Asbestos - Pleural mesothelioma

The lungs are the main organs for breathing and are part of the respiratory system. The respiratory system also includes the nose, mouth, windpipe (trachea) and airways to each lung. These consist of large airways (bronchi) and smaller airways (bronchioles).
The lungs look like two large, spongy cones. Each lung is made up of sections called lobes – the left lung has two lobes and the right lung has three. The lungs rest on the diaphragm, which is a wide, thin muscle that helps with breathing.
The role of pleura
The chest wall and lungs are covered by two layers of a thin sheet of tissue called the pleura.
The inner layer (visceral pleura): lines the lungs.
The outer layer (parietal pleura): lines the chest wall and the diaphragm.
Between the two layers is the pleural cavity (also called the pleural space), which normally contains a small amount of fluid. This fluid allows the two layers of pleura to slide over each other so the lungs move smoothly against the chest wall when you breathe.
When mesothelioma develops in the pleura, the delicate layers of the pleura thicken and may press on the lung, preventing it from expanding when breathing in (inhalation). When excess fluid collects between the two layers, this is known as a pleural effusion.

What is mesothelioma?
Mesothelioma is a type of cancer that starts from mesothelial cells. These cells line the outer surface of most of the body's internal organs, forming a membrane called the mesothelium. The membrane that covers the lungs is the pleura.
What are the different types?
There are two main types of mesothelioma, which are classified according to the area affected.
Pleural: This forms in the covering of the lungs. Pleural mesothelioma is the most common type, accounting for about 90% of all mesotheliomas. This type of mesothelioma is called malignant pleural mesothelioma (MPM). In this book we refer to it as pleural mesothelioma or, simply, mesothelioma.
Peritoneal: This develops in the lining of the abdomen. It accounts for about 10% of cases and is called malignant peritoneal mesothelioma.
Rarely, mesothelioma occurs in the pericardium (the membrane around the heart) or the tunica vaginalis (the membrane around the testicles).
Although pleural mesothelioma develops in the chest and involves the lining of the lungs, it is not lung cancer and is diagnosed and treated differently.
Cell types of mesothelioma
Mesothelioma is also grouped according to how the cells look under a microscope. There are three main types:
Epithelioid: Cells look similar to normal mesothelial cells. This is the most common type, making up about 60% of cases.
Sarcomatoid: Cells have changed and look like cells from fibrous tissue. Accounts for about 15% of cases.
Mixed or biphasic: Has epithelioid and sarcomatoid cells. These make up about 25% of all cases.
Mesotheliomas can differ in the way they grow. Some form a mass; others grow along the pleura forming a thick covering on the lungs.
How common is pleural mesothelioma?
Australia has one of the highest rates of mesothelioma in the world. According to the Australian Mesothelioma Registry, each year close to 600 Australians are diagnosed with pleural mesothelioma. Men are over three times more likely than women to be diagnosed with pleural mesothelioma. This is probably because many cases have been caused by exposure to asbestos at work (see below). Western Australia has the most cases per population due to past asbestos mining.
Pleural mesothelioma is more common in people over the age of 70, but can sometimes occur in younger people.
What causes pleural mesothelioma?
Exposure to asbestos is generally the only known cause of mesothelioma. Sometimes mesothelioma is linked with previous radiotherapy to the chest.
Asbestos is the name of a group of naturally occurring minerals that are resistant to high temperatures and humidity. It was used in many building products in Australia from the 1940s until 1987.
People most likely to have been exposed to asbestos at work include asbestos miners and millers, transport workers (especially waterside workers), laggers and insulators, builders, plumbers and electricians, mechanics, and asbestos cement manufacturing workers.
People who haven't worked directly with asbestos but have been exposed to it can also develop mesothelioma. This can include people washing or cleaning work clothes with asbestos fibres on them or people renovating homes.
It can take many years after being exposed to asbestos for mesothelioma to develop. This is called the latency period or latent interval, and is usually between 20 and 60 years.
"I remember buying sheets of asbestos and using it in bathrooms. You didn't think about it. My kids were little and we were all out there renovating." – Carol
People who develop mesothelioma due to asbestos exposure may be able to claim compensation. It's important to get legal advice from an experienced lawyer as soon as possible after diagnosis. See making a claim.
What are the symptoms?
The earliest signs of pleural mesothelioma are often vague and similar to other conditions or diseases. If you are concerned, especially if you think you've been exposed to asbestos, see your general practitioner (GP).
Shortness of breath (breathlessness)
Most people with pleural mesothelioma experience breathlessness. You may feel like you can't catch your breath no matter what you do. It usually feels worse with activity or when you are lying down. In early mesothelioma, breathlessness is caused by a build-up of fluid in the chest (pleural effusion). See draining fluid from the pleura for information on how this can be treated.
Pain
This can be a sharp pain in the chest, which affects your breathing, or a dull pain in the shoulder and upper arm. The pain might not improve with pain relievers.
Other general symptoms
Less commonly, people notice loss of appetite with weight loss, a persistent cough, or a change in their coughing pattern. Some people also experience heavy sweating, especially at night.
What will it mean for me?
When your doctor first suggests that you may have pleural mesothelioma, you and your family will be understandably shocked. It's common to have many questions and concerns about what the diagnosis will mean for you.
To understand what is happening, it may help to break down the process into a series of steps. The diagram below is a guide to the main steps. Mesothelioma is different for everyone and you may not go through each step in the order shown. You can use the diagram to see what stage you are at and read the section relevant to you.
The diagnosis stage is represented as a central pathway leading to active treatment. This will involve making treatment decisions about the best care for you. During these periods, your health care team will also focus on treating symptoms and improving your quality of life.

