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Q&A: Mesothelioma

CancerWise - March 2009

Google “mesothelioma” and you’ll discover myriad articles, proof of increased awareness of about this relatively rare disease. Interest has piqued since the Sept. 11, 2001, terrorist attacks because workers on the scene at the World Trade Center have experienced respiratory ailments possibly linked to polluted air near the destroyed buildings.

Answering questions about mesothelioma is Anne Tsao, M.D., assistant professor and director of the Mesothelioma Program in the Department of Thoracic/Head and Neck Medical Oncology at MD Anderson.

What is mesothelioma?

Mesothelioma — more precisely malignant mesothelioma — is a cancer of the mesothelium, or lining of the lungs, abdomen or heart. It strikes about 3,000 new patients a year in the United States. Although mesothelioma is most common in the pleura (lungs), it also may occur in the pericardium (lining around the heart) or in the peritoneum (lining of the abdomen).

How is it related to asbestos?

Most people who contract mesothelioma were exposed to asbestos fibers at work or home, often many decades before symptoms appear and the disease is diagnosed. It is believed the initial exposure to asbestos leads to genetic changes that develop slowly and silently over several decades.

Is there a “typical” patient?

Because people in certain jobs are more likely to be exposed to asbestos, mesothelioma affects more men than women. Men and women are equally susceptible to this cancer, but not equally exposed. Because mesothelioma develops slowly, most patients are between 45 and 85 years old when they’re diagnosed.

Why is this disease so difficult to diagnose?

The symptoms — chest or back pain, shortness of breath, a stubborn cough — are nonspecific and could be caused by many disorders. Even in X-rays, mesothelioma may look like lung cancer.

Why is there a sense of urgency when you speak about your work?

Until a few years ago, the treatment options were limited for someone diagnosed with mesothelioma. Most treatments were strictly to relieve pain and suffering, not cure the disease.

Now, because of advances in surgical techniques, staging and treatment, a newly diagnosed patient has many more options. New studies that are looking at combining drugs with surgery and radiation offer hope for a cure.

My sense of urgency comes from the realization that these advances in treatment are most beneficial to those who receive them right after diagnosis, before getting any other treatment. But, even if patients have been treated before, some of the new drugs we are testing in clinical trials may help control the disease. We need to see people with mesothelioma sooner rather than later in their treatment in order to best help them.

Why should newly diagnosed patients seek care at a major cancer center?

Since mesothelioma is such a complex disease, it’s important for patients to receive multidisciplinary care from a team of specialists, possibly including thoracic oncologic surgeons, radiation oncologists, pathologists and pulmonologists.

For a number of reasons, mesothelioma has not been researched very much. A major cancer center that treats hundreds of mesothelioma patients a year will most likely be conducting research that may help patients and eventually lead to a cure.

What is extended surgical staging? How does it help patients?

Extended surgical staging allows us to provide more precise information on how far the cancer has spread, eliminating unnecessary and ineffective treatment and better predicting who might benefit from surgery. It often is performed with a special tool called a laparoscope, which is inserted through a small incision in the abdomen.

What should our readers take away from this discussion of mesothelioma?

I would advise people who are concerned or have been diagnosed with mesothelioma to remember the following three things.

Know your risk. If you’ve worked with asbestos, even decades ago, or were somehow exposed to it, tell your doctor and have regular check-ups.

Seek expert care. If you’re diagnosed with mesothelioma, get to an expert — better yet, a team of experts — as soon as you can.

Participate in a research program. Consider joining a research study if it’s appropriate and if your treatment team offers that option. There’s still so much to learn about this devastating disease.

MD Anderson resources:

© 2015 The University of Texas MD Anderson Cancer Center