Mesothelioma - malignant pleural mesothelioma:
Mesothelioma is a statistically rare disease, a cancer characterized by a condition in whichmalignant cancerous cells develop in the lining (pleura) that surround organs in the patient's body cavities such as chest (thoracic) and/or abdominal (peritoneal) regions.
Pleural Mesothelioma:Pleural Mesothelioma is cancer that develops in the lining that surrounds the lungs (defined as the Pleura) as opposed in the corresponding abdominal tissue, the peritoneum. This is a disease in which cells of the Mesothelium become abnormal and divide and reproduce in a controlled or disorderly manner. This is by no means the same as lung cancer, a more general term which refers to any type of malignant tumor that occurs in the lungs.
Mesothelioma common symptoms are often misdiagnosed. In the early stages of its development, Mesothelioma does not have many readily detectable outward symptoms. When symptoms do develop,they are frequently caused by the pressure of the cancerous tissue pressing on a nerve or other body organ as the Mesothelioma grows and expands.
Mesothelioma Diagnosis:A biopsy is required to confirm a diagnosis of Mesothelioma. In the biopsy process, a surgeon or a medical oncologist (doctors who specialize in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. It may be done in different ways, depending on where the abnormal area is located.
Causes of Mesothelioma:
Exposure to miniscule asbestos fibres or dust, even at low exposure levels, is the most likely cause of most cases of Mesothelioma. Such exposure would probably happened in the 1970s or earlier, but the dormant period may be up to 30 or 40 years.
Asbestos is actually the name of a product that is composed of thread-like minerals occurringnaturally in certain rock formations. Just as "cloth" may be made of several materials (such as wool, cotten or sybthetic fibers), Asbestos can be composed of any of three materials either alone of in combination. The word "Asbestos" comes from a Greek word meaning "inextinguishable".
High Risk JobsAccording to the USA Occupational Safety and Health Administration (OSHA) , an estimated 1.3 million employees in construction and general industry face significant asbestos exposure on the job. Risks of asbestos-related disease increases in direct proportion to exposure to asbestos and length of exposure time. Some individuals with only brief exposures have developed Mesothelioma, while on the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
High-risk working environments and occupations:
- Any asbestos product manufacturing facility (insulation, roofing, building materials).
- Automotive repair shops (installation, repair or replacement of brake pads/shoes and clutch plates).
- Construction sites (residential or commercial).
- Manufacturers of sanding or abrasive materials.
- Oil refineries
- Power generation plants
- Railroad yards
- Steel mills
- Automotive Mechanics
- Building Inspectors
- Carpenters and their helpers (including day labourers)
- Flooring installers
- Furnace installers and repairmen
- Insulation installers
- Iron workers
- Maintenance workers
- Operating Engineers
- Plasterers and drywall hangers
- Sheetmetal workers
- Steam fitters
- Tile cutters/setters
- Ex-Servicemen - Navy, Merchant Marine
Chemotherapy:Mesothelioma chemotherapy treatment is the primary option to surgery. Chemotherapy is definedas the use of drugs to treat cancer. It has had varying degrees of success treating of malignant Mesothelioma. Some drugs result in only limited results. A combined chemotherapy approach (using multiple drugs simultaneously) may result in improved outcomes and some combinations have been shown to hold forth promise and new Mesothelioma drugs are in the experimental phase.
As with radiation treatment, chemotherapy treatment may be used as a follow-up to surgery to destroy any cancerous cells that could not be excised during the procedure.
Radiation Therapy:Radiation is a special kind of energy carried by waves or a stream of particles. It can be generated by machines or from naturally radioactive substances. When radiation is used at high doses (many, many times those used for x-ray exams), it can be used to treat cancer and other illnesses. Highly accurate equipment is used to aim the radiation at tumors or areas of the body where there is disease to destroy cancerous tissues.Also can be called radiotherapy, X-Ray therapy, cobalt therapy, electron beam therapy, or irradiation.
Surgery:Before surgery a number of tests are done to ensure the patient is fit enough to make a full recovery. These can cosist of:
- Blood tests to check general health
- CT (CAT) and MRI scan
- Lung function tests
- Lung perfusion scan
Surgery for malignant Mesothelioma is intended to acheive long-term control (described as aggressive surgery) or to give immediate relief from symptoms (defined as a palliative procedure).
