Source: Cancer Resource Room

What is mesothelioma?
Mesothelioma is a cancer of the lining tissue inside the chest or abdomen. In this section, only mesothelioma of the chest lining will be explained. The chest lining tissue is called the pleura. The pleura cover the lungs and the inner chest wall. The lung covering is called the visceral pleura and the chest wall lining is called the parietal pleura. Mesothelioma can start in or spread to any part of the pleura. Like any cancer, mesothelioma is the result of abnormal cells growing and dividing without control. They form clumps of abnormal cells called a tumor. The tumor cells invade nearby tissues and spread to other tissues through the blood and lymph. Mesothelioma cells can form many small flat tumors in the lining before spreading to other tissues.

Mesothelioma is a rare cancer; only 2000 to 3000 new cases are diagnosed in the United States each year. Even so, many people have heard of mesothelioma. This is because of its suspected relation to asbestos. If someone develops mesothelioma, it is usually 20 to 40 years after asbestos exposure.

What are the symptoms of mesothelioma?
The symptoms of mesothelioma include:

• shortness of breath (dyspnea)
• difficulty taking a breath or painful breathing
• cough
• pain in the chest or upper back

Mesothelioma causes breathing problems and pain. The most common breathing problem is called dyspnea (shortness of breath). The tumor cells make the lining tissues stiff, so the lungs and chest cannot expand as easily as they should. The stiffness of the lining tissue makes the patient work harder to breathe. Fluid in the chest can also make breathing difficult. The tumor causes fluid to build up inside the chest between the lining layers. The lungs cannot expand where there is fluid, so less air is taken into the lungs with each breath.

Pain in mesothelioma can be caused by irritation of the pleura. Pain can come from the tumor cells invading the nerves between the ribs. The nerves are close to the inner lining of the chest and can get trapped among invading tumor cells. The nerves then get pulled on when the chest expands in breathing.

How is mesothelioma diagnosed?
A patient with shortness of breath or painful breathing should be examined by a doctor. A medical history and physical exam, especially of the chest, are important in evaluating the patient. Some tests that help in the diagnosis of mesothelioma are:

• Chest x-ray-a regular chest x-ray to look for thickening of the pleura (chest lining tissue), spots of tumor, or fluid in the chest.
• Chest CT or MRI scan-a series of thin, cross-section x-rays of the chest to show small tumors, the size and spread of tumors seen on a plain chest x-ray, and invasion of tumor into nearby tissues and lymph nodes.
• Thoracentesis and pleural biopsy-if fluid has built up in the chest (called an effusion), a sample of the fluid can be drained out and used for diagnosis. This procedure is done with a thin needle and local anesthetic to numb the skin where the needle is inserted. If the fluid is caused by a tumor, cancer cells may be found in it. The cancer cells do not make a definite diagnosis of mesothelioma, but do mean that a biopsy of tissue from the pleura is needed.
• Thoracoscopy-a narrow tube with a video camera is put into the chest. The procedure is done under general anesthesia in the operating room and requires a short hospital stay. The thorascope is used to look at the tissues inside the chest and to take biopsies (small pieces of tissue) of any tissue that looks abnormal. A pathologist examines the tissue under a microscope. The pathologist can tell whether or not the tissue is from a mesothelioma.

What is the stage of mesothelioma and what does it mean?
The stage of a cancer tells how much tumor there is and whether or not it has spread nearby or to other parts of the body. The stage of a cancer is used in making treatment decisions. It also gives information about the ability to cure the disease. There are three staging systems in use today.

1. Brigham system-describes the tumor by whether or not it can be removed by surgery. It includes information about spread of disease to lymph nodes, too.
2. Butchart system-based on spread of disease in the chest and to other parts of the body.
3. TNM system-determines stage from Tumor size, spread to lymph Nodes, and Metastasis to other parts of the body.

As an example, the Brigham system will be explained. This system stages mesothelioma by whether the tumor can be removed by surgery, and by spread of cancer to lymph nodes.

• Stage I: surgically removable tumor and no lymph node spread
• Stage II: surgically removable tumor with lymph node disease
• Stage III: not surgically removable because tumor extends into the chest wall, to the heart, or through the diaphragm into the peritoneum (abdominal lining). Lymph nodes outside the chest may or may not have disease in them.
• Stage IV: disease spread to other parts of the body

All staging systems are used to decide what treatments are needed and to predict the chances that the disease can be cured.

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