Symptoms of mesothelioma

Symptoms vary depending on whether the mesothelioma is in the pleura or peritoneum. They may include some of those listed in this section. Symptoms of pleural mesothelioma shortness of breath heavy sweating (especially at night) fever chest pain that feels heavy and dull or aching weight loss loss of appetite a cough that doesn’t go away, although this is unusual. A collection of fluid between the layers of the pleura (pleural effusion) may cause shortness of breath and chest pain. Symptoms of peritoneal mesothelioma
swelling in the tummy (abdomen) tummy pain loss of appetite weight loss feeling sick changes to your normal bowel pattern, such as constipation or diarrhoea. A collection of fluid in the abdomen (ascites), may cause swelling in the tummy, pain, sickness and loss of appetite. All of these symptoms can be caused by conditions other than mesothelioma or cancer. If you have symptoms, you should always get them checked by your doctor, particularly if they don’t go away after a couple of weeks.

Staging of mesothelioma

The stage of a cancer is a term used to describe its size and whether it has spread beyond the area of the body where it started. In general terms, most cancers are described as either stage 1, 2, 3 or 4. Stage 1 cancers are usually small in size and haven’t spread. They are often known as early stage cancers. In contrast, stage 4 cancers have usually spread deeply into surrounding tissues or organs and/or to distant parts of the body. They are known as advanced stage cancers. Stage 2 and 3 cancers are between stages 1 and 4. Knowing the stage of the cancer can sometimes help doctors decide on the best treatment. Staging systems are often complicated to understand. Find out more the detailed staging of mesothelioma. You can also ask your specialist to give you more information about the staging of your mesothelioma.

How mesothelioma is diagnosed

Usually, you begin by seeing your family doctor (GP) who will examine you and may arrange for you to have some blood tests and x-rays. On this page Tests for pleural mesothelioma Tests for peritoneal mesothelioma Waiting for test results Your GP should urgently refer you for a chest x-ray if you have a history of asbestos exposure, and any of the following symptoms: chest pain difficulty breathing unexplained symptoms, such as shoulder pain, a cough or weight loss. Depending on the results of any tests and x-rays, your GP may refer you to hospital for further tests and for specialist advice and treatment. At the hospital, the specialist will ask you about your general health and any previous medical problems before they examine you. You may be asked questions about any possible exposure to asbestos in your past, such as during jobs you’ve had or at places you’ve worked. This is called your occupational history. You may also be asked if someone in your family, a parent for example, worked with asbestos. Don’t worry if you can’t remember all of the details at first. You can let your doctor know later about anything you remember. Tests for pleural mesothelioma Back to top Pleural mesothelioma often starts as tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they’re quite large. You may need to have a number of different tests before your doctors can make an accurate diagnosis. We describe some of these tests here. If you need other tests, your doctors will be able to give you information about them. Chest x-ray A chest x-ray checks for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs. There can be other causes of these problems apart from mesothelioma. CT (computerised tomography) scan A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan. You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you’re allergic to iodine or have asthma, because you could have a more serious reaction to the injection. You’ll probably be able to go home as soon as the scan is over. An image of someone having a CT scan Someone having a CT scan. View a large version of the image of someone having a CT scan. Drainage of fluid from the pleura (pleural aspiration) Mesothelioma cells can irritate the pleura and cause a pocket of fluid to develop. This is called a pleural effusion . Your doctor can take a sample of this fluid to send to the laboratory as mesothelioma cells are sometimes present. The sample is taken by first using a local anaesthetic to numb the area. A needle is then inserted through the skin into the fluid and some of the fluid is removed. This procedure is done while you’re having an ultrasound scan. The scan helps the doctor guide the needle to the place where the fluid is. Biopsy A biopsy is always needed to help the doctors diagnose pleural mesothelioma. It involves taking a sample of tissue from the thickened pleura and, occasionally, from the lymph nodes in the middle of the chest. Your doctor may take a biopsy in different ways: CT or ultrasound guided biopsy A local anaesthetic is used to numb the area. Your doctor will pass a special type of needle through the skin into the thickened area while using an ultrasound or a CT scanner to guide the needle into the right place. The needle has a tip that can cut out a sample of tissue. Thoracoscopy This allows the doctors to look at the area of the pleura directly and also to look at other structures around the lungs and take further biopsies, if required. You’ll be given either a general anaesthetic or a local anaesthetic with a sedative to make you drowsy. A small cut is made in the chest wall and the doctor puts a thin, flexible tube with a light and camera at the end (thoracoscope) into your chest. An ultrasound scan may be used to guide the thoracoscope to the thickened area of pleura. Your doctor can then take a biopsy of the pleura. Mediastinoscopy Occasionally, your doctor may arrange for you to have a mediastinoscopy. This test may be done if your doctors think the mesothelioma has spread to the lymph nodes in the middle of the chest.This procedure is similar to a thoracoscopy and is usually done under a general anaesthetic. A small cut is made in the base of the neck. A thin, flexible tube with a light and camera at the end (mediastinoscope) is inserted through the cut and is used to examine the lymph nodes in the space between the lungs. Biopsies can also be taken, if needed. Having a biopsy can be uncomfortable but shouldn’t be painful. If you have any pain during or after the procedure, let your doctor or nurse know. Once a biopsy has been taken, it’s sent to the laboratory and examined by a pathologist (a doctor who advises on the type and spread of cancer). Sometimes, even after taking a biopsy, the doctors may still not be sure of the diagnosis. This is because pleural mesothelioma can be very difficult to tell apart from some other illnesses. In this situation, the biopsy samples may be sent to other laboratories to confirm the diagnosis. Some of your tests may need to be repeated or you may be referred to another hospital for a second opinion. Tests for peritoneal mesothelioma Back to top A number of similar tests may be used to help diagnose a peritoneal mesothelioma. Abdominal x-ray This can help show up any fluid or swelling in the abdomen. CT (computerised tomography) scan You may have a CT scan of your abdomen. Drainage of fluid from the abdomen (peritoneal aspiration) Mesothelioma cells can cause fluid to collect in the abdomen. This is called ascites. Your doctor can take a sample of this fluid to send to the laboratory as mesothelioma cells are sometimes present. The sample is taken by first using a local anaesthetic to numb the area. A needle is then inserted through the skin into the fluid and some of the fluid is removed. Biopsy A biopsy of the peritoneum is always needed to help the doctors diagnose peritoneal mesothelioma. It can be carried out by: Laparoscopy This procedure allows the doctor to look at other structures in the abdomen and take further biopsies if required. You’ll either be given a general anaesthetic or a local anaesthetic with a sedative to make you drowsy. A small cut is made in the tummy wall and your doctor puts a thin, flexible tube with a light and camera at the end (laparoscope) into your abdomen. Your doctor can then take a small biopsy of the peritoneum. CT or ultrasound guided biopsy The doctor uses an ultrasound or a CT scanner to position the needle accurately for the biopsy. As with pleural mesothelioma, peritoneal mesothelioma may be difficult to diagnose. You may need to have further tests or occasionally be referred to another hospital for a second opinion. Waiting for test results Back to top Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend. Your specialist nurse or one of the organisations listed can also provide support. You can also talk things over with one of our cancer support specialists or you can contact Mesothelioma UK’s helpline.