Aggressive Surgery - The procedure known as Extrapleural Pneumonectomy involves the removal of the pleura, the lung, including the diaphragm and the pericardium. This very aggressive, complicated surgery removes as much of the tumorous tissue as possible.Not all hospitals will perform this procedure because of its complexity, associated costs and the high risk of death within 30 days. Extrapleural Pneumonectomy is usually performed only in younger patients in the first stage of the disease's development, whose overall health is good. Prospective patients are evaluated to determine their ability to survive the surgery and surgeons differ in their criteria for selecting candidates. It is important to check with each doctor to determine the standards that will be applied.
Palliative Procedures - When Mesothelioma is well-advanced, palliative procedures may alleviate symptoms e.g. shortness of breath, are caused by effusion (meaning fluid collection)or the pressure of the tumor compressing the lung. This approach is not intended as a curative effort. Another treatment for effusion-related symptoms is Thoracentesis, in which a needle is inserted into the chest to drain the fluid thereby relieving shortness of breath and discomfort. A talc-based powder may be introduced into the pleura to prevent a recurrence of the effusion. A nearly identical procedure may be used to treat ascites (fluid collection) in peritoneal region.
Pleurectal decortication involves the surgical removal of the pleura. It can reduce pain caused by the tumor mass or as a prophilactic measure to prevent the recurrence of pleural effusion. In cases of peritoneal Mesothelioma, surgery intended to provide relief from symptoms such as recurrent ascites or bowel obstructions. As with pleural Mesothelioma, complete surgical removal of the entire tumor is not usually possible.
Extrapleural pneumonectomy - Is the surgical removal of a complete lung and is generally performed as a cancer treatment. There are two types of pneumonectomy: the "traditional" pneumonectomy, in which only the diseased lung is removed and by contrast the "extrapleural" pneumonectomy, the pneumonectomy frequently performed in cases of malignant Mesothelioma. Because Malignant mesothelioma is a cancer of the pleura (the membrane lining the lungs) and therefore the pneumonectomy required to treat this disease, must remove not only the diseased lung, but part of the pericardium (the membrane covering the heart), a portion of the diaphragm and the parietal pleura (the membrane lining the chest cavity) on the same side of the chest. An extrapleural pneumonectomy is the preferred option when a tumor is located in the middle of the lung and has involved a significant portion of the pulmonary artery or veins. Because the surgery is risky and reduces by half the patient's breathing capacity, surgeons usually consider it as a last resort and will usually first consider a pleurectomy.
A Pleurectomy is a more complicated procedure, but spares the lung, involving only the removal of the pleura. Which option is chosen depends on many factors, including the stage of the tumor.
It is unclear if extra-pleural pneumonectomy provides significantly greater benefits than pleurectomy or if either approach is significantly more effective than non-surgical options.Pleurectomy may be technically more difficult and complex than the extrapleural pneumonectomy. However, the mortality of pleurectomy is more favorable (1.5%-5% when performed by an experienced surgeon) and though extrapleural pneumonectomy may appear to be more effective in removing more of the tumor by the en-bloc resection and when performed early enough, pleurectomy is equally effective.
In later stage mesothelioma, when there is a tumor invasion of the lung parenchyma, pleurectomy is no longer an available option.
A recent study designed to compare the effectiveness of pleurectomy, and extra-pleural pneumonectomy revealed that neither was more effective than the other in prolonging survival rates. Instead, other factors seemed to determine how long people survived after treatment. These factors included the stage and cell type of the tumor, the gender of the patient, and the specific choice of treatment(s) given in conjunction with the surgery.
Pleurectomy can provide some symptomatic relief and sometimes the bulk of the tumor can be removed. It is frequently used in combination with other treatments, but its value has been shown to be very limited if the tumor is near any vital organs. Additionally, it is a complex surgical procedure, beyond the skills of most surgeons. Generally, patients are referred to centres specializing in such treatments. Many of these centres also focus on other forms of mesothelioma treatment, either standalone or in combination (multi-modal therapy).
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