Patients with mesothelioma generally do not demonstrate symptoms of this disease until 20 to 50 years after their initial exposure to asbestos. Fibers that embed in the tissue surrounding the body’s internal organs, the mesothelium, usually must be present for many decades before the development of cancer. These fibers gradually accumulate and cause scarring, which leads to inflammation and cancer. Although these fibers are most often introduced into the body through inhalation, the material can also be introduced through ingestion as well. Initially, symptoms may be mild and an individual might not find them cause for alarm. However, as the cancer spreads, these symptoms become more severe and debilitating.
Consulting a Physician Early
As a result of this slow development andlong delay between asbestos exposure and cancer growth, individuals frequently overlook initial symptoms of mesothelioma. Furthermore, these symptoms often mimic those of less serious illnesses, leading to a common delay in seeking treatment. Unfortunately, this delay can limit treatment options and effectiveness. Therefore, it remains vital for any individuals who suspect past asbestos exposure to seek medical screening for the disease, even if symptoms are not currently present. Oftentimes, a second opinion is also recommended as mesothelioma is commonly misdiagnosed. Whether it is the stage the cancer is in, or the type of cancer, misdiagnosis happens and specialists advise patients to get second opinions. Diagnosis of mesothelioma as a stage III when it really is a stage II is a big difference and treatment options as well as prognosis may differ greatly between stages.
Several important steps after diagnosis exist for patients struggling with mesothelioma. These steps can be the difference between succumbing to the disease quickly and maintaining a high quality of life while fighting this illness. Even if symptoms that seem trivial arise, it is important to contact a physician immediately. This is especially vital for those who have had exposure to asbestos in the past.
Early Symptoms
Early symptoms of mesothelioma are generally absent in patients, leading to the disease’s late diagnosis. However, it remains vital for those who were exposed to asbestos to seek regular imaging and diagnostic tests to help detect any latent signs of mesothelioma development. Individuals who experienced prolonged asbestos contact should be even more attentive to this risk, as length and intensity of exposure is strongly correlated with the development of mesothelioma.
Sometimes early symptoms of mesothelioma mirror those of other diseases or physical issues such as congestive heart failure, emphysema, weight gain or constipation. These symptoms may include shortness of breath, constant chest pain or cough, night sweats, weight loss but fluid gain, bowel obstruction, swelling of the feet, and a buildup of fluid on a chest x-ray. This fluid build up is known as a pleural effusion.
What is a Pleural Effusion?
One main symptom of mesothelioma is a buildup of the fluid between the parietal pleura and the visceral pleura. This buildup is called a pleural effusion. These membranes are coated with mesothelial cells that normally secrete a fluid that lubricates and protects the space between one’s chest wall and lung. In a healthy body, excess fluid would be absorbed into the bloodstream and lymph nodes to avoid fluid buildup. Conversely, for abnormal cases such as those seen in mesothelioma, when too much fluid is present in the area, a pleural effusion occurs.
There are two types of pleural effusions. The most common form is a transudative pleural effusion. This effusion is typically clear in color and occurs when there is an imbalance between fluid produced and that which is removed. This form is more common in a congestive heart failure.
An exudative effusion is likely to be a sign of mesothelioma. This effusion is cloudy in color and made up of cells, proteins and other fluids resembling that of a diseased pleura. In order to differentiate between the two types of effusions a fluid sample must be tested.
Removal of excess fluid can be done in a simple procedure requiring local anesthesia. The procedure, called pleurodesis, injects talc into the fluid in the lungs. According to the American Cancer Society, this substance causes irritation in the membranes making them swell and stick together. Once this bond is formed, space is eliminated making the area impermeable to fluid.
Another procedure, called pleurocentesis is a simple outpatient procedure typically lasting only 30 minutes. During this procedure, a long needle is injected through the chest cavity into the lung and drains excess fluid from the lungs.
Pleural Mesothelioma Symptoms
The most common form of this disease, pleural mesothelioma, makes up approximately 75% of all mesothelioma cases. Developing in the pulmonary (lung) region, symptoms of this disease include:
- Persistent dry cough without phlegm
- Plueral effusions (typically containing blood)
- Blood in the sputum (fluid) or coughing up blood (hemoptysis)
- Difficulty swallowing (dysphagia)
- Inexplicable weight loss
- Fatigue
- Sweating or fever
- Persistent chest or rib area pain, painful breathing
- Inexplicable shortness of breath (dyspnea)
- Development of lumps under the skin on the chest
Pleural mesothelioma symptoms generally result from the thickening of the membrane surrounding the lungs, brought on by rapidly-developing cancer cells. This rapid cell production frequently leads to an accumulation of fluid in the pleural space (pleural effusion), which brings on the most common symptoms of pleural mesothelioma, including shortness of breath, inexplicable cough and chest pain.
