Early signs of Mesothelioma a full case study

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What is Mesothelioma?

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Mesothelioma is a type of cancer. It is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs. It starts in the cell of the mesothelium. A cancerous tumour is a group of the cancer cells that can destroy a body cell or tissues. Though it can also spread to the other parts of the body. There are many early signs of Mesothelioma and its symptoms. More than 80% of Mesothelioma cases are caused because of exposure to asbestos. Therefore, the greater is the exposure the greater the risk. As of 2013, about 125 million people have been exposed to asbestos at work. Hence, high rates of disease occur in people who mine asbestos, produce products from asbestos, work with asbestos products, live with asbestos workers, or work in buildings containing asbestos.

Mesothelioma

Mesothelioma is a very rare type of cancer. Though it is tough to find the early signs of Mesothelioma. It usually starts in the pleura, which is called pleural mesothelioma. This type of cancer makes up 70% to 80% of all mesotheliomas. Rarer types of mesothelioma can also develop. This includes pericardial mesothelioma, which starts in the membrane that surrounds the heart. Thus, another rare type is mesothelioma which starts in the outer lining of the testicles.

Now a question may strike in your mind that “what is mesothelium?” The mesothelium is a membrane that covers and protects most of your internal organs. It is made up of 2 layers. One is the inner layer and another is the outer layer. The inner layer wraps around different organs, including the lungs, heart and stomach. The outer layer forms a sac around the inner layer. There is a small amount of fluid between the 2 layers so that the organs can move easily. The mesothelium has different names depending on its location in the body. The mesothelium that protects and cushions the lungs is called the pleura. Hence the inner layer that covers the lungs is called the visceral pleura. Whereas, the outer layer that lines the inside wall of the chest is called the parietal pleura. However, the mesothelium that covers the abdominal organs and lines the walls of the abdomen and pelvis is called the peritoneum of Mesothelioma

There are four primary types of Mesothelioma based on the location where a tumour first develops. Thus, the types are pleural in lungs, peritoneal in the abdomen, pericardial in heart, and testicular. Each type has the early signs of Mesothelioma.

  • Pleural Mesothelioma is the first type. It develops in the lining of the lungs. As the most common form of the disease, pleural Mesothelioma accounts for approximately 80% of the new cases. Pleural mesothelioma is hard to diagnose. In the early stages of the disease, symptoms tend to be mild, while in later stages like stage 3 or stage 4 symptoms can worsen significantly. Unfortunately, since it is often diagnosed at a later stage, Mesothelioma usually has a poor prognosis. Hence most patients live less than 17 months from the time that their first symptoms appear.
  • The second-most prevalent type is Peritoneal Mesothelioma, responsible for about 10% of all cases. The abdominal cavity and its organs are all lined with mesothelial cells. In peritoneal mesothelioma, a CT or MRI of the abdomen typically will reveal thickening of the peritoneal lining. Surgical or needle biopsy is required for cell type diagnosis.
  • Pericardial Mesothelioma, which originates in the lining of the heart cavity is uncommon accounting for less than 1% of all Mesothelioma cases. As this cancer progresses, the heart becomes unable to deliver oxygen to the body, causing a further decline in health at an increasingly rapid rate. It is difficult to diagnose the early signs of Mesothelioma. The most common symptoms of pericardial Mesothelioma mimic those of a heart attack, including pain in the chest and shortness of breath.
  • Testicular Mesothelioma type is extremely rare. There have only been a few hundred reported cases. Since it’s so rare, there’s not a known, standard set of symptoms. But the one seen most often is a painless mass on the scrotum. It mostly happens in men between ages 55 and 75. There’s a possible link to asbestos exposure, but doctors don’t know what the exact connection is. Your doctor will likely perform an ultrasound of your scrotum. You might get a biopsy to see if there’s a mass. Since this form of mesothelioma is so rare, it’s not well understood. Nor is there a standard treatment.

Pleural Mesothelioma symptoms

The first symptoms of mesothelioma include chest or abdominal pain, bloating and shortness of breath, depending on the location of cancer. Because early-stage signs can be slight, doctors often mistake them as normal aches and pains or symptoms of less serious illnesses. Pleural mesothelioma patients may experience symptoms associated with common illnesses, such as the onset of a fever, shortness of breath or persistent coughing. Although these symptoms are common, if a patient has been exposed to asbestos in the past, it is important they consult a physician. Other symptoms include:

sign-of-mesothelioma

  • Lower Back Pain.
  • Shortness of Breath.
  • Unexplained Weight Loss.
  • Swelling of Face or Arms.
  • Fluid Buildup.
  • Chest Pain.
  • A dry or a Painful Cough.
  • Fever or Sweating.
  • Tissue Lumps in the Chest.
  • Coughing up Blood etc.

