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Malignant mesothelioma

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It is a rare cancerous tumor. The mainly affects the lining of the lung and the thoracic cavity (pleura) or the lining of the abdomen (peritoneum). It is due to prolonged exposure to asbestos. The diffuse malignant mesothelioma is a rare malignancy originating from mesothelial cells. Being the most common location pleura its estimated that 10% of cases are located the peritoneal level 1.

Malignant Mesothelioma is usually diagnosed in the fifth decade of life with a clear predominance of the male sex. Due to the latter to its relationship with occupational exposure to asbestos. Its incidence is increasing in Europe, with a peak expected in 2018. Affecting the cohort of men born between 1945 and 1950.
Malignant mesothelioma

IMPORTANT POINTS

  • Malignant mesothelioma is a disease in which malignant (cancerous) cells form in the lining of the chest or abdomen.
  • is possible that exposure to asbestos influences the risk of malignant mesothelioma.
  • The signs and symptoms of malignant mesothelioma include shortness of breath and pain below the rib cage.
  • To detect (find) and diagnose malignant mesothelioma. Tests are used to examine the inside of the chest and abdomen.
  • Certain factors affect the prognosis (probability of recovery) and treatment options.

Causes

Prolonged exposure to asbestos is the biggest risk factor. Asbestos is a fire resistant material. This used to be commonly found on vinyl for ceilings. Ceilings and insulation, cement and automobile brakes. Although many asbestos workers smoked. 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 at 60 years. Most people seem to develop the condition about 30 years after being in contact with asbestos.

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

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

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

Anything that increases the likelihood of having a disease is called a risk factor. The presence of a risk factor does not mean that you will get cancer. But the absence of risk factors does not mean that you will not get cancer. Check with your doctor if you think you are at risk.
Most 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 for malignant mesothelioma to form. Living next to a person who works near asbestos is also a risk factor for malignant mesothelioma.

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

Sometimes cancer causes fluid to build up in the chest or abdomen. The signs and symptoms are caused by a liquid. Malignant mesothelioma or other conditions. Check with 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 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 differentiate a malignant mesothelioma in the chest from a lung cancer.
To diagnose a malignant mesothelioma in the thorax or peritoneum. The following tests and procedures are used:

Physical examination and history: body exam to check the general state of health and identify any signs of disease. Such as masses or anything else that seems abnormal. Data are also collected on health habits, exposure to asbestos. History of diseases and previous treatments.

X-ray of the thorax: X-ray of the organs and bones inside the thorax. X-rays are used, a type of energy beam that can go through the body. And be reflected in a film that shows an image of areas inside the body.

Computed tomography (CT) scan: a procedure that takes a series of detailed images of the chest and abdomen from different angles. The images are created with a machine connected to a computer ray X. injected one dye into a vein or swallowed to the organs or tissues show more clearly. This procedure is also called computed tomography, computerized axial tomography (CAT) or CT scan.

Biopsy: the removal of cells or tissues from the pleura or peritoneum for a pathologist to observe under a microscope. And determine if there are signs of cancer.
The procedures that are used to collect cells or tissues are the following:

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

Thoracoscopy: A procedure for which an incision (cut) is made between two ribs. And a thoracoscope (a thin, tube-shaped instrument with a light and a lens to be observed)is inserted into the chest.

Thoracotomy: incision (cut) made between two ribs to examine the inside of the chest. And determine if there are signs of disease.

Laparotomy: the surgical procedure for which an incision (cut) is made in the wall of the abdomen to look inside the organ. And determine if there are signs of disease.

Open biopsy: A procedure in which an incision (cut) is made in the skin to expose. And remove tissues to examine them for signs of disease.
The samples of cells and tissues are analyzed with tests such as the following:

Examination Cytology: the examination of cells under a microscope to determine if there is something abnormal. 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 for which antibodies are used to identify certain antigens in a tissue sample. Usually, 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 types of cancer.

Electron microscopy: a laboratory test in which cells from a tissue sample are examined with a high-power microscope to observe changes in the cells. An electron microscope allows you to see tiny details better than other types of microscopes.

