Malignant mesothelioma

It is a rare cancer tumor. Above all, the lining of the lungs and the chest cavity (pleura) or the lining of the abdomen (peritoneum) are affected. It is due to prolonged exposure to asbestos. Diffuse malignant mesothelioma is a rare malignancy emanating from mesothelial cells. The most common site of the pleura is estimated to be at peritoneal stage 1, 10% of cases.

Malignant mesothelioma is usually diagnosed in the fifth decade of life with a clear dominance of the male sex. The latter because of their relationship to occupational asbestos exposure. Their incidence is increasing in Europe, peaking in 2018. This concerns the cohort of men born between 1945 and 1950.

IMPORTANT POINTS

• Malignant mesothelioma is a disease in which malignant (cancerous) cells form in the breast or abdominal mucosa.
• This is possible that exposure to asbestos influences the risk of malignant mesothelioma.
• Signs and symptoms of malignant mesothelioma include shortness of breath and chest pain.
• Detect (find) and diagnose malignant mesothelioma. Tests are used to examine the interior of the chest and abdomen.
• Certain factors affect prognosis (recovery probability) and treatment options.

Causes

The biggest risk factor is prolonged exposure to asbestos. Asbestos is a refractory material. This used to be common on vinyl for blankets. Ceilings and insulation, cement and automotive brakes. Although many asbestos workers smoked. The experts do not believe that smoking itself is a cause of this condition.

This affects men more often than women. The average age of diagnosis is 60 years. Most people seem to develop the disease about 30 years after exposure to asbestos.

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

Malignant mesothelioma is a disease that occurs in the pleural malignant cells (cancer). (The thin layer of tissue that lines the thoracic cavity and covers the lungs). The peritoneum (the thin layer of tissue lining the stomach and covering most organs of the abdomen). Malignant mesothelioma can form in the heart or in the testicles, but this is not common. Malignant mesothelioma is cancer that forms in the thin tissue layer of the lung. The chest wall, the stomach, the heart or the testicles.

It is possible that the exposure to asbestos influences to the risk of malignant mesothelioma.

Anything that increases the likelihood of illness is called a risk factor. The presence of a risk factor does not mean that you get cancer. However, the absence of risk factors does not mean that you will not get cancer. Ask to your doctor if you think you are at risk.

Most of the people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After exposure to asbestos, it usually takes a long time to develop a malignant mesothelioma. Living near a person working near asbestos is also a risk factor for malignant mesothelioma.

The signs and symptoms of the malignant mesothelioma include the shortness of breath and pain below the rib cage.

Sometimes, cancer causes fluid to accumulate in the chest or abdomen. The signs and symptoms are caused by a fluid. Malignant mesothelioma or other conditions. Ask your doctor if you have any of the following symptoms:

• Difficulty breathing.
• Cough.
• Pain below the rib cage.
• Abdominal pain or inflammation of it
• Nodules in the abdomen.
•  Constipation.
• Problems with the blood clots (clots that form when they should not).
• Weight loss without known reason.
• Feeling very tired.

To detect (find) and diagnose malignant mesothelioma, tests are used to examine the inside of the chest and abdomen.

In some cases, it is difficult to distinguish malignant breast mesothelioma from lung cancer.

Diagnosis of malignant mesothelioma in the thorax or peritoneum. The following tests and procedures are used:

Physical examination and medical history: physical examination to check general health and to detect signs of illness. Like masses or anything else that seems unusual. Data are also collected on health habits, asbestos exposure. Medical history and pre-treatment.

X-ray of the thorax: X-ray of the organs and bones in the thorax. X-rays are used, a kind of energy beam that can penetrate the body. And be reflected in a movie that shows a picture of areas inside the body.

Computed Tomography (CT): A procedure in which a series of detailed images of the chest and abdomen are taken from different angles. The images are created using a machine connected to a computer beam X. A dye is injected into the vein or the organs or tissue are swallowed more clearly. This procedure is also referred to as Computed Tomography, Computerized Axial Tomography (CAT) or CT Scan.

Biopsy: The removal of cells or tissues from the pleura or peritoneum for a pathologist under a microscope. And see if there are signs of cancer.

The methods for collecting cells or tissues are as follows:

Fine-needle aspiration biopsy (FNA) of the lung: Extraction of tissue or fluid with a fine needle. An imaging the procedure is used to the find abnormal tissue or fluid in the lung. Then the small incision is made in the skin where the biopsy needle passes. The sample of the abnormal tissue or fluid is removed.

Thoracoscopy: A procedure in which a cut is made between two ribs. A thoracoscope (a thin, tubular instrument with a light and a lens to observe) is inserted into the chest.

Thoracotomy: Cut (cut) between two ribs to examine the interior of the breast. And determine if there are signs of illness.