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Treatment and Support for Pleural Cancer

Asbestos cancer is more commonly known as mesothelioma.

Mesothelioma, the type of cancer most commonly associated with asbestos exposure, is a malignancy that occurs in the lining of the lungs, abdomen, and heart. A mesothelioma diagnosis is generally classified as one of the following three types: pleural mesothelioma which occurs in the lining of the lungs (the pleura); peritoneal mesothelioma which occurs in the lining of the abdominal cavity (the peritoneum); and pericardial mesothelioma which occurs in the lining of the heart (the pericardium).

Asbestos, which has been used for, quite literally, thousands of years as a fire-retardant and insulation material has long been connected to sickness, though not necessarily cancer until the last 50 years. Once asbestos was classified as a known carcinogen, the Environmental Protection Agency and Consumer Product Safety Commission imposed strict regulations on its use in commercial and industrial products. Unfortunately, many of the companies producing asbestos products were well aware of the hazards which asbestos posed and continued to expose workers and laborers to the harmful asbestos fibers.

The diagnosis of asbestos cancer is often difficult due to the symptoms of the disease mimicking those of other illnesses.

Asbestos cancer diagnosis, including diagnosis of mesothelioma and lung carcinoma, can be difficult because symptoms of the disease can closely mimic those of other, more minor, respiratory complications. Symptoms, such as shortness of breath, chest pain, or chronic cough, may lead physicians to suspect mesothelioma, particularly if the patient has a known asbestos exposure history.

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Diagnostic tools include CT scans and MRIs for patients where asbestos cancer is suspected. In most cases, these imaging scans will be able to provide a picture of the tumor, but a biopsy will likely be required to determine a conclusive diagnosis of mesothelioma rather than other lung carcinomas. In cases where pleural or peritoneal effusions have manifested in the patient, draining these and extracting the fluid through pleurocentesis can allow oncologists to test the fluid for the presence of malignant cells.

Asbestos Cancer Treatment

Asbestos cancer treatment options typically include some combination surgery, chemotherapy, and radiation

Depending on the location of the cancer, generally asbestos related malignancies can be difficult to resect because the latency period over which the cancer goes undetected can often extend into the time period where the tumor develops through its preliminary stages. Later stage cancers, and particularly those related to asbestos, will often not be resectable malignancies. While diagnosis of early stage asbestos cancer is uncommon, certainly those eligible for surgical removal will often have the cancer resected. Adjuvant chemotherapy is often administered after surgery to complement the resection.

