mesothelioma Causes ;SYMPTOMS; Diagnosis;TREATMENT

Asbestos exposure is the only known cause of mesothelioma. Asbestos occurs naturally in the environment, and is used for building and construction. When asbestos particles get into the air, people may inhale them. This may eventually causes mesothelioma.

At the most basic level, mesothelioma begins the way all cancers do: with the out-of-control growth of abnormal cells.

This unwanted growth comes from damage to the DNA, the chemical in our cells that makes up our genes. Some genes manage the growth and division of new cells in the body. Changes in these genes may cause uncontrollable growth of cells, which can lead to cancer.

Researchers don’t yet understand what causes the genetic changes that lead to mesothelioma, but they do know the factors that increase people’s risk. Mesothelioma, like many cancers, likely stems from a combination of environment, genetics, health, and lifestyle.

In mesothelioma, the abnormal growth of cancer cells form tumors. But it’s important to note that not all tumors are cancerous.

Though rare, benign (non-cancerous) mesothelioma exists. Benign mesothelioma tumors are usually removed by surgery, with no need for additional treatment.

Malignant (cancerous) mesothelioma is aggressive and life-threatening. Patients may experience chest pain, coughing, or shortness of breath. Read more about mesothelioma symptoms.

What Causes Mesothelioma?

Exposure to toxic asbestos fibers is the only conclusive cause of mesothelioma.

In the United States, asbestos was used liberally in the building and manufacturing industries for decades. It was considered an ideal material because of its strength, affordability, and fire-resistance. But in the early 1900s, researchers began to see clear evidence that asbestos could cause deadly diseases.

As early as the 1930s, medical journals published articles linking asbestos to cancer.

Still, many companies that profited from asbestos ignored the dangers. Like the tobacco industry, some companies actively hid the hazards from those at risk.

Many people are stunned to learn that the asbestos industry is thriving today, especially in developing nations. Although usage has been limited in the U.S. since the 1980s, it’s still approved for use in many products, including:

• Chalkboards
• Fire protection products
• Brake linings and pads

In 1981, the Environmental Protection Agency began asking American companies to provide lists of all their products that contain asbestos. (This became required with the Asbestos Information Act of 1988.) Even though asbestos is still used U.S. products, manufacturers must submit detailed information to the EPA.

More than 2.3 million pounds of asbestos were imported into the U.S. in 2012. Lobby groups for the asbestos industry have spent almost $100 million to preserve the market for asbestos.

How Does Mesothelioma Develop?

Asbestos is not an automatic threat. Before it can do damage to your body, it must be inhaled or ingested.

According to the EPA, asbestos does not pose a danger when it is properly contained, but is very hazardous when it’s easily crumbled by hand (friable) and its fibers are released into the air. Therefore, shingles, floor or ceiling tiles, fire doors, and other items containing asbestos are not dangerous unless they are disturbed or damaged in some way.

Repairing, removing, scraping, sanding, drilling, and cutting asbestos-containing products and structures can cause asbestos fibers to become airborne.

When these fibers are inhaled, they tend to stick to the mucus in the throat, windpipe, or large breathing tubes of the lungs (bronchi). They travel to the ends of the small airways and invade the pleural lining of the lung and chest wall, eventually damaging the mesothelial cells and causing pleural mesothelioma.

Peritoneal mesothelioma, which starts in the abdomen, may be caused when a person coughs up and swallows inhaled asbestos fibers.

There are two main forms of asbestos:

• Serpentine has curly fibers. One type, chrysotile, is the most common asbestos used for industrial purposes.

• Amphibole has straight, rigid fibers. This type (particularly crocidolite, use in commercial and industrial products) is more likely to cause cancer, according to researchers.

Mesothelioma isn’t the only asbestos-related disease. Exposure can also cause:

• Lung cancer
• Asbestosis, scar tissue in the lung
• Pleural plaque, the thickening and hardening of the tissue around the lungs and diaphragm
• Pleural effusion, fluid build-up in the pleural space (area between the lungs and the chest wall)

Mesothelioma, asbestosis, and lung cancer are the top three causes of death and disease among people who’ve been heavily exposed to asbestos.

