Pleural mesothelioma typically presents insidiously with symptoms of pleural effusion, including dyspnea and chest pain. Weight loss is common. Physical exam will yield diminished breath sounds and dullness to percussion. A history of asbestos exposure occurs in 60-80% of those with malignant mesothelioma with symptoms presenting 20-50 years after exposure. The average age at symptom onset is 60 years old. Occupational exposure occurs with the mining and manufacturing of asbestos and its products or with direct handling of these products (insulation, textiles, paint, brake linings, gaskets, etc.). Symptoms of peritoneal mesothelioma are similar to those of other abdominal cancers and include abdominal pain, ascites, or bowel obstruction. Additionally, fever and anemia are seen. Pulmonary asbestosis is seen in over half of all cases. Occasionally, peritoneal mesothelioma presents with lymphadenopathy or, in women, a pelvic mass.
Pleural mesothelioma can cause these symptoms:
• Chest wall pain, may be in the side or lower back
• Pleural effusion
• Dyspnea
• Wheezing, and/or persistent cough
• Husky voice, hoarseness
• Difficulty swallowing
• Fever
• In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung.
• Pleural tumors are usually found on only one side of the lung.
Peritoneal mesothelioma can cause these symptoms:
• Cachexia, (physical wasting with loss of weight and muscle mass caused by disease)
• Abdominal pain and swelling due to ascites (may be severe)
• Abdominal mass
• Bowel dysfunction
• Thrombophlebitis
• Disseminated intravascular coagulation
• Jaundice
• Hypoglycemia
• Pleural effusion
• Pulmonary emboli
A mesothelioma does not usually spread to the bone, brain, or adrenal glands.
Patients with mesothelioma of the lungs may present with respiratory symptoms including persistent cough and shortness of breath. Patients may also complain of sharp chest pain and report weight loss. These symptoms are often confused with other diseases of the lungs including congestive heart failure, pneumonia, tuberculosis or pulmonary embolism. On examination, one may detect decreased breath sounds and dullness to percussion. Digital clubbing may also be seen. Radiography may show unilateral pleural effusion, with more than 60% seen in the right lower lobe.
Mesothelioma of the peritoneum often presents with abdominal complaints of nausea and vomiting, pain, and increased abdominal girth. These symptoms may be mistaken for cholescystitis, liver disease, or bowel disorders. Examination may reveal ascites or abdominal mass. Laboratory and xray may show anemia and bowel obstruction.
Often CT scan, thoracentesis/paracentesis, or biopsy is needed for confirmation of the diagnosis.
Symptoms are related to the location and extent of involvement. In pleural mesothelioma, the most frequently occurring symptoms are shortness of breath, chest pain, persistent cough. These symptoms are a result of a pleural effusion that results from fluid collection between the lung and the lung lining which is now compromised by mesothelioma.
If the less common peritoneal mesothelioma occurs there will be abdominal pain, weakness, weight loss, nausea and loss off appetite. Again location and the pattern of involvement determine symptoms displayed which can include abdominal swelling and bowel obstruction. If the peritoneum or organs under the diaphragm is involved difficulty breathing can also be experienced without lung involvement.
In the rare case of pericardial sac involvement symptoms are chest pain, persistent cough and palpitations. Due to restrictions of cardiac filling caused by invading tumor patients can experience shortness of breath.
While advanced invasive mesothelioma, or mesothelioma with associated asbestosis (present in only 20% of cases), might present with hemoptysis, the clinical finding of hemoptysis is more suggestive of an airway lesion than mesothelioma, which arises from the pleura. Pleural membranes line the thoracic wall, lung, and mediastinum, and thus have no direct connection with the airway before the anatomy is deranged by the disease process. Dyspnea, pleural effusion, productive cough, and chest pain can all result from the primary lesion of mesothelioma, which is typically a localized or diffuse thick malignant tissue on the thoracic surface of the lung which can aggravate the pleura (leading to chest pain and/or pleural effusion), and produce a mass effect on the lung (leading to dyspnea).
Many symptoms of malignant mesothelioma are similar to those of other health problems. Chest pain, shortness of breath, persistent cough, difficulty swallowing, and weight loss are symptomatic of pleural mesothelioma. Abdominal pain and swelling, nausea, and weight loss are associated with peritoneal mesothelioma. Peritoneal mesothelioma is also sometimes accompanied by bowel obstruction, anemia, abnormal blood clotting, and fever. A more characteristic symptom of mesothelioma is fluid accumulation in the cavity lined by the mesothelia. In early stages of mesothelioma, tumors are localized to the mesothelial membrane of origin. In malignant pleural mesothelioma, tumors may also develop in the lungs, pericardium, or diaphragm. Advanced pleural mesothelioma is associated with the progressive spread of cancerous cells to the chest wall, esophagus, heart, lymph nodes, and peritoneum.
Clinical presentation is similar to most pulmonary problems. Nonpleuritic chest pain and dyspnea are the most common. During the evaluation, chest x-ray may show a unilateral pleural abnormality or pleural effusion, diffuse pleural thickening or a pleural mass or ipsilateral mediastinal shift. Loss of lung volume is common.
Physical findings may include dullness to percussion, palpable chest wall masses or scoliosis to the side of the malignancy.
In most cases of mesothelioma, symptoms of the disease may not occur until 20-40 years after asbestos exposure. The symptoms can be vague at first and most people will attribute them to a cold or flu.
With pleural mesothelioma, most patients experience a minor discomfort in the lower back or over the side of the chest. This becomes progressively worse which prompts them to seek medical care. A smaller number will complain of shortness of breath along with a chronic cough (sometimes with blood-tinged sputum), hoarseness, fever, fatigue, and weight loss.
Peritoneal mesothelioma produces symptoms of abdominal pain, nausea and vomiting, and weight loss. Sometimes a palpable mass is felt in the abdomen or a hernia may be present.
Though very rare, pericardial mesothelioma produces cardiac symptoms of chest pain, shortness of breath, and fatigue.
Patients with mesothelioma generally present with chest pain that is quite severe and sometimes disabling. The nature of this pain is generally described as aching and non-pleuritic in character. Patients generally also have shortness of breath. This shortness of breath may or may not be accompanied by a cough. Symptoms that are less often seen include night sweats, fever, and weight loss. If the tumor has progressed into the peritoneal cavity, patient may experience abdominal pain or swelling. Peritoneal mesothelioma may also present with nausea, bowel obstruction, anemia, or pedal edema. Some patients present with no symptoms at all. Signs on physical exam may reveal chest dullness to percussion secondary to pleural effusion. Plain radiographs will also reveal pleural effusions. Mesothelioma and its subsequent pleural effusion are most often right-sided.
The first symptoms of pleural mesothelioma are generalized and usually go unrecognized for quite sometime. Symptoms such as shortness of breath, persistent cough, and chest tightness/pain are common but, some patients are asymptomatic. These symptoms are usually caused by a pleural effusion. Pleural effusion is when fluid settles between the parietal and visceral pleura in the lungs. This happens due to the damage, by the cancer, to the mesothelial cells that make up the parietal and visceral pleura. The pleura, under healthy circumstances, should absorb any extra fluid formed in the pleural cavity, when cancer is present, normal fluid is not reabsorbed. There are two types of pleural effusions, transudates and exudates. The type of pleural effusion that presents in mesothelioma is exudative. As the pleural cavity continues to fill with fluid, patients present most commonly with shortness of breath, which then leads to a more thorough exam and more extensive testing.