Pleural mesothelioma can be hard to detect because its symptoms, such as shortness of breath and fever, are common in other respiratory ailments. Because Mesothelioma is so rare, general practitioners may not readily recognize Mesothelioma as a possible diagnosis. Fortunately, research is constantly underway to discover more effective ways to detect mesothelioma. So it is difficult to recognise the early signs of Mesothelioma. Mesothelioma in the pleura can metastasize to the lymph nodes, which can cause cancer to spread throughout the body more quickly. It is common for it to metastasize to the central organs, such as the heart and diaphragm. There have also been cases of pleural mesothelioma spreading to the brain, but this is uncommon.

The 4 Stages of Pleural Mesothelioma:

  • 1st Stage: The cancer is only located in the pleural lining of the lungs.
  • 2nd Stage: Cancer has spread to more of the lung, part of the diaphragm, and localized lymph nodes.
  • 3rd Stage: Cancer has metastasized to nearby organs and more lymph nodes
  • 4th Stage: Cancer has spread to the other organs and all lymph nodes are fully involved.

How Pleural Mesothelioma Develops

  • Inhaled asbestos particles are sharp and can get stuck in the pleura. This can include both the visceral (inner) or the parietal (outer) pleura.
  • The body cannot expel all of the asbestos fibres. These fibres can cause irritation, inflammation, scarring, and genetic damage.
  • The genetically damaged cells can no longer receive signals to stop dividing. They multiply indefinitely, creating tumours. It takes anywhere from 10 to 50 years after asbestos exposure for mesothelioma to develop in the pleura.

Mesothelioma Prognosis

A prognosis is the outcome of a disease. It is like a forecast of how the disease will affect a person and his body. Hence there are some of the factors, such as cancer’s stage, cell type, person’s age and gender, etc. These are beyond your control. However, you do have some control in modifying other factors to positively influence your prognosis. Many patients have lived well past their initial life expectancies by electing treatment, improving their overall health and following the advice of the knowledgeable specialists. A prognosis is a prediction made by a qualified physician of the likely result of your cancer. Doctors base your cancer prognosis on statistics gathered from others with your type of cancer and stage of the disease. An experienced doctor can tell you the early signs of Mesothelioma. However, it is only an assessment made by the doctors. Thus, many people have outlived their initial prognoses. Mesothelioma often has a poor prognosis. Typical survival despite surgery is between 12 and 21 months depending on the stage of disease at diagnosis with about 7.5% of people surviving for 5 years. Women, young people, people with low-stage cancers, and people with epithelioid cancers have better prognoses. Negative prognostic factors include sarcomatoid or biphasic histology, high platelet counts (above 400,000), age over 50 years, white blood cell counts above 15.5, low glucose levels in the pleural fluid, low albumin levels, and high fibrinogen levels. Several markers are under investigation as prognostic factors, including nuclear grade, and serum c-reactive protein. Long-term survival is rare.

Mesothelioma life expectancy stage 1

sign-of-mesothelioma

Stage 1 mesothelioma tumours remain localized in and around the tissue lining of one lung. Treatment options for stage 1 offer a longer life expectancy. Prognosis is better at this stage. The 2-year survival rate for some patients is 41-45%. It can be treated if doctors can diagnose the early signs of Mesothelioma.

End-stage Mesothelioma

In stage 4, pleural mesothelioma tumours have spread into the chest wall, bones, lining of the heart, abdomen, liver or the opposite lung. Lymph nodes on the other side of the chest or above the collarbone may also be affected. The median life expectancy for stage 4 mesothelioma is about 12 months. If early signs of Mesothelioma comes into notice then a patient can take precautions in order to avoid the final stage.

