What is Mesothelioma?

Mesothelioma kills over 2,500 people each year. It is a type of cancer that occurs in the lining of some organs, most often in the lungs. It is strongly linked to asbestos exposure. Asbestos was widely used in many different types of construction materials for several decades until its use was outlawed in 1999.

What is mesothelioma?

Mesothelioma is a form of cancer.

It is also sometimes called:

• Diffuse Mesothelioma.
• Malignant Mesothelioma.

It grows within the thin membrane around some of the organs in the body. This membrane is known as the mesothelium.

The mesothelium membrane lines the inner surface of several organs; these include:

• Chest wall (referred to as the pleura).
• Abdomen (referred to as the peritoneum).
• Testicles.

The mesothelium is also found around organs that are located within these areas of the body, for example the heart, lungs and intestines.

Mesothelioma most commonly affects the lining of the lungs (pleura) – this is called pleural mesothelioma – although it can affect the heart or abdomen area. When found in the abdomen area it is called peritoneal mesothelioma.

There are around 12 cases of pleural mesothelioma to every 1 case of peritoneal mesothelioma in the UK.

What causes mesothelioma?

The main cause of mesothelioma is exposure to asbestos. This is a naturally occurring material that contains tiny fibres that once inhaled or swallowed, pose a serious risk to our health. The microscopic fibres and particles can get stuck in our lungs or digestive area where they cause changes and damage over time.

Once considered a miracle material within manufacturing and construction, asbestos is now categorised as a category 1 carcinogen. This is because asbestos dust can be deadly. Routinely used in many different types of building (including domestic, commercial, vehicle, ship and railway) from the 1950s to the late 1990s, it is no surprise that asbestos can still be found in many places today.

Therefore, it is important that:

• We know where asbestos is located.
• Asbestos is not disturbed.
• If building or maintenance work is needed around asbestos this is done safely.
• Risks are managed and mitigated.
• The health of workers and the general public is protected so that no one comes to harm due to the presence of asbestos.
• Asbestos is no longer used in any new construction projects – it is dangerous and illegal.
• Research into managing and treating those with asbestos-related diseases continues.
• Employers take direct responsibility for the health of their workforce.

There are three main types of asbestos:

• Blue (crocidolite).
• Brown (amosite).
• White (chrysotile).

Exposure to all three types of asbestos is hazardous and has been linked to mesothelioma. None of the three types of asbestos can be used, sold or imported into the UK.

Asbestos can still be found in many different products which were made prior to the ban, such as ceiling tiles, pipes, sprayed coatings, metal sheets and insulation.

How to prevent mesothelioma

The use of asbestos is no longer permitted due to the significant health risks associated with it. Working with existing asbestos materials is also heavily regulated.

Although asbestos is no longer used, it can still be found, especially in old buildings. It poses a risk once it is disturbed or damaged. Those that work in the building trade, including maintenance, demolition or construction, are most likely to come into contact with it.

Asbestos is highly dangerous once disturbed.

It is absolutely vital that all risks relating to working around, or removing, asbestos are managed competently:

• Always ensure an asbestos risk assessment is conducted by a qualified and competent person.
• Once asbestos has been identified and risk assessed, a written plan for any subsequent work in the area has to be prepared.
• Anyone who is at risk must be fully trained and understand what to look for and how to work safely.
• Asbestos removal should only be undertaken by trained professionals with the correct equipment and PPE such as a mask with a P3 filter.
• Employers of those who are doing ‘high risk’ work with asbestos (such as working with asbestos coating or insulation) have to be licensed by the Health and Safety Executive (HSE).

The owners of commercial (and all non-domestic) buildings have a duty of care to manage asbestos. This means keeping a record of the presence and condition of any asbestos within the property. Managing asbestos correctly helps to keep workers and the public safe.

If you have concerns that asbestos may be present in your workplace, you should first speak to your employer.

They will have an asbestos management plan which will detail:

• The location of any asbestos in the building and its condition.
• Any control measures that are in place.
• How asbestos is being managed to ensure no one comes to any harm due to it being there.

If your employer does not have any plan in place or refuses to provide this information, you could consider contacting your union representative or the HSE.

Who is most at risk of developing mesothelioma?

Those most at risk are people who have been exposed to asbestos, especially to fine particles that they could have inhaled or swallowed.

• Males are more like to develop mesothelioma than females.
• Most cases of mesothelioma are in those aged 60 and over.
• Those over 75 years old make up almost half of the diagnosed cases.

Research into mesothelioma is still ongoing and scientists do not fully understand why some people develop this type of cancer after working around asbestos and some do not. It is also unclear why a very small number of cases are amongst people who have not been exposed to asbestos.

However, it is possible that these people were exposed via environmental factors such as:

• Family members from affected industries bringing dust particles home on their hair or clothes.
• Living in close proximity to asbestos factories without knowing.
• Working or residing in buildings and not realising maintenance or extension work caused asbestos to be disturbed.

It is also plausible that as the average time for pleural mesothelioma symptoms to become noticeable is 30–50 years after exposure, some people may have forgotten that they even lived or worked around asbestos.

Doctors and scientists are hopeful that the number of diagnosed cases in the UK will begin to go down in the future as the use of asbestos is now outlawed.

