In 2015, thirty-two year old comedian Quincy Jones’ career was finally starting to take off. Jones (not to be confused with the famous music producer) had moved from Seattle to Los Angeles four years earlier in the hopes of boosting his budding stand-up career. Working as a barista during the day and making the rounds at various comedy clubs at night was finally paying off. Jones had just signed a contract with a break-out East Coast comedy tour, when we went to the doctor to figure out what was the cause of a nagging stomach pain.
It took several hospitalizations, but the diagnosis was finally made in July 2015. Jones had stage 4 peritoneal mesothelioma! He was given one year to live.
Two friends he met on the comedy circuit, Mickey and Nicole Blaine, launched a Kickstarter campaign to defray some of his medical costs, as well as to fund his life-long dream of recording a one-hour stand-up special. As Jones put it:
“My biggest fear used to be — before cancer — it’s the same one I have now: Dying without leaving anything. Dying before I have the chance to do the stuff I want to do. So this (special) would be my opus. This would be my legacy I’m leaving here.”
The campaign went viral, and they quickly raised their goal of $50,000. What’s more, the campaign caught the eye of Ellen DeGeneres, who had Jones on her show twice during the same week. On the second visit, she told Jones that HBO had agreed to air his hour-long special, entitled Quincy Jones: Burning the Light. The special was taped in Los Angeles in April 2016, and premiers June 2, 2016.
Quincy Jones’ story has generated considerable publicity, inadvertently causing him to become a national spokesman for mesothelioma awareness. As he told KPCC’s The Frame:
“The special is not about me. This is bigger than me. The special is dedicated to anybody who has been through cancer, lost someone to cancer or has cancer. This is literally about a disease.”
The peritoneum is the serous membrane that forms the lining of the abdominal cavity. A serous membrane consists of two layers of epithelial cells which secrete a thin watery liquid called serous fluid. The inner surface lays on and covers the abdominal organs and is called the visceral membrane. A second, outer layer of epithelial cells is called the parietal layer. Sandwiched between the two serous layers is a connective tissue layer which provides the blood vessels and nerves for the other layers. The serous fluid produced by the serous membranes reduces friction between the walls of the abdominal cavity and the contained internal organs (such as the bowels and liver) when they move.
Malignant mesothelioma is a disease in which cancer cells form in the lining of the chest or abdomen.
Cancer cells can be 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- as above). Malignant mesothelioma may also form around the heart or testicles, but this is rare.
Approximately 3300 cases of mesothelioma are diagnosed each year. The majority of these have disease in their chest, with malignant peritoneal mesothelioma (MPM) only accounting for 10-15% of patients.
Being exposed to asbestos can affect the risk of malignant mesothelioma. A history of asbestos exposure is reported in about 70% to 80% of all cases of mesothelioma. 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.
Exposure to asbestos is less strong a risk factor for patients with malignant peritoneal mesothelioma. There may be a genetic component that predisposes some individuals to be more susceptible to environment exposure to asbestos. One such mutation, in a tumor suppressor gene called BAP (BRCA-associated protein), has been found frequently in patients with pleural mesothelioma and MPM.
Most patients with MPM have symptoms. On occasion, it is found incidentally while investigating an unrelated problems such as infertility or during a routine physical exam.
The most common signs and symptoms of MPM include abdominal distention/pain, weight loss, trouble breathing and chest pain.
Sometimes, large amounts of fluid can collect in the chest or in the abdomen. A fluid collection in the abdomen is called ascites.
Other symptoms can include:
There are two forms of MPM- diffuse MPM and localized MPM. Diffuse MPM is the more common form, with tumor being present throughout the abdomen. It tends to be more aggressive, and is frequently at an advanced stage at the time of diagnosis. The most common complaints include abdominal distention, increasing abdominal girth, pain and discomfort in the abdomen as well as nausea and loss of appetite.
In the less common form of localized MPM, the patient presents with a discreet abdominal mass. Localized MPM doesn’t typically spread throughout the abdomen. Patients may complain of localized abdominal pain or have a mass that can be felt on examination.
Unfortunately, as most patients with MPM have late stage disease at the time of diagnosis, the prognosis is usually poor, with the average survival of about 1 year.
If clinically possible, the first treatment for patients with MPM is called cytoreductive surgery. This is a procedure where a surgeon tries to remove any and all visible tumor. For selected patients, a promising therapy, called heated intraperitoneal chemotherapy (HIPEC), may be used. 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. Applying the chemotherapy directly to the affected tissues increases the dosage without increasing the side effects. In addition, heating the anticancer drugs may kill more cancer cells by allowing it to penetrate more deeply into the surface of the peritoneum.
For patients ineligible to HIPEC, there is currently only a single chemotherapy regimen (Alimta® (pemetrexed) in conjunction with Cisplatin) approved by the Food and Drug Administration as a prescribed therapy for the treatment of malignant pleural mesothelioma.
There are dozens of clinical trials being conducted for mesothelioma patients experimenting with new drugs, including Gemcitabine, Navelbine, Onconase, and others for the treatment of malignant peritoneal mesothelioma.
To see all peritoneal mesothelioma clinical trials open to new patients, see the NIH Clinical Trials website.