Aisner J, Belani CP, Aisner SC. Tumors of the pleura and mediastinum. In: Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE. Kastan MB, McKenna WG. Clinical Oncology. Philadelphia, PA. Elsevier: 2004: 1745-1786.
American Joint Committee on Cancer. Pleural mesothelioma. AJCC Cancer Staging Manual. 6th ed. New York, New York. Springer: 179-184.
Chahinian AP, Pass HI. Malignant mesothelioma In: Kufe DW, Pollock RE, Weichselbaum RR, Bast RC, Gansler TS, Holland JF, Frei E. Cancer Medicine 6. Hamilton, Ont: BC Decker; 2003. 1447-1466.
Pan X, Day W, Wang W, et al. Residential proximity to naturally occurring asbestos and mesothelioma risk in California. Am J Resp Crit Care. 2005;172:1019-1025.
Pass HI, Vogelzgang NJ, Hahan SM, Carbone M. Benign and malignant mesothelioma In: DeVita VT, Heilman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. Philadelphia, PA: Lippincott Williams & Wilkins 2005: 1687-1716.
Price B, Ware A. Mesothelioma trends in the United States: An update based on Surveillance Epidemiology and End Results program date for 1973-2003.
Robinson BWS, Musk AW, Lake RA. Malignant mesothelioma. Lancet. 2005; 366:397-408.
Robinson BWS, Lake RA. Advances in malignant mesothelioma. N Engl J Med. 2005; 353:1591-1603.
Friday, November 16, 2007
Can Malignant Mesothelioma Be Prevented?
The best way to prevent mesothelioma is to prevent or limit your exposure to asbestos in homes, in public buildings, and at work. People who may be exposed to asbestos at work include miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with insulation. If there is a possibility of on-the-job exposure, such as renovating old buildings, then you should use all protective equipment, work practices, and safety procedures designed for working around asbestos.
If you live in an older home, there may be asbestos-containing insulation or other materials. A knowledgeable expert can check your home to determine if there is any asbestos and if it poses any risk of exposure. This may involve testing the air for asbestos levels. It is often more dangerous to remove the materials containing asbestos than to leave them alone. You may then decide to have the asbestos removed from your home. You should hire a qualified contractor to perform this job, to avoid contaminating your home further or causing any exposure to the workers. You should not attempt to remove asbestos-containing material yourself.
If you live in an older home, there may be asbestos-containing insulation or other materials. A knowledgeable expert can check your home to determine if there is any asbestos and if it poses any risk of exposure. This may involve testing the air for asbestos levels. It is often more dangerous to remove the materials containing asbestos than to leave them alone. You may then decide to have the asbestos removed from your home. You should hire a qualified contractor to perform this job, to avoid contaminating your home further or causing any exposure to the workers. You should not attempt to remove asbestos-containing material yourself.
Do We Know What Causes Malignant Mesothelioma?
Asbestos exposure is the main cause of mesothelioma. After these fibers are breathed in, they travel to the ends of small air passages and reach the pleura where they damage mesothelial cells. The damage they cause is through inflammation and scarring as well as stimulating the growth of these cells. Finally, they may damage DNA and cause changes that result in uncontrolled growth. In addition, they also cause injury to lung cells that can result in lung cancer and/or asbestosis (replacement of lung tissue by scar tissue). If swallowed, these fibers can reach the abdominal cavity where they have a role in causing peritoneal mesothelioma.
Researchers are studying exactly how asbestos causes mesothelial cells to develop into mesothelioma. It is still not known whether the SV40 virus participates in this process.
Researchers are studying exactly how asbestos causes mesothelial cells to develop into mesothelioma. It is still not known whether the SV40 virus participates in this process.
What Are the Risk Factors for Malignant Mesothelioma?
A risk factor is anything that increases your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth, larynx, bladder, kidney, and several other organs. Individuals exposed to asbestos should be encouraged to avoid tobacco exposure because together the risk for lung cancer is significantly higher than from smoking without a history of asbestos exposure. But having a risk factor, or even several, does not mean that you will get the disease.
Asbestos
The main risk factor for developing mesothelioma is exposure to asbestos. Asbestos refers to a family of fibrous minerals made of silicate. Asbestos was once used in many products such as insulation, floor tiles, door gaskets, soundproofing, roofing, patching compounds, fireproof gloves and ironing board covers, and even brake pads. As the link between asbestos and mesothelioma has become well known, the use of this material has almost stopped. Most use stopped after 1989, but it is still used in some products. Experts have linked this drop in asbestos use to the fact that the rate of development of mesothelioma is no longer increasing.
Still, up to 8 million Americans may already have been exposed to asbestos. Exposure to asbestos particles suspended in air and building materials is much less hazardous except when they are being removed.
Since asbestos is a naturally occurring mineral, it can also be found in dust and rocks in certain parts of the United States as well as the world.
According to the U.S. Environmental Protection Agency, as many as 733,000 schools and public buildings in the country today contain asbestos insulation. As many as 10% to 15% of schools in the United States may contain asbestos insulation. People who may be at risk for occupational asbestos exposure include some miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with installing insulation. Several studies have shown that family members of people exposed to asbestos at work have an increased risk of developing mesothelioma, because asbestos fibers are carried home on the clothes of the workers.
The incidence rate for mesothelioma in men is dropping, probably because they are no longer being exposed directly to asbestos in their work. But the incidence rate for mesothelioma in women is steady, which suggests that they are being exposed in a way that is not directly tied to work, but more to their environment either at home or work. One example would be asbestos in buildings where they work or live. A study from California also links mesothelioma to naturally occurring asbestos deposits in mountains.
Another important point about asbestos and mesothelioma is that the risk of mesothelioma does not drop with time after exposure to asbestos. The risk appears to be lifelong and undiminished.
There are 2 main forms of asbestos -- serpentine and amphiboles.
Serpentine fibers are curly and pliable. Chrysotile is the only type of serpentine fiber and it is the most widely used form of asbestos.
Amphiboles are thin, rod-like fibers. There are 5 main types — crocidolite, amosite, anthrophylite, tremolite, and actinolyte. Amphiboles (particularly crocidolite) are considered to be the most carcinogenic (cancer-causing).
However, even the more commonly used chrysotile fibers are associated with malignant (cancerous) mesotheliomas and should be considered dangerous as well.
When asbestos fibers are inhaled, most are cleared in the nose, throat, trachea (windpipe), or bronchi (large breathing tubes of the lungs). Fibers are cleared by sticking to mucus inside the air passages and being coughed up or swallowed. The long, thin, fibers are less readily cleared, and they may reach the ends of the small airways and penetrate into the pleural lining of the lung and chest wall. These fibers may then directly injure mesothelial cells of the pleura, and eventually cause mesothelioma.
Asbestos fibers can also damage cells of the lung and result in asbestosis (formation of scar tissue in the lung), and/or lung cancer. The risk of lung cancer among people exposed to asbestos is increased by 7 times, compared with the general population. Indeed, asbestosis, mesothelioma, and lung cancer are the 3 most frequent causes of death and disease among people with heavy asbestos exposure. Peritoneal mesothelioma, which forms in the abdomen, may result from coughing up and swallowing inhaled asbestos fibers. Cancers of the larynx, pancreas, esophagus, colon, and kidney may also come from asbestos exposure, but the increased risk is small.
The risk of developing a mesothelioma is related to how much asbestos a person was exposed to and how long this exposure lasted. People exposed at an early age, for a long period of time, and at higher levels are most likely to develop this cancer. Mesotheliomas take a long time to develop. The time between first exposure to asbestos and diagnosis of mesothelioma is usually between 20 and 50 years.
Radiation
There have been a few published reports of pleural and peritoneal mesotheliomas that developed following exposure to thorium dioxide (Thorotrast). This material was used in the past by doctors for certain x-ray tests. Because Thorotrast was found to cause cancers, it has not been used for many years.
Zeolite
This is a silicate mineral, chemically related to asbestos, common in the soil of the Anatoli region of Turkey. Many cases of mesothelioma have been described in this region and may have been caused by this mineral.
Tobacco
Although tobacco smoking has not been associated with developing mesothelioma, the combination of smoking and asbestos exposure greatly increases the risk of lung cancer. Asbestos workers who also smoke have a lung cancer risk 50 to 90 times greater than that of the general population. More asbestos workers die of lung cancer than of mesothelioma.
SV40 Virus
Some recent studies have raised the possibility that infection with simian virus 40 (SV40) might increase the risk of developing mesothelioma. Some injectable polio vaccines prepared between 1955 and 1963 were contaminated with SV40. About 10 to 30 million people were probably exposed to the virus.
Intentional infection with SV40 of some laboratory animals, such as hamsters, causes mesotheliomas to develop. Researchers also have noticed that SV40 can cause mouse cells grown in dishes to become cancerous, and that asbestos increases the cancer-causing effect of SV40 on these cells. Other researchers have studied biopsy specimens of human mesotheliomas and detected SV40 DNA. However, similar fragments of SV40 DNA can also be found in noncancerous human tissues and some researchers think the SV40 viruses found are contaminants.
Another study did find SV40 virus in tissues from mesothelioma patients that did not appear to be contaminants. In this study, which also looked at tissue from healthy people, the SV40 virus wasn’t linked to mesothelioma unless the person was also exposed to asbestos. The researchers in this study thought the SV40 infection was not caused by the polio immunization, but occurred naturally as do other viral infections.
So far, the largest studies addressing this issue in humans have not found any increased risk for mesothelioma or other cancers among people who received the contaminated vaccines as children. But, the peak age range for diagnosis of mesothelioma is 50 to 70 years. Some researchers have pointed out that this issue may remain unresolved until more of the people accidentally exposed to SV40 between 1955 and 1963 reach that age range. Research into this important topic is still underway.
A recent study by the Institute of Medicine concluded that we still don’t know whether SV40 is responsible for some mesotheliomas and more research needs to be done.
Asbestos
The main risk factor for developing mesothelioma is exposure to asbestos. Asbestos refers to a family of fibrous minerals made of silicate. Asbestos was once used in many products such as insulation, floor tiles, door gaskets, soundproofing, roofing, patching compounds, fireproof gloves and ironing board covers, and even brake pads. As the link between asbestos and mesothelioma has become well known, the use of this material has almost stopped. Most use stopped after 1989, but it is still used in some products. Experts have linked this drop in asbestos use to the fact that the rate of development of mesothelioma is no longer increasing.
Still, up to 8 million Americans may already have been exposed to asbestos. Exposure to asbestos particles suspended in air and building materials is much less hazardous except when they are being removed.
Since asbestos is a naturally occurring mineral, it can also be found in dust and rocks in certain parts of the United States as well as the world.
According to the U.S. Environmental Protection Agency, as many as 733,000 schools and public buildings in the country today contain asbestos insulation. As many as 10% to 15% of schools in the United States may contain asbestos insulation. People who may be at risk for occupational asbestos exposure include some miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with installing insulation. Several studies have shown that family members of people exposed to asbestos at work have an increased risk of developing mesothelioma, because asbestos fibers are carried home on the clothes of the workers.
The incidence rate for mesothelioma in men is dropping, probably because they are no longer being exposed directly to asbestos in their work. But the incidence rate for mesothelioma in women is steady, which suggests that they are being exposed in a way that is not directly tied to work, but more to their environment either at home or work. One example would be asbestos in buildings where they work or live. A study from California also links mesothelioma to naturally occurring asbestos deposits in mountains.
Another important point about asbestos and mesothelioma is that the risk of mesothelioma does not drop with time after exposure to asbestos. The risk appears to be lifelong and undiminished.
