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Pleural Mesothelioma

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Pleural mesothelioma is a mesothelial tumor. That is the membrane that lines the serous cavities of the body. The mesothelium is a non-vascularized epithelium (does not contain blood vessels). That produces a serous fluid (similar to mucus), is the coating fabric of:
  • Lungs,
  • Stomach,
  • Heart,
  • Testicles and other organs.
Mesothelioma is caused mainly by prolonged exposure to asbestos fibers.
Asbestos causes  inflammation of mesothelial cells,

The evolution of this process causes:

  • Irreversible healing, macrophages stimulate fibroblasts to produce connective tissue. The consequence is the formation of interstitial fibrosis.
  • Asbestos fibers enter the cell. And impede the functions of the cellular structures that are essential for normal cell division.
  • The production of free radicals that damage cellular DNA
  • The production of oncoproteins that cancel out mechanisms of cell proliferation blockade.
Pleural Mesothelioma

The consequence may be the development of cancer.
People exposed directly to asbestos fibers are classified into high-risk groups of pleural mesothelioma.

When a person inhales the small fibers of asbestos. The asbestos fibers adhere firmly to the lungs.
The hair or clothing of a person directly exposed to asbestos. Represent a means of endangering others in close contact with it.
It has been observed that to develop pleural mesothelioma. And show severe effects it takes about 30-40 years after the initial exposure to asbestos.

Types of Mesothelioma

Depending on the portion of mesothelioma affected. There may be 4 types of mesothelioma:
  • The pleural mesothelioma affects the membrane. That surrounds the lungs (the pleura, especially the inner layer or visceral pleura). It is the most frequent type of mesothelioma. And represents more than 80% of the cases.
  • The peritoneal mesothelioma is a cancer that affects the membrane of the stomach. It is not very frequent. And accounts for 10-20% of cases of mesothelioma. Peritoneal mesothelioma affects the outer wall of the stomach.
  • The pericardial mesothelioma affects the membrane that surrounds the heart. It is a rare type of mesothelioma (1-5% of cases). People diagnosed with mesothelioma. Who suffers from this type of cancer are few.
  • Testicular mesothelioma - develops on the membrane that protects the testicles (tunica vaginalis). It's very rare.

Benign and malignant mesothelioma

Mesothelioma can be:
Benign: The benign form of mesothelioma is very rare.
Some benign mesotheliomas are:
  • Adenomatoid tumor,
  • Benign cystic mesothelioma.
Malignant: The most common type is 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 accounts for about 56-75% of cases diagnosed each year. All these cells have a round or polygonal shape. That easily distinguishes them in the microscope.
This type of tumor cell is similar to that of adenocarcinoma.
2) Sarcomatoid Mesothelioma
mesothelioma is a less frequent type of cell. And accounts for about 7-20% of cases diagnosed each year. These cells are spindle-like muscles and bones. Because of this similarity. It may be difficult to distinguish sarcomatoid mesothelioma from tumors in the microscope:
  • Of the bone (osteosarcoma),
  • Connective tissue (fibrosarcoma).
Pleural Mesothelioma

3) Biphasic
mesothelioma Biphasic mesothelioma is formed by both the epithelial component. And the sarcomatoid component. It represents 30-40% of mesotheliomas.
The mesothelioma treatment options do not vary significantly for different cell types. But often the sarcomatoid mesothelioma is more difficult to treat. Due to the spread to the surrounding tissues.

Causes of Pleural Mesothelioma

The first cause of mesothelioma is exposure to asbestos (80% of cases). But only 5% of people exposed to asbestos develop mesothelioma.
This indicates that exposure to asbestos is not solely responsible for cancer.
Other less frequent causes of mesothelioma are:
  • Radiotherapy,
  • SV40 virus (not confirmed)
Mesothelioma is a rare type of cancer. But it is not uncommon in people exposed to asbestos.
These individuals have a 1000-fold increased risk of developing a mesothelioma.
The risk doubles if the person exposed to asbestos is also a smoker. Because smoking stimulates macrophages that play an important role in the development of mesothelioma.
Exposure to asbestos may occur:
  • Directly,
  • Indirectly.
The direct exposure occurs when a person is directly in contact with asbestos fibers.
For example:
  • The workers of asbestos mines,
  • Construction workers,
  • Restorers,
  • Shipbuilders,
  • Breakers and mechanics working with vehicle brakes and clutches.

The indirect exposure occurs when people:

  • They enter into indirect contact with asbestos (eg living or servicing buildings with asbestos parts: pipes, roofs, etc.)
  • They remain in contact with people exposed directly to asbestos. For example, the family and friends of people directly exposed to asbestos. And who incorporated the fibers into clothing or hair. It is not necessary to expose yourself to asbestos for long periods of time. But also short-term exposure can cause mesothelioma. Mesothelioma is the main effect on the health caused by inhalation of asbestos. But it can occur along with:
  • Asbestosis: formation of scar tissue or pulmonary fibrosis by asbestos fibers.
  • The lung cancer: cancer develops in the lung tissue.
Mesothelioma is very different. And should not be confused with lung cancer or asbestosis.

Symptoms of Pleural Mesothelioma

The signs and symptoms of pleural mesothelioma include:
  • Chest pain (from mild to severe)
  • A backache
  • Pleural effusion
  • Shortness of breath or dyspnea, first from exertion, then also at rest
  • Nodules on the skin and chest
  • A persistent cough (from mild to severe)
  • Fever
  • Fatigue
  • Weight loss
  • Muscle weakness
  • Constant breath during respiration
  • Traces of blood in the phlegm.

