Mesothelioma

lungsMalignant mesothelioma is a disease in which cancer cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) or the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen). This information is about malignant mesothelioma of the pleura.

Risk Factors
Symptoms
Screening and Diagnosis
Staging
Treatment
Support

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Risk Factors

Risk factors for malignant mesothelioma include the following:

  • Living or working in places where a person inhales or swallows asbestos
  • Living with a person who works near asbestos
  • Being exposed to a certain virus

Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. A person with any concerns about mesothelioma risk should talk to his or her doctor.

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Symptoms

Sometimes malignant mesothelioma causes fluid to collect around the lung or in the abdomen. Symptoms may be caused by the fluid or the cancer. Symptoms may include the following:

  • Trouble breathing
  • Pain under the rib cage
  • Pain or swelling in the abdomen
  • Lumps in the abdomen
  • Weight loss for no known reason

Other health problems can cause some of these symptoms. A person with such symptoms should see a doctor to be diagnosed and treated as early as possible.

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Screening and Diagnosis 

Sometimes it is hard to tell the difference between malignant mesothelioma and lung cancer. The following tests and procedures may be used to detect and diagnose the disease:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, past illnesses and treatments will also be taken.
  • Chest x-ray: This is an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
    • The portion of the blood sample made up of red blood cells.
  • Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
  • Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the cells or tissues include the following:
    • Fine-needle aspiration: The removal of tissue or fluid using a thin needle. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.
    • Thoracoscopy: The surgeon makes several small incisions in your chest and back. The surgeon looks at the lungs and nearby tissues with a thin, lighted tube. If an abnormal area is seen, a biopsy to check for cancer cells may be needed.
    • Peritoneoscopy: An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen.
    • Laparotomy: An incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.
    • Thoracotomy: The surgeon opens the chest with a long incision. Lymph nodes and other tissue may be removed.
  • Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Cytologic exam: An exam of cells under a microscope (by a pathologist) to check for anything abnormal. For mesothelioma, fluid is taken from around the lungs or from the abdomen. A pathologist checks the cells in the fluid.

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Staging

The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The information gathered from this process determines the stage of the disease. It is important to know the spread of the cancer in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the chest or abdomen.
  • Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.

Stages of Malignant Mesothelioma

Stage I (Localized)

Stage I is divided into stages IA and IB:

  • In stage IA, cancer is found in one side of the chest in the lining of the chest wall and may also be found in the lining of the chest cavity between the lungs and/or the lining that covers the diaphragm. Cancer has not spread to the lining that covers the lung.
  • In stage IB, cancer is found in one side of the chest in the lining of the chest wall and the lining that covers the lung. Cancer may also be found in the lining of the chest cavity between the lungs and/or the lining that covers the diaphragm.

Stage II (Advanced)

In stage II, cancer is found in one side of the chest in the lining of the chest wall, the lining of the chest cavity between the lungs, the lining that covers the diaphragm, and the lining that covers the lung. Also, cancer has spread into one or both of the following:

  • Diaphragm muscle
  • Lung

Stage III (Advanced)

In stage III, cancer is found in one side of the chest in the lining of the chest wall. Cancer may have spread to

  • the lining of the chest cavity between the lungs.
  • the lining that covers the diaphragm.
  • the lining that covers the lung.
  • the diaphragm muscle.
  • the lung.

Cancer has spread to lymph nodes where the lung joins the bronchus, along the trachea and esophagus, between the lung and diaphragm, or below the trachea.

or

Cancer is found in one side of the chest in the lining of the chest wall, the lining of the chest cavity between the lungs, the lining that covers the diaphragm, and the lining that covers the lung. Cancer has spread into one or more of the following:

  • Tissue between the ribs and the lining of the chest wall
  • Fat in the cavity between the lungs
  • Soft tissues of the chest wall
  • Sac that covers the heart

Cancer may have spread to lymph nodes where the lung joins the bronchus, along the trachea and esophagus, between the lung and diaphragm, or below the trachea.

Stage IV (Advanced)

In stage IV, cancer cannot be removed by surgery and is found in one or both sides of the body. Cancer may have spread to lymph nodes anywhere in the chest or above the collarbone. Cancer has spread in one or more of the following ways:

  • Through the diaphragm into the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen)
  • To the tissue lining the chest on the opposite side of the body as the tumor
  • To the chest wall and may be found in the rib
  • Into the organs in the center of the chest cavity
  • Into the spine
  • Into the sac around the heart or into the heart muscle
  • To distant parts of the body such as the brain, spine, thyroid, or prostate

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Treatment

At Huntsman Cancer Institute, mesothelioma is treated by a team of specialists, including surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Mesothelioma treatment options include the following:

A patient may receive more than one type of treatment. The treatment that's right for each patient depends on the type and stage of the cancer.

Surgery

The following types of surgery may be used for mesothelioma:

  • Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.
  • Pleurectomy and decortication: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
  • Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
  • Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage
of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body. When chemotherapy is placed directly into an organ or a body cavity such as the abdomen, he drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.. Learn more about this treatment in our introduction to chemotherapy video.

 

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

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Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

There are several places you can go for support:

  • Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
  • The G. Mitchell Morris Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist.
  • Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to HCI patients and their families.
  • The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.

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Adapted from the National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries
This information last updated on HCI website January 2014

 

*If you are interested in a trial that is currently marked *Not Open, please contact the Patient Education team at 1-888-424-2100 or patient.education@hci.utah.edu for other trial options. Enrollment is updated daily.

Forte Research Systems in partnership with Huntsman Cancer Institute

Wallace L. Akerley, M.D.

