PLEURAL EFFUSION

One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these membranes are covered with mesothelial cells which, under normal conditions, produce a small amount of fluid that acts as a lubricant between the chest wall and the lung. Any excess fluid is absorbed by blood and lymph vessels maintaining a balance. When too much fluid forms, the result is an effusion.

TYPES

Pleural effusion is broken down into two categories, transudates and exudates. A transudate is a clear fluid that forms not because the pleural surfaces are diseased, but because of an imbalance between the normal production and removal of the fluid. The most common cause of transudative fluid is congestive heart failure. An exudate, which is often cloudy and contains many cells and proteins, results from disease of the pleura itself, and is common to mesothelioma. To determine whether a fluid is a transudate or exudate, a diagnostic thoracentesis, in which a needle or catheter is used to obtain a fluid sample, may be conducted.

SYMPTOMS

As the volume of fluid increases, shortness of breath, known as "dyspnea", and sometimes pain, ranging from mild to stabbing, may occur. Some patients may experience a dry cough. When the doctor listens to the patient’s chest with a stethoscope, normal breath sounds are muted, and tapping on the chest will reveal dull rather than hollow sounds.

DIAGNOSIS AND TREATMENT

DIAGNOSIS

Diagnosis of pleural effusion is usually accomplished with a simple chest x-ray, although CT scans or ultrasound may also be used. A special x-ray technique, called a lateral decubitus film, may be used to detect smaller effusions or to enable the physician to estimate of the amount of fluid present. If the underlying cause of the effusion is readily apparent (such as in the case of severe congestive heart failure), sampling of the fluid may not be necessary, however, because pleural effusion may be symptomatic of a number of disease processes from benign to malignant, a fluid sample is generally taken. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists, however, in up to 85% of cases, the fluid tests negative or inconclusive even though cancer is present. It is ultimately a needle biopsy of the pleura (lining of the lung) or an open surgical biopsy which confirms a mesothelioma diagnosis.

TREATMENT

Pleural effusion caused by heart failure or infection can usually be resolved by directing treatment at the cause, however, when testing has realized no diagnosis, and fluid continues to build or recur, doctors may recommend chest tube drainage and chemical pleurodesis. Chemical pleurodesis is a technique in which a sclerosing agent is used to abrade the pleural surfaces producing an adhesion between the parietal and visceral pleurae. This will prevent further effusion by eliminating the pleural space. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is administered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution which forms a wet slurry that can roll around the pleural cavity.

MESOTHELIOMA SYMPTOMS

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

PLEASE KEEP IN MIND THAT THESE SYMPTOMS MAY BE CAUSED BY MESOTHELIOMA OR BY OTHER LESS SERIOUS CONDITIONS. ONLY A DOCTOR CAN MAKE A DEFINITIVE DIAGNOSIS.

MESOTHELIOMA COMMON QUESTIONS

What is Mesothelioma? What is the difference between pleural mesothelioma and peritoneal mesothelioma?Malignant mesothelioma is a disease in which a cancerous tumor grows on the mesothelium - the sac lining the internal body cavities. The specific type of mesothelioma is named for the tissue where the cancer started. Pleural mesothelioma starts in the chest, in the pleura that surrounds the lungs (outer lining of the lungs and internal chest wall). It makes up about 70% of mesothelioma cases. Peritoneal mesothelioma starts in the lining of the abdominal cavity.

Although sometimes referred to as "asbestos lung cancer", mesothelioma is not the same as lung cancer. Lung cancers occur inside the lung itself; mesothelioma occurs in the lining of the lung. Mesothelioma is rare, striking fewer than 3000 Americans per year.

What happens inside the body?
The cancerous cells clump together in a malignant tumor.  As it grows, the tumor pushes against and into other organs and healthy tissue, causing symptoms.  Because the mesothelium is a flat thin lining, the mesothelioma tumor often takes a diffuse shape.

In its advanced stage the cancer metastasizes through the lymph system and spreads to other parts of the body.  It is still referred to as mesothelioma because it started in the mesothelium. 

What are the symptoms of mesothelioma? 
Our mesothelioma symptoms page goes into detail about the signs of this cancer. It is important to seek professional medical advice when trying to diagnose for mesothelioma because the symptoms can be confused with symptoms of other diseases.

Major symptoms of pleural mesothelioma include:

• Shortness of breath caused by expanding pleural effusion
• Persistent dry cough
• Chest pain

Major symptoms of peritoneal mesothelioma include:

• Ascites (fluid in the abdomen)
• Swelling or lumps in the abdomen
• Abdominal pain

Some patients experience few of the visible symptoms.  Formal diagnostic procedures are needed to determine if the cancer is present.

