Mesothelioma Prognosis

Approximately 2,000 to 3,000 new cases of mesothelioma are diagnosed in the United States each year. Once a patient is diagnosed, a doctor will likely discuss their prognosis, or probable course and outcome of the cancer's influence on the body. The best way to improve a patient's mesothelioma life expectancy is through early detection. Mesothelioma treatments are more effective during early stages of cancer development, but there are a number of factors that affect a mesothelioma prognosis.

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What Factors Affect Prognosis?

Mesothelioma is not generally diagnosed until the latest stages of development because of the amount of time it takes for patients to exhibit symptoms. In addition to this, the symptoms of mesothelioma are very general and often resemble less serious conditions, which can make the cancer difficult to diagnose. As a result, the prognosis for the majority of patients is poor, but many doctors can recommend treatment options such as surgery, chemotherapy and radiation to help combat the disease.

Doctors typically address the cancer in terms of stages, ranging from stage one to stage four. Unfortunately, once mesothelioma cancer has reached stage three or four, treatment options not only become more limited but less effective as well. When a patient is diagnosed with stage four mesothelioma, their health condition often rules out the possibility of surgery. Treating mesothelioma becomes more difficult the later a diagnosis occurs.

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In addition to the stage of the cancer and the age of the patient, other factors that affect prognosis include:

• The type of mesothelioma – pleural, peritoneal, pericardial or testicular
• The size of the tumor
• The location of the tumor and whether it can be surgically removed
• The extent of other symptoms, including fluid in the lungs or abdomen
• Whether or not the patient is a smoker

Malignant mesothelioma is typically diagnosed in individuals over 55 years old, though there are certainly exceptions. Some patients already have multiple medical problems caused by advancing age, making treatment even more difficult and increasing the mortality rate among mesothelioma patients.

Mesothelioma Risk Factors

There are several risk factors that increase the likelihood that a person will develop mesothelioma. The primary risk factor is asbestos exposure. Exposure to this very harmful substance can significantly enhance the chances of contracting the disease. Smoking does not have a direct causal relationship with mesothelioma but is a significant compounding factor and increases the chances of developing the disease. Other less common secondary factors include exposure to radiation, zeolite, simian virus 40 (SV40) and erionite. We discuss each of these risk factors in more detail below.

Exposure to asbestos is the leading risk factor associated with mesothelioma. Asbestos is an insulating material comprised of magnesium-silicate mineral fibers. It was favored by builders and contractors for many years for its low heat conductivity and resistance to melting and burning. Since researchers have identified more and more links between mesothelioma and exposure to asbestos, the material is now less widely used. Prior to this discovery, however, millions of Americans have experienced serious exposure to this harmful substance.

Smoking and Mesothelioma
Smoking alone is not linked to mesothelioma, but smokers who are exposed to asbestos have a much higher chance of developing asbestos lung cancer (as much as fifty to ninety percent higher) and as much as double the risk of developing mesothelioma.

Mesothelioma Chemotherapy

Chemotherapy is one of the most widely used treatments for cancers of all types. Literally meaning "chemical therapy", it was developed in the 1940s and, today, more than 100 chemo drugs are on the market. Chemotherapy uses certain medications to kill cancer cells and stop them from multiplying. A number of different chemo drugs can be used to treat mesothelioma, though some have been discovered to be more successful than others. Often, chemo is used for mesothelioma patients in conjunction with other standard therapies such as mesothelioma radiation. It may also be used before mesothelioma surgery or after the surgery to eliminate any cancer that remains after the procedure is complete.

Chemotherapy, over the years, has elicited fear in many patients. Everyone has heard the horror stories about the nasty side effects of the treatment, and though newer chemo drugs carry fewer side effects, getting a course of chemo treatment is generally not a pleasant experience. Those with mesothelioma cancer to whom chemotherapy is recommended for palliative reasons need to carefully consider these side effects before agreeing to the treatment, weighing the positives and negatives and how the treatment will impact quality of life.

