Pleural Mesothelioma

When cancer strikes the lining of the lungs - otherwise known as thepleura - the disease that results is referred to as pleural mesothelioma. Technically speaking, the pleura is a sac which contains the lungs as well as a thin membrane known as the mesothelium, which secretes a vital fluid that enables the lungs to expand and contract during the breathing process.

Indeed, pleural mesothelioma is the most common of the 3 types of mesothelioma, which also include the peritoneal and pericardial varieties of the disease. More than 75% of all diagnosed mesothelioma cases affect the pleura.

How Does Pleural Mesothelioma Develop?

When an individual is exposed to asbestos on a regular basis, whether it be through job-related activity or other environmental issues, inhalation of loose, airborne asbestos fibers can occur. These fibers travel to the lungs and become imbedded in the lung lining, outside of the lungs and inside the ribs.

When these jagged particles settle in the pleura, they cause inflammation. The inflammation, in turn, can lead to dangerous cancerous tumors. In some cases, those who've inhaled asbestos fibers will first develop the less-severe asbestosis, followed by mesothelioma several years later.

Upon diagnosis, patients usually exhibit multiple tumor masses affecting both the visceral (further from the lung) and parietal surfaces (closer to the lung) of the pleura. The parietal surface is more often affected than the visceral surface, and the right lung, due to its larger size, often suffers more damage than the smaller left lung. In addition, more asbestos tends to settle in the lower lungs than the upper lungs.

These tumors often grow quickly in size and can cover the entire lung cavity, making it very difficult to breathe and causing excruciating pain. Also, in the advanced stages of pleural mesothelioma, the cancer may spread to other nearby organs, including the heart, abdomen, and lymph nodes.

Pleural Mesothelioma Symptoms

It's not always easy to diagnosis pleural mesothelioma by examining itssymptoms. All too often, the symptoms of the disease may resemble those of other more common illnesses, including something as simple as the flu, a cold, laryngitis, pneumonia, or whopping cough. It often takes weeks or even months before a correct diagnosis is made, and because the disease usually takes between 20 and 50 years to surface, past exposure to asbestos often doesn't come to mind when attempting to make a diagnosis or when a patient is giving a medical history.

Common symptoms of pleural mesothelioma often include:

• Chest pain
• Coughing
• Wheezing
• Shortness of breath
• Fluid around the lungs (pleural effusion)
• Hoarseness or difficulty speaking
• Blood clots (less common)

Chest pain is usually the first indication of a problem, caused by the growing tumors that enlarge the pleural space and cause it to fill with fluid. Such chest pain is often mistaken for heart problems and many yet-to-be-diagnosed mesothelioma victims believe they are having a heart attack or suffering from heart disease.

The discomfort caused by the above symptoms can also result in loss of appetite and weight loss. Once mesothelioma is diagnosed, it's important for patients to maintain good eating habits in order to better combat the disease.

Diagnosis and Treatment

Ultimately, a definitive diagnosis of malignant pleural mesothelioma is achieved by the use of sophisticated x-rays such as CT scans and MRI, as well as biopsy, the sampling of tissue or fluid around the lungs. Scans can reveal the presence of pleural effusion and biopsies, preferably a needle biopsy, can complete the diagnosis. While somewhat uncomfortable, this test is quick and offers a good success rate for accurate diagnosis.

Because pleural mesothelioma is often so difficult to diagnose, the disease is most often in an advanced stage when discovered. That makesmesothelioma treatment options limited. Only a handful of mesothelioma patients afflicted with this form of the disease are candidates for surgery to remove tumors, especially since the tumors are often large and widespread by the time of diagnosis. Surgery may be an option later, if the oncologist thinks the removal of a lung would benefit the patient.

More often, pleural mesothelioma patients are treated with radiation orchemotherapy. While advancements are being made in the treatment of the disease, especially with chemotherapy, such treatment is often palliative - meant to relieve the symptoms of the disease, make the patient more comfortable, and improve the patient's quality of life during the months ahead.

Some doctors opt for what is commonly known as multi-modal therapy, which is a combination of two or more therapies, usually chemo and radiation. Recent research has also prompted experimentation with different combinations of chemotherapy drugs, resulting in positive outcomes when certain ones are used at the same time.

Prognosis

Currently, the prognosis for those diagnosed with pleural mesothelioma is not good. Many patients die within six months of diagnosis, some last up to a year, but few survive much beyond that length of time. Clinical trialsare constantly underway in hopes that a cure for the disease or a way to further prolong the life of a pleural mesothelioma sufferer will be discovered.

