Written By: Karen Ritter, RN BSN
Mesothelioma
Mesothelioma is a rare and aggressive cancer caused by asbestos. It forms when sharp, loose asbestos fibers become lodged in the lining of either the lungs or abdomen. These fibers irritate tissue, which becomes diseased. Most patients live for around one year after diagnosis, but treatment can prolong survival.
Medically Reviewed By
Dr. Abraham Lebenthal
Mesothelioma Thoracic Surgeon
Medically Reviewed By
Dr. Abraham Lebenthal
Mesothelioma Thoracic Surgeon
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Important Facts About Mesothelioma
- 2,500-3,000 cases each year in the U.S.
- Two main types: pleural (80%) and peritoneal (20%)
- Men = 77% of cases
- Caucasians = 93%
- Ages 55-84 = 80%
- At-risk occupations = Military veterans, shipbuilding, construction, electrical work, automobile repair, mining and plumbing
Asbestos Fibers Entering the Body
Symptoms of Mesothelioma
Some mesothelioma symptoms are similar to pneumonia, such as shortness of breath and coughing. People begin experiencing signs of mesothelioma 20-50 years after exposure to asbestos.
OTHER COMMON SYMPTOMS
Chest or abdominal pain
Pleural effusions
Difficulty breathing
Night sweats
Weight loss
Who Is at Risk?
Exposure to asbestos is the only proven cause of mesothelioma. American industries adored asbestos because it was cheap and fire-resistant. Companies used the mineral to build homes, offices, ships, airplanes and automobiles.
People exposed through their jobs face the highest risk of mesothelioma:
- Construction and insulation workers
- Military veterans
- Electricians
- Pipefitters and plumbers
- Automobile mechanics
- Firefighters
- Shipbuilders and shipyard workers
Others at risk include:
- Loved ones of a high-risk worker (secondary exposure)
- Regular users of talc products (talc exposure)
- Residents near asbestos mines and manufacturing plants (environmental exposure)
Mesothelioma in the Military
Military veterans make up an estimated 33% of mesothelioma cases. The U.S. military used asbestos in ships, aircraft, barracks and on-base housing.
Types of Mesothelioma
Pleural Mesothelioma
- Forms in the lining around the lungs
- Main symptoms: Chest pain, pleural effusions (fluid buildup), coughing, shortness of breath
- Treatment: Surgery, chemotherapy, radiation, immunotherapy and tumor treating fields
- Males = 81% of cases
Peritoneal Mesothelioma
- Forms in the lining of the abdomen
- Main symptoms: Abdominal pain, ascites (fluid buildup), weight loss
- Treatment: Surgery, intravenous chemotherapy and intraoperative chemotherapy
- Females = 44% of cases
Pericardial Mesothelioma
- Forms in the lining around your heart
- Main symptoms: Shortness of breath, chest pain, irregular heartbeat
- Treatment: Surgery and chemotherapy
- 1% of mesothelioma cases
Getting a Medical Diagnosis
A biopsy is the only conclusive way to diagnose mesothelioma. A biopsy is a surgical procedure to remove tissue samples and test them for cancer.
Unfortunately, this cancer can be mistaken for other diseases and often misdiagnosed.
We suggest you visit a cancer center of excellence to go through a series of tests:
- CT scan
- PET scan
- Biopsy
Mesothelioma Stages and Prognosis
There are four stages of mesothelioma. Each stage has a general prognosis, or life expectancy, based on past studies and data. Most mesothelioma cases are diagnosed in stage 3.
The life expectancies listed below are based on median survival for pleural mesothelioma. These include patients who cannot have surgery, which lowers the median length.
Peritoneal mesothelioma survival rates are usually longer than pleural mesothelioma rates. Many patients live five years or more after surgery.
Stage 1
- Life expectancy: 20 months
- Cancer is within the lining where it formed
- Organs and lymph nodes not yet affected
- Surgery is best treatment option
Stage 2
- Life expectancy: 19 months
- Tumors have spread beyond the lining
- Nearby organs and lymph nodes at risk
- Surgery remains an option
Stage 3
- Life expectancy: 16 months
- Cancer is no longer localized to the lining
- Lymph nodes are affected by cancer cells
- Surgery may involve removing the lung
Stage 4
- Life expectancy: 11 months
- Cancer has reached distant organs and areas
- Patients may experience painful symptoms
- Pain-relief treatment available
Mesothelioma Treatment and Survival
There are four main options for mesothelioma treatment: surgery, chemotherapy, immunotherapy and radiation. Doctors often combine them to improve your survival time. Emerging methods include tumor treating fields, oncolytic virus therapy and gene therapy.
The U.S. Food and Drug Administration has approved three therapies for unresectable mesothelioma:
- Chemotherapy drugs pemetrexed and cisplatin
- Immunotherapy drugs Keytruda, Opdivo and Yervoy
- A tumor treating fields device called Optune Lua
Surgery
Surgery is the quickest way to remove mesothelioma tumors from your body. There are different surgeries for each type of mesothelioma, and they have different survival rates.