Detailed staging of mesothelioma

Staging systems are constantly being updated to help doctor plan the best treatment and help give an idea of the likely outcome. Many staging systems are based on the TNM system: T describes the size of the tumour. N describes whether the cancer has spread to the lymph nodes and which nodes are involved. For example, N0 means that no lymph nodes are affected, while N1 means there are cancer cells in the lymph nodes. M describes whether the cancer has spread (metastasised) to another part of the body. For example, M0 means the cancer has not spread to other parts of the body. Pleural mesothelioma Different staging systems have been used for mesothelioma. The staging system that’s most commonly used is known as the International Mesothelioma Interest Group (IMIG) system. It’s also based on the TNM system. A simplified version of the IMIG system is described below. You may find it helpful to refer to the diagram showing the structure of the lungs and pleura in the section explaining what mesothelioma is. Stage 1 Cancer cells are found in the pleura around the lung on one side of the chest. Stage 1a Cancer cells are only found in the outer layer of the pleura (parietal pleura). Stage 1b Cancer cells are also found in the inner layer of the pleura (visceral pleura). Stage 2 The cancer has spread to both layers of the pleura and has either spread into the muscle of the diaphragm or into the lung tissue on one side of the chest. Stage 3 The cancer has spread deeper into the tissues around the pleura. It may have spread to: the chest wall the fatty tissue in the centre of the chest the tissue that separates the ribs from the pleura the outer lining of the heart (pericardium). Or, it may have spread to local lymph nodes. Stage 4 The cancer has spread deeply into the tissues close to the pleura. It may have spread to: the pleura on the other side of the chest the diaphragm and beyond it to the lining surrounding the abdomen (peritoneum) the spine the internal surface of the heart pericardium and into the muscle of the heart. Or, it may have spread to the lymph nodes on the other side of the chest or the lymph nodes above the collar bone on the same or other side of the chest. Or, it may have spread to distant organs or tissues. Peritoneal mesothelioma There isn’t a specific staging system for peritoneal mesothelioma but doctors sometimes use the TNM staging system outlined above.

