The use of products containing asbestos was banned in the UK in 1999. But it’s still found today in many buildings, including homes, schools and hospitals. There are now strict guidelines about removing asbestos safely. Mesothelioma takes a long time to develop. It’s normal for people to get the first symptoms 30 to 40 years after they were first exposed to asbestos. So people who have symptoms now might have been exposed many years ago. People who worked in industries which used asbestos are at higher risk of developing mesothelioma. They include: carpenters and joiners plumbers, heating and ventilation engineers electricians, electrical fitters pipe fitters metal plate workers, shipwrights, riveters labourers in other construction trades sheet metal workers construction operatives energy plant operatives painters and decorators building inspectors vehicle body builders and repairers metalworking production and maintenance fitters shipbuilding workers railway engineering workers people who have worked on DIY projects, particularly Artexing ceilings or working with guttering or insulation materials You can also develop mesothelioma if you lived with someone who worked with asbestos. They may have carried asbestos fibres home on their clothing, where family members could breathe them in. Some people who develop mesothelioma can’t remember coming into contact with asbestos and might not have been aware they were exposed to it. Older people have a higher risk of mesothelioma than younger people. This is partly because it takes so many years for mesothelioma to develop, but also because they are more likely to have come into contact with asbestos before the dangers were known. Mesothelioma is much less common in women, probably because they are less likely to have worked directly with asbestos.
What are the symptoms of mesothelioma?
The symptoms of mesothelioma only show up 30 to 40 years after a person came into contact with asbestos. The condition is slow to appear and then quick to progress. The main symptoms are: feeling out of breath coughing chest pain As mesothelioma develops, it often causes fluid to build up in your pleural space. This is called a pleural effusion. This build-up of fluid squashes your lung, so it can’t expand fully as you breathe. This makes you feel out of breath. Tumours growing around your lung can also stop your lung expanding properly. Mesothelioma usually starts in the outer pleural membrane that lines the inside of your chest wall and ribs. The tumour often causes pain in your chest as it grows into your chest wall. It sometimes spreads outside your chest to other organs of your body, but it’s unusual for this spread to cause symptoms. You might experience other symptoms such as fatigue (feeling tired), loss of appetite and weight loss. Symptoms tend to develop gradually over weeks or months. Some patients put up with the symptoms until they’re really struggling with breathing, and then have to be admitted to hospital urgently for treatment.
Getting a Diagnosis
You should see a GP immediately if you have a cough that lasts for longer than two weeks, or experience any abdominal or chest discomfort for two weeks or more. This is especially the case if you know you’ve worked with asbestos in the past. It’s unlikely that you’ll have mesothelioma as it’s a relatively rare condition – but it’s important to receive formal diagnosis as swiftly as possible.
Seeing your GP:
When you see your doctor, make sure you let them know that you’ve been exposed to asbestos in the past. Depending on your symptoms, you’ll then be referred for a variety of medical tests to ascertain whether or not you have mesothelioma.
Testing for pleural mesothelioma:
Initially, you’ll probably be referred for a chest x-ray, to identify any thickening in the lining around your lungs. The radiologist will also look for any evidence of fluid build-up – another tell-tale sign of mesothelioma.
If the x-ray suggests that mesothelioma might be present, the next step is to have a CT scan. This is a completely painless procedure and enables the doctor to generate a 3D x-ray image of your lungs, in order to perform a better diagnosis.
Further testing:
If your doctor suspects that you may have pleural mesothelioma, it’s likely that they’ll want to drain some of the fluid from the pleura. This process is called pleural aspiration. You’ll be given local anaesthetic, then a needle will be inserted to remove a sample of the fluid for testing.
You may also be required to have a biopsy, where cells are removed from the affected area and tested. A biopsy enables your doctor to provide a more conclusive diagnosis. These cells can be gathered in a variety of ways:
- CT-guided biopsy. Using local anaesthetic, your doctor will pass a needle into the affected area, using a CT scanner to guide them.
- In another procedure, a small incision is made in the chest, and a thin tube inserted into the affected area. The doctor can then use a camera to observe the lungs, and to remove cells for testing. You’ll either be given a general or local anaesthetic for this procedure.
- Generally, you’ll only have a mediastinoscopy if your doctor believes the mesothelioma has spread to your lymph nodes. In this instance, the small incision is made at the base of the neck instead.
Occasionally, even after examining the cells taken at the biopsy, your doctor still won’t definitely know whether or not you have mesothelioma. This is because so many other illnesses are similar in nature to the condition. If this is the case, the biopsy sample will probably be sent to an alternative laboratory for a second opinion and you may need to have some of the tests repeated.
