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1 Mesothelioma Introduction Mesothelioma is a type of cancer. It starts in the tissue that lines your lungs, stomach, heart, and other organs. This tissue is called mesothelium. Most people who get this type of cancer have breathed in asbestos at work. It can take a long time for the disease to develop. It may take 30 to 50 years. This reference summary explains mesothelioma. It talks about the causes and symptoms of this type of cancer. It also covers diagnosis and treatment options. Cancer The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing. The body cannot control the cells. This causes a tumor. A tumor is an abnormal growth. A benign tumor does not attack or invade nearby tissues and body parts. Benign tumors are not cancer. Usually these tumors are not life threatening. A malignant tumor invades nearby tissues and body parts. It is also called cancer. Cancer cells can spread to different parts of the body. They spread through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes. Cancer can move from one tissue to other body parts. This is called metastatic cancer. For example, cancer may start in the lining of the abdomen. The tumor can grow through the abdominal muscles. It can then spread to nearby tissues over time. Cancers in the body are given names. The name depends on where the cancer started. There are different types of mesothelioma. If it begins in the lining that covers the lung or pleura, it will always be called pleural mesothelioma. This is true even if it spreads to other places. 1

2 Mesothelioma Mesothelioma is cancer of a tissue in the body that lines certain organs. This tissue is called mesothelium. It lines the: Lungs. Stomach. Heart. Other organs. Mesothelioma is a rare but serious type of cancer. It often starts in the lungs. However, it can also start in the abdomen or other organs. Each type of mesothelioma has a different name. The most common type starts in the tissue around the lungs. It is called pleural mesothelioma. Other types are less common. They can start in the tissue around the: Abdomen. Heart. Testicles. Most people who get mesothelioma have worked jobs where they breathed in asbestos. It can take a long time to get the disease after being exposed. It can even take around 30 to 50 years. Causes and Risk Factors The main cause of mesothelioma is long term exposure to asbestos. Asbestos is a group of minerals. They take the form of tiny fibers. It is used in: Brake linings. Cement. Cloths and fabrics. Flooring products. Insulation. Roof shingles. 2

3 People can breathe in loose asbestos. The fibers get into the lungs. This may cause mesothelioma. It can also cause lung cancer. Asbestos can cause other types of cancer if it is swallowed. Certain people are at a higher risk of mesothelioma because of the work they do. Some examples include: Asbestos miners, millers, and makers of asbestos products. People working in textile factories. Shipyard workers. Workers in heating and construction industries. Smoking does not seem to raise a person's risk. But smoking and breathing in asbestos greatly raises your risk of lung cancer. Symptoms Mesothelioma can start in different parts of the body. Symptoms are not the same for all types of this cancer. They depend on where in the body the cancer started. When cancer begins in the tissue that surrounds the lungs, symptoms can include: Chest pain under the rib cage. Painful coughing. Shortness of breath. Unexplained weight loss. Unusual lumps of tissue under the skin on the chest. Cancer of the tissue in the abdomen can cause: Abdominal pain. Abdominal swelling. Lumps of tissue in the abdomen. Unexplained weight loss. Not much is known about symptoms of other types of mesothelioma. Other types are very rare. Talk to your health care provider about any changes you notice. 3

4 Diagnosis Your health care provider will try to find out if cancer is the cause of your symptoms. There may be another cause. Your health care provider will ask about your family medical history. You will also be asked about your symptoms. A physical exam will be done. Blood tests can also be used to rule out other causes. Mesothelioma and lung cancer can be similar. Sometimes it is hard to tell the difference between them. Certain tests and procedures may be used to see if cancer is the cause of your symptoms. If so, other tests can tell what kind. Your doctor may order imaging tests to look for problems. Imaging tests may include a chest x-ray and a CT scan. A CT scan is an x-ray machine linked to a computer. A CT scan takes a series of detailed pictures of your organs. You may be given contrast material by mouth or injection to make abnormal areas easier to see. You may need other tests depending on the findings. You may need a bronchoscopy. This procedure looks inside the windpipe and large airways in the lungs. A thin, lighted tube is inserted through the nose or mouth. The tube is then directed into the windpipe and lungs. Other tests may include a biopsy. A small sample of tissue is removed for this test. The tissue can be looked at with a microscope for signs of cancer. This is the only sure way to diagnose mesothelioma. There are many kinds of biopsies. If you need one, your doctor will decide which kind you need. One type of biopsy is a fine-needle aspiration. It is used to remove fluid or a piece of tissue with a small needle inserted into your chest or abdomen. Fine-Needle Aspiration Staging Your health care provider will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread. It is also an attempt to find where the cancer has spread to in the body. There are no formal stages for rare types of mesothelioma. Stages are used for mesothelioma that begins in the tissue that lines the lungs. Other types are not as common. Little is known about them. 4

