Enlarge Image This information will help you understand mesothelioma, including diagnosis, surgery and treatment. Mesothelioma is a rare cancer of the tissue that lines the body's internal organs. The most common type of mesothelioma affect the sac that protects the lungs, called the pleura. This type of mesothelioma is known as pleural mesothelioma. Mesothelioma may also affect the tissue that surrounds abdominal organs, called the peritoneal membrane; this type of mesothelioma is known as peritoneal mesothelioma. In rare cases mesothelioma can also affect the intestines or heart.

Exposure to asbestos, a mineral fiber that was commonly used in building construction, is the main known risk factor for mesothelioma. People in occupations such as mining, milling, construction, plumbing, heating, insulation, carpentry, and electrical and shipyard work generally have had greater exposure to asbestos than those in other occupations and are therefore at higher risk of mesothelioma. Family members of these workers are also at higher risk than others because of indirect exposure to asbestos (in the clothes and hair of family members).

Although asbestos is the most common risk factor, there are patients who develop mesothelioma without being exposed to asbestos or any other risks.

Diagnosis

To see if you have mesothelioma, you will have to have a biopsy. A biopsy involves removing a small amount of tissue from the area where the cancer may be located. The tissue will be looked at under a microscope by a pathologist. A biopsy is usually done by thoracentesis, video-assisted thoracic surgery, or open lung biopsy. Your surgeon will explain which approach is best for you.

Thoracentesis

Thoracentesis is a procedure in which a needle is used to remove fluid from your pleura (the space between your chest wall and your lung) for biopsy. A thoracentesis can be done in your doctor's office or in a hospital.

Video-assisted thoracic surgery

A video-assisted thoracic surgery (VATS) is done in a operating room. A thin telescope attached to a video camera is inserted into your stomach through a small incision (surgical cut). Additional incisions are made and a surgical instrument is used to remove tissue for biopsy.

Open lung biopsy

An open lung biopsy is done in a hospital operating room. Your surgeon will make a small surgical cut between your ribs. A surgical instrument is then used to remove a piece of your pleura for biopsy.

Your doctor may want you to have other tests, such as computed tomography (CT) scan, positron emission tomography (PET) scan, a stress tests, pulmonary function test (PFT) and a ventilation perfusion scan to see if the cancer has spread to other ares in your body and to test how your lungs are working.

Pleural Effusion

Between the inner and outer walls of the pleura is a thin film of fluid that makes it easy for the longs to expand and contract. However, if too much fluid accumulates in this space, it can limit the ability of your lungs to expand. This is called pleura effusion and can make you feel short of breath. Your doctor can drain the fluid in your lungs and perform a a procedure that will prevent more fluid up.

Staging

Staging a cancer is a way of describing its location, whether it has spread, and whether it affects other organs. Staging will help your doctor make the best treatment choice for you.

Stage I mesothelioma is when tumors are confined to the pleura.

Stage II mesothelioma is when tumors have spread from the pleura to 1 lung.

Stage III mesothelioma is when tumors have spread into the chest wall or involves the lymph nodes.

Stage IV mesothelioma is when tumors have invaded the chest wall or have spread to other sites in the body.

Treatment

Your treatment may include, surgery, radiation therapy and chemotherapy. Your health care team will make a treatment recommendation based on the stage of your cancer, how well your lungs are functioning and your overall health.

Surgery

Surgery is the most common treatment for mesothelioma. The goal of surgery is to remove all of the cancer. Depending on your surgery you may have part of all of your pleura, lung, diaphragm, pericardium removed.

A procedure called a pleurodesis may be done to help you breathe and feel more comfortable.

Radiation Therapy

Radiation is the use of high energy x-rays to kill cancer cells and help to reduce the risk of recurrence. Your health care team will review with you radiation planning, treatment and possible side effects.

Chemotherapy

Chemotherapy is a drug or a combination of drugs that is used to treat cancer. The most commonly used chemotherapy to treat mesotheloma includes two drugs: pemetrexed (Alimta®) and cisplatin.

Your doctor may also recommend other drugs or the possibility of joining a clinical trial. Your healthcare team will discuss with you the use of chemotherapy including benefits and risks.

Emotional Resources

The diagnosis and treatment of cancer can be a very stressful and overwhelming event. You may feel depressed, anxious, confused, afraid, or angry. You may have strong feelings about any permanent changes. These changes can have an impact on your emotional and mental well-being. Help is available for you at any time. If you would like counseling, your nurse can give you a referral to see a social worker, psychiatrist, or counselor.

The Memorial Sloan Kettering Cancer Center (MSKCC) Resources for Life After Cancer Program provides support services after your treatment is finished. To learn more about these services, call (646) 888-4740.

Also, you may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, you have a chance to speak with former patients and caregivers. To learn more about this service, please call (212) 639-5007.

External Resources

National Cancer Institute

www.cancer.gov

For additional online information, visit LIBGUIDES on MSKCC's library website at http://library.mskcc.org or the mesothelioma cancer section of www.mskcc.org. You can also contact the library reference staff at (212) 639-7439 for help.