Understanding mesothelioma

Mesothelioma is a rare but aggressive form of cancer that primarily affects the lining of the lungs, abdomen or heart. It is most associated with exposure to asbestos, a naturally occurring mineral once widely used in various industries. Pleural mesothelioma, which affects the lining of the lungs, is the most common type.

Causes

The primary cause of mesothelioma is exposure to asbestos fibers. Once widely used for its heat resistance and durability, asbestos was integrated into numerous industrial, commercial, construction, automotive and consumer products.

“When asbestos fibers are inhaled, they can become lodged in the lining of the lungs, leading to inflammation and, over time, causing mesothelioma,” said Dr. R. Taylor Ripley, professor of surgery in the David J. Sugarbaker Division of Thoracic Surgery and member of the Dan L Duncan Comprehensive Cancer Center at Baylor.

Workers in industries such as construction, shipbuilding and manufacturing are at higher risk of developing mesothelioma. Family members of workers exposed to asbestos also may be at risk through fibers brought home on clothing or skin. People living near asbestos mines or in buildings with deteriorating asbestos-containing materials also are vulnerable.

Symptoms

Mesothelioma symptoms often do not appear for decades after asbestos exposure. However, recognizing these symptoms early can be crucial for diagnosis and treatment.

“Mesothelioma can take 20 to 50 years to develop,” Ripley said. “Common symptoms include a persistent cough, chest pain, shortness of breath, unexplained weight loss, fatigue and lumps of tissue under the skin on the chest. Patients who have these symptoms should see their primary care physician, who can recommend them to a lung specialist like myself.”

Treatment options

While mesothelioma is challenging to treat, several options are available to manage symptoms and improve quality of life. Treatment plans are tailored to the patient’s specific situation, including the stage of the cancer and the patient’s overall health. The primary treatment options include surgery, chemotherapy, radiation and immunotherapy.

Surgery

• Pleurectomy/decortication: Removal of the lining of the lungs and chest and sometimes the diaphragm and the sac around the heart.
• Extrapleural pneumonectomy: Removal of one lung and surrounding tissue, including the diaphragm and the sac around the heart.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells and can be systemic (throughout the body) or localized. For pleural mesothelioma, chemotherapy is used to shrink tumors before surgery or to kill remaining cancer cells after surgery.

Radiation therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. It can be used to reduce symptoms, control tumor growth and improve quality of life.

Immunotherapy

Immunotherapy helps the body’s immune system fight cancer. The combination of nivolumab and ipilimumab is proven to help treat patients with pleural mesothelioma by targeting specific proteins in cancer cells.

“The overall five-year survival rate for mesothelioma is only around 10%, but we are trying to change that,” Ripley said. “We are enrolling patients in a clinical trial to test a combination of chemotherapy and immunotherapy before surgery and immunotherapy for one year after surgery. This combination has been successful in other cancers, and it combines the treatments associated with the longest survivals; therefore, we anticipate it will be a more effective treatment option for these patients with mesothelioma.”

Ripley and his team are currently enrolling mesothelioma patients in the NEMO Trial. For more information or to enroll in the clinical trial, call 713-798-5530.

By Tiffany Harston, communications associate with the Michael E. DeBakey Department of Surgery