Early Symptoms Are Easy to Ignore
The symptoms of mesothelioma play an important role in the overall outlook of this condition and how it is treated. They are at the heart of what makes mesothelioma difficult to treat and impossible to cure in nearly every case. Mesothelioma symptoms are often ignored because they simply don’t seem that serious, especially in the early stages.
Even more difficult is the fact that mesothelioma’s early symptoms often mimic those of other, less serious conditions, leading many to disregard them entirely or misdiagnose them and treat for the wrong illness. This is why it is so vital that if you have been exposed to asbestos, you are aware of mesothelioma’s symptoms and be aware of the potential for a misdiagnosis that could delay life-saving treatment.
Symptoms Vary by Type of Mesothelioma
There are different types of mesothelioma depending on where in the body the tumors first grow. Each causes specific symptoms, though fatigue and weight loss are common in all types. It is important to remember that as the disease progresses, symptoms will change. New ones will appear and old ones will grow worse.
The most common categorization for mesothelioma is by the location in the body in which the tumor originated. For pleural mesothelioma, for instance, the form of the cancer that attacks the lining of the lungs, the symptoms involve the respiratory system and breathing, while peritoneal mesothelioma is related to the abdomen and digestion.
Signs and symptoms of this most common type of mesothelioma include:
- Chest pain
- Shortness of breath
- Pleural effusion
This is the type of mesothelioma that attacks the pleura, the lining of tissue that surrounds the lungs, so most symptoms are associated with breathing and the chest. Pleural effusion occurs when fluid collects between the two layers of the pleura. This is a side effect of mesothelioma that causes pain and/or shortness of breath. Initially it may be noticed during normal or strenuous activity, but over time may be felt even while resting.
These symptoms will vary by individual and by the severity or the stage of the cancer. If the tumor has grown very large or if it has spread and invaded other tissues, these symptoms are likely to be more severe.
The most common symptoms of pleural mesothelioma are easy to mistake for the symptoms of other conditions that are not as serious or life-threatening. Before the symptoms become too severe, a patient may be given a diagnosis of bronchitis or chronic pulmonary obstructive disorder, or even pneumonia or other infections. This confusion about symptoms delays diagnosis and treatment for many patients, which only makes the cancer more difficult to treat once finally diagnosed correctly.
Peritoneal mesothelioma can cause the following:
- Buildup of fluids
- Decreased appetite
- Weight loss
This is the second most common type of mesothelioma, and it affects the lining of the organs in the abdomen called the peritoneum. Peritoneal mesothelioma primarily causes symptoms related to abdominal organs. As with pleural mesothelioma, the most common symptom of peritoneal mesothelioma is the buildup of fluids. In the abdomen this is called ascites and it can cause swelling, discomfort, and even pain.
The second most common symptoms are decreased appetite and the resulting weight loss that occurs. Someone with peritoneal mesothelioma may also experience a feeling of fullness because of the distension caused by ascites; this contributes to the loss of appetite and weight loss. Other symptoms include fatigue, bowel obstructions, indigestion, and hernias.
The symptoms of peritoneal mesothelioma may not seem that serious in the early stages, which can lead to a delay in diagnosis. They also mimic the signs of gastrointestinal conditions, which often lead a doctor to make a misdiagnosis of Crohn’s disease, ulcerative colitis, a food allergy or sensitivity, or irritable bowel syndrome. As with pleural mesothelioma, delay in diagnosis and treatment are common.
Affecting the lining of tissue around the heart, this type can cause:
- Trouble breathing
- Shortness of breath
- Chest pain
- Fatigue and fever
- Heart murmurs
Pericardial mesothelioma is rare. Like the mesothelium around the lungs and abdominal cavity, the pericardium can swell with fluid or simply thicken as a result of the presence of tumors. This is the leading cause of symptoms, which again can be mistaken for other health conditions.
Pericardial mesothelioma can cause many of the same symptoms as pleural mesothelioma, including trouble breathing, shortness of breath, and chest pain. These are the most common symptoms of this form of mesothelioma, but patients may also experience fatigue, fever, shortness of breath that gets worse when lying on the back, heart palpitations, and heart murmurs.
Misdiagnoses also happen with pericardial mesothelioma. It can be diagnosed as a pericardial effusion, which can be caused by a number of conditions other than pericardial mesothelioma. It may be misdiagnosed as heart disease, heart failure, pericarditis, cardiomyopathy, or other types of heart-related conditions.