There are 2 main forms of asbestos -- serpentine and amphiboles.
Serpentine fibers are curly and pliable. Chrysotile is the only type of serpentine fiber and it is the most widely used form of asbestos.
Amphiboles are thin, rod-like fibers. There are 5 main types — crocidolite, amosite, anthrophylite, tremolite, and actinolyte. Amphiboles (particularly crocidolite) are considered to be the most carcinogenic (cancer-causing).
However, even the more commonly used chrysotile fibers are associated with malignant (cancerous) mesotheliomas and should be considered dangerous as well.
When asbestos fibers are inhaled, most are cleared in the nose, throat, trachea (windpipe), or bronchi (large breathing tubes of the lungs). Fibers are cleared by sticking to mucus inside the air passages and being coughed up or swallowed. The long, thin, fibers are less readily cleared, and they may reach the ends of the small airways and penetrate into the pleural lining of the lung and chest wall. These fibers may then directly injure mesothelial cells of the pleura, and eventually cause mesothelioma.
Asbestos fibers can also damage cells of the lung and result in asbestosis (formation of scar tissue in the lung), and/or lung cancer. The risk of lung cancer among people exposed to asbestos is increased by 7 times, compared with the general population. Indeed, asbestosis, mesothelioma, and lung cancer are the 3 most frequent causes of death and disease among people with heavy asbestos exposure. Peritoneal mesothelioma, which forms in the abdomen, may result from coughing up and swallowing inhaled asbestos fibers. Cancers of the larynx, pancreas, esophagus, colon, and kidney may also come from asbestos exposure, but the increased risk is small.
The risk of developing a mesothelioma is related to how much asbestos a person was exposed to and how long this exposure lasted. People exposed at an early age, for a long period of time, and at higher levels are most likely to develop this cancer. Mesotheliomas take a long time to develop. The time between first exposure to asbestos and diagnosis of mesothelioma is usually between 20 and 50 years.
Radiation
There have been a few published reports of pleural and peritoneal mesotheliomas that developed following exposure to thorium dioxide (Thorotrast). This material was used in the past by doctors for certain x-ray tests. Because Thorotrast was found to cause cancers, it has not been used for many years.
Zeolite
This is a silicate mineral, chemically related to asbestos, common in the soil of the Anatoli region of Turkey. Many cases of mesothelioma have been described in this region and may have been caused by this mineral.
Tobacco
Although tobacco smoking has not been associated with developing mesothelioma, the combination of smoking and asbestos exposure greatly increases the risk of lung cancer. Asbestos workers who also smoke have a lung cancer risk 50 to 90 times greater than that of the general population. More asbestos workers die of lung cancer than of mesothelioma.
SV40 Virus
Some recent studies have raised the possibility that infection with simian virus 40 (SV40) might increase the risk of developing mesothelioma. Some injectable polio vaccines prepared between 1955 and 1963 were contaminated with SV40. About 10 to 30 million people were probably exposed to the virus.
Intentional infection with SV40 of some laboratory animals, such as hamsters, causes mesotheliomas to develop. Researchers also have noticed that SV40 can cause mouse cells grown in dishes to become cancerous, and that asbestos increases the cancer-causing effect of SV40 on these cells. Other researchers have studied biopsy specimens of human mesotheliomas and detected SV40 DNA. However, similar fragments of SV40 DNA can also be found in noncancerous human tissues and some researchers think the SV40 viruses found are contaminants.
Another study did find SV40 virus in tissues from mesothelioma patients that did not appear to be contaminants. In this study, which also looked at tissue from healthy people, the SV40 virus wasn’t linked to mesothelioma unless the person was also exposed to asbestos. The researchers in this study thought the SV40 infection was not caused by the polio immunization, but occurred naturally as do other viral infections.
So far, the largest studies addressing this issue in humans have not found any increased risk for mesothelioma or other cancers among people who received the contaminated vaccines as children. But, the peak age range for diagnosis of mesothelioma is 50 to 70 years. Some researchers have pointed out that this issue may remain unresolved until more of the people accidentally exposed to SV40 between 1955 and 1963 reach that age range. Research into this important topic is still underway.
A recent study by the Institute of Medicine concluded that we still don’t know whether SV40 is responsible for some mesotheliomas and more research needs to be done.
What's New in Malignant Mesothelioma Research and Treatment?
There is always research going on in the area of mesothelioma. Scientists are looking for causes and ways to prevent mesothelioma. Doctors are working to improve accuracy of diagnosis and effectiveness of treatment. Despite recent progress, much remains to be learned about the best way to treat these cancers.
Causes and Prevention
Much of the research on mesothelioma has focused on learning exactly how asbestos changes mesothelial cells and their DNA to cause these cancers. Understanding how these fibers produce cancer might help us develop ways to prevent those changes.
The risk of asbestos in developing mesothelioma is a definite public health concern. We are continuously learning more about which fibers can produce cancer, how they cause these cancers, and what levels of exposure can be considered safe. Now that we know about the dangers of asbestos, we can limit or stop exposure in homes, public buildings, and the workplace. Unfortunately, regulations protecting workers from asbestos exposure are much less stringent in some countries and nonexistent in others.
Research is also underway to clarify the role (if any) of SV40, a virus that has been linked to mesothelioma in some studies.
New Drugs
Because chemotherapy drugs have not been very effective against advanced mesothelioma, several new approaches to cancer treatment are now being studied. These include anti-angiogenesis drugs (which kill cancers by stopping their blood supply) such as Bevacizumab (Avastin) and anti-growth factor drugs (which interfere with substances some cancer cells produce to stimulate their own growth) such as Erlotinib (Tarceva).
Multimodality Therapy
Doctors are always learning more about the best way to treat patients with mesotheliomas. The roles of surgery, radiation therapy, and chemotherapy in the treatment of mesothelioma are highly debated. Treatments that use some combinations of surgery, radiation therapy, and chemotherapy, called multimodality therapy, are now being studied and may provide the most promising option for some patients. New chemotherapy drugs are currently being tested in clinical trials, together with other types of treatment.
Ranpirnase (Onconase) is an enzyme that breaks down RNA and in preliminary studies has helped some patients with mesothelioma to love longer. Larger clinical trials are currently in progress. Another new drug being tested in mesothelioma clinical trials is suberoylanilide hydroxamic acid (vorinostat, [SAHA]), which may reduce growth of mesothelioma cells by inhibiting an enzyme that controls certain proteins called histones, which regulate DNA.
Gene Therapy
A new approach to cancer therapy being tested on mesothelioma is gene therapy. One of these approaches to treating mesothelioma uses special viruses that have been modified in the laboratory. The modified virus is injected into the pleural space and infects the mesothelioma cells. When this infection occurs, the virus injects a gene into the mesothelioma for interferon-beta, an immune system hormone (cytokine) that may help activate immune system cells to attack the cancer.
Causes and Prevention
Much of the research on mesothelioma has focused on learning exactly how asbestos changes mesothelial cells and their DNA to cause these cancers. Understanding how these fibers produce cancer might help us develop ways to prevent those changes.
The risk of asbestos in developing mesothelioma is a definite public health concern. We are continuously learning more about which fibers can produce cancer, how they cause these cancers, and what levels of exposure can be considered safe. Now that we know about the dangers of asbestos, we can limit or stop exposure in homes, public buildings, and the workplace. Unfortunately, regulations protecting workers from asbestos exposure are much less stringent in some countries and nonexistent in others.
Research is also underway to clarify the role (if any) of SV40, a virus that has been linked to mesothelioma in some studies.
New Drugs
Because chemotherapy drugs have not been very effective against advanced mesothelioma, several new approaches to cancer treatment are now being studied. These include anti-angiogenesis drugs (which kill cancers by stopping their blood supply) such as Bevacizumab (Avastin) and anti-growth factor drugs (which interfere with substances some cancer cells produce to stimulate their own growth) such as Erlotinib (Tarceva).
Multimodality Therapy
Doctors are always learning more about the best way to treat patients with mesotheliomas. The roles of surgery, radiation therapy, and chemotherapy in the treatment of mesothelioma are highly debated. Treatments that use some combinations of surgery, radiation therapy, and chemotherapy, called multimodality therapy, are now being studied and may provide the most promising option for some patients. New chemotherapy drugs are currently being tested in clinical trials, together with other types of treatment.
Ranpirnase (Onconase) is an enzyme that breaks down RNA and in preliminary studies has helped some patients with mesothelioma to love longer. Larger clinical trials are currently in progress. Another new drug being tested in mesothelioma clinical trials is suberoylanilide hydroxamic acid (vorinostat, [SAHA]), which may reduce growth of mesothelioma cells by inhibiting an enzyme that controls certain proteins called histones, which regulate DNA.
Gene Therapy
A new approach to cancer therapy being tested on mesothelioma is gene therapy. One of these approaches to treating mesothelioma uses special viruses that have been modified in the laboratory. The modified virus is injected into the pleural space and infects the mesothelioma cells. When this infection occurs, the virus injects a gene into the mesothelioma for interferon-beta, an immune system hormone (cytokine) that may help activate immune system cells to attack the cancer.
Thursday, November 1, 2007
This page is about research into mesothelioma causes, prevention and treatments. You can scroll down the page to read all the information here. Or you can use these links to go straight to sections on
Why research?
Causes and prevention
Finding a tumour marker for diagnosing, screening or monitoring treatment
Genetics
Chemotherapy
Chemotherapy for controlling symptoms
Treating fluid collection around the lung (pleural effusion)
Surgery
Gene therapy
Anti-angiogenic therapy (to disrupt the blood supply to the cancer)
Immunotherapy
Photodynamic therapy
Why research?All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
We can be sure they work
We can be sure they work better than the treatments that are available at the moment
They are known to be safeFirst of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.Tests in patients are called clinical trials. There are 4 phases of clinical trials. This is fully explained in the understanding clinical trials section of CancerHelp UK. If you are interested in taking part in a clinical trial, click the button on the left of your screen to visit our searchable database of clinical trials recruiting in the UK. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. All the new approaches covered here are the subject of ongoing research. Mesothelioma is one of the hardest types of cancers to treat. Progress has been made in treating this type of cancer. But we need to learn a lot more about this disease and how best to treat it. Until research studies are completed and new effective treatments are found, the treatments covered here cannot be used as standard therapy for mesothelioma.
Causes and preventionMesothelioma is most often linked to exposure to asbestos. So much of the research into this disease is based on finding out exactly how asbestos affects the normal cells of the lining of the chest and abdominal cavities. If we can have a better understanding of how asbestos fibres cause cancer and how exposure to this chemical affects us, then we may be able to help prevent the disease. Researchers know that there can be an incredibly long time lag between exposure to asbestos and developing mesothelioma. It can be 40 years or more. This probably meant that it took longer to spot the connection between asbestos and cancer than it otherwise would. But we know now, and the use of asbestos in many countries is now illegal.There has been talk for the past few years about a link between a virus called the simian virus (SV40) and developing mesothelioma. Some polio vaccine preparations were contaminated with SV40 between 1955 and 1963 and doctors were concerned that people who'd had them may be at increased risk. One large study has indicated that these people are not at an increased risk of mesothelioma or other types of cancers. The study was published in 2003 and found that mesothelioma rates were actually falling in this group of people. If there is a link between SV40 and mesothelioma, it is likely to be much less important that the link with asbestos.There is some evidence that your genetic make up could affect your risk of mesothelioma. As well as asbestos, exposure to a mineral called erionite is a risk factor. Researchers in Turkey found that in families exposed to this mineral, in some families all the family members developed mesothelioma and in other families, no one developed it. They think that there is a gene in some families in Turkey that increases their risk. (This article is published in The Lancet, volume 357, issue 9254, page 444.) This could explain why some people are exposed to asbestos and do not develop mesothelioma, while others who are exposed do. There is a lot more research to be done before we will know if there are specific gene changes that can increase your risk of mesothelioma. It will be some years after this has been completed before there will be any chance of testing for such a gene.In the past, asbestos was used widely in the
Building industry
Ship building industry
Manufacture of household appliances
Motor industry
Power stations
Telephone exchangesThere is a study going on in the UK looking at the occupations of men and women and the development of mesothelioma and lung cancer (MALCS). There is information about this trial on our clinical trials data base. Choose Lung: Mesothelioma from the drop down menu of cancer types to find mesothelioma trials.
