Mesothelioma Metastasis

The term "metastatic cancer" refers to any form of cancer that has spread from its original location to other parts of the body. Cancer can spread through the lymph nodes or through the blood stream. Doctors have even found that some cancers are predictable as far as the organs to which they will metastasize. In some instances, this predictability can guide doctors and help keep an eye on certain parts of the body that are susceptible to tumors.

Mesothelioma Progression

Because mesothelioma is not generally diagnosed until its later stages (usually Stage III or IV), metastatic disease is common at the time of diagnosis. Mesothelioma metastasis, however, can also occur as the disease continues to progress. Unlike many other cancers, mesothelioma progression does not generally impact the bones or brain, but normally affects the organs around the lungs on the side of the body in which the original tumor was found. This is known in the medical field as a "local spread."

It is also theorized that mesothelioma may actually travel more quickly than other types of cancer. This is because the disease is most often located in or near the lungs, which transfer oxygen throughout the body. Therefore, mesothelioma cells may be able to enter the bloodstream and circulate through the body.

Mesothelioma progression can sometimes be detected through diagnostic imaging tests, which include MRIs or CT scans. Doctors usually suspect that a cancer has spread when a patient complains of symptoms that are not generally associated with mesothelioma. At that time, tests or biopsies will be performed.

Treating Mesothelioma Metastases

Once mesothelioma has metastasized, treatment of the disease will probably change from its original course. The oncologist will need to address the cancer that has spread to other parts of the body and may recommend different therapies. In some cases, both chemotherapy for mesothelioma and radiation may be suggested. However, once the cancer has spread, doctors can usually only offer palliative treatments to ease the pain and improve the quality of life for the patient.

An oncologist with experience in treating this aggressive asbestos-related disease will be able to recommend the best course of treatment for both the original disease and the metastases. 

Mesothelioma Brain Metastases

Though not as common as localized metastases, mesothelioma brain metastases have been reported in medical literature. Malignant mesothelioma does not typically spread to the brain, bones or adrenal glands, so patients should not be highly concerned about a brain metastases. In the cases that have been reported, the mesothelioma diagnosis was typically given in a late stage of development. Once the cancer has spread to distant parts of the body, treatment options tend to be palliative in nature (which aims to relieve symptoms and provide comfort rather than cure the disease).

Mesothelioma Staging

For many decades, doctors have been addressing the seriousness of particular cancers in terms of stages. Throughout the years, various staging systems have been developed to assist cancer doctors in determining diagnosis and the best form of treatment for the individual patient.

There are three popular mesothelioma staging systems used to examine the extent of pleural mesothelioma. Since other forms of mesothelioma are even less common than the occurrence of pleural mesothelioma, there currently are no formal staging systems for other forms of this aggressive cancer (although they can be applied if desired). Each of the three different staging systems measure various factors of malignant mesothelioma, including the extent of the tumor (primary mass), the metastasis (spreading), and the involvement of the lymph nodes.

The knowledge of what particular stage a patient is in after they are diagnosed with mesothelioma greatly affects what treatment options are recommended by doctors. We offer a personalized comprehensive packet that details the various stages of mesothelioma and available treatment options and we can cater this information to meet a patient’s specific situation.

Butchart System - Mesothelioma Staging Systems 

The Butchart System is the oldest staging system for malignant mesothelioma and is the one most commonly used by doctors and specialists to diagnose and treat malignant mesothelioma. The Butchart System is based on the tumor size (mass) and divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma has affected the right or left side of the chest cavity (pleural lining) and may be seen in the diaphragm.
• Stage 2 - Malignant mesothelioma has been found in the pleura on both sides of the body and may have also moved into the heart, stomach, or esophagus on both sides. Lymph nodes may be affected.
• Stage 3 - Malignant mesothelioma has reached the abdominal cavity (peritoneum). Lymph nodes past the chest may be affected.
• Stage 4 - Malignant mesothelioma has reached other organs and has entered the blood stream.

