All tumors of this type are divided into pleural mesothelioma:
Diffuse , in which the cells adjoin each other not tightly, without forming a clear structure. A tumor without smooth borders, resembles a thickening on the surface, can spread to large areas. Cancer cells actively penetrate deeper layers of tissue and grow into neighboring organs. Most of these tumors occur (75%).
Localized, with strict boundaries. Reminiscent of a bright, bulging node, consisting of cells similar to epithelial. Such an education is considered more benign, since it does not give metastases and does not affect neighboring organs.
Depending on the structure of cells in the diffuse type of mesothelioma, several subspecies are distinguished:
Epithelioid tumors . The most common (54% of all cases). Spread over the surface of the mesothelium. Cells are similar in structure to epithelial cells.
Sarcomatoid. Their structures quickly grow into the internal connective tissues and are similar to them in the appearance of the cells.
Desmoplastic . More often formed in the abdominal cavity. Cancerous elements have a rounded shape. Around the tumor, a dense connective tissue rim is formed.
Mixed (biphasic), consisting of cells of the first two groups. They are found quite often – in 25% of patients.
There are very rare forms that today are almost never diagnosed. This is papillary mesothelioma and an adenomatous tumor. They are considered benign because they do not give metastases.
The tumor grows slowly, so the symptoms do not appear immediately. Sometimes, before the first clinical manifestations, three to five years pass. As a result, education is detected mainly in the later stages , which reduces survival. After diagnosis, life expectancy does not exceed two years.
As the first symptom, 70% of patients report pain. It is stupid in nature, it is difficult to determine the exact place of its localization. Further in the affected area, fluid begins to accumulate. This is due to the fact that all mesotheliomas are capable of producing mucus. Weight loss and an increase in body temperature are observed only in 30% of cancer patients.
The remaining symptoms are more specific and depend on the location of the focus.
Pleural tumors are characterized by cough, bloody sputum, swelling of the joints and thickening of the fingers. As the disease develops, hoarseness of the voice appears, squeezing of the vena cava, which disrupts blood circulation in the head and neck. Accumulation of fluid causes shortness of breath.
With a tumor of the peritoneum, bloating, nausea, and upset stool are felt. The abdomen increases in size with the accumulation of mucous secretions. There is swelling of the legs due to squeezing of blood vessels by an enlarged abdomen.
The defeat of the pericardium is initially limited to pain and interruptions in heart activity, reminiscent of other heart diseases. And after the accumulation of fluid, suffocation, significant circulatory disorders can develop.
The progression of the disease occurs slowly in time, but aggressively in the capture of surrounding tissues. Cells of growth sprout into neighboring tissues in the early stages, and in the third stage, multiple metastases are observed. The most accurate description of the stages exists only for pleural mesothelioma stages.
At the first stage, the lining of the cavity is affected.
Further, the cancer affects the lung tissue with which it most often comes in contact.
The formation affects the heart bag and mediastinum (tissues located in the center of the sternum in front).
Cancer affects the intercostal muscles, surrounding organs and blood vessels.
Other mesotheliomas proceed according to a similar pattern, spreading to surrounding tissues and giving metastases, starting from the third stage.
Pleural mesothelioma is the only type of pleural cancer; In almost all cases, mesothelioma is caused by exposure to asbestos. The diagnosis is based on a history and radiography or CT scan of the chest organs, as well as the results of a biopsy. Supportive treatment, surgery, chemotherapy, or both are required.
Asbestosis is the collective name of silicates, whose heat-resistant and structural properties allow it to be used for construction and shipbuilding, in automobile brakes and some textile products. Chrysotile (snake fiber), crocidolite and amosite (amphibole, or straight fibers) – 3 main types a
The risk of developing mesothelioma over the course of life in people working with asbestos is about 10%; the disease can develop 25-30 years after exposure. The risk is not dependent on smoking. Mesothelioma develops from the mesothelium of the pleural cavity and can spread locally or metastasize to the basal and mediastinal lymph nodes, pericardium, diaphragm, peritoneum, liver, adrenal glands or kidneys, rarely to the vaginal membrane of the testicle.
