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Mesothelioma

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Revised Sep 2016

The basics
  • Guidelines for treating this cancer have been developed by the Lung Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • The mesothelium is a thin membrane that surrounds the inner organs in the body. It produces a fluid that lubricates the outer surface of the organ so it can slide against other organs. For example, the fluid makes it easier for the lungs to move inside the chest while a person breathes.
  • Mesothelioma can occur in the chest (pleural), abdomen (peritoneal) and sometimes the heart (pericardial).
  • The most common type of mesothelioma is pleural (in the chest) in the lining outside of the lungs. 
What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • Mesothelioma is not common.
  • In 60-70% of mesothelioma cases the person has been exposed to asbestos.
  • People at highest risk are those employed in these areas:
    • the asbestos industry
    • dockyard workers, especially if they dismantle asbestos-insulated steam piping
    • workers who handle and manufacture asbestos compounds
    • insulators and steam fitters
    • demolition and construction workers
  • Men are most commonly affected because they are usually employed in this type of industry.
  • Spouses and children of asbestos workers are also at risk, especially if soiled work clothing was brought into the home.
  • The time between exposure to asbestos and when mesothelioma develops may be as long as 20-50 years. That is why mesothelioma usually affects men in their 50s, 60s and 70s.
  • Statistics
    • BC 
    • Canada - There were 515 new cases of malignant mesothelioma in Canada in 2010. 
Can I help to prevent it?
  • Mesothelioma can be prevented by avoiding exposure to asbestos.
  • Since the early 1970's, laws have been put in place to limit asbestos use and exposure.
  • The presence of asbestos fibre in the lungs of members of the general population suggests that exposure may occur unknowingly.
Screening for this cancer
  • Screening of workers exposed to asbestos for mesothelioma is not recommended, as it is not known to improve survival.
  • Smoking greatly increases the risk of lung cancer (but not mesothelioma) in asbestos workers, and smoking cessation efforts and lung cancer screening are appropriate in this high-risk group. 
Signs and Symptoms
  • Early signs and symptoms may go undiagnosed as they are also the symptoms of many common, minor ailments.
  • If you experience symptoms that persist for longer than several weeks, consult a doctor.
  • Symptoms occur as the membrane thickens, or as fluid around the affected organ builds up.

Types and Symptoms of Mesothelioma

Pleural (Chest) Symptoms
  • Shortness of breath
  • Chest pain
  • Cough

Peritoneal (Abdomen) Symptoms

  • Abdominal pain or swelling
  • Weight loss
  • Nausea and vomiting
Pericardial (Heart) Symptoms
  • Shortness of breath
  • Heart rhythm disturbances
General Symptoms
  • Fatigue
  • Fever
  • Night sweats
  • Weight loss
Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.
 
  • An X-ray can show whether the fluid around the organ has thickened.
  • A CT scan can show the size and location of the tumour and whether it has spread.
  • Thoracoscopy - a thin, flexible viewing tube is inserted through a small incision in the chest.​​​
  • Biopsy - cells are removed from the body to examine with a microscope
    • needle biopsy - a sample of fluid or tissue may be removed using a thin, hollow needle
    • an endoscope tube may be inserted to view inside the body and remove tissue
    • surgery may be required to get a tissue sample or to remove the entire tumour.
For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment. 

T describes the site and size of the main tumour (primary)

N describes involvement of lymph nodes

M relates to whether the cancer has spread (presence or absence of distant metastases) 

A simplified version of the staging of pleural mesothelioma is found below. An in-depth explanation of the staging is available on the Cancer.net website. 

Stage I
The pleura lining the chest wall on one side of the chest is affected. The pleural lining of the diaphragm, lung, pericardium, or diaphragm on the same side of the chest may or may not be affected. Lymph nodes are not involved. 

Stage II
Mesothelioma involves the pleural lining on one side of the chest and has spread into the lung or diaphragm. There is no spread to the lymph nodes or distant sites. 

Stage III
Mesothelioma is in the pleural lining of one side of the body and at least one other nearby organ or tissue: lung, diaphragm, chest wall, muscle, ribs, mediastinum, esophagus. It may have spread to lymph nodes on the same side of the body, but distant sites are not affected. 

Stage IV
Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumour, to the pleura or lung on the opposite side, or directly into organs in the abdominal cavity or neck. Distant sites may be affected.
Treatment

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.
 
  • There is no cure for mesothelioma.
  • The length of survival depends on the extent of the disease. Patients usually live up to one year after being diagnosed.
Surgery
  • Some patients may be considered for the surgical removal of the lining or part of an organ.
  • Surgery must be performed by very experienced surgeons.
  • If surgery is considered, it is typically combined with other treatments such as chemotherapy and radiation.
  • Often, surgery is not an option because of the local extent of the cancer or because the cancer has spread to other parts of the body.
Radiation
  • Radiation therapy is not able to cure mesothelioma but it may be used to control symptoms.
Chemotherapy
  • Chemotherapy is routinely considered in those fit enough to receive treatment.
General Support and Symptom Control
  • Prescription drugs can control pain that is associated with mesothelioma.
  • Fluid build up (pleural effusions) can be treated by minor surgery to drain the fluid. This enables the lung to re-expand and improves breathlessness.
  • Some patients with mesothelioma may have very slow growing tumours. If the patient does not have symptoms, regular chest X-rays without specific therapy will track the tumour's growth.
Follow-up after Treatment
  • Guidelines​​ for follow-up after treatment are covered on our website.​​
  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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SOURCE: Mesothelioma ( )
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