Receiving Treatment

Chemotherapy is generally given intravenously or may also be administered in pill form. This type of chemo is called "systemic" chemotherapy, as it travels through the blood stream and reaches the entire body. Systemic chemotherapy carries the most side effects because not only does it do the job it is meant to do - kill fast-growing cancer cells - but, unfortunately, it also kills other kinds of fast-growing cells such as hair and blood cells. Hence, many people lose their hair and suffer low white or red blood cell counts as a result.

Some pleural mesothelioma patients may be candidates for a different kind of chemotherapy that more closely targets the tumor and causes fewer side effects. Known as intrapleural chemotherapy, this method involves infusing drugs via a catheter into the chest area, the site of the primary tumor. This intracavitary chemotherapy treatment has proven to be most successful in treating cancers that are still limited to just the pleural surface. A similar procedure is available for those who suffer from peritoneal mesothelioma.

Common Mesothelioma Cancer Chemo Drugs

A number of different chemotherapy drugs can be used to treat mesothelioma. Currently, the most widely used drug and the one with which doctors have had the most success is Alimta®. This drug is usually used in tandem with a platinum agent like Cisplatin and has been shown to add several months to the patient's mesothelioma life expectancy in many cases.

Alimta®

Alimta is a systemic drug and is injected into the vein. It is normally given once every 21 days. Patients who are prescribed a course of treatment with Alimta will also be expected to take folic acid and Vitamin B12 to lower the chance of developing harmful side effects. This is essential! Patients will also be given a round of corticosteroids, usually for 3 days, in conjunction with each Alimta injection in order to avoid certain adverse skin reactions.

Cisplatin

Cisplatin is administered through an IV and is frequently used in combination with other drugs like Alimta. Doctors will treat mesothelioma patients with Cisplatin when surgery is not an option..

Carboplatin

Carboplatin was introduced to the market in the late 1980’s and was derived from an older drug known as Cisplatin. It has fewer and milder side effects than Cisplatin but can inhibit the body’s production of blood cells.

Gemcitabine

Gemcitabine, a chemotherapy drug brought to market by Eli Lilly and Company is often used in combination with Carboplatin. Patients treated with the drug report fewer and milder side effects.

Onconase

Onconase is a promising new chemotherapy drug for treating mesothelioma that is still being evaluated in clinical trials. One of the key advantages of the drug is that it kills cancer cells while preserving healthy tissue.

Navelbine

Navelbine is often used in combination with Cisplatin in treating mesothelioma. It can be administered orally or through an IV and has been successful in reducing the size of tumors.
Other chemo drugs used to treat mesothelioma patients include vinorelbine, mitomycin and raltitrexed. These are generally used in combinations but may be used alone if the patient is unable to tolerate two drugs.
The chemotherapy drug of choice will vary with each different case. Oncologists choose the drugs they believe will most benefit the patient while also taking into consideration side effects and other important issues surrounding the use of chemotherapy. It may take more than one try to discover which drugs will be best suited to the patient.

Side Effects

Chemo brings with it many side effects though, as previously mentioned, newer drugs prompt fewer negative reactions. Most side effects are short term and will indeed go away shortly after treatment ceases. Others will last a little longer. Nonetheless, any and all side effects should be reported to the patient’s medical team, even if they are deemed “common” side effects of chemotherapy. This is especially important after the first treatment when it is particularly difficult to predict how the patient will react to certain drugs. Prompt treatment of certain side effects may help lessen them or stop them all together.
The most common side effects of mesothelioma-related chemotherapy include:

• Chemo Brain - Chemo Brain is a condition that is reported in a large number of patients who receive chemotherapy and other types of cancer treatment. While there is currently no “cure” for chemo brain there are a variety of habits that can be adopted to help manage it.
• Hair loss - Loss of hair occurs because hair cells are fast-growing like cancer cells. Chemo drugs are unable to distinguish one from the other and, as a result, these cells suffer death at the hands of the drugs and the patient’s hair falls out.
• Mouth sores - Mouth sores - or mucositis - are an inflammatory reaction of the mucous lining of the upper gastrointestinal tract, affecting the mouth, lips, throat and surrounding tissues. These are one of the most painful side effects of chemo and can also interfere with nutrition as the sores make it difficult to chew and swallow and can also affect taste. In general, they cannot be prevented but they can be managed. The patient will need to keep the mouth and lips moist and will want to ask their doctor about ways to treat discomfort and pain associated with mucositis.
• Nausea and vomiting - Though newer drugs cause far less nausea than older ones, the patient is generally given an anti-emetic drug before chemo to lessen the chance of stomach distress. Inform your doctor if nausea gets out of hand and lasts more than a day or two, interfering with eating.
• Increased chance of infection - This is due to low white blood cell counts. Those undergoing chemotherapy should avoid contact with sick individuals.
• Bruising or bleeding - This is due to low platelet counts caused by the drugs.
• Fatigue - When the red blood cell count is lowered due to chemo drugs, severe fatigue sets in. Chemo patients should strive to get as much rest as possible.

