Mesothelioma FAQ

Mesothelioma cell lines the inside chest and abdomen, as well as heartfelt bag - the cavity around the heart. These cells are also lines the surface of most internal organs.

Fabric formed mezotelialnymi cells is called mezoteliya. Mezotely chest called pleurisy, abdominal - ventral cavity and heart - pericardium. Tumors mezoteliya are benign and malignant, and usually there are malignant tumors, called mesothelioma.



There are three types of malignant mezoteliom:
1. Epitelioidny type of 50-70% of all mezoteliom and with the best prognosis (outcome).

2. Sarkomatoidny type (7-20%).

3. Mixed type (20-35%).

Nearly 3 / 4 mezoteliom occurs in the thoracic cavity and are called the pleura mezoteliom. In 10-20% of the tumor develops in the abdomen - mesothelioma peritoneum. Mesothelioma pericardiocentesis occur very infrequently.

How frequently malignant mesothelioma occur?
Mesothelioma is a rare tumor, which is more common in men after 50 years. Every year thousands of new evidence of 2-3 cases. The tumor may be a long time, asymptomatic, and therefore is often detected at later stages, which negatively influences the prognosis (outcome) of disease. The average survival rate of patients is usually only 1-2 years.

Risk factors of malignant mesothelioma.
Exposure to asbestos is a major risk factor for mesothelioma. Asbestos is used in the manufacture of insulation and fire-resistant materials, tiles, brake pads, etc. Once the relationship of contact with asbestos and mesothelioma development of this substance has been dramatically reduced.
The risk of developing mesothelioma depends on the intensity and duration of exposure to asbestos. Prolonged contact at a young age greatly increases the risk of mesothelioma. The time period from the time of first contact with asbestos before the diagnosis of tumors is 20-50 years.

Smoking by itself does not affect the increase in the development of mesothelioma, but the combination of smoking and asbestos exposure significantly increases the risk of developing lung cancer. A smoking people exposed to asbestos, the risk of developing lung cancer increased in the 50-90 times compared with the general population.

To prevent (prevent) the development of mesothelioma must be taken to avoid contact with asbestos at home and at work.


Diagnosis of mesothelioma
Early symptoms mezoteliom are not specific. They are sometimes ignored or taken for patients of normal neopuholevyh diseases. Most patients with mesothelioma symptoms appear in 2-3 months to identify the tumor. A number of patients with symptoms may continue for 6 months or more.

50% of patients with mesothelioma pleura note at the bottom of a chest pain in the side or rear surface. Many patients complain of shortness of breath. In some cases, there is difficulty swallowing, coughing, sweating, weakness, weight loss and increased temperature. Other symptoms can indicate osiplost voice, hemoptysis, swelling of the face and upper limbs.

Patients with mesothelioma peritoneum possible abdominal pain, nausea, vomiting, weight loss. Some patients may receive the fluid in the abdomen (ascites) and / or swelling.

If you like mezoteliomu is an urgent need to consult a doctor to ascertain the presence of risk factors and appoint survey. During the examination the doctor can detect the presence of fluid in the pleural cavity (pleurisy), abdomen (ascites) or perikarde (pericarditis), which occurs as a result of the development of tumors.

Chest x-ray can detect thickening of pleura, the presence of kaltsifikatov (mineral deposits) in plevre and fluid in the pleural cavity.

Computer tomography (CT) makes it possible to diagnose mesothelioma and to determine the prevalence of (stage).

Magnetic resonance imaging (MRI) can help identify lesions diaphragm - the muscle tissue, which separates the chest and abdominal cavity.

Thoracoscopy (examination of pleural cavity with a special device) you can not only identify the tumor, but also to make a biopsy (take a piece of tissue for research) or to obtain fluid for microscopic studies to clarify the diagnosis.

Laparoscopy (abdominal examination with the help of the device) you can examine the abdominal cavity, take a piece of the tumor, or fluid for research.


Stages (prevalence), mesothelioma
Currently, only differentiated stage mesothelioma pleura, as occurs much more frequently than others localizations. There are 4 stages pleura mesothelioma.

Stage I - the tumor affects plevru the left or right, and the lymph nodes in the process is not involved.

Stage II - one-sided defeat of pleura and the spread of tumor in the diaphragm or lung tissue.

Stage III - one-sided defeat of pleura and distribution process on the front chest wall, or fatty tissue mediastinum, or pericardium, or lymph nodes on the side of mesothelioma.

Stage IV - mesothelioma involved in muscle or ribs, or sprouts diaphragm, or esophagus, trachea, thymus, the major blood vessels, or spine, or moving to the other side, or distributed through the bloodstream to distant organs.

