Pleural mesothelioma (the most common type)
The pleura are two fi sheets of tissue that cover the lungs and help to protect them. Doctors may call these the lining of the lungs. The term may be a bit confusing for non-medical people as they are on the outside of the lungs. The pleura are also sometimes called the pleural membranes. They are about the thickness of plastic food wrap. The inner (visceral) layer is attached to the lungs and the outer (parietal) layer lines the chest wall and diaphragm.
The gap between the two pleura is called the pleural space or cavity. The pleura produces a fl that fi the gap. As we breathe, the fl helps the lungs to move smoothly in the chest when they are infl
Inner layer }Pleural
Pleural mesothelioma causes the pleura to thicken and many tiny lumps are formed. This thickening can press on the lung or attach itself to the inside of the chest wall making it harder for the lung to expand. Fluid collects between the two layers of the pleura and presses against the lung. This is called a pleural effusion.
Outer layer Pleural cavity Rib
Peritoneal mesothelioma starts in the peritoneum. This is the sheet of tissue covering the internal organs in the abdomen. This sheet helps to protect the organs and allows them to move around in the abdomen.
The peritoneum makes a fluid that helps to keep the abdominal organs moving freely and smoothly as we move around. Mesothelioma causes thickening of the linings surrounding the abdominal organs. It also causes a collection of fluid in the abdomen, this is called ascites.
Side view showing the abdomen
How common is mesothelioma?
In New Zealand in 2008, almost 100 new cases were recorded. Numbers are likely to increase, due to past workplace practices which exposed people to airborne asbestos fi Australian information states that it may take over twenty years after exposure for any disease caused by asbestos to show up (it can take up to and over 50 years). However, most workers exposed to asbestos won’t develop mesothelioma.
Symptoms of mesothelioma
- Weight loss
Large Bowel Small Bowel
- Chest wall pain (a dull, heaviness in the chest)
- A persistent, dry cough
- Abdominal pain and swelling
Causes of mesothelioma
Most mesothelioma is caused by exposure to asbestos. Asbestos is a mineral rock made up of masses of tiny fi Asbestos was widely used in building materials, insulation, fi proofi and sound absorption. When asbestos is disturbed, it sends
up fi into the air that can be easily breathed in. Once the fi are in the lung or abdomen, the body tries to break the fi down and remove them, leading to infl
Other causes of mesothelioma are not fully understood, but on rare occasions mesothelioma has been linked to exposure to radiation.
- Diffi swallowing, a hoarse voice or coughing
up sputum or blood.
If you go to your GP with any of the symptoms listed above, your GP will examine you and arrange for you to have some blood tests and X-rays or they may send you to a specialist. Depending on your symptoms, this may be a lung specialist (for pleural mesothelioma) or a gastroenterologist (for peritoneal mesothelioma).
Diagnosis of mesothelioma
Mesothelioma is hard to diagnose. Mesothelioma may not show up on scans or X-rays until the lumps are quite large. A chest X-ray and/or CT scan may show thickening of the pleura or fl on the lungs or in the abdomen. If fl is there, a sample may be collected using local anaesthetic to make the area numb for passing a needle through the skin into the fl
Staging of mesothelioma
Staging is a way of describing whether a cancer has spread, and if so, how far. Stage 1 means it has not spread; Stage 4 means it has spread to other
organs. Staging helps your doctor to work out the best treatment for you.
Your GP or your respiratory doctor must lodge a claim with ACC (Accident Compensation Corporation) using an ACC45 claim form (this is the normal ACC form that is used for all ACC claims). ACC will then send you and your doctor (by mail or email) a patient
information pack. Once this information pack has been completed by you and your doctor the pack will then go back to ACC. Funding decisions are normally made within two to three weeks from the time ACC gets
the completed forms (ACC National Asbestos Unit,
Your cancer doctor may suggest treating you with a drug called pemetrexed (chemotherapy). Your cancer doctor will then need to complete another form to apply for funding for pemetrexed.
If you are eligible, the quicker your claim is sent to ACC, the faster you can receive funding for all you are entitled to.
Entitlements may include:
- loss of wages
- home help
- lump sum
- housing alterations, for example, rails and
Source: ACC National Asbestos Unit, November 2011.
To receive cover, evidence must show that exposure to asbestos happened in New Zealand during
paid employment. If you are not entitled to ACC,
your cancer doctor can put a claim for ‘exceptional circumstances’ to Pharmac for funding for pemetrexed.
Treatment for mesothelioma
Treatment for mesothelioma may include a combination of chemotherapy, radiation treatment, supportive care and, rarely, surgery. When mesothelioma is diagnosed, it has usually spread beyond the point where it can be removed by surgery. Although there is currently no cure for mesothelioma, the aim of treatment is to make sure you have good quality of life for as long as possible.
Your GP or respiration doctor must also complete a
Notifi Occupational Disease System form.
This is the treatment of cancer by anti-cancer drugs. The aim is to destroy cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.
Chemotherapy used to treat mesothelioma may cause:
- tiredness and feeling weak (fatigue)
- changes to your blood levels: increasing the risk
of infection, bleeding and anaemia
- nausea and vomiting
- bowel problems (diarrhoea or constipation)
- mouth problems (sore, dry or ulcerated mouth)
- dietary problems (loss of appetite, taste changes,
- muscle and nerve problems
- skin changes (rash, swelling, itchiness)
- changes in your ability to have children (fertility)
- hair loss and scalp problems (rare with the drugs
used to treat mesothelioma)
- changes in your memory and ability to concentrate (think clearly). This usually improves once treatment is over.
Radiation treatment treats cancer by using radiation to destroy cancer cells. Radiation can be directed to where the cancer is in your body. Treatment is
carefully planned to do as little harm as possible to the rest of your body.
Radiation treatment is not often used to treat peritoneal mesothelioma. For people with pleural mesothelioma, radiation treatment to small areas of the chest often helps control pain.
Side effects can include tiredness, reddened and peeling skin, and loss of hair in the treatment area.
Other ways of managing symptoms
- Pleural mesothelioma might cause fl to build up in your chest, causing diffi Doctors insert a tube or catheter into your chest to drain the fl This may need to be done several times if fl builds up again.
- Doctors may also insert a substance similar to talcum powder into your chest to prevent fl from returning (pleurodesis).
- Ascites is a build-up of fl in the abdomen that can occur with peritoneal After an abdominal X-ray, a doctor will insert a tube or catheter into the abdomen to drain fl