What Are the Types of Malignant Mesothelioma?
Malignant mesothelioma is a cancer of the cells of the mesothelium. The mesothelium is a thin, double layer of tissue lining the chest cavity, abdominal cavity, and heart.
- Pleural mesothelioma is the most common type. It develops in the pleural tissue around the lungs.
- Peritoneal mesothelioma, which develops in the abdomen, is less common.
- One of the rarest types occurs in the tissue around the heart and is called pericardial mesothelioma.
- More than three-quarters of cases of mesothelioma are pleural.
- Exposure to asbestos is usually through inhalation of the fibers into the airways.
- Inhaled asbestos fibers lodge in the pleural tissue and cause damage.
- Symptoms include difficulty breathing, chest pains, coughing, and shortness of breath.
- This extremely rare form of mesothelioma accounts for just 1% of all cases.
- The primary tumor develops in the pericardium around the heart.
- Treating a cancer so close to the heart is extremely difficult.
- Symptoms include chest pain, difficulty breathing, heart palpitations, fatigue, and coughing.
- Peritoneal mesothelioma accounts for less than 20% of all cases.
- It occurs in the peritoneum in the abdominal cavity.
- Symptoms include abdominal pain, swelling or tenderness, and constipation or diarrhea.
- Peritoneal mesothelioma may be misdiagnosed as colitis or irritable bowel syndrome.
Mesothelioma types can also be organized by the kind of cells that make up the tumor.
What are the Symptoms of
Most patients with mesothelioma experience no symptoms or mild symptoms for many years. The early symptoms are similar to those of more common illnesses.
Only when mesothelioma tumors grow larger and begin to spread do symptoms worsen.
The later stages of mesothelioma cause symptoms more typical of other types of cancer: weight loss, fatigue, fever, and persistent pain, swelling, or feelings of fullness in peritoneal mesothelioma.
- Shortness of Breath
- Trouble Swallowing
- Persistent, Dry Cough
- Coughing up Blood
- Chest Pains
- Pain When Breathing
- Lumps Under Skin of Chest
- Weight Loss
- Pain & Swelling in Abdomen
- Feeling of Fullness
- Weight Loss
- Bowel Obstruction
- Irregular Heartbeat
- Heart Palpitations
- Trouble Breathing
- Heart Murmurs
- Weight Loss
- Shortness of Breath
- Chest Pains
- Night Sweats
- Heart Failure
- Swelling of Lower Limbs
How is Malignant Mesothelioma Diagnosed?
The first step is a physical examination, usually by a patient’s regular physician. This helps rule out more common conditions.
A doctor examines the patient and tests for certain conditions, while also taking a medical history.
In addition to characteristic symptoms, it is important to discuss the possibility of past asbestos exposure.
Next, patients undergo one or more imaging scans. An X-ray can rule out pneumonia and other non-cancerous lung diseases.
MRIs and CT scans provide a more detailed look at soft tissues. These scans can help doctors find areas of abnormal tissue that may be cancerous.
If an image shows abnormal tissue that could be malignant, the next step is a biopsy to determine if the tissue is malignant. 
To perform a biopsy, a doctor takes a sample of cells from the area of abnormal tissue. A pathologist examines the cells under a microscope to look for signs of malignancy and to identify the cancer.
There are a few types of biopsies:
- A fluid biopsy removes fluid from between the pleural or peritoneal tissue layers. This is not the most definitive way to diagnose cancer.
- More accurate is a needle biopsy. Doctors insert a long needle to remove a small sample of tissue from the area in question.
- If the needle sample is inconclusive or the abnormal tissue is too difficult to reach, doctors may need to perform a surgical biopsy to remove tissue and cells.
The Stages of Mesothelioma
A complete cancer diagnosis includes staging. Mesothelioma is staged from one through four. One is the earliest stage with the least progression of disease. Four is the most advanced stage with significant progression.
Specialists stage cancer based on the size of the tumor, the number of lymph nodes involved, and if the cancer has spread to other organs. The stage helps doctors create the best treatment plan and gives the patient a more detailed prognosis.
Stage 1 mesothelioma patients have the best chance of long-term survival. Few patients get a diagnosis at this early stage because symptoms are non-existent or mild: coughing, fever, chest pain, breathing difficulties, and a general fatigue. Early patients have several treatment options, including aggressive surgery. They have the best overall prognosis.
