Malignant mesothelioma, a rare form of cancer, is a disease in
which cancer (malignant) cells are found in the sac lining the
chest (the pleura) or abdomen (the peritoneum). Most people with
malignant mesothelioma have worked on jobs where they breathed
. Like most cancer, malignant mesothelioma is best
treated when it is found (diagnosed) early. You should see your
doctor if you have shortness of breath, pain in your chest, or pain
or swelling in your abdomen.
If you have symptoms, your doctor may order an x-ray of your
chest or abdomen. Your doctor may look inside your chest cavity
with a special instrument called a thoracoscope. A cut will be made
through your chest wall and the thoracoscope will be put into the
chest between two ribs. This test, called
usually done in the hospital. Before the test, you will be given a
local anesthetic (a drug that causes you to lose feeling for a
short period of time). You may feel some pressure, but you usually
do not feel pain.
Your doctor may also look inside your abdomen
) with a special tool called a
peritoneoscope. The peritoneoscope is put into an opening made in
the abdomen. This test is also usually done in the hospital. Before
the test is done, you will be given local anesthetic. If tissue
that is not normal is found, your doctor will need to cut out a
small piece and have it looked at under a microscope to see if
there are any cancer cells. This is called a
Biopsies are usually done during the thoracoscopy or
peritoneoscopy. Your chance of recovery (prognosis) depends on the
size of the cancer, where the cancer is, how far the cancer has
spread, how the cancer cells look under the microscope, how the
cancer responds to treatment, and your age.
Once malignant mesothelioma is found, more tests will be done to
find out if cancer cells have spread to other parts of the body.
This is called staging. Your doctor needs to know the stage of your
cancer to plan treatment. The following stages are used for
Localized malignant mesothelioma Stage I:
The cancer is
found in the lining of the chest cavity near the lung and heart or
in the diaphragm or the lung.
Advanced malignant mesothelioma Stage II:
The cancer has
spread beyond the lining of the chest to lymph nodes in the
Cancer has spread into the chest wall, center
of the chest, heart, through the diaphragm, or abdominal lining,
and in some cases into nearby lymph nodes.
has spread to distant organs or tissues.
Recurrent malignant mesothelioma:
Recurrent disease means
that the cancer has come back (recurred) after it has been treated.
It may come back in the lining of the chest or abdomen or in
another part of the body.
There are treatments for all patients with malignant
mesothelioma. Three kinds of treatment are used:
- surgery (taking out the cancer)
- radiation therapy (using high-dose x-rays or other high-energy
rays to kill cancer cells)
- chemotherapy (using drugs to fight the cancer).
Surgery is a common treatment for malignant mesothelioma. Your
doctor may remove part of the lining of the chest or abdomen and
some of the tissue around it. Depending on how far the cancer has
spread, a lung also may be removed in an operation called a
. Sometimes part of the muscle below the lungs
that helps you breath (the diaphragm) is also removed.
uses high-energy x-rays to kill cancer
cells and shrink tumors. Radiation may come from a machine outside
the body (external radiation therapy) or from putting materials
that produce radiation (radioisotopes) through thin plastic tubes
in the area where the cancer cells are found (internal radiation
therapy). If fluid has collected in the chest or abdomen, your
doctor may drain the fluid out of your body by putting a needle
into the chest or abdomen and using gentle suction to remove the
fluid. If fluid is removed from the chest, this is called
thoracentesis. If fluid is removed from the abdomen, this is called
paracentesis. Your doctor may also put drugs through a tube into
the chest to prevent more fluid from accumulating.
uses drugs to kill cancer cells.
Chemotherapy may be taken by pill, or it may be put into the body
by a needle in the vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels
through the body, and can kill cancer cells throughout the body. In
mesothelioma, chemotherapy may be put directly into the chest
(intrapleural chemotherapy). Intraoperative photodynamic therapy is
a new type of treatment that uses special drugs and light to kill
cancer cells during surgery. A drug that makes cancer cells more
sensitive to light is injected into a vein several days before
surgery. During surgery to remove as much of the cancer as
possible, a special light is used to shine on the pleura. This
treatment is being studied for early stages of mesothelioma in the
Your treatment depends on where the cancer is, how far it has
spread, your age, and your general health. You may receive
treatment that is considered standard based on its effectiveness in
a number of patients in past studies, or you may choose to go into
a clinical trial. Not all patients are cured with standard therapy
and some standard treatments may have more side effects than are
desired. For these reasons, clinical trials are designed to find
better ways to treat cancer patients and are based on the most
up-to-date information. Clinical trials are going on in many parts
of the country for many patients with malignant mesothelioma.
Localized malignant mesothelioma (stage I)
If the cancer is only in one place in the chest or abdomen, your
treatment will probably be surgery to remove part of the pleura and
some of the tissue around it. If the cancer is found in a larger
part of the pleura, your treatment may be one of the following:
- Surgery to remove the pleura and the tissue near it to relieve
symptoms, with or without radiation therapy after surgery.
- Surgery to remove sections of the pleura, the lung, part of the
diaphragm, and part of the lining around the heart.
- External beam radiation therapy to relieve symptoms.
- A clinical trial of surgery followed by chemotherapy given
inside your chest.
- A clinical trial of surgery, radiation therapy, and/or
Advanced malignant mesothelioma (stages II, III, and
Your treatment may be one of the following:
1. Draining of fluid in the chest or abdomen (thoracentesis or
paracentesis) to reduce discomfort. Drugs also may be put into the
chest or abdomen to prevent further collection of fluid.
2. Surgery to relieve symptoms.
3. Radiation therapy to relieve symptoms.
5. A clinical trial of surgery, radiation therapy, and
6. Chemotherapy given in the chest or abdomen.
Recurrent malignant mesothelioma
Your treatment depends on many factors, including where the
cancer came back and what treatment you received before.