Pleural mesothelioma is an extremely dangerous cancer disease, which is accompanied by the appearance and development of a malignant tumor on the pleural membrane of the lungs. Naturally, such an ailment cannot but affect the condition of the lungs and the whole organism. That is why it is so important to get acquainted with the main causes and symptoms of the disease. The sooner a correct diagnosis is made and therapy is started, the more chances there are of achieving remission and prolonging a person’s life.
What is pleural mesothelioma? Photo and short description
Pleural cancer is a fairly rare cancer. Despite the fact that it can be diagnosed at any age, the bulk of patients with this diagnosis consists of mature men who are somehow involved in hazardous industries. It is also worth noting that the number of people suffering from this disease is growing every year.
Mesothelioma is a tumor that forms during the malignant transformation of pleural epithelial cells . At first it looks like small nodules or flakes, the amount of which increases with the development of the disease, forming a kind of shell around the lungs.
Types of malignant tumors
In modern medicine, there are several classification systems. Depending on the type of cell, pleural mesothelioma can be:
- epithelioid (this type of tumor is found in 50-60% of cases);
- fibrous, or sarcomatoid (found in 10% of cases);
- in 30-40% of all cases, the tumor is biphasic, or mixed (consists of both types of cells).
Depending on the structure, acinar, small cell, clear cell and tubopapillary malignancies are distinguished.
Pathogenesis of the disease
Pleural mesothelioma is the result of malignant degeneration of the cells of the integumentary pleural epithelium (mesothelium). With a nodular form, a tumor forms in any part of the parietal or visceral pleura. Nevertheless, a diffuse form of the disease is most often observed, in which malignant cells diffusely spread through the pleura, enveloping the lung with a case. In the event that the pleural cavity remains free, an accumulation of hemorrhagic (with blood impurities) or serous-fibrinous exudate is observed inside.
Since the pleura is in close contact with the pericardium (the membrane that envelops the heart muscle), malignant cells at later stages can also spread to the layers of the pericardium. Also, the tumor is able to give metastases to the lymph nodes.
The main causes of the development of the disease
An interesting question is the causes of this disease. Naturally, it was not possible to fully study the mechanism of malignant transformation of cells to the end. Nevertheless, modern researchers have managed to find out that there are several risk factors that provoke such a terrible disease:
- The cause of malignant degeneration of cells may be contact with asbestos. According to statistical studies, 9 out of 10 men in whom pleural mesothelioma was found previously worked with this material. By the way, asbestos was widely used in industry until about the 1970s.
- Risk factors include infection of a person with the SV40 virus, which is also known in medicine under a different name, namely, the monkey virus. From 1955 to 1963, global vaccination of the population against polio was carried out. Unfortunately, the vaccine was infected with viral particles. How exactly this strain is involved in the formation and development of mesothelioma is not fully known, but a certain relationship is being traced.
- The cause of the development of the disease may be exposure to the body of radioactive radiation. For example, mesothelioma can develop when the body comes in contact with thorium dioxide. By the way, this substance was used during X-ray studies until the 1950s. And the defeat of the pleura may be associated with previously transferred radiation therapy.
- Contact with certain chemicals can also cause illness. For example, the constant work with some types of paints, solvents, aggressive chemicals first leads to damage to the respiratory tract, and then to malignant degeneration of cells.
What are the symptoms of a disease?
It is immediately worth saying that malignant pleural mesothelioma develops incredibly quickly. Without timely diagnosis, literally a few months later, the disease can lead to the death of a person.
Typically, the first symptoms are pain in the lower chest, and sometimes the back. In addition, patients complain of frequent dry cough, which is also accompanied by soreness. As the disease develops, difficulties with swallowing, hoarseness of the voice are observed.
There are other signs that accompany pleural mesothelioma. Symptoms include excessive sweating and fever. Often, patients develop anemia. Weight loss is also possible, without diets or some kind of nutritional change.
Since fluid accumulates in the pleural cavity, shortness of breath is one of the disorders, not only during physical activity, but also at rest. Puncture and extracting exudate help temporarily alleviate the patient's condition. Nevertheless, the thickened pleura presses on the mediastinal organs, often causing disturbances on the part of the cardiovascular system.
