Mesothelioma of the pleura: symptoms, causes, prevention

Mesothelioma of the pleura is an extremely dangerous cancer that is accompanied by the appearance and development of a malignant tumor on the pleural membrane of the lungs. Naturally, such an ailment can not but affect the condition of the lungs and the whole organism. That is why it is so important to get acquainted with the main causes and symptoms of the disease. The sooner a correct diagnosis is made and therapy is started, the greater the chance of achieving remission and prolonging a person's life.

What is pleural mesothelioma? Photo and brief description

Pleural cancer is a rare oncological disease. Despite the fact that it can be diagnosed at any age, the majority of patients with this diagnosis consist of mature men who are somehow involved in harmful production. It is also worth noting that the number of people suffering from this disease is growing every year.

Mesothelioma is a tumor that forms during the malignant degeneration of epithelial cells of the pleura. At first it looks like small nodules or flakes, the number of which increases as the disease develops, forming a kind of shell around the lungs.

Varieties of malignant tumors

In modern medicine, there are several classification systems. Depending on the type of cells, the pleural mesothelioma can be:

• Epithelioid (this type of tumors occurs in 50-60% of cases);
• Fibrotic, or sarcomatoid (occurs in 10% of cases);
• In 30-40% of all cases the tumor is biphasic, or mixed (composed of both types of cells).

Depending on the structure, acinar, small cell, light cell and tubopapillary malignant tumors are isolated.

Pathogenesis of the disease

Mesothelioma of the pleura is the result of malignant degeneration of the cells of the membrane epithelium of the pleura (mesothelium). With the nodular form, a tumor is formed in any part of the parietal or visceral pleura. Nevertheless, most often there is a diffuse form of the disease, in which malignant cells spread diffusely along the pleura, enveloping the lungs with a case. In the event that the pleural cavity remains free, a cluster of hemorrhagic (with blood impurities) or serous-fibrinous exudate is seen inside.

Since the pleura is in close contact with the pericardium (the envelope enveloping the heart muscle), the malignant cells in the later stages can also extend to the pericardial layers. Also, the tumor is able to give metastases to the lymph nodes.

The main causes of the disease

An interesting question is the reasons for the appearance of this disease. Naturally, it was not possible to fully study the mechanism of malignant cell degeneration. Nevertheless, modern researchers managed to find out that there are several risk factors provoking such a terrible disease:

• The cause of malignant cell degeneration can be contact with asbestos. According to statistical studies, 9 out of 10 men who had had pleural mesothelioma had previously worked with this material. By the way, asbestos was widely used in the industry until about the 1970s.
• Risk factors include human infection with the SV40 virus, which is known in medicine under a different name, namely monkey virus. From 1955 to 1963 a global vaccination of the population from poliomyelitis was carried out. Unfortunately, the vaccine was infected with viral particles. How exactly this strain participates in the process of formation and development of mesothelioma is not completely known, but some connection can be traced.
• The cause of the development of the disease can be the effect on the body of radioactive radiation. For example, mesothelioma can develop by contacting the body with thorium dioxide. By the way, this substance was used during X-ray studies until the 1950s. And the pleural lesion may be associated with earlier radiotherapy.
• Contact with certain chemicals is also capable of provoking the disease. For example, constant work with some types of paints, solvents, aggressive chemical reagents first leads to the defeat of the airways, and then to malignant degeneration of cells.

What symptoms occur against the background of the disease?

Immediately it is worth saying that malignant pleural mesothelioma is developing incredibly quickly. Without timely diagnosis, after a few months, the disease can lead to the death of a person.

As a rule, the first symptoms are pain in the lower part of the chest, and sometimes the back. In addition, patients complain of frequent dry cough, which is also accompanied by soreness. As the disease develops, there are difficulties with swallowing, hoarseness of voice.

There are other signs that accompany pleural mesothelioma. Symptoms include severe sweating and fever. Often, patients develop anemia. It is also possible to lose weight, with no diets or any change in nutrition.

Since fluid accumulates in the pleural cavity, dyspnoea is one of the disorders, not only during physical activity, but also at rest. Puncture and extraction of exudate help for a time to alleviate the condition of the patient. Nevertheless, the thickened pleura presses on the organs of the mediastinum, often causing violations from the cardiovascular system.

