The tissue that lines your lungs, stomach, heart, and other organs is called mesothelium. Mesothelioma, also known as malignant mesothelioma, is cancer of that tissue. It usually starts in the lungs, but can also start in the abdomen or other organs.

Malignant mesothelioma is rare but serious. Most people who get it have worked on jobs where they inhaled asbestos particles. After being exposed to asbestos, it usually takes a long time for the disease to form.

Symptoms include

• Trouble breathing
• Pain under the rib cage
• Pain, swelling, or lumps in the abdomen
• Weight loss for no known reason

Sometimes it is hard to tell the difference between malignant mesothelioma and lung cancer. Your doctor uses imaging tests and a biopsy to make the diagnosis. Malignant mesothelioma is often found when it is advanced. This makes it harder to treat. Treatment may include surgery, radiation, chemotherapy, and/or targeted therapy. Targeted therapy uses drugs or other substances that attack specific cancer cells with less harm to normal cells.

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the lining of the chest or abdomen.

Malignant mesothelioma is a disease in which malignant (cancer) cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) or the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen). Malignant mesothelioma may also form in the heart or testicles, but this is rare.

Cancer is a disease in which cells in the body grow out of control. Mesothelioma is a cancer that forms in the thin tissue that lines many of your internal organs. This thin tissue is called the mesothelium.

The most common kind of mesothelioma forms in the tissue around the lungs, called the pleura. This is called pleural mesothelioma. But mesothelioma may also form in—

• The tissue in the abdomen, called the peritoneum.
• The tissue around the heart, called the pericardium.
• The tissue around the testicles, called the tunica vaginalis.

What Are the Symptoms of Mesothelioma?

Pleural mesothelioma can cause—

• Pain in your chest, under your rib cage.
• Coughing.
• Shortness of breath.
• Lumps under the skin on your chest.
• Tiredness.
• Weight loss you can’t explain.

Peritoneal mesothelioma can cause—

• A swollen abdomen.
• Pain in your abdomen.
• Nausea.
• Tiredness.
• Weight loss you can’t explain.

If you have any of these symptoms, talk to your doctor. They may be caused by something other than cancer. The only way to know what is causing them is to see your doctor.

How Is Mesothelioma Diagnosed?

It can be hard to tell the difference between mesothelioma and other cancers. You may need to have a physical exam and other tests, such as imaging tests (a chest X-ray or CT scan) or a biopsy (removing a small piece of tissue to look at under a microscope).

How Is Mesothelioma Treated?

Treatment depends on where the mesothelioma is located and whether it has spread to other parts of the body. Treatment may include surgery, chemotherapy, radiation therapy, immunotherapy, or targeted therapy.

• Surgery. An operation where doctors cut out cancer tissue.
• Chemotherapy. Special medicines that doctors use to shrink or kill the cancer. They can be pills you take or medicines given in your veins, or sometimes both.
• Radiation therapy. High-energy rays (similar to X-rays) that doctors use to kill the cancer.
• Immunotherapy. Special medicines that doctors use to help your body’s immune system fight the cancer.
• Targeted therapy. Drugs that doctors use to block the growth and spread of cancer cells. They can be pills you take or medicines given in your veins. You will get tests to see if targeted therapy is right for your cancer type before this treatment is used.

New treatments are tested in clinical trials. You may want to ask your doctor if taking part in a clinical trial would be right for you.

What Causes Mesothelioma?

Photo of an asbestos mineral called asbestiform riebeckite ore or crocidolite.

Exposure to asbestos causes most cases of mesothelioma. Asbestos is a group of minerals naturally found in rocks and soil that form long, thin, very strong fibers. Asbestos fibers do not evaporate or dissolve in water. They resist heat and fire and cannot be broken down easily by chemicals or bacteria.

Asbestos was used in many consumer products, automobile parts, and building materials in the 20th century, before scientists learned about its dangers to health. Asbestos is no longer mined in the United States, but it is imported from other countries to make some products. It is still present in some older homes and buildings.

Working with materials that contain asbestos can release tiny asbestos fibers, too small to see, into the air. Some workers and others who breathed in or swallowed asbestos fibers over many years have developed mesothelioma and other diseases. Not everyone who is exposed to asbestos will get mesothelioma or other cancers. If you are concerned, ask your doctor if you should get regular checkups or tests for asbestos-related diseases.

Risk factors for mesothelioma include—

• Being exposed to asbestos at work.
• Living with someone who works with asbestos.
• Living or working in a building where materials that contain asbestos have been disturbed.
• Living in an area with natural asbestos deposits or asbestos mines or factories.

Being exposed to asbestos can affect the risk of malignant mesothelioma.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk.

Most people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After being exposed to asbestos, it usually takes a long time for malignant mesothelioma to form. Living with a person who works near asbestos is also a risk factor for malignant mesothelioma.

Signs and symptoms of malignant mesothelioma include shortness of breath and pain under the rib cage.

