Malignant Mesothelioma : Causes, Symptoms, Treatment

Malinant Mesothelioma : Mesothelial cells line the inside of the chest and abdominal cavity, as well as the heart bag – the cavity around the heart. These cells also line the surfaces of most internal organs. The tissue formed by the mesothelial cells is called the mesothelium. The chest mesothelium is called the pleura, the abdominal cavity – the peritoneum and the heart cavity – the pericardium. See more about Malignant Mesothelioma and its types.

Tumors of mesothelium are benign and malignant . and malignant tumors usually occur, which are called malignant mesotheliomas.

Types of Malignant Mesothelioma Cancer –

Malignant Mesothelioma

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1. Epithelioid type-  constituting 50-70% among all mesotheliomas and having the best prognosis (outcome).

2. Sarcomatoid type- (7-20%).

3. Mixed type- (20-35%).

Almost 3/4 of mesotheliomas occur in the chest cavity and are called pleural mesotheliomas. In 10-20% of cases, the tumor develops in the abdomen – peritoneal mesothelioma. Pericardial mesothelioma is very rare.

At What Age  Malignant Mesothelioma occurs ?

Mesothelioma is a rare tumor that is more common in men after 50 years.  2-3 thousand new cases are detected annually.  A tumor can be asymptomatic for a long time . And therefore is often detected in the late stages, which negatively affects the prognosis (outcome) of the disease. The average survival of patients is usually only 1-2 years.

What are the Risk Factors of Malignant Mesothelioma ?

Contact with asbestos is a major risk factor for the development of mesothelioma. Asbestos is used in the manufacture of insulation and refractory materials, tile, brake pads, etc.  After establishing the relationship of contact with asbestos and the development of mesothelioma, the use of this substance has decreased dramatically.

The risk of developing mesothelioma depends on the intensity and duration of contact with asbestos. Prolonged contact at a young age significantly increases the risk of mesothelioma. The time period from the moment of the first contact with asbestos to the diagnosis of the tumor is 20-50 years.

Smoking by itself does not affect the increase in the incidence of mesothelioma. But the combination of smoking and contact with asbestos significantly increases the risk of lung cancer. In smokers who are in contact with asbestos, the risk of developing lung cancer is 50-90 times higher than in the general population.

To prevent (prevent) the development of mesothelioma, it is necessary to avoid contact with asbestos at home and at work.

Diagnosis of Mesothelioma –

The early symptoms of mesothelioma are not specific. They are often ignored by patients or taken for manifestations of common non-neoplastic diseases. In most patients with mesothelioma, symptoms appear 2-3 months before the tumor is detected.

In a number of patients, symptoms may persist for 6 months or more.

50% of patients with pleural mesothelioma note pain in the lower chest on the side or rear surface. Many patients complain of shortness of breath. In some cases, there is difficulty swallowing, coughing, sweating, weakness, weight loss and fever.

Other Symptoms of Malignant Mesothelioma :

Other symptoms include hoarseness, hemoptysis, swelling of the face and upper extremities.

Patients with peritoneal mesothelioma may have abdominal pain, nausea, vomiting, and weight loss. Some patients may develop fluid in the abdomen (ascites) and / or a tumor.

What to do If you see Symptoms of Malignant Mesothelioma ?

If you suspect that you have mesothelioma, you should immediately consult a doctor, who will determine the presence of risk factors and schedule an examination. During the examination, the doctor may detect –

  • presence of fluid in the pleural cavity (pleurisy),
  • abdomen (ascites)
  •  pericardium (pericarditis)

This occurs as a result of tumor development.

Procedure Used in the Diagnosis of Malignant Mesothelioma –

# X- Ray –

Chest X-ray can detect pleural thickening, the presence of calcifications (mineral deposits) in the pleura and fluid in the pleural cavity.

# CT Scan –

Computed tomography (CT) makes it possible to diagnose mesothelioma and determine the prevalence of the process (stage).

# MRI –

Magnetic resonance imaging (MRI) can help in identifying lesions of the diaphragm – the muscle tissue that separates the chest and abdominal cavity.

# Thoracoscopy –

Thoracoscopy (examination of the pleural cavity using a special apparatus) allows not only to identify the tumor. But also to make a biopsy (to take a piece of tissue for the study) . Or to obtain a liquid for microscopic examination to clarify the diagnosis.

# Laparoscopy –

Laparoscopy allows you to examine the abdominal cavity, take a piece of tumor or fluid for research.

Laparoscopy-  examination of the abdominal cavity using the apparatus .

Stages of Mesothelioma –

Currently, only the stages of pleural mesothelioma are distinguished, as they occur much more frequently than other sites.

