Pleural mesothelioma is a rare cancer that grows around the lungs and chest due to exposure to asbestos in most cases. Learn about modern treatment methods used in Turkey.
What is pleural mesothelioma (mesotheloma carcinoma)?
Pleural mesothelioma is a rare cancer that grows around the lungs and chest.
Exposure to asbestos (a material used in construction) accounts for most cases of this type of cancer.
Malignant (cancerous) mesothelioma forms in the pleura.
This thin layer of tissue lines the chest walls and covers the lungs.
This type of cancer takes its name from the middle layer, which is the lining that protects your internal organs.
This layer produces a substance that prevents the organs from sticking together.
Cancer that forms in any part of the middle layer is called mesothelioma.
How common is pleural mesothelioma?
Mesothelioma is diagnosed in approximately 3,000 Americans each year.
Pleural mesothelioma accounts for 3 of 4 of these cancers.
What is asbestos?
Asbestos is the name for a group of strong natural mineral fibers that are resistant to fire and chemicals.
Asbestos has been used for years in construction and industry.
Fibers are found in wood panels, floor tiles, and ceilings in many homes.
Manufacturers use asbestos in car brakes and linings, among many other uses.
Asbestos fibers are only harmful when they are airborne, and are generally not considered dangerous if they are not agitated and dispersed in the air.
Who is at risk of developing pleural mesothelioma?
Asbestos is naturally found in air, water, and soil.
Almost everyone breathes small amounts of asbestos throughout their lives.
This simple exposure does not increase your risk of developing cancer.
Most people who develop pleural mesothelioma have high levels of asbestos exposure over a long period of time.
This exposure usually occurs while working.
Occupations most exposed to asbestos include:
- Auto workers, factories and railways
- Building repair workers and demolition crews
- Construction workers and masons, including shipbuilders
- Insulation Material Manufacturers and Installers
Symptoms and causes of mesothelioma
What causes pleural mesothelioma?
For eight out of 10 people with pleural mesothelioma, exposure to asbestos is the main cause.
But most people exposed to asbestos never develop mesothelioma.
In rare cases, exposure to high levels of radiation (such as radiation therapy for another cancer) may cause pleural mesothelioma.
Airborne asbestos fibers decompose into particles that are too small to be seen.
When you breathe it in, the particles settle in your lungs.
These particles can cause scarring and inflammation.
In some cases, it causes changes in cells that lead to cancer.
Asbestos-containing materials are safe as long as they are held in place.
Asbestos poses a health hazard only when the material is disturbed by releasing the fibers into the air.
What are the symptoms of pleural mesothelioma?
It can take 30 to 50 years for pleural mesothelioma to appear after exposure to asbestos.
Early signs of pleural mesothelioma can be annoying but are easy to get rid of.
The main symptoms are persistent chest pain and shortness of breath.
Other symptoms include:
- Cough and hoarseness.
- Difficulty swallowing (dysphagia).
- lower back pain.
- Swelling of the face and arms.
- Unexplained weight loss.
Diagnostics and tests for mesothelioma
How is pleural mesothelioma diagnosed?
Your doctor will perform a physical exam, review your medical history, and evaluate risk factors.
You may get one or more of these tests:
- Blood tests to check for high levels of these substances (fibulin-3, mesothelin-related soluble peptides) often associated with mesothelioma.
- Chest X-ray to look for changes in the lung, such as thickening of the pleura or pleural effusion (fluid between the lungs and the chest wall).
- Imaging tests, such as an MRI, CT scan, or Positron emission tomography (PET) scan To check for signs of cancer.
- Examination of pleural fluid cells and a biopsy of fluid and tissue for cancer cells.
Management and treatment of mesothelioma cancer in Turkey
What are the complications of pleural mesothelioma?
Pleural mesothelioma increases the risk of pleural effusion.
This condition occurs when fluid builds up between the lungs and the chest wall, making it difficult to breathe.
Your doctor may perform a procedure called a chest blasting to drain the fluid.
It inserts a thin needle into the space between the lungs and the chest wall to remove fluid.
Some people may need a catheter (a thin hollow tube) to drain fluid constantly.
Patients whose mesothelioma has not spread widely may be eligible for surgical treatment.
This is the best way to remove large portions of affected tissue.
Chemotherapy is the appropriate treatment for any type of cancer, and is the traditional way to kill cancer cells in the body.
Mesothelioma requires the use of special chemical solutions to give the desired results.
Radiation is another traditional cancer treatment.