Testing for Peritoneal Mesothelioma:
Initially, the first stages of testing will be the same. Your doctor will book you in for an abdominal x-ray, to see whether or not there’s any evidence of cancerous cells or build-up of fluid. You’re likely to also have a CT scan of the area.
Further testing:
As with pleural mesothelioma, the next stage is to drain fluid from the abdomen for testing. This is called peritoneal aspiration. A local anaesthetic will be administered, then a needle passed through the skin to collect the fluid.
You may also require a biopsy. For peritoneal mesothelioma, the following biopsy techniques are used:
- Laparoscopy: You’ll be given a general or local anaesthetic, then your doctor will make a small incision in your stomach. They’ll then put a tube into your abdomen, to examine the area and remove a small sample of tissue.
- CT-guided biopsy – as with pleural mesothelioma, your doctor will insert a needle into your abdomen to gather the tissue, using CT imaging to guide the process.
When to Expect Results?
Results may take anything from a couple of days to a few weeks to arrive – depending on the procedure used for testing. Once your results are in, your doctor will ask you to come to the surgery or hospital to discuss things further.
Treatment and Rehabilitation
Staging:
The treatment you’ll be offered depends largely on the severity of your condition. As with any form of cancer, mesothelioma is staged – and each stage describes its size, plus whether it’s spread to any other parts of the body. Here’s a brief guide to each stage:
- Stage 1 – Cancerous cells are small and haven’t spread to any other part of the body. This is sometimes called early stage, or localised cancer.
- Stage 2 – Cancerous cells have started to spread regionally within the region, but not significantly to other parts of the body.
- Stage 3 – Evidence of more spreading within the body, but still regional to the area where the cancer started.
- Stage 4 – At this stage, the cancerous cells have spread significantly throughout the body. This is sometimes referred to as ‘distant spread’.
Treatment:
As with any form of cancer, there are three principal treatment options – surgery, radiotherapy and chemotherapy.
- Surgery – Surgery can be useful for removing the bulk of the cancerous cells and controlling symptoms. Not all hospitals will offer this type of treatment and it’s only suitable for certain people.
- Radiotherapy – Radiotherapy uses high levels of radiation to kill the cancerous cells. It cannot eradicate mesothelioma, but can reduce the size of the cells to improve quality of life.
- Chemotherapy – Chemotherapy uses anti-cancer drugs to kill the cancerous cells. Like radiotherapy, it cannot get rid of mesothelioma entirely, but can reduce the cancerous cells, which will make life more comfortable for the patient.
Rehabilitation:
There are a variety of techniques you can use after treatment to improve your symptoms. These include:
- Breathing techniques – Your doctor will demonstrate breathing techniques to help combat breathlessness, plus you may be offered oxygen at home, or medication to help with the problem, such as a low dose of morphine.
- Fluid drainage – A build-up of fluid on the lungs or abdomen can cause discomfort. A pleural effusion, which is a procedure undertaken at the hospital, drains the fluid, then if possible, the area is sealed to reduce fluid build-up in the future. Alternatively, the doctor may decide that you’d benefit more from a pleural catheter, which you can use to drain the fluid from home. In the case of peritoneal mesothelioma, a tablet called spironolactone is sometimes given – which is a diuretic designed to increase urination and reduce fluid on the abdomen.
- Pain relief medication – If you experience pain, your doctor will prescribe medication to make life more comfortable. This might include paracetamol, codeine, morphine, ibuprofen, diclofenac or gabapentin.
- Complementary therapies – Many hospitals offer complementary therapies to mesothelioma patients, which include acupuncture, relaxation techniques and aromatherapy. These can help combat some of the symptoms associated with the disease – such as fatigue, discomfort and depression.
Prognosis for Mesothelioma
Your prognosis will depend largely on how advanced the condition is. Regrettably, by the time symptoms become apparent, the disease is often in its more advanced stages; and as a result, the outlook might not be good. Generally speaking, pleural mesothelioma is easier to treat and offers better prognosis.
Mesothelioma cannot be cured, but cancerous cells can be reduced through treatment, depending on the stage of the disease. There’s a lot that can be done to improve quality of life after diagnosis – and you’ll be assigned a specialist team to assist you with this. You’re also entitled to benefits and a government compensation sum – which is currently capped at £123,000. Alternatively, you may want to file a legal claim against your former employer if you were exposed to asbestos in the workplace.
There are also a number of support groups in operation throughout the UK. You can find out more here.
The Future?
As increasing numbers of people are being diagnosed with mesothelioma, it’s becoming ever more important to understand the disease better – and to seek a cure. After your diagnosis, it’s possible that you’ll be asked to take part in a clinical trial, which will help doctors to develop new treatments for future patients.
Of course, you don’t have to take part in these trials if you don’t wish to – and your decision will be respected.
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