Malignant Mesothelioma: about, risk, symptoms, tests, diagnosis, stages, treatments

Zellos Lambros
Last updated: Sat, 12/09/2017 - 23:49

M.D, M.P.H Thoracic Surgeon, Instructor in Surgery Harvard Medical School

 

Malignant Mesothelioma: About

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the pleura ie thin layer of tissue covering the chest cavity and lungs.

 

Malignant Mesothelioma: Risk factor

Mainly exposure to asbestos and the inhalation of which can be made in:

  •  Jobs
  •  School
  •  Living with a person who works near asbestos.

*After exposure to asbestos, it usually needs long time for malignant mesothelioma to occur.

 

Malignant Mesothelioma:  Signs & Symptoms

Possible signs of malignant mesothelioma include shortness of breath and pain in the thoracic cavity. Sometimes the cancer causes the accumulation of fluid around the lung or abdomen. These symptoms may be caused by fluid pressure or from malignant mesothelioma. Other conditions can cause similar symptoms. A physician should be consulted if any of the following problems occur:

  •  A cough that persists.
  •  Trouble breathing.
  •  Discomfort.
  •  Wheezing.
  •  Strips of blood in the sputum.
  •  Hoarseness.
  •  Loss of appetite.
  •  Unexplained weight loss.
  •  Fatigue.

 

There are two types of mesothelioma: epithelial and non-epithelial.

 

Malignant Mesothelioma:  Tests and procedures to detect, diagnose, and stage

 

Sometimes it is difficult to differentiate between malignant mesothelioma and lung cancer.

The appropriateness of each test depends on the clinical scenario and the physical condition of the patient. Not all tests are necessary.

 

History & Physical examination.

Chest radiograph.

Computed tomography (CAT scan):  A procedure that takes a series of detailed pictures of areas inside the body taken from different angles. The images are made by a computer linked to an X-ray device. A dye may be injected into a vein or swallowed to help the organs or tissues show more clearly.

PET scan (positron emission tomography scan):  A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is used in the body. Malignant tumor cells appear brighter in the picture because they are more active and take up more glucose than normal cells.

MRI (magnetic resonance imaging):  A procedure that uses a magnet, radio waves and a computer to do a series of detailed pictures of the chest or abdomen.

Biopsy of the tumor with a needle:  The removal of part of a lump, suspicious tissue, or fluid in the lungs using a needle. This process is also called needle biopsy with ultrasound, CT scan or other imaging procedure used to detect the abnormal tissue or fluid in the lung. A small incision can be made in the skin where the biopsy needle inserted into the abnormal tissue or fluid. A sample is removed with a needle and sent to the laboratory. A pathologist examines the sample under a microscope for cancer cells. A chest radiograph done after the procedure to make sure that there is no leakage of air from the lungs.

Bronchoscopy:  a procedure within the trachea and large airways of the lung abnormalities. The bronchoscope (a thin, lighted tube) is inserted through the nose or mouth to the trachea and lungs. Tissue samples can be taken for biopsy.

Fine-needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This process is also called a needle biopsy.

Mediastinoscopy:  A surgical procedure for biopsy. A small incision is made above or next to the breastbone and a scope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes can be taken for biopsy.

Thoracoscopy:  An incision is made between the two sides and a scope (a thin, lighted tube) is inserted into the chest. Tissue samples can be taken for biopsy.

Laparoscopy:  An incision (cut) is made in the abdominal wall and scope (a thin, lighted tube) is inserted in the abdomen. Tissue samples can be taken for biopsy.

Laparotomy:  An incision (cut) made in the wall of the abdomen to check the inside of the abdomen for signs of disease. Tissue samples can be taken for biopsy.

Thoracotomy:  An incision (cut) is made between the two sides for control in the chest for symptoms of the disease. Tissue samples can be taken for biopsy.

Cytology:  fluid is taken from around the lungs or the abdomen and the examination of cells in the fluid under a microscope is made by a physician.

 

 

Malignant Mesothelioma:  Stages 

 

Stage I

The cancer is in the lining of the chest wall and can also be found in the lining of the lungs, diaphragm, or pericardium.