Radiation therapy is non-invasive and beneficial for all stages and types of mesothelioma.
Drugs that activate the immune system to target and kill mesothelioma cells are known as immunotherapy.
This type of treatment is becoming more common.
Multimodal therapy is a combination of many of the above treatments. Doctors now believe that the best way to extend survival time is to use multimodal methods such as surgery and chemotherapy.
Each treatment for mesothelioma began in a clinical trial.
The trials allow researchers to test new treatments and give patients access to more options.
Types of treatment
Mesothelioma doctors create a course of treatment based on the patient's prognosis.
The doctor considers the patient's cancer stage, cell type, and tumor location.
These factors play an important role in deciding which types of treatment are appropriate for the patient.
Physicians use curative treatments (aimed at achieving complete recovery from the disease) to remove mesothelioma from the patient's body.
Patients diagnosed with pleural mesothelioma - and eligible for curative treatment - may undergo one of the typical surgeries for pleural mesothelioma: extrapleural pneumonectomy (EPP) or exfoliative pleurectomy (P/D).
People diagnosed with peritoneal mesothelioma may undergo a cytoresection, which doctors often combine with hot chemotherapy in a procedure called cytoreduction with HIPEC.
Treatment is palliative when a doctor uses it to relieve pain caused by symptoms of mesothelioma.
The most common palliative treatments work to drain fluid that has accumulated in the chest or abdomen.
Most patients with pleural mesothelioma have their chest ruptured.
Patients with peritoneal mesothelioma undergo blasting of the abdominal cavity.
Multimodal therapy is a combination of two or more treatments, usually surgery and chemotherapy or radiotherapy.
With multiple treatments, doctors can attack mesothelioma in more than one way.
For example, using cytoreductive surgery to remove most of the tumor, and hot chemotherapy to destroy any remaining cancer cells.
A study conducted by researchers at the Dana-Farber Cancer Center — one of the highest-ranking cancer centers in the United States — showed that 22 percent of patients lived at least 5 years after multimodal treatment.
Surgery for patients with pleural mesothelioma is done either through Video Endoscope or through a large incision.
- pleurectomy with removal of the crust (P/D)
Pleurectomy with removal of the cortex of the lung (P/D) is a surgical procedure that doctors use to remove the lining of the lung most affected by tumor growth and any visible tumors on the surface of the lung itself.
If mesothelioma has spread beyond the lining of the lung, your doctor may also remove parts of the diaphragm and pericardium (the protective lining of the heart).
The goal of using this type of surgery is to relieve symptoms of mesothelioma without sacrificing the lung.
90 % patients had reduced symptoms, and 100 % retained respiratory function.
- extrapleural pneumonectomy (EPP)
Doctors use extrapleural pneumonectomy (EPP) to remove the entire lung and nearby tissue affected by mesothelioma.
To prevent the disease from returning, the diaphragm, nearby lymph nodes and the lining of the heart may also be removed.
Surgery for peritoneal mesothelioma patients
- Excision of the peritoneum. Surgeons use a peritonectomy to remove any part of the peritoneum (the protective lining of the abdomen) affected by tumor growth.
They also remove any visible tumors that may have spread to nearby organs, such as the diaphragm or stomach.
- Cell excision surgery:
Cytectomy surgery is when the surgeon combines multiple peritoneal resections with chemically completely removing mesothelioma from the abdominal cavity.
Doctors often combine cytoreductive surgery and hot chemotherapy in a procedure called cytoreductive aspiration with HIPEC to maximize its effectiveness.
Chemotherapy is the use of drugs to attack and kill cancer. Its effectiveness depends on your diagnosis, specifically the stage of the cancer and the location of the mesothelioma.
Chemotherapy drugs work best when combined with other medications or with surgery.
Doctors use chemotherapy before surgery, during surgery, or after surgery.
There is a difference in management between systemic chemotherapy and intraoperative chemotherapy:
- Systemic therapy Systemic chemotherapy travels through the bloodstream, attacking any cancer cell it comes in contact with.
Your doctor will give you systemic chemotherapy in pill form or through an IV.
- Treatment during surgery. The doctor administers medications during surgery.
Depending on the procedure, he or she applies chemotherapy directly into the lung or into the abdominal cavity and usually heats the drugs to make them more effective at killing the cancer.
Depending on your tolerance, chemotherapy may affect you severely, very little, or not at all.
Its side effects disappear slowly after treatment and vary according to the type of drug, the amount of dose, and the length of time it is given.