Researchers estimate that 10 million people will die from asbestos-related diseases by 2030.

What are the Risk Factors?

A risk factor is something that affects your chance of getting a disease. The most obvious and well-documented risk factor for mesothelioma is repeated asbestos exposure.

Specific factors may increase someone’s risk for developing mesothelioma:

Occupation. People are most likely to encounter asbestos at the workplace. Approximately 70 to 80 percent of all mesothelioma patients report occupational exposure.

Workers in several industries are particularly at risk:

• Factory workers
• Miners
• Insulation manufacturers and installers
• Auto workers
• Construction worker
• Ship builders

Military service. Asbestos use was rampant in the military, where it was used for insulation on ships and in barracks; for fire-resistance in walls, doors and floors; and in numerous items, from clothing to gloves to aprons.

Navy veterans were most frequently exposed to asbestos, but Marine, Army, Air Force and Coast Guard veterans are also at risk.

Veterans represent just 8 percent of the country’s population, but they make up 30 percent of all known mesothelioma deaths in the U.S. Read more about the connection between veterans and mesothelioma.

Secondhand exposure. Asbestos in hair or on clothes may be transferred to other people in the home.

Proximity. People living near asbestos mines or processing plants are at risk.

Age. Older people are more likely to be diagnosed with mesothelioma. Two out of three people with mesothelioma are older than 65. The disease is uncommon in those 45 or younger.

Gender. Mesothelioma is more common in men than in women, perhaps because men are more likely to have worked in jobs with heavy exposure to asbestos.

Smoking does not increase someone’s risk of getting mesothelioma, researchers have found. It may, however, aggravate symptoms.

Other Possible Risk Factors

Despite the clear link between asbestos exposure and mesothelioma, most people who come in contact with the toxic material do not get the disease.

Researchers believe that other factors, such as genetics, make certain people susceptible to mesothelioma. For example, a recent study suggests that people with a BAP1 gene mutation are much more likely to develop mesothelioma from asbestos contact. Other genes may play a role as well.

Some scientists believe that SV40, a virus originally found in monkeys, increases people’s risk of mesothelioma. Millions of people may have come in contact with SV40 through polio vaccinations administered in the 1950s and 1960s. This link, however, is not conclusive.

How Can Mesothelioma be Prevented?

Simply put, the best way to prevent mesothelioma is to avoid exposure to asbestos.

Learn whether you work with asbestos. In addition to high-risk occupations—factory workers, miners, insulation manufacturers and installers, auto workers, construction workers, and ship builders—other professionals may be at risk:

• Firefighters - During a fire, asbestos particles become agitated and are released into the air, endangering firefighters and bystanders.
• Realtors - Homes built before 1980 may have asbestos-containing materials in them.
• Teachers - The EPA estimates that asbestos-containing materials are in most of the country’s primary, secondary, and charter schools.

Ask your employer if you might come in contact with asbestos on the job.

Follow safety regulations. Read and abide by all safety precautions in your workplace. For example, you may be required to wear protective equipment or shower before taking a lunch break or going home. Talk to your doctor about additional actions you can take to protect yourself.

Call a professional. If you come upon a structure or item that may contain asbestos and is damaged, demolished, or otherwise disturbed, be careful. The best approach is to secure the area, back away, and call an EPA-certified asbestos professional. He or she will examine the material, conduct air quality tests, and properly remove the asbestos.

Limit exposure to others. Secondary exposure to asbestos is a very real threat. It can be caused by the simple act of tracking asbestos dust through the house. If you think you might have been exposed, change out of contaminated clothing and shower before interacting with others.

If you’re concerned about past asbestos exposure, contact your doctor immediately. Early detection is critical to getting effective treatment, since symptoms often don’t appear until the disease has advanced.