How do you get malignant mesothelioma?
Mesothelioma is caused by asbestos exposure. Asbestos, once regarded as a miracle mineral, was popular due its lightweight but tough characteristics as well as for its heat-resistant properties. This naturally occurring mineral was used in many commercial and consumer products, from construction materials such as cement, roofing shingles and insulation, to consumer and industrial applications such as hair dryers, automobile brake pads and pipe insulation.

Most people with malignant mesothelioma worked on jobs where they breathed asbestos. Others were exposed to asbestos in a household environment, often without knowing it.

How much exposure does it take to get the disease? What is the latency period?
Very little exposure can result in mesothelioma. Sometimes people who worked with asbestos for as little as one or two months get mesothelioma. The "latency period" refers to the time between asbestos exposure and diagnosis of the disease. For mesothelioma, the latency period can be decades long, and people exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed.

How do doctors treat malignant mesothelioma?
Each patient has an individualized treatment plan which takes into account the type and stage of the cancer as well as the patient's overall health. Traditional mesothelioma treatments include surgery, chemotherapy, radiation or a combination of these. Contact us at 1-877-367-6376 if you want to talk about reviewing treatment options.

Is there any promising research or are there promising new drugs for mesothelioma?
Scientists and doctors are conducting research at cancer centers all over the United States. Researchers are continually developing new and more effective drugs as well as new surgical and radiotherapy treatment techniques. In the past few years, there have been several major advances in the management of mesothelioma, including more accurate staging, improvements in surgical techniques and postoperative care, new chemotherapy regimens, and new radiotherapy techniques such as intensity-modulated radiation therapy. Some of this research is being conducted through clinical trials on meothelioma patients, for which you may be eligible. Please call us if you need additional information on current trials.

What should I do if I think I've been exposed to asbestos but don't have mesothelioma?
You probably will not get this rare disease, but you should remain vigilant and get regular check-ups. Let your doctor know about your asbestos exposure.

I was exposed to asbestos when I was in the military. Could that be how I got mesothelioma?
The armed forces used asbestos extensively in the 20th Century.  Mesothelioma has a long latency period and often does not appear until decades after the patient came into contact with asbestos. Veterans from all branches of the service are now developing malignant mesothelioma. We have worked with veterans from all over the country. We can help you find VA resources and medical assistance. Our veterans section goes into more detail or feel free to call us at 1-877-367-6376.

Where can I find information on living with mesothelioma?
Mesothelioma Aid is a good website for resource for families dealing with mesothelioma. It includes advice and referrals to other resources for coping with cancer, caregiving, financial challenges, and support groups. Alternatively, contact us here at Mesothelioma Web for help finding resources for dealing with this disease and for getting treatment.

What other resources are available for people with malignant mesothelioma?
Should you need more information or have additional questions, please contact us and we can refer you to sources that can answer your specific question. We can be reached at 1-877-367-6376.

How is Peritoneal Mesothelioma Diagnosed?

Mesothelioma doctors may suspect peritoneal mesothelioma if the patient complains of stomach, chest, or abdominal pain. Suspicious hernias may actually be a pleural effusion caused by peritoneal tumor growth. Misdiagnosis is common and patients will likely undergo multiple imaging scans and a diagnostic biopsy before an official diagnosis is made.

Diagnostic procedures in which fluid is extracted from the peritoneum for lab testing are the only way to conclusively diagnose peritoneal mesothelioma. Samples will be examined for the presence of malignant cells. Once malignant cells are detected, further testing will be needed to classify these cells as malignant mesothelioma.

What Causes Peritoneal Mesothelioma?

Peritoneal mesothelioma is known only to be caused by exposure to asbestos, a microscopic natural fiber that was used heavily in industry. Asbestos is said to reach the abdominal wall by one of two methods. The first is through ingested asbestos fibers which are processed through digestion and become lodged in peritoneum. These other method is through the lungs and lymph nodes, by inhaled asbestos fibers. Malignant mesothelioma of the pleura is also known to metastasize directly into the abdominal cavity if its spread is not slowed.

Many of those who have worked with asbestos materials have developed peritoneal mesothelioma as a result of exposure to friable asbestos fibers. Asbestos was used in myriad industrial materials and construction products. Exposure to asbestos was common in aluminum plants, steel mills, power plants, and naval shipyards.