Abdominal Mesothelioma

The medical term for mesothelioma that develops in the abdomen is peritoneal mesothelioma, a variation of the disease that develops in the peritoneum, which is the layer of tissue lining the abdominal cavity wall. The predominant symptom is swelling of the abdomen, due to the production of abnormal amounts of the peritoneal fluid that is normally present in small amounts. The cancer cells develop in the peritoneum, creating small malignancies spread over the surface of the tissue.

The abnormal cells cause the development of excess fluid, which acts as a conduit for malignant cells into adjacent tissues including the lymph systems and eventually nearby organs in the abdominal cavity. Because symptomatic behavior occurs after the disease has matured to a degree the treatment options most patients face are for a cancer that has already moved through the early stages. Peritoneal mesothelioma is generally a diffuse form of cancer made up of a layer of small tumors; on infrequent occasions it will manifest as a single growth of greater mass.

Symptoms of Abdominal Mesothelioma

Physical manifestations that begin to develop as the disease develops are similar to more common abdominal afflictions, which is why diagnosing abdominal mesothelioma can be a process of elimination. Annual diagnoses of the disease in the United States are no more than 500 occurrences per year. Those developing symptoms include:

• Abdominal Swelling
• Abdominal Pain
• Weight Loss
• Nausea
• Gastrointestinal Disturbance
• Fatigue

Abdominial Mesothelioma Diagnosis

There are instances of "dry" peritoneal mesothelioma where the development of excess fluid is not present. In those instances a single tumor may develop which can be seen in a CT scan. The diffuse small tumors normally associated with the disease can also be seen on a CT scan but require further diagnostic steps to determine whether they are in fact tumors or simply cystic growths. A sample of the abdominal fluid can be withdrawn using a procedure called paracentesis for diagnostic purposes, but even then the evidence of cancerous cells is not sufficient. A biopsy is required, most often performed through the naval with the assistance of a laparoscope.

Treatment Options for Abdominal Mesothelioma

If cancerous tissue is located the options for treatment depend on the stage to which the disease has advanced. If it has metastasized to organs within the body then palliative care is likely the only option. If the malignancy is sufficiently contained to be "debulked," the malignant peritoneal tissue may be removed along with growths that have developed in lymph nodes and adjacent surfaces such as the small bowel. Surgical resection is the preferred choice for patients who are healthy enough to recover from major surgical intervention.

The most successful post-surgical treatment has proven to be intraperitoneal chemotherapy that applies chemotherapy medications directly to afflicted areas within the abdominal cavity. The most common medication for this purpose is cisplatin, which is often heated before application. The most responsive cellular form of mesothelioma to this type of treatment is epithelioid; biphasic and sarcomatoid cells are not effectively reduced either by this type of chemotherapy or generalized chemotherapy.

Mesothelioma and Asbestos

While a rare disorder in the general population, mesothelioma is not rare among individuals exposed to asbestos. There are two to three thousand new diagnoses of mesothelioma every year. Exposure to asbestos is the only confirmed cause of mesothelioma. Most mesothelioma victims were exposed to asbestos in the workplace and were never told of its dangers or given proper protective gear. Others were exposed through family members who brought asbestos home on their clothes or through home renovation projects.

Unlike many other predominantly pulmonary-related cancers, cigarette smoking has no known causative effect on mesothelioma incidence, although asbestos workers who smoke do have a much greater likelihood to develop lung cancer — even more so than regular smokers who don’t work with asbestos.
One of the most difficult aspects of mesothelioma to come to terms with is its long latency period, which is the period of time between first exposure to asbestos and the onset of the disease. Mesothelioma can develop anywhere between 10 to 70 years after the initial exposure.