Financial help and compensation for mesothelioma

Most people who have been diagnosed with mesothelioma are able to receive financial help. There are two main ways of receiving financial help: obtaining benefits paid by the Department for Work and Pensions (DWP) and/or obtaining compensation from your employer (this may be your current employer or a former one who was linked to your exposure to asbestos). Benefits People often assume that benefits paid by the government are means-tested and eligibility depends on your savings and income. It’s important to remember that although some benefits are means-tested, many aren’t. A benefits adviser will be able to tell you more about which benefits you can claim. You can also get more information from our Welfare Rights Advisers by calling the Macmillan Support Line on 0808 808 00 00. Local asbestos support groups may also be able to offer you advice and information about benefits. Mesothelioma UK has a list of support groups. Industrial Injuries Disablement Benefit (IIDB) This is an important benefit that’s payable to people with certain asbestos-related illnesses, including mesothelioma. It’s payable in situations where the illness may have been caused by exposure to asbestos dust at work. It isn’t necessary for a person to have worked with asbestos to get this benefit; they only need to have been exposed to asbestos dust at work. This benefit isn’t paid if you were self-employed in the work that led to the asbestos exposure. IIDB can be paid weekly, every four weeks or every 13 weeks directly into your bank account. It’s worth over £7,200 a year. If you’re awarded IIDB, you may also be entitled to further benefits. You’ll be able to get further information about these from a benefits adviser. Lump sum payments You may be able to get a one-off lump sum payment. There are two types, and which one you can apply for depends on what other benefits you’re entitled to. The Pneumoconiosis etc (Workers’ Compensation) Act 1979 You may be entitled to a lump sum payment under this act if you’ve been awarded Industrial Injuries Disablement Benefit. You can claim this payment: whether or not you’re likely to be able to pursue a claim against the employer you were working for when you were exposed to asbestos dust if the employer is no longer in business if you haven’t already settled a compensation claim. Even if you’re likely to get compensation from the employer’s insurers, it can still be worth pursuing a claim for this benefit. This is because you may receive a payment within weeks of making the application. Diffuse Mesothelioma Scheme 2008 This scheme is for people who can’t claim benefits either under the Industrial Injuries Disablement Benefit or the Pneumoconiosis etc (Workers’ Compensation) Act 1979. Usually, this is because their exposure to asbestos wasn’t as a result of their work as an employee. This can include people who came into contact with asbestos from a relative (for example, by washing their clothes that were contaminated with asbestos dust), or who were exposed while self-employed. Payment is made as a one-off lump sum. The claim must be made within a year of being diagnosed with mesothelioma. You’ll be asked to provide information about your illness, which is available from your doctor. Disability Living Allowance (DLA)/Personal Independence Payment (PIP) or Attendance Allowance (AA) These benefits are for people who have difficulty walking or looking after themselves. DLA is for people under the age of 65. As part of the welfare reforms, DLA will be replaced by PIP, starting from April 2013. AA is for people over the age of 65. If you live in Northern Ireland, you’ll need to check with your benefits adviser which of these benefits to claim. Anyone who is not expected to live longer than six months because of an illness can apply for DLA/PIP or AA under the special rules. Under these rules, the claim will be given priority and will be dealt with more quickly. You’ll also receive the benefit at the highest rate. Statutory Sick Pay and Employment and Support Allowance If you’re an employee and unable to work because of illness, you may be able to get Statutory Sick Pay. This is paid by your employer for up to 28 weeks of sickness. Before your Statutory Sick Pay ends, check whether you can claim Employment and Support Allowance (ESA). This benefit gives financial help to people who are unable to work due to illness or disability. It also provides some support to those who can work. There are two types of ESA: contributory-based (dependent on national insurance contributions) and income-related (means-tested). People may get either or both, depending on their national insurance contribution record, their income and their savings. From October 2013, income-related Employment and Support Allowance will be replaced by Universal Credit. Contributory-based Employment and Support Allowance will stay the same. Help for people who were in the armed forces If you were in the armed forces and you have mesothelioma because you came into contact with asbestos, you may be able to make a claim with the War Pensions Agency (your local office will be in the phone book). You can also call the Service Personnel & Veterans Agency Helpline (0800 169 22 77) for more information. Compensation from your employer Anyone diagnosed with mesothelioma who has worked somewhere where they were exposed to asbestos in the past may be able to claim compensation from their employer. This includes people working in the armed forces who have been exposed to asbestos after 1987. This type of compensation claim requires specialist legal knowledge and must be made through an experienced or specialist solicitor. There are several ways you can find a specialist solicitor. You can ask your specialist nurse or consultant if they can recommend one. Or, you can ask your local asbestos support group as they often work closely with a panel of local specialist solicitors. You can get details of local support groups from Mesothelioma UK. When looking for a solicitor, it’s important to look for one from a large firm of solicitors that has experience dealing, not just with asbestos-related disease claims, but also with mesothelioma claims. You should bear in mind that advertisements and websites may be misleading. Before deciding on a solicitor, you may want to ask them the questions below. Don’t be afraid to ask them to go over anything that you haven’t understood or to ask for more information. Questions to consider Does the solicitor specialise in mesothelioma and asbestos-related lung cancer cases? How many asbestos cases has the solicitor handled in the last three years? How many of these have been dealt with at a court hearing? Is the solicitor a Fellow of the Association of Personal Injury Lawyers (APIL)? Will the solicitor provide you with a free initial consultation? Will the solicitor visit you at home, if necessary? Will the solicitor provide you with a free summary of what will be involved in making your claim? Will the solicitor work on a ‘no win, no fee’ basis? Will the solicitor obtain an insurance policy to cover legal fees? Will the solicitor take a percentage of your compensation? Will you be expected to pay expenses, such as medical report costs and court fees up front? How will you be kept informed of what is happening with your claim? How long will the claims process take? How soon does the solicitor expect to start a court action? For a compensation claim to be successful, you have to show that: It’s likely that your mesothelioma is caused by exposure to asbestos during the course of your work. Or, that you washed clothes of someone who came into contact with asbestos at work. This may be difficult to prove. The legal standard of proof is that 'on the balance of probabilities', the exposure caused the mesothelioma. This means that, although it can’t be certain that the mesothelioma was caused by an employer, it’s more likely than not that it was. Your exposure occurred because your employer at the time was careless (negligent) in not keeping up the standards required by common law or they were in breach of specific safety regulations. An example of this is that you were exposed to asbestos during your employment when your employer knew, or ought to have known, of the risks to you. If a previous employer has gone out of business, it may be possible to claim against the employer’s insurers. Claims must be started within three years of the date you were first diagnosed with an injury due to asbestos. This doesn’t mean three years from the date of asbestos exposure, but three years from the time you were told that you had an asbestos-related illness. In Scotland, the claim must be raised in court in the three-year period or it will be time-barred. Sometimes, you may think you have a claim but your employer has gone out of business and your employer’s insurer can no longer be traced. However, tracing an employer is often possible. Costs of claiming compensation Making a personal injury compensation claim shouldn’t cost you a lot of money, if any. Specialist solicitors should offer a free initial consultation and to deal with your claim on a ‘no win, no fee’ basis. They will also come to visit you at home, if needed. Make sure you discuss with the solicitor the various options for funding, before any claim is started. If you’re a member of a trade union or a professional association, or you have legal expenses insurance cover, let your solicitor know. If your solicitor is prepared to take your case on a ‘no win, no fee’ basis, then you may have to pay a one-off insurance premium. The insurance premium will protect you against the risk of having to pay your employer’s legal costs. It may also cover other expenses that have to be paid to progress your claim, such as a fee to the medical expert for a report in support of your claim. Payment of the insurance premium may be delayed until the case is finished - ask your solicitor about this. If your case is successful, the insurance will be paid (in part, if not in full) by the other party. In Scotland, people making a claim may be entitled to Legal Aid. But, if insurance is available, the premium won’t be repaid, even if the claim is successful. Compensation for family members Relatives of people who have died from mesothelioma may be able to claim compensation for their relative’s pain and suffering, and some financial losses suffered as a result of the illness. It’s helpful to get legal advice from a specialist solicitor on how to make a claim.