Common side effects during chemotherapy are:
- hair loss
Radiation therapy for mesothelioma
Radiation therapy is the use of high-energy rays to kill mesothelioma cells.
Doctors may use radiation on its own — as a palliative treatment — or combine it with chemotherapy and/or surgery.
With some types of radiation therapy, patients may not experience as many side effects as chemotherapy because doctors can target tumors directly, reducing damage to healthy cells.
Radiation therapies commonly used for mesothelioma patients include:
3D radiotherapy (3D-CRT)
Using 3D tumor scans, doctors adjust the amount and intensity of each radiation dose according to its size and shape.
Adjusting the amount of radiation helps doctors target tumors more effectively and reduce damage to healthy, noncancerous cells surrounding tumors.
Intensity-modulated radiotherapy (IMRT)
IMRTIt is an advanced form of 3D-CRT. Doctors use computers to adjust the amount and intensity of the beam as it passes through the tumor.
In a recent study, researchers showed that IMRT used after extrapleural pneumonectomy (EPP) produced an average overall survival rate of just over two years.
Of these patients, 41 % lived an additional three years after the operation.
Side effects of radiotherapy
Doctors must use high doses of radiation to get the same cancer-killing effectiveness as chemotherapy drugs.
As doctors increase the amount and intensity of radiation, the chances of the radiation destroying healthy cells also increase and more side effects can occur.
Radiation therapy can cause the following side effects:
- skin redness;
- hair loss;
Palliative treatments for mesothelioma
Doctors use palliative treatments to relieve pain caused by symptoms in all stages of mesothelioma.
Doctors may use them to supplement curative treatments for patients diagnosed with stage 1 or stage 2 mesothelioma.
Stage III and IV patients receive palliative treatment to reduce pain and improve their quality of life.
Several types of palliative treatments are available for mesothelioma patients.
Thoracentesis is draining excess fluid from the pleural cavity - the space between the inner and outer lining of the lungs - with a needle. It reduces pressure from too much fluid that puts pressure on the lung and makes breathing difficult.
- Thoracentesis with the application of powder with the help of the camera
With the help of a camera, the doctor drains the excess fluid from the pleural cavity and seals it with talcum powder (a substance called talk). Talc causes an inflammatory reaction that closes the pleural space.
Over time, scar tissue forms and prevents more fluid from collecting.
Doctors use this procedure to reduce chest pain and relieve pressure caused by fluid buildup.
- Partial pleurectomy
Doctors use a partial pleurectomy to remove the lining of the lung affected by mesothelioma.
The growth of the tumor causes the lining of the lung to harden, making breathing difficult.
Removing part of the hard lining allows the lung to re-expand and makes breathing easier.
- Abdominal puncture
It is the drainage of excess fluid from the abdominal cavity.
Where the fluid is drained through a needle.
Relieves pressure caused by fluid buildup in this vacuum.
Too much fluid in the abdominal cavity puts pressure on the organs, causing severe discomfort and pain.
New treatments in clinical trials
If you don't qualify for traditional treatments, such as surgery or chemotherapy, participating in a clinical trial may give you an opportunity to improve your condition with new treatments.
In clinical trials, researchers have developed new ways to fight mesothelioma such as immunotherapy, a treatment that strengthens the immune system and helps kill mesothelioma cells.
How do I can block tumor epithelium medium pleural?
Since the late 1970s, the Environmental Protection Agency (EPA) has regulated the use of asbestos in building materials.
The Environmental Protection Agency also regulates cleaning of asbestos-containing materials.
Many homes, buildings, cars, and products made before 1980 may still contain asbestos.
Workers at risk of exposure to asbestos should wear protective equipment to prevent breathing in asbestos.
It is also important to avoid staining clothes, hair, and shoes with particles.
Before remodeling an old home, have an asbestos control expert inspect your home.
Removing asbestos from ceilings or walls is not necessary if they are not subject to moving.
If you plan to demolish a wall or dig into a roof that contains asbestos, you need to hire an asbestos control company to do the job.
You should never attempt to remove asbestos-containing materials yourself.
This step is important to protect the health of your family.
Outlook / Prognosis of the disease
What is the outlook for people with pleural mesothelioma?
There is no definitive cure for pleural mesothelioma. Treatments can extend a patient's life, relieve symptoms, and help you feel more comfortable.
You can also try treatments that show promise in clinical trials.
Unfortunately, for most people with pleural mesothelioma, life expectancy is one to four years after diagnosis.