Patients most often experience shortness of breath and non-pleuritic chest pain. When diagnosed, constitutional symptoms are rare. Germination of a tumor in the chest wall and other adjacent structures can cause severe pain, dysphonia, dysphagia, Horner’s syndrome, brachial plexopathy, or ascites.mesothelioma prognosis
Cytological examination of pleural effusion or pleural biopsy
In some cases, videoassisted thoracoscopic surgery (BATH) or thoracotomy
Cancer staging: CT, mediastinoscopy, MRI, sometimes PET and bronchoscopy
The pleural form of mesothelioma, which is > 90% of all cases (the remaining 10% are pericardial and peritoneal mesothelioma), is revealed on the radiograph as a diffuse unilateral or bilateral thickening of the pleura, which seems to cover the lungs, leading to blunting of the costal-diaphragmatic angles. Pleural effusion is present in 95% of cases and is usually one-sided, massive, and hemorrhagic. The diagnosis is made on the basis of cytological examination of pleural effusion or pleural biopsy. Elevated hyaluronidase levels in pleural effusion may indicate mesothelioma, but not diagnostic.
If these methods are not informative, a biopsy is performed using BATH or thoracotomy. Soluble mesothelin-related proteins secreted by mesothelial cells into the blood are being studied as possible markers for diagnosis and control, however, research often produces false-positive results.
Cancer staging is performed using CT, mediastinoscopy and MRI. The sensitivity and specificity of MRI and CT are comparable, although it is more appropriate to use MRI to detect tumor invasion into the chest wall, diaphragm, mediastinal structure, spine or spinal cord. PET has a higher sensitivity and specificity for the differential diagnosis of benign and malignant thickening of the pleura. Bronchoscopy can detect concomitant endobronchial cancer.
Mesothelioma remains incurable cancer; life expectancy of patients is quite low. They remove pleura, ipsilateral lung, phrenic nerve, half of the diaphragm, pericardium in combination with chemotherapy or radiation therapy, although they do not significantly change the prognosis or life expectancy. Treatment significantly prolonging survival is absent. The average survival rate from the time of diagnosis is from 9 to 12 months. depending on the location and type of cells. Diagnostic imaging and histopathological examination provide the most compelling prognostic information ( 1 ). Patient prognosis characteristics include
Age> 75 years old at the time of diagnosis
Low performance status
LDH level> 500 IU / L
Platelet count> 400,000 / μl
Chest pain mesothelioma causes
Histological changes of non-epithelial nature
Pleurodesis or pleurectomy with pleural effusion to relieve shortness of breath
Opiate analgesia and, in some cases, radiation therapy
Chemotherapy to reduce tumor size and alleviate symptoms
Given the diffuse nature of the disease, radiation therapy is usually not suitable, except for the treatment of localized pain or metastases along the puncture channel. It is usually not used to treat radicular pain.
To reduce dyspnea caused by pleural effusion, pleurodesis or plerectomy can be used.
Adequate analgesia is important but difficult to achieve. Usually use opioids, both transdermal and introduced through implanted epidural catheters.
Due to the high morbidity and mortality associated with extrapleural pulmonectomy, pleurectomy and lung decortication are increasingly being used if all macroscopically visible tumors are limited to one hemithorax and can be removed. However, total resection is usually not possible and in this case, a combination of chemotherapy and radiation therapy increases survival ( 1 ).
Non-surgical treatments include a combination of chemotherapy regimens (e.g., pemetrexed and platinum compounds) and radiation therapy. Chemotherapy can relieve symptoms in most cases and sometimes reduces the size of the tumor. Combination chemotherapy with pemetrexed and cisplatin prolonged survival by 3 months compared with cisplatin monotherapy ( 2 ). In the course of this study, the addition of folic acid and vitamin B 12 reduced toxicity. Clinical studies have shown that the addition of bevacizumab to pemetrexed and cisplatin resulted in increased survival ( 3 ).
The types of therapies that are being studied include immunotherapy, gene therapy, photodynamic therapy, and hyperthermic intrapleural chemotherapy.
Mesothelial cells line the within of the chest and abdominal cavities, also because the heart bag – the cavity round the heart. These cells also line the surfaces mesothelioma lung cancer of most internal organs.
The tissue formed by mesothelial cells is named mesothelium. The chest mesothelium is named pleura, the abdomen is named the peritoneum, and therefore the heart cavity is named the pericardium.
Mesothelial tumors are benign and malignant, with malignant tumors commonly called mesotheliomas usually occur.
