Mesothelioma is the cancer of the mesothelium ( internal lining of organs). It majorly affects the inner lining of the lungs and chest wall. Less often, it affects the lining of the heart, scrotal sac, and abdomen. Mesothelioma is often used to describe a malignant tumor that is linked to frequent asbestos exposure. It is named according to the organ affected if it affects the pleura, it is called pleural mesothelioma, and if the abdomen is affected, it is called peritoneal mesothelioma. It should not be confused with benign mesothelioma or solitary fibrous tumor which are benign tumors, unlike the malignant mesothelioma. The pleural and peritoneal mesothelioma is the most common, while pericardial and scrotal mesothelioma occurs in less than 1 percent of cases.

How Common is Mesothelioma?

3,000 new cases per year.

According to center for disease control, in 2017,  2400-2800 people are diagnosed with mesothelioma in the US. People with frequent exposure to asbestos are at the highest risk of having this disease. It takes about 20- 50 years after exposure for the signs and symptoms to become visible.  The life expectancy and prognosis for mesothelioma is poor.

The incidence rate in America is about 3000 new cases each year.

What are the Subtypes of Mesothelioma?

There are three major histological subtypes of malignant mesothelioma:

  • Epitheliod subtypes which contain high amount of calretinin
  • Sarcomatous subtypes which contain reduced amount of calretinin
  • Bi-phasic

Other morphological subtypes include:

  • Adenomatous
  • Desmoid
  • Clear cell
  • Desmoplastic
  • Cartilagineous
  • Osteo metaplasia
  • Lymphohistiocytic
  • Glandular
  • Mucohyaline

What Causes Mesothelioma and Can it Be Prevented?

Exposure to asbestos is number one.

  • Exposure to asbestos: It has been discovered that frequent exposure to asbestos increases the risk of having mesothelioma of the pleural. Asbestos is such a risk factor, that pleural mesothelioma has been named a signal or sentinel tumor. Individuals that work in asbestos manufacturing and producing companies are at high risk of developing pleural mesothelioma due to frequent exposure to asbestos. This asbestos can be inhaled from roof houses, plastics, or soil containing asbestos. The best can lead to lung calcification to from a disease called Metsovo.
  • Radiation: Thiorast radiation to the chest and abdomen can cause pleural mesothelium
  • Silicate inhalation: talc and erionite inhalation can predispose an individual to pleural mesothelioma.
  • Infections: Simian virus, when combined with other factors can cause pleural mesothelioma.
  • Genetics: A mutation in BAP1 gene has increased the risk of developing pleural mesothelioma and uveal melanoma.
  • Co-habitation: Living with someone that works in an asbestos factory can increase an individual’s chance of having mesothelioma. If the people working in this abesto factory comes home with their work clothes, they could have transferred some of the ancestor’s homes, placing their loved ones at the risk of inhaling the asbestos.
  • Family history: Individuals with family history of mesothelioma, have a higher chance of developing mesothelioma.

There are some variations, where people inhale a lot of asbestos and not develop mesothelioma, A lot of factors comes into lay, apart from asbestos exposure, other factors include genetics, environment, and lifestyle habits.

What Causes Mesothelioma and Can it Be Prevented

What are the Signs and Symptoms of Mesothelioma?

Depends on the organ affected and the type of mesothelioma.

What are Pleural Mesothelioma Symptoms?

Dyspnea, chest pain, and dry cough.

  • Pain the chest
  • Dyspnea
  • Pleural effusion
  • Fatigue and weakness
  • Loss of blood resulting in anemia, especially in women
  • Hemoptysis( coughing out blood)
  • Collapsed lung
  • Pneumothorax
  • Anorexia
  • Cachexia
  • Tissue lumps under the skin
  • Nausea and vomiting

The most common symptoms of pleural mesothelioma are dyspnea, chest pain, and dry cough. Pleural mesothelioma is the most common type of mesothelioma, and it forms on the surface of the lungs.

What are Pleural Mesothelioma Symptoms

What are Peritoneal Mesothelioma, Signs, and Symptoms?

The most common symptom is ascites.

  • Ascites
  • Night Sweats
  • Fever
  • Constipation
  • Nausea and vomiting
  • Poor appetite
  • Umbilical hernia
  • Poor bowel function
  • Unexplained weight loss
  • Feeling of lumps in the abdomen

Peritoneal mesothelioma occurs in 20% of cases, and the most common symptom is ascites which leads to abdominal swelling and pain. It affects the lining of the abdomen.

Pericardial Mesothelioma, Signs, and Symptoms

  • Heart failure
  • Constrictive pericarditis
  • Cardiac tamponade
  • Pulmonary embolism
  • Consistent cough
  • Shortness of breath while lying down (orthopnea)
  • Palpitation or tachycardia
  • Heart murmur
  • Chest pain

It is the rarest type, and the most common symptoms include palpitations, heart murmurs, and chest pain.

