Mesothelioma

Saint Luke’s Frank and Evangeline Thompson Thoracic Center provides expert diagnosis and treatment for mesothelioma.  

Malignant Mesothelioma: Introduction

What is cancer?

Cancer is when cells in the body change and grow out of control. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.

Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).

What is malignant mesothelioma?

Malignant mesothelioma, often just called mesothelioma, is a rare kind of cancer. It starts in the mesothelium. This is a thin lining that surrounds organs in certain parts of the body.

Understanding the mesothelium

The mesothelium is a lining that protects the outer surface of some organs. These include the lungs, stomach, and heart. It also makes fluid that helps the organs move against each other, such as when you breathe. The mesothelium has different names in different parts of the body:

  • The lining in the chest cavity and covering the lungs is the pleura.

  • The lining in the abdomen is the peritoneum.

  • The lining around the heart is the pericardium.

  • The lining around the testicles is the tunica vaginalis.

Mesothelioma can start in any of these linings. It’s most common in the chest. There it’s called pleural mesothelioma. The next most common site is the abdomen. There it’s called peritoneal mesothelioma.

What are the types of mesothelioma?

Mesotheliomas can also be grouped based on how the cancer cells look under a microscope:

  • The epithelioid type is the most common. It also tends to have a better outlook than the other types.

  • The sarcomatoid type tends to be harder to treat.

  • The mixed (biphasic) type has both epithelioid and sarcomatoid areas. It tends to have an outlook in between the other 2 types.

How mesothelioma starts and grows

Mesothelioma starts in the thin lining around certain organs. Unlike many other cancers, it usually doesn’t grow as a single large tumor. Instead, it often grows along the lining at first. This can affect how well the lining works, which can lead to symptoms. For instance, if the cancer starts in the lining around the lungs, it can eventually affect their ability to expand. This can lead to symptoms. These include shortness of breath or chest pain. Over time, the cancer can grow into nearby organs or spread to other parts of the body.

Talk with your healthcare provider

If you have questions about mesothelioma, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.

Diagnosis

Malignant Mesothelioma: Diagnosis

If your healthcare provider thinks you might have malingant mesothelioma, you’ll need certain exams and tests to be sure. Diagnosing mesothelioma starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

What tests might I need?

You may have one or more of the following tests:

  • Imaging tests

  • Biopsy

  • Blood tests

Imaging tests

If you have symptoms of mesothelioma, you may have imaging tests. While these tests might strongly suggest you have the cancer, you’ll still need a biopsy to be sure.

X-rays

Chest X-rays are often the first test done when a person has certain symptoms. These can include a cough that doesn’t go away or shortness of breath. X-rays of your chest, especially when you’re positioned in different ways, can help your healthcare provider see certain things. These can include fluid or other signs of cancer in the spaces around your lungs. X-rays of your abdomen can help your healthcare provider see if your abdomen has areas of cancer. If something abnormal is seen on an X-ray, your healthcare provider may do other imaging tests.

Computed tomography (CT scan)

A CT scan uses X-rays. They’re taken from many angles to make detailed pictures of your body. It can show areas of your chest or abdomen in much more detail than an X-ray.

Positron emission tomography (PET scan)

A PET scan can sometimes help your healthcare provider know if fluid in your chest or other issues are due to cancer. For this test, you’re injected with a form of sugar (glucose) that carries a radioactive substance. Cancer cells are more active than normal cells, so they tend to take up more glucose. A special camera then takes pictures of where this glucose is being used in your body.

Biopsy

If an imaging test shows something that looks like it might be cancer, your healthcare provider may take fluid or small tissue samples of the area. This is called a biopsy. Your healthcare provider sends the samples to a lab. There, a specialized doctor, called a pathologist, looks at them under a microscope and checks for cancer cells. There are several different biopsy tests.

Thoracoscopy

Your healthcare provider takes a small sample from a tumor in your chest cavity. He or she puts a small lighted tube with a tiny camera (thoracoscope) through a cut in the skin of your chest to look at the tumor. He or she looks carefully at the lining of the inner part of your chest and your lung. Then he or she removes pieces of tissue from the tumor for the biopsy.