DIFFERENT THREE sorts of MALIGNANT MESOTELIOMI:
1. The epithelioid type, comprising 50-70% among all mesotheliomas and having the simplest prognosis (outcome).
2. Sarcomatoid type (7-20%).
3. Mixed type (20-35%).
Almost 3/4 of mesotheliomas occur within the thoracic cavity and are called pleural mesotheliomas. In 10-20% of cases, a tumor develops within the abdomen – peritoneal mesothelioma. Pericardial mesothelioma is extremely rare.
HOW COMMON ARE MALIGNANT MESOTHELIOMAS?
Mesothelioma may be a rare tumor that’s more common in men after 50 years. per annum , 2-3 thousand new cases of the disease are detected. The tumor are often asymptomatic for an extended time and thus is usually detected within the late stages, which negatively affects the prognosis (outcome) of the disease. the typical survival of patients is typically only 1-2 years.
RISK FACTORS FOR MALIGNANT MESOTHELIOMA
Contact with asbestos may be a major risk factor for mesothelioma. Asbestos is employed within the manufacture of insulating and refractory materials, tiles, restraint , etc. After establishing the connection between contact with asbestos and therefore the development of mesothelioma, the utilization of this substance was sharply reduced.
The risk of developing mesothelioma depends on the intensity and duration of contact with asbestos. Long-term contact at a young age significantly increases the danger of mesothelioma. The period of time from the instant of the primary contact with asbestos to the diagnosis of a tumor is 20-50 years.
Smoking itself doesn’t affect the rise within the incidence of mesothelioma, but the mixture of smoking and exposure to asbestos significantly increases the danger of developing carcinoma . In smokers with asbestos exposure, the danger of developing carcinoma is 50–90 times above within the general population.
To prevent (prevent) the event of mesothelioma, it’s necessary to avoid contact with asbestos reception and within the workplace.
DIAGNOSIS OF MESOTHELIOMA
The early symptoms of mesothelioma aren’t specific. they’re often ignored by patients or taken for the manifestations of ordinary non-tumor diseases.
In some patients, symptoms may persist for six months or more.
50% of patients with pleural mesothelioma note pain within the lower chest on the side or back. Many patients complain of shortness of breath. In some cases, there’s difficulty swallowing, coughing, sweating, weakness, weight loss and fever.
Other symptoms include hoarseness, hemoptysis, and swelling of the face and upper limbs.
In patients with peritoneal mesothelioma, abdominal pain, nausea, vomiting, and weight loss are possible. Some patients may develop fluid within the abdomen (ascites) and / or a tumor.
If you think a mesothelioma, you want to urgently consult a doctor who will determine the presence of risk factors and schedule an examination. During the examination, the doctor can detect the presence of fluid within the cavity (pleurisy), abdomen (ascites) or pericardium (pericarditis), which occurs as a results of the event of the tumor.
X-ray of the chest allows you to detect thickening of the pleura, the presence of calcifications (mineral deposits) within the pleura and fluid within the cavity .
Computed tomography (CT) makes it possible to diagnose mesothelioma and determine the prevalence of the method (stage).
Magnetic resonance imaging (MRI) can help detect damage to the diaphragm, the muscle tissue that separates the chest and abdominal cavities.
Thoracoscopy (examination of the cavity employing a special apparatus) allows not only to spot the tumor, but also to try to to a biopsy (take a bit of tissue for examination) or get a liquid for microscopic examination to clarify the diagnosis.
Laparoscopy (examination of the abdomen using the apparatus) allows you to look at the abdomen , take a bit of the tumor or fluid for examination.
STAGES (PREVALENCE) OF MESOTHELIOMA
Currently, only the stages of pleural mesothelioma are distinguished, since it occurs far more often than other localizations.
There are 4 stages of pleural mesothelioma.
Stage I – the tumor affects the pleura on the left or on the proper , while the lymph nodes aren’t involved within the process.
Stage II – a unilateral lesion of the pleura and therefore the spread of the tumor to the diaphragm or lung tissue.
Stage III – a unilateral lesion of the pleura and therefore the spread of the method to the anterior chest wall, or to the fat of the mediastinum, or pericardium, or lymph nodes on the side of mesothelioma.
Stage IV – Mesothelioma involves muscles or ribs within the process, or the diaphragm, or esophagus, trachea, thymus, large blood vessels, or spine grows, or passes to the opposite side, or spreads through the bloodstream to distant organs.