesothelioma, your doctor will discuss the best options to treat it. This depends on several things, including:

Type of mesothelioma
Stage of disease
Location of cancer
Your age and general health

Your treatment for mesothelioma will be tailored to your needs. Your doctor may suggest one or more of the following therapies to treat the cancer or help relieve symptoms.

Surgery

The main goals of surgery for mesothelioma are to:

Reduce the amount of cancer to increase the chance for successful treatment with additional therapy such as radiation and chemotherapy or targeted agents
Relieve symptoms of pain and shortness of breath

Two main types of surgery for mesothelioma are used at Brown Cancer Center:

Extrapleural pneumonectomy (EPP) is considered to have the best chance of complete tumor removal. It allows other therapies to be given with less risk to other organs.

EPP is a complex surgery. It includes removal of all organs where the mesothelioma has spread. This may include the lung, lymph glands and parts of the diaphragm and the pericardium. The diaphragm and pericardium are rebuilt with a sheet of artificial material. You must be in good physical shape to tolerate the procedure.

Pleurectomy or pleurectomy/decortication (P/D) involves peeling the tumor away from the lung, diaphragm and chest wall but leaving these structures intact. We may perform a P/D if you cannot have EPP because of poor lung or heart function.

Usually the tumor cannot be removed entirely. Since the lung and diaphragm remain in place, high doses of radiation to the chest cannot be given.

Return of mesothelioma is much more likely with this procedure than EPP. However, because the lung tissue is preserved, lung function usually is retained.

Radiation therapy

Radiation therapy (also called radiotherapy) alone does not cure mesothelioma. However, when given after surgery, it may reduce the chance of the cancer coming back. In some cases, radiation may help relieve pain or discomfort.

Intensity-modulated radiation therapy (IMRT): IMRT may be used after surgery for mesothelioma. Only a few centers in the country offer IMRT. It may lead to better outcomes and fewer side effects than other types of radiotherapy.

Chemotherapy

Brown Cancer Center offers the most up-to-date and advanced chemotherapy options for mesothelioma. Our dedicated thoracic medical oncologists have significant expertise in the management of chemotherapy. A team of nurses, physician assistants, pharmacists, social workers and physicians who specialize in thoracic cancer cares will care for you if you receive chemotherapy.