What is Mesothelioma?

Mesothelioma is cancer of the mesothelium, the tissue that lines and protects vital organs such as the heart, lungs and stomach, as well as the inner body wall. An uncommon but aggressive type of cancer, mesothelioma is most often caused by exposure to asbestos. There are three types of mesothelioma: pleural mesothelioma (cancer of the lung lining) accounting for 75 percent of all mesothelioma diagnoses; peritoneal mesothelioma (cancer of the mesothelium surrounding the abdomen); and pericardial mesothelioma (a rare cancer of the mesothelium around the heart).

Because it is so rare and symptoms often mimic those associated with other common problems, mesothelioma can be difficult to diagnose. Pleural mesothelioma affects over 2,000 people a year in the U.S.; it is estimated that there will be 300,000 cases before the year 2030.

Brigham and Women's Hospital was a founding member of The International Mesothelioma Program (IMP) when it was launched in 2002. The IMP is a collaborative research and treatment effort between Boston’s finest medical institutions: BWH, Dana-Farber Cancer Institute, Massachusetts General Hospital, the Boston VA Health Care System and Harvard School of Public Health. The participating institutions combined goal is to develop treatment strategies that extend life, while also supporting patients physically, emotionally and practically throughout treatment.

What are the risk factors for mesothelioma?

Factors contributing to an increased risk of developing mesothelioma include:

Men older than 65
Asbestos exposure: inhaling or swallowing fibers at work or home
Occupation: factory workers, shipbuilders, military veterans or insulation professionals
Secondary exposure: family members exposed to asbestos fibers and dust
High doses of radiation to the chest or abdomen
Infection with simian virus 40 (SV40)
Exposure to Zeolite, Erionite, Carbon Nanotubes
Smoking

What are the types of mesothelioma?

There are three mesothelioma cell-types:

Epithelioid: 60 to 70 percent of cases, usually best outcome
Sarcomatoid: 10 to 15 percent of cases, more aggressive
Biphasic or mixed: 10 to 15 percent of cases, extremely aggressive

What are the symptoms of mesothelioma?

Pleural mesothelioma may cause these symptoms:

Chest pain or sensation of tightness
Coughing, usually a dry/nonproductive cough
Shortness of breath
Difficulty swallowing
Fatigue
Unexplained weight loss, decrease in appetite
Fluid buildup (effusion) in lung

Peritoneal mesothelioma may cause these symptoms:

Abdominal pain or swelling
Weight loss, decrease in appetite
Nausea/vomiting
Bowel irregularity
Fatigue
Fluid build-up in abdomen (ascites)

Pericardial mesothelioma may cause these symptoms:

Difficulty breathing
Chest pain
Fatigue
Weight loss
Irregular heartbeat
Heart murmurs

How is mesothelioma diagnosed?

Sometimes it is hard to tell the difference between mesothelioma and other conditions, such as lung cancer. To effectively diagnose mesothelioma, your specialist in The Lung Center may conduct the following diagnostic tests and procedures:

Medical history, including history of exposure to asbestos and physical exam
Blood test to determine the existence of tumor markers (certain proteins) released in the presence of cancer.
Chest X-ray to show any thickening of the pleura, calcium deposits on the pleura, and whether there is an accumulation of fluid around the lungs (pleural effusion). An abdominal X-ray will be performed if there is suspicion for peritoneal mesothelioma to determine accumulation of fluid in the abdomen (ascites).
Computerized tomography scan (CT scan) helps determine the location, size and extent of mesothelioma tumors and can help determine whether the tumor has invaded any of the adjacent structures.
Pulmonary function tests measure the lungs’ ability to move air into and out of the lungs. Helps to predict lung function/capacity after surgery.
Magnetic resonance imaging (MRI) uses radio waves and strong magnets instead of X-rays. It produces cross sectional slices of the body like a CT scanner, but it also can produce slices that are parallel with the length of your body (both front to back and side to side). This study is different from a CT scan in that it helps to determine if there is involvement of the diaphragm or chest wall with mesothelioma.
Echocardiogram uses ultra-high-frequency sound waves to create an image of the heart muscle. An “echo” test can provide useful information, including the size and shape of the heart, its pumping strength, and the location and extent of any damage or heart disease. We also use this study to look at the pressure in the arteries carrying blood from the heart to the lungs, to make sure the pressure is not elevated.
PET/CT Scan is a full body CT scan that uses radionuclide tagged glucose (sugar) cells to determine if there has been any spread of disease beyond the suspected primary site (lymph nodes, bones or other organs).
Biopsy If the results of these tests are suspicious for mesothelioma, a biopsy will be taken to confirm the diagnosis.

