MESOTHELIOMA SYMPTOMS

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

Pleural Effusions

One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the lining of the lung and the chest cavity. As the volume of fluid increases, shortness of breath, known as "dyspnea", and sometimes pain may occur. The primary goal in treating this effusion is to relieve shortness of breath, prevent recurrence and minimize discomfort. Doctors use x-rays and CT scans to identify effusions and help determine a course of treatment. MRIs are used to a lesser extent in evaluating pleural effusions, but may be helpful in assessing the extent of chest wall involvement by tumor.

Diagnosis from Pleural Fluid

A diagnostic thoracentesis, in which cells are extracted from the pleural cavity is many times used as an aid in the diagnosis of mesothelioma. This is not usually considered a reliable test, however, since in up to 85% of the cases, the fluid tests negative or inconclusive even though cancer is present. It is ultimately a needle biopsy of the pleura (lining of the lung) or an open surgical tissue biopsy that confirms a mesothelioma diagnosis.

Treatment for Pleural Effusion
One way to treat the symptoms of difficult diseases is called palliative therapy. This approach is often considered for patients with malignant pleural effusions and is directed by evaluation of the symptoms, general health and functional status. Relief of dyspnea is a major consideration in mesothelioma. For patients who have large pleural effusions, doctors may recommend chest tube drainage and chemical pleurodesis. It is important to remember, however, that once patients have a talc treatment, they may be eliminated from certain chemotherapy treatments or clinical trials.

Chemical pleurodesis is a technique used to produce an adhesion inside the pleural cavity. It is used on patients who have significant relief of symptoms when pleural fluid is drained and show evidence of lung reexpansion. It is performed with a standard tube thoracostomy. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is admistered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution that forms a wet slurry that can roll around the pleural cavity.