After treatment for mesothelioma – follow-up

Following treatment, your hospital doctor, GP or nurse specialist will organise for you to have regular check-ups. They will continue to monitor your symptoms and will aim to give you further treatments, if these are needed to control your symptoms. If you have any concerns or symptoms that you’re worried about, let your doctor or specialist nurse know as soon as possible. You don’t have to wait until your next appointment (if you have one booked). Many people find they get very anxious for a while before appointments. This is natural and it may help to get support from family and friends. You can also find details of useful organisations in our resources and organisations section. Rehabilitation and recovery Mesothelioma affects people in different ways. Some people find that they need to take things more slowly for a while after treatment, especially if they’ve been in hospital or have had to rest at home for long periods. Others find that it doesn’t take them long to get back to their normal routine. If you think you need extra help at home, let the doctors or nurses who are looking after you know. They can assess your needs and organise extra support. They can also arrange for you to see a physiotherapist if you need help with your mobility or advice on breathing exercises. Share your experience When treatment finishes, many people find it helps to talk about it and share their thoughts, feelings and advice with other people. This can be especially helpful for other people with mesothelioma who are perhaps about to start their treatment. Just hearing about how you’ve coped, what side effects you had and how you managed them is very helpful to someone in a similar situation. We can help you share your story. Call us or read our information about becoming a Cancer Voice. You might also want to join our Online Community to chat to other people who might be feeling the same as you.

Research - clinical trials for mesothelioma

Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials. Clinical trials may be carried out to: test new treatments, such as new chemotherapy drugs or targeted therapies look at new combinations of existing treatments, or change the way they are given to make them more effective or reduce side effects compare the effectiveness of drugs used to control symptoms find out how cancer treatments work find out which treatments are the most cost-effective. Trials are the only reliable way to find out if a different type of surgery, chemotherapy, hormone therapy, radiotherapy, or other treatment is better than what is already available. Taking part in a trial You may be asked to take part in a treatment research trial. There can be many benefits in doing this. Trials help to improve knowledge about cancer and develop new treatments. You will be carefully monitored during and after the study. Usually, several hospitals around the country take part in these trials. It’s important to bear in mind that some treatments that look promising at first are often later found not to be as good as existing treatments or to have side effects that outweigh the benefits. If you decide not to take part in a trial, your decision will be respected and you don’t have to give a reason. However, it can help to let the staff know your concerns so that they can give you the best advice. There will be no change in the way that you’re treated by the hospital staff, and you’ll be offered the standard treatment for your situation. We have more information about cancer research trials (clinical trials) available. Blood and tumour samples Blood and bone marrow or tumour samples may be taken to help make the right diagnosis. You may be asked for your permission to use some of your samples for research into cancer. If you’re taking part in a trial, you may also be asked to give other samples which may be frozen and stored for future use, when new research techniques become available. These samples will have your name removed from them so you can’t be identified. The research may be carried out at the hospital where you are treated, or at another one. This type of research takes a long time, and results may not be available for many years. The samples will, however, be used to increase knowledge about the causes of cancer and its treatment. This research will hopefully improve the outlook for future patients. Current research Your doctors will be able to tell you about any current mesothelioma trials and whether they are suitable for you. Find out more about research trials on mesothelioma on our clinical trials database.

