Symptoms of Mesothelioma

Presenting symptoms of pleural mesothelioma can be as nondescript as a chest pain, slight fatigue, or a shortness of breath during physical activity. Symptoms often mirror signs of less serious respiratory issues and are hardly unusual for a senior.

Pleural mesothelioma cancer may take decades to develop after exposure to asbestos, but it attacks quickly once taking hold. The microscopic asbestos fibers that are inhaled can lodge in the thin lining around the lungs and trigger physiological cellular changes that lead to this rare but aggressive cancer.

Many people with pleural mesothelioma are unaware of their own condition for months or even years because initial symptoms are often mistaken for less threatening illnesses. Any history of asbestos exposure, or even suspected asbestos exposure, should be discussed with a physician, who can refer a patient to a specialist right away. An early diagnosis is critical to survival because it can lead to more effective therapy options.

Symptoms Can Be Confusing

Most symptoms of pleural mesothelioma involve the respiratory system and often are misdiagnosed because most medical professionals rarely see this disease. It’s estimated that more than 2,000 people in the United States are diagnosed annually with this cancer. By comparison, an estimated 150,000 Americans are diagnosed with lung cancer each year.

Initial symptoms of pleural mesothelioma often are confused with pneumonia or asthma or another respiratory ailment. Even a specialist will need considerable time — in addition to results of various, complex tests — to provide a definitive diagnosis.

According to a 2011 study of 221 pleural mesothelioma patients, many reported similar symptoms in the early stages, often before it was diagnosed.

They included:
  • 79 percent experienced shortness of breath
  • 64 percent suffered chest pain
  • 36 percent had a chronic cough
  • 90 percent presented with pleural effusions (excess fluid around lungs)
  • 30 percent experienced significant weight loss

If any of these symptoms appear, and there is a history of asbestos exposure, it is important to see a specialist.

Many patients diagnosed in stage I have no symptoms and the cancer is accidentally detected through routine X-ray or other tests. In this early stage, the tumor burden is relatively minimal and may not cause any noticeable symptoms. The two most common presenting symptoms of pleural mesothelioma are shortness of breath and chest pain. These symptoms usually develop as a result of pleural effusion or tumors pressing against the lung and chest wall, which can happen in in stages I through III.

In stage II, as tumors spread beyond the pleural lung lining and into the lung and diaphragm, pain may increase and may be felt in the shoulder or upper abdomen in addition to the chest. Difficulty breathing and coughing may arise or worse at this stage.

During stage III, tumors spread more thoroughly throughout the chest, placing pressure on the lungs and chest wall. These physical changes can lead to an increase in pain and difficulty breathing, dry cough, tightness in the chest, fatigue and weight loss.

By stage IV, tumors have spread throughout the chest and rarely spread to distant locations. The degree of tumor burden in the chest can severely worsen pulmonary symptoms like shortness of breath. Others symptoms may include lumps of tissue under the skin on the chest, pain in the lower back, fever and night sweats. Some patients experience a hoarse voice and difficulty swallowing. At this stage, patients often need help breathing and require continuous oxygen.

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Recognizing Symptoms

Because a pleural mesothelioma diagnosis is often not made until after the cancer has spread, the prognosis can be grim. The process of recognizing the symptoms and turning them into a definitive diagnosis so treatment can begin usually involves multiple procedures with different medical professionals and often takes several months.

During the diagnostic process, a patient may see a pulmonologist, a radiologist, a pathologist and a surgeon, as well as an oncologist and a primary care physician. Patients might also then opt for a second opinion. Early symptoms could lead to imaging tests that include X-rays, an MRI, CT scans and PET scans. If one of the scans reveals an irregularity, a biopsy is needed to confirm the presence of mesothelioma. Although it can take 10 to 50 years after exposure to asbestos before cancer develops and symptoms appear, the survival time after symptoms are diagnosed can be short. The majority of patients are given a prognosis of six to 18 months to live.

Early diagnostic methods, more awareness and improved treatments have allowed some patients to live well beyond their initial prognosis. The most important thing is to find a specialist who understands the disease and understands all the intricacies and treatment options.

"It's important to have someone who is comfortable with the disease," said Hedy Kindler, M.D., director of the mesothelioma program at the University of Chicago Medical Center. "You need a quarterback who understands all the options."

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