Mesothelioma is atumor of the lining of the lungs, heart, or abdomen. Mark Iannettoni, MD, professor and head of the cardiothoracic surgery department, UI Hospitals and Clinic, talks about this specific tumor and its treatment:
Are mesothelioma tumors generally benign or malignant?
Mesothelioma is usually a malignant tumor that occurs in the lining over the lung and affects usually, one side more than the other.
What causes mesothelioma tumors?
What we’ve been able to find is that mesothelioma is usually associated highly with asbestos exposure. When asbestos was used in insulation or in brake linings (there was a high concentration in the plumbing industry and in the Boston shipyards), it used to be used relatively common—especially in larger buildings such as schools. The other exposure is when people were removing the asbestos for reconstructions. We’re probably going to see a lot more problems with mesothelioma after the 9-11 incident.
Are there other ways that people were exposed, maybe indirectly, to some of this asbestos?
Yes, there have been reports of people actually not working with the material itself, but simply cleaning people’s clothes that worked in the shipyards. There have been reports of people who worked in buildings and who had no smoking history or no exposure history whatsoever to develop the disease, but through the air conditioning ducts had developed mesothelioma.
How many years after the initial asbestos exposure might someone develop this type of tumor?
One of the difficult things with mesothelioma is that it develops very, very slowly, so exposure and development of disease usually takes about 20 to up to 50 years before the disease becomes apparent in symptomatic form.
What are the symptoms of a mesothelioma tumor?
When we talk about mesothelioma, we’re usually talking about a disease of the chest or the covering over the lung. It’s usually associated with gradual shortness of breath; people will become more and more short of breath with regular activity. They’ll wind up with frequent pneumonias, and sometimes it can be associated with pain—generalized chest pain. The other associated symptom is weight loss, and this is usually the most common three problems that we will see. And it’s a gradual onset so it takes a long time to make the diagnosis.
How are the tumors diagnosed?
Usually it’s made on a chest X-ray. There’s a classic abnormality that we’ll see with calcification or plaquing in the lung. As well, we’ll see it more commonly now on the CT scan with thickening of the covering over the lung, and then we’ll make the diagnosis by actually obtaining a piece of tissue through a small incision in the chest wall with a camera and a scope.
Are there different stages of tumor development?
Yes, and unfortunately we usually find mesothelioma in late stages and it’s confined, usually, to one side of the chest when it occurs. The other issue that can happen is that it can grow through the diaphragm and affect the abdomen, as well. It has typical staging similar to lung cancer.
What is the treatment mesothelioma?
The initial treatment is to stage the patient, and if it is confined to the chest, the treatment is initially surgery to try to remove or debulk the tumor as much as possible. There are two forms of mesothelioma and the cell types actually determine prognosis. What we try to do is remove the entire lining of the chest, the lung, and the covering over the heart, as well as the diaphragm, and then reconstruct that. Then people are typically given chemotherapy and radiation therapy for residual disease after their surgical treatment.
If the mesothelioma tumor is cancerous, is it curable?
Mesothelioma in certain forms is curable, but the cure rates we’re looking for usually are in the 5 to 10 percent range for five years. Unfortunately, it’s a disease that we typically measure survival in months after treatment. There are a few case reports or series that look at cure rates in carefully selected patients of up to 20 percent of patients being cured from the disease. |
