Pleural mesothelioma is a rare aggressive cancer which develops in the thin layer of soft tissue known as the ‘pleura’ or ‘pleural membrane’ which surround the lungs. The pleura has a space between an inner and outer layer in which a lubricant type fluid is produced to enable the lungs to move in and out smoothly and allow you to breathe easily.
When mesothelioma develops the pleura thickens and creates pressure against the lungs which can cause fluid to build up (pleural effusion) which causes breathing difficulties.
In the UK more than 2,600 people are diagnosed with mesothelioma each year 50% of whom are men aged 75 years and over.
Mesothelioma is more commonly found in the lungs (pleural mesothelioma) but can also develop in the stomach (peritoneal mesothelioma), within the lining of the heart (pericardial mesothelioma) and rarest of all within the testicles (testicular mesothelioma).
In 90% of all cases the cause of mesothelioma is attributed to fine asbestos fibres encountered across a wide range of industrial settings where asbestos materials were commonly used and fibres were allowed to become airborne. Once inhaled the harmful fibres travel through the lung tissue and become trapped in the outer lining of the membrane where the body’s defence mechanism tries to break them down and remove them. Inflammation and irritation develops over many years causing scarring to the lungs which can lead to cancerous changes. Typically mesothelioma can take 15 – 60 years to develop.
In addition to workers, other groups of people might be at risk of developing mesothelioma which would include family members of workers who have been exposed to asbestos dust and fibres brought home from places of work on the workers clothes and skin. Physical contact could result in the fibers being inhaled as too could shaking and washing soiled clothing and this type of exposure is often referred to as ‘secondary exposure’. Instances are reported were wives have developed mesothelioma from hugging their husbands as too have young children during play and contact.
Residents who lived near asbestos factories and people who worked and were present in buildings where asbestos was present in the fabric of the building, which was disturbed or damaged during maintenance, improvement or through general decay are also at some risk.
There are various ways to measure risk in developing a disease like mesothelioma but this does not always mean a disease or cancer will develop. Certain types of cancer have different risk factors and with mesothelioma the risk is higher in people exposed to asbestos before the age of 30.
It is estimated that almost 6% of British men born in the 1940’s who worked in carpentry for more than 10 years before the age of 30 develop mesothelioma. A high risk group would typically include those who have worked in manufacturing asbestos and those who have used asbestos materials and products in one or more of the following industries;
Symptoms develop gradually and typically might include;
It is likely you will first be seen by your GP who will examine you and wherever necessary refer you for further tests at your local hospital.
A number of tests are used to diagnose pleural mesothelioma and if a previous exposure history is indicated it is likely the first test will be a chest x-ray. Further tests might include a blood test, CT Scan, pleural biopsy, CT or ultrasound guided biopsy, thoracoscopy;
A blood test in itself will not detect mesothelioma but it is recognised that people with mesothelioma have higher concentrations of certain proteins in their blood. Blood tests can help determine how advanced a cancer is. Researchers in Japan are developing advanced blood tests using an enzyme-linked system to detect a protein biomarker (N-ERC/mesothelin) which could enable earlier diagnosis of mesothelioma. Early diagnosis and early intervention offers a more favourable outcome in terms of treatment options and survival periods.
This straight forward test looks for abnormalities in your lungs such as fluid build-up around the lungs (pleural effusion) or thickening of the pleura which could indicate mesothelioma and wherever possible comparison can be made to earlier images.
CT (computerised tomography) scan
A CT Scan involves a series of x-rays to produce a 3D image of the body which is important to any diagnosis of mesothelioma and can help differentiate malignant disease from benign disease. The scan takes between 10 – 30 minutes and is considered painless using only small amounts of radiation. Where a CT scan is inconclusive it might then be necessary to undertake further investigation.
A biopsy is normally required to enable a diagnosis of mesothelioma and involves taking a tissue sample, usually from the thickened pleura and occasionally from lymph nodes located in the chest. There are various types of biopsy which can be considered in each particular case, including;
Initial diagnosis of mesothelioma can be overwhelming, both physically and emotionally not only for the sufferer but their loved ones and friends and the enormity and implication of such a diagnosis cannot be overstated. Given the prognosis, sufferers might feel burdened by the responsibility of getting their affairs in order and coping with the knowledge of a reduced life-expectancy.
Sufferers will deal with their diagnosis in different ways but in most instances there will be fundamental steps one could take to make dealing with their situation that much easier.
Malignant pleural mesothelioma is an incurable condition and difficult to treat, particularly in an advanced state with most available treatments aimed at relieving symptoms and extending a quality life for as long as possible.
Treatments for pleural mesothelioma are similar to that in other types of cancer and in most instances will be dictated by certain factors such as the stage of the mesothelioma, age and general fitness/health of the sufferer and the symptoms experienced.
Drugs – A range of drugs and clinical trials are continually tested and evaluated. If appropriate, your specialist will advise upon the most suitable medicines for you.
Surgery – There are two main procedures used the first of which is referred to as a ‘pleurectomy’ which involves the removal of all or part of the affected pleura (membrane lining of the lung) and is recognised as a major operation. Removal of part of the pleura can sometimes be achieved by keyhole surgery and will normally require a 7 day stay in hospital followed by a further recovery period of between 4-6 weeks. Removal of the entire pleura is normally only conducted in a specialist hospital requiring a 10 – 15 day stay in hospital followed by a further 6 – 8 weeks recovery.
A less common procedure known as ‘extrapleural pneumonectomy’ is used in early diagnosed cases of mesothelioma where the lymph nodes and other areas outside the lung have been unaffected. This major operation involves removal of the affected lung and pleura together with other structures associated to the lung and heart (pericardium) and is often accompanied with chemotherapy or radiotherapy. A debilitating treatment option which normally requires at least 2 weeks stay in hospital followed by a further 3 – 4 months recovery.
Chemotherapy – Different chemotherapy and anti-cancer drugs are available for different conditions, and most treatments are administered by cancer nurses on an outpatient basis at a local hospital or clinic. The drugs can be injected into a vein, through a drip or be in the form of a tablet and are designed to kill cancer cells and prevent them from multiplying.
Radiotherapy – This involves the use of high energy x-rays to kill and prevent the spread of cancer cells and to help alleviate symptoms of pain. It is also used following removal of fluid from around the lungs via a chest drain, or following thoracoscopy in case cancer cells have been disturbed.
Pleurodesis – A common symptom in mesothelioma is the build-up of fluid from the lungs known as a ‘pleural effusion’ which can create pressure upon the lungs and cause breathing difficulties. The fluid can be removed by various means and to prevent re-accumulation a sterile talc is inserted into the pleural spaces to close the space by sticking the two layers of the pleura together. This procedure is known as pleurodesis and is applied at hospital by way of a chest drain or during a thoracoscopy procedure.