What you should know about mesothelioma

It’s been five years since mesothelioma treatment pioneer, Dr. David Sugarbaker, arrived in Houston to open the Lung Institute and the Mesothelioma Treatment Center at Baylor College of Medicine. The late Dr. Sugarbaker was regarded as a leader in the treatment of mesothelioma and made it his life’s effort to work towards a cure for the disease.

Dr. R. Taylor Ripley, director of the Mesothelioma Treatment Center at Baylor, discusses mesothelioma risk factors, treatment options, and the importance of research to find new therapies.

Q: What is mesothelioma?
A: Mesothelioma is a disease of the pleural (occurring around the lung) or peritoneal lining (occurring around the stomach). These linings are on the inside of the chest and abdomen and are usually very thin. With certain environmental risk factors such as asbestos, these linings can thicken and become malignant pleural mesothelioma (in the chest) and malignant peritoneal mesothelioma (in the abdomen).

Q: How common is mesothelioma?
A: In the United States, there are about 3,000 new cases each year. Mesothelioma is more common in other parts of the world, but it is hard to get definite numbers since many cases are not tracked.  However, the estimated number of people with exposure to asbestos is currently about 125 million worldwide.

Q: How is mesothelioma diagnosed?
A: The vast majority of mesothelioma comes from exposure to asbestos, (a group of minerals that look like very thin fibers), which were commonly used in building construction prior to 1980. Mesothelioma usually presents 30-50 years after a person was exposed. The most dangerous and most common type of exposure to asbestos is when it is aerosolized as dust in the air that enters the lungs.

Also, individuals who received radiation to the chest for testicular cancer or lymphoma as teenagers sometimes develop mesothelioma later in life. There are also sporadic cases of the disease occurring in individuals where the cause is unknown or unidentified.

The diagnosis of mesothelioma is usually determined after several months of symptoms. Most patients first experience shortness of breath or chest pain. When they are evaluated, fluid is found in the chest. Once the fluid is drained, the patient feels better for a short time but the fluid recurs. When this happens, a biopsy of the pleural or peritoneal lining is obtained, which establishes the diagnosis.

Q: What steps are taken after a mesothelioma diagnosis?
A: If a patient has a new diagnosis, it’s important to see a physician who deals with this disease regularly. There are centers of excellence for treatment of this disease around the country. The Mesothelioma Treatment Center at Baylor is one of them.

Once a person finds a treatment center, several tests will be performed. First, there will be confirmation of the diagnosis. Then, the disease will be classified as one of several subtypes.  Following that, the doctors will assess how far along the disease is in its development and if it has spread. Finally, the patient’s heart and lungs will be tested to see that they are strong enough to withstand treatment.

Q: What are the treatment options for mesothelioma?
A: Treatment options for mesothelioma include the following:

• Surgical resection: Most commonly, this means surgically removing the cancer from the pleural lining, sparing the lung. This treatment is an option for some patients.
• Treatment with medication: Also known as systemic therapy, medication is administered as a two- or three-drug combination. Often, chemotherapy is part of an overall treatment plan that includes surgical resection. In 2004, the combination of two drugs called cisplatin and pemetrexed became the standard chemotherapy regimen for pleural mesothelioma and has remained the standard since.
• Other options do exist, mainly within clinical trials: These options include drugs known as small molecule inhibitors and immunotherapy. Most are still administered only on a trial basis, and they have not yet been approved by the FDA.

Q: What role does research play in mesothelioma treatment?
A: Research is critical in this disease. Despite best efforts of patients and physicians, most patients do not survive long-term. That means that the disease is dangerous and current therapies are not adequate. In such a situation, it is imperative that we push forward with new advances to try to change the course of this disease and help patients achieve long-term survival.

Q: What is your message to individuals or family members of patients who have been diagnosed with this disease?
A:The most important step to take once diagnosed with this disease is to reach out to centers of excellence to receive a full evaluation before embarking on any treatment course.

Dr. Ripley is an associate professor of surgery in the Division of General Thoracic Surgery at Baylor. Call 713-798-6376 to schedule an appointment with the Mesothelioma Treatment Center.

Additional Resources

Learn more about National Mesothelioma Awareness Day.

Read more facts about mesothelioma.

-By Debbie Sugarbaker, editor in the Michael E. DeBakey Department of Surgery at Baylor