Stage II

Cancer is found in the lining of the chest wall and can also be found in the lining of the lungs, diaphragm, or pericardium and lymph nodes in the lung.

Stage III

Cancer has spread to any of the following areas:

  •  Chest wall.
  •  The mediastinum.
  •  The heart.
  •  Beyond the diaphragm.
  •  Peritoneum.
  •  Lymph nodes outside the lung

 

Stage IV

The cancer has spread to distant organs or tissues.

 

Malignant Mesothelioma: Treatment Options

 

1. Surgery

The following surgical therapies may be used:

 Wide local resection: surgery to remove cancer and some healthy tissue around it.

 Pleurectomy/Decortication (Peeling):  Surgery to remove the tumor and the shell of the lungs, the lining of the chest and part of the outer surface of the lungs.

 Pleuropneumonectomy:  Surgery to remove a whole lung and part of the lining of the chest, diaphragm, and the investment of the cavity around the heart.

 Pleurodesis:  A surgical procedure that uses chemicals or drugs to stop the accumulation of fluid in the pleural cavity. Fluid drained from the first site using a catheter or chest tube and chemical injected in the thorax.

Further treatment such as chemotherapy or radiotherapy after surgery to kill any cancer cells remaining may be given even if the doctor removes the entire volume of cancer is seen at the time of surgery.

2. Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping by the division of cells. When chemotherapy is taken by mouth or by injection into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ or body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is dependent on the type and stage of cancer treatment.

3. Radiotherapy

Radiotherapy is a cancer treatment that uses high energy X-rays or other radiation to kill cancer cells. There are two types of radiotherapy. External radiation therapy uses a machine outside the body to send radiation to cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of cancer treatment.

 

Certain factors affect prognosis and treatment options:

  •  The stage of cancer.
  •  The size of the tumor.
  •  If the volume can be removed completely by surgery.
  •  The amount of fluid in the chest or abdomen.
  •  The patient's age and general health, including lung and heart.
  •  The type of mesothelioma cancer cells and how they look under a microscope.
  •  If the cancer has just been diagnosed or has recurred (returned).

 

Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family and medical team.

 

Malignant Mesothelioma:  treatment selection & review by stage

 

Stage I

Treatment will probably be surgery with one of these interventions and adjunctive therapy.

  •  Surgical removal, chemotherapy with or without radiotherapy
  •  Surgical removal, radiation therapy
  •  Pleurodesis and chemotherapy
  •  Chemotherapy

 

Stage II, III

Treatment of patients with advanced malignant mesothelioma may include the following:

  •  Surgical removal, chemotherapy with or without radiotherapy
  •  Chemotherapy, surgical removal, with or without radiotherapy
  •  Surgical removal, radiation therapy
  •  Pleurodesis and chemotherapy
  •  Chemotherapy

 

Stage IV

  •  Pleurodesis and chemotherapy
  •  Chemotherapy

 

 

Recurrent Malignant Mesothelioma

Recurrent malignant mesothelioma is cancer that has relapsed (returned) after being treated. The cancer may come back to the chest or abdomen or other body parts.

 

 

 

 

Info:

Lambros Zellos

MD MPH American Board of Thoracic Surgery Certified

American Board of Thoracic Surgery Certified
 

Dr.  Lambros Zellos  (lzellos@post.harvard.edu)   is a highly qualified thoracic surgeon and researcher with experience in studying mesothelioma, the cancer that affects the pleura and other membranes within the body's cavities.

He was trained at Harvard, and practiced thoracic surgery for a number of years at the Brigham & Women’s Hospital (the busiest thoracic surgery division of the Harvard Medical School with over 2800 thoracic procedures annually) at the rank of Instructor in Surgery.
 
Dr Zellos performed lung and esophageal resection, as well as lung transplants. He was named one of Boston’s 2007 top thoracic surgeons as voted by his peers. He treats thoracic malignant and benign disease, and specializes in the use of minimally invasive techniques that avoid painful rib spreading, also known as VATS (video-assisted thoracoscopic surgery).