There are 4 stages of pleural mesothelioma –

# Stage I – The tumor affects the pleura on the left or on the right, while the lymph nodes are not involved in the process.

# Stage II – Unilateral defeat of the pleura and the spread of the tumor on the diaphragm or lung tissue.

# Stage III – One-sided lesion of the pleura and the spread of the process on the anterior chest wall, or on adipose tissue of the mediastinum. Or pericardium, or lymph nodes on the side of the mesothelioma.

# Stage IV – Mesothelioma involves muscles or ribs in the process, or a diaphragm, or esophagus, Or trachea, thymus gland, large blood vessels, or spine, grows. Then passes to the other side, or spreads through the bloodstream to distant organs.

Treatment of Malignant Mesothelioma –

The choice of treatment depends on a number of factors, including the stage of the tumor, the general condition of the patient and his opinion. Given the rarity of mesothelioma, it is advisable to carry out treatment in specialized oncological institutions that have experience in treating such patients.

# Surgery –

The operation can be performed with both palliative and therapeutic purposes. By palliative surgery is meant surgery, with which you can eliminate or reduce pain or discomfort caused by the growth of a tumor.

Such operations are used when it is impossible to remove the tumor due to the prevalence of the process or the patient’s severe condition.

# Pleuroectomy –

Pleuroectomy / decortication is usually a palliative operation and consists in removing the pleura, which prevents the accumulation of fluid and the reduction of pain.

# Thoracocentesis –

Thoracocentesis is a procedure whereby a needle is used to remove fluid from the pleural cavity to relieve the patient’s condition.

# Antibiotic –

The introduction of talc or antibiotic into the pleural cavity in order to temporarily prevent fluid accumulation in it is effective in 90% of patients with pleural mesothelioma.

Puncture of the anterior abdominal wall allows you to remove the accumulated fluid in the abdomen in patients with peritoneal mesothelioma.

In patients with pericardial mesothelioma, performing puncture of the pericardium makes it possible to remove fluid and improve cardiac activity.

Radical surgery is performed in the patients who are in satisfactory condition with localized tumor .

Radical surgery – complete removal of mesothelioma

It should be borne in mind that often after the alleged radical operations remain microscopic tumor foci. In this regard, the value of radical operations in patients with mesothelioma is contested.

# Non-Pleural Pneumonectomy –

Non-pleural pneumonectomy consists of removing the pleura, diaphragm, pericardium, and lung on the affected side. Such an extended operation can only be performed by highly qualified oncology surgeons in patients with a good general condition without serious concomitant diseases.

In patients with localized mesothelioma peritoneum, an attempt can be made to remove the tumor along with part of the abdominal wall. Unfortunately, in most patients with peritoneal mesothelioma, radical surgery is impossible due to the prevalence of the process.

In the case of a localized lesion of the pericardium, its removal is performed. And in the case of a common process, palliative interventions that prevent fluid accumulation are performed.

# Radiation Therapy

External radiation is used in patients with mesothelioma most often.

During internal irradiation, the radioactive material is supplied directly to the tumor.

This type of radiation therapy is used as the main method of treatment in patients in serious condition when they cannot undergo serious surgery.

Auxiliary radiation therapy is administered after non-radical surgeries to destroy the remaining tumor cells.

Palliative irradiation is used to alleviate the symptoms caused by tumor growth. It includes shortness of breath, pain, bleeding and difficulty swallowing.

Radiation therapy can cause adverse reactions and complications . Such as skin burns, weakness, nausea, vomiting, loose stools, lung tissue damage, and difficulty in breathing.

Most adverse reactions occur after completion of the course.

Be aware that radiation therapy may aggravate the side effects of chemotherapy.

# Chemotherapy

When treating patients with malignant mesothelioma, chemotherapy drugs can be administered not only intravenously, but also intrapleurally and intraperitoneally (into the abdominal cavity).

Depending on the stage of the tumor, chemotherapy can be either a primary or secondary treatment. Moreover, chemotherapy is used only as a palliative, giving only a temporary effect.

The anticancer drugs used are :

  • doxorubicin
  • cisplatin
  • methotrexate
  • vinorelbine

There are many other medicines used in various combinations.

The adverse reactions of chemotherapy include –

  • nausea,
  • vomiting,
  • loss of appetite,
  • baldness,
  • the appearance of mouth ulcers,
  • increased susceptibility to infections,
  • bleeding.

Most adverse reactions go away after completion of treatment.

Now you know about the Malignant Mesothelium , its symptoms , risk factors, types and stages , diagnosis and treatment.