Other Forms of Mesothelioma and End-time Mesothelioma

Types include testicular mesothelioma. This type of mesothelioma affects the tunica vaginalis of the testes. When the mesothelioma gets severe, it consists of the following signs and symptoms:

  • Thrombophlebitis(blood clot in the vein)
  • Disseminated intravascular coagulation
  • Pleural effusion
  • Hypoglycemia
  • Jaundice
  • Pulmonary emboli
  • Ascites

The most common sites of metastasis for mesothelioma are lungs, liver, kidney, and adrenal gland.

Usually, because of the various awareness program and information that the common cause of mesothelioma is inhaling asbestos.

People frequently ask this common question:

Can You Get Mesothelioma from One Exposure to Asbestos?

No, it takes consistent exposure.

Can this question be likened to asking If smoking in a day can cause lung cancer? In medicine, diseases and conditions are formed by long-time habits, not in one day. We all inhale asbestos one way or the other, once in a while in our lifetime, but this is not enough for us to have mesothelioma.

Do you get obese, by eating pizza in a day? No, you don’t it takes consistent bad habits be obese.

The answer to this famous question is no, you can’t get mesothelioma in one exposure. It takes a lot of consistent exposure to asbestos, especially in those working in companies producing asbestos and military veterans. These individuals are prone to developing lung cancer, mesothelioma, or asbestosis due to the nature of their type of jobs.

When Should You See a Doctor for Signs and Symptoms of Mesothelioma?

After frequent exposure or symptoms. You need to see a doctor that specialized in mesothelioma when you discover any of the signs and symptoms of mesothelioma or are frequently exposed to asbestos or have worked for a long time in the asbestos-producing and manufacturing company.

When Should You See a Doctor for Signs and Symptoms of Mesothelioma

How Long Does it Take for Mesothelioma to Develop?

20 to 25 years after exposure. It takes about 20 50 years after exposure to asbestos for the signs and symptoms to appear. It is more common in people with military experience or those who have worked at various blue-collar jobs or offices.

How is the Diagnosis of Mesothelioma Accomplished?

Many types of imaging studies.

  • Imaging studies which include:
  • Inspection, palpation, and percussion, family and job history
  • Xray: this imaging study helps to see the thickening of the organs and calcium deposits on the lungs due to prolonged exposure to asbestos
  • Liver function test: this is used to detect the functioning capacity of the lungs
  • Ct scan or MRI:  helps to detect the presence of fluids in an organ, exact location, and shape of the mesothelioma.
  • Cytopathology: this is used to detect the presence of abnormal cells
  • Thoracocentesis or tube thoracostomy: this is used for detecting the presence of ascites.
  • Paracentesis and pericardiocentesis: this is used to drain ascites and pericardial effusion.
  • Echocardiography: this is used to detect pericardial effusion
  • Positron emission tomography (PET scan): it involves the injection of sugar-related substances into the blood  to detect whether an abnormal cell is cancerous or not
  • Blood tests: The blood test of an individual diagnosed with mesothelioma reveals an increase in the following substances:
  • Osteopontin
  • Soluble mesothelin-related peptides( SRMP): these peptides can be detected with MESOMARK TEST.
  • Biopsy: A biopsy is often done to confirm a diagnosis of a disease, the type of biopsy done depends on the location of the cancerous cells .such as:
  • Thoracoscopy, if the cancerous cells are located in the thorax
  • Laparoscopy, if the cancerous cells are found in the abdomen
  • The open surgical procedure could be done, if necessary if other methods prove not productive.
  • Thoracotomy and laparotomy: this involves opening of the chest and abdomen through an incision to detect the presence of an abnormal cell.
  • Fine needle aspiration
  • Immunohistochemistry

How is the Diagnosis of Mesothelioma Accomplished

What is the Staging of Pleural Mesothelioma?

  • Stage 1: it is also called localized mesothelioma because it is limited to one part of the organ. It is restricted and confined to the lining of the chest.
  • Stage 2: this is an advanced form, in which the mesothelioma has metastasized to the diaphragm or lungs
  • Stage 3: this occurs when the cancerous mesothelioma cells have spread to other structures within the chest and other surrounding lymph nodes
  • Stage 4: This indicates advanced cancer that has metastasized beyond the chest and lymph nodes. This phase involves cancerous cells that have metastasized to nearby organs such as the brain, liver, and lymph nodes.

What is the Prevention of Mesothelioma?

Reducing exposure to asbestos.

  • It can be prevented by reducing the frequency of exposure to asbestos, especially those working in factories that produce It is recommended by the “US National Institute for occupational safety and health” to maintain a daily recommendation of not more than 0.1 asbestos fiber per cubic centimeter.
  • Removing the work clothes, before entering your house, especially for those working in asbestos manufacturing companies.
  • Taking a shower after work, to eliminate any debris of asbestos on your body, before going home.
  • YOU SHOULD USE PROTECTIVE EQUIPMENT AND APPARATUS WHEN WORKING AROUND ASBESTOS.
  • Hiring experts to detect and check the asbestos level of your home.
  • Having a healthy clean eating lifestyle.
  • Frequent medical check-ups and mesothelioma blood tests, especially if your job is asbestos- related.