Sometimes the cancer causes fluid to collect in the chest or in the abdomen. Signs and symptoms may be caused by the fluid, malignant mesothelioma, or other conditions. Check with your doctor if you have any of the following:

• Trouble breathing.
• Cough.
• Pain under the rib cage.
• Pain or swelling in the abdomen.
• Lumps in the abdomen.
• Constipation.
• Problems with blood clots (clots form when they shouldn’t).
• Weight loss for no known reason.
• Feeling very tired.

Tests that examine the inside of the chest and abdomen are used to diagnose malignant mesothelioma.

Sometimes it is hard to tell the difference between malignant mesothelioma in the chest and lung cancer.

The following tests and procedures may be used to diagnose malignant mesothelioma in the chest or peritoneum:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, and past illnesses and treatments will also be taken.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer.

  Procedures used to collect the cells or tissues include the following:

  • Fine-needle (FNA) aspiration biopsy of the lung: The removal of tissue or fluid using a thin needle. An imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid, and a sample is removed.

  • Thoracoscopy: An incision (cut) is made between two ribs and a thoracoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the chest.
  • Thoracotomy: An incision (cut) is made between two ribs to check inside the chest for signs of disease.
  • Peritoneoscopy: An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted into the abdomen.
  • Open biopsy: A procedure in which an incision (cut) is made through the skin to expose and remove tissues to check for signs of disease.

  The following tests may be done on the cells and tissue samples that are taken:

  • Cytologic exam: An exam of cells under a microscope to check for anything abnormal. For mesothelioma, fluid is taken from the chest or from the abdomen. A pathologist checks the fluid for signs of cancer.
  • Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
  • Electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under a high-powered microscope to look for certain changes in the cells. An electron microscope shows tiny details better than other types of microscopes.

After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know whether the cancer has spread in order to plan treatment.

The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. EUS may be used to guide fine-needle aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.

• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples to be checked under a microscope for signs of disease.
• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells.
• Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungs for abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if malignant mesothelioma spreads to the brain, the cancer cells in the brain are actually malignant mesothelioma cells. The disease is metastatic malignant mesothelioma, not brain cancer.

The following stages are used for malignant mesothelioma of the lung:

Stage I

Stage I is divided into stages IA and IB:

• In stage IA, cancer is found in the inside lining of the chest wall on one side of the chest. On the same side of the chest, cancer may also be found in one or more of the following:
  • The thin layer of tissue that covers the lung.
  • The thin layer of tissue that covers the organs between the lungs.
  • The thin layer of tissue that covers the top of the diaphragm.
• In stage IB, cancer is found in the inside lining of the chest wall, and in each of the thin layers of tissue that cover the lung, the organs between the lungs, and the top of the diaphragm on one side of the chest. On the same side of the chest, cancer has also spread into one or more of the following:
  • Diaphragm.
  • Lung tissue.
  • Tissue between the ribs and the inside lining of the chest wall.
  • Fat in the area between the lungs.
  • Soft tissues of the chest wall.
  • Sac around the heart.

Stage II

In stage II, cancer is found in the inside lining of the chest wall on one side of the chest. On the same side of the chest, cancer may also be found in one or more of the following:

• The thin layer of tissue that covers the lung.
• The thin layer of tissue that covers the organs between the lungs.
• The thin layer of tissue that covers the top of the diaphragm.

Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.

or

Cancer is found in the inside lining of the chest wall, and in each of the thin layers of tissue that cover the lung, the organs between the lungs, and the top of the diaphragm on one side of the chest. On the same side of the chest, cancer has also spread into one or both of the following:

• Diaphragm.
• Lung tissue.

Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.

Stage III

Stage III is divided into stages IIIA and IIIB.

• In stage IIIA, cancer is found in the inside lining of the chest wall, and in each of the thin layers of tissue that cover the lung, the organs between the lungs, and the top of the diaphragm on one side of the chest. On the same side of the chest, cancer has also spread into one or more of the following:
  • Tissue between the ribs and the inside lining of the chest wall.
  • Fat in the area between the lungs.
  • Soft tissues of the chest wall.
  • Sac around the heart.

  Cancer has spread to lymph nodes along the center of the chest on the same side of the chest as the tumor.

• In stage IIIB, cancer is found in the inside lining of the chest wall, and may also be found in the thin layers of tissue that cover the lung, the organs between the lungs, and/or the top of the diaphragm on one side of the chest. On the same side of the chest, cancer may have also spread into one or more of the following:
  • Diaphragm.
  • Lung tissue.
  • Tissue between the ribs and the inside lining of the chest wall.
  • Fat in the area between the lungs.
  • Soft tissues of the chest wall.
  • Sac around the heart.

