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Pleural Mesothelioma

2008-02-18T05:09:00.002+07:00

Pleural mesothelioma is an aggressive form of cancer that originates in the mesothelial cells lining the pleura, a membrane that covers the lungs and lines the chest cavity. Approximately 75% of all mesotheliomas diagnosed are pleural mesotheliomas. Pleural mesothelioma is most commonly unilateral (on one side of the chest), and occurs most often in men age 60-80 with a history of asbestos exposure, often decades prior to diagnosis.

When pleural mesothelioma begins, it appears as a series of small white nodules which become diffuse, or widespread on the pleural surface. Gradually, these nodules begin to grow together and thicken, forming a “rind” that encases the lung and extends into the fissures or grooves of the pleura and the diaphragm. The tumor spreads by direct invasion of surrounding tissue, inwardly compressing the lung, and outwardly invading the chest wall and ribs.

Symptoms

The early symptoms of pleural mesothelioma are not, as a rule, specific enough to cause alarm, and in most cases are attributed to increasing age or overwork. Because of this, it may be several months from the onset of generalized symptoms until the first acute symptom, pleural effusion, occurs. At that time, progressive shortness of breath caused by the effusion, and chest pain caused by chest wall invasion may be in evidence. More general symptoms include dry cough, fatigue, night sweats and weight loss.

Diagnosis

On initial examination by a doctor, 80% to 95% of patients show pleural effusion on x-ray, the remaining percentage show little or no fluid. At first, the fluid is free-flowing, and is similar in appearance to that seen in other benign causes or in congestive heart failure, and because of this, these other possibilities are the first to be ruled out in the diagnostic process. Later, the effusion becomes “loculated”, or contained within a boundary in the pleural space, where the fluid does not move.

CT scans are more definitive, and may show not only the effusion, but the presence of pleural masses as well as the size certain lymph nodes; MRI is more sensitive in determining chest wall invasion and spread of disease through the diaphragm; PET may help in staging the disease for possible surgical resection by ruling out extension to the contralateral (opposite) lung or to other distant sites.

Analysis of pleural fluid yields a confirmed diagnosis in a relatively small percentage of patients, and needle biopsy offers only slightly better results. Today, the procedure of choice is the VATS (video-assisted thoracoscopy) procedure, which has a diagnostic yield of >95%, and allows for pleural biopsy, drainage of fluid and pleurodesis. VATS also ensures adequate tissue samples to facilitate a definitive diagnosis.

Mesothelioma Treatment: Chemotherapy & Radiation

2008-02-02T00:10:00.000+07:00

1. Mesothelioma Treatment Options: Chemotherapy

Chemotherapy uses drugs to kill cancer cells and may be used as the primary treatment to mesothelioma, or it may be used as part of a multi-modal approach. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle.

In addition to killing cancer cells, chemotherapy drugs work to restrict the uncontrolled spread of abnormal cancer cells - preventing them from dividing and multiplying.

Chemotherapy is not considered a “curative” approach for the treatment of mesothelioma and instead focuses on shrinking existing tumors (usually prior to surgery - neoadjuvant therapy), controlling the spread of the cancerous cells, and removing residual cancer cells following surgery (adjuvant therapy).

To effectively treat mesothelioma, more than one drug may be used in chemotherapy. This is known as combination therapy. Depending on the drugs, the amount taken and the treatment period, there may be side effects.

The present chemotherapy standard of care for the treatment of pleural mesothelioma is Alimta® + cisplatin, although another platinum agent may be used in place of cisplatin if needed.

2. Mesothelioma Treatment Options: Radiation Therapy

Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation).

In pleural mesothelioma, it is difficult to irradiate tumor tissue successfully without injuring nearby organs like the lungs, heart, and liver. However, radiation therapy can be very effective in relieving pain in certain situations. Factors which can impact the use of radiation treatment include the volume of the tumor and how near it is to vital organs.