Diagnosis of the disease
Upon examination, an experienced doctor may suspect that the patient has pleural mesothelioma. Diagnosis is supplemented by an x-ray of the chest. But in the pictures you can see only some signs. Therefore, other studies are needed:
- The main diagnostic method is computed tomography. During the examination, you can notice the presence of effusion in the pleural cavity, nodular thickening of the pleura, tumor masses that surround and compress the lung, mediastinal displacement.
- Magnetic resonance imaging gives a more accurate picture of the extent of the spread of the tumor. You can also determine the degree of damage to the diaphragm and the spread of the disease to the surrounding soft tissue.
- In the presence of indications, positron emission tomography is also performed, which allows you to determine the presence of distant metastases and the degree of damage to the lymph nodes.
Some procedures for morphological confirmation of the diagnosis
After the above procedures, morphological confirmation of the diagnosis is also required. This means that it is necessary to determine whether the detected neoplasms are actually malignant mesothelioma.
First of all, exudate from the pleural cavity is taken for analysis, which is then sent for a cytological examination. Unfortunately, the sensitivity of this technique is only 25-50%, and therefore other analyzes are needed. Sometimes a histological examination is carried out, the accuracy of which, unfortunately, is also not too high and amounts to about 60%. Nevertheless, these procedures are the most affordable and cheapest, and therefore they are prescribed in the first place.
More accurate are invasive methods, in particular mediastinoscopy and thoracoscopy (includes diagnostic opening of the chest).
What does the treatment process look like?
Unfortunately, the effect of drugs that are used in chemotherapy for chemotherapy is only 20%. The use of “Cisplatin”, “Mitomycin”, “Etoposide”, “Gemzar” and some other medicines can reduce the size of the tumor and achieve objective improvements in the patient's condition. However, combination chemotherapy is the gold standard. For example, a scheme might look like this: Gemcitabine + Alimta or Gemcitabine + Cisplatin.
If there is pleural effusion, then the patient may be prescribed the introduction of cytostatics directly into the pleural cavity. Sometimes interferon is used for the same purpose. This helps to slow down or completely stop the accumulation of exudate and, accordingly, significantly facilitate the patient's breathing.
Naturally, today there are active studies of a variety of anti-cancer drugs. Promising drugs are inhibitors of vascular endothelial growth factor. Unfortunately, the survival rate among patients is poor.
Necessary surgical procedures
This disease leaves not much room for maneuvers, especially when it comes to the later stages of the disease. So is surgery possible if a patient is diagnosed with pleural mesothelioma? Surgical treatment, as a rule, is carried out only if the tumor is localized in one place. In such cases, pleura is removed, sometimes together with part of the lung. Similar procedures are carried out in approximately 11-15% of cases. Life expectancy even after such radical therapy is 9-22 months, at best several years. The most effective result is given by combination therapy, in which operations are combined with chemotherapy.
Pleural Mesothelioma: Prognosis
Cancer is dangerous anyway. So what to expect to the patient who was diagnosed with pleural mesothelioma? The forecast, alas, is not very comforting. Naturally, it all depends on what stage the disease is diagnosed with. It is worth taking into account the age and general state of the patient’s health, the effectiveness of the drugs used, etc. In general, with proper therapy at the early stages of the development of the disease, remission can be achieved, sometimes even saving the patient’s life for 5-6 years.
Unfortunately, quite often patients are diagnosed with more advanced pleural mesothelioma (stage 4). How many live with such a disease? Unfortunately, even with all the methods of modern medicine, it is rarely possible to save a patient’s life for more than 2-8 months.
Are there preventative measures for the disease?
Mesothelioma of the pleura of the lung is an incredibly dangerous disease that often causes the death of a person. Unfortunately, an effective prophylactic does not exist. Nevertheless, it is worthwhile to thoroughly study the main factors that can provoke malignant degeneration of cells, and if possible try to avoid them. For example, pulmonologists strongly do not recommend working with asbestos, living in adverse conditions, etc.
Naturally, it is worth giving up smoking, as this bad habit can provoke a lot of diseases of the respiratory system, including this. And it is also important to undergo a preventive X-ray examination of the lungs (fluorography) every year, because the sooner a disease is diagnosed, the greater the chance of treatment success. Particular attention should be paid to workers in hazardous industries whose health is in great danger.