Pleural Mesothelioma

The pleural mesothelioma is a mesothelioma tumor. This is the membrane that lines the serous cavities of the body. The mesothelioma is a non-vascularized epithelioid (contains no blood vessels). This produces a serous fluid (similar to mucus), the coating tissue is:

• Lung,
• Belly,
• Heart,
• Testicles and other organs.

Mesothelioma is mainly caused by prolonged exposure to asbestos fibers.
Asbestos causes inflammation of mesothelial cells.

The evolution of this process causes:

• By irreversible healing, macrophages stimulate fibroblasts to form connective tissue. The result is the formation of interstitial fibrosis.
• Asbestos fibers penetrate the cell. And obstruct the functions of cell structures that are essential for normal cell division.
• The production of the free radicals that damage cellular DNA
• The production of oncoproteins that abolish the mechanisms of cell proliferation blockade.

The consequence can be the development of cancer.

Persons who are directly exposed to asbestos fibers are classified into risk groups of the pleural mesothelioma.

When a person inhales the small asbestos fibers. The asbestos fibers adhere firmly to the lungs.

The hair or clothing of the person who is directly exposed to asbestos. Provide a means to put others in close contact with it.

It has been observed that pleural mesothelioma develops. And show strong effects that it takes about 30 to 40 years after the first asbestos exposure.

Types of Mesothelioma

Depending on the proportion of affected mesothelioma. There may be 4 types of mesothelioma:

• The pleural mesothelioma affects the membrane. This surrounds the lungs (the pleura, especially the inner layer or pleura visceral). It is the most common type of mesothelioma. And it accounts for more than 80% of the cases.
• Peritoneal mesothelioma is cancer that affects the stomach membrane. It is not very common. And responsible for 10-20% of cases of mesothelioma. The peritoneal mesothelioma affects the outer wall of the stomach.
• The pericardial mesothelioma affects the membrane surrounding the heart. It is the rare type of mesothelioma (1-5% of cases). People diagnosed with mesothelioma. Who suffers from this cancer, there are only a few.
• Testicular mesothelioma - develops on the membrane that protects the testes (tunica vaginalis). That's very rare.

Benign and malignant mesothelioma

Mesothelioma can be:

Benign: The benign form of the mesothelioma is very rare.

Some benign mesotheliomas are:

• Adenomatoid tumor,
• Benign cystic mesothelioma.

Malignant: The most common type of a rare but very aggressive neoplasm. Malignant mesothelioma differs depending on the type of malignant cell.

Cellular Types of Mesothelioma

1) Epithelioid Mesothelioma

Mesothelioma is the most common cell type. And it accounts for about 56-75% of cases diagnosed each year. All of these cells have a round or polygonal shape. That makes them easy to distinguish in a microscope.
This type of tumor cell is similar to that of an adenocarcinoma.

2) Sarcomatoid Mesothelioma

Mesothelioma is a less common cell type. About 7-20% of cases are diagnosed each year. These cells are spindle-like muscles and bones. Because of this similarity. It can be difficult to distinguish sarcomatoid mesothelioma from tumors in a microscope:

• Of the bone (osteosarcoma),
• Connective tissue (fibrosarcoma).

3) Biphasic

Mesothelioma The biphasic mesothelioma is formed by both components of the epithelioid. And the sarcomatoid component. It accounts for 30-40% of mesothelioma.

The treatment options for mesotheliomas are not significantly different for different cell types. But sarcomatoid mesothelioma is often harder to treat. Due to the spread of the surrounding tissues.

Causes of Pleural Mesothelioma

The main cause of mesothelioma is exposure to asbestos (80% of cases). But only 5% of asbestos-exposed develop mesothelioma. This indicates that the exposure to asbestos is not solely responsible for cancer.
Other less common causes of mesothelioma are:

• Radiotherapy,
• SV40 virus (not confirmed)

Mesothelioma is a rare cancer. But it's not uncommon for asbestos-exposed people. These individuals have a 1000-fold increased risk of developing mesothelioma. The risk is doubled if the person exposed to asbestos is also a smoker. Because smoking stimulates macrophages, which play an important role in the development of mesothelioma.