Common symptoms of late-stage mesothelioma include:
  • Shortness of breath.
  • Pain and tightness in the chest.
  • Night sweats and fever.
  • Coughing up blood.
  • Fluid buildup in chest or abdomen.
  • Abdominal pain.
  • Fatigue.
  • Blood clots in the veins, which may cause thrombophlebitis.
  • Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs.
  • Jaundice, or yellowing of the eyes and skin.
  • Low blood sugar level.
  • Pleural effusion.
  • Pulmonary emboli, or blood clots in the arteries of the lungs.
  • Severe ascites etc.

If a Mesothelioma forms metastases, these most commonly involve the liver, adrenal gland, kidney, or another lung. Only about 7% of people who have end-stage Mesothelioma with a spread of the disease to distant areas of the body live beyond 5 years. However, as newer treatments begin to emerge, there is hope and expectation that more people diagnosed with stage 4 Mesothelioma will live longer.

Is Mesothelioma painful?

Sometimes cancer causes no pain. Symptoms may even be subtle until the cancer is advanced. But with Mesothelioma, pain in the chest, where a tumour is usually found, painful coughing, and pain as cancer spreads and presses on organs are common. If in the last stage, a patient may suffer many problems including pain. So it is better to identify the early signs of Mesothelioma in the initial stage.

Mesothelioma causes

Working with asbestos is the most common risk factor for Mesothelioma. However, Mesothelioma has been reported in some individuals without any known exposure to asbestos. Thus, tentative evidence also raises concern about carbon-fibre nanotubes. When asbestos fibres in the air are inhaled, they can get into the lungs. Hence, fibres that stay in the lungs can travel to the ends of the small airways and enter the pleural lining of the lung and chest wall. However, these fibres can then injure the cells of the pleura, and eventually cause Mesothelioma. In case of diagnosing the Mesothelioma, imaging scans and other tests are imperative in making an accurate diagnosis of Pleural Mesothelioma. When a patient presents with the shortness of breath or a constant cough, the first test most doctors perform is a chest X-ray. Mesothelioma does not always show up on a chest X-ray, especially in the early stages. But a chest X-ray may be able to show a pleural effusion. This is a build-up of fluid in between the pleura. X-Rays sometimes may not able to tell the early signs of Mesothelioma.

Early signs of Mesothelioma

Many of the early signs of Mesothelioma are more likely to be caused by other conditions, so at first, people may ignore them or mistake them for common, minor ailments. Most people with Mesothelioma have symptoms for at least a few months before they are diagnosed. These symptoms can be caused by Mesothelioma, but more often they are caused by other conditions.

Some of the early signs of Mesothelioma are:

Pleural Mesothelioma symptoms are similar to those occurring with less severe respiratory and other diseases, making diagnosis difficult. Anyone with a history of asbestos exposure should seek immediate medical attention if they experience any of the following symptoms:

  • Shortness of breath.
  • Chest pain.
  • Fluid buildup around the lungs.
  • Significant and unexplained weight loss.
  • Chronic and dry or a raspy cough.
  • Coughing up blood.
  • Loss of appetite.
  • Difficulty in swallowing.
  • Fatigue.
  • Lumps under the skin of the chest etc.

Peritoneal Mesothelioma patients most often experience the following symptoms:

  • Ascites.
  • Abdominal pain.
  • Unexplained weight loss.
  • Nausea and vomiting.
  • Diarrhoea or constipation.
  • Bowel obstruction.
  • Anaemia.
  • Fever.
  • Night sweats etc.

So, these were some of the early signs of Mesothelioma.

Mesothelioma diagnosis

Patients experiencing potential Mesothelioma symptoms such as coughing, shortness of breath, or chest pains should visit a doctor. These are the early signs of Mesothelioma. After seeing a physician, the diagnostic process determines the causes of these symptoms and a treatment plan.

  • Imaging tests are the first step in diagnosing Mesothelioma. These tests show the presence of the abnormalities in a body. This helps doctors know where a tumour is and how advanced cancer may be. Each imaging test has its own purpose, which helps the specialist make an accurate diagnosis.
  • X-Ray test provides a 2D image of the patient and can show a tumour and fluid buildup. This test is used for all suspected diagnoses. However, Mesothelioma does not always show up on a chest X-ray, especially in the early stages.
  • Blood and biomarker tests allow physicians to better diagnose the patient. They also aid in providing an accurate prognosis. However, these tests work by measuring the levels of certain biomarkers that are present in healthy people as well as Mesothelioma patients, that can then be studied and compared.
  • Surgical biopsies are used to extract tissue from a patient. This sample of tissue is sent to a pathologist to examine for the presence of the early signs of Mesothelioma. This can be accomplished with traditional surgical methods or camera-assisted surgery.

