What is mesothelioma?
This page tells you what mesothelioma is. You can scroll down the page to read all the information here. Or you can use these links to go straight down to sections on
What mesothelioma is
Mesothelioma in the chest
Mesothelioma in the abdomen
Benign (non cancerous) mesothelioma
What mesothelioma isMesothelioma is a type of cancer. It is a cancer of mesothelial cells. These cells cover the outer surface of most of our internal body organs, forming a lining that is sometimes called the mesothelium. So this is where this type of cancer gets its name. Mesothelioma cancer can develop in the tissues covering the
Lungs
Abdomen
The pleuraThe tissues lining (or covering) the lungs are called the pleura. There are two pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the two pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.Mesothelioma is most often diagnosed in the pleura. This is known as pleural mesothelioma. Because it is so close, pleural mesothelioma can also affect the sheet of tissue covering the heart - the pericardium. Doctors call the pericardium the lining, although it is on the outside of the heart. It protects the heart and allows it to move smoothly within the sac that surrounds it. So it does much the same job for the heart as the pleura do for the lungs.

The peritoneumThe tissue lining the abdomen is called the peritoneum. It helps to protect the contents of the abdomen. It also produces a lubricating fluid. This helps the organs to move smoothly inside the abdomen as we move around.Mesothelioma of the tissues lining the abdominal cavity is known as peritoneal mesothelioma. It is much less common than pleural mesothelioma.It is unusual for mesothelioma to spread to other parts of the body. But if it does, it does not usually cause troublesome symptoms.
Benign mesotheliomaThere is a form of non cancerous (benign) mesothelioma that can develop in the lining of the lungs, or in the lining of the reproductive organs. It can occur in either men or women. These non cancerous tumours are very rare and we don't cover them in this section of CancerHelp UK.

Mesothelioma risks and causes
Mesothelioma is quite a rare cancer but it is becoming more common. Just over 2,100 people were diagnosed with mesothelioma in the UK in 2003. There are about 4 times as many cases in men as in women. This is probably because many cases have been caused by exposure to asbestos at work. Pleural mesothelioma is much more common than peritoneal mesothelioma. This page is about the risk factors and possible causes of mesothelioma. You can scroll down the page to read all the information here. Or you can use these links to go straight to sections on
Asbestos and mesothelioma
What is asbestos?
How does asbestos cause mesothelioma?
Radiation
Other chemicals
A virus called SV40
Asbestos and mesotheliomaUnusually for cancer, we do know what causes the majority of cases of mesothelioma. It is most often linked to exposure to asbestos. We have known of a link between asbestos and lung disease since the beginning of the 18th century. But the link with mesothelioma has only been known since the 1960's. Unfortunately, the number of cases of mesothelioma in the UK each year is expected to rise sharply over the next 20 years because of the heavy use of asbestos in industry from the end of the second world war up until the mid 1970s.Between 7 and 8 out of every 10 people (70–80%) diagnosed with mesothelioma say they have been in contact with asbestos. Your risk is greater if you were exposed to large amounts of it from an early age for a very long period of time. But there are some patients that say they have no history of any heavy exposure to asbestos.Remember: Many people who develop mesothelioma due to asbestos exposure may be eligible for compensation. You should talk to a solicitor about this as early as possible. Your specialist doctor or nurse may be able to give you some information on this from their dealings with other mesothelioma patients. Or some of the mesothelioma organisations in Help and Support should be able to help.
What is asbestos?Asbestos is an insulating material that is heat and fire resistant. In the past, asbestos was used widely in the
Building industry
Ship building industry
Manufacture of household appliances
Motor industry
Power stations
Telephone exchangesSo most cases of mesothelioma occur in men who have worked in manufacturing using asbestos or used asbestos products, particularly in construction or engineering. The use of asbestos was very heavy in the years after the war (after 1945). Mesothelioma may not develop until 15 - 40 years after you have been exposed to asbestos, which is why we are seeing an increase in cases now. The number of cases is expected to peak around 2020 and then start to decline.There are three main types of asbestos: blue, brown and white. Blue and brown asbestos are strongly linked with mesothelioma. They have been banned since the late 1980's and cannot be imported into the UK. White asbestos is now also thought to be harmful. The use of all asbestos was banned in 1999 in the UK.
How does asbestos cause mesothelioma?Asbestos is made up of tiny fibres. You can breathe these fibres in when you come into contact with asbestos. The fibres work their way into the pleura, lining the lung. They irritate the pleura and damage the cells that the pleura are made of. Some of the fibres that have been breathed in can be coughed up and swallowed. This is probably the cause of peritoneal mesothelioma.If you have been exposed to asbestos, your family may also have been exposed. Asbestos fibres can be carried home on your clothes. Research studies have confirmed that the family of people exposed to asbestos also have a higher risk of developing mesothelioma.
Radiation Pleural and peritoneal mesothelioma has been known to develop after exposure to a type of radiation called thorium dioxide (Thorotast). This was used until the 1950's in some X-ray tests.
Other chemicalsA mineral found in Turkey called Zeolite may cause mesothelioma.
The SV40 virusThere has been some research into a virus called SV40 (the SV stands for 'simian virus'). There is a lot of dispute amongst scientists about this and it isn't generally accepted as a cause. It seems more likely that the virus doesn't cause mesothelioma. It is possible that SV40 may help to increase risk if you've been exposed to another more major risk factor. Doctors call this a 'co-factor'. But SV40 certainly hasn't been proved to be a co-factor so far. In any case, it is far less important a risk factor than asbestos.

