Mesothelioma

Mesothelioma is an incurable malignancy which affects the parietal layer (lining) of the pleura. It may also affect the abdominal cavity (the peritoneum). The majority of cases affect the pleura. As the disease progresses the pleura or the peritoneum thickens from the calibre of a cigarette paper to form a hard tumour mass often between 0.5 and 1.0 cm thick. This tissue compresses the lung and the gastrointestinal tract. This may cause intestinal obstruction.

Cigarette smoking is not related to the development of mesothelioma.

Mesothelioma is the most lethal of all asbestos disease. Unfortunately it is also one of the most prevalent.

The latency period between first exposure to asbestos and the onset of mesothelioma is rarely less than 20 years from the first exposure and may be more than 50 years. Diagnosis of mesothelioma is usually made by biopsy by either a needle biopsy or through key-hole surgery.

Of the various types of asbestos, mesothelioma is predominantly associated with exposure to the blue asbestos, crocidolite and brown asbestos, amosite. White asbestos, chrysotile has also been linked to the incidence of mesothelioma. All asbestos exposure should be avoided given the potential of developing mesothelioma which is also often associated with the quite brief and low level of asbestos exposure.

People are terrified when they hear of such a diagnosis and believe that whatever life is left undoubtedly will be miserable and related to a great deal of discomfort and personal suffering. This is not so.

Modern medical treatment of pain, Dyspnoea (shortness of breath), cough and the other complications is all possible. A person who suffers from mesothelioma should see an oncologist and a respiratory physician as part of routine team management. These specialists together with the general practitioner, are able to treat people appropriately in most cases until the person dies. If necessary palliation and an appropriate palliation unit can be consulted.

Recently there has been some progress in the treatment of mesothelioma particularly with the chemotherapy drug Alimta which has been found to extend life expectancy in some cases. Other treatments are also being trialled such as immunotherapy drugs.

Another treatment for mesothelioma is a pleuropneumonectomy which is the surgical removal of the lung, the pleura and the diaphragm. This is a major operation.

The treatment of mesothelioma can be divided into three stages. Stage one is the time during which diagnosis occurs. Often the tumour is found incidentally when some other condition is being investigated.

Stage two occurs during the period of accelerated tumour growth and stage three is the palliative stage.

After the initial diagnosis the presenting symptom or symptoms which have resulted in the person’s initial discomfort and diagnosis need to be treated accordingly. Most often shortness of breath and chest pain are the presenting symptoms.

Shortness of breath, which is frequently associated with the collection of fluid in the pleural space (a pleural effusion), is treated by a procedure called a VATS pleurodesis. During this procedure the surgeon obtains a biopsy and can perform pleurodesis. This prevents fluid accumulating in the pleural space in the future.

Pain is another important symptom which needs to be treated by the physician appropriately and if

necessary a pain specialist should be consulted. The modern concept of pain control is to treat pain immediately and increase drug doses as necessary. Associated with the use of analgesics and in particular opiate analgesics is constipation. This diagnosis needs to be anticipated and if a person is taking opiates then appropriate aperients need to be prescribed. Much discomfort occurs when a patient with chest pain or chest discomfort develops constipation.

Breathlessness can also be treated with oxygen therapy. People who suffer from mesothelioma often have other lung disease such as asthma, or smoker’s-induced lung disease. This needs to be treated.

Other complications should be diagnosed early and the person encouraged to report symptom or sign of discomfort, or any concern that he/she has with his/her doctor immediately and not wait until more serious symptoms occur.

Nutrition is an important treatment modality. Ongoing weight loss needs to be avoided. Dietitians should be consulted. High protein foods are often use to stimulate and maintain appetite and also maintain the person’s energy levels and abilities. Please refer to the Eating well with Mesothelioma booklet.

In addition to the distressing symptoms suffered by the person, family members and friends often become quite distressed when they heard of the diagnosis and seeing their loved one suffer the consequences of the illness. Psychological disturbances and depression may result. It is important to consult psychiatrists and psychologists to deal with these problems.

As previously stated, the treatment of mesothelioma is a team approach. Regular visits to the general practitioner and the respiratory specialist are advised. Regular history and physical exams can detect complications early.

Early diagnosis of symptoms often prevents severe complications. The use of home oxygen, increase in analgesia and nutrition-related complications can be anticipated.

Ultimately the person will need home and portable oxygen. Alteration in the home environment to allow wheelchair and oxygen use may be necessary. Consultation with the Asbestos Disease Support Society can be very helpful and appropriate advice obtained if this is necessary.

Home care palliative unit, Allied Health Professional and volunteer organisations are advised and encouraged during the palliative stage of the disease.

Mesothelioma, while a serious diagnosis, should not result in a person “retiring from life”. Adopting a team approach, visiting physicians frequently and not ignoring warning signs, will result in a person suffering less morbidity and having a more enjoyable lifespan. Treatment should be aggressive and progressive so as the remaining life of the person can be fruitful and enjoyable.

Advice should be obtained from the various experts concerning any Pension or Compensation entitlements, estate planning and for the wishes of the patient to be fulfilled when she/she has died.

It is important for the person to sleep well and obtain appropriate advice so that worry, anxiety and pain do not convert night-time into daytime sleep. Tired depressed patients do not do as well as those who face each day awake, alert and optimistic.

Whilst no physician can yet claim to cure mesothelioma, there are people who are alive many years after treatment.

[May 2016]

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