Pleural Mesothelioma

Pleural mesothelioma is the most common type of mesothelioma, a rare cancer that develops in the mesothelial cells that make up the mesothelium, a membrane that lines many of the body’s organs and cavities. In the case of pleural mesothelioma, the cancer develops in the lining of the lungs, called the pleura or pleural membrane.

Malignant Pleural Mesothelioma Succeptablility by Country.

The pleura is comprised of two layers which provide support and protection for the lungs and chest cavity. The outer layer, or the parietal layer, lines the entire chest cavity and the diaphragm. The inner layer, or visceral layer, covers the lungs. Pleural mesothelioma typically develops in one layer, but can metastasize, or spread, to the other layer.

Like all mesothelioma cancers, pleural mesothelioma is caused by asbestos exposure and develops when the toxic asbestos fibers become trapped in the spaces between the mesothelial cells.

Asbestos.com offers pleural mesothelioma patients and their loved ones a comprehensive packet including information about various treatment options and top doctors to help those diagnosed understand their condition and applicable treatment options available. To receive this complimentary packet, pleaseclick here or call 1-800-ASBESTOS.

Symptoms of Pleural Mesothelioma

Once trapped in the body, asbestos fibers cause cancerous cells to divide abnormally, resulting in the thickening of the pleural membrane layers and mesothelial cells, causing build-up of fluid (called pleural effusion). The fluid begins to put pressure on the lungs and the respiratory system in general, preventing normal breathing.Symptoms of pleural mesothelioma are largely caused by these developments and may include the following:

Pleural mesothelioma specifically develops in the pleural lining of the lungs.

• Persistent dry or raspy cough
• Coughing up blood (hemoptysis)
• Difficulty in swallowing (dysphagia)
• Shortness of breath that occurs even when at rest (dyspnea)
• Persistent pain in the chest or rib area, or painful breathing
• Development of lumps under the skin on the chest
• Night sweats or fever
• Unexplained weight loss
• Fatigue

Pleural Mesothelioma Diagnosis

As with other types of mesothelioma, pleural mesothelioma is difficult to diagnose since symptoms do not typically arise for some time after initial asbestos exposure occurs. Additionally, since the symptoms of pleural mesothelioma are typical of many illnesses, in the early stages of the cancer the symptoms are often mistaken for less threatening diseases such as influenza and pneumonia.

X-rays or CT-Scans are often used to diagnose pleural mesothelioma.

A pleural mesothelioma diagnosis is made partly on the basis of symptoms but additional diagnostic tests are needed to confirm the presence of cancer. Following a medical history review and physical examination, patients must typically undergo imaging tests, such as x-rays or CT scans, to confirm the location of cancer. A patient must also usually endure fluid and tissue tests, also known as biopsies, to confirm the type of cancer involved.

Treatment for Pleural Mesothelioma

The on-going development of new drugs and detection techniques is improving the outlook for patients with pleural mesothelioma. Since pleural mesothelioma is the most common form of the cancer, more research and knowledge about this type of mesothelioma is present to utilize when detailing a treatment plan.

In general, pleural mesothelioma patients have three options: surgery, chemotherapyand radiation therapy. Typically, patients will receive a combination of two or more of these types of treatment.

Understanding available treatment options is often very important to patients and their loved ones. We offer a complimentary informational packet detailing treatment options for pleural mesothelioma patients. Click here to receive your packet overnight or call 1-800-ASBESTOS to speak with a patient and family advocate available at no charge to answer questions and offer guidance.

Early detection of pleural mesothelioma can improve a patient's mesothelioma prognosis considerably, and these patients have more extensive treatment options. If the disease is diagnosed early enough, surgery to remove localized tumors, followed by chemotherapy or radiation therapy to kill any remaining cancer cells can be an effective treatment. Curative surgery candidates must be in a good general state of health, and their cancer must not have spread beyond localized sections of the lungs.

When mesothelioma is diagnosed before the cancer has greatly progressed, a patient is typically in the first stages of mesothelioma. Doctors typically address the seriousness of cancer in terms of stages ranging from one to four, with the level of the cancer’s progression increasing with each stage. Patients diagnosed with pleural mesothelioma in stage one or two generally have greater treatment options and a better prognosis.

According to some current studies, approximately 10 percent of all pleural mesothelioma patients will survive for three to five years following diagnosis, and about 5 percent will survive five years or more.

Pleural mesothelioma patients who are not diagnosed early enough for curative treatment have fewer treatment options, mostly limited to palliative treatments, designed to relieve pain and discomfort to improve a patient's quality of life, rather than their prognosis. Palliative treatments include removal of built-up fluid from the pleural spaces, and surgical removal of tumors to relieve pressure on the lungs.

