Mesothelioma

What is Mesothelioma?

Mesothelioma (also known as ‘diffuse’ or ‘malignant’ Mesothelioma) is a form of cancer, which affects the thin membranes which line the chest (pleural mesothelioma). Less commonly it can affect the linings of the abdomen (peritoneal mesothelioma). It may also surround the organs found within these cavities for example the heart, lung and intestines.

Pleural Mesothelioma

The pleural lining has two layers - an inner (visceral) layer that lines the lung and an outer (parietal) layer that lines the chest wall. The pleura produces fluid to lubricate the space between the two layers allowing the layers to slide comfortably over each other as we breathe.

Pleural Mesothelioma causes the pleura to thicken. This may make it press on the lung or attach itself to the chest wall. Fluid, sometimes several litres, can collect between the two layers and cause breathlessness. This is known as a Pleural effusion.

Peritoneal Mesothelioma

The peritoneum also has two layers, the inner (visceral) layer which is next to the abdominal organs, and the outer (parietal) layer which lines the abdominal wall. Peritoneal Mesothelioma causes the peritoneum to thicken and fluid to collect in the abdomen, this collection of fluid is called ascites and causes the abdomen to swell. Peritoneal Mesothelioma is much less common than Pleural Mesothelioma.

What causes Mesothelioma?

Exposure to asbestos is responsible for the majority of cases. There are thought to be possibly other unknown causes. It has previously been a

rare disease but is now occurring more frequently because of the heavy use of asbestos in the post-war years. For most people diagnosed with Mesothelioma, the exposure happened 20-40 years previously. (It may in some instances be a longer or a shorter interval than this.) 

Sometimes the asbestos exposure may have been very brief and not always easy to identify. Mesothelioma is however more common in people who have had repeated exposure, usually in a work environment. There are several types of asbestos all of which have been known to cause Mesothelioma.

How is Mesothelioma diagnosed?

Early diagnosis is difficult and in most cases, the first noticeable sign is sudden breathlessness caused by an accumulation of fluid in the pleural space - a pleural effusion. It may be accompanied by other symptoms such as chest pain. 

Scans and X-rays can provide strong evidence to support the diagnosis especially coupled with a history of asbestos exposure. However, other diseases can produce these symptoms and to be certain of a correct diagnosis more investigations often need to be carried out.

Scans, Fluid took for laboratory examination, possibly needle biopsy or keyhole surgery to take a biopsy (a small sample of tissue) are likely to be carried out to help with the confirmation of the diagnosis. These tests and results may take several weeks to complete.

Is there any treatment that may help?

Mesothelioma responds very little to the normal cancer treatments such as chemotherapy and radiotherapy. There are a number of trials being run in an attempt to improve treatment but nothing has been found to cure this disease. Any treatment offered depends on several factors. These should include patient choice, how well someone is, and how advanced the disease is.

The initial most helpful treatment is that which deals with symptoms. Removing fluid from around the lung can help to relieve breathlessness. Firstly the fluid may be drained either by drawing off fluid or inserting a small drainage tube. However the fluid often reaccumulates and the chest physician or surgeon may perform a procedure called a ‘Pleurodesis’.

This is an attempt to stick the lung surface to the chest wall by inserting sterile talc into the pleural space. This may be done by a surgeon using ‘key hole surgery’ otherwise called VATS - Video Assisted Thoracoscopic Surgery.

Surgery

There are minor forms of surgery which the surgeon may carry out during the VATS procedure which can involve removing some of the bulk of the tumour. Surgery may also improve some of the symptoms of the disease.

A very major operation which is called an Extra-pleural Pneumonectomy (EPP) is only suitable for a very select group of patients with early-stage disease and who are physically and mentally able to tolerate such extensive surgery. The operation involves the removal of the whole affected lung along with its lining, the lining of the heart and part of the diaphragm. This operation is only carried out by a limited number of thoracic surgeons in the country.

Chemotherapy

This is drug treatment used to try to destroy or control cancer cells. Unlike some other cancers, there is no evidence that chemotherapy ever cures Mesothelioma. Some trials and studies have however indicated that it may help to improve symptoms temporarily and may extend life expectancy slightly.

Not all patients with Mesothelioma will benefit from chemotherapy and there is no way of knowing which patients will benefit and which will not. It is important for you to discuss this with the doctors and nurses involved in providing it.

Radiotherapy

This is the use of high energy radiation to kill diseased cells in the body. In Mesothelioma it can be used in two ways:

1. A short course of treatment to the chest wall where a biopsy has been done. This is a preventative measure and is intended to stop Mesothelioma from growing in the skin layer.
2. Some patients with pain may get some benefit from radiotherapy.

Will it spread to other parts of my body?

It is unusual for distant spread to be a problem. Mesothelioma spreads slowly outwards from its starting place, along the lining of the chest or abdominal wall, and problems experienced are usually confined to that locality and areas in close contact.

Will I have any pain? If so how can it be handled?

Because of the nature and position of the tumour near to the chest wall, some people with mesothelioma have aches and pains even before the diagnosis, whilst others have few problems with pain. It is important to realise that, if you are one of the unfortunate ones with early pain, this is

not necessarily related to the extent of your disease - but more to do with where the mesothelioma is situated.

The pleural area is very well supplied with nerve endings which can easily

be irritated or compressed by the tumour. 

To maintain the quality of your life it is very important to be sure that you obtain adequate help with pain control if this is a problem for you. It is very rare for pain to be out of control and drugs are readily available which need to be given at the correct level and combination for the individual. You can ask for specialist help if you are having difficulties with pain.

How can I help myself to stay as well as possible?

There is quite a lot you can do . . .

You can help yourself by maintaining your general health as much as possible i.e. a good balanced diet, preferably high calorie and rich in protein. If your appetite is not good, it may be beneficial to supplement your diet with specially balanced drinks which can be prescribed by your GP - or ask to see your hospital or community dietitian for advice.

Exercise is essential to maintain good muscle tone. If your energy level is low you can still do passive exercises of legs and ankles whilst sitting down.

If you are lacking in energy or get breathless on exertion, save your energy for the things you really want to do; make life as easy and convenient as you possibly can - and don’t be too proud to accept help to achieve this (other people like to feel needed and useful).

Complementary therapies such as relaxation, massage and aromatherapy may be helpful in dealing with stress and anxiety.

What help is available if I need it?

Support is available from your GP and consultant. Many hospitals now have Lung Nurse Specialists who you may meet when the diagnosis is first made. Nursing help is available in the community and your local Community Nursing Sister should possibly be your first point of contact - preferably soon after the diagnosis. She can give ongoing support and can arrange practical help as needed.

Domestic help, adaptations to your house and loan equipment e.g. bathing aids can be provided via your local Social Services. They can also help with day-to-day living problems e.g. washing, dressing and cooking. These services are ‘means tested’ so it is important to claim benefits, which will help cover any of these costs.