Malignant Mesothelioma

Mesothelioma is an aggressive and deadly form of cancer. It is divided into different types based on what part of the Mesothelium is affected. Mesothelioma most often affects the tissue that surrounds the lungs known as pleura. This type is called pleural mesothelioma. Other and the rarer types of Mesothelioma affect tissue in the abdomen are known as peritoneal mesothelioma, around the heart and around the testicles. Malignant Mesothelioma is a type of cancer that occurs in the thin layer of tissue that covers the majority of your internal organs. It is a rare, asbestos-related cancer. Malignant Mesothelioma forms on the protective tissues covering the lungs, abdomen and heart. The connection between asbestos exposure and Mesothelioma was discovered in the 1970s.

There are three primary types of Malignant Mesothelioma:

  • Malignant pleural Mesothelioma that occurs in the lining of the lungs.
  • Malignant peritoneal Mesothelioma that occurs in the lining of the abdomen.
  • And Malignant pericardial Mesothelioma that occurs in the lining of the heart.

The early signs of Mesothelioma (Malignant) include chest pain, difficulty breathing, shortness of breath, chronic cough, or difficulty swallowing. However, since these symptoms are also associated with other conditions, further diagnostic procedures are usually required to make an accurate diagnosis.

  • Imaging Scans like X-ray, CT scan, MRI, or PET scan etc.
  • Blood Tests like assays that look for biomarkers in the bloodstream.
  • Biopsies etc.

Misdiagnosis is easy with Malignant Mesothelioma since the disease’s symptoms so closely resemble those of other related conditions such as lung cancer or other respiratory ailments.

Epithelioid Mesothelioma

Mesothelioma can be categorized based on cell type. Hence the cell types are epithelioid, sarcomatoid, or biphasic. Epithelioid mesothelioma accounts for 60-70% of all diagnosed cases. Patients who are treated for epithelioid mesothelioma usually have the best outcomes during treatment. A patient may be lucky if he diagnosed the early signs of Mesothelioma before it is too late. Therefore, a patient can get treatment on time. This cell type gets its name because it is a cancerous mutation of epithelial cells. Epithelioid cells have prominent papilla-tubular structures. Epithelioid cells are the most common cell type in cases of mesothelioma. Patients diagnosed with an epithelioid cell type generally have the best life expectancy. Epithelioid mesothelioma cells have some characteristics:

  • They are square-shaped cells and have visible nuclei.
  • Tumours made of epithelioid cells grow quickly. These cells replicate faster than sarcomatoid or biphasic mesothelioma tumours. However, the square shape of epithelioid cells causes them to stick together, slowing down their spread to other parts of the body.
  • Epithelioid Mesothelioma responds the best to treatment since it spreads slower than other cell types etc.

The subtypes of Epithelioid Mesothelioma are :

  • Tubulopapillary.
  • Acinar.
  • Adenomatoid.
  • Solid mesothelial cell.
  • Clear cell.
  • Small cell.
  • Deciduoid.
  • Adenoid Cystic etc.

Mesothelioma life expectancy without treatment

Mesothelioma prognosis has remained poor for many years. Survival rates have improved slightly in recent years, but many patients still face the same grim life expectancy. Therefore on an average, mesothelioma patients have a life expectancy of just 12 to 21 months. This may be because of diagnosing the early signs of Mesothelioma. Though some patients live well beyond this average, only about 9% survive 5 years or more. Patients whose mesothelioma is detected earlier have more treatment options, like curative surgery with chemotherapy. This is because the cancer is more localized and the tumours are easier to remove. Complete resection, in these instances, may be possible, and chemotherapy could help kill any remaining cancer cells. Those at an advanced stage will have difficulty finding a curative treatment plan. One of the main reasons a Mesothelioma patient may not have treatment is because there are no curative options left. When diagnosed at a late stage, especially stage 4 mesothelioma, surgery is not an option and the patient may not be able to tolerate aggressive chemotherapy or radiation therapy. Comparatively, patients who have aggressive surgery for stage 1 or 2 mesotheliomas often live longer than three years. Survival among people diagnosed in stage 3 or 4 who forgo treatment can vary greatly depending upon several prognostic factors, including a person’s overall health, age, gender, tumour cell type and stage at diagnosis.

