Mesothelioma is a rare disease type of cancer. This cancer occurs in the lining of the body's internal organs, a thin layer of cells known as the mesothelium, a protective lining that covers most of the body's internal organs. While very thin, this layer of cells is vitally important to organ function and the health of the inner body structures. Its common site is the pleura (outer lining of the lungs and internal chest wall). But it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surround the heart), or tunica vaginalis.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
The primary cause of mesothelioma is exposure to asbestos, where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing mesothelioma.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems.
In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic ung ailment), and other cancers, such as those of the larynx and kidney. Unlike lung cancer, there is no association between mesothelioma and smoking. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Mesothelioma that affects the pleura can cause chest wall pain, pleural effusion, or fluid surrounding the lung, shortness of breath, fatigue or anemia, wheezing, hoarseness, or cough, blood in the sputum (fluid), and coughed up (hemoptysis).
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax or collapse of the lung. The disease may metastasize (spread) from their original site to other parts of the body. Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include abdominal pain, ascites or an abnormal buildup of fluid in the abdomen, a mass in the abdomen, problems with bowel function, and weight loss.
In severe cases of the disease, the following signs and symptoms may be present: blood clots in the veins, which may cause trombophlebitis; disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs; jaundice, or yellowing of the eyes and skin; low blood sugar level; pleural effusion; pulmonary emboli, or blood clots in the arteries of the lungs; and severe ascites. A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis.
While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. Tuberculosis, heart failure). If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma.
A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs.
Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary. To diagnose mesothelioma, the doctor will learn the stage (or extent) of the disease.
Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment. There are three types of mesothelioma. Pleural mesothelioma is a cancer of the lining of the lung (pleura), peritoneal mesothelomia is a cancer of the lining of the abdominal cavity (peritoneum), and pericardial mesothelomia is a cancer of the lining surrounding the heart (pericardium). Sub-types (or cell types) of mesothelioma are epithelioid (the most common, and considered the most amenable to treatment), sarcomatous (a much more aggressive form), and biphasic or mixed (a combination of both of the other cell types).
The structural appearance of cells under the microscope determine the cell or sub-type of mesothelomia. Epithelioid is the least aggressive; sarcomatoid, the most aggressive. The biphasic or mixed cell type shows structural elements of both of the other two. More on the histologic subtypes of mesothelomia.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
THE SYMPTOMS OF MESOTHELIOMA
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.Mesothelioma that affects the pleura can cause chest wall pain, pleural effusion, or fluid surrounding the lung, shortness of breath, fatigue or anemia, wheezing, hoarseness, or cough, blood in the sputum (fluid), and coughed up (hemoptysis).
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax or collapse of the lung. The disease may metastasize (spread) from their original site to other parts of the body. Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include abdominal pain, ascites or an abnormal buildup of fluid in the abdomen, a mass in the abdomen, problems with bowel function, and weight loss.
In severe cases of the disease, the following signs and symptoms may be present: blood clots in the veins, which may cause trombophlebitis; disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs; jaundice, or yellowing of the eyes and skin; low blood sugar level; pleural effusion; pulmonary emboli, or blood clots in the arteries of the lungs; and severe ascites. A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
DIAGNOSIS
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A complete physical examination may be performed, including x-rays, of the chest or abdomen and lung function tests.The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis.
While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. Tuberculosis, heart failure). If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma.
A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs.
Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary. To diagnose mesothelioma, the doctor will learn the stage (or extent) of the disease.
Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment. There are three types of mesothelioma. Pleural mesothelioma is a cancer of the lining of the lung (pleura), peritoneal mesothelomia is a cancer of the lining of the abdominal cavity (peritoneum), and pericardial mesothelomia is a cancer of the lining surrounding the heart (pericardium). Sub-types (or cell types) of mesothelioma are epithelioid (the most common, and considered the most amenable to treatment), sarcomatous (a much more aggressive form), and biphasic or mixed (a combination of both of the other cell types).
The structural appearance of cells under the microscope determine the cell or sub-type of mesothelomia. Epithelioid is the least aggressive; sarcomatoid, the most aggressive. The biphasic or mixed cell type shows structural elements of both of the other two. More on the histologic subtypes of mesothelomia.
TREATMENT
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy and chemotherapy. Sometimes, these treatments are combined. There are conventional and new approaches to treat malignant mesothelioma. The combinaton of complementary and conventional therapies is sometimes referred to as integrative medicine.Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
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