What are the signs and symptoms of mesothelioma?

The symptoms of mesothelioma usually show up gradually with a lot of cases being diagnosed 20+ years after asbestos exposure.

Symptoms of pleural mesothelioma (cancer in the lining of the lungs) include:

• Shortness of breath.
• Pain in the chest area.
• Persistent cough.
• Lack of appetite.
• Unexplained weight loss.
• Tiredness/fatigue.
• Fever and sweats (especially at night).
• Swollen fingertips.

Symptoms of peritoneal mesothelioma (cancer in the lining of the abdomen area) include:

• Swelling/bloating.
• Nausea or vomiting.
• Lack of appetite.
• Unexplained weight loss.
• Diarrhoea or constipation.

There are an array of other health problems including other types of cancer, as well as some less serious causes that can present similar symptoms. If you have concerns about your health, you should always speak to your GP and tell them about any potential asbestos exposure you have had or may have had in previous years or decades.

What are the risk factors for mesothelioma?

The main risk factor for mesothelioma is exposure to asbestos. It is a material that is most harmful when the small particles of asbestos fibres are breathed in. This means anyone who has been involved in high-risk activities with asbestos, where dust and powders have been created, is most likely to develop health problems.

This includes:

• Cutting materials containing asbestos.
• Breaking asbestos-containing materials.
• Sanding/drilling anything that has asbestos in.
• Being around asbestos materials that are disintegrating due to age/poor maintenance.

People who have been subject to long-term or repeated exposure are at a more significant risk than those who had single or short-term exposure.

According to HSE data, occupations that were most affected by asbestos exposure when it was allowed to be routinely used include:

• Metal plate workers.
• Vehicle builders.
• Plumbers/gas fitters.
• Construction workers.

The jobs were often associated with industries such as:

• Railway/carriage building.
• Shipbuilding.
• General construction.
• Oil refineries.
• Textiles.

The health and safety measures put in place to protect workers were not sufficient when asbestos was being used across many key industries. It was also not understood at the time just how deadly prolonged exposure could be and this has resulted in death and ill health for thousands of affected workers.

If you have been diagnosed with an asbestos-related disease, you may be entitled to financial support from a government scheme.

What is the diagnosis and treatment for mesothelioma?

Your GP will refer you for some tests if they are concerned that you may have mesothelioma. You will need to wait for an appointment and then attend the hospital for various diagnostic tests.

Which might include:

• A chest or abdominal x-ray.
• CT scan.
• Blood tests.
• Fluid analysis – If there is a build-up of fluid around the affected organ this can be drained using a needle and sent for analysis.
• Thoracoscopy or laparoscopy – This is where your insides are examined via a camera that is inserted into the body. This requires you to be sedated or anesthetised.
• Biopsy – Where a sample of tissue is removed and collected to analyse cell changes.

Treatment to help manage the condition is available but, unfortunately, it is rarely curable. Once you are diagnosed with mesothelioma, doctors will need to find out how far the cancer has spread to give you an accurate prognosis. You will also need to attend regular check-ups.

Because symptoms often present over time, once they are severe enough to be diagnosed it is often too late for life-saving treatment. However, palliative care is usually offered. This focuses on managing symptoms, prolonging life and keeping you comfortable and as pain-free as possible.

Treatments you might be offered for mesothelioma include:

• Chemotherapy – A common cancer treatment where medicine is used to try to shrink cancer cells.
• Radiotherapy – High-energy radiation is used to shrink cancer cells or slow down their rate of growth.
• Surgery – Removing cancerous cells.
• Fluid drainage – This can be done regularly at the hospital or by inserting a tube into the chest so fluid can be drained out as needed at home.
• Strong painkillers – Such as morphine.

The prognosis for those diagnosed with mesothelioma is not good. Once at the stage where it can be diagnosed it is almost always a life-limiting condition.

According to NHS figures:

• Approximately 50% of people with mesothelioma live for at least 1 year after their diagnosis.
• Approximately 10% of people with mesothelioma live for at least 5 years after their diagnosis.

Being diagnosed with cancer leaves you feeling not only physically unwell but can take a psychological and emotional toll on you and your family. Try to make use of any support that is out there for you including from friends and family, medical professionals, charities or within the community.

If you are caring for someone with mesothelioma:

• Reach out to your GP or nurse if you need extra support.
• Look after yourself as well – This means getting enough sleep, eating a balanced diet and staying active.
• If you need financial help you may be entitled to carer’s allowance and your loved one may be entitled to claim some form of compensation.

If you are concerned about any changes in your health, you should make an appointment to speak to your GP immediately. In an emergency situation, always dial 999.

For support and information about living with cancer, you can visit Macmillan Cancer Support which has a dedicated forum where those suffering from mesothelioma can share their experiences.

Anyone who doubts the need for health and safety to be taken seriously within the workplace only needs to look at the disastrous effects asbestos exposure has had on so many lives.

Since it has been illegal to use asbestos materials for over two decades, the number of people presenting with mesothelioma should begin declining in the future. However, it is a material that is still present today and effective risk management is always key to protect people from substances that are hazardous to health. If in any doubt, you can turn to the HSE for expert advice and assistance.