It can take decades for someone who was exposed to asbestos to develop mesothelioma symptoms. Doctors call this the latency period, or the time between the patients initial exposure to asbestos and the occurrence of mesothelioma. The standard latency period for mesothelioma is 20 to 50 years, but it can range from 10 to 60 years or even longer.

Additionally, mesothelioma is often mistaken for other, less severe illnesses with similar symptoms, like the common cold. It can also be confused forother serious conditions, such as heart disease or ovarian cancer.

Due to its long latency period, the slow onset of symptoms, and the fact that it is easily mistaken for other diseases, mesothelioma is often not diagnosed until it has progressed to stage 3 or stage 4. Unfortunately, a late-stage diagnosis can negatively affect prognosis and treatment options.

The earlier you are diagnosed, the more treatment options are available to you, which can significantly extend your life expectancy and improve your quality of life.

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The three main most common sites of mesotheliomaare the pleura, the peritoneum, and the pericardium. The site of mesothelioma will influence the type of symptoms patients may experience.

Pleural mesothelioma is the most common form of mesothelioma, accounting for approximately 80 percent of all cases. It affects the lining of the lungs and chest, called the pleura. The chest pain and respiratory symptoms of pleural mesothelioma are associated with the growth and spread of the primary tumor as it develops and hardens into a sheath-like formation across the pleura. Symptoms can also be a result of fluidbuildup around the lungs, known as pleural effusion.

The symptoms of pleural mesothelioma often mirror those of other respiratory ailments, such as:

Peritoneal mesothelioma accounts for approximately 20 percent of all mesothelioma cases and affects the lining of the abdomen. The abdominal symptoms of peritoneal mesothelioma are associated with the growth and spread of the primary tumor throughout the abdomen. In some later-stage patients the buildup of fluid in the abdomen also known as ascites.

The symptoms of peritoneal mesothelioma can be mistaken for other conditions, such as:

Pericardial mesothelioma accounts for less than 5 percent of mesothelioma cases and affects the lining of the heart. The initial symptoms of pericardial mesothelioma are associated with the growth and spread of the primary tumor around the heart. Respiratory symptoms such as shortness of breath and dry cough occur in later-stage patients as the cancer spreads throughout the chest cavity and into the pleura.

The symptoms of pericardial mesothelioma can be confused for other cardiac issues, such as:

In addition to the type of mesothelioma, the stage can also significantly affect which symptoms are present. Patients with early-stage mesothelioma stages 1 and 2 may exhibit few symptoms, if any. At this point, the disease is still localized and there is minimal spreading to the lymph nodes or nearby organs. If symptoms are present, they will likely be mild and can be easily mistaken for other diseases. Specific symptoms depend on the type of mesothelioma. But in general, stage 1 and 2 mesothelioma symptoms may include a dry cough, chest or stomach pain, shortness of breath (dyspnea), fever, body aches, fatigue, and weight loss.

As the mesothelioma advances to stages 3 and 4, symptoms will become more apparent and more acute as the tumors spread to other organs, lymph nodes, and blood vessels. Stage 3 and 4 mesothelioma symptoms may include persistent dry cough or coughing up blood (hemoptysis), more severe chest or stomach pain, shortness of breath, fever, night sweats, body aches, fatigue, weight loss, anemia, blood clots, and fluid buildup around the affected organ(s).

Patients with advanced pleural mesothelioma may have difficulty speaking or swallowing (dysphagia), while those with peritoneal mesothelioma may experience nausea, vomiting, hernia, bowel issues, or seizures. Late-stage pericardial mesothelioma can cause heart complications, such as arrhythmia or heart palpitations. Unfortunately, due to the rarity of pericardial mesothelioma, it is usually diagnosed only after the patient has died.

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If the cancer metastasizes, spreading beyond the original tumor site to other parts of the body, the patient may experience additional symptoms in those areas of the body. For instance, peritoneal mesothelioma often spreads to other abdominal organs, such as the liver, kidneys, spleen, appendix, and pancreas. This can prompt new symptoms not necessarily associated with peritoneal mesothelioma that hasnt metastasized.

Although mesothelioma symptoms usually appear gradually over months or years, the type of asbestos the patient was exposed to can speed up the onset of symptoms. More hazardous forms of asbestos, such as crocidolite, can cause symptoms to present earlier and more acutely.

Patients who were continuously exposed to asbestos even small amounts in the workplace over a span of years may display symptoms sooner than usual. Similarly, patients who were exposed to a larger-than-average amount of asbestos all at once may experience an earlier onset of mesothelioma even if the exposure was short-lived.