Locations
Huntsman Cancer Hospital (801) 213-4266

Specialties: Lung Cancer, Medical Oncology, Metastatic Disease, Oncology

David Brock, PA-C

Locations
Primary Children's Hospital (801) 662-5582

Specialties: Cardiothoracic Surgery, Physician Assistant

David A. Bull, M.D.

Locations
University Hospital (801) 581-5311

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Esophageal Surgery, Heart Transplant, Lung Cancer, Lung Transplant, Valvular Heart Disease

Phillip T. Burch, M.D.

Locations
Primary Children's Hospital (801) 662-5577

Specialties: Cardiothoracic Surgery, Pediatric Cardiothoracic Surgery

Barbara C. Cahill, M.D.

Locations
University Hospital (801) 585-3697
University Hospital (801) 581-7806

Specialties: Advanced Lung Disease, Critical Care, Lung Transplant, Pulmonary, Tuberculosis

Elisabeth M. Carr, M.D.

Locations
University Hospital (801) 581-7806

Specialties: Asthma, Critical Care, General Pulmonary, Lung Cancer, Medical Ethics, Pulmonary, Pulmonary Fibrosis

Shamus R. Carr, M.D., FACS

Locations
Huntsman Cancer Hospital (801) 587-4470
University Hospital (801) 581-5311

Specialties: Barrett's Esophagus, Bronchoscopy surgery, Cardiothoracic Surgery, Esophageal Diseases, Gastroesophageal Reflux Disease (GERD), Lung Cancer, Minimally Invasive Gastrointestinal Surgery, Therapeutic Endoscopy

Daniel Christopherson, P.A.

Locations
University Hospital (801) 581-7806

Specialties: Advanced Lung Disease, Physician Assistant, Pulmonary, Pulmonary Fibrosis

Jessica M. De St Jeor, B.S.

Specialties: Cardiothoracic Surgery

Aaron W. Eckhauser, M.D., M.S.C.I

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Kyle Gubler, PA-C

Specialties: Cardiothoracic Surgery, Physician Assistant

Terri M. Hancock, DNP, ACNP-BC

Locations
University Hospital (801) 581-5311

Specialties: Acute Care Nurse Practitioner, Cardiothoracic Surgery

Richard E. Kanner, M.D.

Locations
University Hospital (801) 581-7806

Specialties: Advanced Lung Disease, General Pulmonary, Pulmonary, Pulmonary Function, Pulmonary Rehabilitation

Kristine E. Kokeny, M.D.

Specialties: Breast Cancer, Genitourinary Cancers, Lung Cancer, Radiation Oncology

Antigoni Koliopoulou, M.D.

Specialties: Cardiothoracic Surgery

Ganesh S. Kumpati, M.D.

Locations
University Hospital (801) 581-5311
Veterans Administration Medical Center (801) 582-1565

Specialties: Cardiothoracic Surgery

Thomas Lewis, PA-C

Locations
University Hospital (801) 231-2200

Specialties: Cardiothoracic Surgery, Physician Assistant

Taylor Lies, PA-C

Specialties: Cardiothoracic Surgery

Julie Bylund Luckart, FNP, APRN, M.S.N.

Locations
Huntsman Cancer Hospital (801) 213-4266

Specialties: Family Nurse Practitioner, Lung Cancer, Oncology

Stephen McKellar, M.D., M.Sc.

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Minimally Invasive Lung & Esophageal Surgery, Valvular Heart Disease

Robert Paine III, M.D.

Locations
University Hospital (801) 581-7806

Specialties: Advanced Lung Disease, Critical Care, General Pulmonary, Pulmonary

Amit N. Patel, M.D., B.S., M.S.

Locations
University Hospital (801) 587-7946

Specialties: Cardiothoracic Surgery, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Valvular Heart Disease

Sanjeev M. Raman, M.D.

Locations
University Hospital (801) 585-3697
University Hospital (801) 581-7806

Specialties: Advanced Lung Disease, Critical Care, Lung Transplant, Pulmonary

Mary Beth Scholand, M.D.

Locations
South Jordan Health Center (801) 213-4500
University Hospital (801) 581-7806

Specialties: Advanced Lung Disease, Pulmonary, Pulmonary Fibrosis

Craig H. Selzman, M.D.

Locations
University Hospital (801) 587-9348

Specialties: Adult Congenital Heart Disease, Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Surgical Ventricular Restoration, Valvular Heart Disease

Dennis C. Shrieve, M.D., Ph.D.

Locations
Huntsman Cancer Hospital (801) 581-2396

Specialties: Brain Tumors, Gastrointestinal Cancers, Genitourinary Cancers, Lung Cancer, Pediatric Radiation Therapy, Prostate Cancer, Radiation Oncology, Soft Tissue Sarcomas

Nathan C. Sontum, PA-C, M.H.S.

Specialties: Cardiothoracic Surgery

Scott A. Tatum, PA-C

Locations
University Hospital (801) 581-2121

Specialties: Cardiothoracic Surgery, Physician Assistant

HCI Resources

Make An Appointment

kim mcaffee neuro oncology-thoracicLung Cancer Program
Care coordinator: Kim McAffee
Phone: 801-587-4470
E-mail: kim.mcaffee@hci.utah.edu

Did You Know?

  • Asbestos is the name given to a group of minerals that occur naturally in the environment as bundles of fibers.
  • Exposure to asbestos may increase the risk of asbestosis, other nonmalignant lung and pleural disorders, lung cancer, mesothelioma, and other cancers.
  • Smokers who are also exposed to asbestos have a greatly increased risk of lung cancer.
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