Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). Most people with malignant mesothelioma have worked on jobs where they breathed asbestos.

A doctor should be seen if a person has shortness of breath, pain in the chest, or pain or swelling in the abdomen. If there are symptoms, the doctor may order an x-ray of the chest or abdomen.

The doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time). Some pressure may be felt, but usually there is no pain.

The doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, a local anesthetic will be given.

If tissue that is not normal is found, the doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.

The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient's age.

Stages of Malignant Mesothelioma

Once malignant mesothelioma is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the cancer to plan treatment. The following stages are used for malignant mesothelioma.

• Localized Malignant Mesothelioma

  Stage I
  The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung.

• Advanced Malignant Mesothelioma

  Stage II
  The cancer has spread beyond the lining of the chest to lymph nodes in the chest.

  Stage III
  Cancer has spread into the chest wall, center of the chest, heart, through the diaphragm, or abdominal lining, and in some cases into nearby lymph nodes.

  Stage IV
  Cancer has spread to distant organs or tissues.

• Recurrent Malignant Mesothelioma
  Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lining of the chest or abdomen or in another part of the body.

How Malignant Mesothelioma is Treated

There are treatments for all patients with malignant mesothelioma. Three kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
• Chemotherapy (using drugs to fight the cancer).

Surgery is a common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

If fluid has collected in the chest or abdomen, the doctor may drain the fluid out of the body by putting a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. The doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).

Intraoperative photodynamic therapy is a new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.

Treatment By Stage

Treatment depends on where the cancer is, how far it has spread, and the patient's age and general health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for many patients with malignant mesothelioma. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

• Localized Malignant Mesothelioma (Stage I)

  If the cancer is only in one place in the chest or abdomen, treatment will probably be surgery to remove part of the pleura and some of the tissue around it.

  If the cancer is found in a larger part of the pleura, treatment may be one of the following:

  • Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
  • Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
  • External beam radiation therapy to relieve symptoms.
  • A clinical trial of surgery followed by chemotherapy given inside the chest.
  • A clinical trial of surgery, radiation therapy, and/or chemotherapy.

• Advanced Malignant Mesothelioma (Stages II, III, and IV)
  Treatment may be one of the following:

  • Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.
  • Surgery to relieve symptoms.
  • Radiation therapy to relieve symptoms.
  • Chemotherapy.
  • A clinical trial of surgery, radiation therapy, and chemotherapy.
  • Chemotherapy given in the chest or abdomen.

• Recurrent Malignant Mesothelioma
  Treatment depends on many factors, including where the cancer came back and what treatment the patient received before. Clinical trials are testing new treatments.

To Learn More

• Call

  For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

• Web sites and Organizations

  The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

• Publications

  The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

• LiveHelp

  The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

• Write
  For more information from the NCI, please write to this address:
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  Suite 3036A
  6116 Executive Boulevard, MSC8322
  Bethesda, MD 20892-8322

About PDQ

• PDQ is a comprehensive cancer database available on Cancer.gov.

  PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

• PDQ contains cancer information summaries.

  The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

• The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

  Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

• PDQ also contains information on clinical trials.

  Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

  Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.