Malignant mesothelioma is a rare form of cancer that can originate in several areas of the body, but most commonly in the visceral pleura of the lungs. There are about 2,200 new cases of malignant mesothelioma of the visceral pleura each year. Mesothelioma is difficult to diagnose and is rarely curable. The most common symptoms are dyspnea and chest wall pain. 

On this page:

• Risk Factor
• Diagnosis
• Staging
• Treatment
• Clinical Trials
• Thoracic Oncology Clinical Program
• Care Team Members

Risk Factor

Asbestos is the predominant cause of malignant mesothelioma of the visceral pleura. The period between the time of exposure to asbestos and the onset of symptoms is about 35 to 40 years. Because of this late onset, it occurs most commonly in the later years of life. It also occurs more often in men than in women. 

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Diagnosis

A doctor should be seen if a person has shortness of breath, pain in the chest, or pain or swelling in the abdomen. If there are symptoms, the doctor may order an x-ray of the chest or abdomen. 

The doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. If tissue that is not normal is found, the doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy. 

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Staging

Localized malignant mesothelioma: 
Stage I: The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung. 

Advanced malignant mesothelioma: 
Stage II: The cancer has spread beyond the lining of the chest to lymph nodes in the chest. 
Stage III: Cancer has spread into the chest wall, center of the chest, heart, through the diaphragm, or abdominal lining, and in some cases into nearby lymph nodes. 
Stage IV: Cancer has spread to distant organs or tissues. 

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Treatment

For localized stage I disease with a history of asbestos exposure, surgery may be curative. For stages II to IV, treatment by surgery is still evolving. Most patients, however, regardless of stage, cannot be cured with surgery alone, due to high rates of local and systemic recurrences. Eighty percent of patients have residual disease following surgery. The five-year survival rate using surgery alone is less than 1 percent.

Surgery is usually used to control or prevent pleural effusion. It is also used to decrease the discomfort caused by the bulk of the tumor. Pleural effusion is controlled by putting talc (a form of powder) into the chest cavity. This procedure has a 90 percent effectiveness rate for palliation.

Radiation is not appropriate treatment except in context of combined treatment or for symptomatic treatment of pain associated with metastases. 

Another commonly used treatment for mesothelioma is combination chemotherapy (using more than one chemotherapy agent), similar to that used to treat nonsmall cell lung cancer. The results are similar to those for nonsmall cell lung cancer. Just as with nonsmall cell lung cancer, there is no combination of drugs that works all the time for every person, and multimodality therapy appears to offer the best treatment at this time. 

Cytoreductive surgery plus hyperthermic (heated) chemotherapy improves the survival and quality of life for patients with peritoneal metastases (tumors involving the lining of the abdomen). Physicians at the Masonic Cancer Center have nationally recognized expertise in this innovative treatment.

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Clinical Trials

Clinical trials are human research studies that evaluate the effectiveness of new interventions for patients. Such interventions have already been tested in laboratories and showed enough promise to be pursued further.

Different types of cancer clinical trials include prevention trials, early detection trials, and treatment trials. If you take part in a clinical trial, you may benefit from a new drug, procedure, or symptom-control method while helping scientists evaluate its effectiveness.

The Thoracic Cancer Clinical Team of the University of Minnesota Cancer Center is actively engaged in both national and regional clinical trials for various thoracic cancers.

• Thoracic cancer trials available through Cancer Center
• All clinical trials available through the Masonic Cancer Center

Contact our program coordinator (Teri Kast, 612-273-5396) for more information about clinical trials.

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Thoracic Oncology Clinical Program

The University of Minnesota Cancer Center's Thoracic Oncology Program offers thoracic cancer patients a comprehensive approach to diagnosis, treatment, and after-treatment support. 

This multidisciplinary program consists of specialists in thoracic surgery, oncology, radiotherapy, and pathology. These specialists meet weekly in the multidisciplinary thoracic oncology conference. They review information about all patients currently undergoing therapy at Fairview-University Medical Center and help determine the best treatment plan for each. 

Also available are smoking cessation programs; the Hospice Program, which provides supportive services to dying patients; and social work services for emotional support and counseling. 

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Care Team Members

The links below go to physician profiles on the University of Minnesota Physicians Web site. To return to this site, either bookmark this page or use your browser's back button.

General Thoracic and Minimally Invasive Surgery

Rafael Andrade, M.D.

Jonathon D'Cunha, M.D., Ph.D.

Michael Maddaus M.D.

Medical Oncology-Thoracic

Arkadiusz Dudek, M.D., Ph.D.

Mark Klein, M.D.

Robert Kratzke, M.D.

Priya Kumar, M.D.

Nauman Moazzam, M.D.

Radiation Oncology-Thoracic

Chinsoo Cho, M.D.

Pathology

Jose Jessurun, M.D.

Thoracic Oncology Nurse Coordinator

Teri Kast, M.S., R.N., A.O.C.N.S.
tkast@umphysicians.umn.edu, 612-273-5396

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