Metastasis and Progression of Mesothelioma
Page Medically Reviewed and Edited by Shanel Bhagwandin DO, MPH This page has been fact checked by a Doctor of Osteopathic Medicine who specializes in mesothelioma. Sources of information are listed at the bottom of the article.
We make every attempt to keep our information accurate and up-to-date.
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Metastasis and progression of mesothelioma is often aggressive and rapid.[1] Patients diagnosed with stage IV, or metastatic mesothelioma, have limited treatment options and face a very poor prognosis.
Mesothelioma Progression
Pleural mesothelioma is staged most often using the TNM system. The cancer can be assigned as stage I, II, III, or IV. Each stage describes how far the original tumor has invaded, whether the cancer involves lymph nodes, and whether it has progressed to metastasis. Staging is associated with prognosis and allows doctors to assess the extent of the disease.[2]
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Progression may be different for each patient, but generally, the tumor begins in the pleura on one side of the chest cavity, either the pleura lining the lung or the pleura that lines the chest wall. From there the original tumor may grow into the pleura around the lungs or lining the chest wall, the diaphragm, or the area between the lungs, known as the pleural space.[2]
As mesothelioma continues to invade, it can eventually reach the lymph nodes; usually those on the same side of the chest as the tumor. The cells also spread to more distant lymph nodes.[2] The lymph nodes are a network of immune system cells that circulate lymph through the whole body. When cancer spreads to the lymph nodes metastasis is usually not far behind because the lymphatic system allows cancer cells to travel to more distant parts of the body.[3]
Factors Affecting Progression
Mesothelioma progresses quickly and developing metastasis may occur as quickly as in several weeks. Compared to other types of cancer, it is generally aggressive and quick-moving. However, it can also progress at different rates based on the original cell type. Malignant mesothelioma tumors have three main cell types: epithelial, sarcomatoid, and biphasic, a mixture of epithelial and sarcomatoid cells.[4]
Sarcomatoid mesothelioma is the most aggressive and will metastasize and progress rapidly. These cells do not adhere strongly to each other and can easily break off from the tumor and spread. Epithelial mesothelioma is the most common and these cancer cells cling more strongly to each other, so metastasis is slower with this type of mesothelioma. Biphasic tumors fall in between the two.[4]
Metastasis of Pleural Mesothelioma
Pleural mesothelioma, which attacks the tissue lining in the chest cavity, is the most common site of occurrence. Studies show the most common locations of metastasis include the liver, adrenal glands, kidneys, and the lung on the opposite side of the chest.[5] Although less common, there have been instances of pleural mesothelioma metastasizing to the brain or spinal cord, bones, and one case of recorded metastasis to the tongue.[6]
Metastasis of Peritoneal Mesothelioma
Peritoneal mesothelioma, the second most common form, begins in the tissue lining the abdominal cavity. Early progression of this cancer may see it spread throughout the abdomen, but distant metastasis only occurs later and outside the abdomen. Some metastatic sites include the liver, heart, lungs, adrenal glands, kidneys, thyroid, bones, brain, and skin.[7]
Metastatic Mesothelioma to the Liver
Malignant mesothelioma most commonly spreads to the liver.[5] It occurs in more than half of patients who have metastatic mesothelioma. Some signs of secondary liver cancer include nausea, jaundice, decreased appetite and weight loss, fever, sweating, confusion, and pain in the upper right abdomen.
Treatments for liver involvement by mesothelioma most often include chemotherapy. Surgery is not often a treatment of choice once the disease has spread.