MESOTHELIOMA TREATMENT

The best mesothelioma treatment is one that is tailored specifically to you. Most doctors recommend a mix of procedures depending on your condition, medical history, and cancer stage. Both traditional and alternative options are available, and advances in treatment are being made all the time.

Mesothelioma treatment generally falls into two categories:

• Curative, which aims to remove cancer from your body.
• Palliative, which aims to manage your cancer and make you more comfortable.

Sometimes, the treatments used to relieve your symptoms are the same that are used to treat cancer. For example, both surgery and radiation therapy can be used as curative or palliative, depending on the patient.

Before you choose a treatment, talk to a qualified mesothelioma doctor.

IS SURGERY RIGHT FOR ME?

In the early stages of mesothelioma, surgery can be used to slow the advance of the disease and, in some cases, cure it completely. Surgery is often supplemented by chemotherapy and radiation therapy for a more well-rounded approach.

For pleural mesothelioma, surgical options include:

• Extrapleural Pneumonectomy (EPP): Removes a cancerous lung and parts of the chest lining, heart lining, nearby lymph nodes, and diaphragm.
• Pleurectomy Decortication (P/D): Removes the lining of the lung along with the mesothelial tumors. It may be “radical,” removing the entire lining, or “non-radical,” extracting up to 70 percent of the affected lining.
• Pleurodesis: Aims to prevent fluid buildup in the chest by inserting a hollow tube into the chest wall to drain the fluid. It is not a curative treatment, but one that tries to relieve symptoms.

Both EPP and P/D are potentially curative if they’re performed during the early stages of the cancer. However, they are major surgeries that carry potential complications.

Side effects for EPP include internal bleeding, respiratory failure, pneumonia, and even death. Complications from P/D are rare. Though medical professionals don’t agree on which one is better, both can increase your survival time.

For peritoneal mesothelioma, surgical options include:

• Cytoreductive surgery (peritonectomy): This involves the removal of cancerous growth from multiple places in the abdomen, including the stomach, bowels, bladder, gall bladder, liver, pancreas, and spleen. It’s potentially curative if performed during the early stages of the cancer.

• Paracentesis: This aims to remove fluid buildup from the abdominal cavity by inserting a needle or catheter into the peritoneal cavity. It is not a curative treatment, but one that tries to relieve symptoms.

HOW CAN CHEMOTHERAPY HELP?

Chemotherapy is the use of medicine or drugs to kill cancer cells. While it’s not a cure for mesothelioma, it’s the only treatment proven to improve survival rates in randomized and controlled trials.

Depending on the stage of your mesothelioma, chemotherapy can be the primary form of treatment or act as a supplement to other forms of treatment. Chemotherapy may be used before surgery to make an operation easier or used after surgery to decrease the chance that the cancer will come back.

Newer chemotherapy treatments include:

• Intrapleural chemotherapy (pleural mesothelioma): Drugs are heated and dispensed directly into the chest cavity.
• Intraperitoneal chemotherapy (peritoneal mesothelioma): Drugs are heated and dispensed directly into the abdominal cavity.

These newer strategies allow the drugs to reach the mesothelioma without harming healthy cells in other parts of the body, enabling doctors to give higher doses of chemotherapy.

Chemotherapy side effects include nausea, vomiting, and/or diarrhea, and hair loss.

HOW CAN RADIATION THERAPY HELP?

Radiation therapy is one of the most popular forms of mesothelioma treatment, as it has been shown to reduce pain in patients. It uses X-rays that are “sprayed” outside the body through an external beam, targeting cancerous cells. It’s sometimes used as a stand-alone treatment for those who want to manage discomfort.

Because radiation therapy can have dangerous effects on the small intestine, liver, kidneys and other organs, it is not used to treat peritoneal mesothelioma.