Laparotomy: The surgical procedure in which a cut is made in the abdominal wall to look into the organ. And determine if there are signs of illness.

Open biopsy: A procedure in which a cut is made in the skin to expose it. And remove tissue to check for signs of disease.

The samples of cells and tissues are analyzed with the following tests:

Investigation Cytology: Examining cells under a microscope to see if anything abnormal is present. In the case of mesothelioma, fluid is removed from the chest or abdomen. A pathologist analyzes these fluids to determine if there are signs of cancer.

Immunohistochemical test: A test that uses antibodies to identify specific antigens in a tissue sample. Normally, the antibody binds to a radioactive substance a dye, so that the cells light up under the microscope. This type of test is used to determine the difference between different cancers.

Electron Microscopy: A laboratory test in which cells from a tissue sample are examined for changes in the cells using a high-performance microscope. With an electron microscope, you can see the smallest details better than other types of microscopes.

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

Malignant mesothelioma is difficult to treat.

Usually, there is the no cure, unless the disease is detected very early. And tumor can be completely removed by the surgery. Mostly at the time of diagnosis. The disease is too advanced for surgery. Chemotherapy or radiotherapy can be used to reduce the symptoms. Likewise, the combination of certain chemotherapeutic drugs may help reduce the symptoms. But cancer can not cure. Without the treatment, most of the people survive for about 9 months.

Participation in a clinical trial (evaluation of new treatments) can provide the person with more treatment options.

Treatments for pain relief, oxygen therapy. And other complementary treatments can also help alleviate the symptoms.

The prognosis (recovery probability) and the treatment options depend on the following factors:

• The stage of cancer.
• The size of the tumor.
• If it is possible to completely remove the tumor surgically.
• The amount of the fluid in the chest or abdomen.
• The age of the patient.
• The level of activity of the patient.
• The general health of the patient. Including the health of lungs and the heart.
• The type of the mesothelioma cells and their appearance under a microscope.
• The number of white blood cells and the amount of hemoglobin in the blood.
• If the patient is male or female.
• If the cancer has recently been diagnosed or relapsed (returned).

Palliative treatment 

Relieving symptoms is the main goal of mesothelioma treatment. And should focus on the previously mentioned as the two main symptoms: dyspnea and chest pain. When the patient presents a pleural fluid. An evacuating thoracocentesis should be performed. If this is alleviated, evaluate the performance of chemical pleurodesis.

Surgery

In the treatment of mesothelioma, three surgical procedures were used: thoracoscopy with pleurodesis. Pleurectomy / decortication an extrapleural pneumonectomy. As for the first point, a recent review found that talc is the best sclerosed. And video-thoracoscopy is the best way to perform it.

With regard to the other two, a systematic review was very critical in the studies where their application relied on the absence of a control group. And to base his best survival on the choice of favorable cases before the operation. Performed with curative intent, there seems to be no significant improvement in survival.

Chemotherapy

Pleural mesothelioma is a neoplasm with a low response to chemotherapy. Berghmans et al 31 conducted a systematic review. Because cisplatin is the most active isolated active ingredient. And the combination with doxorubicin offers the highest response rate. Pemetrexed is a new antifolate agent that was tested in Phase III with cisplatin versus cisplatin. Median survival for combination and delay of disease progression.

Radiotherapy 

Mesothelioma responds to radiation therapy. But given the extension at the time of diagnosis. The treatment fields are wide. This complicates its application without significant risks to the adjacent structures. In the treatment of mesothelioma, three possible remedies have been identified:

- The prophylaxis of "tumor seeding" after biopsy or drainage.

- The palliative pain treatment.

- As a supplement to extrapleural pneumonectomy as part of a multimodal treatment plan.

New therapies 

Ranpirnase is a ribonuclease that has been studied in Phase II and III studies and appears to be more potent. Than doxorubicin in selected patients who require further studies to support the application.

Interferon α-2b has been studied in Phase II studies in combination with cisplatin. And doxorubicin response of 29% and a median survival of 9.3 months 35.

The possibility of vaccination against SV-40. Investigated are inhibitors of the vascular endothelial growth factor and COX-2.

Expectations (prognosis)

The average survival varies between 4 and 18 months. The prognosis depends on:

• The stage of the tumor
• Age and general health of the person
• If an operation is an option
• The answer of the person to the treatment

Possible complications

Complications of malignant mesothelioma can be:

• Side effects of chemotherapy or radiotherapy
• Continuous spread of cancer to other organs

When to contact a medical professional

Request to the appointment with the provider if you have the symptoms of malignant mesothelioma.

Prevention

Avoid the exposure to asbestos.

Alternative names

Mesothelioma - malignant; Malignant pleural mesothelioma; (MPM)