Other treatments (supportive therapies) to control symptoms of mesothelioma

For most people with mesothelioma, the main aim of treatment is to control symptoms. There are a number of drug treatments and minor procedures that can be used to control the symptoms of both pleural and peritoneal mesothelioma. On this page Treatments to control symptoms of pleural mesothelioma Treatments to control symptoms of peritoneal mesothelioma Treatments to control other symptoms of mesothelioma Loss of appetite Tiredness Complementary therapies There are also several people who can help manage your symptoms, including your hospital consultant, nurse specialist and GP. They may suggest referring you to a palliative care team. These teams specialise in managing symptoms and also provide emotional support for you and your family. Many palliative care teams have nurse specialists who can visit you at home. Treatments to control symptoms of pleural mesothelioma Back to top Breathlessness is a common symptom of pleural mesothelioma. It’s often caused by a build-up of the fluid between the two layers of the pleura (the membranes that cover the lungs). This is called a pleural effusion. Treating a pleural effusion A pleural effusion is treated by placing a small tube, connected to a drainage bag or bottle, between the two layers of the pleura and draining off the fluid. This is done under a local anaesthetic. You may need to have the fluid removed on a regular basis. A pleural effusion A pleural effusion. View a large version of the image showing a pleural effusion. After the fluid from the pleural effusion has been drained, it may be possible to seal the two layers of the pleura. This is called pleurodesis. Your doctor can put sterile talcum powder (talc), or a particular chemical powder, into the pleural space through the tube. This causes the membranes to stick together and helps stop pleural effusions happening again. A pleurodesis may sometimes be carried out during a procedure know as video-assisted thoracoscopy. Your doctor will be able to tell you about this. Some people may have a pleural catheter put in, particularly if they’re unable to have pleurodesis. The catheter is a soft flexible tube that can be inserted into the space where fluid collects. It can be left in position so that any fluid can be drained off whenever needed without you having a tube put in each time. You may have a catheter put in as a day-case procedure or you may need to stay in hospital for a few days. You can be taught how to drain the fluid yourself or the hospital staff can arrange for a district nurse to do this. We have more information available about managing a pleural effusion. Other ways to manage breathlessness These include breathing techniques, relaxation and coping strategies. These can all help to reduce the distress of breathlessness and make your breathing easier. Even simple measures, such as how you position yourself when sitting or standing, can be helpful. Using a fan or sitting by an open window with cool air blowing on to your face may also help ease breathlessness. Your doctor may also prescribe medicines to help with breathlessness, such as a low dose of the painkiller morphine, or drugs to help relieve the anxiety and panic that breathlessness can cause. Some people may benefit from using oxygen at home. Your doctor or palliative care nurse can organise for you to have oxygen at home if it’s suitable for you. We have more detailed information available about managing breathlessness. Treatments to control symptoms of peritoneal mesothelioma Back to top Peritoneal mesothelioma can cause a build-up of fluid in the tummy (abdomen) known as ascites. When this happens, the tummy becomes swollen and it may cause you to feel sick and breathless. You may also have pain. Treating ascites Ascites can be treated by draining off the fluid from the tummy. This helps to relieve the symptoms. A small cut is made in the abdominal wall under a local anaesthetic, and a thin drainage tube is inserted. The fluid is then slowly collected into a bag. The length of time that the drainage tube needs to stay in place depends on the amount of fluid that needs to be drained off. Sometimes a small amount of fluid can be drained in the outpatients clinic. If there is a large amount of fluid however, the procedure may need to be carried out in hospital under the supervision of the doctors and nurses. The drain may stay in place for up to 24 hours, although occasionally it may stay in longer. It’s possible for the ascites to build up again, and drainage may need to be carried out more than once. If the fluid builds up again quickly, your doctor may insert a tube known as a catheter into the abdomen. The catheter is used to drain fluid from the abdomen and may be left in place for several weeks. Your doctor will be able to give you more information about this. Large version of the image of the abdomen showing draining of ascites Side view of the abdomen showing draining of the ascites. View a large version of the image showing the side view of the abdomen showing draining of the ascites. You may also be prescribed a tablet called spironolactone. This is a water tablet (diuretic), which makes you pass urine more frequently. This helps stop the build-up of fluid in the abdomen. We have more information available about ascites. Managing bowel obstruction Occasionally, peritoneal mesothelioma may cause the bowel to block. Symptoms may include pain, tummy bloating, sickness and constipation. If this happens, your doctors will give you medicines to control your symptoms. They may also suggest treatments that will help rest your bowel for a while and help with the blockage. Treatments to control other symptoms of mesothelioma Back to top Pain Pain is a common symptom of mesothelioma. If you have pain, let your doctors or specialist nurse know so that they can assess and treat it early on. Painkillers There are many painkilling drugs available to treat different types and levels of pain. They include: painkillers, such as paracetamol, codeine or morphine; and antiinflammatory drugs, such as Ibuprofen (Brufen®) and diclofenac (Voltarol®). Some people find that they have nerve pain (also known as neuropathic pain), which happens when the mesothelioma presses on nerves. This type of pain is best treated with specific painkillers that treat nerve pain such as gabapentin and pregabalin (Lyrica®). Often, a combination of painkillers is needed to get the best pain control. Other ways to control pain Other general ways of relaxing and helping to reduce your pain include: listening to relaxation CDs having a long soak in a warm bath having a massage to an area of your body that isn’t painful, such as your hand or foot. Occasionally, if your pain is troublesome, your doctor or nurse may suggest a short admission to hospital or into a hospice so that your pain can be controlled while you’re an inpatient. They may also suggest referring you to a doctor who specialises in pain control, or a specialist pain clinic. They may use other methods of pain control, such as specialised procedures to block nerves, if nerve pain is a problem. We have more information available about controlling cancer pain. Night sweats Mesothelioma can cause some people to sweat a lot at night. This can be distressing, especially if you wake at night with damp bed clothes and bedding. Let your doctor know if this happens to you as they may be able to give you medicines to help. You may also find the following tips helpful: Try avoiding drinks that contain caffeine before you go to bed or in the night. Keep the room temperature cool or use a fan. Avoid using duvets or blankets that make you too hot. Lie on a towel so that you avoid getting your bedding damp. Use cotton sheets and bed clothes, and have some spare so that you can change them in the night if you need to. Loss of appetite Back to top Mesothelioma and some cancer treatments can cause problems with eating and digestion. If your appetite is poor, you can add high-protein powders to your normal food or you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. If you have lost your appetite, medicines such as steroids may help improve it. You can also ask to be referred to a dietitian at your hospital. They can advise you which foods are best for you and also whether any food supplements would help you. If you’re at home, your GP can arrange this for you. We have more information available about eating problems and cancer. Tiredness Back to top Many people with mesothelioma feel tired and have less energy to do the things they normally do. This may be due to the illness or it may be a side effect of treatment. It’s important not to do too much. Your body will tell you when you need to rest, but it’s important not to stop doing things completely. Try to balance rest with gentle activity, such as walking. Some people find it helpful to set goals to help them plan their daily activities. These goals may include cooking a light meal, going for a short walk or meeting a friend. Keeping a treatment diary can help you record your energy levels and plan activities for when you’re feeling stronger. Some causes of tiredness can be treated, for example anaemia (low red blood cells) can be treated with a blood transfusion. Your doctor can take a blood sample from you to find out if you have anaemia. If sleep problems are causing or contributing to your tiredness, then improving your sleep will help you feel better. We have more information available about coping with tiredness in our section on coping with fatigue. Tiredness is a common symptom of depression. If you think you’re depressed, talk to your doctor or nurse. You and your doctor will be able to work out if what you’re feeling is depression or fatigue. Talking about your feelings with a professional counsellor can often help depression. Antidepressants may also help you feel better. Complementary therapies Back to top Some people find that complementary therapies, such as acupuncture, massage, aromatherapy and relaxation techniques, can help them feel better and reduce symptoms. Many hospitals and hospices offer these therapies. If you’d like to try a complementary therapy, check with your cancer specialist or GP before using it. This is important because some complementary therapies should be avoided during, and for a short time after, cancer treatments. We have more information available about complementary therapies.

Treatment for peritoneal mesothelioma

Treatment for peritoneal mesothelioma is given to control symptoms and to slow tumour growth. Treatments may include chemotherapy and other treatments sometimes known as supportive therapies. Radiotherapy and surgery aren’t usually used to treat peritoneal mesothelioma. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells. It’s used to slow the growth of the mesothelioma and control symptoms. It may not be suitable for some people as you need to be fit enough to have it. Your doctor will let you know if it’s a suitable treatment for you. How chemotherapy is given The chemotherapy is usually given into a vein (intravenously). Each session of chemotherapy may last between one and a few days and is followed by a rest period of a few weeks. This is known as a cycle of treatment. The number of cycles you have will depend on your type of cancer and how well it is responding to the treatment. The drugs that are used The most commonly used drugs to treat peritoneal mesothelioma are the same as those for pleural mesothelioma. They include pemetrexed (Alimta®) together with cisplatin. If you have pemetrexed, you’ll be given the vitamins B12 and folic acid as these help to reduce the side effects of treatment without reducing its effectiveness. Other chemotherapy drugs may sometimes be used to treat peritoneal mesothelioma. These may be given as part of a clinical trial. We have more information available about these chemotherapy drugs and their side effects. Side effects Chemotherapy can cause unpleasant side effects. However, many people have few side effects, and those that occur can often be controlled well with medicines. Find out more about the main side effects.