Treatment of malignant mesothelioma
The choice of treatment depends on several factors including the stage of the tumor, the general condition of the patient and his views. Given the rarity of mesothelioma, it is advisable to carry out specialized cancer treatment facilities that have experience in the treatment of such patients.
Surgical treatment
The operation can be performed as a palliative or therapeutic purposes. A palliative operation meant surgery, which can eliminate or reduce pain or discomfort caused by the growth of tumors. Such operations are used when it is impossible to remove a tumor because of the prevalence of the condition of the patient or heavy.

Plevroektomiya / decortication is generally palliative operation is to remove the pleura, which prevents the accumulation of fluid and reduce the pain.

Torakotsentez - a procedure in which a needle is removed from the liquid from the pleural cavity to facilitate the patient's condition.

The introduction of talc or antibiotics in the pleural cavity in order to temporarily prevent the accumulation of fluid in the well in 90% of patients with mesothelioma pleura.

Puncture the front abdominal wall allows you to remove the accumulated fluid in the abdomen in patients with mesothelioma peritoneum.

Patients with mesothelioma pericardiocentesis pericardiocentesis execution provides an opportunity to remove fluid and improve the heart's activity.

Patients in a satisfactory condition with a localized tumor, performing radical surgery, ie complete removal of mesothelioma.
One should bear in mind that often, after the alleged radical operations are microscopic tumor foci. In this regard, the importance of radical operations in patients with mesothelioma contested.

Vneplevralnaya pneumonectomy is the removal of pleura, diaphragm, pericardiocentesis and light on the side of destruction. This extended operation can be performed only highly trained surgeons, oncologists in the patients with good general condition with severe concomitant diseases.

In patients with localized mezotelimoy peritoneum may be an attempt to remove a tumor along with part of the abdominal wall. Unfortunately, most patients with mesothelioma peritoneum performance of radical operations can not be in the prevalence of the process.

In the case of localized lesions pericardiocentesis performed his disposal, and in the dissemination process - palliative intervention to prevent the accumulation of fluid.


Radiation therapy
External radiation is used in patients with mesothelioma frequently.
With internal radiation radioactive material is brought directly to the tumor.
This type of radiation therapy is used as the primary method of treatment for patients in serious condition, when they can not move a serious operation.

Supporting radiotherapy after non appointed operations to destroy the remaining cancer cells.
Palliative irradiation is used to alleviate symptoms caused by the growth of tumors: shortness of breath, pain, bleeding and difficulty swallowing.

Radiation therapy can cause adverse reactions and complications in the form of burning the skin, weakness, nausea, vomiting, liquid stool, damage lung tissue, difficulty breathing.
Most adverse events being held after the completion of the course of irradiation.
It is known that radiation therapy may increase the side effects of chemotherapy.


Chemotherapy
When treating patients with malignant mesothelioma drugs could be imposed not only intravenously, but intrapleural and vnutriperitonealno (in the abdominal cavity).
Depending on the stage of tumor chemotherapy can be both substantive and supportive treatment. Moreover, chemotherapy is used only as a palliative, giving only a temporary effect.
Of the anticancer drugs used: doxorubicin, cisplatin, methotrexate, vinorelbin and others in various combinations.

On the adverse reactions of chemotherapy include: nausea, vomiting, loss of appetite, hair loss, the appearance of ulcers in the mouth, increased susceptibility to infections, bleeding. Most adverse events being held after completion of treatment.

Malignant mesothelioma

Mesothelioma as a malignant tumor was first described in 1870, more frequent failure plev-market than the peritoneum, with a predominance of pravostoronney localization. Men get sick more often than women, with respect, 8:1. Mesothelioma may occur at any age, even among children 2-4 years old. In the etiology of mesothelioma main importance is the duration of contact with asbestos and mineral erionitom used in construction practice. Etiological factor considered to be a genetic predisposition, as well as the simian virus SV40.

According to the WHO histologic classification (1999), malignant mesothelioma are divided into epitelial items, sarkomatoidnye and mixed (bifaznye). The most frequent adverse is sarcoma-toidny version of the tumor. Effusion in the pleural cavity may be in 60-80% of patients, but the growth of tumors can cause the complete obliteration of pleural cavity.

The forecast in the pleura mesothelioma unfavorable, the median survival time (when symptomatic therapy) is 7 months.

