Mesothelioma

Mesothelioma Types

Mesothelioma affects different parts of the body. Each type of mesothelioma is distinguished by the location where the disease started.

Pleural Mesothelioma

makes up

85-90%

of all mesothelioma cases

Pleural Mesothelioma

Pleural mesothelioma is the most common disease location. It makes up 85-90% of all mesothelioma cases. Pleural mesothelioma affects the protective lining that covers the lungs, called the pleura.

Pleural tumors can cause fluid buildup in the space between two pleural layers, a condition called a pleural effusion. Effusions can cause symptoms such as shortness of breath and tightness in the chest. Over time, mesothelioma can spread to the outer chest cavity or nearby lymph nodes in the armpits or collarbone.

Pleural mesothelioma has a poor prognosis compared to peritoneal mesothelioma. Approximately 40% of pleural mesothelioma patients survive longer than 12 months. Patients who have had surgery, like an extrapleural pneumonectomy (EPP), often live much longer than their initial prognosis.

Peritoneal Mesothelioma

makes up

10-15%

of all mesothelioma cases

Peritoneal Mesothelioma

Peritoneal mesothelioma is the second most common form of mesothelioma, making up 10-15% of all cases. Peritoneal mesothelioma usually has a better prognosis than pleural or pericardial mesothelioma.

The average life expectancy for peritoneal mesothelioma patients is 12 months after diagnosis. Many patients live several years after their diagnosis thanks to a procedure involving cytoreduction surgery (which removes visible cancer tissue) followed by chemotherapy using heated drugs (called HIPEC).

Peritoneal mesothelioma affects the lining of the abdominal cavity, called the peritoneum. The peritoneum protects the organs inside the abdomen. These organs include the stomach, pelvic organs and part of the diaphragm.

Mesothelioma tumors can cause symptoms like stomach aches and abdominal bloating as fluid builds up in the peritoneum.

Pericardial Mesothelioma

makes up

< 1%

of all mesothelioma cases

Pericardial Mesothelioma

Pericardial mesothelioma is the least common form of mesothelioma. Less than 1% of all mesothelioma diagnoses are of this type. Pericardial mesothelioma affects the protective lining that covers the heart, called the pericardium. Unlike pleural and peritoneal mesothelioma, researchers still aren’t sure how pericardial mesothelioma develops.

To date, there have been fewer than 500 cases of pericardial mesothelioma worldwide. Pericardial mesothelioma has the poorest prognosis of all types. Half of all patients live only six months after their diagnosis.

Cancer that surrounds the heart is very difficult to treat. Mesothelioma specialists use a combination of surgical procedures and anti-cancer drugs to help remove tumors and slow disease progression.

No matter your disease or prognosis, there may be hope.

Mesothelioma Cell Types

Cell type refers to how mesothelioma cells look under the microscope. Pathologists study these cells to help make a conclusive diagnosis.

There are three cell types that can appear in any of the three mesothelioma locations:

1. Epithelioid cells: Epithelioid cells are the most common and the easiest to treat. They don’t divide and spread as aggressively as sarcomatoid cells.
2. Sarcomatoid cells: Sarcomatoid cells are the least common and most aggressive mesothelioma cell type. They divide and spread quickly. Sarcomatoid mesothelioma is the most difficult form of mesothelioma to treat.
3. Biphasic: Biphasic mesothelioma tumors have both epithelioid and sarcomatoid cells. These tumors are sometimes referred to as “mixed” cell type. A biphasic tumor takes on the characteristics of whichever cell type is most dominant. Doctors consider a biphasic tumor with epithelioid-dominant cells to be easier to treat than one with sarcomatoid-dominant cells.

Mesothelioma Causes

Mesothelioma is caused by asbestos exposure. Asbestos is a natural substance made up of tiny microscopic fibers. It was commonly used in construction as an insulator and fire retardant.

Until the 1980s, asbestos was used extensively by the military. Army barracks, vehicles, vessels, and aircraft all contained asbestos. Service members who worked in onboard ships or in a shipyard were at the greatest risk of exposure.

When asbestos is disturbed or moved, it releases its sharp fibers into the air. Anyone working around asbestos may accidentally inhale or ingest asbestos fibers. These fibers can migrate deep within the tissue layers covering the chest cavity, abdomen or heart.

Over time, the fibers cause irritation, inflammation, and eventually cellular mutation. Cancer cells divide and spread at faster rates than most healthy cells. As they divide, they clump together to form masses of cancer cells called tumors. These tumors continue to spread and shut down organs in their path.

Mesothelioma Symptoms

Mesothelioma symptoms vary depending on the cancer location. Symptoms can take decades to appear after asbestos exposure, making them difficult to identify and easy to ignore.

The long latency (period of development) of mesothelioma symptoms can confuse physicians who have limited experience with this rare cancer. Seeking consultation and treatment from a specialist is critical. A second opinion can ensure you receive the best treatment possible to extend your life.