TNM System - Mesothelioma Staging Systems 

The TNM System is a more modern staging system for malignant mesothelioma. The TNM System is based on the extent of the tumor, metastasis, and lymph node involvement. Again, the TNM System divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma is present in the left or right chest cavity (pleura) and may have metastasized to the lung, the sac around the heart (pericardium) or the diaphragm on the same side. Lymph nodes at stage 1 are not involved.
• Stage 2 - Malignant mesothelioma has reached from one side of the chest cavity to a lymph node near the lung area on the same side as the cancer. The cancer has metastasized to the diaphragm, pericardium (sac around the heart), or the lung on the same side as the primary tumor.
• Stage 3 - Malignant mesothelioma has penetrated the chest lining, heart, esophagus, muscle, ribs and vital organs within the chest cavity on the same side as the cancer. Lymph nodes may or may not be involved during this stage.
• Stage 4 - Malignant mesothelioma has metastasized to the pleural area and the lymph nodes on the opposite side of where the cancerous tumor is located. It may also have reached the chest cavities or lungs on both sides, or may have spread to the abdomen.

Brigham System - Mesothelioma Staging Systems 

 

The Brigham System is the most modern of the three malignant mesothelioma staging systems. The Brigham System looks at different variables such as the involvement of the lymph nodes and the surgical ability to remove a malignant mesothelioma tumor (respectability). For this reason, it is not often used to refer to mesothelioma stages, as the cancer is rarely operable. The Brigham System divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma tumor is still resectable (able to be removed surgically) and the lymph nodes are not affected.
• Stage 2 - Malignant mesothelioma tumor is still resectable, but the lymph nodes are now affected.
• Stage 3 - Malignant mesothelioma tumor is not resectable and the malignant mesothelioma has penetrated the heart, chest wall, abdominal cavity or diaphragm. Lymph nodes may or may not be affected.
• Stage 4 - Malignant mesothelioma tumor is not resectable and has completely metastasized (spread throughout the body).

Staging Malignant Mesothelioma

When mesothelioma is diagnosed by a physician or specialist, they must determine the extent of the cancer and how far it has spread. Most often, they will use imaging procedures to see inside the chest or abdomen to help determine the staging of the malignant mesothelioma. The imaging options physicians may use include:

• Chest x-ray
• CT scan of the chest and/or abdomen
• MRI scan of the chest and/or abdomen
• PET scan of the chest and/or abdomen

Once the doctor is able to determine the stage of the mesothelioma, they will be able to formulate a plan for treatment and provide a prognosis.

 

Malignant Mesothelioma Types

In biological terms, malignant mesothelioma is divided into three types: epithelial, sarcomatoid and biphasic. These classifications pertain to the shape and structure of the cancer cells.

Diagram of Malignant Mesothelioma Types.

Between 50 to 70 percent of malignant mesothelioma cases are epithelial, approximately 20 to 35 percent are biphasic, and 7 to 20 percent are sarcomatoid. Epithelial cells are marked by their well-defined and uniform shape and can closely resemble cells of another form of cancer known as adenocarcinoma. Sarcomatoid cells display an elongated spindle shape, which tend to be irregular rather than uniform in shape, and the cells often overlap one another. Cells of the biphasic variety contain both epithelial and sarcomatoid cells, which form in groups of like cells rather than displaying a uniform mixture.

Diagnosing what type of malignant mesothelioma a patient has can be challenging. One contributing factor is that it can be difficult to differentiate mesothelioma from adenocarcinoma, a cancer originating in glandular tissue, on small tissue specimens.

Mesothelioma ICD-9 Code

Pleural mesothelioma may also be referred to as ICD-9 code 163, a disease category and mesothelioma diagnosis code that represents malignant neoplasm of the pleura. Peritoneal mesothelioma may be called ICD-9 code 158, which accounts for malignant neoplasm of the retroperitoneum and peritoneum. Pericardial mesothelioma falls under the category ICD-9 code 164, which represents malignant neoplasm of the thymus, heart and mediastinum.