Symptoms of peritoneal mesothelioma

The signs and symptoms of peritoneal mesothelioma can be:
  • Constant belly pain (from mild to severe)
  • Abdominal bloating
  • Tissue lumps in the abdomen
  • Intestinal occlusion 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 the formation of testicular nodules.
In some cases, it causes pain in the testicle.

Diagnosis of mesothelioma

The diagnosis of mesothelioma is not easy. Because the symptoms are similar to those of other more frequent diseases such as:
  • Pneumonia,
  • Pleuritis,
  • Colds,
  • Seasonal allergies.
After examining the patient's complete medical history. The doctor prescribes other tests if he or she suspects the presence of mesothelioma.

Instrumental exams

The best way to diagnose mesothelioma is through instrumental exams, for example:
  • Chest X-ray ( X-ray ): This is the main exam. In mesothelioma, radiography shows a thickening of the mesothelium in the lower (basal) part of the lung. In the advanced stages, the thickening extends to the higher parts of the lung. Often, a pleural effusion is also seen.
  • Computed tomography: it is useful to evaluate the extent of the disease.
  • Magnetic Resonance: This test may be useful in determining the severity of mesothelioma.
  • PET scintigraphy: used to evaluate the progression stage of mesothelioma.

Biopsy and laboratory tests

Another way to confirm mesothelioma is to remove the tissue with a biopsy.
Issa may include:
  • Surgical thoracoscopy in laparoscopy for pleural mesothelioma.
  • Peritoneoscopy for peritoneal mesothelioma (in laparoscopy).

Treatment for Mesothelioma

A definitive cure for mesothelioma is not possible; treatments are used to:
  • Reduce symptoms,
  • Increase the patient's life expectancy.
The doctor considers:
  • The internship,
  • The site of the tumor,
  • The age,
  • The health condition of the patient.
The most common treatment for mesothelioma is surgery, followed by:
  • Radiotherapy,
  • Chemotherapy.
A combination of these treatments may be used, depending on the specific case.

Pleural Mesothelioma

Surgery for pleural mesothelioma

Surgeons remove mesothelioma. When it is diagnosed at an early stage and still operable.
Surgery can help reduce the signs. And symptoms caused by mesothelioma that is spreading throughout the body.

Surgical options may include:

1. Surgery to decrease fluid accumulation
Pleural mesothelioma can result in fluid accumulation (pleural effusion). Causing difficulty in breathing. The surgeon inserts a tube or catheter into the chest to drain the fluid. He may also inject a drug into the chest to prevent the return (pleurodesis) of the fluid.

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

If the removal of the entire tumor is not possible. Surgeons may try to remove most of it. Debulking allows physicians to more accurately target chemotherapy or symptoms.

4. Surgery to remove a lung and the surrounding tissue (pleuropneumonectomy extrapleurica). Removal of the affected lung and surrounding. Tissue may relieve the signs and symptoms of pleural mesothelioma. Performing radiotherapy on the chest after surgery allows doctors to use higher doses of radiation. Because they do not have to worry about protecting the lung from the harmful effects of treatment.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells.
Systemic chemotherapy travels throughout the body and can reduce or decrease the growth of non-operable mesothelioma.
Chemotherapy may also be used:
  • Before surgery (neoadjuvant chemotherapy) to make the operation easier,
  • After surgery (adjuvant chemotherapy) to reduce the chance of recurrence.
  • In the abdomen (intraperitoneal chemotherapy) in the case of peritoneal mesothelioma,
  • In the thoracic cavity (intrapleural chemotherapy) in the case of pleural mesothelioma.
Using this strategy, chemotherapists can achieve mesothelioma directly without damaging healthy cells in other parts of the body.
This allows physicians to administer high doses of chemotherapeutic drugs.

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

Experimental therapies
Immunotherapy: Vaccine
Scientific studies on the vaccine for diseases caused by asbestos are being carried out.
This medicine may help the immune system identify cancer cells.
The vaccine may be useful for blocking tumor growth.

Gene
Therapy identifies and modifies the genes responsible for the development of cancer.

Photodynamic Therapy Photodynamic
The therapy uses the properties of light, consisting of:
  • Taking a photosensitizing medicine (ie increasing the sensitivity to light) that is absorbed in greater amounts by the cancer cells.
  • Laser therapy in mesothelioma to destroy cells.

Prognosis, survival and life expectancy of patients with pleural mesothelioma

Mesothelioma is not only a very rare but also the most deadly cancer.
The survival time after diagnosis (which usually occurs 30-40 years after initial exposure to asbestos) is only 12-18 months. Or even less, in the absence of treatment/medication.
One of the main factors influencing life expectancy is the stage of disease progression.

Progress and development of the disease

One of the typical characteristics of mesothelioma is the latency period (ie between exposure to asbestos and the onset of symptoms) that ranges from about 15 to 40 years.
Stage I: In the beginning mesothelioma is located in a layer of the pleura. And the cancer may have extended to the pericardium or diaphragm. The life expectancy of the mesothelioma patient in the first stage is approximately 2 years (21 months).
Stage II: In the second stage the involvement of both layers of the pleura is observed, only on one side of the body. Life expectancy at this stage may be about 1-2 years after diagnosis.
Stage III: In the third stage, cancer spreads through the wall of the thorax, oesophagus. And lymph nodes, on one side of the body. The life expectancy for this phase can be approximately 16 months.
Stage IV (last): In the fourth (terminal) stage of mesothelioma. There is a diffusion to the other organs of the body. And metastases are formed in the bones. liver, brain or other areas of the body.

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Mesothelioma Master: Pleural Mesothelioma
Pleural Mesothelioma
Pleural mesothelioma is a rare malignant cancer caused by asbestos.It is caused by inhaling asbestos fibers into the lungs.
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