Mesothelioma

Because other diseases can cause similar symptoms, mesothelioma often is not diagnosed until it has spread. Symptoms vary from person to person and may include:

Common symptoms: 

• Shortness of breath
• Chest or abdominal pain
• Fatigue
• Collapse of lung

Less common symptoms:

• Cough that does not go away
• Losing a lot of weight without trying
• Blood in sputum (phlegm) coughed up from the lungs
• Difficulty swallowing
• Prolonged hoarseness
• Nausea
• Low oxygen levels

If you have one or more of these symptoms, it does not mean you have mesothelioma. However, it is important to discuss any symptoms with your doctor. They may indicate other health problems.

The symptoms of mesothelioma often are the same as those of other diseases. This may make mesothelioma hard to diagnose. In particular, pleural effusion (fluid build-up in the chest cavity) may be found in several other diseases including lung cancer, heart failure and pneumonia. Early and precise diagnosis is important to successful mesothelioma treatment. However, doctors often are unsure if a person has mesothelioma, even after chest fluid has been removed and tested.

Experience Counts

If you have been exposed to asbestos and have symptoms, try to see a doctor who has experience in mesothelioma. If you have been diagnosed with mesothelioma, it is important that a doctor experienced in mesothelioma reviews your tests. Because doctors at MD Anderson focus on mesothelioma and see many patients with the disease, they are among the most skilled and experienced in the nation.

Mesothelioma Diagnosis

If you have symptoms that may signal mesothelioma, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your exposure to asbestos. One or more of the following tests may be used to find out if you have mesothelioma and if it has spread. These tests also may be used to find out if treatment is working.

Needle biopsy or drainage of lung fluid

Lung function test

Imaging tests, which may include:

• CT or CAT (computed axial tomography) scans
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans
• Chest X-ray

Thoracoscopic surgical biopsy: A small incision (cut) is made in the chest. A tiny tube with a camera on the end is inserted, and a small amount of tissue is removed and looked at under a microscope.

Mesothelioma Staging

If you are diagnosed with mesothelioma, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. Staging helps the doctor plan the best way to treat the cancer. Surgery often is needed to stage mesothelioma. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Mesothelioma Stages

(source: National Cancer Institute)

Stage 1A: Tumor is in the outer layer of pleura (parietal pleura). It is not in the pleura covering the lung (visceral pleura).

Stage 1B: Tumor is in the parietal and the visceral pleura.

Stage 2: Tumor has spread into the lung or diaphragm (the thin muscle that separates the chest from the abdomen).

Stage 3: Tumor has spread into one of the following:

• Pericardium (sac around the heart)
• One area of the chest wall
• Lymph glands within the chest

Stage 4: Tumor has spread to one or more of the following:

• Multiple areas of the chest wall
• Across the diaphragm or through the pericardium
• Other organs such as the heart, windpipe, esophagus, liver
• The opposite lung

MD Anderson offers pioneering treatments for mesothelioma, some of which are available at only a few cancer centers in the nation. When we treat mesothelioma, we also focus on lung function and quality of life. To do this, we draw upon mesothelioma treatments that may include specialized, less-invasive surgical methods and highly focused radiation therapy.

Doctors often suggest a clinical trial (research study), some of which are available only at MD Anderson. This may include surgery, radiotherapy, chemotherapy and a targeted agent. If surgery is not possible, some patients may be treated with targeted agents.

Targeted agents are innovative drugs that offer new hope for some patients with mesothelioma. MD Anderson offers more targeted therapies than many cancer centers. As a matter of fact, we are among the leading research sites discovering these treatments.

If you have mesothelioma, your doctor will discuss the best options to treat it. This depends on several things, including:

• Type of mesothelioma
• Stage of disease
• Location of cancer
• Your age and general health

Your treatment for mesothelioma will be tailored to your needs. Your doctor may suggest one or more of the following therapies to treat the cancer or help relieve symptoms.

Surgery

The main goals of surgery for mesothelioma are to:

• Reduce the amount of cancer to increase the chance for successful treatment with additional therapy such as radiation and chemotherapy or targeted agents
• Relieve symptoms of pain and shortness of breath

Two main types of surgery for mesothelioma are used at MD Anderson: 

Extrapleural pneumonectomy (EPP) is considered at MD Anderson to have the best chance of complete tumor removal. It allows other therapies to be given with less risk to other organs.

EPP is a complex surgery. It includes removal of all organs where the mesothelioma has spread. This may include the lung, lymph glands and parts of the diaphragm and the pericardium. The diaphragm and pericardium are rebuilt with a sheet of artificial material. You must be in good physical shape to tolerate the procedure.

Pleurectomy or pleurectomy/decortication (P/D) involves peeling the tumor away from the lung, diaphragm and chest wall but leaving these structures intact. MD Anderson surgeons may perform a P/D if you cannot have EPP because of poor lung or heart function.

Usually the tumor cannot be removed entirely. Since the lung and diaphragm remain in place, high doses of radiation to the chest cannot be given.

Return of mesothelioma is much more likely with this procedure than EPP. However, because the lung tissue is preserved, lung function usually is retained.

Radiation Therapy

Radiation therapy (also called radiotherapy) alone does not cure mesothelioma. However, when given after surgery, it may reduce the chance of the cancer coming back. In some cases, radiation may help relieve pain or discomfort.

Intensity-modulated radiation therapy (IMRT): MD Anderson pioneered this advancement in radiation technology, which is offered at only a few cancer centers in the nation. It may be used after surgery for mesothelioma. Only a few centers in the country offer IMRT. It may lead to better outcomes and fewer side effects than other types of radiotherapy.

Chemotherapy

MD Anderson offers the most up-to-date and advanced chemotherapy options for mesothelioma. Our dedicated thoracic medical oncologists have significant expertise in the management of chemotherapy. A team of nurses, physician assistants, pharmacists, social workers and physicians who specialize in thoracic cancer cares will care for you if you receive chemotherapy.

Targeted Therapies

MD Anderson is leading into the future of mesothelioma treatment by developing innovative targeted therapies. These agents are specially designed to focus on each cancer’s specific genetic/molecular profile to help your body fight the disease. Many of the doctors who treat mesothelioma at MD Anderson are dedicated researchers who have pioneered and actively lead national and international clinical trials with novel targeted agents.