Treatment for peritoneal mesothelioma

Treatment for peritoneal mesothelioma is given to control symptoms and to slow tumour growth. Treatments may include chemotherapy and other treatments sometimes known as supportive therapies. Radiotherapy and surgery aren’t usually used to treat peritoneal mesothelioma. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells. It’s used to slow the growth of the mesothelioma and control symptoms. It may not be suitable for some people as you need to be fit enough to have it. Your doctor will let you know if it’s a suitable treatment for you. How chemotherapy is given The chemotherapy is usually given into a vein (intravenously). Each session of chemotherapy may last between one and a few days and is followed by a rest period of a few weeks. This is known as a cycle of treatment. The number of cycles you have will depend on your type of cancer and how well it is responding to the treatment. The drugs that are used The most commonly used drugs to treat peritoneal mesothelioma are the same as those for pleural mesothelioma. They include pemetrexed (Alimta®) together with cisplatin. If you have pemetrexed, you’ll be given the vitamins B12 and folic acid as these help to reduce the side effects of treatment without reducing its effectiveness. Other chemotherapy drugs may sometimes be used to treat peritoneal mesothelioma. These may be given as part of a clinical trial. We have more information available about these chemotherapy drugs and their side effects. Side effects Chemotherapy can cause unpleasant side effects. However, many people have few side effects, and those that occur can often be controlled well with medicines. Find out more about the main side effects.

Treatment for peritoneal mesothelioma

Treatment for peritoneal mesothelioma is given to control symptoms and to slow tumour growth. Treatments may include chemotherapy and other treatments sometimes known as supportive therapies. Radiotherapy and surgery aren’t usually used to treat peritoneal mesothelioma. Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells. It’s used to slow the growth of the mesothelioma and control symptoms. It may not be suitable for some people as you need to be fit enough to have it. Your doctor will let you know if it’s a suitable treatment for you. How chemotherapy is given The chemotherapy is usually given into a vein (intravenously). Each session of chemotherapy may last between one and a few days and is followed by a rest period of a few weeks. This is known as a cycle of treatment. The number of cycles you have will depend on your type of cancer and how well it is responding to the treatment. The drugs that are used The most commonly used drugs to treat peritoneal mesothelioma are the same as those for pleural mesothelioma. They include pemetrexed (Alimta®) together with cisplatin. If you have pemetrexed, you’ll be given the vitamins B12 and folic acid as these help to reduce the side effects of treatment without reducing its effectiveness. Other chemotherapy drugs may sometimes be used to treat peritoneal mesothelioma. These may be given as part of a clinical trial. We have more information available about these chemotherapy drugs and their side effects. Side effects Chemotherapy can cause unpleasant side effects. However, many people have few side effects, and those that occur can often be controlled well with medicines. Find out more about the main side effects.

