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Types of Mesothelioma

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Types of Mesothelioma

There are three main types of mesothelioma and one extremely rare type, all of which are caused by regular and prolonged asbestos exposure. In all cases, the cancer develops in the mesothelial cells, which comprise the membranes that protect organs and help them to maintain their proper position in the body. The types of mesothelioma are distinguished by the area of the body in which they originate.

Pleural Mesothelioma

Pleural mesothelioma affects the pleura, which is the lining around the lungs. This is the most common form of mesothelioma and accounts for between 70-80% of the cases.

The symptoms of pleural mesothelioma are often similar to those associated with the flu or common code. They include:

  • Chest pain
  • Shortness of breath
  • Difficulty swallowing
  • Dry, raspy cough

Diagnosing pleural mesothelioma often involves the use of imaging techniques such as the CT scan, X-ray, or MRI and may also include biopsies of tumors or fluids found in the pleural mesothelium. In many cases, patients who are in the earlier stages of pleural mesothelioma are good candidates for surgery.

Pathology and Progression of Pleural Mesothelioma

When the majority of pleural mesotheliomas are diagnosed, the patient has developed small nodules along the pleural surface. These nodules are about one millimeter to one centimeter in size. In most cases, nodule growth is associated with a pleural effusion, which is a buildup of pleural fluid. As the disease progresses, the nodules merge to create solid tumors that surround the lung and fill the pleural cavity.

Cancerous cells penetrate the skeletal muscle in the chest wall and can also invade the skin, the tissue below the skin, and the main functional area of the lung. A “rind” of tumors that varies in thickness will typically grow until it surrounds one or both lungs. When this layer is relatively thin, it may resemble other types of lung cancer.

However, pleural mesothelioma typically also creates a thicker section of tumor near the base of the pleural cavity. Additionally, it may spread to the lymph nodes that are located in the central area where arteries, veins, nerves, and bronchial airways connect to the lungs. When this occurs, the resulting mass is easier to recognize on a chest x-ray.

Pleural mesothelioma can spread to the sac surrounding the heart (the pericardium) and affect the muscular heart tissue itself. It is common for pleural mesothelioma to penetrate through the side of the diaphragm near the diseased lung and extend into the abdominal cavity.

Is Metastasis Common?

Metastases are not as common in pleural mesothelioma patients as they are among patients with other lung cancers. When it does spread, pleural mesothelioma typically affects the:

  • Lymph nodes in the triangular section in the center of the lung
  • Lymph nodes that collect the lymph that drains out of the lungs
  • Pleural surface of the lung that is not covered by the tumor

However, mesothelioma can metastasize to almost any organ. There have been about 25 cases of the disease metastasizing to the brain.

Peritoneal Mesothelioma

Peritoneal mesothelioma develops in the lining that surrounds organs in the abdomen. This is the second most common type of mesothelioma, accounting for around 15-20% of cases.

Symptoms of peritoneal mesothelioma include:

  • Abdominal pain
  • Lumps in the abdomen
  • Nausea and/or vomiting
  • Abnormal weight loss
  • Changes in bowel habits

The cause of these symptoms is the buildup of excess cells and fluid in the peritoneum, which leads to pressure on internal organs. Similar to pleural mesothelioma, the diagnosis of peritoneal mesothelioma may involve CT or MRI scans and biopsies of mesothelial fluid and tissue.

Peritoneal mesothelioma can rapidly spread to other parts of the body, which makes treatment difficult. In some cases, surgery and other treatments can be offered to enhance the patient’s comfort.

Pathology of Peritoneal Mesothelioma

Just like pleural mesothelioma, peritoneal mesothelioma starts as a series of small nodules on the interior of the mesothelium. Over time, these nodules merge into a rind of tumor surrounding the organs in the abdominal cavity. As it thickens this rind may compress the organs together and/or cause ascites, a buildup of fluid in the cavity.

Pericardial Mesothelioma

Pericardial mesothelioma affects the pericardium, the membrane that surrounds the heart. Only roughly 5% of mesothelioma patients develop this form of the disease.

Pericardial mesothelioma symptoms are caused by tumors and/or a buildup of fluids putting pressure on the heart. They may include:

  • Chest pain
  • Difficulty breathing
  • Heart palpitations
  • Irregular heartbeat

The proximity of tumors to the heart makes pericardial mesothelioma particularly hard to treat. Surgery is only effective when the cancer is detected in an extremely early stage.

Pathology of Pericardial Mesothelioma

Tumors in the pericardium are more likely to be a metastasis of pleural mesothelioma than a symptom of pericardial mesothelioma. Therefore, a diagnosis may entail testing a patient for pleural mesothelioma as well. When cancer does originate in the pericardium, it does so in a similar manner to other forms of mesothelioma. Small nodules begin to grow in the mesothelium and slowly combine into a tumor or tumors that surround the heart.

Testicular Mesothelioma

Testicular mesothelioma is an extremely rare form of peritoneal mesothelioma. There have only been around 20 cases of this variety of cancer documented in the U.S. in the last 100 years. Testicular mesothelioma usually presents in the form of lumps or tumors in the scrotum which may or may not be painful.

Pathology of Mesothelioma in the Tunica Vaginalis

Mesothelioma of the tunica vaginalis, or the lining of the testes, starts as a mass in that area. It can remain localized; however, it is very common for this type of tumor to invade the abdominal cavity. Because so few cases of testicular mesothelioma have been observed, much less is known about this form of the cancer.

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