For example, the original World Trade Center in New York was built in the early 1970s. Asbestos was used in the steel support beams, walls, insulation, and other fireproofing materials. After the towers collapsed during the terrorist attack on Sept. 11, 2001, hundreds of tons of asbestos fibers were released into the air. First responders, such as paramedics, firefighters, and police officers; search and rescue crews; and those tasked with cleaning up the site, were exposed to extremely large amounts of asbestos both on the day of the attack and in the days, weeks, and months after. In 2004 just three years after asbestos exposure at Ground Zero a 9/11 first responder died of mesothelioma. Another died in 2006, demonstrating a significantly shortened latency period compared to the average mesothelioma patient.

The symptoms of mesothelioma can range from uncomfortable, to painful, to life-threatening. However, there are things you and your doctors can do to relieve pain and mitigate these symptoms.

After you have been diagnosed with the type and stage of your mesothelioma, you and your doctor will determine a customized course of treatment, often involving a combination of surgery, chemotherapy, radiation, and other treatments, such as immunotherapy.

Your treatment will likely address many of your mesothelioma symptoms by attacking the root cause: the cancer itself. But there are also steps and procedures that can help alleviate many of the symptoms apart from or in addition to potentially curative treatment.

Your doctor may recommend steroids for you during the course of the disease to treat symptoms or prevent complications. Many mesothelioma patients experience fatigue, weakness, loss of appetite, and weight loss, both as symptoms of the disease itself and as side effects of treatment. Steroids can help increase energy and appetite, helping patients maintain active lives before, during, and after treatment. Steroids can also be effective to reduce inflammation, especially after surgery or reduce the risk of side effects of chemotherapy treatment.

Your doctor may recommend over-the-counter pain medicine, such as acetaminophen or ibuprofen, for mild symptom relief. They may prescribe stronger pain relievers, such as morphine, hydrocodone, oxycodone, or fentanyl to address worsening symptoms if necessary. Nerve blocks may also be used to target pain in specific areas of the body. Certain antidepressant medications can also be used for certain types of pain related to mesothelioma. Some patients may get referred to pain specialists to manage their pain.

Although lifestyle factors like diet, exercise, weight management, and adequate sleep cannot cure mesothelioma, they can help you stay healthy during treatment and positively influence your prognosis. On the other hand, smoking can worsen symptoms (especially respiratory problems) and has been shown to decrease life expectancy for mesothelioma patients. The American Cancer Society also recommends that cancer patients get an annual flu shot, as mesothelioma and the methods used to treat it can weaken the immune system. This can put mesothelioma patients at a higher risk of contracting and developing complications from the flu virus. However, its important to talk with your mesothelioma specialist before getting a flu shot to ensure that it will not interfere with your current course of treatment.

Patients also have to deal with the mental and emotional ramifications of their diagnosis, in addition to the physical symptoms. Talk to your doctor about methods for reducing stress (meditation, yoga, counseling, etc.), or consider speaking with a mental health care provider or spiritual counselor. In some cases, your doctor may prescribe antidepressants for stress or depression. Certain antidepressant medications may also be used for certain types of pain related to mesothelioma.

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Muaiad Kittaneh, MD, FACP, MBA, is a hematology and oncology professor at Loyola University Medical Center on the Palos Health South Campus in Illinois. He specializes in treating patients with mesothelioma, as well as lung, breast, kidney, and gastrointestinal cancers. Dr. Kittaneh plays the role of both clinician and researcher, focusing on cancer genomics and immunotherapy. He is currently studying the BAP1 gene mutation, which is found in nearly 70% of patients who develop mesothelioma, and could play a role in the prevention and treatment of this rare cancer.

Sources

American Cancer Society. (2018). Signs and Symptoms of Mesothelioma. Retrieved on July 25th, 2019, from https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/signs-symptoms.html

American Lung Association. (2019). Mesothelioma Symptoms, Causes, and Risk Factors. Retrieved on September 18th, 2019 from https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/mesothelioma/mesothelioma-symptoms-causes-risks.html

ASCO Journals. (2019). Mesothelioma: Symptoms and Signs. September 18th, 2019 from https://www.cancer.net/cancer-types/mesothelioma/symptoms-and-signs

Mayo Clinic. (2019) Mesothelioma. Retrieved on September 18th, 2019 from https://www.mayoclinic.org/diseases-conditions/mesothelioma/symptoms-causes/syc-20375022

Shavelle, Robert. (2017). Life Expectancy in Pleural and Peritoneal Mesothelioma. Retrieved on July 25th, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292397/#B2

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