Malignant mesothelioma is a rare, asbestos-related cancer that forms on the thin protective tissues that cover the lungs and abdomen. A combined approach to treatment is helping people improve their survival and ease symptoms.
|Exposure to asbestos|
|Shortness of breath, swollen abdomen, chest wall pain, cough, feeling tired, weight loss|
|Surgery, radiation therapy, chemotherapy, multimodal treatment, clinical trials|
|Depends on type, stage and patient profile|
|Occupations at Risk|
|Construction, shipyard workers, veterans|
|More than $30 billion in asbestos trust funds, lawsuits|
Perceptions about malignant mesothelioma are changing.
Incidence rates still hover around 3,000 new cases each year in the U.S., according to a 2017 report from the Centers for Disease Control and Prevention.
However, scientific research and increased awareness are leading to earlier diagnoses, while improved and developing mesothelioma treatments are allowing patients to live longer than ever.
As more thoracic surgeons and oncologists become familiar with mesothelioma, patients will have more experienced doctors who can extend their life expectancy and increase their chances of surviving this disease.
In order to understand mesothelioma and choose the best path to extend survival, you must first grasp some of the basic information about this type of cancer, including its causes, types and symptoms.
Exposure to asbestos, a naturally occurring mineral once highly regarded for its insulation and fire-retardant properties, is still the overwhelming cause of mesothelioma.
Approximately 75 percent of cases are men who were exposed to asbestos while serving in the military or working certain high-risk blue-collar jobs, including construction, firefighting, shipbuilding and industrial work.
Secondhand exposure also occurs when washing the clothes of someone in a high-risk occupation and living near abandoned asbestos mines or areas where asbestos occurs naturally in the environment.
Each type of mesothelioma is classified by the location in the body where it develops. Prognosis, symptoms and treatment options vary by type.
The pleural and peritoneal types of mesothelioma are the most common, while pericardial accounts for just 1 percent of cases. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.
Mesothelioma symptoms do not usually arise until tumors have grown and spread, and they begin to press against the chest wall or abdominal cavity.
If you have a history of asbestos exposure and experience these symptoms, you should consult a mesothelioma specialist as soon as possible. Although symptoms appear during the late stage of the cancer, early diagnosis may improve your prognosis, survival rate and life expectancy.
The main reason the majority of patients are diagnosed later in life is because mesothelioma can take anywhere from 20 to 50 years after asbestos exposure before symptoms appear.
Doctors use several methods to test for malignant mesothelioma, but only a biopsy can truly confirm a diagnosis. This usually comes after a series of other tests and scans once symptoms arise.
Most people initially undergo a basic chest X-ray. If an abnormal growth is detected, doctors will recommend a more detailed imaging scan such as a PET scan, CT scan or MRI.
About 3,000 new cases are diagnosed annually
Blood tests are also available, but they do not confirm the presence of mesothelioma. Research is underway to determine if blood tests can aid in early diagnosis for at-risk former asbestos workers.
If cancer is suspected, doctors will recommend taking a tissue sample, also known as a biopsy. Doctors use biopsies to definitively confirm the presence of mesothelioma cells.
Because mesothelioma is rare, the cancer is often misdiagnosed as less serious conditions such as the flu or pneumonia.
Anyone who thinks or knows they were exposed to asbestos at some point in time should immediately notify their primary care doctor about their exposure history. This will ensure mesothelioma and other asbestos-related diseases are not ruled out as the cause of the symptoms.
“I remain optimistic that we can, in the next decade, put together the right combination of patients and treatments to effect a cure, which is our holy grail.”
– Dr. David SugarbakerDirector of Lung Institute at Baylor College of Medicine
The stage of mesothelioma describes how far the cancer has spread locally, regionally, and distantly (metastasized) from its point of origin, and doctors label the extent of pleural mesothelioma as stage 1, 2, 3 or 4.
During the early mesothelioma stages, tumors are localized. By the late stages, the cancer has spread to nearby locations or throughout the body.
The cancer is localized, surgery is most effective at this stage, and the survival rate is higher. Median life expectancy at stage 1 is 21 months.
Tumors have started to spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 19 months.
Cancer has progressed to a more advanced stage with spread into the regional lymph nodes. Surgery may still be an option. Median life expectancy at stage 3 is 16 months.
The spread of cancer is extensive, and surgery is usually not effective for prolongation of life. It may still have some utility to control symptoms. Chemotherapy and radiation, and involvement in clinical trials of new and emerging treatments, such as immunotherapy, may reduce symptoms and possibly extend survival. Median life expectancy at stage 4 is 12 months or less.
More than 70 percent of mesothelioma patients undergo chemotherapy
The leading treatment options for mesothelioma include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, which is an approach known as multimodal therapy. Numerous studies show this approach improves survival rates.
Palliative treatments that ease symptoms are quite common for patients of all stages. Emerging therapies in clinical trials, such as immunotherapy, show promise. Additionally, many survivors credit less traditional alternative treatments for helping them live longer. Care in pursuit of these alternative approaches is recommended, as evidence to support claims of benefit may be lacking, and some practitioners may only be preying on fear and desperation to take advantage of patients.
Surgery can be used for diagnostic or aggressive and potentially curative purposes. It offers the best chance of long-term survival for pleural and peritoneal mesothelioma patients eligible for surgery.
Chemotherapy can alleviate symptoms, improve quality of life and extend survival, but it can carry unpleasant side effects.