Common types of radiation therapy for mesothelioma patients are:

• Three-Dimensional Radiation Treatment (3D-CRT): Using detailed imaging scans, doctors customize a dose for a three-dimensional tumor. This may protect the liver and heart from receiving as much radiation.
• Intensity-Modulated Radiation Therapy (IMRT): More complicated than a 3D-CRT, this applies non-uniform radiation beam intensities across the tumor. It can cover more of the tumor while protecting healthy tissue.
• Brachytherapy: Radioactive material is placed directly into the chest or the abdomen at the site of the mesothelioma. This may be an option for patients who are not physically strong enough to handle surgery.

Radiation therapy side effects include skin changes (dryness, peeling, or itching), tiredness, diarrhea, and hair loss.

WHAT ARE MY EXPERIMENTAL TREATMENT OPTIONS?

Advances in mesothelioma treatment research have created additional—and promising—options for patients. Clinical trials are continually exploring new methods to cure the disease or increase survival rates. Some emerging treatments include:

Immunotherapy. While not yet a cure for mesothelioma, this treatment continues to be the focus of much research. Immunotherapy uses your body’s own immune system to fight the cancer while leaving healthy cells untouched. Immunotherapy aims to make your immune system recognize antigens on cancer cells as foreign—which your immune system normally cannot do—and therefore destroy those cells.

Gene therapy. This method aims to cure or prevent various diseases by manipulating a patient’s genes. Because of potential complications, the Food and Drug Administration (FDA) hasn’t approved gene therapy for mesothelioma patients. However, the location of pleural mesothelioma tumors is particularly well-suited for gene therapy. Doctors can easily access the membrane surrounding the lungs to perform biopsies, deliver genes, and observe results.

Photodynamic therapy. This procedure uses a photosensitizing agent and light source to attack cancer cells. In the process, it damages the blood vessels inside tumors, rendering them unable to absorb nutrients. Results from clinical trials have shown that this treatment can increase life expectancy in pleural mesothelioma patients, particularly when combined with other treatments such as surgery.

ARE THERE ALTERNATIVE TREATMENTS?

A variety of alternative treatments exist for the mesothelioma patient. Often referred to as CAM (Complementary and Alternative Medicine), these methods don’t provide a cure, but they may help manage the symptoms and increase survival rates. And with minimal side effects, they’re an attractive option for patients seeking gentler treatment.

Doctors have found the most effective mesothelioma treatment programs incorporate alternative treatments with the traditional options of surgery and radiation/chemotherapy.

Popular alternative therapies include:

Chiropractic care. Chiropractors use their hands or a small tool to apply a controlled force to a spinal joint. Their goal is to treat and prevent pain involving the musculoskeletal system, which controls the body’s movement. For mesothelioma patients, chiropractic adjustments may reduce tension, headaches, and stress.

Yoga. A popular way to reduce stress and increase flexibility, yoga is usually understood to be a physical exercise, though its ancient Indian roots are spiritual. During a series of postures, yoga students are encouraged to develop mindful awareness. Certain types of yoga may also include breathing techniques, visualization, and meditation. Make sure to talk with your doctor before starting a yoga practice and to tell the instructor about your condition.

Physical therapy. A physical therapist can create a treatment plan and lead you through exercises to increase your strength, flexibility, and endurance. Depending on the type of mesothelioma, this may mean:

• Cardiovascular training to help with breathing before or after surgery.
• Exercises to increase chest or abdominal wall mobility.
• Strategies for scar tissue management and healing.

Acupuncture. A technique that began in China thousands of years ago (and one that is popular in the United States today), acupuncture uses thin needles inserted at specific points on your body. When these pressure points are stimulated, according to the practice, the body’s balance and harmony is restored. For cancer patients, acupuncture may help manage pain and relieve anxiety.

Breath and relaxation exercises. Slowly tensing and relaxing different muscle groups may help you feel more at ease and breathe easier. To manage breathlessness, there are various breathing techniques that can help, such as correct posture, visualization, and physical exercises. Your doctor may refer you to a therapist who can teach you exercises to do on your own.