Peritoneal mesothelioma is a relatively rare disease, with only 200-500 diagnoses each year in the United States being documented. Risk however, is sustained in those who have been exposed to asbestos. Even those exposed many years ago are potentially at risk for the development of malignant peritoneal mesothelioma. Latency between exposure to asbestos and the development of peritoneal mesothelioma symptoms can be anywhere from 20-50 years. Misdiagnosis is also common because peritoneal mesothelioma symptoms closely mimic minor stomach/abdominal discomfort and hernia. Nevertheless, those with clear asbestos exposure history should be aware of the disease and speak with their doctor or cancer specialist if they believe they be experiencing symptoms related to mesothelioma.

How is Peritoneal Mesothelioma Treated?

Prognosis of mesothelioma patients is poor, and peritoneal mesothelioma patients are no exception. Most peritoneal mesothelioma treatment regimens for patients include palliative methods such as mesothelioma chemotherapy and radiation therapy. However, if the disease is diagnosed in its earlier stages, such patients as those diagnosed with stage 1 mesothelioma, these individuals  may be eligible for surgical resection of the disease, which could potentially add years to initial prognoses.

Surgery is possible for patients diagnosed with earlier-stage disease. Some surgical options include pneumonectomy, extra-pleural pneumonectomy, and palliative procedures such as thoracentesis or pleurodesis. Pneumonectomy and extra-pleural pneumonectomy are extensive procedures that involve there removal of the affect lung and surrounding body structures. Certain physicians, including Dr. David Sugarbaker of the International Mesothelioma Program at Brigham and Women’s Hospital in Boston, MA, have become extremely well-versed and experienced in the surgical treatment of malignant mesothelioma. In many cases, surgical treatments for mesothelioma will be coupled with chemotherapy or radiation therapy regimens.

Chemotherapy is the most common treatment for mesothelioma disease. Currently, there is only a single chemotherapy regimen (Alimta (pemetrexed) in conjunction with Cisplatin) approved by the Food and Drug Administration as a prescribed therapy for the treatment of malignant pleural mesothelioma. There are however, dozens of clinical trials being conducted for mesothelioma patients experimenting with new drugs, including gemcitabine, Navelbine, Onconase, and others for the treatment of malignant peritoneal mesothelioma.

Peritoneal Mesothelioma

Malignant peritoneal mesothelioma is a rare type of cancer that occurs in the thin cell walls which surround the abdominal cavity, known as the peritoneum. This thin membrane acts a lubricant within the abdominal cavity so that surrounding organs and internal body structures may contract and expand within their normal body function.

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Other types of mesothelioma cancer include malignant pleural mesothelioma, occurring in the cell wall surrounding the lungs, and malignant pericardial mesothelioma, which occurs in the pericardial lining of the heart. Peritoneal mesothelioma is the second rarest form of the disease and accounts for approximately 20% of all mesothelioma cases each year.

Pericardial Mesothelioma

Malignant mesothelioma is a type of cancer that originates in the mesothelium, a thin wall of cells that surround the body's organs and internal structures. Pericardial mesothelioma originates in the lining of the heart. Other locales of the disease are malignant pleural mesothelioma, which occurs in the lining of the lungs and malignant peritoneal mesothelioma, which occurs in the abdomen wall. Pericardial mesothelioma is the rarest of these malignancies and accounts for only an estimated 10 percent of all mesothelioma incidences annually.

What Causes Pericardial Mesothelioma?

Pericardial mesothelioma is an asbestos cancer, meaning it's only known cause is asbestos exposure. Asbestos is a naturally occurring, but toxic, mineral that was used in industrial capacities. While the precise route by which microscopic asbestos fibers reaches the pericardial lining is not known, mesothelioma doctors surmise that inhaled asbestos fibers are absorbed into the bloodstream and become entangled in the heart's lining as the blood processes through the heart. Malignant mesothelioma occurring in other parts of the body, such as in the pleura or peritoneum, can also metastasize to the pericardial lining.

How is Pericardial Mesothelioma Treated?

Prognoses are poor in cases of pericardial mesothelioma, just as nearly every mesothelioma prognosis is. However, several treatment options exist to help patients manage the disease and maintain comfort. Chemotherapy and radiation therapy are the most likelymesothelioma treatment options for patients of this disease. Mesothelioma surgery is typically not an option because of the location of the disease and the risk of grave damage to the tumor area.

What Causes Pleural Mesothelioma?

Pleural mesothelioma is known only be caused by exposure to asbestos. Asbestos is a naturally occurring and microscopic mineral that was used for hundreds of years in a number of different industrial compounds. Asbestos fibers are extremely durable, but also extremely difficult to expel from the body once introduced to the internal tissue.

