MEDICAL PROCEDURES
Mesothelioma
What is mesothelioma?
Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum).
How do you get mesothelioma?
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Others have been exposed to asbestos in a household environment, often without knowing it.
How much exposure does it take to get mesothelioma?
An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later.
How long does it take after exposure for mesothelioma to show up?
People exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.
How is mesothelioma diagnosed?
Mesothelioma is diagnosed by pathological examination from a biopsy. Tissue is removed, placed under the microscope, and a pathologist makes a definitive diagnosis, and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid build-up around the lungs (pleural effusions), shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an x-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:
For pleural mesothelioma the doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test is usually done in a hospital with a local anesthetic or painkiller.
If fluid has collected in your chest, your doctor may drain the fluid out of your body by putting a needle into your chest and use gentle suction to remove the fluid. This is called thoracentesis. For peritoneal mesothelioma the doctor may also look inside the abdomen with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is usually done in the hospital under a local anesthetic.
If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.
If abnormal tissue is found, the doctor will need to cut out a small piece and have it looked at under a microscope. This is usually done during the thoracoscopy or peritoneoscopy, but can be done during surgery.
What is the prognosis for mesothelioma?
Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated.
Mesothelioma Treatment Options (Traditional & New Treatments Being Studied)
Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use and each one measures somewhat different variables.
The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages.
The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis.
The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.
Traditional care
There are three traditional kinds of treatment for patients with malignant mesothelioma: - Surgery (taking out the cancer)
- Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
- Chemotherapy (using drugs to fight the cancer)
NOTE: Often two or more of these are combined in the course of treatment.
New Approaches Being Studied
New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include: - Promising drugs
- L-NDDP or Platar. Intrapleural administration of this platinum product is designed to overcome the toxicity and drug resistance currently limiting the usefulness of platinum drugs like Cisplatin. NOTE: A recent trial produced remission in two patients.
- Endostatin, shown to work with angiostatin in destroying a tumors' ability to grow blood vessels without harming normal cells.
- Lovastatin is a cholesterol drug shown in a recent study to potentially inhibit mesothelioma cancer cell growth.
- Intrapleural interferon gamma is the direct administration of the anti-cancer drug Interferon Gamma.
- Photodynamic therapy kills cancer cells using the energy of light
- Immunotherapy treats cancer by helping the immune system fight the disease.
- Gene therapy treats cancer by correcting the genetic deficits that allow tumors to develop. A September 1999 study found that Interferon interleukin prevented the growth of mesothelioma cells in mice.
Additional Information
Surgery: There are several types of surgery used in treating mesothelioma. - A pleurectomy is the removal of part of the chest or abdomen lining and some of the tissue around it.
- Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy.
- In an extrapleural pneumonectomy, the lung is removed along with the lining and diaphragm (the muscle that helps you breathe) on the affected side. In this surgery, the lining around the heart is also removed.
- Sometimes a pleurectomy/decortication is performed. In this surgery, the lining of the lung is removed along with as much of the tumor as possible.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and use gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be administered by pill, or it may be put into the body by a needle in the vein or muscle.
Chemotherapeutic agents can be administered either systemically (through the blood stream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.
Butchart System extent of primary tumor mass - Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
- Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
- Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
- Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.
TNM System -- variables of T (tumor), N (lymph nodes), M (metastasis) - Stage I:Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
- Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
- Stage III:Mesotheliomas is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
- Stage IV:Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal al cavity or neck. Any distant metastases is included in this stage.
Brigham System: (variables of tumor resectability and nodal status) - Stage I: Resectable mesothelioma and no lymph node involvement
- Stage II: Resectable mesothelioma but with lymph node involvement
- Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
- Stage IV: Distant metastatic disease
Is there any promising research or are there promising drugs for mesothelioma?
Research is being conducted at various cancer centers all over the United States.
A recent study involving L-NDDP (brand name: Platar) produced two cases of remission in mesothelioma patients. Another study found that a drug known as Lovastatin may hold promise for mesothelioma patients.
To learn more about mesothelioma clinical studies and journal medical journal articles visit the Mesothelioma Web http://www.mesotheliomaweb.org.
What kinds of resources are available for people with mesothelioma?
There are numerous cancer web sites, some specific to mesothelioma. Because they are often difficult to locate, we have listed some relevant medical web sites that have information about mesothelioma.
American Institute for Cancer Research
(http://www.aicr.org)
American Thoracic Society
(http://www.thoracic.org/)
Canadian Cancer Society
(http://www.bc.cancer.ca)
MesotheliomaWeb
(http://www.mesotheliomaweb.org)
The above content is supplied with kind permission from MesotheliomaWeb (www.mesotheliomaweb.org). - Mesothelioma is a cancer that arises from the cells lining the chest or abdominal cavities.
- Mesothelioma typically results from exposure to asbestos.
- When mesothelioma affects the chest the doctor may look inside the chest cavity with a special instrument called a thoracoscope.
- When mesothelioma affects the abdomen, the doctor may look inside the abdomen with a special tool called a peritoneoscope.
- Mesothelioma is diagnosed by a biopsy.
- The outlook for patients with mesothelioma depends on how early the disease is detected and how aggressively it is treated.
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