Mesothelioma in Youth

Mesothelioma is a rare cancer most commonly diagnosed in people in their 60s and 70s, but doctors have reported roughly 300 cases worldwide in young adults, children and even infants. In most cases of mesothelioma diagnosed in youth and childhood, there is no history of exposure to asbestos, which is a much more common cancer among adults.

During childhood, most exposures to asbestos come from the environment. However, it is unclear whether asbestos is a risk factor for cases diagnosed in childhood.

Some studies suggest other potential causes may be contributing factors, such as radiation exposure, the drug isoniazid and a history of mesothelioma in the family. However, most of these unique cases are more likely to be a consequence of unidentified genetic anomalies.

Potential Sources of Childhood Exposure to Asbestos

• Secondhand exposure from a parent who worked with asbestos

• Asbestos in schools

• Environmental asbestos (breathing the air or playing in or eating contaminated soil)

• Asbestos in toys such as chalk, crayons and modeling clay

The symptoms of childhood mesothelioma are similar to the adult variety, and doctors use the same therapies to treat it. Symptoms in children typically include pleural effusion and acute episodes of pain, fever or shortness of breath.

The leading treatment option first removes visible tumors with surgery, then uses chemotherapy and radiation therapy to kill remaining cancer cells and prevent the cancer from returning.

Causes

Many cases of pediatric mesothelioma develop spontaneously, and while several risk factors have been identified, the majority of cases are not linked to asbestos or any one specific cause.

The primary cause of this cancer in adults — occupational exposure to asbestos — is not considered a risk factor for children with mesothelioma. It is rare for this age group to be diagnosed with an asbestos-related illness because it takes several decades after the initial exposure to asbestos before mesothelioma even begins to develop.

Unlike adults, children diagnosed with mesothelioma rarely have a history of asbestos exposure. This has led researchers to look for other potential causes of the disease in children and young adults.

The occurrence of mesothelioma during infancy, childhood and adolescence supports the notion of true spontaneous mesotheliomas.

— Joseph Tomashefski, Dail and Hammar’s Pulmonary Pathology

Children may inhale or ingest environmental asbestos or experience secondhand exposure if a parent is exposed at work or somewhere else, but the likelihood of these exposures to cause mesothelioma in children is low because the cancer develops decades after asbestos exposure.

A potential link between asbestos and pediatric cancer is currently unsupported. Researchers believe asbestos exposure during childhood may increase a person’s risk for respiratory diseases later in life, but these early exposures hardly ever cause cancer in children or young adults.

One large international study involving 80 children diagnosed with mesothelioma reported a history of asbestos exposure in only two children, and two others met additional risk factors. The remaining 76 cases had no identifiable cause. Another study found that people first exposed to asbestos before age 10 were less likely to develop mesothelioma than those who were exposed to the fibers later in life.

Radiation Exposure

Some pediatric oncologists suggest radiation may play a role in the development of mesothelioma in children or young adults. Radiation exposure is only loosely linked to this cancer in adults. Patients who received radiation therapy during childhood for a disease called Wilms’ tumor may face the highest risk for radiation-related mesothelioma, but this risk is still low.

A study published in 1984 showed two children were diagnosed with mesothelioma directly related to childhood radiation therapy for Wilms’ tumor.

Isoniazid Exposure

In utero exposure (exposure in the womb) to a drug called isoniazid, which is a powerful antibiotic used to treat infectious tuberculosis, has also been suggested as a risk factor for childhood mesothelioma. Pregnant animals injected with isoniazid have given birth to offspring with pulmonary tumors. However, only one recorded case of childhood mesothelioma in humans has resulted from isoniazid exposure.

Genetics

Because of the insubstantial links among asbestos, radiation, isoniazid and pediatric mesothelioma, researchers believe children may develop the disease simply through genetic predisposition. Children born with certain genetic mutations may be more likely to have a cancerous response to asbestos-like fibers such as erionite, which is a naturally occurring fibrous mineral that is thought to be of volcanic origin belonging to a group of minerals called zeolites.

In 2013, Dr. Michele Carbone and colleagues published a groundbreaking study on BAP1, a gene that plays an important role in cancer development. Carbone’s team determined that a mutation in the BAP1 gene can increase a person’s risk of developing mesothelioma, melanoma of the eye and other cancers.

The mutated BAP1 gene, which can be passed from parent to child, makes a person more likely to develop mesothelioma after exposure to asbestos and other environmental carcinogens.

Learn more about the genetic link to mesothelioma.

What Are the Symptoms?

Children who develop this cancer often show the same symptoms as adults with the disease. Some of the primary symptoms include pleural effusions (excess fluid in the lungs), loss of appetite, abdominal pain and weight loss. Other possible symptoms include breathing problems, fever and fatigue.

Because many of these symptoms arise from diseases far more common than mesothelioma, doctors may not immediately suspect mesothelioma. Unfortunately, people with mesothelioma are often initially misdiagnosed with more common conditions like pneumonia, asthma or irritable bowel syndrome before test results confirm the correct diagnosis.

Without performing special marker studies, pathologists may also mistake mesothelioma for other cancers with similar clinical features such as adenocarcinoma.

Mesothelioma cancer cells spreading to distant locations, such as the brain, may occur more frequently in pediatric cases than adults. One study published in 1981 noted this pattern in three of seven pediatric patients seen. Children may develop symptoms more quickly than adults do, which reinforces one theory that pediatric mesothelioma may arise spontaneously.

Learn more about the symptoms of mesothelioma.

How Is It Treated?

Children can receive many of the same types of treatments as adults. Debulking surgeries and chemotherapy are commonly used to manage pediatric mesothelioma.

The chemotherapy drugs given to adult patients are also used for children. Often, cisplatin is combined with either pemetrexed or gemcitabine. These drugs are administered over four to six cycles. Children receive these drugs on a dosing schedule that takes their weight and body size into consideration.

Young Adults Who Developed Mesothelioma

One young adult who developed mesothelioma was Austin Lacy, who lost his battle at age 18. It is unknown if he came into contact with asbestos.

Australian Adam Sager died of mesothelioma at age 26, years after documented asbestos exposure. When Adam was a toddler, he played in his home while his parents were making renovations. The home was built when asbestos was commonly used in insulation, and the home tested positive for asbestos.

Kevin Morrison was diagnosed with peritoneal mesothelioma in 2011 at age 21. He was treated at the Dana-Farber Cancer Institute, but lost his battle just six months after being diagnosed. It is unclear if he came in contact with asbestos.

Firefighter Jonathan Smith was diagnosed with pleural mesothelioma at age 29, just several weeks after the birth of his daughter. He may have been exposed to asbestos as a child.

Randy Sloan was diagnosed with pleural mesothelioma in 2016 and passed away less than a year later at the age of 27. “Randy lived a lot while he was dying,” said his mother, who credits the Zen Hospice Project in San Francisco for the compassionate care he received.