Mesothelioma treatment

The most common treatment for mesothelioma involves a combination of surgery, chemotherapy and radiation therapy. Supportive treatments can help relieve symptoms and improve quality of life for many mesothelioma patients. Mesothelioma can be prevented in most cases by preventing exposure to asbestos. Malignant Mesothelioma is extremely aggressive and has a long latency period, which means it usually remains undetected until cancer has reached an advanced stage. There is no cure for Mesothelioma, though the prognosis has been slowly improving over the years. Mesothelioma is generally resistant to radiation and chemotherapy treatment. Long-term survival and cures are exceedingly rare. Treatment of malignant Mesothelioma at earlier stages has a better prognosis. Early signs of Mesothelioma if recognised on time, then the chances of a successful treatment is more.

Clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient’s age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology.

  • Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery was only 11 months. However, research indicates varied success when used in combination with radiation and chemotherapy, or with one of the latter. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the semi-diaphragm and the pericardium are removed. In localized pericardial mesothelioma, pericardectomy can be curative; when a tumour has metastasized, pericardectomy is a palliative care option. An entire tumour is not often able to be removed.
  • Radiation: For patients with localized disease, and who can tolerate a radical surgery, radiation can be given post-operatively as a consolidative treatment. The entire hemithorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations. It can also induce severe side-effects, including fatal pneumonitis. As part of a curative approach to mesothelioma, radiotherapy is commonly applied to the sites of chest drain insertion, in order to prevent the growth of a tumour along the track in the chest wall.
  • Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials.
  • Immunotherapy: Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. 
  • Multimodality therapy: All of the standard approaches to treating solid tumours like radiation, chemotherapy, and surgery have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation has produced significant survival extension among patients with favourable prognostic factors.
  • Heated intraoperative intraperitoneal chemotherapy: This technique is used in conjunction with surgery, including in patients with malignant pleural mesothelioma. The surgeon removes as much of a tumour as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48 °C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained. High concentrations of selected drugs are then administered into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

Mesothelioma life expectancy

Life expectancy is the number of months or years a patient is expected to live with a disease or illness. Mesothelioma life expectancy often ranges from about 12 to 21 months. However, there are many factors that contribute to life expectancy and each patient is unique. Mesothelioma is cancer that affects the thin membrane protecting several of the body’s most important organs, including the lungs, abdomen and heart. Treatment for this disease includes surgery, chemotherapy and radiation therapy. Many other factors can go into determining a patient’s life expectancy, from the overall health of the individual to gender to certain genetic factors. The table below provides a list of things that can affect life expectancy positively and negatively. From diagnosis to treatment, the medical bills can add up quickly and for those who have longer life expectancies, the costs of follow-up visits, continued medications, and other ongoing expenses will build over time. Furthermore, many people with mesothelioma are unable to work, making it that much harder to pay for tests and treatments.

Mesothelioma survival stories

Mesothelioma is a terrifying diagnosis, and because of its rarity, new patients often have no idea who to turn to for advice and perspective. Statistics don’t lie, but they don’t tell the whole story of mesothelioma either. Here are some of the survivors we found from the sources:

  • Alexis: Alexis lives in Houston and has survived Mesothelioma for more than 6 years. She was diagnosed with peritoneal Mesothelioma after her surgeon, who was set to remove her gallbladder, noticed small, unidentified formations on her diaphragm. A biopsy confirmed a Mesothelioma diagnosis, despite the fact that subsequent radiographic imaging tests showed no signs of the disease. She went through the surgery and heated intraperitoneal chemotherapy (HIPEC).
  • Suellen: Suellen has survived with mesothelioma for 12 years. Since she was diagnosed after a visit to her general practitioner for a severe ear-ache. Therefore, after a series of tests and exploratory surgeries, she was diagnosed with malignant peritoneal mesothelioma. Her initial treatment involved surgery, which removed the parts of her peritoneum most affected by tumours. She then received both intravenous and intraperitoneal chemotherapy, consisting of Taxol, carboplatin and gemcitabine, to remove remaining cancer. After many rounds of this multimodal approach, she started taking a daily dose of imatinib and underwent a few more rounds of post-surgical chemotherapeutic infusions.

  • There are also many survivors like them who underwent treatment on time as they diagnosed the early signs of Mesothelioma. 

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