How Does Asbestos Cause Pleural Mesothelioma?

In cases of pleural mesothelioma, asbestos exposure occurs via inhalation of asbestos fibers. Once these fibers have entered the lungs, they work their way to the pleural membrane, and the body experiences great difficulty in expelling the fibers. Over a long period of time - typically two decades or more - asbestos fibers cause changes in these pleural cells, which may cause scarring of the lungs and, eventually, the formation of tumors.

When pleural cells become cancerous, they are no longer regulated by the mechanisms that control division of normal healthy cells. They begin to divide continuously, and this causes thickening of pleural membranes. As a result, lung capacity is reduced, and fluid begins to build up between pleural layers.

Pleural Mesothelioma: Mesothelioma of the Pleura

Pleural mesothelioma is a disease that affects the lining of the lungs, or lung pleura. Sometimes doctors refer to this disease as mesothelioma of the pleura. It is a common misconception that mesothelioma is a type of primary lung cancer; it is not.Mesothelioma is a cancer of the serous membranes. These membranes enclose a number of organs throughout the midsection of the body, including the lungs. The most common type of mesothelioma, pleural mesothelioma,  affects the serous membranes of the lungs.

Mesothelioma can also affect the serous membranes surrounding the abdomen, calledperitoneal mesothelioma, and the membranes surrounding the heart, or pericardial mesothelioma. When mesothelioma spreads to the lungs from the serous linings of the lungs, abdomen or heart, it is considered secondary lung cancer. Also, pleural mesothelioma is sometimes referred to as an asbestos lung cancer. Technically, cancers that do not originate in the lungs are not considered lung cancer; thus, terms such as secondary lung cancer and asbestos lung cancer (pleural mesothelioma) are misleading. Asbestosis is a type of asbestos lung disease that does originate in the lungs and is often confused with mesothelioma.

Pleural Mesothelioma Cancer

Pleural mesothelioma cancer represents about 75 percent of all mesothelioma cases. This disease is caused by the inhalation of asbestos fibers, which then settle in the lungs. These asbestos fibers become imbedded in the lining of the lung (the pleura). Over time, they cause chronic inflammation that eventually leads to growth of cancerous tumors or, in some cases, asbestosis.

Pleural mesothelioma cancer normally appears as multiple tumor masses affecting the parietal surface (outside; further from the lung) and visceral surface (inside; closer to the lung) of the pleura. Typically, the parietal surface has greater involvement than the visceral. There is a slightly higher incidence of mesothelioma in the right lung , apparently due to the fact that the right lung is larger and has a greater amount of pleural surface area. Also, the lower lungs typically show more tumor masses than the upper lung. This is thought to be due to gravitational factors influencing how the asbestos fibers settle in the lungs after they have been inhaled.

Large growths in the pleura are normally noted in patients upon diagnosis. As the diseases progresses, these growths lead to a complete obliteration of the lung cavity. The tumors can spread from the lung pleura to other organs, including the heart and abdomen. Mesothelioma can also invade the lymph nodes and circulatory system.

Tumors unrelated to pleural mesothelioma also grow in the pleura. These tumors start in other parts of the body and metastasize to the pleura. The most common form of non-pleural mesothelioma cancer that occurs is lung cancer, representing about 36 percent of the cancer occurring in the pleura. The next most common forms are breastcancer (25 percent), ovarian cancer (5 percent) and gastric cancer (2 percent). Lymphoma also accounts for a small portion of cancers that  metastasize to the pleura.

Pleural Mesothelioma Symptoms

The most common symptom for pleural mesothelioma patients is chest pain. But, the pain often is not associated directly with the lung pleura and often appears in the shoulder or upper abdomen. Shortness of breath, called dyspnea, is also a symptom. Cough, weight loss and anorexia are present in some patients, but are less common. Finally, the rapid growth of the pleural mesothelioma cancer tumors   enlarges the pleural space, causing it to fill with fluid, which leads to the discomfort or pain associated with fi

Benign Mesothelioma

While the vast majority of mesothelioma cases are malignant, benign - or non-malignant - mesothelioma can occur in some cases.

What is Benign Mesothelioma?

More recently referred to as a "solitary fibrous tumor of the pleura," benign mesothelioma - as the name indicates - is usually not cancerous, though cancerous forms can occur from time to time.

Appearing more in men than women, these tumors usually start in the tissues under the mesothelium, which is known as the submesothelium. A similar tumor may grow in the peritoneum, the lining of the abdomen. Doctors have appropriately named that disease "solitary fibrous tumor of the peritoneum."

Why is this Tumor Different?

