Dr. M. J. Bazos, Patient Handout

About Your Diagnosis
Your lungs have an outer layer called the pleura. The pleura is made of cells called mesothelium. Mesothelioma is cancer of these cells. The main cause of mesothelioma is asbestos exposure. Asbestos is resistant to heat and was used in products such as insulation, heat protectors, filters, materials for roofing, spackling, floor and ceiling tiles, boilers, and heating equipment in ships, cars, and homes. Mesothelioma is rare. Approximately 2000 new cases are diagnosed each year in the United States. The cancer is difficult to diagnose, and the only sure way is by means of biopsy and examination of the
tissue with a microscope. Even with tissue examination, the diagnosis can be inaccurate, so the tissue specimens should be reviewed by different pathologists. Malignant mesotheliomas usually is not curable.

Living With Your Diagnosis
Most patients with mesothelioma have shortness of breath and chest wall pain. The cancer tends to spread locally to nearby structures. Mesothelioma can involve the ribs, spinal column, esophagus, and heart. As the disease advances, patients report increasing shortness of breath, fatigue, and fevers with cough and pneumonia. Most patients die of pneumonia and breathing problems. Survival time ranges anywhere from 4 months to slightly longer than 1 year.

A definite diagnosis must be made to exclude other, possibly curable forms of cancer with a similar presentation. If the biopsy tissue does not allow a definite diagnosis, a second biopsy or open lung biopsy can be performed by a surgeon. Bronchoscopy (examination with a lighted scope passed into the breathing tubes) is performed to look for possible lung cancer (not mesothelioma) as the diagnosis. Magnetic resonance imaging (MRI) or computed tomography (CT) of the chest can be performed to determine the extent of the cancer. This helps in staging of the disease and determining whether the cancer has spread. Stage I means the cancer is on one side of the chest and involves only the lining of lung, not the lung itself. Stage II means the cancer has invaded the esophagus, heart, or opposite lung. Stage III means the cancer has penetrated below the diaphragm (the muscle that separates the chest from the abdomen). Stage IV means the cancer has spread to distant parts of the body. Treatment options include surgical, radiation, and chemotherapy. Surgical treatment is limited to stage I disease and involves removing the lining of the lung (pleurectomy). In a more radical operation, the surgeon removes the lining of the lung, the lung, the lining of the heart, and the diaphragm (extrapleural pneumonectomy). Some reports show that about 25% of patients survive 2 years after this treatment. The effectiveness of radiation and chemotherapy is not well known. The decision to use these therapies should be made between you and your oncologist.

The DOs
• Seek advice from large cancer referral centers concerning the treatment of mesotheliomas. Mesotheliomas usually are not curable, but certain treatment options have enabled people to live longer than if they had no treatment.
• Understand the difficulty in diagnosing this form of cancer. You must be sure of the diagnosis before proceeding with risky treatment.
• Ask for a second opinion on the pathologic interpretation of your biopsy specimen. The difficulty in diagnosing mesothelioma cannot be overemphasized.

The DON’Ts
• Do not forget the cause of mesothelioma in most cases is exposure to asbestos. Avoid working with asbestos and take proper precautions.
• Do not forget that asbestos can cause scarring of the lung (pulmonary fibrosis). Fifteen percent of patients with asbestos involvement of the lung
eventually have lung cancer, which is different from mesothelioma.
• Do not forget that the combination of asbestos and tobacco smoking markedly increases your risk for lung cancer.

When to Call Your Doctor
• If you notice blood in your phlegm.
• If you have a persistent cough.
• If you have shortness of breath.
• If you have chest pain.
• If you need emotional support.
• If you need referral to in-state or out-of-state cancer centers.