Mesothelioma Symptoms and Treatment
Mesothelioma is the cancer nightmare triggered by inhaled asbestos fibers. It can develop in the outer lining of the lungs, the lining of the abdominal cavity and rarely, in the lining around the heart. Because it is caused by what was once a ubiquitous industrial and consumer product, progress in treating the disease has been a high-profile medical topic.
As with any form of cancer, survival rates for mesothelioma improve if the disease is diagnosed early in its development. One of the barriers to early diagnosis is the fact that mesothelioma usually doesn’t manifest symptoms for many years – twenty years is not uncommon – after the harmful asbestos exposure has taken place. The other difficulty associated with early diagnosis is the fact that the early symptoms for mesothelioma mimic symptoms for diseases that are far more common.
About seventy percent of all mesothelioma cases develop in the pleura, which is the membrane that lines the outside of the lungs and the wall of the chest cavity. Pleural mesothelioma causes a persistent cough and chronic chest pain, along with shortness of breath. Many times these symptoms are mistaken for chronic bronchitis or pneumonia.
The less common peritoneal mesothelioma develops in the membrane lining the abdominal cavity. Early symptoms of this version of the disease include swelling in the abdomen, abdominal pain, partial bowel obstruction and anemia. Early symptoms can be mistaken for a gallbladder problem or a hernia
As the disease develops it causes thickening of the mesothelium, which is the membrane lining the lungs, the abdominal wall and the chest cavity wall. That leads to fluid accumulation, which is called pleural effusion in the case of pleural mesothelioma and ascites if the fluid accumulation is in the abdomen. The fluid causes pressure on the lungs – or heart, in the rare case of pericardial mesothelioma – and abdominal swelling if the disease has developed in the abdominal mesothelium.
When the disease has developed to the point of fluid accumulation, malignant cells are in place and reproducing at an uncontrolled rate. Mesothelioma is not always like more common cancers that develop easily identifiable tumors. The cancer is often diffuse, spreading across the surface of the mesothelium, causing it to thicken but not showing growths that can be readily identified with a CT scan or an X-ray.
Treatment of mesothelioma depends on the degree to which the disease has advanced. With some cases of pleural mesothelioma, surgery is performed to resect portions of the mesothelium that are malignant and on occasion, a portion of the lung. This procedure is usually attempted when the disease is in its earlier stages, so that there is a chance of removing all or almost all of the malignant tissue. Removing malignant tissue is only part of the battle, however. Surgery is almost always combined with radiation treatment and chemotherapy. Sometimes, targeted radiotherapy is performed during the course of the surgical procedure in order to closely target specific areas and minimize the collateral damage that radiation can cause.
Peritoneal mesothelioma can be the “wet” type, where fluid is present, or the “dry” type where the cancer does often manifest as a single larger growth. In the case of wet peritoneal mesothelioma, a process called paracentesis is used to remove the fluid. With pleural effusion, often a “sclerosing agent” is used that effectively causes the membrane lining the lungs to fuse with the lining of the chest wall, which eliminates the space in which fluid accumulates.
Chemotherapy for mesothelioma often will involve more than one drug. There are three principal cell types with malignant mesothelioma and one type will respond to one drug while a different cell may be unaffected by that medication but be affected by another. Generally, chemotherapy drugs are designed to halt the reproduction process of malignant cells and to kill them in the process. This approach can involve the interaction of enzymes, or some method of starving the malignant cells, or a chemical reaction that destroys the nucleus of the cancerous cell.
All of these approaches are designed, at least, to minimize damage to healthy cells or in the case of radiation, healthy tissue surrounding the malignant areas. The combination of drugs currently under scrutiny is the use of pemetrexed (marketed under the name Alimta) and Cisplatin.
Alimta is the first drug specifically approved by the FDA for use with mesothelioma. Alimta works by blocking the enzymes necessary for DNA copying and cell division. Cisplatin is used to treat various cancers – the active ingredient in cisplatin is platinum, which acts to form cellular complexes in the nuclei of malignant cells, thereby causing a DNA malfunction that causes death of the cell.
Chemotherapy was formerly the only option for treatment of mesothelioma that had advanced beyond the stage where surgery was a viable option. Now it is in the experimental stages as a medication to reduce the presence of malignant cells and provide a meaningful extension of survival rates for mesothelioma patients.
It’s a complex disease and there will be many clinical trials before protocols evolve for treatment of the various stages of the three types of mesothelioma. The positive side of this situation is the fact that so much experimentation is underway for what is essentially a rare form of cancer.
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