With fewer side effects than chemotherapy, radiation can help shrink tumors and relieve pain. It can be performed at all stages.
A combination of two or more traditional treatments, including chemotherapy, surgery and radiation. Studies show multimodal therapy can improve survival.
Heated or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a multimodal treatment that involves heating chemotherapy drugs and delivering them to the abdomen after surgery.
Because this disease represents only 0.3 percent of all diagnosed cancers, most primary care doctors and many oncologists rarely treat or see mesothelioma. Finding a mesothelioma specialty center with a staff that truly understands the intricacies of the cancer — and the best ways to treat it — is crucial to extending survival.
“Mesothelioma is not just a death sentence anymore. There have been wonderful advancements in treating this disease in recent years.”
– Dr. Rodney LandreneauThoracic Surgeon
Mesothelioma specialists have diagnosed and treated this disease throughout their medical careers. They know the latest medical advancements specific to this unique disease and have the tools to improve prognosis.
Aside from conventional treatments, many mesothelioma patients turn to clinical trials to potentially extend survival. Participation in such trials can advance the knowledge of those treating mesothelioma and therefore can also help other patients with this disease now and in the future. These experimental studies are small and controlled opportunities for scientists to test new drugs, therapies and different combinations of treatments.
Clinical trials often become an option for patients whose traditional treatments were unsuccessful or for those not eligible for surgery.
“The therapy has given me a new window. It’s like getting my life back.”
– Mesothelioma survivor Walter Merth on participating in Keytruda clinical trial
Immunotherapy is a promising cancer treatment only available to mesothelioma patients through clinical trials. Checkpoint inhibitors, such as pembrolizumab (Keytruda) and avelumab (Bavencio), have shown encouraging results in multicenter trials testing the drugs in combination with surgery and chemotherapy regimens. In May 2017, the U.S. Food and Drug Administration approved pembrolizumab as a first-line treatment of metastatic non-small cell lung cancer, making approval for mesothelioma a possibility in the near future.
mesothelioma clinical trials active or recruiting patients worldwide since 2016
Photodynamic therapy uses light energy to kill cancer cells. A 2016 clinical trial at the Penn Medicine Abramson Cancer Center nearly doubled survival for pleural mesothelioma patients who received intraoperative photodynamic therapy (PDT) and chemotherapy following a P/D procedure.
The process of killing tumor cells by exposing them to extreme cold — known as cryotherapy — is a viable treatment option for mesothelioma patients in the few places that offer the procedure. Unlike many treatments, cryotherapy causes few side effects. In May 2015, the Mayo Clinic in Rochester, Minnesota, opened the only ongoing cryotherapy clinical trial for mesothelioma in the U.S.
A patient’s prognosis, or survival outlook, is individualized to the patient based on how the disease is expected to affect their body and life span. Prognosis varies greatly from person to person, but younger patients, women and people diagnosed with peritoneal mesothelioma typically have a better prognosis than older men diagnosed with the pleural type.
The two biggest factors that determine a mesothelioma prognosis are the stage and cell type of the cancer. Other factors affecting prognosis include age, gender, overall health and history of the patient’s asbestos exposure.
Patients with early stages typically have a better prognosis than those with stage 3 or stage 4 because more treatment options are available the earlier the cancer is detected.
There are three types of mesothelioma cancer cells: Epithelioid, sarcomatoid and biphasic. Epithelioid is the most common and easier to treat than the other types.
Because asbestos use in the military was widespread from 1940 to 1980, veterans from all branches of the U.S. armed forces who served during those years are now at high risk of developing mesothelioma and other asbestos-related conditions.
of all mesothelioma cases
Job duties known for high rates of harmful exposures include pipefitting, mechanical work, equipment maintenance and shipyard work.
Veterans diagnosed with mesothelioma or other asbestos-related diseases have the option to pursue benefits from the U.S. Department of Veterans Affairs (VA), including VA health care and VA Disability Compensation.
While this is often the only way for veterans to receive compensation from the government, veterans exposed to asbestos before or after military service and their family members may be eligible to file a lawsuit or to make a claim against asbestos bankruptcy trust.
Our VA-Accredited Claims Agents can help veterans diagnosed with mesothelioma understand and file VA benefits claims.
Treatment is expensive, and insurance companies may not cover the cost of diagnostic tests or experimental therapies. People without medical insurance will face an even harder battle. If you or a loved one is diagnosed, consider taking steps to protect your finances.
Mesothelioma and other asbestos-related diseases are preventable, but the companies that mined, manufactured and sold asbestos products put profits before the health of customers and their own employees. Our legal system ensures these companies are held accountable for their negligence.
The median value for mesothelioma claims, according to the latest report from the RAND Corporation, a nonprofit institution that conducts research and analysis on asbestos bankruptcy trusts.
Mesothelioma lawsuits include personal injury claims and wrongful death claims. Most lawsuits are settled out of court before a trial takes place.
Asbestos trust funds are established by now defunct companies that filed for bankruptcy protection. To date, these funds contain more than $30 billion to compensate workers and their families.
Veterans exposed to asbestos during military service can file for asbestos-related claims through the U.S. Department of Veterans Affairs (VA).
Government programs, such as Medicare or Medicaid, can help older patients or those with limited finances, while workers’ compensation may be available to people exposed to asbestos on the job.
Don’t let the notion of high costs of mesothelioma treatments deter you from pursuing the best treatment options possible. In addition to legal options, travel and housing grants may be available as well as access to social security disability benefits.
Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.