WHAT’S THE MOST SUCCESSFUL MESOTHELIOMA TREATMENT?

This varies from person to person, but studies suggest that combining two or more treatment methods (a “multimodal” approach) is most effective in increasing survival rates. A popular option is a combination of surgery, chemotherapy and radiation therapy. However, doctors may recommend experimental therapies as well.

When creating a multimodal treatment plan, doctors consider three stages of treatment:

• Stage 1: Neoadjuvant therapy.The patient receives treatment—usually chemotherapy—to help shrink the tumor and increase the odds of success in the main treatment.
• Stage 2: Main treatment. Often, this is surgery with the goal of removing as much of the tumor as possible. Chemotherapy is an option for those who don’t qualify for surgery.
• Stage 3: Adjuvant therapy: A follow-up treatment, this stage aims to manage any tumor recurrence or symptoms. Often, this treatment is radiation therapy or chemotherapy.

Click here to learn more about cancer, how to choose a doctor, and discover cost-effective ways to pay for treatment. Also, uncover information about life expectancyand your mesothelioma prognosis.

WHAT ARE THE SIGNS?

Mesothelioma is a rare cancer caused by exposure to asbestos, a toxic mineral used for building and manufacturing. Because early symptoms may be similar to other illnesses, it’s often misdiagnosed initially. If you’re concerned about past asbestos exposure, see your doctor immediately.

Mesothelioma can lie dormant in your body for a long time. Many patients start experiencing symptoms 20 to 50 years after their initial asbestos exposure.

Factory workers, miners, construction workers, and military veterans are some of the groups considered to be high risk because they had regular on-the-job contact with asbestos.

Most people who come in contact with asbestos do not get mesothelioma. With about 3,000 diagnosed cases each year, the disease is considered rare. Indeed, researchers find that it’s hard to draw large-scale conclusions about treatments and survival rates because the sample sizes are so small.

Like many cancers, mesothelioma is likely triggered by a combination of environment (in this case, contact with asbestos), genetics, health, and lifestyle. Read more about mesothelioma causes.

WHAT TO LOOK FOR

Pleural mesothelioma forms in the protective tissue surrounding the lungs (pleura). It represents 75 percent of all mesothelioma cases.

Most pleural symptoms affect the airways, lungs, and breathing muscles (respiratory system). Patients with pleural mesothelioma commonly report:

• Pleural effusion, excess fluid buildup around the lung (90 percent)
• Shortness of breath (79 percent)
• Chest pains (64 percent)
• Dry cough (36 percent)
• Weight loss (30 percent)

Some patients also report diminished chest expansion and unusual breathing sounds.

EARLY-STAGE PLEURAL MESOTHELIOMA SYMPTOMS (STAGES 1 AND 2)

In the early stages of pleural mesothelioma, the cancer is localized or has spread (metastasized) minimally. At this point, many patients don’t have any symptoms at all, though some may notice chest pains, fatigue, or shortness of breath.

Pleural mesothelioma may also cause pleural thickening, a condition that reduces the lungs’ elasticity. It’s characterized by shortness of breath and chest pain, symptoms that are not exclusive to pleural mesothelioma.

The doctor cannot diagnose on symptoms alone. He or she must run further tests to determine the cause of your symptoms.

LATE-STAGE PLEURAL MESOTHELIOMA SYMPTOMS (STAGES 3 AND 4)

In stages 3 and 4, the cancer has metastasized to other parts of the body and, possibly, to the lymph nodes. At this point, patients may continue to experience symptoms from earlier stages as well as additional signs, including:

• Abdominal pain (if the cancer has spread to that area)
• Loss of appetite
• Difficulty swallowing
• Pleural effusions
• Anemia
• Fever and/or night sweats

Unlike symptoms in the early stages, these signs more clearly point to pleural mesothelioma. Read more about the stages of pleural mesothelioma.