5 Chest x-rays can reveal signs of cancer in the chest. Other imaging tests may also be done to look for signs of mesothelioma in other parts of the body. These include a CT scan, MRI, or PET scan. An MRI uses strong magnets to create images of the inside of the body. A PET scan uses a small amount of safe radioactive sugar injected into a vein. It makes detailed images of areas inside the body where the sugar is used. Cancer cells often use more sugar than normal cells. The pictures can help find cancer cells in the body. CT Scan Stages are usually described using the numbers 1-4. A lower number is an earlier stage. Staging is helpful in deciding the best course of treatment. Stage I is called localized cancer. This means it's limited to one area of the lining of the chest. Stage II mesothelioma may have spread beyond the lining of the chest to the diaphragm or to the lung itself. Stage III may have spread to other structures within the chest. It may involve nearby lymph nodes. Stage IV mesothelioma is an advanced cancer. It has spread more widely within the chest. The cancer may also have spread to distant areas of the body, like the brain. Treatment and Supportive Care Treatment for mesothelioma depends on: The stage of the disease. Whether the cancer has been treated before. The patient s age, symptoms, and general health. Treatment for mesothelioma may include: Surgery. Radiation therapy. Chemotherapy. Some combination of these treatments may also be used. Surgery may be done to remove the cancer and some of the healthy tissue around it. It may also be used to remove part of the covering of the lungs and lining of the chest. In some cases, one whole lung and part of the lining of the chest must be removed. 5

6 Another type of surgery uses special chemicals. The chemicals make scar tissue between layers of pleura. Pleura is the tissue that lines the inside of the chest. The scarring helps stop the build-up of fluid in this area. Radiation therapy uses high energy x-rays or other types of radiation. The radiation kills cancer cells. There are two types of radiation therapy: External radiation uses a machine outside the body to send radiation toward the cancer. Internal radiation places objects containing small amounts of radiation into or near the cancer. Chemotherapy uses drugs to stop the growth of cancer cells. More than one drug may be used. This is called combination chemotherapy. The type used depends on the type and stage of the cancer being treated. Chemotherapy may be taken by mouth. It may also be injected into a vein or muscle. This allows the drugs to kill cancer cells throughout the body. Chemotherapy can also be placed directly into a certain organ or body area. This mainly kills cancer cells in those areas. There may be clinical trials for people with mesothelioma. Clinical trials test new medical approaches and treatments. Mesothelioma and its treatment can lead to other health problems. It is important to have supportive care before, during, and after cancer treatment. Supportive care is treatment to: Control symptoms. Relieve the side effects of therapy. Help you cope with emotions. Sometimes cancer and its treatment can cause pain. Supportive care also deals with relieving pain. Your health care provider can suggest ways to reduce pain. You may also see a pain control specialist. 6

7 Summary Mesothelioma is a rare type of cancer. It begins in the cells of the mesothelium. The mesothelium is the tissue that lines your lungs, stomach, heart, and other organs. Most people who get it worked jobs where they breathed in asbestos. It can take 30 to 50 years for the cancer to develop. The symptoms of mesothelioma depend on where the cancer begins. It most often begins in the lungs. Symptoms may include chest or abdominal pain and unexplained weight loss. Mesothelioma is diagnosed using a physical exam, imaging tests, and a biopsy. A bronchoscopy may also be used during diagnosis to look at the airway. Different types of treatments are available for patients with mesothelioma. Sometimes patients choose to join clinical trials to try new forms of treatment. Three types of standard treatment are used: Surgery. Radiation therapy. Chemotherapy. 7

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