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Mesothelioma

Published by Bupa's health information team, July 2008.

This factsheet is for people who have mesothelioma, or who would like information about it.

Mesothelioma is a type of cancer which affects thin tissue that lines the organs in the body called the mesothelium. The mesothelium thickens due to an abnormal and uncontrolled growth of cells which can be either malignant (cancerous) or benign.

Mesothelioma doesn't usually spread to other parts of your body like other types of cancer.

• Animation - How cancer develops
• About mesothelioma
• Symptoms of mesothelioma
• Causes of mesothelioma
• Diagnosis of mesothelioma
• Treatment of mesothelioma
• Help and support
• Further information
• Questions and answers
• Related topics
• Sources

How cancer develops

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About mesothelioma

In the UK, about 1,800 people get mesothelioma each year. Mesothelioma is four times more common in men than women.

The mesothelium

The mesothelium consists of a thin layer of mesothelial cells. A mesothelium layer surrounds some of the organs in the body. Each mesothelium has an inner (visceral) layer and an outer (parietal) layer. These two layers produce fluid which allows the layers to slide over each other easily.

If you have mesothelioma, the mesothelium thickens due to the growing cancer cells. This causes the mesothelium to restrict what it surrounds, such as the lungs or bowels. Fluid can also collect between the inner and outer layers of the mesothelium which can put pressure on surrounding organs and tissues. This collection of fluid has a different name, depending on where it is. For example, if the fluid is in the mesothelium surrounding the lungs it's called pleural effusion and if the fluid is in the mesothelium around the abdomen (tummy) it's called ascites.

Types of mesothelioma

There are different types of mesothelioma which affect different areas of the body.

• Pleural mesothelioma affects the mesothelium surrounding the lungs, which is called the pleura. This is the most common type. Nine out of 10 people who have mesothelioma usually get it in this area first.
• Peritoneal mesothelioma affects the mesothelium surrounding the abdomen called the peritoneum.

Sometimes it can affect the mesothelium layer surrounding the heart called the pericardium or the tunica vaginalis which is the layer that surrounds the testes. This factsheet will focus on pleural (lungs) and peritoneal (abdomen) mesothelioma.

Mesothelioma is also separated into groups because the cancer cells look different when they are seen using a microscope. The types include:

• epithelial mesothelioma
• sarcomatoid or fibroid mesothelioma which can grow and spread more rapidly
• mixed type mesothelioma which has both epithelial and sarcomatous type cells

Symptoms of mesothelioma

The general symptoms of mesothelioma include:

• fever
• sweating - particularly at night
• unexplained weight loss
• feeling tired

Depending on which mesothelium is affected by the cancer, you may also have other symptoms.

If you have pleural mesothelioma you may:

• have chest or back pain
• feel breathless
• cough
• have a hoarse voice
• have difficulty swallowing

If you have peritoneal mesothelioma you may:

• have a swollen abdomen
• have abdominal pain
• lose your appetite
• have diarrhoea or constipation

Although not necessarily a result of mesothelioma, if you have these symptoms you should visit your GP.

Causes of mesothelioma

In nine out of 10 people with mesothelioma, the cause is asbestos. Asbestos is a mineral which was used in construction, ship-building and household appliances until 1999 when its use was banned. For example, you may have breathed in asbestos when you worked in a factory which produced products containing asbestos, or when washing work clothes which had asbestos on them.

Your body reacts to asbestos by trying to get rid of it. Asbestos is made up of tiny fibres which, when breathed in, pass into the lungs and cause inflammation and fibrous tissue to form. The fibres then pass into other areas of the body such as the mesothelium as the body tries to get rid of the fibres from the lungs.

Mesothelioma caused by asbestos takes between 10 and 60 years to develop. It's been predicted that an increasing number of people will be diagnosed with it before 2015, when the number of people affected will be highest. When it peaks, about 3,000 people will be diagnosed each year. The number of people diagnosed should then decrease.

The causes of mesothelioma in people who haven't been exposed to asbestos aren't fully understood. But there are certain factors that may make mesothelioma more likely.

