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Todd Kelly
Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the
mesothelium, a protective sac that covers most of the body's internal organs. Most people who
develop mesothelioma have worked on jobs where they inhaled asbestos particles.

What is the mesothelium?

The mesothelium is a membrane that covers and protects most of the internal organs of the body.
It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms
a sac around it. The mesothelium produces a lubricating fluid that is released between these
layers, allowing moving organs (such as the beating heart and the expanding and contracting
lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is
the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the
membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium
covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive
organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal
reproductive organs in women.

What is mesothelioma?

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become
abnormal and divide without control or order. They can invade and damage nearby tissues and
organs. Cancer cells can also metastasize (spread) from their original site to other parts of the
body. Most cases of mesothelioma begin in the pleura or peritoneum.

How common is mesothelioma?

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a
relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United
States each year. Mesothelioma occurs more often in men than in women and risk increases with
age, but this disease can appear in either men or women at any age.

What are the risk factors for mesothelioma?

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure
at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has
been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible
fibers that can be separated into thin threads and woven. Asbestos has been widely used in many
industrial products, including cement, brake linings, roof shingles, flooring products, textiles,
and insulation. If tiny asbestos particles float in the air, especially during the manufacturing
process, they may be inhaled or swallowed, and can cause serious health problems. In addition
to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a
noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of
smoking and asbestos exposure significantly increases a person's risk of developing cancer of the
air passageways in the lung.

Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased
during World War II. Since the early 1940s, millions of American workers have been exposed to
asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an
increased risk of developing mesothelioma was later found among shipyard workers, people who
work in asbestos mines and mills, producers of asbestos products, workers in the heating and
construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health
Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace.
People who work with asbestos wear personal protective equipment to lower their risk of
exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer
exposure time. However, some individuals with only brief exposures have developed
mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-
related diseases.

There is some evidence that family members and others living with asbestos workers have an
increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk
may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos
workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers
are usually required to shower and change their clothing before leaving the workplace.

What are the symptoms of mesothelioma?

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos.
Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often
symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss
and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of
peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia,
and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms
may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions. It is
important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

How is mesothelioma diagnosed?

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a
number of other conditions. Diagnosis begins with a review of the patient's medical history,
including any history of asbestos exposure. A complete physical examination may be performed,
including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an
MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body
created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a
computer is used to make detailed pictures of areas inside the body. These pictures are viewed on
a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical
oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of
tissue for examination under a microscope by a pathologist. A biopsy may be done in different
ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor
may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest
wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs.
Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer
is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination,
the doctor makes a small opening in the abdomen and inserts a special instrument called a
peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more
extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the
disease. Staging involves more tests in a careful attempt to find out whether the cancer has
spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor
plan treatment.

Mesothelioma is described as localized if the cancer is found only on the membrane surface
where it originated. It is classified as advanced if it has spread beyond the original membrane
surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal
organs.

How is mesothelioma treated?

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and
the patient's age and general health. Standard treatment options include surgery, radiation
therapy, and chemotherapy. Sometimes, these treatments are combined.

Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of
the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part
of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer
cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The
radiation may come from a machine (external radiation) or from putting materials that produce
radiation through thin plastic tubes into the area where the cancer cells are found (internal
radiation therapy).

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs
used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are
also studying the effectiveness of putting chemotherapy directly into the chest or abdomen
(intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid
that has built up in the chest or abdomen. The procedure for removing fluid from the chest is
called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be
given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy
and surgery may also be helpful in relieving symptoms.

Are new treatments for mesothelioma being studied?

Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is
sponsoring clinical trials (research studies with people) that are designed to find new treatments
and better ways to use current treatments. Before any new treatment can be recommended for
general use, doctors conduct clinical trials to find out whether the treatment is safe for patients
and effective against the disease. Participation in clinical trials is an important treatment option
for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information
about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–
4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database,
to identify and provide detailed information about specific ongoing clinical trials. Patients also
have the option of searching for clinical trials on their own. The clinical trials page on the
NCI's Cancer.gov Web site, located at http://www.cancer.gov/clinicaltrials on the Internet,
provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Cancer
Treatment Research Studies. This booklet describes how research studies are carried out and
explains their possible benefits and risks. The booklet is available by calling the CIS, or from the
NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.