Mesothelioma Treatments: Surgery

2008-02-02T00:05:00.000+07:00

There are several types of surgeries that may be available for mesothelioma. The disease type, stage and the individual's age and condition will determine if and what type of surgery may be performed. Because mesothelioma is a diffuse malignancy, where tumors are spread throughout the mesothelial tissue making complete extraction of the cancerous tissue impossible, surgery is usually combined with chemotherapy and/or radiation therapy to ensure the best results.

There are generally two types of surgical methods for the treatment of mesothelioma:

1. Palliative Procedures

Palliative Procedures are those which treat the symptoms of mesothelioma, providing relief for the patient, without aggressively treating the disease itself. These procedures include:

Chest Tube Drainage and Pleurodesis
The goal of chemical pleurodesis is to cause an irritation between the two layers covering the lung. This irritation causes an obliteration of the space between the layers where the fluid accumulated, and prevents further fluid to be able to accumulate there. A variety of agents can be used for this, including talc and bleomycin. As the pleural space is closed,fluid drains out of the chest cavity using a chest tube.

Pleuroperitoneal Shunt
Pleuroperitoneal shunting has been used in patients who have failed chemical pleurodesis, chemotherapy, or radiation therapy. Pleuroperitoneal shunting can provide effective palliation in patients with a trapped lung or others who have failed treatment.

2. Potentially Curative Procedures

Potentially Curative Options are medical procedures that attempt to remove all gross disease with “curative intent.” Residual microscopic disease cells are then removed through Adjuvant therapy. These procedures include:

Pleurectomy/Decortication
A Pleurectomy/Decortication is a surgical procedure where the pleura, the membrane lining the lungs and chest cavity, is removed, without removing the entire lung. This treatment option is usually performed on patients in the early staging of mesothelioma.

Extra-Pleural Pneumonectomy (EPP)
EPP is the removal of the pleura, diaphragm, pericardium, and the whole lung involved with the tumor. EPP is considered a radical therapy and is not frequently performed by most surgeons, patients are referred to centers specializing in these treatments.

Multi-modal Therapy
Both the above “potentially curative” procedures are typically used in combination with other treatment options (multi-modal therapy).

Mesothelioma Treatments

2008-02-02T00:04:00.000+07:00

While there is currently no known cure for malignant mesothelioma, treatments are available with the most common being surgery, chemotherapy and radiation therapy.

Your doctor will recommend one treatment or a combination of therapies that are best for your situation. The course of treatment will depend on a number of factors including the location of the disease, the stage of the disease, your age, overall health and your preferences.

The information provided throughout this website is for your information only, and should NOT take the place of a full medical diagnosis.
Mesothelioma Treatment Types

As in all forms of cancer treatment, there are traditional modalities for the treatment of mesothelioma, as well as experimental, non-traditional options.

Traditional Mesothelioma Treatment Options

* Surgery (physical removal of the cancer)
There are several types of surgeries that may be available for mesothelioma. The disease type, stage and the individual’s age and condition will determine if and what type of surgery may be performed.

* Chemotherapy (using drugs to fight the cancer)
Chemotherapy uses drugs to kill cancer cells and may be used as the primary treatment to mesothelioma, or it may be used as part of a multi-modal approach. Chemotherapy is referred to as systemic treatment because the drug is introduced into the patient’s bloodstream and travels throughout the body killing cancer cells. The drugs may be in pill form, or injected into the body through a needle.

* Radiation Therapy (using high-dose x-rays to kill cancer cells)
Radiation therapy uses high-energy x-rays help to destroy cancer cells and shrink tumors. The radiation may come from outside the body from a machine (external radiation) or from radioactive materials placed directly in or around cancer cells through thin plastic tubes (internal or implant radiation).

Doctors will often use two or more of these treatment courses jointly to provide the maximum likelihood of success. This multi-modal approach holds the most promise for survival of malignant mesothelioma patients. Trimodality therapy, in which all three of these modalities are used, is considered the most effective, and aggressive, approach.

Non-Traditional Mesothelioma Treatment Options

* Photodynamic Therapy
Photodynamic therapy destroys cancer cells by using the energy from light and may also be effective when combined with surgery. Although this treatment is in the experimental stage for mesothelioma, it has shown promising results in treating other cancers.

