What is Mesothelioma?
Mesothelioma or malignant mesothelioma is a rare type of cancer that develops in the tissue that covers the outside of your internal organs. This is an aggressive and deadly type of cancer and even though there are treatments available, there is no cure for mesothelioma. Doctors segregate mesothelioma into different types depending on what part they affect. Mesothelioma most commonly impacts the tissue that surrounds the lungs, known as the pleura. Other rarer forms of mesothelioma can also impact the tissues in the abdomen, around the testicles, and around the heart as well. There are several different types of mesothelioma and the exact kind you have depends on where exactly in the body the cancer develops. There are four types of mesothelioma.(1, 2, 3, 4) Read on to find out more about the different types of mesothelioma and their symptoms.
The Different Types of Mesothelioma and their Symptoms
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Pleural Mesothelioma (Mesothelioma in the Lungs)
Pleural mesothelioma is the most common type of mesothelioma in the world, accounting for almost 75 percent of all mesothelioma cases. It is estimated that nearly 2500 to 3500 cases of pleural mesothelioma are diagnosed every year in the United States alone.(5, 6, 7)
Pleural mesothelioma affects the pleura, which is the lining around your lungs. The main cause of pleural mesothelioma is exposure to asbestos. Asbestos was once widely used in the construction of houses and several other products. This was because the asbestos fibers were resistant to fire and heat. However, it was only much later that doctors found that the fibers get stuck in the lungs when you inhale them. This causes scarring and inflammation. Over a period of many years, this can cause mesothelioma to develop in the lungs. At the same time, other factors and your genes are also responsible for determining your exact risk of developing pleural mesothelioma.(8, 9)
You may experience pain in your check of it may hurt when you cough. You may also experience shortness of breath. Lumps or bumps may develop underneath the skin on your chest. Some of the other symptoms of pleural mesothelioma include:(10, 11)
- Chest pain
- Pain in the side of the chest
- Painful coughing
- Persistent coughing and hoarseness
- Unexplained weight loss
- Difficulty swallowing (known as dysphagia)
- Swelling in arms and face
- Night sweats
- Lower back pain
- Fatigue
- Fever
Diagnosing pleural mesothelioma can be tricky as it shares many of its symptoms with other diseases. Your doctor is likely to order X-rays of your chest or carry out a CT scan to look for signs of asbestos exposure. They may also order a PET scan to detect where the cancer is and the extent to which it has spread. All these imaging tests help your doctors determine if something is wrong. If they suspect cancer, they may take a small sample of your lung tissue to do a biopsy and determine if it’s mesothelioma.(12)
The treatment of pleural mesothelioma depends on how advanced your cancer is at the time of detection. Your doctor may prescribe more imaging tests to diagnose what stage of mesothelioma you have. There are four stages of cancer, with the higher the number denoting a more advanced stage of cancer.(13)
If your pleural mesothelioma is in the early stages, you may need surgery, which may sometimes cure the cancer by taking out the cancerous cells. In other cases, surgery may only help reduce the severity of your symptoms. You may also need chemotherapy, which is sometimes used before surgery or as a standalone treatment to help shrink the size of your cancer or prevent it from spreading rapidly. Chemotherapy is sometimes also used after surgery to reduce the chances of the cancer reoccurring. Radiation therapy is given after surgery to kill off any cancer cells that might still be left in your body.(14)
Most of the time, though, mesothelioma does not get diagnosed until it has already reached an advanced stage. If it is too advanced, doctors won’t be able to operate, in which case your doctor will recommend other treatments to reduce the severity of your symptoms.
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Peritoneal Mesothelioma (Mesothelioma in the Abdomen)
Only about 15 to 20% of all cases of mesothelioma are diagnosed as peritoneal mesothelioma. This type of mesothelioma typically affects the abdomen and the abdominal cavity. This happens if you end up swallowing asbestos fibers. As surprising as it seems, it is actually possible to swallow asbestos fibers as they are too small to be seen with the naked eye. This can damage the lining of your abdominal cavity and organs. This substantially increases the risk of getting mesothelioma in these parts of the body. Again, other factors like your genes also have a role to play in this.(15, 16, 17)
Peritoneal mesothelioma does not usually cause any symptoms until it has already spread to the organs in your abdominal cavity. The most common symptom of this type of mesothelioma is fluid build-up in the abdomen. As the fluid begins to accumulate, the abdomen may start getting bigger. Abdominal pain is another common symptom.(18)
The symptoms of this type of cancer also cause the following symptoms:
- Fluid build-up in the abdomen
- Bulging or swelling in the abdomen
- Nausea and vomiting
- Pain that spreads out in the abdomen or remains localized to one spot, though localized pain is less common
- Constipation
- Bowel obstruction
- A painful mass in the pelvic region
- Fever
- Night sweats
- Loss of appetite
- Unexplained weight loss
To diagnose this type of mesothelioma, your doctor will again order imaging tests to check for things that do not appear to be normal in the abdominal region. If something is found, they will proceed with a biopsy. If you are diagnosed with mesothelioma, your doctor will order more tests for staging the cancer.(19, 20)
Treatment of peritoneal mesothelioma involves a combination of things, including chemotherapy, surgery, and radiation therapy. If you are diagnosed at an advanced stage, it might be too late to attempt a surgical intervention. In such cases, the doctor will recommend other types of treatments to ease your symptoms.(21, 22)
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Pericardial Mesothelioma (Mesothelioma in the Heart)
Only about one percent of all diagnosed cases of mesothelioma occur in the tissue that surrounds the heart. It is actually a sac of tissue surrounding the heart, which is known as the pericardium.(23, 24, 25)
Some of the common symptoms of pericardial mesothelioma include chest pain, difficulty breathing or shortness of breath, and heart palpitations. Similar to peritoneal mesothelioma, patients with pericardial mesothelioma also do not experience any symptoms at first. This fact is majorly responsible for the late-stage diagnosis associated with all types of mesothelioma. At the same time, symptoms of pericardial mesothelioma also resemble those of other heart conditions, making the condition difficult to diagnose.
