Mesothelioma is an aggressive cancer that attacks the tissue lining in some body organs. Cancer starts when mesothelial cells start growing out of control. The mesothelium is a lining formed around internal organs like the lungs, abdomen, heart, and testicles.
The mesothelium has a slippery surface that protects the body organs from rubbing against each other and shields them against invading pathogens. Malignant mesothelioma causes fluids to accumulate between the visceral and parietal layers of the mesothelium. These effusions are considered one of the primary symptoms of the disease.
The mesothelium goes by different names depending on the body organs:
- The pleura covers the lungs and chest
- The peritoneum covers the abdomen
- The pericardium is found around the heart
- The tunica vaginalis covers the testes
Causes and Risk Factors
Malignant mesothelioma begins when epithelial cells start to mutate and multiply uncontrollably. While many cancers have inherent genetic risk factors, it has been established that exposure to asbestos poses the highest risk. Asbestos is a fibrous, naturally occurring chemical compound. It is widely used in the construction industry as an insulator.
The CDC reports show that malignant mesothelioma usually develops during 20 to 40 years of occupational exposure to asbestos compounds. It explains why shipping and construction contribute to most of the known mesothelioma diagnosis cases.
What Are the Major Symptoms/Types of Mesothelioma?
Mesothelioma symptoms differ according to the location of the cancer cells.
Pleural mesothelioma
Malignant pleural mesothelioma is a cancer type that affects the lining of the lungs and is different from lung cancer. It accounts for more than 70% of diagnosed cases of mesothelioma. Researchers believe that this type of cancer is caused by the inhalation of asbestos fibers, which interfere with the DNA structure of the mesothelial cells.
People with pleural mesothelioma diagnoses may experience shortness of breath, chest pains, dry cough, fatigue, difficulty swallowing, and fever. The following conditions are closely linked to the development of mesothelioma, even though some might not present any severe symptoms:
- Pleural effusion is a resultant condition where fluid collects between the two mesothelium layers. The fluid compresses the lungs, leading to breathing difficulties.
- Pleural plaques are layers of thickened tissue around the mesothelium. Pleural thickening happens when scar tissue thickens the mesothelium.
- Asbestosis is a condition directly linked with the inhalation of asbestos fibers. It leads to tissue scarring and breathing difficulties and increases the risk of pleural mesothelioma.
Clinical diagnosis often involves medical imaging (CT scans or X-rays) and blood tests. A biopsy is the only way to identify aggressive tumors.
Pleural mesothelioma has a low life expectancy. On average, stage 1 and 2 patients may survive about two years after diagnosis. Stages 3 and 4 are more aggressive, and the life expectancy is about 12-17 months. Early diagnosis presents the best chance of recovery, but some mesothelioma treatment options can prolong survival.
Treatment options depend on the stage where the cancer is diagnosed. Doctors often prescribe chemotherapy as a treatment option to kill the cancer cells and prevent them from spreading. Surgery can be prescribed to remove early-stage tumors, followed by radiotherapy to keep them from recurring. Extrapleural pneumonectomy (EPP) is a more aggressive surgical procedure. It may prolong life expectancy in severely affected patients.
Immunotherapy is an emerging treatment for managing pleural mesothelioma more effectively with minimal side effects.
Peritoneal mesothelioma
Peritoneal mesothelioma is cancer of the abdomen. It’s the second-most common type of mesothelioma condition after Pleural mesothelioma. It is caused by ingesting asbestos fibers which cause abnormal cell activity in the peritoneum.
Common symptoms of peritoneal mesothelioma include weight loss, abdominal pain, swelling, and fluid build-up in the abdominal lining. The onset of symptoms might mimic common abdominal diseases, as patients experience bloating, tenderness on the abdominal region, or irregular bowel movements.
Clinical diagnosis is needed to rule out other abdominal conditions. Medical imaging is used to locate tumors and determine their sizes. The doctor might require blood samples to check for biomarkers associated with cancerous cells. A patient may also be taken through a biopsy to reveal the spread of the tumors.
Survival rates in peritoneal mesothelioma patients are determined by age, sex, diagnostic stage, and treatments like surgery and chemotherapy. The life expectancy varies from 2-5 years depending on individual characteristics, and advancements in treatment are helping more patients to live longer.
Traditional treatments may include one or a combination of surgery, chemotherapy, and radiotherapy. Success rates are higher when cancer is caught in the early stages, but research also shows an improvement in life expectancy for patients undergoing treatment for late-stage Peritoneal mesothelioma. Alternative treatments for cancer other than chemo also exist.
There are different clinical clinics for new treatment options like pressurized intraperitoneal aerosol chemotherapy (PIPAC). PIPAC involves pressurized drug therapies to manage the tumors.
Pericardial mesothelioma
Pericardial mesothelioma accounts for about 1% of all diagnosed cases of mesothelioma. Research surrounding the causal agents is limited by the rarity of the disease. Some experts believe it is caused by breakaway cancer cells from other body parts. But it is still believed that asbestos exposure plays a crucial role in its development.