By stage 3, the cancer has spread more extensively throughout the chest cavity or abdomen, depending on the type. Treatment may shift to palliative care. Extending survival time is difficult, but possible. Symptoms include severe chest pain, weight loss, night sweats, coughing, fatigue, and other uncomfortable symptoms.
What Are the Options for Mesothelioma Treatment?
Treatment plans for mesothelioma vary depending on the needs, limitations, and preferences of each patient. Treatment also depends on the type and stage of the cancer. Mesothelioma is aggressive and spreads fast. Diagnosis usually comes in the later stages, which limits treatment options.
Typical treatment plans are multimodal, including two or more strategies. The most standard options are surgery, chemotherapy, and radiation therapy.
Palliative care is an important aspect of mesothelioma treatment. It includes hospice and end of life care but also treatments and therapies to improve quality of life for patients in any stage.
Palliative care providers enrich and strengthen the care provided by an oncologist and surgeon. They are experts in pain and symptom management and can help support important decision making and patients’ goals. Patients with advanced cancers who are not eligible for surgery or chemotherapy need more palliative care services.
The goal of surgical treatment for mesothelioma is to remove as much of the cancerous tissue as possible.
Treatment plans often combine surgery with chemotherapy and radiation to eliminate cancer cells the surgeon could not remove or to shrink tumors ahead of surgery.
Not all patients are eligible for surgery. Surgery may extend life expectancy, or in rare cases lead to remission.
Some surgical procedures relieve symptoms and are a part of palliative care.
Chemotherapy uses drugs that target and destroy fast-growing cancer cells to shrink tumors.
Chemotherapy is the most common treatment mesothelioma patients receive.
An exciting and effective new treatment for peritoneal mesothelioma uses a heated solution of chemotherapy drugs circulated in the abdominal cavity.
Radiation therapy uses high-energy beams of particles to destroy tumors and cancer cells.
Radiation is traditionally delivered externally, by aiming the beam at the location of the tumor.
To minimize damage to healthy tissues, and to target tumors more directly, some patients may receive internal radiation therapy.
Some patients benefit from adding complementary and alternative therapies to a traditional treatment plan. Examples include: acupuncture, gentle massage, exercise, yoga, aromatherapy, and consultation from an oncology dietitian. These may help manage symptoms and side effects of living with mesothelioma: pain, anxiety, fatigue, and others.
What Is the Prognosis for Mesothelioma Patients?
A patient’s prognosis depends on average life expectancy for each stage of the cancer. Typical life expectancy by stage is based on past patients.
Other factors influence prognosis:
- Patients with early stage mesothelioma have a better prognosis than those in the later stages.
- The type of mesothelioma, by cell and location, impacts prognosis. Those with peritoneal disease generally have better survival rates than pleural mesothelioma, for instance.
- Age and overall health effect outcomes. Younger, healthier patients have a better prognosis.
- When surgery is still a treatment option, patients who choose a more aggressive procedure generally have a better prognosis.
How Do I Find the Best Doctor?
See your general practitioner first to rule out more common illnesses. Don’t be afraid to get a second opinion if you feel your doctor is not taking your concerns seriously, especially if you know you have been exposed to asbestos.
If you receive a mesothelioma diagnosis, find a specialist as soon as possible. This is a rare type of cancer that even many oncologists have never encountered. A mesothelioma specialist can provide the best care and treatment options as part of a multi-disciplinary team.
How Do I Find the Best Treatment Facility?
Many specialists in mesothelioma work as part of multi-disciplinary teams at cancer treatment centers. These facilities include units or departments with teams that focus entirely on the diagnosis, treatment, and research of mesothelioma.
A good place to start your search is at the National Cancer Institute (NCI). The NCI lists several facilities throughout the country as Designated Cancer Centers. Several of these employ mesothelioma specialists.
Are there Clinical Trials for Mesothelioma?
NCI Cancer Centers and other mesothelioma specialty treatment facilities often give patients access to clinical trials.
Clinical trials study experimental medications, therapies and procedures. They give patients the opportunity to try new treatments, not yet available to everyone.
For an aggressive cancer like mesothelioma, with no cure, clinical trials can be a ray of hope for patients. Your specialist can help you determine if you are eligible for any trials.
What Are My Options to Pay for Mesothelioma Treatment?
Treatment costs for mesothelioma skyrocket quickly. Take advantage of any resources available, including legal actions for compensation.