SYMPTOMS OF OTHER MESOTHELIOMA TYPES

Peritoneal mesothelioma (begins in the lining of the abdominal cavity) and pericardial mesothelioma (begins in the lining around the heart) are much less common than pleural mesothelioma. Therefore, they don’t have a formal stage classification system. The timeline of symptoms may vary from patient to patient.

Peritoneal mesothelioma patients commonly have:

• Abdominal fluid buildup (77 percent)
• Weight loss (60 percent)
• Loss of appetite (60 percent)
• Seizures (10 percent)

Many patients also report abdominal pain/tenderness and abdominal hernias. Some also experience bowel obstruction, which tends to occur when the cancer is more advanced. Similarly, fluid buildup is usually a late-stage symptom.

Less information is available about peritoneal mesothelioma symptoms, but in general, patients may have:

• Chest pain
• Pericardial thickening
• Irregular heartbeat
• Bleeding in the lining around the heart (cardiac tamponade)
• Difficulty breathing
• Fluid buildup around the heart (pericardial effusion)

For all types of mesothelioma, certain symptoms indicate that the cancer has spread. These signs appear in locations other than where the cancer began. The most common metastatic symptoms are:

• Coughing or spitting up blood (hemoptysis)
• Injury to one or both of the nerves attached to the voice box (laryngeal nerve palsy)
• Nerve malfunction in arms
• Neurological syndromes

HOW TO AVOID A MISDIAGNOSIS

Recognizing your symptoms in this list will not tell you whether you have mesothelioma. The only way to get a correct diagnosis is to see your doctor.

Mesothelioma is often mistaken for other illnesses in the beginning. Pleural mesothelioma, for example, shares symptoms with:

• Pneumonia
• Common cold
• Flu
• Asthma

Pleural thickening, common in pleural mesothelioma patients, is also a symptom of:

• Tuberculosis
• An inflammation of the lining of the lungs and chest (pleurisy)
• A buildup of pus in the pleural space (empyema)

Peritoneal mesothelioma may be misdiagnosed as:

• A hernia
• Irritable Bowel Syndrome (IBS)

Doctors may think pericardial mesothelioma is:

• Inflammation of the lining surrounding the heart (pericarditis)
• Inflammation of the heart (myocarditis)

The correct diagnostic procress for mesothelioma begins with a physical exam from your doctor, followed by an imaging test (X-ray, CT scan, MRI). The results of your imaging test will help doctors look for suspicious-looking masses or growths.

If they see a mass that looks like mesothelioma, doctors will request a small fluid or tissue sample (biopsy) to confirm the diagnosis. Right now, a biopsy is the only reliable way to confirm a mesothelioma diagnosis. Read more about the diagnostic process.

If your biopsy reveals mesothelioma, your doctor will assign a cancer stage, which describes how far the cancer has spread. It’s critical at this point to find a specialist and get a second opinion.

Your cancer stage is the most important factor in determining your outlook (prognosis); it also guides your treatment plan. If your doctor incorrectly identifies it, you could miss out on potentially life-saving surgeries and treatment.

WHEN TO SEE A DOCTOR

If you’ve had past exposure to asbestos fibers, don’t wait for symptoms to show up before you see a doctor. If you’re worried about a loved one’s previous contact with asbestos, encourage him or her to make an appointment.

Early detection is key, and signs of mesothelioma usually appear after it’s too late to cure. Click here to learn more about the diagnostic process.

IDENTIFYING MESOTHELIOMA

Mesothelioma can lie dormant for decades. People who are in the early stages of the disease frequently have no symptoms. When the signs do appear, the cancer may be advanced. Read how you can best navigate the diagnostic process and be prepared for what comes next.

GOING THROUGH THE DIAGNOSTIC PROCESS

A mesothelioma diagnosis is usually not a straight path. It usually involves numerous tests and procedures, each performed by a different medical professional, and it can take several months to get an official diagnosis.

The diagnostic process can be emotionally (and often physically) difficult for patients and their loved ones.

