• Pleural Mesothelioma: This type affects the lining of the lungs and is the most common form of the disease. Symptoms include shortness of breath, difficulty swallowing, coughing, fever, weight loss and pain.
• Peritoneal Mesothelioma: This cancer may also affect the abdomen and symptoms include nausea and vomiting, abdominal pain, loss of appetite, bowel obstruction and fever.
• Pericardial Mesothelioma: This form of the disease affects the heart and the tissues surrounding it. Although this is the most rare variation of mesothelioma, the symptoms may include heart palpitations, chest pain, breathing difficulties and persistent coughing.
The symptoms of mesothelioma are very common to a number of many other diseases. For this reason, it is not unusual for the patient to be initially misdiagnosed. People who have worked with asbestos should inform their physician if they experience any symptoms because it is most important that a speedy diagnosis be made in order for treatment to be most effective.
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Technically there are two types of mesothelioma:
1. Localized (benign or malignant)
2. Diffuse (highly malignant)
Localized mesothelioma often presents with: pleuritic pain, joint pain and swelling, and dyspnea. Diffuse mesothelioma often presents with chest pain (not necessarily pleuritic), malaise, weight loss, and cough. Pleural effusion is the hallmark sign presenting in greater than 75% of diffuse cases, but on 10% to 15% of the time in local disease. Benign disease presents as “broccoli” or “cauliflower” pedunculated masses on the visceral pleura, as opposed to the “sheet like” growth of malignant disease. Overall malignant mesothelioma occurs in the pleura 90% of the time. Pleural malignant mesothelioma is associated with asbestos exposure in 77% of cases.
The 3 main subtypes are epitheloid which account to 50-70% of cases diagnosed, and has the best outlook to respond to treatment. The other 2 are mixed/biphasic, and sarcomatoid, which do not respond as well as the epitheloid. All 3 subtypes are treated the same, and traditional treatments are surgical removal of tumor, chemotherapy, and radiation therapy.
The 3 forms of mesothelioma listed by the NCI are the following: pleural mesothelioma which is the most common, with 3/4 of all cases involving the chest cavity. The second form is peritoneal mesothelioma, which accounts for 10-20 percent of cases which start in the abdominal cavity. The third form is pericardial mesothelioma, which occurs around the lining of the heart, and is very rare. The disease is very difficult to diagnose as the symptoms are non-specific, and the latency period of the disease manifesting itself is on an average 35-40 years from the time of exposure until symptoms are manifested. Symptoms can include pain in the lower back, the side of the chest, shortness of breath with the pleural form. Abdominal symptoms include belly pain, weight loss, nausea, and vomiting. Pleural effusion (fluid collecting between the lining of the lung and chest cavity) represents one of the most common symptoms of pleural mesothelioma.
Regardless of the location, malignant mesotheliomas occur in three forms. The epithelioid type is the most common, accounting for 50-70% of all mesotheliomas. Between 20-35% of mesotheliomas are sarcomatoid, or fibrous. These cells are typically oval shaped, but more irregular, and with the nucleus not as clearly visible under an electron microscope as the nuclei of the epithelioid mesothelioma cancer cells. Because the oval irregular shape is a common form of a cancer cell type, sarcomatoid mesothelioma can be confused with sarcomatoid carcinoma and with sarcoma. The remaining 7-20% of tumors are classified as mixed/biphasic. Epithelioid mesothelioma has the best outlook for survival. Biphasic mesothelioma cancer typically produces a combination of epithelioid and sarcomatoid cancer cells as opposed to a mixture, meaning that the two subtypes occur in different parts of the tumor.
Mesothelioma occurs in the lining of the lungs (pleura), abdominal (peritoneum) and heart (pericardium). Its occurrence is greatest in the lungs with about two-thirds of all cases. The abdomen accounts for 20-30% of cases. Involvement of the pericardium or reproductive organs is rare. Unlike other forms of cancer that form a lump, mass or tumor mesothelioma spreads sheet like along the surface of the pleura or peritoneum and then extends into the tissue it surrounds.
Another aspect of mesothelioma is the hardening of the mesothelioma tissue that then forms a case like structure around the organs involved. In the case of pleural mesothelioma this would then restrict movement of the lungs making it difficult for an individual to take a deep breath. It does metastasize like other types of cancer but this usually occurs only after localized involvement is extensive.
Malignant mesothelioma can be categorized into pleural, peritoneal, or pericardial mesothelioma based on the location of the tumor.
Pleural mesothelioma – the most common form of malignant mesothelioma – is cancer of the thin membrane that covers the lungs and lines the walls of the chest; this membrane is called the pleura. The pleura function to assist the movement of the lungs during breathing.
A small percentage of malignant mesotheliomas originate in the abdomen. This form of the disease is referred to as peritoneal mesothelioma. The peritoneum is the lining that surrounds the stomach; it functions to protect the stomach by producing a lubricating fluid that allows the stomach to move freely during various activities.
Pericardial mesothelioma is a rare form of the disease that affects the lining of the heart, which is known as the pericardium.
There are three forms of mesothelioma. All forms are the result of exposure to asbestos. Pleural mesothelioma is the most common form. It affects the lungs, the protective lining and cavity of the lungs. The patient may experience shortness of breath, chest pains, and a persistent cough. All these symptoms are caused by pleural effusion; this is a fluid build up in between the lining of the lung and the chest cavity.
Peritoneal mesothelioma is a rarer form that starts in the abdomen and can spread to other areas of the body. The patient’s symptoms are abdominal pain, nausea, vomiting swelling and loss of appetite.
Pericardial mesothelioma is the rarest form of this disease. It starts in the cavity surrounding the heart and the tumors can spread to other areas of the body. Patients with this form of mesothelioma may experience, chest pain, shortness of breath and palpitations.