Video-assisted thoracic surgery (VATS) pleural biopsy involves making one or two small incisions in the chest to insert a small video camera and instruments with which to take the sample. The surgeon watches a TV monitor connected to the camera to enable precision in taking the sample. If the sample is taken from the abdomen, it is called a peritoneal biopsy. This is the standard biopsy for tissue diagnosis.
Mediastinoscopy involves inserting a lighted tube under the breast bone (sternum) and moving it down into the chest so the surgeon can see the lymph nodes and take samples. This determines whether a mesothelioma tumor has spread.
Pleural fluid analysis involves removing fluid (pleural effusion) from the chest with a needle and having the pathologist study the cells. There is a chance for false-negative results with this test.
CT-guided needle biopsy (FNA or Core) involves a radiologist using CAT scan guidance to advance a needle to aspirate or obtain cells for diagnosis. This test also may yield false negatives, or not provide enough tissue to determine the cell type of mesothelioma.

What are the stages of mesothelioma?

The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The stage is determined from the results of physical exams, imaging tests and biopsies.

Do you offer personalized care?

Yes. Our Lung Center clinicians tailor treatment strategies to the individual disease of each patient. Two new tests help our clinicians tailor therapy for their patients:

The four-gene ratio test was developed in the IMP Thoracic Surgery Oncology Laboratory. It is a molecular test that helps to define patient prognosis in terms of benefiting from standard trimodality (surgery, chemotherapy, and radiation therapy) mesothelioma. When combined with other patient-specific information, the test allows surgeons to predict which patients will respond favorably to surgery and which should consider more aggressive experimental therapy. BWH has recently licensed this test to Castle Biosciences, a company which will soon make this available clinically.
Researchers at the IMP have developed a new paradigm of testing novel biological drugs in clinical trials for mesothelioma patients. There are several such drugs in our pipeline and these are administered in addition to surgery based on the genetic makeup of the tumors. More information is available at the time of your visit.

What are the treatment options for mesothelioma?

Mesothelioma is an uncommon cancer, rarely seen in most medical centers. Specialists in The Lung Center have more than 20 years of experience in treating mesothelioma and offer the full spectrum of conventional and novel therapies, personalized to each individual patient and cancer, in a caring and compassionate environment. Options include surgery, chemotherapy, radiation therapy, and combined approaches.

Is surgery available for mesothelioma?

Brigham and Women’s Hospital has pioneered and refined the most advanced surgical treatments for mesothelioma, including the introduction of interoperative chemotherapeutic drugs. Today, clinicians from around the world come to Boston to learn from our experts.

The purpose of surgery is to remove all visible disease, with the goal of extending life. Surgical options for mesothelioma include:

Pleurectomy involves removal of the lining around the affected lung (like peeling the rind off of an orange).
Extrapleural Pneumonectomy involves removal of the affected lung along with the lining around the lung (pleura), portions of the lining around the heart (pericardium), and the diaphragm. This typically involves reconstruction of the lining around the heart (pericardium) and the diaphragm with a Gore-Tex patch.

What non-surgical cancer treatments are available?

Following surgery, additional treatments (called adjuvant treatment) are offered to enhance control of the disease. The main ones are chemotherapy and radiation therapy.

Chemotherapy at Dana-Farber Brigham Cancer Center uses anticancer drugs to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery or alone in the most advanced cases. Chemotherapy may be used in conjunction with radiation.
Radiation therapy uses high-energy rays to kill or shrink cancer cells. Radiation is often used in conjunction with chemotherapy to shrink the tumor. The Radiation Oncology service at Dana-Farber Brigham Cancer Center uses the most advanced equipment and techniques to deliver radiation to cancerous areas, while minimizing exposure to normal tissues.

What can I expect?

When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. You will receive a thorough diagnostic examination and receive clinically-proven treatment by a board-certified thoracic surgeon experienced in diagnosing and treating mesothelioma. Our goal is to alleviate or eliminate symptoms so you can confidently resume everyday activities.

To support patients and families through this process, there is a dedicated mesothelioma support team consisting of social work, chaplaincy and patient liaison. These professionals provide counseling and spiritual support as well as practical help navigating care, housing and travel needs.

Do you offer housing assistance?

The Thornton & Naumes House at 48 Francis Street, Boston is located directly across from the main entrance of Brigham and Women's Hospital. This house is designated for mesothelioma patients and families undergoing treatment at the Thoracic Surgery Division, Brigham and Women’s Hospital.