  Cancer has spread to lymph nodes above the collarbone on either side of the chest or cancer has spread to lymph nodes along the center of the chest on the opposite side of the chest as the tumor.

  or

  Cancer is found in the inside lining of the chest wall, and in each of the thin layers of tissue that cover the lung, the organs between the lungs, and the top of the diaphragm on one side of the chest. Cancer has also spread to one or more of the following:

  • The chest wall and may be found in the rib.
  • Through the diaphragm into the peritoneum.
  • The tissue lining the chest on the opposite side of the body as the tumor.
  • The organs in the area between the lungs (esophagus, trachea, thymus, blood vessels).
  • The spine.
  • Through the sac around the heart or into the heart muscle.

  Cancer may have spread to lymph nodes.

Stage IV

In stage IV, cancer has spread to the tissue covering the lung or the lung on the opposite side of the chest, peritoneum, bones, liver, lymph nodes outside the chest, or to other parts of the body.

Malignant mesothelioma can recur (come back) after it has been treated.

The cancer may come back in the chest or abdomen or in other parts of the body.

There are different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Five types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma in the chest:

• Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.
• Pleurectomy and decortication: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
• Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
• Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. It may also be used as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the chest or peritoneum, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug.

Hyperthermic intraperitoneal chemotherapy is used in the treatment of mesothelioma that has spread to the peritoneum (tissue that lines the abdomen and covers most of the organs in the abdomen). After the surgeon removes all the cancer that can be seen, a solution containing anticancer drugs is heated and pumped into and out of the abdomen to kill cancer cells that remain. Heating the anticancer drugs may kill more cancer cells.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This cancer treatment is a type of biologic therapy.

The following types of immunotherapy are being used in the treatment of malignant mesothelioma:

• Immune checkpoint inhibitor therapy: Some types of immune cells, such as T cells, and some cancer cells have certain proteins, called checkpoint proteins, on their surface that keep immune responses in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with advanced malignant melanoma.

  There are two types of immune checkpoint inhibitor therapy:

  • CTLA-4 inhibitor therapy: CTLA-4 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA-4 inhibitor.

  • PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Nivolumab is a type of PD-1 inhibitor.

• Interferon: Interferon affects the division of cancer cells and can slow tumor growth. Gamma interferon is being studied in the treatment of recurrent malignant mesothelioma.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Monoclonal antibody therapy is a type of targeted therapy. Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody used to treat advanced malignant mesothelioma. It binds to a protein called vascular endothelial growth factor (VEGF). This may prevent the growth of new blood vessels that tumors need to grow. Other monoclonal antibodies are being studied in malignant mesothelioma.

Kinase inhibitors are a type of targeted therapy being studied in the treatment of malignant mesothelioma. Kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow.

New types of treatment are being tested in clinical trials.

Treatment for malignant mesothelioma may cause side effects.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

If stage I malignant mesothelioma is in one part of the chest lining, treatment may be the following:

• Surgery to remove the part of the chest lining with cancer and the tissue around it.

If stage I malignant mesothelioma is found in more than one place in the chest, treatment may be one of the following:

• Extrapleural pneumonectomy.
• Pleurectomy and decortication, with or without radiation therapy, as palliative therapy to relieve symptoms and improve quality of life.
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of anticancer drugs placed directly into the chest after surgery to remove the tumor.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.
• A clinical trial of a new treatment.

If stage I malignant mesothelioma is in the peritoneal lining, treatment may be the following:

• Surgery to remove the part of the peritoneal lining with cancer and the tissue around it.

If stage II, stage III, or stage IV malignant mesothelioma is found in the chest, treatment may be one of the following:

• Immunotherapy with an immune checkpoint inhibitor (nivolumab and ipilimumab).
• Combination chemotherapy and targeted therapy with or without a monoclonal antibody (bevacizumab).
• Chemotherapy placed directly into the chest cavity to shrink the tumors and keep fluid from building up.
• Surgery to drain fluid that has collected in the chest, to relieve chest discomfort and improve quality of life. Pleurodesis may be done to stop more fluid from collecting in the chest.
• Pleurectomy and decortication, as palliative therapy to relieve symptoms and improve quality of life.
• Radiation therapy as palliative therapy to relieve pain.
• A clinical trial of combinations of surgery, radiation therapy, and chemotherapy.

If stage II, stage III, or stage IV malignant mesothelioma is found in the peritoneum, treatment may be one of the following:

• Surgery to remove the tumor followed by hyperthermic intraperitoneal chemotherapy.
• Chemotherapy.

Treatment of recurrent malignant mesothelioma may be one of the following:

• Surgery to remove part of the chest wall.
• Chemotherapy, if it was not given as initial treatment.
• A clinical trial of immunotherapy.
• A clinical trial of targeted therapy.
• A clinical trial of chemotherapy.
• A clinical trial of surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

• The stage of the cancer.
• The size of the tumor.
• Whether the tumor can be removed completely by surgery.
• The amount of fluid in the chest or abdomen.
• The patient's age.
• The patient's activity level.
• The patient's general health, including lung and heart health.
• The type of mesothelioma cells and how they look under a microscope.
• The number of white blood cells and how much hemoglobin is in the blood.
• Whether the patient is male or female.
• Whether the cancer has just been diagnosed or has recurred (come back).