Mesothelioma

What is Mesothelioma?

Mesothelioma is an uncommon cancer, originating from the cells which form the membrane lining the abdominal cavity (peritoneal membrane or peritoneum)which houses the intestines, or the chest (pleural membrane or pleura) cavity housing the heart and lungs, in which the cells making up those tissues begin to grow out of control.

Mesothelioma is most often are seen in older patients, more often men that have a history of occupational exposure to asbestos, although other causes such as radiation and certain viruses have occasionally been implicated. In a proportion of cases, no asbestos exposure can be identified.

Mesothelioma involving the lung and pleura characteristically present as progressive shortness of breath due to the thickening of the lining membrane of the lung with gradual contraction of the breathing space; often, fluid accumulates in the lung spaces as well, further interfering with breathing, Mesothelioma involving the abdominal cavity present with digestive symptoms, and abdominal swelling due to thickening of the lining membranes of the gut, and accumulation of large amounts of fluid in the abdomen.

How serious is mesothelioma?

Mesothelioma is serious and potentially life-threatening. Survival of patients with mesothelioma is usually short if effective treatment is not found, especially those with tumors that can be shown to be growing aggressively. Because mesothelioma has usually spread throughout the pleural or peritoneal cavity before the diagnosis is made, complete surgical removal is only rarely possible. Moreover, mesothelioma is not as sensitive to radiation therapy or chemotherapy as are many other tumors.

Diagnosis

In all cases, the diagnosis of mesothelioma must first be unquestionably established by biopsy of affected or suspicious tissues, and by definitive microscopic examination by a trained pathologist. Biopsy almost always requires an invasive procedure such as thoracoscopy and pleural biopsy, or laparotomy or laparoscopy. The removed tissues may be treated with special biological or chemical stains which are used to help the pathologist establish a firm diagnosis. The pathologist usually also comments upon the rate of growth and biological virulence of the tumor

Second, the tumor must be staged if possible by X-ray, CAT scan, MRI or other types of scans to clarify its location within the body, and to estimate the likelihood of effective curative or palliative therapy. Staging of mesothelioma by x-ray measurements, however, is difficult and often unreliable.

Treatment

A treatment plan is devised depending upon the mesothelioma type, aggressiveness, primary location, and degree of local (rarely, distant) spread. The treatment of pleural mesothelioma is difficult. Treatment with surgery, radiation therapy or chemotherapy used alone or in combination may be proposed, depending upon the potential benefits and risks of each modality. Surgery is rarely used alone, but sometimes suffices when only a small pleural patch of mesothelioma is detected, thus allowing visually complete removal of the tumor. More often, mesothelioma of the left or right pleural cavity cannot be completely removed without taking the entire lung (pneumonectomy) on the same side as well. In such cases, radiation therapy and/or chemotherapy is given postoperatively to help eradicate any residual mesothelioma that may have escaped the surgeon.

The treatment of peritoneal mesothelioma is even more problematic; until recently no consistent treatment was available. Peritoneal mesotheliomas have been managed in the experimental setting with combined modality treatment consisting of extensive(usually not complete) debulking surgery, followed by intraperitoneal and systemic chemotherapy followed in turn by whole abdominal radiation therapy.

Because mesothelioma now represents less than one percent of cancers and are infrequently seen in the practice of most community oncologists, finding the correct treatment can be very difficult. Proper management of mesothelioma often requires evaluation at larger tertiary hospitals or Comprehensive Cancer Centers by specialists in medical, surgical and radiation oncology with experience in all aspects of the clinical care of mesothelioma patients, including the newest experimental treatments.

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