Malignant Mesothelioma Treatment

Regardless of the type of malignant mesothelioma a patient has, treatment options are available for all mesothelioma patients, though a patient’s response to different treatments will vary. The stage , or level of maturity of the cancer, as well as the patient’s general health are greatly considered when a doctor creates a treatment plan. 

Common curative treatments, or treatments designed to remove cancer cells and cure the disease, for mesothelioma patients include surgery, chemotherapy and radiation. Chemotherapy and radiation treatments aim to kill cancerous cells and stop rapid cell division and growth. Though harmful cells are targeted, the treatments can also affect healthy cells. Patients may experience side effects such as nausea throughout treatment.

Palliative treatments, designed to increase a patient’s comfort and ease pain, may also be recommended. Patients may also wish to explore experimental treatments offered in the studies testing up-and-coming drugs or procedures called clinical trials.

Malignant Mesothelioma Symptoms

Patients with malignant mesothelioma generally do not display any symptoms until 20 to 50 years after exposure to asbestos occurs. This is due to the long latency period (the amount of time it takes for a patient to demonstrate symptoms after initial exposure to a disease-causing agent) associated with mesothelioma. The symptoms of mesothelioma are very general and often resemble less serious conditions, which can make diagnosis difficult. 

Symptoms vary depending on the type of mesothelioma a patient has, but the most common symptoms expressed by pleural mesothelioma patients include shortness of breath, chest pain and persistent cough. Peritoneal mesothelioma patients may display symptoms such as abdominal swelling, changes in bowel movement and development of lumps under the skin on the abdomen. Patients with pericardial mesothelioma may experience heart palpitations, chest pain, difficulty breathing and fever or night sweats. Testicular mesothelioma patients may notice testicular lumps. 

Asbestos.com offers a complimentary informational packet personalized to a patient’s specific mesothelioma diagnosis. With information about the cancer, treatment options and top doctors, many patients and their loved ones find the packet to be a valuable resource.

Mesothelioma Types

Mesothelioma is caused by long-term, repeated exposure to asbestos fibers. The disease is generally found in four different forms: pleural, peritoneal, pericardial, and testicular. In each case, the cancer develops in mesothelial cells, which form the membranous linings that surround and protect organs. The different names for each type of mesothelioma refer to the point of origin of the cancer. 

Mesothelial membranes are made up of two different layers, called the parietal and visceral layers. Parietal layers are outer layers, and these typically cover large areas such as the chest cavity (in the case of pleural and pericardial membranes) and the abdominal cavity (as in the case of peritoneal membranes). Visceral layers are those that cover organs such as the lungs and heart. Mesothelioma develops in these membranes when asbestos fibers become trapped in the spaces between mesothelial cells. 

Mesothelioma is a particularly aggressive type of asbestos cancer, and is highly resistant to treatment, resulting in very high mortality rates and poor prognosis for people diagnosed with the disease. In general, pleural mesothelioma responds more positively to treatment, particularly if the disease is diagnosed early. However, all forms of mesothelioma are difficult to diagnose, and unfortunately, it is common for the disease to be diagnosed too late for treatment to be effective.

The type of mesothelioma a patient is diagnosed with will invariably determine the treatment plan suggested by their doctor. A myriad of treatment options are available for patients diagnosed with all types of mesothelioma and a comprehensive packet detailing the options will be provided overnight to those interested who fill out this form.

Pleural Mesothelioma

 

Pleural mesothelioma develops in the mesothelial lining of the lungs, which is known as the pleura. About 75 percent of all mesothelioma cases are pleural.

Symptoms of pleural mesothelioma include difficulty swallowing, a persistent dry cough, persistent chest pain, or pain when breathing, and difficulty breathing even when resting. These mesothelioma symptoms result from pressure on the lungs and respiratory system, caused by thickening of the pleural membrane and fluid build-up between membrane layers. As the cancer advances, lumps may develop under the skin of the chest.