Pericardial mesothelioma symptoms take years to develop. They’re often never diagnosed or mistaken for other conditions. Possible symptoms may include shortness of breath, fatigue, chest pains, cardiomyopathy, right shoulder pain, and swelling of the lower limbs. Pericardial effusion is fluid buildup between the pericardial lining, interfering with the heart’s functioning.
Medical imaging tests like echocardiograms, MRIs, CT scans, PET scans, and X-rays may be used to identify tumors. Or verify the fluid buildup on the pericardium. A CT-guided biopsy can be used to determine the developmental stage and type of cancerous cells. Histology and Cytology are pathological procedures used to identify cell types and how they function.
Treatment may include one or a combination of the following:
- Radiation therapy
- Surgical tumor removal
- Surgical removal of the heart lining
- Draining the excess fluids from the pericardium
- Chemotherapy
There are no known permanent cures, and most treatment plans aim at managing severe symptoms and improving life expectancy.
Even though pericardial tumors are rare, it has a poor survival rate of 6-12 months. However, newer therapies are being advanced using clinical trials, with some medical experts proposing immunotherapies.
Testicular mesothelioma
Malignant mesothelioma of tunica vaginalis is among the rarest types of mesothelioma. Primary testicular hydrocele is an abnormal collection of fluid on the scrotal lining and occurs in about 1% of the adult male population over 40. Due to its rarity, the progression is not well understood, and the prognosis is poor.
Common symptoms of testicular mesothelioma include:
- Swelling of the scrotum(caused by fluid buildup)
- A lump on the testicle(s)
- Inflammation in the testes or the epididymis
Testicular mesothelioma is often misdiagnosed for other conditions like hernia and other testicular cancers. A patient who presents symptoms is likely to be tested using testicular mesothelioma ultrasound. The procedure is used to check for the presence of tumors and hydroceles. Doctors can perform a biopsy to verify if biomarkers are present, but a biopsy is the surest way to get an accurate diagnosis.
Testicular mesothelioma can be treated using chemotherapy, surgery, and radiotherapy. Combined therapies may be used to treat aggressive tumors. Ultimately, more therapies will be developed to manage the condition and increase the survival rates.
The condition has a higher life expectancy, with the median survival rate pegged at about two years for malignant cases. However, it should be noted that the cancer is clinically aggressive, and the chances are that tumors might recur after surgical removal.
Mesothelioma Cell Type
Mutated cancerous cells are called malignant mesothelioma cells. Because each cell type responds differently to a chosen treatment, identifying the type of malignant cell is key to managing the disease. Doctors usually perform a biopsy on the mesothelioma patient to identify the cell types, and there are three main ones, which include:
Epithelial cells
Epithelial cells can mutate from asbestos exposure, and they make up the highest number of mesothelioma cancers. Epithelioid mesothelioma is the easiest to treat. It is partly because the cells do not spread as quickly as other cancerous tumors. Abnormal epithelial cells are easily recognizable because they usually cluster around each other.
Sarcomatoid cell types
Sarcomatoid cells are spindle-shaped, with a more plump and rounded structure. Sarcomatoid cells are more aggressive than epithelioid mesothelioma, but the cells are rarer than the latter. Research shows that it responds poorly to treatment and tends to be diagnosed at later stages.
Biphasic cells
Biphasic cell types are responsible for the second most common type of mesothelioma after epithelial cells. Biphasic mesothelioma tumors contain both epithelial and sarcomatoid cells. Prognosis and cancer treatment depend on the dominant cancerous cells.
More epitheloid cells mean that the cancer is easier to treat, and the survival rate is higher. Sarcomatoid dominance is harder to manage, and the prognosis is poor.
Rare cell types
Rare subtypes of mesothelioma are caused by variations in the three major cell types. They include:
- Small cell mesothelioma is a rare subtype commonly associated with the abdominal tissue.
- Deciduoid mesothelioma mainly occurs in the abdominal lining and occasionally in the pleura.
- Lymphohistiocytoid mesothelioma is a rare sub-type with an average life expectancy of 2-20 months.
- Well-differentiated papillary mesothelioma is a less-malignant variant typically observed in peritoneal mesothelioma.
- Multicystic mesothelioma is a recurring variant, and there’s almost no association with asbestos exposure.
- Desmoplastic mesothelioma is a very aggressive subtype of sarcomatoid mesothelioma. Its life expectancy is about four months.
- Transitional mesothelioma is the rarest form of sarcomatoid mesothelioma. It’s often misdiagnosed as epithelial mesothelioma.
- Pure sarcomatoid mesothelioma is a rare form of peritoneal mesothelioma with very malignant tumors.
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Written By: Dr. Pablo Orozco
Dr. Pablo Orozco is a Board Certified Medical Doctor from Universidad Autónoma de Baja California.
Dr. Orozco has been a treating physician at the Immunity Therapy Center for more than 3 years providing daily on site patient care. He works with patients on a daily basis and guides them through the treatment process. Dr. Orozco’s passion for Alternative Cancer Treatments along with his commitment to patient care is key to insure that our patients have the best experience and results possible.
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