Symptoms of mesothelioma

The general symptoms of mesothelioma include:

• fever
• sweating - particularly at night
• unexplained weight loss
• feeling tired

Depending on which mesothelium is affected by the cancer, you may also have other symptoms.
If you have pleural mesothelioma you may:

• have chest or back pain
• feel breathless
• cough
• have a hoarse voice
• have difficulty swallowing

If you have peritoneal mesothelioma you may:

• have a swollen abdomen
• have abdominal pain
• lose your appetite
• have diarrhoea or constipation

Although not necessarily a result of mesothelioma, if you have these symptoms you should visit your GP.

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Causes of mesothelioma

In nine out of 10 people with mesothelioma, the cause is asbestos. Asbestos is a mineral which was used in construction, ship-building and household appliances until 1999 when its use was banned. For example, you may have breathed in asbestos when you worked in a factory which produced products containing asbestos, or when washing work clothes which had asbestos on them.
Your body reacts to asbestos by trying to get rid of it. Asbestos is made up of tiny fibres which, when breathed in, pass into the lungs and cause inflammation and fibrous tissue to form. The fibres then pass into other areas of the body such as the mesothelium as the body tries to get rid of the fibres from the lungs.
Mesothelioma caused by asbestos takes between 10 and 60 years to develop. It's been predicted that an increasing number of people will be diagnosed with it before 2015, when the number of people affected will be highest. When it peaks, about 3,000 people will be diagnosed each year. The number of people diagnosed should then decrease.
The causes of mesothelioma in people who haven't been exposed to asbestos aren't fully understood. But there are certain factors that may make mesothelioma more likely.

• Exposure to radiation.
• A mineral found in Turkey called Zeolite may cause mesothelioma.
• Previous infection with the Simian monkey virus (SV40). This may be a co-factor, making mesothelioma more likely if you have come into contact with one of the other risk factors, such as asbestos.

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Diagnosis of mesothelioma

Your GP will ask you about your symptoms and will examine you. He or she may refer you to a doctor who specialises in respiratory medicine; this is a doctor who treats conditions affecting the lungs, or a gastroenterologist, a doctor specialising in conditions of the digestive system. Further tests may include the following.

• A chest or abdominal X-ray.
• A CT (computerised tomography) scan, which uses X-rays to make a three-dimensional image of the body.
• An MRI (magnetic resonance imaging) scan, which uses magnets and radiowaves to produce images of the inside of your body.
• A sample of the fluid (either the pleural effusion or ascites) may be taken and sent to a laboratory for testing.
• A biopsy may be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
• A flexible narrow tube may be used to look for mesothelioma. This is called a mediastinoscopy.
• A PET (positron emission tomography) scan involves the use of an injected weak radioactive substance to look for mesothelioma using a PET machine.

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Treatment of mesothelioma

Mesothelioma is difficult to treat because the cancer has usually spread and can't be removed. Treatments can include the following.

Medicines

There are a number of chemotherapy medicines which may be used to treat mesothelioma. Only one medicine is currently licensed in the UK, this is called pemetrexed. You may be advised to take supplements, such as folic acid and vitamin B12, with pemetrexed. Other medicines include methotrexate, vinorelbine, mitomycin and cisplatin. These, or other medicines, may be suggested to you as part of a clinical trial. Ask your doctor for advice.
Painkillers may be given to help reduce pain.
Steroid medicines, such as prednisolone, may be given to help reduce inflammation and can improve appetite.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. It may be used to try cure the mesothelioma or to reduce symptoms.

Surgery

You may have surgery if the cancer is only in one area of the mesothelium. This type of treatment may help pleural (lung) mesothelioma but isn't usually helpful for peritoneal (abdomen) mesothelioma. Surgery may involve taking the whole pleura (mesothelium) or part of the tissues near the pleura. Sometimes this may include the diaphragm and one of the lungs.

Other treatments

Chemical irritants may be used which will cause the layers of the mesothelium to become inflamed; this makes them stick together so fluid doesn't build up. The chemicals will be added using a tube which will be put through the skin.
Excess fluid can be drained using a needle to help you breathe more easily. You can have this done regularly as the fluid will return. For this you will need a local anaesthetic.
Physiotherapy and relaxation techniques may also be helpful.

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