* Gene Therapy
This is a new treatment, currently in clinical trials. This approach allows treatment to target tumors, rather than destroying healthy cells which is the negative of traditional chemotherapy.

* Immunotherapy
Immunotherapy (or biological therapy) treats cancer by using the body’s own immune system to fight cancer cells. Another name often applies to this therapy: biological response modifiers (BRMs).

Lung Cancer - Mesothelioma

2008-01-27T05:56:00.000+07:00

Lung cancer is the leading cause of death in asbestos-related injuries and illnesses. Asbestos is a highly toxic group of fibrous minerals that was widely used in the production of buildings, homes, schools, automobile brakes and clutch parts, ceiling and floor tiles, cement, and thousands of other products around the world.

If asbestos fibers are compromised by renovation, remodeling, deterioration, or disturbance, the fibers may break loose and become airborne. Once these fibers are inhaled or ingested, they may become trapped in the lungs or the digestive tract permanently, causing serious illness or disease such as lung cancer.

Lung cancer risk factors

While smoking is the highest risk factor for lung cancer, frequent workplace or non-occupational exposure to high levels of asbestos is another leading cause of the disease. Tradesmen in the steel, plumbing, electrical, auto, milling, mining, and insulation industries, among others, are at the highest risk of developing lung cancer caused by asbestos exposure. Studies have found that workers who are regularly exposed to asbestos increase their risk of lung cancer by seven to ten times than those in the general population. In addition, asbestos workers who also smoke cigarettes are 50 to 100 times more likely to die from lung cancer.

Symptoms of lung cancer

Lung cancer is difficult to diagnose early, spreads at a rapid rate, and is rarely cured. Lung cancer caused by asbestos exposure typically occurs at a younger age than other lung cancers and is most likely found in the lower lobes. Some common symptoms of lung cancer include, but are not limited to:

* Change in breathing patterns
* Shortness of breath
* Persistent chest pains
* Coughing
* Hoarseness
* Anemia

Peritoneal Mesothelioma

2008-01-27T03:58:00.000+07:00

Peritoneal mesothelioma is a relatively rare form of malignant mesothelioma, making up slightly less than 30% of diagnosed mesothelioma cases. This type of mesothelioma affects the cells of the abdominal lining, also known as the peritoneum, which supports and protects organs in the abdomen.

The peritoneum is made up of two layers, called the visceral and parietal layers. The parietal layer is an outer layer that covers the abdominal cavity, while the visceral layer covers internal organs and the intestinal tract.

Asbestos and Peritoneal Mesothelioma

Exposure to asbestos may cause peritoneal mesothelioma in one of two ways. One theory suggests that asbestos fibers are ingested and eventually work their way into the peritoneum, while another suggests that asbestos fibers that are inhaled are transported to the peritoneum via the lymphatic system.

Once in the peritoneum, asbestos fibers cause changes in peritoneal cells that cause them to divide without restraint, causing the peritoneal layers to thicken. The growth of cancer cells puts pressure on internal organs, and this pressure is increased by fluid that builds up in the area as a result of cancer growth.

Symptoms of Peritoneal Mesothelioma

Mesothelioma is a very late onset form of cancer. After initial asbestos exposure has occurred, it is common for two or three decades to elapse before symptoms begin to appear. Symptoms of peritoneal mesothelioma may include the following:

* Weight loss
* Fever or night sweats
* Pain or swelling in the abdominal area
* Obstruction of the small or large intestine
* Anemia

Peritoneal Mesothelioma Diagnosis

Diagnosis of peritoneal mesothelioma is based on these and other symptoms, as well as the results of diagnostic procedures such as x-rays, CT scans and MRI scans. These are used not only to diagnose the disease itself, but also to discover how far it has advanced.This information will help to determine the best course of treatment.

Often a biopsy is also required to confirm a diagnosis of peritoneal mesothelioma. This may take the form of a needle biopsy or tissue biopsy, although in some cases both may be required. A needle biopsy involves using a long needle to remove fluid from the abdominal cavity, while a tissue biopsy requires minor surgery to remove tissue from the area. The fluid or tissue is then tested to determine whether malignant mesothelial cells are present.

