Early symptoms of mesothelioma may mimic those of pneumonia:
• dyspnea
• cough,
• shortness of breath
• chest pain
• hypoxia
Symptoms worsen if fluid builds up in the pleural space causing a pleural effusion. Invasion of adjacent structures or metastasis to other parts of the body can occur, with symptoms depending on the structures or organs affected. Sometimes there are no symptoms and diagnosis occurs as a result of routine physical exams.
Treatment can consist of radiation, surgery, or chemotherapy but results have been disappointing. Clinical trials are underway to study other ways to fight this cancer and interested patients should consult with their doctor about participation in such trials. For now, palliative care with narcotic pain relief and supplemental oxygen for shortness of breath is frequently all that can be done. Fluid build-up is drained via thoracentesis or paracentesis.
There are a variety of symptoms for mesothelioma, dependent on where the mesothelioma is located. The most common symptoms for pleural mesotheliomas (cancer of the lining of the lung) are difficulty in breathing/shortness of breath, pain under the rib cage, and a dry, hacking cough. These symptoms are caused by the excess fluid and build-up of tumor tissue in the pleural space surrounding the lungs. Less common symptoms may include weight loss for no reason, fever, night sweats and feeling easily fatigued.
The symptoms of peritoneal mesothelioma (cancer of lining of the abdomen) may include abdominal swelling and pain, weight loss, and a mass in the abdomen, all due to the accumulation of excess fluid and tissue building in the abdominal cavity. Additional symptoms include bowel obstruction, anemia (a lowered red blood cell count), fever, and blood clotting abnormalities.
The most common sites for mesothelioma are the pleura (lining of the lungs) and the peritoneum (lining of the abdomen.)
Symptoms of pleural mesothelioma can include: dyspnea (difficulty breathing), chest pain near or under the rib cage, fever, night sweats, persistent dry cough, weight loss, lethargy, and fatigue.
Symptoms of peritoneal mesothelioma can include: swelling, pain (due to increased fluid and pressure in the abdomen), weight loss, a mass or lump in the abdomen, bowel obstruction (blockage), irregular blood clotting, anemia (decreased red blood cell count), and fever.
Symptoms of pericardial mesothelioma can include: chest pain and shortness of breath . This can be caused by a tumor or fluid build-up that may compress the heart during beats.
Symtoms of mesothelioma can manifest as many as 30 years from the initial time of exposure.
Patients with pleural mesothelioma often have a presentation with insidious onset of dyspnea, nonpleuritic chest pain, cough, increased sputum production, weight loss, fevers, sweats and increasing weakness. On physical examination patients may have clubbing of the fingernails, dullness to percussion of the chest and decreased breath sounds of the lungs with auscultation caused by pleural effusion. Pleural effusion caused by mesothelioma will not have a mediastinal shift to the opposite side of the chest, as seen in typical pleural effusions, because of the restriction placed on the chest wall. With palpation of the chest wall there may be a coarse vibration, usually on inspiration, that suggest a pleural friction rub caused by inflammation of the pleural surfaces, the feeling is analogous to the feel of leather rubbing on leather. Patients usually have an occupational history of asbestos exposure, such as construction or ship yards.
• Systemic manifestations may be present with any type of malignant mesothelioma and include weight loss, malaise, anorexia, and fever.
• Types of mesothelioms
-Pleural mesothelioma
-Symptoms include pain in the back or the lower chest, dyspnea, and dry cough. The presence of a large pleural effusion (more than 200-300 mL of pleural fluid) can be detected clinically by the absence of chest wall movement, mediastinal shift to the opposite side, decreased breath sounds, and dullness to percussion over the effusion.
-Peritoneal mesothelioma
-Symptoms include abdominal pain, bowel obstruction, and abdominal distension due to ascites or bowel obstruction.
-Pericardial mesothelioma
-Symptoms may include pain, dyspnea, and cough. A pericardial friction rub may be present. Cardiac tamponade is an ominous sign and is suggested by symptoms of tachycardia, tachypnea, and a narrow pulse pressure.
- The most common presenting symptoms of mesothelioma are shortness of breath and non-pleuritic chest pain.
- Weight loss, fatigue, fever, and sweats are other symptoms of mesothelioma.
- The lung exam may reveal dullness to percussion and diminished breath sounds.