Pleural Mesothelioma Symptoms

Because pleural mesothelioma affects the lining of the chest cavity, the symptoms mostly cause difficulty breathing.

Many of the initial symptoms, like shortness of breath, can be confused with other respiratory conditions.

Peritoneal Mesothelioma Symptoms

Peritoneal mesothelioma produces symptoms that affect digestion.

Pericardial Mesothelioma Symptoms

Pericardial mesothelioma produces a mixed set of symptoms related to the heart.

Mesothelioma Diagnosis

It can be difficult for doctors to determine a mesothelioma diagnosis because its initial symptoms are vague. These symptoms can easily be confused with other conditions like bronchitis or irritable bowel syndrome. Many physicians and general oncologists have never encountered a mesothelioma patient and don’t always know what to look for.

Here are the basic steps of a mesothelioma diagnosis:

1. Physical Exam: The patient’s primary care physician will review symptoms, family history and assess possible causes. For veterans with known asbestos exposure, it is imperative that he or she mention this exposure to their doctor during the initial exam.
2. X-Rays and Imaging Scans: X-rays, ultrasounds and CT scans are important diagnostic tools for finding the cause of the patient’s symptoms. These tests help specialists see where the mesothelioma has formed and how advanced it is.
3. Biopsies: Once X-rays or imaging scans have revealed the location of any tumors, a biopsy is ordered. A biopsy is a tissue sample collected from the tumor that is analyzed under a microscope. This helps pathologists determine if the tumor is mesothelioma. The pathologist also determines the cell type. Cell type allows specialists to recommend the best and most appropriate treatment course. A biopsy is the only conclusive way to diagnose mesothelioma.

A general oncologist may be able to diagnose mesothelioma, but most are unfamiliar with specialized treatment and surgeries for mesothelioma. If you were diagnosed by a general oncologist, consider getting a second opinion from a mesothelioma specialist. A second opinion can present a better prognosis or new treatment options.

Mesothelioma Stages

The stages of mesothelioma explain how advanced a patient’s disease is, the size of tumors and how far the disease has spread. Doctors also look at a patient’s stage to determine which treatments are best for that individual.

Only pleural mesothelioma has an official staging system because the other types of mesothelioma are still too rare to have collected enough data for an official staging system. As more cases of peritoneal mesothelioma are diagnosed, doctors will be able to better stage this type of mesothelioma.

Doctors stage pleural mesothelioma using the following criteria:

Stage 1
This is the least advanced stage of pleural mesothelioma. It’s broken into two sub-stages.

• Stage 1A
  Mesothelioma is still localized within the pleura around one lung on one side of the chest. Mesothelioma cells are contained in the outer layer of the pleura (parietal pleura) on one side of the chest.
• Stage 1B
  Mesothelioma cells are contained in the inner layer of the pleura (visceral pleura) on one side of the chest.

Stage 2
Mesothelioma cells are in both the inner and outer layers of the pleura. The tumor mass has enlarged within the pleural tissue around one lung, or the tumor has spread to the diaphragm or lung tissue. There is minimal lymph node involvement.

Stage 3
Mesothelioma cells have spread through the pleura. They are now attached to the chest wall or the covering of the heart (pericardium). Or the tumor has spread to the nearby lymph nodes on the same side of the chest as the affected lung.

Stage 4
Mesothelioma cells are now affecting multiple parts of the chest wall. The cells have spread through the diaphragm and into the peritoneum, or the mesothelioma cells have spread to the other side of the chest and into the pleura of the other lung.

Mesothelioma Prognosis

Along with a diagnosis, your mesothelioma specialist will provide you with a prognosis. A prognosis is the expected outcome that the disease will take.

A prognosis is different for every patient. It can vary depending on what type of mesothelioma the patient has and when they were diagnosed.

Those diagnosed with mesothelioma before the cancer has spread tend to have a better prognosis.

Average prognoses for each type of mesothelioma are: 

• Pleural mesothelioma: Average survival time is 12-21 months
• Peritoneal mesothelioma: Survival time ranges from 12 months to several years
• Pericardial mesothelioma: Average survival time is 6 months or less

While mesothelioma is almost always fatal, some have outlived their initial prognosis and achieved long-term survivorship.

Mesothelioma Treatment

Mesothelioma specialists have the best understanding of the disease and access to cutting-edge treatments. They are highly trained in determining disease progression, surgical options, and in prescribing treatments that provide veterans the greatest chance of significantly improving their prognosis.

Key aspects of mesothelioma treatment:

• Get a second opinion from a mesothelioma specialist.
• Surgery offers the best chances for long-term survival.
• Every patient has a chance to improve their prognosis.

If you have been diagnosed with mesothelioma, call one of our patient advocates at (877) 450-8973 to get connected with a mesothelioma specialist or assistance in filing a VA claim.