Pleural Mesothelioma

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Pleural Mesothelioma Cancer

Pleural mesothelioma is a rare form of cancer that affects the pleura or lining around the outside of the lungs. Its only known cause is asbestos exposure. It generally manifests itself twenty to forty years after exposure (minimum of 15 years) and tends to appear most often in men, 50 to 70 years old. In its malignant form is a very serious condition.

There are generally two types of pleural mesothelioma the first being 'diffuse and malignant' , and the second being 'localized and benign' . The first type is cancerous and is generally fatal within a year of diagnosis. The second type is generally not life threatening and can usually be removed through surgery.

Pleural mesothelioma is difficult to detect early on because its initial symptoms tend to be somewhat generic i.e. shortness of breath, chest pain, and coughing, and in some cases there are no initial symptoms. As the disease develops, however, symptoms become more acute. In some cases, pain develops in the abdomen, in others, a severe cough is developed or breathing becomes restrictive. Only with a CT scan or an X-ray will a doctor be able to detect the possible presence of mesothelioma. If possible tumors are detected generally the doctor will perform a procedure called a Thoracoscopy .

During this procedure a doctor makes an incision in the chest wall and passes an instrument called a thorascope between the ribs. The thorascope allows the doctor to look inside the chest cavity to see if there are any abnormalities. A procedure called thoracentesis in which fluid is drained from pleurum may also be done at this time and may serve two purposes: First, the fluid obtained in this process may be analyzed and may occasionally provide a diagnosis. Secondly, draining the fluid or pleural effusion as it is also called, will in many cases help alleviate symptoms such as pain and restricted breathing. Because fluid analysis alone is generally not sufficient to make a diagnosis, the doctor, who discovers abnormalities during the thoracoscopy, will usually require a tissue sample so that the cells of the tissue may be viewed under a microscope by a pathologist. This tissue sample is called a biopsy.

Once mesothelioma has been diagnosed, the next step is determining how far the illness has progressed so that an appropriate treatment plan may be devised. This is done by studying the imaging of MRIs or CT Scans and is known by doctors as 'staging' or rather determining what 'stage' the disease has reached. Doctors chart mesothelioma in five stages of development and will refer to mesothelioma in terms of these stages. i.e. Stage I mesothelioma, Stage II mesothelioma, etc. Stages II through V are considered advanced mesothelioma and typically removal of the cancer is no longer an option. In general, Mesothelioma is very difficult to treat. First its tumors appear in the membranes surrounding the chest cavity and abdominal cavity, than spread to the underlying organs. This type of growth makes a complete surgical removal of Mesothelioma very unlikely.

Therefore, surgery is one of three primary treatment options for malignant mesothelioma. There are two types of surgery; palliative and aggressive. With palliative surgery the goal is to relieve painful symptoms caused by fluid build up or painful pressure exerted by the tumor's growth. The goal is to improve the quality of life and not to cure the disease. This type of surgery includes Thoracentesis a procedure used to drain fluid.

In aggressive surgery, or extrapleural pneumonectomy, the goal is to remove as much of the tumor as possible and attempt a cure. This option will generally only be sought if the disease is in its earliest stage (stage I), and the patient is both relatively young and in good health. Because of the high post surgery mortality rate involved with this operation many hospitals do not perform it. Even when the patient survives the operation it is unlikely to have completely eliminated the tumor.

Radiation therapy is another treatment option and like surgery is a very difficult and risky procedure. The biggest dilemma for the treating doctor is deciding the amount of radiation to use. For while radiation may serve to reduce the cancer, if too great a dose is used, it may also adversely affect surrounding organs. Often radiation therapy is used in conjunction with surgery in the hope that it will eliminate remaining cancerous growths that could not be removed.

Chemotherapy is yet another treatment option and like the other treatments has had limited success in treating mesothelioma. In fact it still hasn't been shown definitively to prolong the life of the patient with malignant mesothelioma. Like Radiation Therapy it is often used after surgery in order to eliminate any cancerous growth that could not be removed during the operation.

The good news is that cancer research is on going and future treatments are being developed. In some cases newer techniques will be available for patients who have run out of other options. A technique called "combination chemotherapy" which uses different combinations of chemotherapy is currently being developed and has so far met with partial success. As far as new medications are concerned, Lovastatin, a cholesterol-lowering drug, was found to destroy mesothelioma cells and therefore might be effective used in conjunction with chemotherapy or radiation. Immunotherapy, treatments which stimulate the immune system to combat the mesothelioma are also being researched. Intracavitary chemotherapy, a technique by which chemotherapy drugs are introduced directly into the peritoneal or pleural space is being researched as well, and has been shown in some studies to be effective. Intracavitary radiation therapy (or Brachytherapy) is based on the same premise. Forms of multimodality therapy, (which refers to techniques combining radiation treatment, chemotherapy, and surgery) are also being researched. Orders of procedure are also being researched. i.e. some physicians are using chemotherapy before surgery as a way of reducing the tumor size. Gene therapy is another burgeoning area of research. An advanced technique called photodynamic therapy, that introduces light sensitive drugs to the tumor than exposes the tumor to light, is also being researched. The future holds a great deal of hope for cancer victims, and mesothelioma patients should always have "there ear to the ground" for the emergence of new techniques.

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