Malignant Mesothelioma

Malignant Mesothelioma

What is malignant mesothelioma?
Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos.
Malignant mesothelioma is a type of lung cancer that affects the delicate lining of the lung. Mesothelioma is a rare condition However, numbers are expected to continue to rise until 2020, and then gradually diminish.

Who can get the malignant mesothelioma?
In more than 85% cases of malignant mesothelioma is caused by inhaling asbestos fibres, although how these get to the chest lining is unclear. The time between exposure to asbestos and developing malignant mesothelioma is extremely long – usually between 20 and 40 years.

Malignant mesothelioma is therefore more common in men. The risk increases with the amount of asbestos exposure. However, it is important to recognize that only a very few people who have been exposed to asbestos will develop malignant mesothelioma. Often people are worried because they have been in a building where asbestos has been present, sometimes as paneling. In this situation the risk is minimal because without dust, asbestos is harmless.

What are the symptoms of malignant mesothelioma?

In malignant mesothelioma, the chest wall lining reacts to the asbestos by causing pain, becoming progressively thickened or causing fluid to accumulate in the chest cavity. So, the two most common symptoms are breathlessness and chest pain. Less common symptoms include dry cough and some people with mesothelioma may notice tiredness and loss of appetite.
A doctor should be seen if a person has shortness of breath, pain in the chest, or pain or swelling in the abdomen. If there are symptoms, the doctor may order an x-ray of the chest or abdomen. The doctor may look inside the chest cavity with a special instrument called a thoracoscope. The doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. T The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient's age.

Stage Explanation

Stages of malignant mesothelioma

Once malignant mesothelioma is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the cancer to plan treatment. The following stages are used for malignant mesothelioma.

Localized malignant mesothelioma

Stage I

   The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung.

Advanced malignant mesothelioma

Stage II

The cancer has spread beyond the lining of the chest to lymph nodes in the chest.

Stage III

Cancer has spread into the chest wall, center of the chest, heart, through the diaphragm, or abdominal lining, and in some cases into nearby lymph nodes.

Stage IV

Cancer has spread to distant organs or tissues.

Recurrent malignant mesothelioma

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lining of the chest or abdomen or in another part of the body.

Treatment Option Overview

What treatment is available for malignant mesothelioma?
If there is a large amount of fluid causing breathlessness, the best treatment is to drain it. A local anaesthetic is given and then a small flexible plastic tube is inserted into the chest. Once the fluid has fully drained away, a chemical is introduced into the area around the lung to stick the lining of the lung to the chest wall. This procedure, termed pleurodesis, reduces the chance of the pleural fluid reaccumulating. The tube is then removed. Pleurodesis is only done when the diagnosis has been confirmed. Should itbe necessary to use thoracoscopy to make the diagnosis, the biopsies, drainage and pleurodesis are done at the same session.

Biopsy involves putting an instrument through the chest wall, and mesothelioma may then grow outwards towards the skin. This can be prevented by early radiotherapy, which can also be extremely helpful in controlling any pain.

At present the role of chemotherapy is uncertain. Although a proportion of patients have obtained benefit, results are often disappointing. All patients with mesothelioma are given have the opportunity to discuss treatment options with a specialist oncologist and respiratory physician.

Recently there has been interest in chest surgery to remove all of the tumour, but this is a major undertaking which can only be considered in a minority of patients, and would need to be considered very carefully by an experienced chest surgeon.

Although it is usually possible to keep pleural fluid under control, breathlessness due to the tumour enlarging and becoming thicker can be a problem. In those who have chest pain, radiotherapy may not be as effective as well-managed medication prescribed by an experienced professional.



Survival depends, usually between six months and three years, the average being 18 months. Where mesothelioma has been caused by occupation, doctors must report death to the local coroner.