Diagnosis of pleural mesothelioma involves imaging tests such as chest x-rays, MRIs, and CT scans, and may also include biopsies that remove tissue and fluid to test for the presence of cancer cells. These tests also help determine the stage of the cancer and the options available for treatment. Generally, patients in stage one and two mesothelioma are good candidates for surgery, whereas patients in stages three and four have more limited treatment options, and may only be able to receive palliative treatments.

Peritoneal Mesothelioma

Peritoneal mesothelioma develops in the peritoneal lining of the abdominal cavity. This is a relatively rare form of mesothelioma; approximately 10 to 20 percent of all mesothelioma cases are peritoneal in nature.

Symptoms of peritoneal mesothelioma include pain or swelling of the abdomen, changes in bowel habits (such as constipation or diarrhea), unexplained weight loss, and nausea or vomiting. These symptoms are caused by thickening of peritoneal membranes and fluid build-up, which puts pressure on internal organs and prevents normal function of some organs. As the cancer advances, people with peritoneal mesothelioma may notice lumps developing under the skin of the abdomen.

Diagnosis of peritoneal mesothelioma involves imaging tests such as CT scans and MRIs, as well as biopsies of fluid and tissue to detect the presence of mesothelioma cells. There is currently no recognized staging process for peritoneal mesothelioma.

Peritoneal mesothelioma is problematic in terms of treatment, because the cancer can spread quickly throughout the peritoneum and often metastasizes more quickly than other types of mesothelioma. In some cases surgery is possible, but this is typically a palliative treatment option.

Pericardial Mesothelioma

 Pericardial mesothelioma accounts for approximately half of all pericardial tumors and is an extremely rare. Researchers from various mesothelioma studies report that pericardial mesothelioma accounts for approximately 1 to 6 percent of all mesotheliomas. To date, fewer than 150 cases have been presented in medical literature and approximately 200 cases have been reported worldwide. Pericardial tumors are typically diffuse (not localized) and tend to cover most of the heart.

Pericardial mesothelioma develops in the pericardium, a membrane made up of mesothelial cells that surrounds the heart and provides protection and support to this organ. The membrane is composed of two different layers: an outer layer called the parietal layer (called the heart sac or theca cordis), and an inner layer known as the visceral layer (called the epicardium). The parietal layer is part of a larger membrane that lines the entire chest cavity, while the visceral layer is the pericardial membrane that lines the heart.

Those diagnosed with pericardial mesothelioma usually have a number of questions about how to approach the treatment process. We offer a complimentary packet for pericardial mesothelioma patients containing information about their specific diagnosis, treatment options and top doctors. To receive this packet overnight,

Testicular Mesothelioma

Testicular mesothelioma is the rarest of all mesothelioma cancers, as less than one hundred cases have been recorded. This type of mesothelioma develops in the lining that surrounds the testicles, known as the tunica vaginalis.

Due to the extreme rarity of testicular mesothelioma, very little has been noted about its symptoms and the treatment options available. Often, the disease is not diagnosed until patients notice the appearance of testicular lumps. In some cases, surgery for an unrelated condition such as a hernia leads to the detection of testicular mesothelioma.

If the primary tumor has developed in the testicles, treatment involves removal of part or the entire affected testicle, followed by chemotherapy or radiation therapy. In many cases the testicular tumor is secondary, and the primary cancer is located in the peritoneum. In these cases, treatment follows established patterns for peritoneal mesothelioma in addition to removal of testicular tumors.

Mesothelioma Treatment

After diagnosis, patients and their loved ones are often anxious to do everything possible to fight mesothelioma. This may involve several different treatment options. The most common treatments mesothelioma patients utilize include surgery, chemotherapy and radiation.  Though a cure for mesothelioma does not currently exist, many patients undergo several treatments for relief from symptoms to improve the quality of life. Patients may also experience relief through experimental options and treatments available through clinical trials and alternative therapies. 

Asbestos.com offers additional information about mesothelioma treatment options, top doctors and cancer centers nationwide through a complimentary informational packet. Click here to receive your copy and learn more about symptoms, causes and support resources for mesothelioma patients.