If your health insurance coverage is limited, consider other resources:
- Funding from nonprofit advocacy groups and charities
- Disability or workers’ compensation insurance
- Veterans benefits
- Lawsuits against companies that made asbestos products
- Claims to trust funds set up by companies that exposed workers
What is the Mesothelioma Trust Fund?
Mesothelioma or asbestos trust funds are financial resources for people who got sick after being exposed to asbestos on the job. These funds were established by companies responsible for asbestos injuries to workers and their families.
You may qualify for compensation from an established trust fund even if you aren’t sure where you were exposed to asbestos. For most people it was on the job.
Getting Benefits for Veterans with Mesothelioma
Mesothelioma patients who experienced asbestos exposure while serving in the United States military may receive compensation and free healthcare.
Veterans are at the greatest risk of developing mesothelioma because of the heavy use of asbestos in barracks, equipment, vehicles, and ships.
Asbestos use in the military peaked between 1935 and 1975. The U.S. Navy used more asbestos than any other branch.
Applying for VA benefits can be complicated and confusing. Rely on an experienced attorney for guidance. You may also be able to file a lawsuit against the manufacturers of the asbestos-containing materials you used during your time in the military.
Asbestos in the Navy
U.S. veterans have some of the highest rates of mesothelioma, but U.S. Navy veterans receive more asbestos-related diagnoses than any other group. Asbestos was used extensively on all types of ships in the Navy for decades, beginning in the 1930s. Working around and living with asbestos materials, especially in the confined and poorly-ventilated spaces of ships put these veterans at the greatest risk of asbestos exposure and later illnesses.
Asbestos in the Marine Corps
Many Marine Corps veterans were exposed to asbestos through time spent on Navy ships. The U.S. Navy fleet has long supported and transported the men and women of the Marine Corps. These ships were made with asbestos in nearly every component, increasing exposure risks for this branch of the military. After serving their country, many Marine veterans were diagnosed with mesothelioma and other asbestos-related illnesses.
Asbestos in the Army
Veterans who served in the U.S. Army put their lives on the line in many ways, but the risk of exposure to asbestos was preventable. These men and women spent time in military installations, bases, and vehicles that were constructed with asbestos. Some veterans even worked directly with asbestos and many were later diagnosed with mesothelioma.
Asbestos in the Air Force
Asbestos use in ships, airplanes, bases, vehicles, and all types of military buildings put all veterans at risk, including those that served in the Air Force. Engines and brake systems in planes contained asbestos to insulate and protect against friction and overheating. This use, as well as the use of asbestos in many other places, caused too many of these veterans to develop mesothelioma, asbestosis, or lung cancer decades after serving their countries.
Asbestos in the Coast Guard
The use of asbestos in ships was common practice for many decades and Coast Guard ships were no exception. Asbestos in Coast Guard vessels, in the shipyards where they worked and repaired ships, and in buildings led to numerous cases of dangerous exposure. Many of these men and women who served in the Coast Guard were later diagnosed with mesothelioma and other asbestos illnesses.
How Do I Find the Best Mesothelioma Lawyer?
Immediate treatment should be your top priority after receiving a mesothelioma diagnosis. But you may also need legal assistance.
You have a right to seek compensation through legal means if exposed to asbestos.
A lawyer experienced with asbestos cases can help you determine your rights and what legal steps you can take to seek compensation.
Look for an attorney or law firm with experience handling asbestos cases and winning compensation for victims. Be sure you feel comfortable working with the lawyer you choose and that he or she will devote time and effort to your case.
Can’t Afford a Lawyer?
Most people undergoing expensive mesothelioma treatments aren’t able to pay attorney fees. This is why reputable, experienced lawyers in asbestos cases never charge anything up front.
They work on a contingency basis. This means that you pay nothing at all until your lawyer wins your case. Your lawyer then takes an agreed-upon percentage of your compensation.
Be sure to do your research on fees before retaining legal help. Lawyer fees vary.
Will I Go to Trial?
Most mesothelioma lawsuits end in settlements and never go to trial. Your attorney will investigate your case, provide proof of your injuries to the defense, and help negotiate a settlement amount on your behalf.
Only if an agreement cannot be reached by both sides will your case go to trial.
It is rare to have to go to court for mesothelioma. However, if you are too ill your lawyer can make accommodations. For example, some plaintiffs have given their testimony via video from the comfort of their home. Most of the hard work in a trial is done by your legal team.
Frequently Asked Questions
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.