Fluid buildup around the heart along with the thickening of the pericardial layers of the heart is responsible for causing the symptoms.
Some of the other symptoms of pericardial mesothelioma may include:
- Difficulty breathing, even while you are at rest
- Chest pain
- Shortness of breath, when even lying flat
- Heart palpitations or irregular heartbeat
- Heart murmurs
- Cough
- Night sweats
- Fever
- Fatigue
Doctors are not really sure what causes pericardial mesothelioma, and it remains unclear whether exposure to asbestos causes this type of mesothelioma in the heart. To diagnose pericardial mesothelioma, your doctor will prescribe a test known as echocardiography. This diagnostic test allows them to see just how thick the heart tissues are. A biopsy will need to be done to determine if you have cancer or not.(26, 27)
In case the cancer is at too advanced stage, your doctor will recommend a treatment known as pericardiectomy. This is a type of surgical procedure during which some or all of the pericardium is removed. This may also be followed up with chemotherapy.(28)
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Testicular Mesothelioma (Mesothelioma in the Testicles)
This is an extremely rare form of mesothelioma and there have only been a couple of hundred cases of testicular mesothelioma ever to be reported. Since it is so rare, there is no known, standard set of signs and symptoms for this form of mesothelioma, but the one symptom that most patients tend to experience is the appearance of a painless mass in the scrotum.(29)
It usually affects men between the ages of 55 to 75 years. There is a suspected link to exposure to asbestos, though the exact link is not discovered yet.
To diagnose testicular mesothelioma, your doctor is going to perform an ultrasound examination of the scrotum. You may also need to get a biopsy done to check if there is a mass and if it is cancerous. Your doctor may also remove the tumor through surgery and then analyze it to check for cancerous cells. Due to this form of cancer being so rare, understanding is still poor, which is why there is no standard treatment format for testicular mesothelioma.(30)
Conclusion
There are four major types of malignant mesothelioma that exist, with one type, testicular mesothelioma, being extremely rare. Mesothelioma is a rare form of cancer that develops in the tissue that covers many of your internal organs. This type of cancer has been strongly linked with exposure to asbestos.
The four main types of mesothelioma are pleural mesothelioma, peritoneal mesothelioma, pericardial mesothelioma, and testicular mesothelioma. The symptoms of mesothelioma vary depending on which type of the cancer you have, and also depends on how advanced your cancer is. While there is no cure for any of the four types of mesothelioma, getting an early diagnosis and seeking proper treatment can help improve your chances of surviving this type of cancer.
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- Robinson, B., Nowak, A., Robinson, C. and Creaney, J., 2008. Malignant mesothelioma. Textbook of Lung Cancer, pp.206-222.
- Robinson, B.W. and Lake, R.A., 2005. Advances in malignant mesothelioma. New England Journal of Medicine, 353(15), pp.1591-1603.
- Carbone, M., Adusumilli, P.S., Alexander Jr, H.R., Baas, P., Bardelli, F., Bononi, A., Bueno, R., Felley‐Bosco, E., Galateau‐Salle, F., Jablons, D. and Mansfield, A.S., 2019.
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- Boutin, C., Schlesser, M., Frenay, C. and Astoul, P.H., 1998. Malignant pleural mesothelioma. European Respiratory Journal, 12(4), pp.972-981.
- Bibby, A.C., Halford, P., De Fonseka, D., Morley, A.J., Smith, S. and Maskell, N.A., 2019. The prevalence and clinical relevance of nonexpandable lung in malignant pleural mesothelioma. A prospective, single-center cohort study of 229 patients. Annals of the American Thoracic Society, 16(10), pp.1273-1279.
- Wagner, J.C., Sleggs, C.A. and Marchand, P., 1960. Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province. Occupational and Environmental Medicine, 17(4), pp.260-271.
- Whitwell, F. and Rawcliffe, R.M., 1971. Diffuse malignant pleural mesothelioma and asbestos exposure. Thorax, 26(1), pp.6-22.
- Bibby, A.C., Tsim, S., Kanellakis, N., Ball, H., Talbot, D.C., Blyth, K.G., Maskell, N.A. and Psallidas, I., 2016. Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment. European Respiratory Review, 25(142), pp.472-486.
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- Kannerstein, M. and Churg, J., 1977. Peritoneal mesothelioma. Human pathology, 8(1), pp.83-94.
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Also Read:
- Mesothelioma: Causes, Who Is At Risk, Types, Symptoms, Diagnosis, Present Treatment, Emerging Treatment
- Pericardial Mesothelioma: Prevention, Disability Benefits, Prognosis
- What is Malignant Mesothelioma: Causes, Signs, Symptoms, Risk Factors, Diagnosis, Facts
- What Is Mesothelioma: Causes, Symptoms, Treatment, Diagnosis