Asbestos exposure can occur:

• Directly,
• Indirectly.

Direct exposure occurs when a person comes into direct contact with asbestos fibers.
For example:

• The workers of the asbestos mines
• Construction worker,
• restorers,
• Shipbuilders,
• Crushers and mechanics working with vehicle brakes and clutches.

The indirect exposure occurs when people:

• They are in indirect contact with asbestos (eg living or waiting for buildings with asbestos parts: pipes, roofs, etc.).
• You stay in contact with people who are directly exposed to asbestos. For example, the family and friends of people who were directly exposed to asbestos. And who has incorporated the fibers into clothing or hair? It is not necessary to be exposed to asbestos for a long time. But even short-term exposure can cause mesothelioma. Mesothelioma is the main health effect of inhaling asbestos. But it can work together with:
• Asbestosis: formation of the scar tissue or pulmonary fibrosis by asbestos fibers.
• Lung cancer: Cancer develops in the lung tissue.

Mesothelioma is very different. And should not be confused with the lung cancer or asbestosis.

Symptoms of Pleural Mesothelioma

The signs and symptoms of pleural mesothelioma are:

• Chest pain (from mild to severe)
• back pain
• pleural effusion
• Shortness of breath or dyspnoea, first under exertion, then at rest
• Knot on skin and chest
• A persistent cough (mild to severe)
• fever
• Fatigue
• weight loss
• muscle weakness
• Constant breath during breathing
• Traces of blood in the mucus.

Symptoms of peritoneal mesothelioma

The signs and symptoms of peritoneal mesothelioma can be:

• Constant abdominal pain (from mild to severe)
• bloating
• Tissue lumps in the stomach
• Intestinal obstruction and constipation
• Sudden and unexplained weight loss
• Nausea.

Symptoms of pericardial mesothelioma

Some symptoms may be:

• Irregular heart rhythm (arrhythmias)
• Chest pain
• Heart Palpitations
• Shortness of breath
• Night Sweats.

Symptoms of Testicular Mesothelioma

The main symptom of testicular mesothelioma is a formation of testicular nodules.

In some cases, it causes pain in the testicle.

Diagnosis of mesothelioma

Diagnosing mesothelioma is not easy. Because the symptoms are similar to those of other, more common diseases:

• Lung infection,
• Pleurisy,
• colds,
• Seasonal allergies.

After examining the patient's complete medical history. The doctor prescribes the other tests if he or she suspects the presence of mesothelioma.

Instrumental exams

The best way to diagnose mesothelioma is through instrumental testing, for example:

• Chest x-ray (x-ray): This is the main exam. In mesothelioma, radiography shows thickening of mesothelium in the lower (basal) part of the lung. In the advanced stage, the thickening extends to the higher lung areas. Often a pleural effusion is also visible.
• Computed Tomography: It is useful to the evaluate the extent of the disease.
• Magnetic Resonance Imaging: This test may be helpful in determining the severity of mesothelioma.
• PET scintigraphy: To assess the progression stage of mesothelioma.

Biopsy and laboratory tests

Another way to confirm the mesothelioma is to remove the tissue with a biopsy.

Issa can include:

• Surgical thoracoscopy in laparoscopy for pleural mesothelioma.
• Peritoneoscopy in peritoneal mesothelioma (in laparoscopy).

Treatment for Mesothelioma

A definitive cure of mesothelioma is not possible. Treatments are used to:

• Reduce symptoms,
• Increase the life expectancy of the patient.

The doctor considers:

• The internship,
• The site of the tumor,
• Age,
• The health status of the patient.

The most of the common treatment for mesothelioma is surgery, followed by:

• Radiotherapy,
• Chemotherapy.

A combination of these treatments may be used as appropriate.