Laparoscopy

Your healthcare provider takes a small sample from a tumor in your abdomen. He or she puts a small lighted tube with a tiny camera (laparoscope) through a cut in the skin of your belly to look at the tumor. He or she looks carefully at the lining of the inner part of your belly and on your intestines and other organs. Your healthcare provider takes biopsies from suspicious looking areas.

Bronchoscopy

Your healthcare provider puts a thin tube (bronchoscope) into your mouth, down your windpipe, and into the main air passages of your lungs. This tube lets him or her see if there are any tumors in your airways. He or she can also take a biopsy while doing this test.

Thoracotomy

In this surgery, your healthcare provider makes a larger incision in your chest. This is done to remove a larger piece of tissue from the tumor or the entire tumor. This is often the best way to make a diagnosis of mesothelioma.

Laparotomy

In this surgery, your healthcare provider makes a larger incision in your abdomen. This is done to remove a larger piece of tissue from the tumor or the entire tumor.

Thoracentesis, pericardiocentesis, and paracentesis

In this procedure, your healthcare provider uses a long, hollow needle. He or she puts it through your skin to remove fluid from your chest, sac around your heart, or from your abdomen.

It can be hard to diagnose mesothelioma by looking at fluid or tissue samples. This is because this cancer can look like other kinds of cancer. You may need more tests.

Blood tests

You may have blood tests to help diagnose mesothelioma. However, not all healthcare providers agree that these tests are useful. Your healthcare provider may look for these substances in your blood:

  • Soluble mesothelin-related peptides (SMRPs)

  • Osteopontin

These blood tests alone cannot diagnose mesothelioma. But high levels of these substances can make the diagnosis more likely.

Getting your test results

When your healthcare provider has the results of your tests, he or she will contact you with the results. Your provider will talk with you about other tests you may need if mesothelioma is found. Make sure you understand the results and what follow-up you need.

Treatment Choices

Malignant Mesothelioma: Treatment Choices

There are various treatment choices for malignant mesothelioma. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage (extent) of your cancer. Other factors include your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may recommend a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best choice.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. You may also want to involve your family and friends in this process.

Understanding the goals of treatment for mesothelioma

For some mesotheliomas, the goal of treatment is to cure the cancer. If a cure isn’t possible, you may receive treatment to shrink the cancer or keep it under control. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of treatment can include one or more of these things:

  • Remove or destroy the mesothelioma in the place where it started

  • Remove or destroy tumors in other parts of your body

  • Stop or slow the growth or spread of mesothelioma cells

  • Prevent or delay the cancer's return

  • Ease symptoms from the cancer, such as pain or trouble breathing

Types of treatment for mesothelioma

There are several types of treatment for mesothelioma. Different combinations of treatment may be used, depending on a number of factors, such as: 

  • The type and location of the cancer 

  • The stage (extent) of the cancer

  • Your age and overall health

  • Your personal concerns and preferences

Each treatment has its own goals.

Surgery

For some early stage mesotheliomas, surgery can be used to try to remove all of the cancer. But this is often a complex operation. Plus, it can be hard to remove all of the mesothelioma. In some cases, surgery is done to remove as much of the cancer as possible. This is then followed by other treatments. For more advanced cancers, less extensive forms of surgery are used to help relieve symptoms from the cancer. These include trouble breathing.

Radiation

Radiation therapy uses high-energy X-rays or particles to kill cancer cells. This treatment might be used after surgery. It’s done to try to kill any remaining cancer cells. It may also be used to help relieve symptoms in people with advanced cancer.

Chemotherapy

Chemotherapy (chemo) is the use of medicines to kill cancer cells. For early stage mesothelioma, chemo can be used before surgery to try to make the operation easier. Or it may be done during or after surgery to try to kill any remaining cancer cells. Chemo is often the main treatment (sometimes with radiation) for people with advanced mesothelioma or who cannot have surgery for some other reason.

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.

Clinical trials for new treatments

Researchers are always looking for new ways to treat mesothelioma. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your doctor

At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and side effects of each option. Discuss your concerns with your healthcare provider before making a decision.