Upon inhalation, asbestos fibers will lodge on the outer layers of the lung tissue and within the pleura, a thin membrane of mesothelial cells which lines the chest cavity. This lining allows for the free movement of the body’s internal body structures because it provides a special lubrication to the surface of these structures. The pleura, like other mesothelial membrane, is a delicate structure and even microscopic asbestos fibers can cause pleural plaques to form on its surface and eventually, pleural mesothelioma tumor cells. Generally, it takes many years between asbestos exposure and the development of adverse health complications, as the fibers will slowly irritate and inflame the internal tissue until symptoms appear.

Many of those exposed to asbestos have successfully received compensation from asbestos product manufacturers for injuries and illnesses such as pleural mesothelioma. If you believe you were wrongfully exposed to asbestos and have developed an asbestos-related health complication, we urge you to complete the brief form on this page. We’ll rush you a complimentary mesothelioma and asbestos exposure information packet detailing advancements in the treatment of pleural mesothelioma, top doctors and cancer centers, and mesothelioma attorney options you may have.

Pleural Mesothelioma Chemotherapy

Chemotherapy is likely the most prevalent treatment utilized by patients of malignant pleural mesothelioma. While several different chemotherapy drugs have been utilized to varying degrees of effectiveness for the management of malignant pleural mesothelioma, only one has been approved by the Food and Drug Administration as a prescribed therapy for the treatment of malignant pleural mesothelioma. A combination of Alimta(Pemetrexed) and Cisplatin is currently the only cocktail prescribed en masse for the general treatment of pleural mesothelioma. However, several other clinical trials are currently active attempting to determine the effectiveness of other drugs including Gemcitabine, Navelbine, and Onconase.

Pleural Mesothelioma Radiation Therapy

Radiation therapy has been utilized in the treatment of many types of cancer and pleural mesothelioma is no different. Often, radiation is not able to manage cancer by itself so it is combined with either surgery, chemotherapy, or both to augment the treatment plan as a whole. Radiation therapy for pleural mesothelioma utilizes external beam radiation to mutate tumor cells within the body and slow their growth and spread.

Alternative Therapy for Pleural Mesothelioma

A growing school in cancer care is integrative approaches in the treatment of cancer. Integrative oncology utilizes not only the conventional therapies discussed above, but also untraditional therapies such as acupuncture, massage, and reflexology to assist the patient in managing pain, anxiety, and restlessness. Patients battling pleural mesothelioma have effectively utilized alternative therapies such as these to increase the effectiveness of their treatment program overall. Generally, patients who are able to withstand the difficult side-effects of more potent chemotherapy and radiation treatments will be best able to extend their mesothelioma prognosis. Patients of pleural mesothelioma who have utilized alternative therapies have been able to do just that. However, most of these therapies are preferential and will depend on the health of the patient as to whether or not they will be able to engage in them. As will anything, patients should seek the consultation of their physician or cancer specialist before engaging in any alternative therapy.

Pleural Mesothelioma Treatment

Nearly all patients diagnosed with pleural mesothelioma are able to receive some form of treatment for their illness. While there is currently no cure for mesothelioma, patients have been able to extend survival rates through advanced mesothelioma treatment regimens currently being developed at mesothelioma clinics and cancer centers across the United States.

Pleural Mesothelioma Surgery

Surgical resection is difficult in pleural mesothelioma patients when the disease is diagnosed in later stages because at that time the tumor has typically metastasized to other areas of the body like the abdominal cavity and lymph nodes. However, in early stage diagnoses, surgery can absolutely be utilized to slow the advance of mesothelioma disease.

Common surgical procedures utilized in the management of malignant mesothelioma are pneumonectomy and extrapleural pneumonectomy. Pneumonectomy is a general procedure utilized not only in patients of malignant mesothelioma, but also those battling lung cancers or related lung conditions. Pleurectomy involves the removal of a portion or the entire affected lung in patients. Extrapleural pneumonectomy is a more comprehensive procedure that is more tailored to mesothelioma patients. Extrapleural pneumonectomy involves the removal of the entire affected lung, the pleura, the diaphragm, and the pericardium, which is the mesothelial lining that surrounds the heart cavity.

Pleural Mesothelioma

Pleural mesothelioma is often seen in people who have been exposed to high levels of asbestos on the job. It sometimes takes 10 years or more for changes to appear that are indicative of pleural disease which affects the thin membrane layer in the chest. These differences can include a thickening or calcification of the pleural lining and is usually diagnosed as pleural plaques, pleural thickening and pleural calcification.