Tragedy of Mesothelioma

The great tragedy of mesothelioma is that it was preventable. Many of the corporations that manufactured and profited from the sale of asbestos-containing products were aware of the hazards of asbestos. These companies did not warn of the risks or protect workers. It was their legal duty to know about their products and to test them for any potential hazards. If a potential hazard did exist, the company had a responsibility to warn workers of these hazards.

In many cases, they hid the knowledge they had in order to protect themselves from liability or from having to find a new business model. The result is that many workers have unnecessarily developed mesothelioma. If you are one of the victims of mesothelioma, you should seek out a competent mesothelioma lawyer so you can file a claim or a lawsuit against those responsible for your cancer

Mesothelioma Surgery

When an individual is diagnosed with cancer, treatment options will be one of the first topics discussed with the oncologist. The available treatment options will vary from patient to patient depending on the type of mesothelioma that has been diagnosed and the stage that the disease has progressed to. Mesothelioma, in particular, is a very serious and aggressive form of cancer for which treatment options have traditionally been quite limited.

When a recently-diagnosed mesothelioma patient is presented with options for treatment, surgery may be recommended. There are different forms of mesothelioma surgery and some are proposed as a curative measure, while others are designed to relieve symptoms of the disease that can be quite debilitating and interfere with the patient's quality of life.
Curative Surgeries

Due to the nature of mesothelioma and the fact that by the time a diagnosis is made the disease has usually reached an advanced stage, a surgical cure is not a likely option. However, in some cases, surgery is suggested in order to remove as much of the cancer as possible and is often followed by other mesothelioma treatments such as chemotherapy and/or radiation.

Ideally, candidates for these surgeries will be in the early stages of the disease where the tumor is still fairly localized and metastasis has not occurred. In addition, the patient will need to be in overall good health and free of other medical issues that can complicate these procedures and lengthen the recovery period. Extant medical issues - like heart disease, hypertension, and diabetes - are often an issue with older mesothelioma patients, further limiting treatment options and making aggressive surgical procedures a less favorable choice.

A pneumonectomy is a radical surgery that involves the removal of the diseased lung. Candidates for this procedure have mesothelioma that is limited to just one lung. Performed under general anesthesia, this is quite a complicated surgery that can take up to three hours to perform. During the surgery, the diseased lung will be deflated and after several steps to prevent bleeding into the chest cavity, the lung is removed through a fairly large incision. At times, part of the fifth rib must be removed as well to provide better access to the lung. A drainage tube will then be inserted and the incision closed. The patient will remain in surgical intensive care for about 48 hours and then in a regular hospital room for one to two weeks, depending on complications, which are very common with this procedure and occur in some 50 percent of patients. It can also take up to six months for the healthy lung to learn to do the job of both lungs; hence, shortness of breath is a considerable problem for pneumonectomy patients and many take several months to resume their normal activity.
Extrapleural Pneumonectomy

Recommended only in rare cases, this surgery involves the removal of the affected lung as well as the areas surrounding it. It is a very risky surgery and carries with it a long list of complications including heart failure and serious gastrointestinal problems. The procedure is similar to that of the pneumonectomy and candidates are those who are in the earlier stages of mesothelioma, which has not spread to the lymph nodes. Candidates should also be in otherwise good health. The recovery period can last for up to a half-year or longer.

A pleurectomy involves the removal of the visceral and parietal pleura, which is the lining of the lungs. This may be used as a potential curative procedure but also may be performed to address pleural effusion, the build-up of fluid in the lungs. This surgery is performed under general anesthesia. To perform a pleurectomy, an incision is made in the affected area, which has been numbed with a local anesthesia. Through this incision, both the inner and outer linings of the lungs are removed. The surgeon may also opt to remove the lung tissue beneath the pleura. The procedure is sometimes followed by chemo or radiation to remove any remaining cancerous tissue. The post-surgery stay for the pleurectomy is generally about a week but may be longer if complications arise during or after surgery, including bleeding or infection.