Screening for mesothelioma
Screening means testing people for early stages of a disease before they have any symptoms. There is no screening programme for mesothelioma in the UK. Before screening for any type of cancer can be carried out, doctors must have an accurate test to use. The test must be reliable in picking up cancers that are there. And it must not give a positive result in people who do not have cancer. If screening were to be introduced for mesothelioma, the test would have to be simple, quick and not too expensive. Diagnosing mesothelioma can be difficult. The usual tests for lung diseases often appear to be negative with mesothelioma. As only about 2,000 cases are diagnosed each year, it is not sensible to screen everyone in the country for such a rare disease. It would be more cost effective to screen people who are thought to be at a higher risk of mesothelioma. But to do that, we have to be able to identify all those who are at higher risk. If you think you have been exposed to asbestos in the past, talk to your doctor.

The stages of mesothelioma:
Pleural mesothelioma stagesThere are two main staging systems in use for pleural mesothelioma. These are called the International Mesothelioma Interest Group (IMIG) system and the Brigham system. In the UK, the system that is mostly commonly used is the IMIG system. Specialists generally don't use the Brigham system any more, but we've left it in here for now in case your own doctor refers to it.
The IMIG systemThis is based on the TNM staging system. The TNM system is the staging system most commonly used in cancer staging generally. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M). Once the TNM categories have been decided, this information is grouped together to give the stage. Stage 1 is the earliest stage and stage 4 is the most advanced stage.
Stage 1a mesothelioma affects the outer layer of the pleura around the chest wall, on one side of the chest only. It may have grown in the pleural tissue covering the diaphragm
Stage 1b mesothelioma has started to spread to the inner pleural layer (closest to the lungs), but remains on one side of the chest.
Stage 2 mesothelioma has spread to both layers of the pleura on one side of the body, and has enlarged to form a tumour mass on the pleural tissue around the lungs, or has started to spread into the diaphragm muscle or the lung tissue
Stage 3 mesothelioma has spread to the chest wall or the covering of the heart (pericardium), but is still potentially removable by surgery. Or it has spread to the lymph nodes on the same side of the chest
Stage 4 mesothelioma cannot be removed by surgery because it has spread to different parts of the chest wall, or grown through the diaphragm into the peritoneum, or to the pleura on the other side of the body, or to the chest organs, or through to the inner layer of the pericardium. Or it has spread to the lymph nodes on the other side of the chest, or above the collarbone. Or has spread to other parts of the body.
The Brigham staging systemThis is based on whether the mesothelioma can be removed by surgery and whether the lymph nodes are involved or not. Again there are four stages, which are similar to the TNM system.
Stage 1 mesothelioma can be removed with surgery and there are no lymph nodes containing cancer cells
Stage 2 mesothelioma can be removed with surgery but there are lymph nodes containing cancer cells
Stage 3 mesothelioma cannot be removed with surgery because it has spread into the chest wall, heart, or through the diaphragm into the peritoneum. There may or may not be lymph nodes containing cancer cells
Stage 4 mesothelioma has spread via the bloodstream to other organs in the body such as the liver, brain or bone
Peritoneal mesothelioma stagesThere is no established staging system for peritoneal mesothelioma. If your cancer is staged it may be done according to the TNM system. The TNM system is the staging system most commonly used in cancer. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).

