Mesothelioma is an incurable cancer caused, in the vast majority of cases, by exposure to asbestos dust and fibres.
There are two main types of mesothelioma. Pleural mesothelioma affects a thin membrane that covers the lungs and peritoneal mesothelioma occurs in the lining of the abdomen. Pleural mesothelioma is much more common than peritoneal mesothelioma.
It is quite a rare cancer, but it is becoming increasingly more common. Figures from the Health and Safety Executive show that more than 2,500 people are diagnosed with pleural mesothelioma in the UK each year and according to the Department for Health and Pensions, 53,000 people will die from pleural mesothelioma between 2013 and 2037.
There are about five times as many cases of the deadly lung cancer in men as there are in women. This is most likely because the majority of cases are found in an older generation of skilled and manual workmen who were exposure to asbestos dust and fibres during their working life.
Mesothelioma and asbestos
Asbestos is a fibrous material that was widely used for its fire resistant and insulating properties until the late 1990s. The use of asbestos is now banned in the UK and there are strict guidelines about its safe removal.
It is estimated that in the UK, more than 9 out of 10 men with mesothelioma and more than 8 out of 10 women have been in contact or were exposed to asbestos dust and fibres. We know that exposure to asbestos is the leading cause of pleural mesothelioma.
Dr Robin Rudd, a medical expert in mesothelioma and asbestos cases, has stated: “Mesothelioma can occur after a low level of asbestos exposure and there is no threshold dose of asbestos below which there is no risk.”
This means that inhaling even a single asbestos fibre could potentially cause mesothelioma.
How asbestos causes mesothelioma
The tiny fibrous particles that make up asbestos become airborne and can be inhaled. These dust fibres work their way into the pleura through the respiratory system. The asbestos fibres irritate the lining of the lung over time and eventually cause gene changes (mutations) that can lead to the growth of tumours.
Mesothelioma in the abdomen (peritoneal mesothelioma) is a lot rarer than pleural mesothelioma.
The sheets of tissue covering the organs of the abdomen are called the peritoneum. The lining helps to protect the contents of the abdomen and keep them in place.
Peritoneal mesothelioma is also caused by exposure to asbestos. The deadly fibres can reach the abdominal wall in two ways. It can be through ingested asbestos fibres, which make their way through the digestion system to become trapped in the peritoneum. The other method is spread through the lungs and lymph nodes after the asbestos fibres have been breathed in.
Abdominal mesothelioma does not usually spread to other parts of the body.
When mesothelioma occurs in the chest it is found in the lining of the lungs known as the pleural membrane (or pleura). This membrane is meant to protect the lungs and aid its smooth movement while breathing.
Pleural mesothelioma is typically fatal within one year of diagnosis, but research into potential treatments is improving.
Symptoms of pleural mesothelioma
Mesothelioma takes 10 to 50 years to manifest and for a person to develop noticeable symptoms.
- Feeling breathless
- Chest pain
- Weight loss when not dieting
- Heavy sweating
- Loss of appetite
Some people may also suffer from a change in the shape of their fingers and nails called finger clubbing, but this isn’t as common as other symptoms.
Difficulty diagnosing mesothelioma
Mesothelioma can be difficult to diagnose. Many of the usual tests doctors use to diagnose lung disease prove negative when they are used to diagnose mesothelioma. For this reason, if your doctor thinks that you might have mesothelioma, you may have to undergo quite a few tests so they can be sure of a correct diagnosis. In a few cases, people have needed to have surgery to find out what’s wrong. This surgery is called a surgical biopsy or an open biopsy.
What are the treatments?
Each person is different, so it is important that you discuss these treatments with specialists. As with any treatment, the potential benefits must be balanced against the risks and side effects.
The focus of treatment is to attempt to stop the progress of the disease and, where possible, prolong survival and improve outcomes.
There are a range of treatments available for mesothelioma, and these include:
Pleural Tap or Thoracocentesis relieves breathlessness caused by a build-up of fluid in the space (called the pleural cavity) between the lungs and the rib cage. The extra fluid is caused by the tumour. The procedure is carried out under local anaesthetic and the fluid is drained from the chest using a simple needle or small tube.
Pleurodesis is used if patients continue to develop fluid in the pleural cavity. Doctors often insert a medical talcum powder into the chest via a chest drain (a small tube) or thoracoscopy. Although this may sound odd, this is a well prescribed procedure which can prevent fluid build-up.
Chemotherapy is a course of drugs is used to kill cancer cells and slow their growth.
The role of surgery in mesothelioma is controversial. Although some centres do offer surgical debulking (the removal of as much of the tumour as possible) no clinical trials have shown any clear benefits.
Radiotherapy uses high-energy X-rays to destroy cancer cells. This helps with symptoms and supports other treatments to stop potential spreading.
Palliative care is very important. It will be available immediately and throughout your treatment. Palliative care provides a wide range of pain relief offers a comprehensive choice of psychological support and assists with breathlessness via a range of techniques, such as meditation, counselling techniques or, occasionally, oxygen therapy if it can be of benefit.
A patient should also speak to their consultant, specialist nurse or a mesothelioma focused organisation about current clinical trials, which occur from time to time.
Who is at risk of developing mesothelioma?
Those who have worked as laggers, pipe fitters, electricians, dockworkers, engineers, joiners, plumbers, welders, builders, fitters and heating engineers are generally thought to be at risk of high asbestos exposure, but this list is not exhaustive. A person who has worked in these trades or anyone that has been exposed to any amount of asbestos may be at risk of developing mesothelioma.
If you have been exposed to asbestos, there is a chance your family may have been exposed too. Asbestos fibres can be carried home on your clothes or work overalls you may have worn for your job. This is known as secondary exposure, or “shakedown” exposure.
How will mesothelioma affect my life?
It can be extremely difficult to cope with a diagnosis of mesothelioma. You may feel frightened, upset and confused, or perhaps that things are out of your control. If you are well informed about your condition and its treatment you should be more able to make decisions and cope with what happens after diagnosis.
Mesothelioma and its treatment will cause physical changes in your body. These changes can be difficult to cope with and may affect the way you feel about yourself. Surgery may cause scarring and you may have pains in the area the surgery took place for some months afterwards. This can affect your self esteem and the way you relate to other people, especially those who are close like family and friends.
Another problem you will have to cope with is feeling very tired or out of breath a lot of the time, especially for a while after treatment or if the cancer is advanced.
Remember, don’t go it alone. If you need help, just ask. It could be your family, friends, your doctor or you could give The National Asbestos Helpline a call and ask for assistance.
Coping with mesothelioma
As well as having to cope with the fear and anxiety of a diagnosis of mesothelioma brings, you may also have to work out how to manage practically. There may be money matters that you have to sort out. You may need information about financial support, such as benefits and grants.
You may have to figure out who to tell that you have cancer, and how to find the words to tell them. You may also have family members to think about, such as your children and grand children.
Remember that you don’t have to sort everything out at once. It may take some time to deal with each issue. Make sure to ask for help if you feel at any point that you need it. Your doctor or specialist will know who you should contact to get help. They can put you in touch with people specially trained in supporting those with cancer.