• Exposure to radiation.
• A mineral found in Turkey called Zeolite may cause mesothelioma.
• Previous infection with the Simian monkey virus (SV40). This may be a co-factor, making mesothelioma more likely if you have come into contact with one of the other risk factors, such as asbestos.

Diagnosis of mesothelioma

Your GP will ask you about your symptoms and will examine you. He or she may refer you to a doctor who specialises in respiratory medicine; this is a doctor who treats conditions affecting the lungs, or a gastroenterologist, a doctor specialising in conditions of the digestive system. Further tests may include the following.

• A chest or abdominal X-ray.
• A CT (computerised tomography) scan, which uses X-rays to make a three-dimensional image of the body.
• An MRI (magnetic resonance imaging) scan, which uses magnets and radiowaves to produce images of the inside of your body.
• A sample of the fluid (either the pleural effusion or ascites) may be taken and sent to a laboratory for testing.
• A biopsy may be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
• A flexible narrow tube may be used to look for mesothelioma. This is called a mediastinoscopy.
• A PET (positron emission tomography) scan involves the use of an injected weak radioactive substance to look for mesothelioma using a PET machine.

For information, see Related topics.

Treatment of mesothelioma

Mesothelioma is difficult to treat because the cancer has usually spread and can't be removed. Treatments can include the following.

Medicines

There are a number of chemotherapy medicines which may be used to treat mesothelioma. Only one medicine is currently licensed in the UK, this is called pemetrexed. You may be advised to take supplements, such as folic acid and vitamin B12, with pemetrexed. Other medicines include methotrexate, vinorelbine, mitomycin and cisplatin. These, or other medicines, may be suggested to you as part of a clinical trial. Ask your doctor for advice.

Painkillers may be given to help reduce pain.

Steroid medicines, such as prednisolone, may be given to help reduce inflammation and can improve appetite.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. It may be used to try cure the mesothelioma or to reduce symptoms.

Surgery

You may have surgery if the cancer is only in one area of the mesothelium. This type of treatment may help pleural (lung) mesothelioma but isn't usually helpful for peritoneal (abdomen) mesothelioma. Surgery may involve taking the whole pleura (mesothelium) or part of the tissues near the pleura. Sometimes this may include the diaphragm and one of the lungs.

Other treatments

Chemical irritants may be used which will cause the layers of the mesothelium to become inflamed; this makes them stick together so fluid doesn't build up. The chemicals will be added using a tube which will be put through the skin.

Excess fluid can be drained using a needle to help you breathe more easily. You can have this done regularly as the fluid will return. For this you will need a local anaesthetic.

Physiotherapy and relaxation techniques may also be helpful.

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

Compensation may be available through government benefits and/or suing your employer. You can contact your local citizens' advice bureau (CAB) for more information.

Further information

• Cancerbackup
  0808 800 1234
  www.cancerbackup.org.uk
• Citizens Advice Bureau
  www.citizensadvice.org.uk

 

Related topics

• Chemotherapy
• CT scan
• MRI scan
• Radiotherapy
• Abdominal ultrasound

Sources

• Joint Formulary Committee, British National Formulary. 54 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
• Cassidy J, Bissett D and Spence RAJ Obe, Oxford Handbook of Oncology: Oxford University Press, 2002:286-289
• Mesothelioma Framework. Department of Health. 7907. 27 February 2007. www.dh.gov.uk
• Mesothelioma. Cancer Research UK. www.cancerhelp.org.uk, accessed 20 November 2007
• Pemetrexed disodium in combination with cisplatin versus other cytotoxic agents or supportive care for the treatment of malignant pleural mesothelioma. The Cochrane Collaboration. 24 January 2007. www.cochrane.org
• Souhami R, Tobias J. Cancer and its management. 5th ed. Oxford, 2005:212-215
• Statement on the malignant mesothelioma (MM) in the United Kingdom: 2007. British Society Standards of Care Committee. British Thoracic Society. June 2007. www.brit-thoracic.org.uk
• Mesothelioma. Cancerbackup. www.cancerbackup.org.uk, accessed 21 November 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008.