Finding a tumour marker for mesotheliomaMesothelioma can be very difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumour. Mesothelioma tumour cells are very similar to some types of lung cancer cells. Sometimes it can be very difficult for a pathologist to decide whether or not the cancerous cells are mesothelioma cells, lung cancer cells or even, sarcoma cells. To help with diagnosis, scientists are trying to find a tumour marker for mesothelioma. A tumour marker is a chemical given off by cancer cells that can be found in the blood and picked up in a blood test. If a definite tumour marker could be discovered for mesothelioma this would be of great benefit for doctors in making more accurate diagnosis of this disease and may also be helpful to monitor the success of treatment. An Australian paper, published in The Lancet in November 2003, is about this search. The researchers were looking into tests for proteins related to mesothelioma. This is early research, but they have had promising results. In their study, 84% of people with mesothelioma tested positive, compared to 2% with other cancers or other lung disease. In a group of people who had been exposed to asbestos but did not have mesothelioma, 7 out of 40 tested positive. 3 of these 7 developed mesothelioma and another got lung cancer within 5 years of the positive test. None of the 33 people who tested negative got mesothelioma within the 8 years following the study. It may be that researchers can build on this work to develop a test for screening for mesothelioma and tests for monitoring the disease in people who already have it.
ChemotherapyIt has been a major challenge for doctors to find chemotherapy drugs that work well in treating malignant mesothelioma. Many trials have been done using epirubicin, doxorubicin, cisplatin and methotrexate, but no standard treatment has been set. This has led researchers to look at newer chemotherapy drugs in combination with some already tried. Drugs and combinations in trial include
Gemcitabine and cisplatin
Vinorelbine (Navelbine)
Topotecan
Irinotecan, cisplatin and mitomycin C
Pemetrexed
Raltitrexed (Tomudex)
OnconaseMost studies giving gemcitabine alone have not been successful. A small number of trials using gemcitabine in combination with cisplatin, have produced some promising results. Many doctors now use this combination of drugs to treat malignant mesothelioma. But more trials are needed before it may be considered as standard treatment. There is information on the side effects of gemcitabine in the side effects of cancer drugs page of CancerHelp UK. In one study 29 patients were given vinorelbine alone, 6 (24%) patients disease improved and 16 (55%) patients disease remained stable. This has led to further trials using this drug. A trial called MS-01 has been comparing active symptom control (ASC) with ASC and vinorelbine and with ASC, mitomycin, vinblastine and cisplatin. This trial has now closed and we are waiting for the results. You can find information about the side effects of vinorelbine, cisplatin, mitomycin C and vinblastine in the cancer drugs section of Cancerhelp UK.Topotecan and irinotecan have not shown significant responses when given by themselves. But in combination with other drugs, there have been some good results. There was a trial looking at irinotecan, cisplatin and mitomycin C (IPM). The results were encouraging, but more investigations are needed. There is information about the side effects of topotecan, cisplatin and irinotecan in the cancer drugs section of CancerHelp UK.Pemetrexed is a type of chemotherapy drug. It is also called Alimta. It is a little similar to another drug in regular use called methotrexate. It has been used in the largest phase 3 clinical trial ever conducted for malignant pleural mesothelioma. This international trial began in 1998 and results were reported on in May 2002. The study was aimed at finding out whether pemetrexed plus cisplatin was more effective in treating malignant mesothelioma than cisplatin alone. All patients were given supplements of vitamin B12 and folic acid to help reduce side effects (such as diarrhoea). The outcome of this trial was promising. A number of recent trials are now looking at the use of pemetrexed in combination with other chemotherapy agents.Pemetrexed has now been licensed in the UK for use in combination with cisplatin to treat mesothelioma. This was announced by the company who developed it on 1st November 2004. In August 2005 pemetrexed was approved for use in Scotland by the Scottish Medicines Consortium. In July 2007 NICE (National Institute for Health and Clinical Excellence) announced that they would recommend it for use in England and Wales, for people with advanced mesothelioma which is not suitable for surgery, who are fit enough to look after themselves. Others who are already receiving pemetrexed will be able to continue their treatment while they and their doctors agree that it is helpful. NICE's final decision is expected in September 2007.There is more about pemetrexed in the question and answer section of CancerHelp UK.
Chemotherapy for controlling symptomsA trial reported in 2004 on the combination of raltitrexed (Tomudex) and cisplatin. The researchers believe that this combination is better for advanced mesothelioma that cisplatin on its own. But the actual difference between the two groups in this trial was quite small.
OnconaseOnconase is an experimental chemotherapy drug, made from leopard frog eggs. It is not available in the UK. We have included it here because you may have come across information about it on the web. Onconase may have fewer side effects than many other chemotherapy drugs. But not all the side effects may be known as yet. A phase 3 clinical trial has been going on in the USA and Germany comparing the use of Onconase with doxorubicin to doxorubicin alone for people with mesothelioma. Unfortunately, the trial reports aren't very promising. The researchers say that onconase may be better than doxorubicin for some patients, but doxorubicin isn't the chemotherapy drug of choice for mesothelioma now anyway.
Treating fluid around the lungIn mesothelioma, fluid can collect inside the chest. This makes it more difficult for your lung to expand and so it is harder to breathe. Doctors call this pleural effusion. It is usual to treat this by drawing off the fluid and 'sticking' the pleura together. Doctors do this by putting in some sort of irritant, usually bcg vaccine, talc or chemotherapy. You can also treat pleural effusion by operating to remove the pleura (a pleurectomy). This is called a pleurectomy. There is a trial that is comparing these two approaches to see which is better. While this trial is open and recruiting patients, it will be listed on our clinical trials database. To find it and other trials, go to the database and choose 'lung - mesothelioma' from the drop down menu of cancer types.
SurgeryMajor surgery for people with mesothelioma has not always been thought a good idea by surgeons. This is because surgery cannot cure the disease. And because many people with mesothelioma are not fit enough to get through a very large operation. But the point of surgery in mesothelioma is to slow the cancer down, rather than cure it. The operation that can be done to remove mesothelioma is called an extrapleural pneumonectomy (EPP). This means removing the lung and the lining of the chest cavity (the pleura) on the affected side. It may help people to live more comfortably for longer. But this has to be tested because, on the other hand, it could mean that having such major surgery means people die sooner than they would have.In 2001 a programme was started in the UK to look at patients with mesothelioma and see who would benefit most from this type of surgery. 45 patients have been evaluated and 21 patients have been operated on. Of these patients, so far 16 of these patients (about 75%) have lived for at least 6 months and 13 of them have lived for at least 12 months (about 60%). This programme has led to a trial called 'MARS' which opened in 2005. The MARS trial is looking at the benefits and risks of EPP for mesothelioma patients who have had chemotherapy. Results from some studies in the USA suggest that giving a course of radiotherapy after the EPP will help to keep the disease under control for even longer. Some patients in the MARS trial will have an EPP operation combined with radical radiotherapy. Others will have other treatments, such as radiotherapy or less major surgery. There is more information about the MARS trial on our clinical trials database. Either follow the link or click on the blue button to the left of your CancerHelp UK screen. Then choose lung, and select mesothelioma, from the drop down list of cancer types.
Gene therapyThere are a number of new types of treatments being researched that can be put under this heading. Some doctors and researchers are now calling this type of treatment 'molecular therapy', which is a more general term including research into
Oncogenes
Tumour suppressor genes
Gene therapy and repair genesBy studying how changes in these genes cause normal cells to become cancerous, scientists aim to eventually develop gene therapy where damaged genes in the cancer cells can be replaced with normal ones. The main focus of gene therapy research for mesothelioma involves injecting a virus that has been modified in the laboratory. The virus is injected into the pleural space in your chest, where mesothelioma develops. The idea is that the virus infects the mesothelioma cells with a gene. The gene makes the cancer sensitive to a specific drug that will kill the mesothelioma cells. Without the virus carrying this gene into the cells, the drug would not usually kill them. Much gene therapy research is still centred on how to get the virus into the cancer cells reliably and it will be a while before we will be able to see whether this will develop into a useful treatment. We don't know of any current mesothelioma gene therapy trials that are open and recruiting patients in the UK.
Anti-angiogenic therapyAngiogenesis means growth of new blood vessels. As they get bigger, cancers need to grow their own blood vessels. Without its own blood supply, a cancer cannot continue to grow. Two of the most important chemicals controlling blood vessel growth are called vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (FGF-2). People with mesothelioma have much higher levels of VEGF than people with any other type of cancer. If the VEGF can be blocked, this could control the growth of blood vessels supplying the mesothelioma tumours. This treatment is a type of biological therapy. These are treatments that use natural body substances (or drugs that block them) to treat cancer. There is more about biological therapies in our cancer treatments section. A drug called bevacizumab is a treatment that stops production of VEGF.Bevacizumab has been studied in a number of cancers, including mesothelioma, and bowel, kidney, breast, ovarian, non small cell lung, and prostate cancers. One trial recently reported that this drug may increase survival for patients with lung cancer. An American phase 2 trial tested bevacizumab for mesothelioma, in combination with the chemotherapy drugs gemcitabine and cisplatin. This trial closed in 2005, and we are waiting for the results.Bevacizumab is still very experimental and much larger trials are needed before we will know how effective it will be in treating mesothelioma and other types of cancers.
ImmunotherapyImmunotherapy is treatment with natural substances that the body uses to fight infection and disease. Immunotherapy works by encouraging the body's natural defence system - the immune system - to attack cancer cells. Immunotherapy is really a type of biological therapy. These are a group of treatments that use natural body substances (or drugs that block them) to treat cancer. There is a separate section about biological therapy (including immunotherapy) in CancerHelp UK.The types of immunotherapies being researched for mesothelioma include
Interferon and interleukin 2
Vaccines
Interferon and interleukin 2Two types of immunotherapy in trials for mesothelioma are interferon and interleukin-2 (also called IL-2 or aldesleukin). Interferon has been used in trials both on its own and in combination with various chemotherapy drugs. The results of the combination treatment haven't been any better than the chemotherapy drugs on their own. More trials have to be done before we know how useful interferon will be in treating mesothelioma.IL-2 is made naturally as part of the body's immune response. But now it can be made in the laboratory and used in much larger quantities as cancer treatment. IL-2 can be injected directly into the pleural cavity (intrapleurally) or into the bloodstream. Clinical trials using both these methods have shown some success in stage 1 and 2 mesothelioma. Unfortunately most mesothelioma patients are diagnosed at a later stage than this, when this treatment is not very effective.