Specific Preventive Measures You Can Practice at Work

  • Performing air monitoring
  • Educating your workers about the side effects of asbestos
  • Ensuring proper work practice and controlling the limits of exposure.
  • Providing respiratory protection for your workers that are regularly exposed to asbestosis
  • Provide training on how to work with asbestos-containing environment
  • Availability of medical surveillance for those exposed to asbestos, especially those exceeding their daily limits.
  • Don’t sweep asbestos containing substances in the presence of people, do it before they would arrive at work
  • Dispose of your asbestos according to the medical safety rules and regulations.

Specific Preventive Measures You Can Practice at Home

Most times mesothelioma can be gotten from home, during the renovation of an old hose, or when moving to a new house. To prevent mesothelioma from home, it is necessary to conceal or be careful around asbestos- made equipment in our home.

Asbestos- made equipment includes:

  • Arctic insulation
  • Glues
  • Floor tiles
  • Roofs
  • Popcorn ceilings
  • Pipes and electric wires

Specific Preventive Measures You Can Practice at Home

How To Prevent Your Family and Loved Ones From Having Mesothelioma

  • Replacing asbestos- containing compounds, if possible
  • Properly concealing asbestos-containing products
  • Calling an abatement specialist, if you have a damaged asbestos compounds at home.

Screening of Mesothelioma

There is no general rule concerning screening of mesothelioma. However, the level of biomarkers such as osteopontin and soluble mesothelin-related proteins can be used to screen for the presence, progress, or degree of mesothelioma

Treatment of Mesothelioma

  • Radiation: mesothelioma can be treated with radiotherapy
  • Chemotherapy and immunotherapy: this is a useful treatment for mesothelioma
  • Surgical treatment: Various surgical procedure can be used to treat mesothelioma. Such surgical treatment includes extrapleural The surgery aims to remove excess fluid, debulk, and remove infected tissues around the lungs and surrounding tissues.
  • Heated intraoperative chemotherapy: this is an effective treatment for
  • Multimodal therapy: This is a combination treatment, that involves the combination of both surgery and other treatment options, such as radiation therapy

Treatment of Mesothelioma

Clinical Trials and Breakthrough Treatment Options For Treating Mesothelioma

  • Targeted therapy: This type of treatment involves using specific drugs aimed at the cancerous cells causing mesothelioma.
  • Biological therapy: this is an immunity- based therapy, it involves fighting the cancerous cells with the help of your immune system.
  • Gene therapy: this treatment involves alteration in the genetic makeup of the cancerous cells causing mesothelioma/
  • Phototherapy: this includes the formation of a bond between a drug injected into you and the cancerous cells causing mesothelioma. This bond is activated by high-intensity light.
  • Cryotherapy: this involves the use of extreme temperature to destroy the cancerous cells.

Prognosis

The prognosis for mesothelioma is very poor, and the survival rate depends on the time of detection and mode of treatment. People survive for an average of 12-21 months depending on the time of discovery, and treatment options.

Adequate knowledge about mesothelioma not enough to save anyone, early detection and prevention is the key, if you are a veteran, or work in an asbestos manufacturing company, see the nearest doctor close to you, to get a favorable prognosis and treatment.

 

References

Cancer.org. (2017). Treating Malignant Mesothelioma. [online] Available at: https://www.cancer.org/cancer/malignant-mesothelioma/treating.html [Accessed 22 Sep. 2017].

Cancer.org. (2017). What Are the Risk Factors for Malignant Mesothelioma?. [online] Available at: http://www.cancer.org/Cancer/MalignantMesothelioma/DetailedGuide/malignant-mesothelioma-risk-factors [Accessed 22 Sep. 2017].

Oge, M. (1992). Overview of the United States Environmental Protection Agency Radon Action Programme. Radiation Protection Dosimetry, 45(1-4), pp.751-757.

Selby, K. (2017). Mesothelioma – What is Malignant Mesothelioma Cancer. [online] Mesothelioma Center – Vital Services for Cancer Patients & Families. Available at: https://www.asbestos.com/mesothelioma/ [Accessed 22 Sep. 2017].

Therapy, G. and Therapy, P. (2017). Mesothelioma Treatment. [online] Mesothelioma.com. Available at: https://www.mesothelioma.com/treatment/ [Accessed 22 Sep. 2017].

Whitmer, M. (2017). Mesothelioma Prevention – How to Prevent Asbestos Cancer. [online] Mesothelioma Center – Vital Services for Cancer Patients & Families. Available at: https://www.asbestos.com/mesothelioma/prevention.php [Accessed 22 Sep. 2017].

SaveSave