Surgery for pleural mesothelioma

Surgeons remove mesothelioma. If it is diagnosed early and is still functional. Surgeries can help to reduce the signs. And symptoms caused by mesothelioma spreading in the body.

Surgical options may include:

1. Surgery to reduce fluid retention

Pleural mesothelioma can lead to fluid accumulation (pleural effusion). Cause respiratory distress. The surgeon inserts to a tube or catheter into the chest to drain the fluid. He can also inject a drug into the chest to prevent the return (pleurodesis) of the fluid.

2. Surgery to remove the tissue around the lungs or abdomen (pleurectomy). The surgeon removes the parietal and visceral pleura. This procedure can be only performed in 10-15% of patients.

3. Surgery to remove the most of cancer (debulking or cytoreduction).
If its removal of the entire tumor is not possible. Surgeons can try to remove most of it. Debulking allows physicians to more accurately treat chemotherapy or symptoms.

4. Surgery to remove a lung and surrounding tissue (pleuropneumonectomy extrapleural). Removal of the affected lung and surrounding area. Tissue can reduce the signs and symptoms of pleural mesothelioma. By irradiating the breast after surgery, doctors can use higher doses of radiation. Because they do not have to worry about protecting the lungs from the harmful effects of the treatment.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells.

Systemic chemotherapy goes through the entire body and can reduce or reduce the growth of inoperable mesothelioma.

Chemotherapy can also be used:

• Before surgery (neoadjuvant chemotherapy) to facilitate surgery,
• After surgery (adjuvant chemotherapy) to reduce the likelihood of recurrence.
• In the abdominal area (intraperitoneal chemotherapy) in peritoneal mesothelioma
• In the chest cavity (intrapleural chemotherapy) in pleural mesothelioma.

With this strategy, chemotherapists can get mesothelioma directly without damaging healthy cells in other parts of the body. This allows physicians to administer high doses of chemotherapeutic agents.

Radiotherapy

Radiotherapy focuses on high-energy rays such as X-rays. In one or more specific points in the body.
Radiation can reduce the signs. And symptoms in people who suffer from pleural mesothelioma.
Sometimes radiotherapy is used after a biopsy or surgery for prevention. The spread of the mesothelioma to the surgical incision.

Experimental therapies
Immunotherapy: Vaccine

Scientific studies on the vaccine against asbestos-related diseases are being carried out.

This drug can help the immune system identify cancer cells. The vaccine may be the useful for blocking tumor growth.

gene
The therapy identifies and modifies the genes responsible for the development of cancer.

Photodynamic Therapy Photodynamic

The therapy can use the properties of light, consisting of:

• Taking a photosensitizing drug (ie increasing photosensitivity) that is absorbed by the cancerous cells in larger quantities.
• Laser therapy in mesothelioma for the destruction of cells.

Prognosis, survival and life expectancy of patients with pleural mesothelioma

Mesothelioma is not only a very rare, but also the deadliest cancer.

Post-diagnosis survival (usually 30 to 40 years after the first asbestos exposure) is only 12 to 18 months. Or even less, without treatment/medication.

One of the major factors in life expectancy is the stage of progression of the disease.

Progress and development of the disease

A typical feature of mesothelioma is latency (ie, between asbestos exposure and the onset of symptoms), which is about 15 to 40 years.

Stage I: In the beginning, the mesothelioma is in a layer of the pleura. And cancer may have spread to the pericardium or diaphragm. The life expectancy of mesothelioma patient in the first stage is approximately 2 years (21 months).

Stage II: In the second phase, the involvement of both pleural layers is observed only on one side of the body. The life expectancy at this stage may be about 1-2 years after diagnosis.

Stage III: In the third stage, cancer was spreading through the wall of the thorax (esophagus). And the lymph nodes on the one side of the body. The life expectancy of this phase can be about 16 months.

Stage IV (last): in the fourth (terminal) stage of the mesothelioma. To the other organs of the body, it comes to a diffusion. And metastases are formed in the bones. Liver, brain or other parts of the body.