Testicular mesothelioma is the rarest type of mesothelioma, with fewer than 100 cases ever reported. Because there have been so few cases, there is no comprehensive list of symptoms. Typically the symptom that leads to a diagnosis is the presence of a hydrocele. This is the buildup of fluid between the layers of the mesothelium within the scrotum.
The next most common complaint with this type of mesothelioma is a lump under the skin on one or both of the testicles. This is often mistaken for a hernia, a condition in which part of an abdominal organ or tissue protrudes through the wall of the abdominal muscle. Surgery to remove a lump discovered on the testicles is most often what leads to a diagnosis of mesothelioma. Without surgery it is difficult to determine if it is a hernia, mesothelioma, or another type of cancer.
Symptoms by Stage
Mesothelioma, like other cancers, is staged between one and four. Stage I cancer is the earliest stage when the original tumor has not yet metastasized or invaded other tissues. As the original tumor grows and metastasis occurs, the cancer develops into stage II, III, and finally IV. The symptoms of all types of mesothelioma get more severe as the cancer develops.
The stage I and II symptoms may be mild enough that a patient does not get alarmed and does not seek out a diagnosis. By stage III the patient may seek a diagnosis, but there may still be a delay as symptoms worsen, but seem similar to other, more common conditions.
Many people are not diagnosed with mesothelioma until the cancer is already at stage IV. By this point symptoms have become severe, painful, and very uncomfortable. There may have already been several misdiagnoses based on the symptoms. Stage IV treatment usually has the goal of relieving symptoms and improving quality of life.
Symptoms of Benign Mesothelioma
Mesothelioma is almost always malignant, which means that it has the potential to spread and invade tissues and organs outside of where it originated in the body. Benign mesothelioma is very rare, but possible. It is unrelated to asbestos exposure and may begin with a tumor in any area of the mesothelium. The tumor may grow very large and can be surgically removed, but it may also recur after surgery.
The symptoms of benign mesothelioma are similar to the early symptoms of malignant mesothelioma. In the pleura it may cause shortness of breath, pleural effusion, and chest pain, just as with malignant pleural mesothelioma. In the peritoneum it can cause indigestion, swelling, and loss of appetite. The larger the tumor grows, the worse the symptoms may be; although, surgery typically relieves all symptoms and may cure the condition.
Symptoms and the Latency Period
Mesothelioma has a long latency period—between twenty and seventy-one years—compared to other illnesses and cancers. This is the period of time between the exposure to asbestos and a diagnosis. One reason there is such a long latency is that the symptoms are often mild in the early stages of mesothelioma. Many people do not take them seriously until they worsen as the cancer develops. Another issue is that the symptoms mimic those of more common illnesses. This further delays diagnosis and lengthens the latency period.
Symptoms of Metastasis
Metastasis is the spread of cancer cells to more distant tissues in the body. The exact time frame or stage when the cancer starts spreading is not known. As the tumor metastasizes, symptoms typically become more severe. Chest pain, pleural effusion, shortness of breath, and other signs worsen. The symptoms may also shift depending on where the cancer spreads.
As pleural mesothelioma metastasizes, it may begin to spread to the lymph nodes, pericardium, peritoneum, diaphragm, chest wall, and the lungs. Symptoms may progress to include abdominal symptoms, fatigue, and fever. Peritoneal mesothelioma may spread to the intestines, liver, spleen, stomach, and other abdominal organs causing more related symptoms with greater severity.
Early Detection of Symptoms Is Crucial
It is vitally important that if you know, or even suspect, that you have been exposed to asbestos, you educate yourself about these symptoms and let your physician know about your occupational or environmental history. Because few physicians have ever dealt with mesothelioma, the condition and its symptoms are easy to overlook. Time is of the utmost importance. Being aware of early symptoms can gain you valuable treatment time.
If you suspect you have been given a misdiagnosis, don’t be afraid to seek a second opinion. A good doctor not only won’t mind that you do, he or she will encourage you to take the steps you need to feel more comfortable. A second opinion for a condition as serious and as easy to misdiagnose as mesothelioma just makes sense.
It’s also a good idea to take your concerns to a specialist. Mesothelioma is a highly specialized type of cancer. Most doctors, even oncologists, have little to no experience diagnosing or treating it. Especially if you have the risk factors for mesothelioma, if you experience symptoms that concern you, seek out a specialist in this kind of cancer or a cancer center that staffs experts in mesothelioma. It could be the best decision you make for your health and your future.
Page Medically Reviewed and Edited byLuis Argote-Greene, M.D.
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.