Photodynamic Therapy (PDT)This is a relatively new treatment that is used for a few types of cancers. In PDT, a drug called a photosensitising agent is injected into the bloodstream and absorbed by the body's cells. The drug makes cells sensitive to light. When the area to be treated is exposed to laser light, the cells are killed. PDT has to be combined with an operation to treat mesothelioma. This has been tried for early stage mesothelioma. The photosensitising drug is injected into your bloodstream a few days before surgery. During surgery, the surgeon then shines the laser light directly onto the pleura.PDT has been shown to be a safe type of treatment with other types of cancer. But in phase 1 and phase 2 clinical trials for mesothelioma, there were some major complications on a few occasions and so doctors have not widely accepted this treatment. It is particularly likely to be risky when used with major surgery and this combination of treatments is not available in the UK. There are no claims that this treatment will cure anyone of mesothelioma. It is very experimental. We have included it here because it is something you may have read or heard about.
Why research?
Causes and prevention
Finding a tumour marker for diagnosing, screening or monitoring treatment
Genetics
Chemotherapy
Chemotherapy for controlling symptoms
Treating fluid collection around the lung (pleural effusion)
Surgery
Gene therapy
Anti-angiogenic therapy (to disrupt the blood supply to the cancer)
Immunotherapy
Photodynamic therapy
Why research?All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that
We can be sure they work
We can be sure they work better than the treatments that are available at the moment
They are known to be safeFirst of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.Tests in patients are called clinical trials. There are 4 phases of clinical trials. This is fully explained in the understanding clinical trials section of CancerHelp UK. If you are interested in taking part in a clinical trial, click the button on the left of your screen to visit our searchable database of clinical trials recruiting in the UK. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. All the new approaches covered here are the subject of ongoing research. Mesothelioma is one of the hardest types of cancers to treat. Progress has been made in treating this type of cancer. But we need to learn a lot more about this disease and how best to treat it. Until research studies are completed and new effective treatments are found, the treatments covered here cannot be used as standard therapy for mesothelioma.
Causes and preventionMesothelioma is most often linked to exposure to asbestos. So much of the research into this disease is based on finding out exactly how asbestos affects the normal cells of the lining of the chest and abdominal cavities. If we can have a better understanding of how asbestos fibres cause cancer and how exposure to this chemical affects us, then we may be able to help prevent the disease. Researchers know that there can be an incredibly long time lag between exposure to asbestos and developing mesothelioma. It can be 40 years or more. This probably meant that it took longer to spot the connection between asbestos and cancer than it otherwise would. But we know now, and the use of asbestos in many countries is now illegal.There has been talk for the past few years about a link between a virus called the simian virus (SV40) and developing mesothelioma. Some polio vaccine preparations were contaminated with SV40 between 1955 and 1963 and doctors were concerned that people who'd had them may be at increased risk. One large study has indicated that these people are not at an increased risk of mesothelioma or other types of cancers. The study was published in 2003 and found that mesothelioma rates were actually falling in this group of people. If there is a link between SV40 and mesothelioma, it is likely to be much less important that the link with asbestos.There is some evidence that your genetic make up could affect your risk of mesothelioma. As well as asbestos, exposure to a mineral called erionite is a risk factor. Researchers in Turkey found that in families exposed to this mineral, in some families all the family members developed mesothelioma and in other families, no one developed it. They think that there is a gene in some families in Turkey that increases their risk. (This article is published in The Lancet, volume 357, issue 9254, page 444.) This could explain why some people are exposed to asbestos and do not develop mesothelioma, while others who are exposed do. There is a lot more research to be done before we will know if there are specific gene changes that can increase your risk of mesothelioma. It will be some years after this has been completed before there will be any chance of testing for such a gene.In the past, asbestos was used widely in the
Building industry
Ship building industry
Manufacture of household appliances
Motor industry
Power stations
Telephone exchangesThere is a study going on in the UK looking at the occupations of men and women and the development of mesothelioma and lung cancer (MALCS). There is information about this trial on our clinical trials data base. Choose Lung: Mesothelioma from the drop down menu of cancer types to find mesothelioma trials.
Finding a tumour marker for mesotheliomaMesothelioma can be very difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumour. Mesothelioma tumour cells are very similar to some types of lung cancer cells. Sometimes it can be very difficult for a pathologist to decide whether or not the cancerous cells are mesothelioma cells, lung cancer cells or even, sarcoma cells. To help with diagnosis, scientists are trying to find a tumour marker for mesothelioma. A tumour marker is a chemical given off by cancer cells that can be found in the blood and picked up in a blood test. If a definite tumour marker could be discovered for mesothelioma this would be of great benefit for doctors in making more accurate diagnosis of this disease and may also be helpful to monitor the success of treatment. An Australian paper, published in The Lancet in November 2003, is about this search. The researchers were looking into tests for proteins related to mesothelioma. This is early research, but they have had promising results. In their study, 84% of people with mesothelioma tested positive, compared to 2% with other cancers or other lung disease. In a group of people who had been exposed to asbestos but did not have mesothelioma, 7 out of 40 tested positive. 3 of these 7 developed mesothelioma and another got lung cancer within 5 years of the positive test. None of the 33 people who tested negative got mesothelioma within the 8 years following the study. It may be that researchers can build on this work to develop a test for screening for mesothelioma and tests for monitoring the disease in people who already have it.
ChemotherapyIt has been a major challenge for doctors to find chemotherapy drugs that work well in treating malignant mesothelioma. Many trials have been done using epirubicin, doxorubicin, cisplatin and methotrexate, but no standard treatment has been set. This has led researchers to look at newer chemotherapy drugs in combination with some already tried. Drugs and combinations in trial include
Gemcitabine and cisplatin
Vinorelbine (Navelbine)
Topotecan
Irinotecan, cisplatin and mitomycin C
Pemetrexed
Raltitrexed (Tomudex)
OnconaseMost studies giving gemcitabine alone have not been successful. A small number of trials using gemcitabine in combination with cisplatin, have produced some promising results. Many doctors now use this combination of drugs to treat malignant mesothelioma. But more trials are needed before it may be considered as standard treatment. There is information on the side effects of gemcitabine in the side effects of cancer drugs page of CancerHelp UK. In one study 29 patients were given vinorelbine alone, 6 (24%) patients disease improved and 16 (55%) patients disease remained stable. This has led to further trials using this drug. A trial called MS-01 has been comparing active symptom control (ASC) with ASC and vinorelbine and with ASC, mitomycin, vinblastine and cisplatin. This trial has now closed and we are waiting for the results. You can find information about the side effects of vinorelbine, cisplatin, mitomycin C and vinblastine in the cancer drugs section of Cancerhelp UK.Topotecan and irinotecan have not shown significant responses when given by themselves. But in combination with other drugs, there have been some good results. There was a trial looking at irinotecan, cisplatin and mitomycin C (IPM). The results were encouraging, but more investigations are needed. There is information about the side effects of topotecan, cisplatin and irinotecan in the cancer drugs section of CancerHelp UK.Pemetrexed is a type of chemotherapy drug. It is also called Alimta. It is a little similar to another drug in regular use called methotrexate. It has been used in the largest phase 3 clinical trial ever conducted for malignant pleural mesothelioma. This international trial began in 1998 and results were reported on in May 2002. The study was aimed at finding out whether pemetrexed plus cisplatin was more effective in treating malignant mesothelioma than cisplatin alone. All patients were given supplements of vitamin B12 and folic acid to help reduce side effects (such as diarrhoea). The outcome of this trial was promising. A number of recent trials are now looking at the use of pemetrexed in combination with other chemotherapy agents.Pemetrexed has now been licensed in the UK for use in combination with cisplatin to treat mesothelioma. This was announced by the company who developed it on 1st November 2004. In August 2005 pemetrexed was approved for use in Scotland by the Scottish Medicines Consortium. In July 2007 NICE (National Institute for Health and Clinical Excellence) announced that they would recommend it for use in England and Wales, for people with advanced mesothelioma which is not suitable for surgery, who are fit enough to look after themselves. Others who are already receiving pemetrexed will be able to continue their treatment while they and their doctors agree that it is helpful. NICE's final decision is expected in September 2007.There is more about pemetrexed in the question and answer section of CancerHelp UK.
Chemotherapy for controlling symptomsA trial reported in 2004 on the combination of raltitrexed (Tomudex) and cisplatin. The researchers believe that this combination is better for advanced mesothelioma that cisplatin on its own. But the actual difference between the two groups in this trial was quite small.
OnconaseOnconase is an experimental chemotherapy drug, made from leopard frog eggs. It is not available in the UK. We have included it here because you may have come across information about it on the web. Onconase may have fewer side effects than many other chemotherapy drugs. But not all the side effects may be known as yet. A phase 3 clinical trial has been going on in the USA and Germany comparing the use of Onconase with doxorubicin to doxorubicin alone for people with mesothelioma. Unfortunately, the trial reports aren't very promising. The researchers say that onconase may be better than doxorubicin for some patients, but doxorubicin isn't the chemotherapy drug of choice for mesothelioma now anyway.
Treating fluid around the lungIn mesothelioma, fluid can collect inside the chest. This makes it more difficult for your lung to expand and so it is harder to breathe. Doctors call this pleural effusion. It is usual to treat this by drawing off the fluid and 'sticking' the pleura together. Doctors do this by putting in some sort of irritant, usually bcg vaccine, talc or chemotherapy. You can also treat pleural effusion by operating to remove the pleura (a pleurectomy). This is called a pleurectomy. There is a trial that is comparing these two approaches to see which is better. While this trial is open and recruiting patients, it will be listed on our clinical trials database. To find it and other trials, go to the database and choose 'lung - mesothelioma' from the drop down menu of cancer types.
SurgeryMajor surgery for people with mesothelioma has not always been thought a good idea by surgeons. This is because surgery cannot cure the disease. And because many people with mesothelioma are not fit enough to get through a very large operation. But the point of surgery in mesothelioma is to slow the cancer down, rather than cure it. The operation that can be done to remove mesothelioma is called an extrapleural pneumonectomy (EPP). This means removing the lung and the lining of the chest cavity (the pleura) on the affected side. It may help people to live more comfortably for longer. But this has to be tested because, on the other hand, it could mean that having such major surgery means people die sooner than they would have.In 2001 a programme was started in the UK to look at patients with mesothelioma and see who would benefit most from this type of surgery. 45 patients have been evaluated and 21 patients have been operated on. Of these patients, so far 16 of these patients (about 75%) have lived for at least 6 months and 13 of them have lived for at least 12 months (about 60%). This programme has led to a trial called 'MARS' which opened in 2005. The MARS trial is looking at the benefits and risks of EPP for mesothelioma patients who have had chemotherapy. Results from some studies in the USA suggest that giving a course of radiotherapy after the EPP will help to keep the disease under control for even longer. Some patients in the MARS trial will have an EPP operation combined with radical radiotherapy. Others will have other treatments, such as radiotherapy or less major surgery. There is more information about the MARS trial on our clinical trials database. Either follow the link or click on the blue button to the left of your CancerHelp UK screen. Then choose lung, and select mesothelioma, from the drop down list of cancer types.
Gene therapyThere are a number of new types of treatments being researched that can be put under this heading. Some doctors and researchers are now calling this type of treatment 'molecular therapy', which is a more general term including research into
Oncogenes
Tumour suppressor genes
Gene therapy and repair genesBy studying how changes in these genes cause normal cells to become cancerous, scientists aim to eventually develop gene therapy where damaged genes in the cancer cells can be replaced with normal ones. The main focus of gene therapy research for mesothelioma involves injecting a virus that has been modified in the laboratory. The virus is injected into the pleural space in your chest, where mesothelioma develops. The idea is that the virus infects the mesothelioma cells with a gene. The gene makes the cancer sensitive to a specific drug that will kill the mesothelioma cells. Without the virus carrying this gene into the cells, the drug would not usually kill them. Much gene therapy research is still centred on how to get the virus into the cancer cells reliably and it will be a while before we will be able to see whether this will develop into a useful treatment. We don't know of any current mesothelioma gene therapy trials that are open and recruiting patients in the UK.