Peritoneal mesothelioma

Peritoneal Mesothelioma is a relatively rare form of malignant mesothelioma, making up twenty to twenty five percent of diagnosed mesothelioma cases. This type of mesothelioma affects the cells of the peritoneal mesothelium, also known as the peritoneum, which is the membrane lining the abdominal cavity wall. In this area of the body the mesothelium membrane also supports and protects organs in the abdomen. The peritoneum is made up of two layers, called the visceral and parietal layers. The parietal layer is an outer layer that covers the abdominal cavity, while the visceral layer covers internal organs and the intestinal tract.

All types of mesothelioma are caused by the presence of microscopic asbestos fibers which most often enter the human body by inhalation. These fibers are given off by deteriorating or torn asbestos material, they can float in a dust cloud for a long period, and they are unnoticed when inhaled. That is how they enter the lungs and cause pleural mesothelioma in the lung lining. It is less clear how these fibers make their way to the abdominal cavity.

It is possible that they are ingested in some fashion and work their way through the intestinal system just as they pass through the lungs to the outer layer. It has also been suggested that they pass through the body via the lymphatic system. In any case, when they become embedded in the peritoneum they can cause an assortment of symptoms and eventually cause the development of abnormal, malignant cells.

Impact of Asbestos Fibers on the Peritoneum
One of the most common symptoms of peritoneal mesothelioma is ascites, or the accumulation of excess fluid in the abdominal cavity. This symptom can be assigned to a number of more common conditions, from liver disease to intestinal problems. Just as with pleural mesothelioma, the nature of the symptoms can be misleading. One study cited a mean period of 122 days from the presentation of symptoms to diagnosis.

Once in the peritoneum, asbestos fibers cause changes in peritoneal cells that cause them to divide without restraint, causing the peritoneal layers to thicken. The growth of cancer cells puts pressure on internal organs, and this pressure is increased by the fluid buildup. The accumulation of pressure can sometimes cause adjacent organs to begin to malfunction, further complicating diagnosis. Intestinal obstruction can occur, as can emergency surgery due to inflammatory lesions. Thrombosis in the veins and hypoglycemia are common symptoms.

Despite the evidence of some sort of highly intrusive affliction, CT scans and radiology exams won't result in a firm diagnosis. A precise diagnosis based on imaging alone is not possible. Peritoneal mesothelioma may consist of a single tumor, diffuse small tumors, or a combination along with benign calcified nodules. It is not a disease that can easily be addressed surgically.

Symptoms of Peritoneal Mesothelioma
The section above discusses many of the more severe symptoms of peritoneal mesothelioma. When a patient is first seen, however, the collection of complaints may include some very common physical conditions that can be attributed to several different ailments. A brief list of common initial symptoms:

    * Weight loss
    * Fever or night sweats
    * Pain or swelling in the abdominal area
    * Obstruction of the small or large intestine
    * Anemia
    * Edema or thrombosis in the legs

Peritoneal Mesothelioma Diagnosis
Once a physician has determined that this rare disease may be involved in the case, diagnostic measures are multifaceted. While the use of imaging equipment cannot produce a complete diagnosis, it can produce evidence of a mass growing on one of the peritoneal mesothelium surfaces, or show an accumulation of small irregularities that may be tumors or plaques.

Biopsy is a common choice at this juncture, often performed along with a laparoscopy in order to allow for more accurate observation of any internal masses. Protein markers found in blood samples that are evidence of one of the two types of mesothelioma cells – epithelial or sarcomatoid – are used in some pathology labs.

Treatment for Peritoneal Mesothelioma
Despite the commonly diffuse nature of peritoneal mesothelioma, surgical resection is still the best option if the disease is at the stage where most or all of the malignant tissue can be removed. In situations where all of the diseased tissue cannot be removed, as much as possible is taken and the procedure is called "debulking." Where possible, "intracavity" chemotherapy is undertaken during the surgical process to more precisely target the malignant areas remaining within the abdomen.

For most patients with peritoneal mesothelioma that has metastasized to one of the nearby organs treatment is palliative, and is designed reduce the rate at which the cancer spreads. If the surgery is relatively successful and the following therapy has some effect the survival time can stretch beyond two years. For partial resections the survival period is far shorter.