It may begin with symptoms, such as shortness of breath, a persistent cough, or stomach pains. Symptoms of the most common form of mesothelioma, pleural mesothelioma, are often confused with pneumonia or the common flu.

Because it’s easy to misdiagnose mesothelioma, choosing a qualified mesothelioma doctor or specialist is critical.

The first step is to make an appointment with your general practitioner, who will take note of your symptoms and identify next steps, including tests and visits with specialists. Most of the time, your initial visit will include a physical exam so the doctor can learn more about your condition. You may spend time discussing previous asbestos exposure, if that applies to you.

GETTING AN IMAGING TEST

The next step usually involves imaging tests that will help doctors identify suspicious-looking masses or growths. During an imaging test, forms of energy (X-rays or sound waves, for example) are sent through your body, creating pictures for doctors to examine.

It’s important to note that imaging tests are painless, but some require you to be still for long periods of time. Some people may find this uncomfortable.

Common imaging tests for mesothelioma include:

• X-ray: Uses electromagnetic radiation to create images.
• Magnetic resonance imaging (MRI): Uses a magnetic field and radio waves to create detailed images.
• Computerized tomography (CT) scan: Uses an electromagnetic imager to create cross-sectional images of the tissues and bones.
• Positron emission tomography (PET) scan: Uses a small amount of radioactive material to show how your tissues and organs are functioning.

GETTING A BIOPSY

If the doctors see a mass that looks like mesothelioma, they will request a small fluid or tissue sample (biopsy) to confirm the diagnosis. Right now, this is the only way to find out if you have mesothelioma.

Depending on what area of your body is involved, your doctor will choose the right biopsy procedure for you. These procedures range from minor to invasive. Biopsy options include:

• Fine-needle aspiration: A doctor inserts a small needle inserted into your chest or abdomen and removes fluid or a piece of tissue.
• Thoracoscopy: The surgeon inserts a tube with a tiny video camera into your chest cavity and cuts away small pieces of tissue for testing.
• Laparoscopy: The surgeon inserts a tiny camera and special surgical tools into your abdomen to obtain a small piece of tissue for examination.
• Thoracotomy. A surgeon opens your chest between the ribs and looks for signs of disease, sometimes removing a sample of tissue for testing.
• Laparotomy. A surgeon opens your abdomen and looks for signs of disease, sometimes removing a sample of tissue for testing.

Your tissue sample is studied under a microscope to determine whether it’s mesothelioma and, if so, what types of cells are involved. Your treatment plan depends on many factors, including your cancer stage and type of mesothelioma.

Throughout the process, you’ll meet various medical professionals who will assess the disease, offer options, and guide you through your diagnosis. You might meet with a:

• Pulmonologist, who specializes in lung diseases (pleural mesothelioma)
• Gastroenterologist, who specializes in abdominal problems (peritoneal mesothelioma)
• Radiologist, who specializes in diagnosing diseases and injuries using imaging techniques, such as X-rays
• Pathologist, who identifies and classifies the disease
• Surgeon, if surgery is part of your treatment

You may also be referred to an oncologist, who specializes in the treatment of cancer.

PREPARING FOR YOUR APPOINTMENTS

Preparation is key to getting the most out of each doctor’s visit, especially since time with your doctor is limited. Before your appointment, it’s helpful to do the following:

Ask about pre-appointment requirements. When you call to make the appointment, find out if there’s anything you need to bring or do in advance. For example, you might need to restrict your diet several hours before the appointment.

Make a list of your symptoms—even if you think you can remember them. It’s helpful to start keeping a symptom journal a few weeks before your appointment. This allows you to record symptoms as they happen and include relevant information. Make sure to write down any health issues that seem unrelated; the doctor might recognize a connection.

Write down important personal information. This may include past asbestos exposure, significant life changes, or recent trauma. This will help the doctor get a more complete picture of your symptoms.

Write down all the medications you’re taking or have taken recently. Include supplements, vitamins, and over-the-counter medications.