In a 2009 study conducted by the Texas Occupational Medicine Institute regarding 221 cases of pleural mesothelioma, they found these signs and symptoms to be the most presenting:
Peritoneal Mesothelioma Symptoms
The second most common form of mesothelioma, peritoneal mesothelioma, develops in the tissue surrounding the abdominal cavity, known as the peritoneum. Symptoms of peritoneal mesothelioma include:
- Nausea or vomiting
- Inexplicable weight loss
- Sweating or fever
- Swelling or pain in the abdomen
- Ascites (fluid buildup between the peritoneum and the abdominal organs)
- Anemia
- Fatigue
- Diarrhea, constipation or any other inexplicable changes in the bowels
- Development of lumps under the skin on the abdomen
Peritoneal mesothelioma symptoms generally result from the thickening of the membrane surrounding the abdomen, brought on by rapidly-developing cancer cells. This rapid cell production frequently leads to an accumulation of fluid between the membrane layers in this area, placing pressure on the abdomen and bringing on these symptoms.
In the same study done by the Texas Occupational Medicine Institute in 2009, symptom results from 13 cases of peritoneal mesothelioma disclosed the following as the most prevalent symptoms:
Pericardial Mesothelioma Symptoms
Less than 5% of mesothelioma patients develop this form of the disease, which is present in the membrane surrounding the heart. Symptoms of pericardial mesothelioma are brought on by a thickening of the pericardial membrane and subsequent fluid buildup. Pericardial mesothelioma symptoms include:
- Heart palpitations, irregular heartbeat
- Pain in the chest
- Inexplicable difficulty breathing (dyspnea)
- Sweating or fever
- Fatigue
Because this form of mesothelioma so rarely affects patients, its symptoms are not as widely recognized, making this condition more difficult to diagnose. This difficulty in diagnosismakes treating this disease especially difficult, leading to a generally-poorer prognosis for this form of mesothelioma than others.
In a 1994 study done by the Texas Heart Institute, in an assessment of 28 individuals diagnosed with pericardial mesothelioma, the following were the most commonly cited presenting symptoms:
Testicular Mesothelioma Symptoms
Since 1950, less than 100 cases of this form of mesothelioma have been recorded, making it extremely rare. Because of this rare appearance, the symptoms of this disease remain largely unknown. Today, the only recognized symptom of testicular mesothelioma are testicular lumps and swelling of the scrotum.
Oftentimes the tumor in the testicle is only discovered when a patient undergoes surgery for other reasons, such as hernia repair.
Symptoms Indicative of Metastatic Spread
Unfortunately, not all mesothelioma cases stay confined to the originating site. When cancer cells travel to other parts of the body and form new tumors, this process is called metastasis. This can happen when cancer cells get into the bloodstream or lymph vessels and travel to other parts of the body.
Research says that about 44% of cases end up metastasizing. Moreover, since most cases of mesothelioma are not diagnosed until the later stages of the cancer, it is probable that the cancer has spread making it either inoperable or prognosis of an operation grim.
Symptoms that are most clearly noted for local invasion include:
- Dysphagia (coughing/spitting up blood)
- Horners syndrome
- Other neurological syndromes
- Laryngeal nerve palsy
- Nerve involvement of the arm
Furthermore, in rare instances, if the cancer spreads to the spinal canal, paraplegia can occur. Other rare occurrences include clubbing of the fingers and hypertrophic pulmonary osteoarthropathy (HPOA). These incidences tend to appear in patients who also have asbestosis.
When Do Mesothelioma Symptoms Arise
As stated above, since the latency period of mesothelioma is 20 to 50 years, most patients do not notice symptoms for years, even decades after their exposure to asbestos. A 2009 study conducted by the Texas Occupational Medicine Institute reviewed 217 men and 21 women diagnosed with malignant mesothelioma.
Latency, the time period between the initial exposure and diagnosis of the cancer was detected in 191 of the 238 cases. The average latency time interval was 48. 5 years with a range of 18 to 70 years. The study also stated that there was no statistical difference in the latency for peritoneal versus pleural cases of mesothelioma (45.9 versus 48.6, respectively). Also, there was no statistical difference between those with and without asbestosis. Conversely, the study found evidence to prove that women had a longer latency period compared to men (53.3 versus 47.9).
The average age of diagnosis was 70.3 years with a range of ages from 34 to 92. While the age of diagnosis for peritoneal mesothelioma was slightly younger than the pleural mesothelioma cases (65.4 versus 70.6). Another study with a larger pool of mesothelioma patients was conducted in 1992. This study, encompassing 1,690 cases, found the median latency to be 32 years.
With such a great latency period, the best method is early detection. If the cancer is caught instage I or II there is a better chance the patient can undergo curative surgery. Only a medical specialist can diagnose something as complex as malignant mesothelioma so it is best to consult a physician if symptoms become present.