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

Malignant mesothelioma is a difficult cancer to treat.
Usually, there is no cure, unless the disease is detected very early. And the tumor can be completely removed with surgery. Most of the time, at the time of diagnosis. The disease is too advanced for surgery. The chemotherapy or radiation therapy can be used to reduce symptoms. Likewise, combining certain chemotherapeutic drugs can help reduce symptoms. But will not cure cancer.
Without treatment, most people survive for approximately 9 months.
Participating in a clinical trial (evaluation of new treatments) can give the person more treatment options.

Malignant mesothelioma

Treatments for pain relief, oxygen therapy. And other complementary treatments can also help relieve symptoms.
The prognosis (probability of recovery ) and treatment options depend on the following:
  • The stage of cancer.
  • The size of the tumor .
  • If it is possible to remove the tumor completely by surgery.
  • The amount of fluid in the chest or abdomen.
  • The age of the patient.
  • The degree of activity of the patient.
  • The general state of health of the patient. Including the health of the lungs and the heart.
  • The type of mesothelioma cells and their appearance under a microscope.
  • The number of white blood cells and the amount of haemoglobin in the blood.
  • If the patient is male or female.
  • If the cancer was recently diagnosed or relapsed (returned).

Palliative treatment 

The palliation of symptoms is the main objective of mesothelioma treatment. And should focus on those previously mentioned as the two main symptoms: dyspnea and chest pain. If the patient presents a pleural fluid. An evacuating thoracocentesis should be performed and. If this is relieved, assess the performance of chemical pleurodesis.

Surgery

Three surgical procedures have been used in the treatment of mesothelioma: thoracoscopy with pleurodesis. Pleurectomy/decortication an extrapleural pneumonectomy. Regarding the first one, a recent review has concluded that talc is the best sclerosing agent. And video thoracoscopy is the best procedure to carry it out.
Regarding the other two, a systematic review has been very critical with the studies on which its use is based on the lack of a control group. And to base its best survival on the choice before surgery of "favourable cases". Carried out with curative intent, none seems to offer a significant improvement in survival.

Chemotherapy

Pleural mesothelioma is a neoplasm with low response to chemotherapy. Berghmans et al 31 carried out a systematic review. With cisplatin being the most active isolated agent. And the combination with doxorubicin providing the highest response rate. Pemetrexed is a new antifolate agent studied in phase III along with cisplatin versus cisplatin with favourable data regarding. The median survival for the combination and delay in the time of disease progression.

Radiotherapy 

Mesothelioma responds to radiotherapy. But given its extension at the time of diagnosis. The treatment fields are wide. Which makes its application difficult without significant risks for the adjacent structures. Three possible utilities have been pointed out in the management of mesothelioma:

- The prophylaxis of "tumor seeding" after carrying out biopsies or placement of drainages.
- The palliative treatment of pain.
- As an adjunct to extrapleural pneumonectomy as part of a multimodal treatment plan.

New therapies 

Ranpirnase is a ribonuclease studied in phase II and III trials that seems to offer greater efficacy. Than doxorubicin in selected patients, requiring further studies to support its use.
Interferon α-2b has been evaluated in phase II studies in combination with cisplatin. And doxorubicin response of 29% and a mean survival of 9.3 months 35.
The possibility of vaccination against SV-40. Inhibitors of the vascular endothelial growth factor as well as COX-2 is being studied.

Expectations (prognosis)

The average survival time varies from 4 to 18 months. The prognosis depends on:
  • The stage of the tumor
  • The age and general health of the person
  • If surgery is an option
  • The response of the person to the treatment

Possible complications

Complications of malignant mesothelioma can include:
  • Side effects of chemotherapy or radiotherapy
  • Continuous spread of cancer to other organs

When to contact a medical professional

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

Prevention

Avoid exposure to asbestos.

Alternative names

Mesothelioma - malignant; Malignant pleural mesothelioma; (MPM)

COMMENTS

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Mesothelioma Master: Malignant mesothelioma
Malignant mesothelioma
Malignant mesothelioma is a rare cancer.Treatment for malignant mesothelioma may include radiation therapy, and chemotherapy, as well as targeted therapy.
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