Treatment for Peritoneal Mesothelioma

Symptoms of peritoneal mesothelioma are non-specific in that they are often associated with other less serious conditions. Diagnosis is therefore often made too late for curative treatment to be an effective option.

For most patients with peritoneal mesothelioma, treatment is palliative, and is designed reduce the rate at which the cancer spreads, and to provide relief from the symptoms of the disease. Treatment typically involves a combination of surgery and chemotherapy, as either treatment alone is much less effective as when they are used in conjunction with each other.

Surgery is not always a practical option for individuals with peritoneal mesothelioma. Surgical procedures involve the removal of diseased sections of the peritoneum, and are often followed up with intravenous or intraperitoneal chemotherapy (where drugs delivered through a vein or directly to the peritoneal cavity) to remove residual cancer cells that were not able to be removed during surgery.

In cases where surgery and chemotherapy are not suitable treatment options, palliative treatment is used to provide symptomatic relief; however, such treatments cannot slow the progression of the cancer. These types of treatments are used simply to manage pain and provide relief from symptoms such as the build up of fluid in the peritoneal cavity.

What is Mesothelioma ?

2008-01-27T01:02:00.000+07:00

Mesothelioma is a dreaded cancer that is nearly always caused by just one factor: exposure to asbestos. It's an unfortunate truth that millions of Americans and people all over the world have been poisoned by toxic levels of asbestos, putting them at risk for mesothelioma, asbestosis, lung cancer, and other deadly diseases that are directly caused by the inhalation of asbestos fibers.

Causes of Mesothelioma

Before the grave dangers of asbestos were known, and even for years after the dangers were known, asbestos was used in literally thousands of products that humans and animals encounter every day — particularly in building components such as ceiling and floor tiles, walls, bricks and stucco, and in automotive parts such as brakes and clutches.

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People who worked in the asbestos industry or in fields in which asbestos is used as a component of a product are most at risk for mesothelioma. Many individuals who have mesothelioma labored for years or even decades in jobs that required frequent contact with asbestos. When this mineral is mined, processed, woven, sprayed or otherwise manipulated, its microscopic fibers can be released into the air, where they may be inhaled, initiating the development of mesothelioma.

Types of Mesothelioma

Mesothelioma can attack the pleural lining around the lungs. It can also attack the peritoneum, a tissue that surrounds the GI tract. Mesothelioma can attack the stomach lining, other internal organs, or even the pericardium (the tissue sac covering the heart). Thus, mesothelioma can be generally classified into the following types:

* Pleural — 75% of all mesothelioma cases
* Peritoneal — 10%–20%
* Pericardial — 5%

Mesothelioma can also be classified by the cancer type rather than the location of the cancer:

* Epithelioid — most common, best survival rate
* Sarcomatoid — most severe, but more rare
* Mixed/biphasic — a mixture of epithelioid and sarcomatoid cancer

Symptoms of Mesothelioma

The symptoms of mesothelioma differ somewhat according to the location of the cancer cells. In addition, each mesothelioma patient may have a different combination of symptoms. Tumors that affect the pleura may result in the following signs:

* Wheezing, cough, and/or hoarseness
* Anemia, fatigue
* Bloody sputum
* Shortness of breath
* Chest wall pain, or pain under the rib cage
* Pleural effusion (fluid surrounding the lung)

Mesothelioma in the abdominal cavity often doesn't show symptoms until it's at a late stage. These symptoms may include:

* A mass in the abdomen
* Abdominal pain and/or swelling
* Weight loss
* Bowel problems
* Ascites (an abnormal buildup of fluid in the abdomen)

Treatments for Mesothelioma

Research into new and more effective treatments for mesothelioma is ongoing. There is no cure as yet for mesothelioma. The standard treatments that attempt to hold back the progression of this cancer are:

* Surgery — to remove part of all of the affected body tissues
* Radiation therapy — to target and kill the mesothelioma cells
* Chemotherapy — the use of drugs, injected or taken orally, to kill or stop the growth of the cancer cells