- Another physical exam finding may be finger clubbing which is also found in asbestosis.
- Radiographic studies may aid in the diagnosis of mesothelioma.
- Chest x-rays may reveal nodular, irregular, unilateral pleural thickening and unilateral pleural effusion.
- CT scans are helpful in determining the extent of pleural involvement.
- Abdominal CT may show sheet-like masses involving the omentum and mesentery.
- Pleural fluid is usually exudative and may be hemorrhagic, but this is not diagnostic.
- Open pleural biopsy is necessary for histologic diagnosis.
- Histological types of mesothelioma are epithelial, sarcomatous, or mixed.
- Special stains and electron microscopy may be needed to confirm the histologic diagnosis.
- Diagnosis of mesothelioma is confirmed by thoracoscopy or pleuroscopy.
Patients with a pleural mesothelioma may present with a variety of complaints such as shortness of breath, fever, or chest wall pain. They may also be asymptomatic. Depending on the progression of the disease your assessment may reveal clubbing or pre-clubbing of the fingers, decreased breath sounds on the effected side, or maybe a pleural rub.
Pericardial mesothelioma may present with fever, mid-sternal chest wall pain, shortness of breath, generalized fatigue or other cardiac symptoms caused by fluid compressing the heart. Cardiac tamponade can result and be fatal if not treated in a timely manner. Assessment of vital signs is important paying special attention to the pulse for tachycardia and listening for a paradoxical pulse when taking the blood pressure. Cardiac auscultation may reveal decreased heart tones or a pericardial rub. EKG may reveal pulses alternans.
Peritoneal mesotheliomas can present with fever, abdominal swelling, and various GI complaints but males can also present with scrotal pain.
The early symptoms of mesothelioma resemble common, minor illnesses. Symptoms of mesothelioma generally appear 2 to 3 months before a diagnosis is made. In about 25% of cases, symptoms may have appeared for six months before a diagnosis is made.
In 50% of patients, pleural mesothelioma presents with hyperesthesia in the low back and at the side of the thorax. The hyperesthesia may be accompanied with difficult respiration. Patients may also report difficulty while swallowing, coughing, elevated temperature, tiredness and loss of weight.
Peritoneal mesothelioma presents with abdominal hyperesthesia, vomiting, nausea and loss of weight.
If a patient exhibits the symptoms of mesothelioma, and also has the risk factors, imaging test will be performed to determine the diagnosis.
An x-ray is generally the first test performed as it will show an irregularity which would suggest the presence of a mesothelioma. If a mesothelioma is suspected, either a computed tomography (CT) scan, or a magnetic resonance imaging (MRI) scan will be performed to establish the size, extent, and location of the mesothelioma.
Although patients can be completely asymptomatic at the time of diagnosis, more often there are vague, non-specific complaints. The rapid proliferation of malignant cells causes pleural effusions in pleural mesothelioma. These effusions can result in dyspnea, hemoptysis, persistent cough, hoarseness, lower back pain, and chest pain. Abdominal mesothelioma is accompanied by ascites and symptoms include bowel obstruction, weight loss, anemia, lower back pain, abdominal pain, edema, fatigue, and fever. Many of these same symptoms may also be seen in pericardial manifestations of the disease.
Patients may complain of their symptoms for 2-6 months before a diagnosis of mesothelioma is made. Imaging studies may reveal the presence of fluid accumulation and tumor, but definitive diagnosis is made only by biopsy or autopsy.
The early symptoms of mesothelioma can be somewhat vague and non-specific. Pleural mesothelioma patients usually present with what appears to be a viral pneumonia. This can include cough, shortness of breath or chest pain. Some of the less common symptoms are weight loss, fever and night sweats. A delay in diagnosis often occurs due to the generalized nature of the complaints and the fact that many other illnesses present in this manner.
Peritoneal mesothelioma patients generally present with abdominal pain and swelling, weight loss, peripheral edema, bowel obstruction and ascites.
As the fluid accumulation progresses, symptoms become more severe. There is increased shortness of breath, chest and/or abdominal pain, profound fatigue and a dry cough. Mesothelioma of the pericardium may result in pericardial effusion which can lead to cardiac tamponade which is a cardiac emergency. Long term survival of mesothelioma patients is generally unexpected.