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Questions for your doctor about living with mesothelioma:

How long will it take me to get over my treatment?
What precautions will I have to take while I am recovering?
What practical help is available?
Can I go back to work?
Can I take up my usual hobbies and sports again?
Can I go abroad on holiday?
Can I drink alcohol?
My partner and I would like to see a counsellor. Can you put us in touch with someone? How much will this cost?
Can you help me with claiming compensation for my illness from my former employers?Note: To print these questions, go to our printer friendly version using this link or the link at the top of the page. Then use the PRINT button at the top of your browser screen. If there is no PRINT button, there is advice on how to print on CancerHelp UK.

Living with advanced cancer
Finding out that you have advanced cancer when you are diagnosed, or that your cancer has come back can be devastating. You probably feel confused and find it difficult to take anything in that is being said to you. At first, you are likely to experience a whirl of powerful emotions. Anger, fear, and sadness may come one on top of the other, leaving you exhausted. You may think you should be talking all this through with your partner, other family members or close friends. But you may find this impossible to do.Give yourself time to begin to come to terms with what you have been told. You will benefit from talking to others about how you are feeling. But not necessarily straight away. Some people need to begin to put their own thoughts in order before they can talk to anyone else. Some feel they need to talk straight away. Trying to talk things through helps them sort out their own thoughts and feelings. There is no right or wrong way to handle this.

What does advanced cancer mean? Having advanced cancer means your cancer cannot be cured. But it very rarely means you are immediately terminally ill. There are treatments available that can slow your cancer down. It may be possible to shrink it and put it into remission for quite a while. You will need to talk very carefully to your own specialist to understand
What the diagnosis means
What treatment is available
How treatment can help youYou are likely to feel very anxious and uncertain about the future. And there will be days when the cancer is the only thing you can think about. But many people say that a diagnosis of advanced cancer helps them appreciate ordinary everyday things much more than they did. You have an opportunity to work out your priorities. Think about what is important to you and what isn't. There may be things you had always wanted to do. Having cancer doesn't mean you have to abandon all your plans. You may have to adapt some and one or two may be less realistic than they were. But you may also feel it is time to get round to something you'd always wanted to do but never made the time for.
Coping with every day life It is important that you feel as well as you possibly can. If you haven't already been referred, ask your hospital doctor or GP about a Macmillan nurse. Macmillan nurses can help control your cancer symptoms and improve the quality of your life physically. Many have counselling training and can help you work through some of the emotions you are experiencing.If you are having any physical difficulties in coping at home your Macmillan nurse or a district nurse can talk to you about ways you may cope more easily. They can help you to get simple mobility aids, for example a seat to help you get in and out of the bath. And tell you how to get more permanent adaptations such as safety rails fitted in your bathroom. Macmillan nurses have information about charitable funds who can provide grants for mobility aids, heating costs, help with holidays and many other household expenses related to your illness or quality of life. They also have information on benefits available to you or to someone helping to care for you.If you are having problems with breathlessness there is information on coping with this in the living with lung cancer section of CancerHelp UK. Knowing what to expect can help to alleviate anxiety. Talk to your doctor or nurse about your illness and treatment. It is important that you know all the options. There are organisations that can provide information about cancer and treatment. Or put you in touch with cancer support groups where you can talk to others who have been through similar experiences to your own.If you would like to talk to someone outside your own friends and family, look in our help and support section for counselling organisations.