Malignant Mesothelioma: Frequently Asked Questions

Here are some answers to frequently asked questions about malignant mesothelioma.

What is malignant mesothelioma?

Malignant mesothelioma is a rare kind of cancer. It starts in the mesothelial cells which form a lining called the mesothelium. This lining protects your internal organs. These include your lungs, heart, and organs in the abdomen.

The cancer can start in any of these places. When this cancer starts in the lining of the lungs, healthcare providers call it pleural mesothelioma. This is the most common type. This cancer can also start in the lining of the heart or abdomen, but this is not as common. Rarely, this type of cancer can start in the lining around the testicles.

Who gets malignant mesothelioma?

Most people who get this type of cancer have worked with asbestos in the past. More men get it than women. Most people who get it are older than 65.

What are the risk factors for malignant mesothelioma?

Certain factors can make a person more likely to get this type of cancer than another person. These are called risk factors. Just because a person has one or more risk factors does not mean he or she will get the cancer. In fact, a person can have many risk factors and still not get the disease. On the other hand, a person may have few or no risk factors and get malignant mesothelioma. Here are some things that may put a person at risk for this cancer:

• Exposure to asbestos. The main risk factor for this cancer is contact with asbestos. People who have worked with asbestos include miners, factory workers, construction workers, and insulation manufacturers and installers. They also include ship construction workers, railroad and automotive workers, and those in other asbestos-related fields. Family members of these workers could also be exposed to asbestos if it comes home on clothing.

• Zeolite exposure. Zeolites are a group of minerals like asbestos. They’re common in the soil and rocks in certain parts of the world. Breathing in these fibers can increase the risk of this cancer.

• Past radiation  exposure. A small number of people with this cancer, especially those with the cancer in the chest, have had radiation for cancer in the chest. Up until the 1950s, healthcare providers sometimes gave people a radiocontrast material called Thorotrast to help see things better on X-rays. This was found to increase the risk of some cancers (including mesothelioma), so its use was stopped.

• Age. Most people who get this disease are older than 65.

• Gender. More men than women get this disease.

What are the symptoms of malignant mesothelioma?

In most cases, this cancer doesn’t cause symptoms in early stages. You may have symptoms when the cancer is more advanced. Symptoms depend on where the cancer is located. Some people will have pain under the rib cage or in the chest itself. Some may have shortness of breath. Other people may have pain, swelling, or lumps in the stomach, trouble swallowing, fever, or other problems.

Although these are symptoms of malignant mesothelioma, they may also be caused by other, less serious health problems. If you have any of these symptoms, see your healthcare provider.

How is malignant mesothelioma diagnosed?

If you have symptoms of malignant mesothelioma, your healthcare provider will ask about your health history and your family's history of cancer. He or she will also ask about other risk factors, such as working with asbestos.

Your healthcare provider will also do a physical exam. The exam can help tell if there is fluid in your chest, stomach, or heart. This fluid can be a sign of mesothelioma. Then you may have one or more of these tests to confirm cancer:

• X-rays

• CT scan

• MRI

• Positron emission tomography (PET) scan

• Biopsy of the tumor. This involves removing a sample of the tumor. It can be done in many ways.

Should everyone get a second opinion for malignant mesothelioma?

Many people with cancer get a second opinion from another healthcare provider who is an expert in treating the type of cancer. There are many reasons to get one. Here are some of those reasons:

• Not feeling comfortable with the treatment decision

• Being diagnosed with a rare type of cancer

• Having several options for how to treat the cancer

• Not being able to see a cancer expert

Many people have a hard time deciding which treatment to have. It may help to have a second healthcare provider look at the diagnosis and treatment options before starting treatment. Note that in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer get a second opinion. Many insurance companies will pay for a second opinion.

How can I get a second opinion for malignant mesothelioma?

A: There are many ways to get a second opinion:

• Ask a primary care healthcare provider. He or she may be able to suggest a specialist. This may be a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.

• Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about places to get treatment. These include cancer centers and other programs supported by the National Cancer Institute.

• Look for other options. Check with a local medical society or support group to get names of healthcare providers who can give you a second opinion. You can also check with a local hospital or medical school. Or ask other people who have had cancer for their suggestions. The internet also has a number of sites where you can learn more about a person's options.

How is malignant mesothelioma treated?

There are several treatments for this cancer. Your treatment depends on your age, the stage (extent) of your cancer, and how much the cancer has affected your health.

Treatment can be local, systemic, or both:

• Local treatments get rid of the cancer in one area. These treatments include surgery, radiation, and chemotherapy that healthcare providers put into your chest or abdomen.

• Systemic treatments wipe out cancer cells all through the body. This includes getting chemotherapy through your veins.

What's new in malignant mesothelioma research?

Cancer research should give you hope. Experts around the world are studying better ways to treat this cancer. They’re also finding ways to diagnose it earlier.

Experts are also looking at ways of preventing the cancer from forming in the first place. They are looking at new treatments for this cancer. New treatments include a combination of surgery, radiation, and chemotherapy. There are also new medicines being tested in clinical trials.

What should I know about clinical trials for malignant mesothelioma?

Clinical trials are studies of new kinds of cancer treatments. Healthcare providers use clinical trials to learn how well new treatments work and what their side effects are. Sometimes, healthcare providers find new treatments that work better or have fewer side effects than current treatments. People who join these studies get to use the treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future people with cancer.