Surgical treatment of plevrektomy or plevropnevmonektomy a rare, with localized forms, only 7-10% of patients. After plevropnevmonektomy operating mortality reaches 14-15%, far exceeding the (minimum) plevrektomy mortality. Indicators of a long-tion of life after these operations, little different: the median survival in line with 9-21 months. 2-year survival rate is 11-45% (Giaccone G., 2002; Rahman M. Et al., 2003). Improving the long-term results of surgical treatment (primarily plevropnevmonektomy) associated with adjuvant chemotherapy.

The experience of surgery, combined treatment (surgery + chemotherapy + radiotherapy) helped to develop the following recommendations in the pleura mesothelioma: Performing ekstraplevralnoy pneumoectomy (plevropnevmonektomii), through a 4-6 weeks to 6 cycles of chemotherapy drugs with the appointment of platinum, followed by radiotherapy in the area Remote lung and mediastinum. Direct mortality, in different groups of comparison, was 5-22%, median survival - 21 months., 2-5-year survival - 45 and 22% respectively. The factors most favorable prognosis are the type of epithelial tumors, as well as the absence of metastasis.

Radiation therapy (ODS to 50 Gy.) Leads to a reduction in pain, but does not increase life expectancy (increasing doses, as well as a combination of radiation and chemotherapy does not increase the survival rate).

The effectiveness of modern drugs in the pleura mesothelioma rarely exceeds 20%. Marked tumor regression and objective improvement in the application of cisplatin, cycloplatam, mitomycine, raltitreksida (tomudeksa), etoposide, karboplatina, ifosfamida, vinorelbina, gemtsitabina (gemzara) pemetrekseda (alimty).

Combination chemotherapy is carried out as follows: doxorubicin + CYCLOPHOSPHAMIDE, doxorubicin + ifosfamid, doxorubicin + cisplatin + - mitomycine C kampto + cisplatin + mitomycine C gemtsitabin + cisplatin (karboplatin) gemtsitabin + alimta, alimta + cisplatin (karboplatin). Last 3 schemes are considered the standard treatment pleura mesothelioma.

If there is effusion in the pleural cavity may intrapleural introduction of cytostatic drugs or biotherapy to stop or slow the accumulation of exudation. To do this, apply cisplatin, bleomycin, as well - interferon and interleukin-2. Features of photodynamic therapy are studied.

In addition, undergoing clinical trials targetnye drugs: avastin, iressa, glivek, thalidomide, etc., which can increase the survival rate. Among targetnyh drugs should be given to the inhibitors of vascular endothelial growth factor. It is noted that the pleura mesothelioma at a high level of expression of vascular endothelial growth factor correlates with higher density of capillaries and low survival. In this regard, with mesothelioma studied semaksanib, bevatsizumab (Awa-Steen) and thalidomide.

Pleura mesothelioma

Relatively rare tumor, characterized by diffuse infiltrative growth. The risk of the disease is significantly higher in patients with asbestosis. The literary figures in the U.S., where the effects of asbestos are subject to a professional 7-8 million people, the incidence of malignant mesothelioma of 0,1-0,2 per 100 thousand inhabitants and the annual increases (peritoneum and pleura affected equally often). Since 1976 in France this pathology refers to occupational diseases (B. Saillard et al., 1977). The latent period of malignant mesothelioma is 20-30 years.

Pathogenesis pleura mesothelioma insufficiently explored, however, found that asbestos fibers are tropnost to seroznym shells. Of the respiratory tract, they migrate to pleurisy, which can accumulate in large quantities and serve as trigger for the development of tumors. With the lymph flow, towards the parietal pleura, tumor cells implanted in it, and gradually spread across the surface. Thus, the tumor involves both visceral or parietal pleura sheets, leading to the circulation of lymph, the rapid accumulation of exudation in the pleural cavity.

Certainly, the diagnosis of mesothelioma pleura difficult. Its non-clinical manifestations vary depending on the incidence of breast cancer patients and the localization of lesions.

The diagnosis of mesothelioma pleura determined with the use of biopsy pleura, electron microscopy and immunohistochemical study. Surgical treatment of mesothelioma are rare (in 7-10% of patients), and 2-year survival rate after surgery is only 10-35%. Radiation therapy is usually conducted to reduce the pain syndrome and has no effect on survival. Among cytostatics, active against mesothelioma, mention should be made of platinum derivatives, gemtsitabin, antratsikliny. The use of these drugs leads to the objective effect at 20-48% of patients. It should be noted gemtsitabin combination + cisplatin (karboplatin), doxorubicin + cisplatin + mitomycine C + cisplatin alimta. Perspective may also be a combination of new cytostatics, as well as their combination with targetnymi drugs. The important prognostic factor is the young age epitelioidny type of tumor, as well as the effect of adjuvant chemotherapy after radical plevropnevmonektomy.