Bring along a friend or family member. There’s no need to do this alone. A loved one can offer support and help you answer the doctor’s questions. He or she may even remember something you forget to mention, and think of questions you forget to ask.

Bring medical records that relate to your condition. This may be chest X-rays, blood tests, or other test results. If you’re unable to locate copies of your records, try to provide the doctor with a general date and description of the procedure.

Make a list of questions to ask your doctor. The doctor is there for you, so don’t hesitate to talk about your concerns. Most doctors prefer to have patients who are actively involved in the diagnosis process. Again, even if you think you can remember all your questions, it’s very helpful to have a list in front of you.

Some basic mesothelioma questions include:

• What do you think is causing my symptoms? Are there other possible causes for my condition?
• What kinds of tests will I need? How involved are these procedures?
• I have other health problems. How might they affect this condition? What’s the best way to manage them together?
• Do I need to see a specialist? Will my insurance cover that?
• What websites or resources do you recommend I read?
• Should I plan a follow-up visit?

If you’re referred to a specialist, you’ll have different questions and concerns. Depending on where you are in the process, you may want to ask:

• Can I see my chest X-ray?
• What other options are available aside from the approach you’re recommending?
• What are our next steps? What’s the best course of action?
• What restrictions, if any, do I need to follow?

UNDERSTANDING YOUR DIAGNOSIS

Mesothelioma is a complicated disease. It can be overwhelming to hear about stages, cell type, and procedure names for the first time. Fortunately, the terminology is more complicated than the concepts. Here’s what you need to know.

Tumors can be categorized by benign (non-cancerous) or malignant (cancerous). Benign tumors can be surgically removed with a high success rate. Malignant tumors may be so advanced that by the time they are correctly diagnosed, removal isn’t possible.

Mesothelioma starts in the linings of certain parts of the body. The three main locations are:

• The lungs, called pleural mesothelioma (most common)
• The abdominal cavity, called peritoneal mesothelioma
• The lining of the heart, called pericardial mesothelioma

In addition, mesothelioma can be grouped by cell type:

• Epithelial: The most common type (50 to 60 percent of all diagnosed cases each year), it’s also the easiest to treat. Epithelial cells are commonly associated with lung cancers.
• Sarcomatoid: These cells are less common, making up just 10 to 20 percent of mesothelioma cases each year. Sarcomatoid cells grow out of supportive structures like muscles and bones.
• Biphasic: These cells are a mix of epithelial and sarcomatoid cell types.

Each cell type responds differently to certain treatment, so it’s important for your doctor to know what type you have before creating your treatment plan.

Pleural mesothelioma falls into one of four stages:

• Stage 1: The cancer is limited to one portion of the lining of the chest (localized).
• Stage 2: The cancer may have spread to a lung or to the diaphragm.
• Stage 3: The cancer may have spread to other areas within the chest; this may include nearby lymph nodes.
• Stage 4: The cancer has advanced extensively within the chest. It may also mean that it has spread to distant areas of the body, such as the brain and lymph nodes.

Because other types of mesothelioma are rare and haven’t been studied as frequently, doctors haven’t assigned official stages.

TAKING THE NEXT STEPS

Getting a diagnosis is the first step in managing your prognosis. After that, you can take certain actions to improve your outlook:

1. Get a second opinion. Mesothelioma is rare, so it’s important to get a second opinion from an experienced doctor. This can help you feel more confident about your treatment plan. You might even find that you’re more comfortable working with a different doctor.

2. Decide on a treatment. Talk to your doctor about the best course of action for you. Ask about side effects and possible risks. Remember, your doctor can make recommendations, but you are the person who makes that decision ultimately.

3. Surround yourself with the support of loved ones. The research is clear: If you have close relationships, you’re happier and healthier. Some studies even suggest that social bonds improve cancer patients’ prognoses.

4. Get your free treatment guide. Learn about the latest research, treatments to improve your prognosis, and inspiring survivor stories in our complimentary mesothelioma packet. Request your free copy and we’ll deliver it the next day.