In cases where surgery and chemotherapy are not suitable treatment options, palliative treatment is used to provide symptomatic relief; however, such treatments cannot slow the progression of the cancer. These types of treatments are used simply to manage pain and provide relief from symptoms such as the build-up of fluid in the peritoneal cavity.

It is difficult to find survival period figures that reflect the results of a large sample. However the consensus seems to be that post-surgical survival times for peritoneal mesothelioma is better, on the average, than for pleural mesothelioma. A study done in the UK followed seventeen patients over a period from 1998 to 2007 who underwent surgery for resection of peritoneal mesothelioma, followed by a thorough chemotherapy program. Eight of the patients had a partial resection, or debulking, of malignant tissue and eight had a full resection. The average survival period for those with a partial removal of cancerous tissue was one year, while for the patients with a full resection it was 3.7 years. Either figure is well beyond the survival rates for pleural mesothelioma patients

Pericardial Mesothelioma

Pericardial mesothelioma, or mesothelioma of the pericardium, is a disease that affects the lining of the heart (pericardium). It is a common misconception that mesothelioma is a type of primary lung cancer; it is not. Mesothelioma is a cancer of the serous membranes. These membranes enclose a number of organs throughout the midsection of the body, including the heart. The most common type of mesothelioma is pleural mesothelioma, which affects the serous membranes of the lungs.

The least common form of mesothelioma cancer is pericardial mesothelioma. Pericardial mesothelioma can spread to the lungs and when this occurs, it is considered secondary lung cancer. Mesothelioma is also sometimes referred to as an asbestos lung cancer. Technically, this is also incorrect, since it does not originate in the lungs. Asbestosis is a type of asbestos lung disease that does originate in the lungs and is often confused with mesothelioma.

Pericardial Mesothelioma Cancer
Pericardial mesothelioma cancer is found in less than 10 percent of mesothelioma patients. While pleural mesothelioma is fairly well understood (inhaled asbestos fibers become imbedded in the lining of the lung and lead to cancerous tumors), pericardial mesothelioma is not. Pleural mesothelioma develops because the inhaled asbestos fibers are very durable and cannot be eliminated through the body's processes. Over time, these fibers cause chronic inflammation that eventually leads to growth of cancerous tumors or, in some cases, asbestosis. In contrast, researchers and doctors are unsure how the asbestos fibers become lodged in the heart’s serous lining, or pericardium. One theory holds that asbestos fibers are broken into smaller pieces in the lungs and then carried  into the blood stream. From there, proponents of this theory hypothesize, the fibers are pumped through the heart, become lodged in the heart lining, and cause the chronic inflammation that leads to cancerous growths (as with pleural mesothelioma).

For pericardial mesothelioma, it is not clearly understood how the asbestos fibers become lodged in the heart serous lining or pericardium. It is possible that asbestos fibers, after being broken into smaller pieces in the lungs, are carried from the lungs into the blood stream. As the fibers are pumped through the heart, they become lodged in the heart lining. Once lodged in the pericardium, the chronic inflammation process leading to cancerous growths is similar to that occurring in pleural mesothelioma.

Because pericardial mesothelioma is so rare, there is little specific research on this type of mesothelioma. Approximately 2,000 new cases of mesothelioma are diagnosed each year, and fewer than 200 of them are pericardial mesothelioma.

Pericardial Mesothelioma Symptoms
As in the lung, the rapid growth of the cancerous tumors can cause expansion of the tissue and accumulation of fluid. The fluid can interfere with the functioning of the heart and cause chest pain and irregular heartbeat. Patients are typically diagnosed when they complain of chest pain or other heart-related symptoms after even limited exertion. Shortness of breath and cough are less common symptoms of pericardial mesothelioma cancer. Unlike the lungs, it is less common for other cancers to metastasize to the heart.

Pericardial mesothelioma patients can exhibit all three kinds of mesothelioma cancer cells: epithelioid mesothelioma, sarcomatoid mesothelioma and biphasic mesothelioma. The type of cancer cells can affect the mesothelioma prognosis. It is thought that patients with biphasic mesothelioma cancer cells have a shorter life expectancy.