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References:
Merk Source
Texas Occupational Medicine Institute
Cancer.org
Mayo Clinic
A patient with mesothelioma usually begins showing symptoms 15 to 50 years after their exposure to asbestos. The cancer may take decades to develop in the body and symptoms do not arise until after the cancer is present. Common early symptoms of mesothelioma include fatigue, coughing, shortness of breath and reduced respiratory function. Many patients are unaware they have developed mesothelioma or the severity of their condition as mesothelioma symptoms typically resemble symptoms of less serious illnesses and occur so long after the initial exposure.
If you have a history of asbestos exposure, the leading cause of mesothelioma, and believe you may be showing signs of mesothelioma, it is best to seek immediate medical advice. Informing your doctor of previous asbestos exposure can alert them to the possibility of an asbestos-related disease such as mesothelioma.
What are the Symptoms of Pleural Mesothelioma?
Most pleural mesothelioma symptoms affect the respiratory system. Although they are rarely part of a patient's initial presentation and are typically discovered by imaging tests, pleural thickening orpleural plaques are also indicative of mesothelioma.
The most commonly reported symptoms of pleural mesothelioma include:
- Chest pains
- Shortness of breath (dyspnea)
- Reduced chest expansion
- Barely audible or harsh breathing sounds
- Dry cough or wheezing
- Pleural effusions
These benign lesions can be as large as 6 cm in diameter and appear in scattered clusters across the visceral and parietal pleural surface. In a 2011 study of 221 pleural mesothelioma patients, symptoms were reported with the following frequency:
90%
of patients presented pleural effusions
79%
of patients experienced shortness of breath
64%
of patients reported chest pain
36%
of patients developed a chronic cough
30%
of patients experienced weight loss
What are the Symptoms for Other Types of Mesothelioma?
Peritoneal mesothelioma:
Abdominal pain is the first symptom that most peritoneal mesothelioma patients exhibit. This is commonly followed by abdominal enlargement and tenderness. Ascites, fluid buildups between the peritoneum and the abdominal organs, are very common, but they often develop later in the progression of the illness. In a study of 13 peritoneal mesothelioma patients, 77 percent of participants developed ascites.
Peritoneal mesothelioma is also associated with a loss of appetite that often results in weight loss, abdominal distention/pelvic mass and abdominal hernias. In one study, 69 percent of peritoneal mesothelioma patients lost weight. Patients may also note bowel obstruction very late in the progression of peritoneal mesothelioma. Additionally, one Australian study found that 10 percent of all diffuse malignant peritoneal mesothelioma patients experienced short, mild seizures.
69%
of patients experienced weight loss or loss of appetite
77%
of patients developed ascites
Abdominal pain is an early sign of peritoneal mesothelioma
Bowel obstruction generally occurs later
Pericardial mesothelioma:
The few available case reports on pericardial mesothelioma name difficulty breathing and chest pain as the symptoms of this subtype. These symptoms are the result of the pericardium thickening.
Testicular mesothelioma:
The only consistent sign that has been presented by patients with testicular mesothelioma is a lump in the testes. Testicular mesothelioma is incredibly rare, yet as more studies are conducted, additional symptoms may be revealed.
What Symptoms Indicate Metastatic Spread?
Not all mesothelioma symptoms are confined to the site where the cancer originates. The symptoms that are most closely related to local invasion include:
Localized spread to the lymph nodes is most common and occurs in approximately 44% percent of cases.- Dysphagia (coughing/spitting up blood)
- Horner's syndrome (or other neurological syndromes)
- Laryngeal nerve palsy
- Nerve involvement of the arm
Paraplegia can occur if the cancer spreads to the spinal canal. Metastatic mesothelioma can also obstruct the superior vena cava. Hypoglycemia has also been reported as a clinical feature of invasive mesothelioma, yet this primarily occurs in patients with rare localized fibrous mesothelioma. Clubbing of the fingers and hypertrophic pulmonary osteoarthropathy (HPOA) are even rarer but occur in a handful of malignant mesothelioma cases, primarily when asbestosis is also present.
When do Mesothelioma Symptoms Emerge?
Typically, mesothelioma patients notice the first signs of their disease 30 to 50 years after they were first exposed to asbestos. This latency period is not significantly different between varying subtypes of mesothelioma, but some studies have noted a shorter latency period for peritoneal mesothelioma (20 to 30 years) than pleural mesothelioma. However, in one 2011 study of 191 malignant mesothelioma cases, women were found to have a longer latency period than men:
A larger retrospective study of 1,690 mesothelioma patients found the median latency period to be 32 years, while an even larger 2006 Italian study of 5,173 mesothelioma patients reported an average latency of 43.6 years. Once signs of mesothelioma finally emerge, they are typically mild. Many patients may not pay attention to them when they first arise, only seeking a medical consultation when symptoms intensify. Additionally, a high percentage of mesothelioma patients have other respiratory diseases and the onset of mesothelioma is often misinterpreted as a progression of an existing condition such as COPD.
Because of the long latency period, symptoms are not always addressed right away. One study found that the interval between the first presentation of symptoms and referral to appropriate treatment was as high as 39 months.
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