Treatment for pleural mesothelioma

For most people, treatment is given to help control symptoms and to slow the growth of the pleural mesothelioma. Treatments may include chemotherapy, radiotherapy and other treatments, sometimes known as supportive therapies. On this page Chemotherapy for pleural mesothelioma Side effects of chemotherapy Radiotherapy for pleural mesothelioma Side effects of radiotherapy Surgery Very occasionally, if the mesothelioma is diagnosed before it has spread or it has spread to nearby tissues, surgery may be a treatment option. Chemotherapy for pleural mesothelioma Back to top Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of the cancer cells. It’s used to help slow the growth of the mesothelioma and control its symptoms. It may not be suitable for some people as you need to be fit enough to have it. Your doctor will let you know if it’s a suitable treatment for you. How chemotherapy is given The drugs are usually given by injection into a vein (intravenously). Each session of chemotherapy may last between one and a few days, and is followed by a rest period of a few weeks. This is known as a cycle of treatment. The number of cycles you have will depend on the stage of your cancer and how well it is responding to treatment. The drugs that are used The most commonly used drugs to treat pleural mesothelioma are pemetrexed (Alimta®) together with cisplatin (or sometimes carboplatin). You’ll usually be given these drugs on the same day as an outpatient. You’ll then have a rest with no chemotherapy for 20 days before starting your next cycle. If you have pemetrexed, you’ll be given the vitamins B12 and folic acid as these help to reduce side effects of treatment without reducing its effectiveness. Other chemotherapy drugs may sometimes be used. These may be given as part of a clinical trial. We have more information about chemotherapy available. Side effects of chemotherapy Back to top Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The most common side effects of pemetrexed and cisplatin are described here. Feeling sick (nausea) and being sick (vomiting) This is common and may begin soon after the treatment is given and last for a few days. Occasionally, it may last longer. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. Risk of infection Pemetrexed and cisplatin chemotherapy can reduce the number of white blood cells in your body, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you’ll be more prone to infections. A low white blood cell count is called neutropenia. Always contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if: you develop a high temperature - this may be over 37.5°C (99.5F) or over 38°C (100.4F) depending on the hospital’s policy. Follow the advice that you’ve been given by your chemotherapy team. you suddenly feel unwell, even with a normal temperature you feel shivery and shaky you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection) or diarrhoea. If necessary, you’ll be given antibiotics to treat any infection. You’ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if the number of your white blood cells is still low. Anaemia The number of red blood cells, which carry oxygen around the body, may also be reduced. A low red blood cell count is called anaemia. This may make you feel tired and breathless. You may need to have a blood transfusion if the number of red blood cells becomes too low. Sore mouth Your mouth may become sore or dry, or you may notice small ulcers during treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It’s important to drink plenty of fluids if you have diarrhoea. Numbness or tingling in hands or feet This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Let your doctor know if you develop these symptoms. Tiredness (fatigue) Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and balance rest with some gentle exercise. Eye problems Pemetrexed may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Your doctor can prescribe soothing eye drops to help with this. Changes in hearing Cisplatin may cause ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Very occasionally, your sense of balance may be affected. Any hearing loss (and balance changes if they occur) may be permanent. However, tinnitus usually improves when treatment ends. Although they may seem hard to bear at the time, most of the side effects are temporary and will disappear once your treatment is over. We have more detailed information on coping with the side effects of chemotherapy. Chemotherapy affects different people in different ways. Some people are able to lead a normal life during their treatment; others find they become very tired and have to take things more slowly. Just do as much as you feel like doing and try not to overtire yourself. Radiotherapy for pleural mesothelioma Back to top Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. It’s usually given by aiming the high-energy x-rays at the lung from a radiotherapy machine. This is known as external beam radiotherapy. The treatment is given in the hospital radiotherapy department as an outpatient. Radiotherapy can be given for different reasons: It can be given to shrink or reduce the size of the mesothelioma - this can help relieve symptoms such as pain and breathlessness. It’s sometimes given to the chest wall at the place where a biopsy has been done or a drainage tube has been inserted. In this situation, the radiotherapy may prevent the tumour from growing out through the scar. It can also be used alongside surgery and chemotherapy (usually within a clinical trial). Often, only one or two treatments are needed, but occasionally a course of treatment is given over two weeks or so. For single treatments, the planning discussed below isn’t needed. Planning your radiotherapy Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It’s planned by a cancer specialist (clinical oncologist) and it may take a few visits. On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or to lie under a machine called a simulator, which takes x-rays of the area to be treated. If you’re having radiotherapy to the place where a drainage tube has been, you won’t need a CT scan. You may need some small marks made on your skin to help the radiographer (who gives you your treatment) position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) are usually used. These are extremely small, and will only be done with your permission. It may be a little uncomfortable while they are done. Treatment sessions At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch and make sure you’re comfortable. You’ll be alone in the room during your treatment but the radiographers will be able to see you. There may also be an intercom in the treatment room so that they can talk to you during your treatment. Radiotherapy isn’t painful, but you will have to lie still for a few minutes during the treatment. An image of a radiotherapy machine Positioning the radiotherapy machine. View a large version of the image of someone positioning the radiotherapy machine. Side effects of radiotherapy Back to top Radiotherapy can cause general side effects, such as feeling sick (nausea), being sick (vomiting) and tiredness. It can also make you temporarily more breathless. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your clinical oncologist and radiographer can advise you on what to expect. Nausea and vomiting This can usually be effectively treated with anti-sickness (anti-emetic) drugs, which your doctor can prescribe. Tiredness If you feel tired, get plenty of rest but balance this with some gentle exercise, such as short walks. This will give you more energy and help to keep your muscles working. Save some energy for doing the things you enjoy and ask others for help doing chores if these are tiring you out. Discomfort when swallowing This may start in the first week after your treatment and last a few days. Tell your doctors if you have problems swallowing as they can give you medicines to help. They can also prescribe you nutritious, high-calorie drinks if eating is difficult. These side effects should disappear gradually once your course of treatment is over, but it’s important to let your doctor know if they continue. We have more detailed information on coping with these side effects. Radiotherapy does not make you radioactive and it’s perfectly safe for you to be with other people, including children, throughout your treatment. We have more detailed information about radiotherapy available. Surgery Back to top Surgery is only suitable for a small number of people with pleural mesothelioma. The aim of surgery is usually to help with symptoms and to control the disease rather than to cure it. The operation will be done by a specialist chest surgeon who is experienced in the treatment of mesothelioma. An operation may be carried out as part of a clinical trial. Pleurectomy The type of surgery that may occasionally be used for pleural mesothelioma is called a pleurectomy. This involves removing the tumour and part, or all, of the pleura and the lung tissue close to it. It’s used to help stop the build-up of fluid in the lung and to help with breathlessness and pain. Pleurectomy can also help a collapsed lung to reinflate with air, which will help reduce breathlessness. For some people, it may be possible to have a pleurectomy using keyhole surgery. With this type of surgery, only small openings are made instead of one large cut (incision). Pleurectomy is only suitable for some people with mesothelioma. There are other treatments that don’t involve major surgery, which can be used to control the build-up of fluid in the lung, breathlessness and pain.

Treatment overview of Mesothelioma

Pleural and peritoneal mesothelioma are treated in different ways. We have split the information about treatment into two sections, so that you find the information that's relevant to your type of mesothelioma. On this page Multidisciplinary team Giving your consent The benefits and disadvantages of treatment Second opinion Find out more about treatment for pleural mesothelioma. Find out more about treatment for peritoneal mesothelioma. Multidisciplinary team Back to top If your tests show that you have mesothelioma, you’ll be looked after by a multidisciplinary team (MDT). This is a team of people who specialise in treating mesothelioma and in giving information and support. It will normally include: chest physicians – doctors experienced in lung disease (if you have pleural mesothelioma) oncologists – doctors experienced in using chemotherapy and radiotherapy to treat mesothelioma surgeons experienced in chest surgery (if you have pleural mesothelioma) specialist nurses who give information and support symptom-control specialists radiologists who help to analyse x-rays pathologists who advise on the type and extent of cancer. It may also include other healthcare professionals, such as a physiotherapist, counsellor, psychologist, social worker or dietitian. The MDT will work together to plan the best treatment for you. When planning your treatment, they will take a number of factors into account, including your general health and the stage of the mesothelioma. Occasionally, you may be offered a choice of treatments. If this happens, make sure you have enough information about the different treatments, what’s involved and the possible side effects, to help you make the right decision. If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a relative or close friend with you. Giving your consent Back to top Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you’re asked to sign the form you should be given full information about: the type and extent of the treatment its advantages and disadvantages any significant risks or side effects any other treatments that may be available. If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations. It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment. People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions. You can always ask for more time if you feel that you can’t make a decision when the treatment is first explained to you. You’re also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice. The benefits and disadvantages of treatment Back to top Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending on your individual situation. For many people with mesothelioma, the cancer has already spread when it’s diagnosed and treatment is given with the aim of slowing the growth of the cancer. This can lead to an improvement in symptoms and a better quality of life. However, for some people, the treatment will have no effect on the cancer and they will get the side effects of the treatment with little benefit. If you’ve been offered treatment that aims to cure the cancer, deciding whether to accept it may not be difficult. However, if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have it, you can still be given supportive (palliative) care with medicines to control any symptoms. It’s important that you ask your doctors and nurses any questions you have about your treatment. The more you understand about your treatment, the easier it will be for you and them. We have more information about making treatment decisions. Second opinion Back to top Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Risk factors and causes of mesothelioma