Pleurectomy and extrapleural pneumonectomy, both extensive surgeries, are often used in the treatment of pleural asbestos cancer. Surgery is much less common in malignant peritoneal and pericardial cancer, as the origin of the tumor is difficult to access without endangering the survival of the patient.

Top Mesothelioma Surgeons in the Country
David Sugarbaker, M.D.
David Sugarbaker, M.D.

Professor of Surgery, Chief of General Thoracic Surgery, Director of the Lung Institute Map Marker Baylor College of Medicine
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Raphael Bueno, M.D.
Raphael Bueno, M.D.

Chief, Division of Thoracic Surgery; Vice Chair of Surgery for Cancer and Translational Research Map Marker Brigham and Women's Hospital
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Chemotherapy is the most frequently utilized treatment mechanism for the control of asbestos cancer. Drugs like Alimta®, Cisplatin, and Gemcitabine have all been used with varying degrees of efficacy to halt or slow the spread of malignant mesothelioma and lung carcinomas. Ongoing clinical trials continue to test new drugs and drug cocktails for the management and treatment of asbestos cancer. Recent trends suggest that researchers are making strides in determining approved treatment regimens not only for malignant pleural mesothelioma, but also peritoneal and pericardial cancers.

Currently, the only FDA-approved chemotherapy regimen for the asbestos cancer malignant pleural mesothelioma is a combination of Alimta® and Cisplatin, delivered intravenously, with 21 days between each subsequent injection. Asbestos lung cancer carcinomas are also treatable with chemotherapy. Because asbestos cancer incidence of this type is much more prevalent (and not necessarily directly attributable to asbestos exposure), there are many more chemotherapy options available to patients.

External beam radiation is popular among patients receiving treatment for pleural and peritoneal cancer. Pericardial cancer patients may also utilize radiation in the control of their cancer, but in lower dosages considering the region's proximity to the heart. Radiation therapy is considered useful for palliation as well to prevent malignant cells from taking hold again following surgery.

As part of developing studies into the control of asbestos cancer through radiotherapy, researchers have begun utilizing brachytherapy to control mesothelioma tumor spread and growth. Brachytherapy is an internal radiation source implanted in the affected area which has shown promise in clinical studies in reducing tumor mass and slowing. Every year, survival rates are extended further and more funding is now being invested in research to evaluate new options for treatment. Researchers hope to, one day, find a cure for mesothelioma.

Resources for Asbestos Cancer Patients and Families

Request a Free Asbetsos Cancer Treatment Guide
Connect with Top Asbestos Cancer Doctors
Locate the Nearest Comprehensive Cancer Center
Support a Loved One Diagnosed with Asbestos Cancer
Learn about your Legal Rights
Financial Assistance Available to Help with Treatment Costs
Financial Assistance for Asbestos Cancer Victims

Many asbestos cancer patients have successfully collected compensation from asbestos companies responsible for their exposure.

Unfortunately, it has come to light in recent years that many manufacturers of asbestos products were fully aware of the harmful nature of asbestos fibers and continued to expose hundreds of thousands of laborers to the toxic mineral. Asbestos products were prevalent in naval shipyards, power plants, oil refineries, and in ventilation/steam fixtures. Asbestos was also common in home construction materials, automobile parts, and thousands of other products.

Fortunately, you may be eligible for financial assistance if you have been diagnosed with asbestos-related cancer or other injury. While prognosis for asbestos related cancer is often poor, those who have been exposed negligently are able to secure compensation for their treatment as well as for their families in their battle with terminal disease. If you or a loved one has been diagnosed with mesothelioma or other asbestos disease, we urge you to fill out the brief form on this page. We'll send you an up-to-date information packet on new treatment options for mesothelioma, how to obtain compensation for your injuries, and important timelines associated with legal recourse for asbestos cancer patients.

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