Anti-angiogenic therapyAngiogenesis means growth of new blood vessels. As they get bigger, cancers need to grow their own blood vessels. Without its own blood supply, a cancer cannot continue to grow. Two of the most important chemicals controlling blood vessel growth are called vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (FGF-2). People with mesothelioma have much higher levels of VEGF than people with any other type of cancer. If the VEGF can be blocked, this could control the growth of blood vessels supplying the mesothelioma tumours. This treatment is a type of biological therapy. These are treatments that use natural body substances (or drugs that block them) to treat cancer. There is more about biological therapies in our cancer treatments section. A drug called bevacizumab is a treatment that stops production of VEGF.Bevacizumab has been studied in a number of cancers, including mesothelioma, and bowel, kidney, breast, ovarian, non small cell lung, and prostate cancers. One trial recently reported that this drug may increase survival for patients with lung cancer. An American phase 2 trial tested bevacizumab for mesothelioma, in combination with the chemotherapy drugs gemcitabine and cisplatin. This trial closed in 2005, and we are waiting for the results.Bevacizumab is still very experimental and much larger trials are needed before we will know how effective it will be in treating mesothelioma and other types of cancers.
ImmunotherapyImmunotherapy is treatment with natural substances that the body uses to fight infection and disease. Immunotherapy works by encouraging the body's natural defence system - the immune system - to attack cancer cells. Immunotherapy is really a type of biological therapy. These are a group of treatments that use natural body substances (or drugs that block them) to treat cancer. There is a separate section about biological therapy (including immunotherapy) in CancerHelp UK.The types of immunotherapies being researched for mesothelioma include
Interferon and interleukin 2
Vaccines
Interferon and interleukin 2Two types of immunotherapy in trials for mesothelioma are interferon and interleukin-2 (also called IL-2 or aldesleukin). Interferon has been used in trials both on its own and in combination with various chemotherapy drugs. The results of the combination treatment haven't been any better than the chemotherapy drugs on their own. More trials have to be done before we know how useful interferon will be in treating mesothelioma.IL-2 is made naturally as part of the body's immune response. But now it can be made in the laboratory and used in much larger quantities as cancer treatment. IL-2 can be injected directly into the pleural cavity (intrapleurally) or into the bloodstream. Clinical trials using both these methods have shown some success in stage 1 and 2 mesothelioma. Unfortunately most mesothelioma patients are diagnosed at a later stage than this, when this treatment is not very effective.
Photodynamic Therapy (PDT)This is a relatively new treatment that is used for a few types of cancers. In PDT, a drug called a photosensitising agent is injected into the bloodstream and absorbed by the body's cells. The drug makes cells sensitive to light. When the area to be treated is exposed to laser light, the cells are killed. PDT has to be combined with an operation to treat mesothelioma. This has been tried for early stage mesothelioma. The photosensitising drug is injected into your bloodstream a few days before surgery. During surgery, the surgeon then shines the laser light directly onto the pleura.PDT has been shown to be a safe type of treatment with other types of cancer. But in phase 1 and phase 2 clinical trials for mesothelioma, there were some major complications on a few occasions and so doctors have not widely accepted this treatment. It is particularly likely to be risky when used with major surgery and this combination of treatments is not available in the UK. There are no claims that this treatment will cure anyone of mesothelioma. It is very experimental. We have included it here because it is something you may have read or heard about.
Questions for your doctor
How long will it take me to get over my treatment?
What precautions will I have to take while I am recovering?
What practical help is available?
Can I go back to work?
Can I take up my usual hobbies and sports again?
Can I go abroad on holiday?
Can I drink alcohol?
My partner and I would like to see a counsellor. Can you put us in touch with someone? How much will this cost?
Can you help me with claiming compensation for my illness from my former employers?Note: To print these questions, go to our printer friendly version using this link or the link at the top of the page. Then use the PRINT button at the top of your browser screen. If there is no PRINT button, there is advice on how to print on CancerHelp UK
What precautions will I have to take while I am recovering?
What practical help is available?
Can I go back to work?
Can I take up my usual hobbies and sports again?
Can I go abroad on holiday?
Can I drink alcohol?
My partner and I would like to see a counsellor. Can you put us in touch with someone? How much will this cost?
Can you help me with claiming compensation for my illness from my former employers?Note: To print these questions, go to our printer friendly version using this link or the link at the top of the page. Then use the PRINT button at the top of your browser screen. If there is no PRINT button, there is advice on how to print on CancerHelp UK
Living with advanced cancer
Finding out that you have advanced cancer when you are diagnosed, or that your cancer has come back can be devastating. You probably feel confused and find it difficult to take anything in that is being said to you. At first, you are likely to experience a whirl of powerful emotions. Anger, fear, and sadness may come one on top of the other, leaving you exhausted. You may think you should be talking all this through with your partner, other family members or close friends. But you may find this impossible to do.Give yourself time to begin to come to terms with what you have been told. You will benefit from talking to others about how you are feeling. But not necessarily straight away. Some people need to begin to put their own thoughts in order before they can talk to anyone else. Some feel they need to talk straight away. Trying to talk things through helps them sort out their own thoughts and feelings. There is no right or wrong way to handle this.
What does advanced cancer mean? Having advanced cancer means your cancer cannot be cured. But it very rarely means you are immediately terminally ill. There are treatments available that can slow your cancer down. It may be possible to shrink it and put it into remission for quite a while. You will need to talk very carefully to your own specialist to understand
What the diagnosis means
What treatment is available
How treatment can help youYou are likely to feel very anxious and uncertain about the future. And there will be days when the cancer is the only thing you can think about. But many people say that a diagnosis of advanced cancer helps them appreciate ordinary everyday things much more than they did. You have an opportunity to work out your priorities. Think about what is important to you and what isn't. There may be things you had always wanted to do. Having cancer doesn't mean you have to abandon all your plans. You may have to adapt some and one or two may be less realistic than they were. But you may also feel it is time to get round to something you'd always wanted to do but never made the time for.
Coping with every day life It is important that you feel as well as you possibly can. If you haven't already been referred, ask your hospital doctor or GP about a Macmillan nurse. Macmillan nurses can help control your cancer symptoms and improve the quality of your life physically. Many have counselling training and can help you work through some of the emotions you are experiencing.If you are having any physical difficulties in coping at home your Macmillan nurse or a district nurse can talk to you about ways you may cope more easily. They can help you to get simple mobility aids, for example a seat to help you get in and out of the bath. And tell you how to get more permanent adaptations such as safety rails fitted in your bathroom. Macmillan nurses have information about charitable funds who can provide grants for mobility aids, heating costs, help with holidays and many other household expenses related to your illness or quality of life. They also have information on benefits available to you or to someone helping to care for you.If you are having problems with breathlessness there is information on coping with this in the living with lung cancer section of CancerHelp UK. Knowing what to expect can help to alleviate anxiety. Talk to your doctor or nurse about your illness and treatment. It is important that you know all the options. There are organisations that can provide information about cancer and treatment. Or put you in touch with cancer support groups where you can talk to others who have been through similar experiences to your own.If you would like to talk to someone outside your own friends and family, look in our help and support section for counselling organisa
What does advanced cancer mean? Having advanced cancer means your cancer cannot be cured. But it very rarely means you are immediately terminally ill. There are treatments available that can slow your cancer down. It may be possible to shrink it and put it into remission for quite a while. You will need to talk very carefully to your own specialist to understand
What the diagnosis means
What treatment is available
How treatment can help youYou are likely to feel very anxious and uncertain about the future. And there will be days when the cancer is the only thing you can think about. But many people say that a diagnosis of advanced cancer helps them appreciate ordinary everyday things much more than they did. You have an opportunity to work out your priorities. Think about what is important to you and what isn't. There may be things you had always wanted to do. Having cancer doesn't mean you have to abandon all your plans. You may have to adapt some and one or two may be less realistic than they were. But you may also feel it is time to get round to something you'd always wanted to do but never made the time for.
Coping with every day life It is important that you feel as well as you possibly can. If you haven't already been referred, ask your hospital doctor or GP about a Macmillan nurse. Macmillan nurses can help control your cancer symptoms and improve the quality of your life physically. Many have counselling training and can help you work through some of the emotions you are experiencing.If you are having any physical difficulties in coping at home your Macmillan nurse or a district nurse can talk to you about ways you may cope more easily. They can help you to get simple mobility aids, for example a seat to help you get in and out of the bath. And tell you how to get more permanent adaptations such as safety rails fitted in your bathroom. Macmillan nurses have information about charitable funds who can provide grants for mobility aids, heating costs, help with holidays and many other household expenses related to your illness or quality of life. They also have information on benefits available to you or to someone helping to care for you.If you are having problems with breathlessness there is information on coping with this in the living with lung cancer section of CancerHelp UK. Knowing what to expect can help to alleviate anxiety. Talk to your doctor or nurse about your illness and treatment. It is important that you know all the options. There are organisations that can provide information about cancer and treatment. Or put you in touch with cancer support groups where you can talk to others who have been through similar experiences to your own.If you would like to talk to someone outside your own friends and family, look in our help and support section for counselling organisa
Living with mesothelioma
Coping with mesothelioma
It can be very difficult coping with a diagnosis of mesothelioma both practically and emotionally. You are likely to be feeling very upset and confused. Mesothelioma is often diagnosed at quite an advanced stage. As well as coping with your diagnosis, you may be trying to cope with the news that your cancer is very difficult to treat and unlikely to be curable. As well as coping with the fear and anxiety that any diagnosis of cancer brings, you have to work out how to manage practically. There may be money matters to sort out. Who do you tell that you have cancer? And how do you find the words? There may be children to consider.It is important that you have enough information to enable you to make decisions about your treatment if that is what you want. At every stage you and your relatives or carers should be offered clear and comprehensive information both verbally and in writing about all aspects of your cancer and its treatment.The living with cancer section of CancerHelp UK contains lots of information you may find helpful. There are sections on
Your feelings
Talking to people: who and what to tell
Talking to children
How you can help yourself
Who else can help you
Sick pay and benefits: coping financiallyYou should have access to physiotherapists, specialist nurses and social workers who can all help you manage at home, as well as in hospital.There are support groups located around the country where you can discuss your feelings and fears with other people who are in the same situation. Look in Help and Support for organisations that can put you in touch with local support groups. Your GP can also help to arrange social and/or psychological support for you as appropriate.
CompensationMost cases of mesothelioma are related to exposure to asbestos. If you know you were exposed to asbestos at work, you may be able to claim compensation from your employer at the time of the exposure. Of course, no one is suggesting that anything could really compensate you for having mesothelioma. But it may be helpful for you and your family to have some extra funds to fall back on at a difficult time.If you are interested in trying to make a compensation claim, look in our mesothelioma organisations section for help. Your specialist will have come across this before with mesothelioma and will have to provide evidence supporting your claim.
