Although pleural mesothelioma is a type of lung cancer, swiftly determining which disease a patient has is critical to the treatment plan. Pleural mesothelioma and other lung cancers exhibit overlapping symptoms, however, the diseases’ physical characteristics and risk factors vary.
Disease risk factors, onset of disease and location of the cancer are a few features that set lung cancer and mesothelioma apart. “Mesothelioma is almost exclusively caused by any history of exposure to asbestos, while the majority of lung cancers are caused by tobacco use and other environmental exposures including secondhand smoke and radon gas,” shared Snehal Smart, MD, patient and family advocate for the Pleural Mesothelioma Group at PleuralMesothelioma.com.
To make a medical diagnosis, Joe M. Pressler, Jr., MD, assistant professor of medicine in the Division of Pulmonary and Critical Care at University of Mississippi Medical Center, relies on a thorough patient history combined with imaging and a tissue biopsy. “Early diagnosis improves our chance of providing a cure or an improvement in mortality,” he conveyed.
Pleural mesothelioma settles into the inner lining of the lungs, whereas lung cancer develops in the lung tissue itself. “For mesothelioma, imaging will show calcification around the chest wall or large masses on the chest wall,” Pressler explained. “It’s easy to distinguish between the two at that point. The appearance of mesothelioma stands out from lung cancer by location and presentation.”
Mesothelioma patients commonly present with a history of asbestos exposure, onset of shortness of breath, and a large amount of fluid in one lung or the other, Pressler explained. The list of overlapping symptoms with lung cancer is long and can include chest pain, dyspnea or difficulty breathing, chronic coughing, fatigue and weight loss.
Pleural mesothelioma has a latency period of 20 to 50 years, whereas lung cancers have a shorter latency period after the first exposure to the carcinogen which can be asbestos or smoking, Smart shared.
Although smoking is not a cause for pleural mesothelioma, Smart clarifies that the habit can greatly increase one’s risk.
“When gathering a patient history, the asbestos exposure timeframe can become clear when the patient is in his 50s, 60s or 70s,” Pressler mentioned. “Patients don’t walk in saying they’ve been exposed to asbestos but we know to ask about occupations and environmental hazards. A history of working in a shipyard or with brakes can be a strong indicator of exposure.”
Mesothelioma and lung cancers can be treated with surgery, chemotherapy, radiation or a combination. “First and foremost, the patient and the physician need to decide what the goal of treatment is,” Pressler said. “Is the patient trying for a full and complete curative therapy or palliative therapy? That determines the course you take.”
“It’s critical to distinguish between the two diseases early on because the standard courses of treatment may be different,” Smart said. To treat pleural mesothelioma, she explained, a surgeon might remove the lining of the lung and the affected portion of the lung or the entire cancerous lung, whereas for typical lung cancer surgeries, the surgeon might remove a small portion of the lung, lobe or entire lung.
“Because pleural mesothelioma develops in the chest cavity and the outside of the lung, it’s more invasive into the chest wall and therefore, more difficult to surgically remove,” Pressler said. “Surgery for mesothelioma tends to be fairly intense and extensive.”
There are select standard-of-care options for each type of lung cancer. According to Smart, the cell type of the lung cancer diagnosed will play a role in which type of chemotherapy regimen is offered. The different types of non-small cell lung cancers include adenocarcinoma, squamous cell carcinoma or large cell carcinoma, and small-cell lung cancer can include a cell type known as oat cell carcinoma.
Respiratory care approaches differ for the two patient types. According to Pressler, mesothelioma patients don’t necessarily have with an airway issue, so care tends to focus on support including interventions such as BiPAP/ CPAP, pain control and oxygen support. Lung cancer patients have a higher association with COPD, he explained, so treating the comorbid conditions such as cough, chronic bronchitis and airway inflammation becomes an important part of the treatment plan.
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One of the most common symptoms of pleural mesothelioma is difficulty breathing. “An interdisciplinary team of specialists often recommends a range of therapies and treatments based on the needs of the patient,” Smart relayed. “These therapies include exercise, breathing techniques and educating the patient on ways to conserve energy.”
Patients with pleural mesothelioma who are looking for other ways to improve lung function might consider creating a positive outlook, correcting nutritional deficiencies, increasing exercise performance and seeking emotional support, Smart advised. “A patient may find it helpful to seek help from a mental health counselor for anxiety, which can also play a role in difficulty breathing,” she said.
“Research indicates the duration and concentration of asbestos exposure plays an important role in the risk of developing cancer,” Smart advised. Thin asbestos fibers can become trapped in the lungs after being inhaled. Eventually, the fibers can trigger inflammation, scarring and potentially lead to the development of cancer.
According to Smart, research shows higher concentrations of asbestos fibers can increase the risk of lung cancer. The size of the asbestos fibers and the location in which they settle are the two main determinants in whether the patient develops lung cancer or mesothelioma, she explained. “Researchers discovered that 3 mm fibers are more likely to become lodged in the lining of the lungs, leading to pleural mesothelioma,” she clarified. “Larger fibers tend to lodge directly in the lung tissue, leading to lung cancer.”
Educating the public about the hazards and possible health implications of asbestos is important. Conferences and other resources provide an opportunity to discuss new testing and treatment options. Patient advocacy centers like the Pleural Mesothelioma Group reach out to physicians, patients and families to help raise awareness and counsel patients.
Rebecca Mayer Knutsen is on staff. Contact: [email protected]