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Understanding Mesothelioma: Causes, Symptoms, Diagnosis, and Treatment Options

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on July 19th, 2023.

Key Takeaways

  • Asbestos fibers become trapped in the mesothelium for 20-50 years before triggering malignant transformation, with pleural (lung lining) accounting for 75% of cases and peritoneal (abdominal) for 20%.

  • Construction workers, shipbuilders, and military veterans face the highest risk, with even brief exposure potentially deadly—family members can develop secondary exposure from contaminated work clothes.

  • Chest X-rays miss early-stage disease in 90% of cases; CT scans and pleural biopsies are essential for diagnosis, often revealing the cancer only after it has spread locally.

  • Surgical resection combined with heated chemotherapy (HIPEC) can extend survival to 12-21 months in eligible patients, compared to 6-12 months with palliative care alone.

  • Immunotherapy drugs like pembrolizumab show promise in clinical trials, extending progression-free survival by 2-3 months when combined with traditional chemotherapy regimens.

Mesothelioma is a rare and aggressive cancer that affects the mesothelium, a thin membrane that lines the inside of the body's cavities, such as the chest and abdomen. In most cases, mesothelioma is caused by exposure to asbestos, a group of minerals with thin, microscopic fibers that were widely used in construction and other industries.

Understanding Mesothelioma: Causes, Symptoms, Diagnosis, and Treatment Options

Causes of Mesothelioma

The primary risk factor for developing mesothelioma is working with asbestos. When asbestos fibers are inhaled or swallowed, they can lead to serious health problems, including mesothelioma. Other potential causes of mesothelioma include exposure to zeolites, radiation, the SV40 virus, and genetic predisposition.

Symptoms of Mesothelioma

Mesothelioma symptoms typically do not appear until 20 to 50 years after initial asbestos exposure. Common symptoms of mesothelioma affecting the lungs include:

  • Shortness of breath

  • Chest pain

  • Fluid accumulation in the pleura (pleural effusion)

Symptoms of peritoneal (abdominal) mesothelioma may include:

  • Weight loss

  • Abdominal swelling and pain

  • Blood clotting abnormalities

  • Bowel obstruction

  • Anemia

  • Fever

Diagnosing Mesothelioma

Diagnosing mesothelioma involves a combination of medical history, physical examination, and various tests. Your doctor will likely ask about your symptoms and potential asbestos exposure. Tests used to diagnose mesothelioma include:

  • Blood tests to measure levels of fibulin-3, osteopontin, and soluble mesothelin-related peptides (SMRPs)

  • Fluid and tissue sample tests (thoracentesis, paracentesis, or pericardiocentesis)

  • Biopsies (needle biopsy, thoracoscopy, laparoscopy, mediastinoscopy, surgical biopsy, or endobronchial ultrasound-guided biopsy)

  • Imaging tests (chest X-ray, CT scan, PET scan, or MRI)

Treatment Options for Mesothelioma

Treatment for mesothelioma depends on several factors, including the stage and location of the cancer, the size of the tumor, and the patient's overall health. The three standard treatment options are surgery, radiation therapy, and chemotherapy. Treatment often involves a combination of these methods.

Surgery

Surgical options for mesothelioma include wide local excision, pleurectomy and decortication, extrapleural pneumonectomy, and pleurodesis. The goal of surgery is to remove as much of the cancer as possible and to relieve symptoms.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill mesothelioma cells or prevent them from growing. Radiation can be administered externally or internally, depending on the location and extent of the cancer.

Chemotherapy

Chemotherapy involves the use of drugs to stop the growth of cancerous mesothelioma cells. Chemotherapy can be given orally, intravenously, or directly into the affected area of the body. Sometimes, a combination of chemotherapy drugs is used for more effective treatment.

Other treatment options include immunotherapy, which uses drugs to help the immune system fight cancer, and tumor-treating fields (TTF), which combines chemotherapy with electric fields to slow the division of cancer cells.

Despite advances in treatment, the prognosis for mesothelioma remains poor, with a 5-year survival rate of around 5% to 10%. Early detection and treatment can improve outcomes, so it is essential to seek medical attention if you experience symptoms or have a history of asbestos exposure.

For more information on mesothelioma, visit the following reputable sources:

The Bottom Line

This aggressive cancer remains challenging to treat because symptoms appear decades after exposure and diagnosis typically occurs in advanced stages. Early recognition of persistent chest pain or unexplained breathing difficulties is critical for improving outcomes. If you have a history of asbestos exposure and concerning symptoms, Doctronic can help connect you with specialists for rapid evaluation.

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