It can be very difficult coping with a diagnosis of mesothelioma both practically and emotionally. You are likely to be feeling very upset and confused. Mesothelioma is often diagnosed at quite an advanced stage. As well as coping with your diagnosis, you may be trying to cope with the news that your cancer is very difficult to treat and unlikely to be curable. As well as coping with the fear and anxiety that any diagnosis of cancer brings, you have to work out how to manage practically. There may be money matters to sort out. Who do you tell that you have cancer? And how do you find the words? There may be children to consider.It is important that you have enough information to enable you to make decisions about your treatment if that is what you want. At every stage you and your relatives or carers should be offered clear and comprehensive information both verbally and in writing about all aspects of your cancer and its treatment.The living with cancer section of CancerHelp UK contains lots of information you may find helpful. There are sections on
Your feelings
Talking to people: who and what to tell
Talking to children
How you can help yourself
Who else can help you
Sick pay and benefits: coping financiallyYou should have access to physiotherapists, specialist nurses and social workers who can all help you manage at home, as well as in hospital.There are support groups located around the country where you can discuss your feelings and fears with other people who are in the same situation. Look in Help and Support for organisations that can put you in touch with local support groups. Your GP can also help to arrange social and/or psychological support for you as appropriate.
CompensationMost cases of mesothelioma are related to exposure to asbestos. If you know you were exposed to asbestos at work, you may be able to claim compensation from your employer at the time of the exposure. Of course, no one is suggesting that anything could really compensate you for having mesothelioma. But it may be helpful for you and your family to have some extra funds to fall back on at a difficult time.If you are interested in trying to make a compensation claim, look in our mesothelioma organisations section for help. Your specialist will have come across this before with mesothelioma and will have to provide evidence supporting your claim.
Where this
On this page are the major sources of information that we use to put together this section of CancerHelp UK.All our information is checked by cancer specialists and surgeons who specialise in treating cancer. The names of our specialist reviewers are at the end of this list. We also try to find patients to review all our sections. If you have had mesothelioma, are a resident of the UK and would like to become a patient reviewer, You can write to us by clicking on 'contact us' at the top of the page.British Thoracic Society Standards of Care Committee
Statement on malignant mesothelioma in the UKPublished in Thorax, 2001, vol 56, pp250-265(also available on line from the British Thoracic Society)De Vita, V.T., Hellman, S. and Rosenberg S.A.Principles and practice of oncology (6th edition)Lippincott, Williams and Wilkins, 2001NICE www.nice.org.uk(Appraisal in development only at time of writing)Souhami R & Tobias J
Cancer and its management (4th edition)Blackwell, 2003US National Cancer Institute
Information on the treatment of mesotheliomahttp://www.cancer.gov/cancerinfo/types/malignantmesothelioma/Waller D. A.Malignant mesothelioma - British surgical strategiesLung Cancer, 2004, vol 455, ppS81 - 84
Specialist reviewers: Mr Marcelo Migliore, MD PhD FETCSDr J Steele, MD FRCPMr D Waller, BM BS
Statement on malignant mesothelioma in the UKPublished in Thorax, 2001, vol 56, pp250-265(also available on line from the British Thoracic Society)De Vita, V.T., Hellman, S. and Rosenberg S.A.Principles and practice of oncology (6th edition)Lippincott, Williams and Wilkins, 2001NICE www.nice.org.uk(Appraisal in development only at time of writing)Souhami R & Tobias J
Cancer and its management (4th edition)Blackwell, 2003US National Cancer Institute
Information on the treatment of mesotheliomahttp://www.cancer.gov/cancerinfo/types/malignantmesothelioma/Waller D. A.Malignant mesothelioma - British surgical strategiesLung Cancer, 2004, vol 455, ppS81 - 84
Specialist reviewers: Mr Marcelo Migliore, MD PhD FETCSDr J Steele, MD FRCPMr D Waller, BM BS
Diagnosing mesothelioma
Tests for mesothelioma
This page tells you about tests you may have that can diagnose mesothelioma. You can scroll down the page to read all the information here. Or you can use these links to go straight down to sections on
Seeing your GP
At the hospital
X-rays
CT scan
Thoracoscopy (and biopsy of the pleura)
Fluid drainage (thoracocentesis or abdoparacentesis)
Difficulty diagnosing mesothelioma
At the GPUsually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. Your doctor will listen to your chest, to see if there are any signs of fluid collecting. After your examination, your doctor may need to refer you to hospital for tests and X-rays. You may be referred directly to a specialist. Or your GP may send you to hospital for some tests first.
At the hospitalIf you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests to check your general health. Then your tests will be arranged in the out patients department. If your doctor suspects you may have mesothelioma, you may have quite a few tests. This is because it can be difficult to diagnose. Many of the usual tests used to diagnose lung disease prove negative when used to diagnose mesothelioma. You may have
X-rays
CT scan
Thoracoscopy (and biopsy of the pleura)
Fluid drainage (thoracocentesis or abdoparacentesis) Of these tests, X-ray, CT scan and thoracoscopy are the most important for diagnosing mesothelioma. But of course, at this stage, your specialist doesn't know what's wrong. So, as mesothelioma can be difficult to diagnose you may have a range of tests.
X-ray You will almost certainly be asked to have a chest X-ray or abdominal X-ray. A chest X-ray can show up fluid collecting around the lung. An abdominal X-ray may show up a swelling or fluid in the abdomen (tummy).CT scanThis is a computerised scan using X-rays. You may be asked to have a CT scan of your chest or abdomen. A CT scan can show abnormal swellings in body organs or lymph nodes. You may be given an injection of dye called ‘contrast’ before the scan. This helps to make the scan clearer to read. There is more about having a CT scan in the CancerHelp UK section about cancer tests.Thoracoscopy This is a small operation usually carried out by a specialist surgeon. It is done under a general anaesthetic. A small cut (incision) is made in your chest wall and a thoracoscope (a telescope like instrument with a video camera attached) is inserted through the hole. Using forceps the doctor can take a small sample (biopsy) of the pleura, the tissues which cover the lungs. This is then sent to a laboratory for testing to see if there are any cancer cells. This is sometimes the only certain way of finding out what's wrong because mesothelioma can be so difficult to diagnose. Other tests may not always show mesothelioma or may not be able to show whether the problem is mesothelioma or a different type of lung problem.
Fluid drainageMany people with pleual mesothelioma have fluid around their lungs (a pleural effusion). People with peritoneal mesothelioma may have fluid in their abdominal cavity (peritoneal effusion). The diagram shows a pleural effusion.
Fluid build up happens because cancer cells are irritating the pleura or peritoneum. Fluid in the plura can make it difficult to breathe. Fluid in the abdomen can make the abdomen feel swollen and tight and uncomfortable. If mesothelioma is the cause of the fluid build up, the fluid may contain cancer cells. To drain the fluid off, a needle is put into the chest or abdominal cavity and the fluid drained through a tube into a bag. A sample of the fluid will be sent to a laboratory for testing to see if contains cancer cells. Your doctor may call this 'thoracocentesis' or pleural aspiration if you are having fluid removed from your chest. If you are having fluid removed from your tummy (abdomen), you may hear your doctor call it an abdoparacentesis or peritoneal aspiration.
Difficulty with diagnosisMesothelioma can be difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumour. Sometimes it can be very difficult for a pathologist (doctor who looks at cells under a microscope) to decide if the cells or tissue taken from the lungs (pleura) or the abdomen (peritoneum) are a type of mesothelioma. These cells can often look very similar to other types of cancerous cells. For example, pleural mesothelioma can look like other types of lung cancer and peritoneal mesothelioma can look like some types of ovarian cancer. Also, many of the usual tests doctors use to diagnose lung disease prove negative when they use them to diagnose mesothelioma. For these reasons if your doctor suspects you may have mesothelioma, you may have quite a few tests so they can be sure of a correct diagnosis. In some cases, you may even need to have surgery to find out what's wrong. This surgery is called a surgical biopsy.
Further tests for mesothelioma
This page tells you about further tests you may have to find out whether the mesothelioma has spread. This is called staging. The stage of your cancer is important because it helps to decide on the best treatment. But it may not be possible to be sure of the stage without having surgery. There is information on
Bronchoscopy
MRI scan
Mediastinoscopy
PET scan
CT-PET scan
Laparoscopy (only for suspected abdominal disease)
BronchoscopyThis is a test that looks at the inside of the airways. A flexible tube called a bronchoscope is put into the airway. The tube has an eyepiece so that the doctor can see into your airways. Biopsies (samples of tissue and cells) can also be taken during a bronchoscopy. These are sent to a laboratory for testing to see if there are any cancer cells present. The test is usually done as an outpatient under local anaesthetic. This means you are awake for the test, but your throat has been numbed. Sometimes it is done with a general anaesthetic. If you have an anaesthetic, you may have to stay in hospital overnight. This depends on the time of day the test is carried out and your general health.
MRI scanThis is a scan that uses magnetism to build up a picture of the inside of the body. You may be asked to have a chest MRI or an abdominal MRI, depending on which type of mesothelioma you are being investigated for. But MRI isn't a routine test for mesothelioma, so you may not have one at all.MRI scans can be very noisy and some people who don't like small spaces find them difficult to cope with. Tell your doctor beforehand if you have any of these worries or fears. If you have any metal in your body, you cannot have an MRI scan. There is more about having an MRI scan in the About Cancer Tests section of CancerHelp UK. MediastinoscopyThis is a test that examines the mediastinum (the centre of your chest) to see if the mesothelioma has spread there. This area contains
The heart
The main blood vessels
Lymph nodes
The oesophagus (foodpipe)Sometimes in pleural mesothelioma, the lymph nodes in the chest are enlarged.
You need to have a general anaesthetic for this test and so have to stay in hospital for at least one night. The surgeon makes a small cut at the base of the neck. A small tube is put through the cut and into the mediastinum. The surgeon can look through this tube to examine the area. The tube may contain a small video camera, so the surgeon can look at the area on a screen. Tissue samples can also be taken, which will be examined under a microscope to see if there are any cancer cells. When you wake up, you will have a small dressing over the cut where the tube was put in. Don't be afraid to say if you are feeling sore. The nurses will be happy to give you a painkiller. Once you have got over the anaesthetic, you will be able to go home. This will probably be the day after the test.
PET scanYour doctor may suggest a PET scan if your mesothelioma is likely to be treatable with surgery. Unfortunately, surgery is only possible for a small number of people with mesothelioma. PET stands for 'positron emission tomography'. It is a fairly new type of scan that can show how body tissues are working, and not just what they look like. A PET scan may show whether the cancer has spread to lymph nodes or another part of the body. Your surgeon may need to rule this out before finally deciding that surgery is possible. There is more about having a PET scan in the CancerHelp UK section about cancer tests .CT-PET scanA combined CT and PET scan can give the doctor more information than either test on its own, and is more helpful in deciding which patients are likely to benefit from surgery.Laparoscopy This is a small operation that may be used to diagnose peritoneal mesothelioma. A tube with a camera and a light is put into your abdomen through a small cut. Your doctor can look inside to see whether there is any sign of cancer. The doctor will take samples (biopsies) of any abnormal looking areas. These will be sent to the laboratory for examination under a microscope. Laparoscopy is done under general anaesthetic. You will have a small wound with a couple of stitches. Sometimes, the camera is put in through more than one cut, so you may have more than one wound.
After the testsYou will be asked to come back to the hospital when your test results have come through. This is bound to take a little time, even if only a day or two. You may feel very anxious during this time.
Suggestion
While you are waiting for results it may help to talk to a close friendor relative about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience. Look in help and support for an organisation that can give you information about support groups or counselling services near you.