The most important difference between these benign mesothelioma tumors and the cancerous forms is that these tumors do not spread, invading adjacent tissue. On the other hand, malignant tumors often spread quite quickly, making mesothelioma treatment difficult and non-effective.

Symptoms of Benign Mesothelioma

Benign mesotheliomas are actually very rare. They account for less than 10 percent of all mesothelioma cases worldwide. However, they do occur, usually presenting symptoms that are quite similar to those connected with malignant pleural mesothelioma. As a matter of fact, it is nearly impossible to differentiate between the two without extensive testing orsurgical procedures.

The most common symptoms that may indicate the presence of a solitary fibrous tumor of the pleura are:

• Chest pain
• Shortness of breath
• Chronic cough

The major reason for these symptoms is usually the growth of the benign tumor, which may be pressing on the lungs.

The doctor may also spot a clubbed appearance of the fingers, which is often a sign of such a tumor. With clubbed fingers, the nail bed takes on a distorted angle, which is indicative of a dangerously low level of oxygen in the blood. Clubbing is often associated with both lung cancers and heart diseases as well as cystic fibrosis.

Diagnosing Benign Mesothelioma

The same tests used for diagnosing malignant mesothelioma are used for diagnosing the benign form, because it's impossible to distinguish one from the other without the aid of sophisticated imaging or other procedures. The doctor may first suggest a regular x-ray, followed by a:

• CT scan

  Images produced by a machine that consists of an x-ray-generating device that rotates around the entire body. The device, which is connected to a high-tech computer, provides cross-section images (or "slices") of the inside of the body.

• MRI

  A diagnostic tool that uses a magnetic field and radio waves to create cross-sectional images of the head or body. This test has proven especially successful in detecting tumors in or around the lungs, which makes it especially useful fordiagnosing mesothelioma.

Though these tests can provide excellent pictures of the lungs and other affected areas, most doctors now opt for an open lung biopsy in order to reach a definitive conclusion. This biopsy involves surgery under general anesthesia, during which a small piece of the lung tissue will be removed and sent to a pathologist for examination.

Treatment of Benign Mesothelioma

Cases of benign mesothelioma are easily treatable, unlike malignant mesothelioma. Surgery to remove the tumor is usually sufficient. The prognosis is usually excellent in these cases.

Follow-Up

The development of benign mesothelioma could be an indication that more serious mesothelioma-type diseases may develop in the future. Anyone diagnosed with benign mesothelioma should continue with regular check-ups and chest x-rays after surgery.

BENIGN MESOTHELIOMA - What is benign mesothelioma?

Mesothelioma (benign-fibrous)

Definition:

A noncancerous tumor of the pleura (lining of the lung and chest cavity).

Causes, incidence, and risk factors:

Nonmalignant mesothelioma is usually a localized tumor that affects men more frequently than women. The tumor may grow to a large size and compress the lung, causing the symptoms of shortness of breath.

Symptoms:

• chroniccough
• shortness of breath
• chest pain

Signs and tests:

A physical examination reveals the clubbed appearance of the fingers.

Tests that may show benign mesothelioma:

• chest X-ray
• CT scan of the chest
• open lung biopsy

Treatment:

Surgery is indicated for a solitary tumor.

Expectations (prognosis):

The outcome is expected to be good with prompt treatment.

Complications:

Pleural effusion (fluid escaping into the membranes around the lungs) is a complication.

Calling your health care provider:

Call for an appointment with your health care provider if you notice a chroniccough or other signs of mesothelioma.

Prevention:
There is no known prevention for this very rare disorder.

---

Review Date: 12/2/2001
Reviewed By: Steven Kawut, M.D., Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York City, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation programis the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial reviewers. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

 

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

What Is Malignant Mesothelioma?

Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially the chest or abdomen. A layer of specialized cells called mesothelial cells lines the inside of the chest, the abdomen, and the space around your heart. These cells also cover the outer surface of most of your internal organs. The lining formed by these cells is called mesothelium. The mesothelium helps protect your organs by making a special lubricating fluid that allows organs to move around. For example, this fluid makes it easier for the lungs to move inside the chest during breathing. The mesothelium has different names in different parts of the body: In the chest it is called the pleura. In the abdomen it is called the peritoneum. In the space around the heart it is called the pericardium. Tumors of the mesothelium can be non-cancerous (benign) or cancerous (malignant). Malignant mesothelioma A cancerous tumor of the mesothelium is called a malignant mesothelioma, although this is often simply shortened to just mesothelioma. Mesotheliomas can start in 4 main areas in the body. Pleural mesotheliomas start in the chest cavity. They account for about 3 out of 4 mesotheliomas. Peritoneal mesotheliomas begin in the abdomen. They make most of the remaining cases. Pericardial mesotheliomas start in the cavity around the heart and are very rare. Mesotheliomas of the tunica vaginalis are very rare tumors that start in the covering layer of the testicles, which is actually an outpouching of peritoneum into the scrotum. Malignant mesotheliomas can also be classified into 3 types based on how the cells are arranged when looked at under a microscope: epithelioid: About 50% to 60% of mesotheliomas are of this type. It tends to have a better outlook (prognosis) than the other types. sarcomatoid (fibrous): About 10% to 20% of mesotheliomas are of this type. mixed (biphasic): These mesotheliomas have both epithelioid and sarcomatoid areas. They make up about 30% to 40% of mesotheliomas. Benign tumors of the mesothelium It is important not to confuse malignant mesothelioma with benign tumors that also start in the mesothelium. Adenomatoid tumor: This benign tumor can develop in the mesothelium of certain female and male reproductive organs. In men, it often starts in the epididymis (a small collection of ducts that carry sperm cells out of the testicle). In women, this tumor may begin in the fallopian tubes (tubes that carry eggs from the ovaries to the uterus or womb). Benign cystic mesothelioma: This is another non-cancerous tumor that may begin in mesothelium near female reproductive organs. Solitary fibrous tumor of the pleura: This type of benign tumor can form in the pleura surrounding the lungs. It used to be called benign fibrous mesothelioma, but doctors now know that this tumor actually starts from tissue under the mesothelium and not from mesothelial cells. This disease is usually benign, but about 1 in 10 are cancerous. A similar disease starting in the peritoneum is called solitary fibrous tumor of the peritoneum. These benign tumors are typically removed by surgery, and there is usually no need for additional treatment. Only malignant mesothelioma will be discussed further in this document.

Malignant Mesothelioma Treatment (PDQ®)

General Information About Malignant Mesothelioma

Key Points for This Section

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the lining of the chest or abdomen. Being exposed to asbestos can affect the risk of developing malignant mesothelioma. Possible signs of malignant mesothelioma include shortness of breath and pain under the rib cage. Tests that examine the inside of the chest and abdomen are used to detect (find) and diagnose malignant mesothelioma. Certain factors affect prognosis (chance of recovery) and treatment options.

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the lining of the chest or abdomen.

Malignant mesothelioma is a disease in which malignant (cancer) cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) or the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen). This summary is about malignant mesothelioma of the pleura.

Enlarge

Anatomy of the respiratory system, showing the trachea and both lungs and their lobes and airways. Lymph nodes and the diaphragm are also shown. Oxygen is inhaled into the lungs and passes through the thin membranes of the alveoli and into the bloodstream (see inset).

Being exposed to asbestos can affect the risk of developing malignant mesothelioma.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.

Many people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After being exposed to asbestos, it usually takes a long time for malignant mesothelioma to occur. Other risk factors for malignant mesothelioma include the following:

• Living with a person who works near asbestos.
• Being exposed to a certain virus.

Possible signs of malignant mesothelioma include shortness of breath and pain under the rib cage.

Sometimes the cancer causes fluid to collect around the lung or in the abdomen. These symptoms may be caused by the fluid or malignant mesothelioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Trouble breathing.
• Pain under the rib cage.
• Pain or swelling in the abdomen.
• Lumps in the abdomen.
• Weight loss for no known reason.

Tests that examine the inside of the chest and abdomen are used to detect (find) and diagnose malignant mesothelioma.

Sometimes it is hard to tell the difference between malignant mesothelioma and lung cancer. The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, past illnesses and treatments will also be taken.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

  Enlarge

  X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.

• Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made up of red blood cells.
• Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
• Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the cells or tissues include the following:
  • Fine-needle (FNA) aspiration biopsy of the lung: The removal of tissue or fluid using a thin needle. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A smallincision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.

    Enlarge

    Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.

  • Thoracoscopy: An incision (cut) is made between two ribs and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the chest.
  • Peritoneoscopy: An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen.
  • Laparotomy: An incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.
  • Thoracotomy: An incision (cut) is made between two ribs to check inside the chest for signs of disease.
• Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

  Enlarge

  Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease.

• Cytologic exam: An exam of cells under a microscope (by a pathologist) to check for anything abnormal. For mesothelioma, fluid is taken from around the lungs or from the abdomen. A pathologist checks the cells in the fluid.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer.
• The size of the tumor.
• Whether the tumor can be removed completely by surgery.
• The amount of fluid in the chest or abdomen.
• The patient's age and general health, including lung and heart health.
• The type of mesothelioma cancer cells and how they look under a microscope.
• Whether the cancer has just been diagnosed or has recurred (come back).