Asbestos is the most common cause of mesothelioma. Up to nine out of ten cases of mesothelioma (90%) are caused by exposure to asbestos fibres. Asbestos Asbestos is a natural mineral found in many countries. It acts as an insulator (to keep heat in and cold out) and it protects against fire and corrosion. There are three main types of asbestos: blue (crocidolite), brown (amosite) and white (chrysotile). These were used in UK industries until the ban on imports of blue and brown asbestos in the 1980s and on all types in 1999. Exposure to blue and brown asbestos is commonly linked with mesothelioma. However, exposure to all types of asbestos is harmful. Mesothelioma doesn’t usually develop until many years after exposure to asbestos. It can take any time from 10–60 years, although the average is about 30–40 years after exposure. Pleural mesothelioma When asbestos is disturbed or damaged, it releases tiny fibres that can be breathed into the lungs. Asbestos fibres are very fine and can make their way into the smallest airways of the lungs. Once the fibres are in the lungs, the body’s defence mechanisms try to break them down and remove them. This leads to inflammation in the lung tissue. The asbestos fibres can also travel through the lung tissue to settle in the outer lining of the lung (the pleura). Over many years they can cause mesothelioma or other lung diseases to develop. Peritoneal mesothelioma Asbestos fibres can also be swallowed, and some of the fibres can stick in the digestive system. They can then move into the outer lining of the abdomen (the peritoneum). Here, they cause swelling and thickening of the lining and can lead to peritoneal mesothelioma. Exposure to asbestos People most likely to have been exposed to asbestos at work include: joiners and construction workers plumbers electricians boilermakers shipbuilders. As these jobs were mostly done by men, mesothelioma is five times more common in men than in women. People who haven’t worked directly with asbestos can also sometimes develop mesothelioma. These can include: family members of people who’ve worked with asbestos and brought the dust home on their clothes people who lived near asbestos factories people who worked in buildings containing asbestos materials that were disturbed or damaged. Other causes Occasionally, mesothelioma develops in people who have never been exposed to asbestos. The other causes of the disease are not fully understood, but, in rare cases, mesothelioma has been linked to exposure to radiation. A mineral called erionite, which has been found in Turkey and North America, has also been linked to mesothelioma. Mesothelioma isn’t infectious and can’t be passed on to other people. It isn’t caused by inherited faulty genes, so family members don’t have an increased risk of developing it, unless they have also been exposed to asbestos.

What is mesothelioma?

Mesothelioma is a tumour of the mesothelium. This is the thin lining (membrane) that covers the outer surface of most of our body's organs. On this page Pleural mesothelioma Peritoneal mesothelioma Rare types of mesothelioma Cell types of mesothelioma More than 2,500 people are diagnosed with mesothelioma in the UK each year. The mesothelium has different names in different parts of the body. For example: • in the chest it’s called the pleura • in the abdomen it’s called the peritoneum. A cancer of the mesothelium is called a malignant mesothelioma. However, it’s usually referred to simply as mesothelioma. There are other tumours of the mesothelium, such as adenomatoid tumours, benign cystic mesotheliomas and solitary fibrous tumours of the pleura. Our cancer information specialists can give you information about these. This section is about malignant mesothelioma. There are two main types of malignant mesothelioma: pleural mesothelioma and peritoneal mesothelioma. Pleural mesothelioma is much more common than peritoneal mesothelioma. Around 9 out of 10 cases (90%) of mesothelioma develop in the pleura, compared with around 1 in 10 (10%) in the peritoneum. Ratio of pleural mesothelioma to peritoneal mesothelioma Ratio of pleural mesothelioma to peritoneal mesothelioma. View a large copy of the infographic showing the ratio of pleural mesothelioma to peritoneal mesothelioma Pleural mesothelioma Back to top The pleura is the smooth outer lining (membrane) that covers each lung. It has two layers: the inner (visceral) layer, which is next to the lung, and the outer (parietal) layer, which lines the chest wall. The two layers of the pleura are usually in contact and slide over each other as we breathe. The layers produce fluid, which allows them to move smoothly over each other. When mesothelioma develops in the pleura (pleural mesothelioma), the delicate layers of the pleura thicken and may press inwards on the lung. Fluid may also collect between the two layers, which is known as a pleural effusion. Pleural mesothelioma can sometimes spread to the lymph nodes in the chest or above the collarbone, or elsewhere in the body. Structure of the lungs and pleura Structure of the lungs and pleura. View a large copy of the infographic showing the structure of the lungs and pleura Peritoneal mesothelioma Back to top The outer lining (membrane) that covers the organs in the abdomen is known as the peritoneum. The peritoneum helps protect the organs of the abdomen and keep them in place. It also has two layers: the inner (visceral) layer, which is next to the abdominal organs, and the outer (parietal) layer, which lines the abdominal wall. Side view of the abdomen Side view of the abdomen. The peritoneum is shown as the thick line surrounding the abdominal organs. View a large version of the image showing the side view of the abdomen Mesothelioma in the peritoneum is called peritoneal mesothelioma. It causes thickening of the peritoneum and a collection of fluid in the abdomen. The collection of fluid is called ascites and causes swelling of the tummy (abdomen). Rare types of mesothelioma Back to top Very rarely, a mesothelioma may develop in the outer lining of the heart (pericardial mesothelioma) or in the outer lining of the testes (testicular mesothelioma). These are not discussed in this booklet. If you’d like information about them, contact our cancer information specialists on 0808 808 00 00. Cell types of mesothelioma Back to top Pleural and peritoneal mesothelioma can also be grouped according to how the cells look under a microscope. There are three main types: • epithelial – this is the most common • sarcomatoid (fibrous) • mixed (biphasic) – this has both epithelial and sarcomatoid cells. Knowing the type of cell involved may give your doctors an idea of how well the disease will respond to treatment.