Metastatic Mesothelioma to the Heart
Metastasis to the heart lining, or pericardium, is rare. In case reports, symptoms of a secondary cardiac tumor vary significantly. It may cause shortness of breath, low blood pressure, an irregular heartbeat, pericardial effusion, or congestive heart failure. The most common issue is fluid buildup in the sac surrounding the heart. This can be drained to relieve some pressure, but it often reaccumulates without additional treatment or catheter-directed drainage.[8]
Metastatic Mesothelioma to the Lung
A common site of metastasis in pleural mesothelioma is the lungs, including the lung on the opposite side of the chest from where the cancer originated. This occurs in more than one quarter of patients with metastasis. Peritoneal mesothelioma may also metastasize to the lungs. Symptoms include chest pain, coughing with or without blood, shortness of breath, weight loss, and weakness. Primary treatment for these tumors typically utilizes chemotherapy. Surgery is rarely used. Depending on the size and overall status of the cancer, radiation may also be used.[5]
Metastatic Mesothelioma to the Adrenal Glands
Several cases have been recorded of mesothelioma spreading to the adrenal glands.[5] It occurs in up to a third of the cases of metastasis of pleural mesothelioma, but it may also occur with peritoneal mesothelioma. The adrenal glands are paired organs that sit on top of each kidney.
Symptoms include back pain, abdominal pain, weight loss, or muscle weakness. It may also cause signs of adrenal sufficiency, a decrease in the hormones normally produced in the glands: low blood pressure, low blood sugar, and darkened skin.
Metastatic Mesothelioma to the Kidney
Metastasis to the kidneys has been reported, especially with peritoneal mesothelioma.[5] Symptoms include blood in the urine, a mass on the side of the lower back, fatigue, lower back pain, loss of appetite and resulting weight loss, a fever, and anemia. As this can commonly be confused with a primary cancer of the kidney, imaging scans and a biopsy can confirm whether the cancer has spread to the kidneys.
Metastatic Mesothelioma to the Thyroid
The thyroid is a gland in the neck that secretes hormones and impacts metabolism. It is a possible site of metastasis for both peritoneal and pleural mesothelioma. Signs of metastasis to the thyroid gland may include a lump in the throat or neck, pain in the neck, changes to the voice or hoarseness, difficulty breathing or swallowing, and a persistent cough.[9]
Metastatic Mesothelioma to the Brain
Studies show approximately 3% of mesothelioma cases result in metastasis to the central nervous system. There are many possible symptoms of metastasis to the brain, including poor balance and coordination, headaches, memory loss, changes in sensation, personality changes, new seizures, vision changes, and vomiting. Treatment for this type of metastatic cancer usually involves radiation, consideration of a clinical trial, or best supportive care.[10]
Metastatic Mesothelioma to the Skin
Mesothelioma that spreads to distant sites in the body may cause secondary skin cancer. Cancer cells can travel through the lymphatic system or through the blood to reach the skin. The symptoms of metastasis to the skin are lesions which may appear anywhere, usually as red or pink raised masses. A common location is near or on the surgical scar where the primary cancer was removed. This can often occur as a result of cancer seeding, or tracking of cancer cells during a biopsy or tube placement through the skin.[11]
Slowing the Progression of Mesothelioma
Mesothelioma is a quick and aggressive cancer that is only rarely curable. Most patients will experience a progression of the disease until it metastasizes to other sites. There are, however, steps that can be taken to slow progression in the form of treatment.[12] Eating well, getting exercise and enough sleep, and not smoking or drinking can afford healthier, fit patients the opportunity for more aggressive treatments.
Most patients will experience the progression of the disease and metastasis that will most likely cause more symptoms, such as bowel obstructions, difficulty breathing, infections, pain, and discomfort.
Metastatic cancer can be treated with the intent of slowing its progression, but this is generally considered a palliative measure with a focus on quality of life. Treatments like surgery, chemotherapy, medications, radiation, and other procedures are aimed at improving life expectancy and symptom control.
Page Medically Reviewed and Edited by Shanel Bhagwandin DO, MPH
Dr. Shanel Bhagwandin is a surgeon with special training in surgical oncology. In 2019 he joined the team at Jupiter Medical Center in Palm Beach County, Florida as the Medical Director of the Gastrointestinal Surgical Oncology Program. He came to Jupiter from Mount Sinai in New York, where he still holds teaching and leadership positions and where he trained alongside experts in complex surgical oncology. Dr. Bhagwandin came to Jupiter to bring HIPEC, a treatment for peritoneal mesothelioma that is not available everywhere, to the patients in the region. He is board certified in general surgery, surgical oncology gastroenterology, and hepato-pancreato-billiary surgery.