This page tells you about tests you may have that can diagnose mesothelioma. You can scroll down the page to read all the information here. Or you can use these links to go straight down to sections on
Seeing your GP
At the hospital
X-rays
CT scan
Thoracoscopy (and biopsy of the pleura)
Fluid drainage (thoracocentesis or abdoparacentesis)
Difficulty diagnosing mesothelioma
At the GPUsually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. Your doctor will listen to your chest, to see if there are any signs of fluid collecting. After your examination, your doctor may need to refer you to hospital for tests and X-rays. You may be referred directly to a specialist. Or your GP may send you to hospital for some tests first.
At the hospitalIf you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests to check your general health. Then your tests will be arranged in the out patients department. If your doctor suspects you may have mesothelioma, you may have quite a few tests. This is because it can be difficult to diagnose. Many of the usual tests used to diagnose lung disease prove negative when used to diagnose mesothelioma. You may have
X-rays
CT scan
Thoracoscopy (and biopsy of the pleura)
Fluid drainage (thoracocentesis or abdoparacentesis) Of these tests, X-ray, CT scan and thoracoscopy are the most important for diagnosing mesothelioma. But of course, at this stage, your specialist doesn't know what's wrong. So, as mesothelioma can be difficult to diagnose you may have a range of tests.
X-ray You will almost certainly be asked to have a chest X-ray or abdominal X-ray. A chest X-ray can show up fluid collecting around the lung. An abdominal X-ray may show up a swelling or fluid in the abdomen (tummy).CT scanThis is a computerised scan using X-rays. You may be asked to have a CT scan of your chest or abdomen. A CT scan can show abnormal swellings in body organs or lymph nodes. You may be given an injection of dye called ‘contrast’ before the scan. This helps to make the scan clearer to read. There is more about having a CT scan in the CancerHelp UK section about cancer tests.Thoracoscopy This is a small operation usually carried out by a specialist surgeon. It is done under a general anaesthetic. A small cut (incision) is made in your chest wall and a thoracoscope (a telescope like instrument with a video camera attached) is inserted through the hole. Using forceps the doctor can take a small sample (biopsy) of the pleura, the tissues which cover the lungs. This is then sent to a laboratory for testing to see if there are any cancer cells. This is sometimes the only certain way of finding out what's wrong because mesothelioma can be so difficult to diagnose. Other tests may not always show mesothelioma or may not be able to show whether the problem is mesothelioma or a different type of lung problem.
Fluid drainageMany people with pleual mesothelioma have fluid around their lungs (a pleural effusion). People with peritoneal mesothelioma may have fluid in their abdominal cavity (peritoneal effusion). The diagram shows a pleural effusion.
Fluid build up happens because cancer cells are irritating the pleura or peritoneum. Fluid in the plura can make it difficult to breathe. Fluid in the abdomen can make the abdomen feel swollen and tight and uncomfortable. If mesothelioma is the cause of the fluid build up, the fluid may contain cancer cells. To drain the fluid off, a needle is put into the chest or abdominal cavity and the fluid drained through a tube into a bag. A sample of the fluid will be sent to a laboratory for testing to see if contains cancer cells. Your doctor may call this 'thoracocentesis' or pleural aspiration if you are having fluid removed from your chest. If you are having fluid removed from your tummy (abdomen), you may hear your doctor call it an abdoparacentesis or peritoneal aspiration.
Difficulty with diagnosisMesothelioma can be difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumour. Sometimes it can be very difficult for a pathologist (doctor who looks at cells under a microscope) to decide if the cells or tissue taken from the lungs (pleura) or the abdomen (peritoneum) are a type of mesothelioma. These cells can often look very similar to other types of cancerous cells. For example, pleural mesothelioma can look like other types of lung cancer and peritoneal mesothelioma can look like some types of ovarian cancer. Also, many of the usual tests doctors use to diagnose lung disease prove negative when they use them to diagnose mesothelioma. For these reasons if your doctor suspects you may have mesothelioma, you may have quite a few tests so they can be sure of a correct diagnosis. In some cases, you may even need to have surgery to find out what's wrong. This surgery is called a surgical biopsy.
Further tests for mesothelioma
This page tells you about further tests you may have to find out whether the mesothelioma has spread. This is called staging. The stage of your cancer is important because it helps to decide on the best treatment. But it may not be possible to be sure of the stage without having surgery. There is information on
Bronchoscopy
MRI scan
Mediastinoscopy
PET scan
CT-PET scan
Laparoscopy (only for suspected abdominal disease)
BronchoscopyThis is a test that looks at the inside of the airways. A flexible tube called a bronchoscope is put into the airway. The tube has an eyepiece so that the doctor can see into your airways. Biopsies (samples of tissue and cells) can also be taken during a bronchoscopy. These are sent to a laboratory for testing to see if there are any cancer cells present. The test is usually done as an outpatient under local anaesthetic. This means you are awake for the test, but your throat has been numbed. Sometimes it is done with a general anaesthetic. If you have an anaesthetic, you may have to stay in hospital overnight. This depends on the time of day the test is carried out and your general health.
MRI scanThis is a scan that uses magnetism to build up a picture of the inside of the body. You may be asked to have a chest MRI or an abdominal MRI, depending on which type of mesothelioma you are being investigated for. But MRI isn't a routine test for mesothelioma, so you may not have one at all.MRI scans can be very noisy and some people who don't like small spaces find them difficult to cope with. Tell your doctor beforehand if you have any of these worries or fears. If you have any metal in your body, you cannot have an MRI scan. There is more about having an MRI scan in the About Cancer Tests section of CancerHelp UK. MediastinoscopyThis is a test that examines the mediastinum (the centre of your chest) to see if the mesothelioma has spread there. This area contains
The heart
The main blood vessels
Lymph nodes
The oesophagus (foodpipe)Sometimes in pleural mesothelioma, the lymph nodes in the chest are enlarged.
You need to have a general anaesthetic for this test and so have to stay in hospital for at least one night. The surgeon makes a small cut at the base of the neck. A small tube is put through the cut and into the mediastinum. The surgeon can look through this tube to examine the area. The tube may contain a small video camera, so the surgeon can look at the area on a screen. Tissue samples can also be taken, which will be examined under a microscope to see if there are any cancer cells. When you wake up, you will have a small dressing over the cut where the tube was put in. Don't be afraid to say if you are feeling sore. The nurses will be happy to give you a painkiller. Once you have got over the anaesthetic, you will be able to go home. This will probably be the day after the test.
PET scanYour doctor may suggest a PET scan if your mesothelioma is likely to be treatable with surgery. Unfortunately, surgery is only possible for a small number of people with mesothelioma. PET stands for 'positron emission tomography'. It is a fairly new type of scan that can show how body tissues are working, and not just what they look like. A PET scan may show whether the cancer has spread to lymph nodes or another part of the body. Your surgeon may need to rule this out before finally deciding that surgery is possible. There is more about having a PET scan in the CancerHelp UK section about cancer tests .CT-PET scanA combined CT and PET scan can give the doctor more information than either test on its own, and is more helpful in deciding which patients are likely to benefit from surgery.Laparoscopy This is a small operation that may be used to diagnose peritoneal mesothelioma. A tube with a camera and a light is put into your abdomen through a small cut. Your doctor can look inside to see whether there is any sign of cancer. The doctor will take samples (biopsies) of any abnormal looking areas. These will be sent to the laboratory for examination under a microscope. Laparoscopy is done under general anaesthetic. You will have a small wound with a couple of stitches. Sometimes, the camera is put in through more than one cut, so you may have more than one wound.
After the testsYou will be asked to come back to the hospital when your test results have come through. This is bound to take a little time, even if only a day or two. You may feel very anxious during this time.
Suggestion
While you are waiting for results it may help to talk to a close friendor relative about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience. Look in help and support for an organisation that can give you information about support groups or counselling services near you.
Mesothelioma
This section of CancerHelp UK tells you about mesothelioma. It includes symptoms and causes of mesotheliona, tests and treatment, living with mesothelioma and current research.
About mesothelioma
What is mesothelioma?
This page tells you what mesothelioma is. There are sections on
What mesothelioma is
Mesothelioma in the chest
Mesothelioma in the abdomen
Benign (non cancerous) mesothelioma
What mesothelioma isMesothelioma is a type of cancer. It is a cancer of mesothelial cells. These cells cover the outer surface of most of our internal body organs, forming a lining that is sometimes called the mesothelium. So this is where this type of cancer gets its name. Mesothelioma cancer can develop in the tissues covering the
Lungs
Abdomen
The pleuraThe tissues lining (or covering) the lungs are called the pleura. There are two pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the two pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.Mesothelioma is most often diagnosed in the pleura. This is known as pleural mesothelioma. Because it is so close, pleural mesothelioma can also affect the sheet of tissue covering the heart - the pericardium. Doctors call the pericardium the lining, although it is on the outside of the heart. It protects the heart and allows it to move smoothly within the sac that surrounds it. So it does much the same job for the heart as the pleura do for the lungs.
The peritoneumThe tissue lining the abdomen is called the peritoneum. It helps to protect the contents of the abdomen. It also produces a lubricating fluid. This helps the organs to move smoothly inside the abdomen as we move around.Mesothelioma of the tissues lining the abdominal cavity is known as peritoneal mesothelioma. It is much less common than pleural mesothelioma.It is unusual for mesothelioma to spread to other parts of the body. But if it does, it does not usually cause troublesome symptoms.
Benign mesotheliomaThere is a form of non cancerous (benign) mesothelioma that can develop in the lining of the lungs, or in the lining of the reproductive organs. It can occur in either men or women. These non cancerous tumours are very rare and we don't cover them in this section of CancerHelp UK.
Mesothelioma risks and causes
Mesothelioma is quite a rare cancer but it is becoming more common. Just over 2,100 people were diagnosed with mesothelioma in the UK in 2003. There are about 4 times as many cases in men as in women. This is probably because many cases have been caused by exposure to asbestos at work. Pleural mesothelioma is much more common than peritoneal mesothelioma. This page is about the risk factors and possible causes of mesothelioma. You can scroll down the page to read all the information here. Or you can use these links to go straight to sections on
Asbestos and mesothelioma
What is asbestos?
How does asbestos cause mesothelioma?
Radiation
Other chemicals
A virus called SV40
Asbestos and mesotheliomaUnusually for cancer, we do know what causes the majority of cases of mesothelioma. It is most often linked to exposure to asbestos. We have known of a link between asbestos and lung disease since the beginning of the 18th century. But the link with mesothelioma has only been known since the 1960's. Unfortunately, the number of cases of mesothelioma in the UK each year is expected to rise sharply over the next 20 years because of the heavy use of asbestos in industry from the end of the second world war up until the mid 1970s.Between 7 and 8 out of every 10 people (70–80%) diagnosed with mesothelioma say they have been in contact with asbestos. Your risk is greater if you were exposed to large amounts of it from an early age for a very long period of time. But there are some patients that say they have no history of any heavy exposure to asbestos.Remember: Many people who develop mesothelioma due to asbestos exposure may be eligible for compensation. You should talk to a solicitor about this as early as possible. Your specialist doctor or nurse may be able to give you some information on this from their dealings with other mesothelioma patients. Or some of the mesothelioma organisations in Help and Support should be able to help.
What is asbestos?Asbestos is an insulating material that is heat and fire resistant. In the past, asbestos was used widely in the
Building industry
Ship building industry
Manufacture of household appliances
Motor industry
Power stations
Telephone exchangesSo most cases of mesothelioma occur in men who have worked in manufacturing using asbestos or used asbestos products, particularly in construction or engineering. The use of asbestos was very heavy in the years after the war (after 1945). Mesothelioma may not develop until 15 - 40 years after you have been exposed to asbestos, which is why we are seeing an increase in cases now. The number of cases is expected to peak around 2020 and then start to decline.There are three main types of asbestos: blue, brown and white. Blue and brown asbestos are strongly linked with mesothelioma. They have been banned since the late 1980's and cannot be imported into the UK. White asbestos is now also thought to be harmful. The use of all asbestos was banned in 1999 in the UK.