Diagnosis of the disease

Upon examination, an experienced physician may suspect that the patient has pleural mesothelioma. Diagnosis is supplemented by chest X-ray. But in the pictures you can see only a few signs. Therefore, other research is needed:

• The main method of diagnosis is computed tomography. During the examination, you can notice the presence of effusion in the pleural cavity, nodal thickening of the pleura, tumor masses that surround and squeeze the lung, the displacement of the mediastinum.
• Magnetic resonance imaging provides a more accurate picture of the extent of the tumor. You can also determine the degree of damage to the diaphragm and the spread of the disease to surrounding soft tissues.
• In the presence of indications, positron emission tomography is also performed, which allows to determine the presence of distant metastases and the degree of lesion of the lymph nodes.

Some procedures performed for the morphological confirmation of the diagnosis

After the above procedures, morphological confirmation of the diagnosis is required. This means that it is necessary to determine whether the detected neoplasms are a malignant mesothelioma.

First of all, exudate from the pleural cavity is taken for analysis, which is then sent for cytology. Unfortunately, the sensitivity of this technique is only 25-50%, and therefore other tests are needed. Sometimes a histological examination is carried out, the accuracy of which, unfortunately, is also not too high and is about 60%. Nevertheless, these procedures are the most affordable and cheap, and therefore they are appointed in the first place.

More precise are invasive methods, in particular mediastinoscopy and thoracoscopy (includes diagnostic chest dissection).

What does the treatment process look like?

Unfortunately, the effect of drugs, which are used in modern medicine for chemotherapy, is only 20%. The use of "Cisplatinum", "Mitomycin", "Etoposide", "Gemzar" and some other medicines makes it possible to reduce the size of the tumor and achieve objective improvements in the patient's condition. Nevertheless, the gold standard is combined chemotherapy. For example, the scheme may look like this: "Gemcitabine" + "Alimta" or "Gemcitabine" + "Cisplatinum."

If there is a pleural effusion, the patient may be given the injection of cytostatics directly into the pleural cavity. Sometimes, for the same purpose, interferon is used. This helps to slow or completely stop the accumulation of exudate and, accordingly, significantly ease the breathing of the patient.

Naturally, active research on a variety of anticancer drugs is underway. Promising drugs are inhibitors of vascular endothelial growth factor. Unfortunately, the percentage of survival among patients leaves much to be desired.

Necessary surgical procedures

This disease leaves not much room for maneuvers, especially if it is a question of later stages of the disease. So is surgery possible if the patient is diagnosed with pleural mesothelioma? Surgical treatment, as a rule, is carried out only if the tumor is localized in one place. In such cases, the pleura is removed, sometimes together with a part of the lung. Similar procedures are carried out in approximately 11-15% of cases. Life expectancy even after such radical therapy is 9-22 months, at best several years. The most effective result is combined therapy, in which the operations are combined with chemotherapy.

Mesothelioma of the pleura: prognosis

Cancer is dangerous in any case. So what to expect for a patient who is diagnosed with "pleural mesothelioma"? The forecast, alas, is not very comforting. Naturally, it all depends on which stage the disease is diagnosed. In consideration it is necessary to take the age and general health of the patient, the effectiveness of the drugs used, etc. In general, with proper therapy in the early stages of the disease, one can achieve remission, sometimes even saving the patient's life for 5-6 years.

Unfortunately, quite often the patients are diagnosed with more advanced pleural mesothelioma (stage 4). How many live with such a disease? Unfortunately, even with the use of all methods of modern medicine, it is rare to save a patient's life for longer than 2-8 months.

Are there any preventive measures for the disease?

Mesothelioma of the pleura of the lung is an incredibly dangerous disease that often causes the death of a person. Unfortunately, there is no effective preventive agent. Nevertheless, it is worthwhile to thoroughly study the main factors that can provoke malignant cell degeneration, and if possible try to avoid them. For example, pulmonologists strongly do not recommend working with asbestos, living in adverse conditions, etc.

Naturally, it is worth to give up smoking, since this bad habit can provoke a lot of diseases of the respiratory system, including this. And it is also important to take preventive X-ray examination of the lungs every year (fluorography), because the sooner one or another disease is diagnosed, the greater the chance of success of treatment. Special attention should be paid to workers of harmful industries whose health is in great danger.