In most instances, pleural disease is not considered fatal but it does have the ability to impair lung function and it does confirm that a person has sustained significant asbestos exposure and could be at a higher risk for developing more severe asbestos cancer. If you have been diagnosed with pleural disease it is important to preserve your legal rights.

However, pleural plaques can lay the groundwork for pleural mesothelioma, which is an extremely aggressive cancer known only to be caused by asbestos exposure. Pleural mesothelioma originates in the pleura but quickly spreads to the outer chest wall, abdomen, and heart. Pleural mesothelioma is typically fatal within 1 year of diagnosis. However, early recognition of risk factors, like asbestos exposure will typically lead to early detection of the cancer. Those whose disease is discovered early enough will likely be much more eligible for life-sustaining and bettering treatments. Patients who receive an early mesothelioma diagnosis may be eligible for surgical resection of the cancer, which can extend life years beyond that of typical mesothelioma patients.

There are ways for patients to manage the disease through mesothelioma treatment, including traditional mesothelioma radiation and chemotherapy methods which can ease symptoms of the disease and make the cancer much more manageable. In patients where a diagnosis is made of early stage disease, mesothelioma surgery can extend the survival ratefar beyond previous levels in untreated disease.

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Mesothelioma Treatment

Once an individual has been diagnosed with mesothelioma, the next step is to discussmesothelioma treatment options with his/her physician. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing mesothelioma and supporting improved quality of life. Newly diagnosed mesothelioma patients always have many questions about the treatment options that would be most effective for them, including those about new treatment therapies like Alimta® and Cisplatin and other chemotherapy drugs. In addition to these newer drugs that are being used to treat asbestos cancer, mesothelioma patients also have a number of "conventional" treatment options to consider, including mesothelioma chemotherapy, radiation therapy and surgery.

Mesothelioma clinical trials and experimental treatments are still other options that some mesothelioma patients may be eligible to participate in. Our site features a comprehensivemesothelioma cancer treatment section that includes important information for patients and families. We've included resources on top mesothelioma doctors such as Dr. Sugarbaker, as well as a comprehensive list of questions that you may wish to discuss with your personal physician when preparing a mesothelioma treatment plan. We are always providing new and informative resources regarding mesothelioma treatment including: Clinical Trials, conventional treatments, experimental therapies, as well as alternative mesothelioma treatment options. Check back often for the most recent advances in mesothelioma treatments.

Who is at risk for Mesothelioma?

The only recognized cause of mesothelioma is exposure to asbestos, though other factors such as smoking can make mesothelioma more or less likely in some individuals. Industrial laborers were widely subjected to asbestos exposure on the job, as the material was widely used throughout the 20th century. Few of these workers knew they were being exposed to asbestos and thus put at risk for mesothelioma, however, despite the fact that many manufacturers were aware the material was hazardous. In most cases, mesothelioma symptoms will not appear in an individual exposed to asbestos until many years after the exposure has occurred. Those who believe they may have been exposed to asbestos are at risk for mesothelioma and should fill out our form to receive a free mesothelioma information packet, detailing treatment options, emerging therapies, and jobsite exposure information.

What is Mesothelioma?

Mesothelioma is a rare form of cancer that can arise in the mesothelial lining of the lungs, heart or abdomen. Some cases have even been reported to develop in the lining of the testicles as well. These four types of mesothelioma are called pleural mesothelioma (lung), pericardial mesothelioma (heart), peritoneal mesothelioma (abdomen) and testicular mesothelioma.

Combined, these cancers affect 2,000 to 3,000 people in the United States each year. Receiving a diagnosis can be difficult due to the similarity of symptoms to other, more common conditions and doctors may overlook mesothelioma as a diagnosis. Another contributing factor that makes these cancers difficult to diagnose is the severe latency period of symptoms. From the time of someone's initial exposure to asbestos, the primary cause of mesothelioma, signs of development may take as long as 20 to 50 years to arise.

Mesothelioma Symptoms

Unfortunately, there are no early symptoms of mesothelioma. A patient's best chance of detecting mesothelioma at an early stage of development is through receiving regular checkups for signs of asbestos exposure with a qualified physician. Symptoms of pleural mesothelioma may include shortness of breath, difficulty while swallowing, or having a persistent raspy cough. Pericardial mesothelioma symptoms may include chest pain, coughing, fatigue or having an irregular heartbeat. Peritoneal mesothelioma may carry symptoms involving fatigue, nausea, abdominal pain or swelling and the development of lumps under the skin on the abdomen. Due to the rarity of the cancer, very little information has been reported concerning symptoms of testicular mesothelioma.