Chemotherapy
Chemotherapy is a cancer-killing drug that looks for fast-growing cells. It’s the most-used treatment for mesothelioma. Chemotherapy on its own can extend survival by 6-8 months.
Radiation
Radiation uses high-energy beams to kill diseased cells. This method is primarily used for pleural mesothelioma. When used before or after surgery, radiation may improve survival.
Immunotherapy
The FDA approved Opdivo and Yervoy together in October 2020 for unresectable pleural mesothelioma. The pair led to an average survival of 18 months since the start of treatment. The FDA also approved Keytruda for a small group of patients.
Tumor Treating Fields
The FDA approved the NovoTTF-100L System in May 2019 for unresectable pleural mesothelioma. It’s a tumor treating fields device, made by Novocure, and was renamed “Optune Lua.” When paired with chemotherapy, it led to 18 months median survival.
Top Doctors and Cancer Centers for Mesothelioma
Before beginning treatment, you should visit one of the top cancer centers of excellence. Speak to a mesothelioma specialist for a second opinion. You may learn about new treatment options.
Some of the top cancer centers for mesothelioma are:
- Brigham and Women’s Hospital (Boston)
- National Cancer Institute (Bethesda, Maryland)
- Baylor St. Luke’s Medical Center (Houston)
- Mount Sinai Medical Center (New York City)
- MD Anderson Cancer Center (Houston)
- Moffitt Cancer Center (Tampa)
- Memorial Sloan Kettering Cancer Center (New York City)
VA Healthcare System for Mesothelioma
Veterans with mesothelioma have three VA hospitals with dedicated mesothelioma treatment programs. Specialists from prestigious nearby cancer centers work at these VA hospitals as part of the VA healthcare system:
- Boston VA
- Los Angeles VA
- Houston VA
Common Questions About Mesothelioma
What causes mesothelioma?
The only proven cause of mesothelioma is asbestos exposure. Loose strands of asbestos float in the air, invisible to the naked eye, and are easily inhaled or ingested. These fibers can travel into your lungs or abdomen and lodge into sensitive mesothelial linings, which causes cells to mutate and tumors to form.
Is mesothelioma always fatal?
Mesothelioma is an aggressive cancer that can spread quickly to vital organs, such as your lungs, diaphragm, heart or intestines. The average survival time for mesothelioma is 1-2 years, but medical advancements have improved the prognosis for many patients. Starting treatment immediately offers the best chance for beating this cancer.
Who faces the highest risk of mesothelioma?
Men ages 55 and older account for the majority of all mesothelioma cases. This is due to men working jobs that involved high risks of asbestos exposure. The occupations at greatest risk of developing mesothelioma are construction, electrical work, automobile repair, shipbuilding and military service.
How many types of mesothelioma are there?
There are three main types of mesothelioma: pleural, peritoneal and pericardial. The last one is very rare, accounting for around 1% of cases. Pleural mesothelioma, which develops in the thin lining covering your lungs, is the most common. Peritoneal mesothelioma, which forms in the lining around your abdomen, accounts for around 20%.
How can you stop mesothelioma?
The main way to stop the spread of mesothelioma is through multimodal treatment. The top three options are surgery, chemotherapy and radiation. Emerging methods include immunotherapy and tumor treating fields, which either helps the immune system fight mesothelioma or stops cancerous cells from replicating. Aggressive treatment often extends survival by multiple years.
How do you know if you have mesothelioma?
The primary symptoms of mesothelioma are pain, fluid buildup in the chest or abdomen, fever, weight loss, decreased appetite, fatigue, and difficulty breathing. Unfortunately, these symptoms are also features of the flu, pneumonia and COPD. If you have mesothelioma symptoms, visit a doctor immediately for testing.
How many people get mesothelioma in the United States?
There are around 3,000 documented cases of mesothelioma in the U.S. each year. This makes mesothelioma one of the rarest known cancers. It is four times more common in men than women, and it predominantly affects elderly Americans at an alarming rate compared to young adults.
Sources & Author
- Mesothelioma incidence in 50 states and the District of Columbia, United States, 2003–2008. International Journal of Occupational and Environmental Health. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406225/. Accessed: 04/15/2021.
- Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. Journal of Thoracic Oncology. Retrieved from: https://www.jto.org/article/S1556-0864(15)33132-4/fulltext. Accessed: 04/15/2021.
- Life Expectancy in Pleural and Peritoneal Mesothelioma. US National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/. Accessed: 03/19/19.
- Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/29792828/. Accessed: 03/19/19.
- Mesothelioma: Symptoms and Signs. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs. Accessed: 04/15/2021.
- Initial analysis of the international association for the study of lung cancer mesothelioma database. Journal of Thoracic Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/23070243/. Accessed: 04/15/2021.
- Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma. Accessed: 04/15/2021.
- Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging. UpToDate. Retrieved from: https://www.uptodate.com/contents/malignant-peritoneal-mesothelioma-epidemiology-risk-factors-clinical-presentation-diagnosis-and-staging. Accessed: 04/15/2021.