How does asbestos cause mesothelioma?Asbestos is made up of tiny fibres. You can breathe these fibres in when you come into contact with asbestos. The fibres work their way into the pleura, lining the lung. They irritate the pleura and damage the cells that the pleura are made of. Some of the fibres that have been breathed in can be coughed up and swallowed. This is probably the cause of peritoneal mesothelioma.If you have been exposed to asbestos, your family may also have been exposed. Asbestos fibres can be carried home on your clothes. Research studies have confirmed that the family of people exposed to asbestos also have a higher risk of developing mesothelioma.
Radiation Pleural and peritoneal mesothelioma has been known to develop after exposure to a type of radiation called thorium dioxide (Thorotast). This was used until the 1950's in some X-ray tests.
Other chemicalsA mineral found in Turkey called Zeolite may cause mesothelioma.
The SV40 virusThere has been some research into a virus called SV40 (the SV stands for 'simian virus'). There is a lot of dispute amongst scientists about this and it isn't generally accepted as a cause. It seems more likely that the virus doesn't cause mesothelioma. It is possible that SV40 may help to increase risk if you've been exposed to another more major risk factor. Doctors call this a 'co-factor'. But SV40 certainly hasn't been proved to be a co-factor so far. In any case, it is far less important a risk factor than asbestos.
Mesothelioma symptoms
In its early stages, mesothelioma does not have many symptoms. When symptoms do develop, they are often caused by the cancer growing and pressing on a nerve or other body organ.The symptoms of the 2 main types of mesothelioma are different.The symptoms of pleural mesothelioma are
Pain in the lower back or the side of the chest
A persistent cough
Shortness of breath
A hoarse or husky voice
Losing more than 10% of your weight when not dieting
Sweating and fevers
Difficulty swallowingThe symptoms of peritoneal mesothelioma are
Pain in the abdomen (tummy)
Swelling in the abdomen
Feeling or being sick
Poor appetite
Losing more than 10% of your weight when not dieting
Diarrhoea or constipationThese symptoms are all more likely to be caused by some other illness, rather than by mesothelioma. But if you have these symptoms, see your doctor. This is particularly important if you have been exposed to asbestos in the past.
Types of mesothelioma
This page tells you about pleural and peritoneal mesothelioma. It also has details about where to go for more information on mesothelioma.Types of mesotheliomaThere are 2 main types of mesothelioma
Pleural mesothelioma
Peritoneal mesotheliomaThe pleural type grows in the tissues covering the lungs. The peritoneal type grows in the tissue lining the inside of the abdomen (tummy). Pleural mesothelioma is much more common than peritoneal mesothelioma. Between 7 and 8 out of 10 (70-80%) cases of mesothelioma are pleural mesothelioma. Peritoneal mesothelioma is much less common, making up between 1 and 2 out of every 10 cases (10 - 20%).
Cell typesMesothelioma is also grouped according to how the cells look under a microscope. When mesothelioma is grouped this way, there are 3 types
Epitheloid
Sarcomatoid or fibrous
Mixed type (also called Biphasic type)Between 5 and 7 out of 10 cases (50-70%) of mesothelioma diagnosed are the epitheloid type.Between 7 and 20 out of every 100 cases (7 – 20%) of mesothelioma diagnosed are sarcomatoid type.Between 20 and 35 out of every 100 cases (20 – 35%) of mesothelioma diagnosed are mixed and have both epitheloid and sarcomatoid cells.These types of mesothelioma cells can further divide into other types of cancerous cells called
Clear cell
Small cell
Acinar cell
Tubopapillary cellWith so many different types of cells capable of developing into mesothelioma, it makes it very difficult to diagnose this disease.
About mesothelioma
What is mesothelioma?
This page tells you what mesothelioma is. There are sections on
What mesothelioma is
Mesothelioma in the chest
Mesothelioma in the abdomen
Benign (non cancerous) mesothelioma
What mesothelioma isMesothelioma is a type of cancer. It is a cancer of mesothelial cells. These cells cover the outer surface of most of our internal body organs, forming a lining that is sometimes called the mesothelium. So this is where this type of cancer gets its name. Mesothelioma cancer can develop in the tissues covering the
Lungs
Abdomen
The pleuraThe tissues lining (or covering) the lungs are called the pleura. There are two pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the two pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.Mesothelioma is most often diagnosed in the pleura. This is known as pleural mesothelioma. Because it is so close, pleural mesothelioma can also affect the sheet of tissue covering the heart - the pericardium. Doctors call the pericardium the lining, although it is on the outside of the heart. It protects the heart and allows it to move smoothly within the sac that surrounds it. So it does much the same job for the heart as the pleura do for the lungs.
The peritoneumThe tissue lining the abdomen is called the peritoneum. It helps to protect the contents of the abdomen. It also produces a lubricating fluid. This helps the organs to move smoothly inside the abdomen as we move around.Mesothelioma of the tissues lining the abdominal cavity is known as peritoneal mesothelioma. It is much less common than pleural mesothelioma.It is unusual for mesothelioma to spread to other parts of the body. But if it does, it does not usually cause troublesome symptoms.
Benign mesotheliomaThere is a form of non cancerous (benign) mesothelioma that can develop in the lining of the lungs, or in the lining of the reproductive organs. It can occur in either men or women. These non cancerous tumours are very rare and we don't cover them in this section of CancerHelp UK.
Mesothelioma risks and causes
Mesothelioma is quite a rare cancer but it is becoming more common. Just over 2,100 people were diagnosed with mesothelioma in the UK in 2003. There are about 4 times as many cases in men as in women. This is probably because many cases have been caused by exposure to asbestos at work. Pleural mesothelioma is much more common than peritoneal mesothelioma. This page is about the risk factors and possible causes of mesothelioma. You can scroll down the page to read all the information here. Or you can use these links to go straight to sections on
Asbestos and mesothelioma
What is asbestos?
How does asbestos cause mesothelioma?
Radiation
Other chemicals
A virus called SV40
Asbestos and mesotheliomaUnusually for cancer, we do know what causes the majority of cases of mesothelioma. It is most often linked to exposure to asbestos. We have known of a link between asbestos and lung disease since the beginning of the 18th century. But the link with mesothelioma has only been known since the 1960's. Unfortunately, the number of cases of mesothelioma in the UK each year is expected to rise sharply over the next 20 years because of the heavy use of asbestos in industry from the end of the second world war up until the mid 1970s.Between 7 and 8 out of every 10 people (70–80%) diagnosed with mesothelioma say they have been in contact with asbestos. Your risk is greater if you were exposed to large amounts of it from an early age for a very long period of time. But there are some patients that say they have no history of any heavy exposure to asbestos.Remember: Many people who develop mesothelioma due to asbestos exposure may be eligible for compensation. You should talk to a solicitor about this as early as possible. Your specialist doctor or nurse may be able to give you some information on this from their dealings with other mesothelioma patients. Or some of the mesothelioma organisations in Help and Support should be able to help.
What is asbestos?Asbestos is an insulating material that is heat and fire resistant. In the past, asbestos was used widely in the
Building industry
Ship building industry
Manufacture of household appliances
Motor industry
Power stations
Telephone exchangesSo most cases of mesothelioma occur in men who have worked in manufacturing using asbestos or used asbestos products, particularly in construction or engineering. The use of asbestos was very heavy in the years after the war (after 1945). Mesothelioma may not develop until 15 - 40 years after you have been exposed to asbestos, which is why we are seeing an increase in cases now. The number of cases is expected to peak around 2020 and then start to decline.There are three main types of asbestos: blue, brown and white. Blue and brown asbestos are strongly linked with mesothelioma. They have been banned since the late 1980's and cannot be imported into the UK. White asbestos is now also thought to be harmful. The use of all asbestos was banned in 1999 in the UK.
How does asbestos cause mesothelioma?Asbestos is made up of tiny fibres. You can breathe these fibres in when you come into contact with asbestos. The fibres work their way into the pleura, lining the lung. They irritate the pleura and damage the cells that the pleura are made of. Some of the fibres that have been breathed in can be coughed up and swallowed. This is probably the cause of peritoneal mesothelioma.If you have been exposed to asbestos, your family may also have been exposed. Asbestos fibres can be carried home on your clothes. Research studies have confirmed that the family of people exposed to asbestos also have a higher risk of developing mesothelioma.
Radiation Pleural and peritoneal mesothelioma has been known to develop after exposure to a type of radiation called thorium dioxide (Thorotast). This was used until the 1950's in some X-ray tests.
Other chemicalsA mineral found in Turkey called Zeolite may cause mesothelioma.
The SV40 virusThere has been some research into a virus called SV40 (the SV stands for 'simian virus'). There is a lot of dispute amongst scientists about this and it isn't generally accepted as a cause. It seems more likely that the virus doesn't cause mesothelioma. It is possible that SV40 may help to increase risk if you've been exposed to another more major risk factor. Doctors call this a 'co-factor'. But SV40 certainly hasn't been proved to be a co-factor so far. In any case, it is far less important a risk factor than asbestos.
Mesothelioma symptoms
In its early stages, mesothelioma does not have many symptoms. When symptoms do develop, they are often caused by the cancer growing and pressing on a nerve or other body organ.The symptoms of the 2 main types of mesothelioma are different.The symptoms of pleural mesothelioma are
Pain in the lower back or the side of the chest
A persistent cough
Shortness of breath
A hoarse or husky voice
Losing more than 10% of your weight when not dieting
Sweating and fevers
Difficulty swallowingThe symptoms of peritoneal mesothelioma are
Pain in the abdomen (tummy)
Swelling in the abdomen
Feeling or being sick
Poor appetite
Losing more than 10% of your weight when not dieting
Diarrhoea or constipationThese symptoms are all more likely to be caused by some other illness, rather than by mesothelioma. But if you have these symptoms, see your doctor. This is particularly important if you have been exposed to asbestos in the past.
Types of mesothelioma
This page tells you about pleural and peritoneal mesothelioma. It also has details about where to go for more information on mesothelioma.Types of mesotheliomaThere are 2 main types of mesothelioma
Pleural mesothelioma
Peritoneal mesotheliomaThe pleural type grows in the tissues covering the lungs. The peritoneal type grows in the tissue lining the inside of the abdomen (tummy). Pleural mesothelioma is much more common than peritoneal mesothelioma. Between 7 and 8 out of 10 (70-80%) cases of mesothelioma are pleural mesothelioma. Peritoneal mesothelioma is much less common, making up between 1 and 2 out of every 10 cases (10 - 20%).
Cell typesMesothelioma is also grouped according to how the cells look under a microscope. When mesothelioma is grouped this way, there are 3 types
Epitheloid
Sarcomatoid or fibrous
Mixed type (also called Biphasic type)Between 5 and 7 out of 10 cases (50-70%) of mesothelioma diagnosed are the epitheloid type.Between 7 and 20 out of every 100 cases (7 – 20%) of mesothelioma diagnosed are sarcomatoid type.Between 20 and 35 out of every 100 cases (20 – 35%) of mesothelioma diagnosed are mixed and have both epitheloid and sarcomatoid cells.These types of mesothelioma cells can further divide into other types of cancerous cells called
Clear cell
Small cell
Acinar cell
Tubopapillary cellWith so many different types of cells capable of developing into mesothelioma, it makes it very difficult to diagnose this disease.
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