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Mesothelioma is an uncommon form of cancer, usually associated with previous exposure to asbestos. In this disease, malignant (cancerous) cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).
Most people who develop mesothelioma have worked on jobs where they inhaled
asbestos particles, or have been exposed to asbestos dust and fibre in other
ways, such as by washing the clothes of a family member who worked with
asbestos, or by home renovation using asbestos cement products.
Signs and symptoms
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos. Shortness of breath and pain in the chest due to an accumulation of
fluid in the pleural space often symptoms of pleural mesothelioma.
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Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal
swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood
clotting abnormalities, anemia, and fever. If the cancer has spread beyond the
mesothelium to other parts of the body, symptoms may include pain, trouble
swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious
conditions.
Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms are similar to
those of a number of other conditions. Diagnosis begins with a review of the
patient's medical history. A history of occupational exposure to asbestos may
increase clinical suspicion for mesothelioma. A physical examination is
performed, followed by chest X-ray and often lung function tests. The X-ray may
reveal pleural thickening commonly seen after asbestos exposure and increases
suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If
a large amount of fluid is present, abnormal cells may be detected by cytology
if this fluid is aspirated with a syringe. For pleural fluid this is done by a
pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and
in a pericardial effusion with pericardiocentesis. While absence of malignant
cells on cytology does not completely exclude mesothelioma, it makes it much
more unlikely, especially if an alternative diagnosis can be made (e.g.
tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is
needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of
tissue for examination under a microscope by a histopathologist. A biopsy may be
done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this
procedure, the doctor makes a small cut through the chest wall and puts a thin,
lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy
allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain
tissue for examination, the doctor makes a small opening in the abdomen and
inserts a special instrument into the abdominal cavity. If these procedures do
not yield enough tissue, more extensive diagnostic surgery may be necessary.
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