Everything You Need to Know About Mesothelioma

November 19, 2019    English , health    Comment   

Mesothelioma is cancer that attacks the mesothelium, the tissue that lines various body organs. There are four types of mesothelioma cancer, namely:

• Pleural mesothelioma ( pleural mesothelioma ), which is cancer that attacks the mesothelium of the lining of the lungs (pleura). This type is the most common.
• Mesothelioma peritoneum ( peritoneal mesothelioma ), which is mesothelioma in the lining of the abdominal cavity (peritoneum).
• Pericardial mesothelioma ( pericardial mesothelioma ), which is mesothelioma that attacks the protective layer of the heart organ.
• Mesothelioma testis ( testicular mesothelioma ), mesothelioma that invades the protective layer of testis or penis.

There is a benign tumor in the chest called a solitary fibrous tumor, which is sometimes called benign mesothelioma. This condition is not included in the mesothelioma that will be discussed.

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Causes of Mesothelioma
The purpose of mesothelioma is not known with certainty. However, mesothelioma is always associated with exposure to asbestos or asbestos. Asbestos is a mineral that is widely used as building construction materials, such as roofs, because of its heat-resistant and fire-resistant properties. The use of asbestos has been officially banned since 1999.

When asbestos is destroyed, either during mining or building renovations, asbestos will produce fibers or fine dust. Asbestos fine fiber is very easily inhaled, then enters and settles in the body's organs, especially the lungs. Asbestos fibers that are ingested can also move through the lymphatic system, pay, and infect cells in the lining of the abdominal cavity (peritoneum).

Asbestos exposure can also affect the function of the reproductive organs and heart. However, it is not known for sure the spread process because it is scarce.

• In general, several factors increase the risk of mesothelioma, namely:
• The work environment is vulnerable to asbestos exposure, such as mineral mines, construction sites, the automotive industry, power plants, the textile industry, and steel mills.
• Residing in old buildings or neighborhoods whose land contains asbestos.
• Having family members who work in an environment that is vulnerable to asbestos exposure. Asbestos can stick to the skin and clothing, so asbestos can be carried into the house or other situations.
• Have a history of mesothelioma or genetic disorders that increase the risk of cancer.

Apart from asbestos, several other factors can increase the risk of mesothelioma, although it is rare. Among these are exposure to erionite minerals, exposure to radiation from the chemical thorium dioxide used in X-ray examinations until the 1950s, and infected with simian viruses (SV40).

Symptoms of Mesothelioma
Mesothelioma symptoms develop gradually and usually take 20-30 years until symptoms appear. The patient may not feel any symptoms when mesothelioma is at an early stage. But over time, cancer cells will grow and press on nerves or other organs, causing symptoms.

The symptoms of mesothelioma differ depending on the location of the presence of cancer cells. In pulmonary mesothelioma, symptoms that may appear are as follows:

• Fever is accompanied by sweat, especially at night.
• Excessive fatigue.
• Cough accompanied by unbearable pain.
• Shortness of breath due to a buildup of fluid in the lungs, precisely in the pleural cavity, which is the space between the two layers of pleura lining the lungs.
• Weight loss for no apparent reason.
• Chest pain.
• Swelling and deformation at the tip of the finger (clubbing).
• Lumps appear in the tissue under the skin surface of the chest area.

Meanwhile, stomach mesothelioma (peritoneal) has the following symptoms:

• Loss of appetite.
• Weight decreased dramatically.
• Diarrhea.
• Constipation.
• Pain in the abdomen.
• Swelling in the abdominal area.
• A lump in the stomach appeared.
• Urinary disturbance and urination.

Pericardial mesothelioma and testes are scarce types of mesothelioma. Pericardial mesothelioma usually causes symptoms in the form of chest pain and respiratory distress, while mesothelioma testis is characterized by swelling or the appearance of a lump in the testicular area.

The symptoms of mesothelioma are not specific and can be caused by other conditions. Therefore, see a doctor immediately if you feel the symptoms above, especially if you have a history of asbestos exposure.

Diagnosis Mesothelioma

• The doctor will suspect a patient suffering from mesothelioma if there are symptoms, which are strengthened by physical examination. But to be sure, imaging tests need to be done. Among others are:
• X-rays, to detect abnormalities, such as thickening in the lung lining, fluid in the pleural cavity, or changes in lung shape.
• CT scan, to examine the chest and stomach area, and detect any signs of cancer, determine the location of cancer, and check whether cancer has spread to other organs.
• PET ( Positron Emission Tomography ). Examination using compounds containing radioactive atoms that are injected into the body to get a detailed picture of the tissue suspected cancer cells.
• MRI, to get a more detailed picture of the tissue, determines the location of the tumor.

Also, the doctor can suggest further examinations in the form of:

• Liquid sample examination. If the patient experiences a buildup of fluid in the body related to mesothelioma, the doctor will take a fluid sample using a needle inserted through the skin into the area where the fluid is located. Next, the liquid will be analyzed in a laboratory to detect the presence of cancer cells. There are several types of fluid and tissue sample tests, namely:

1. Thoracentesis, fluid sampling in the area of ​​the pleural cavity.
2. Paracentesis, taking fluid in the abdominal cavity.
3. Pericardiocentesis, taking fluid in the layers (membranes) around the heart.

• Biopsy, which is the procedure of removing tissue samples from specific body parts for later analysis in a laboratory. There are several types of biopsy examinations, namely:

Needle biopsy. This type of biopsy uses a long needle that is inserted through the skin into the chest or abdomen to take tissue samples.

Thoracoscopy, laparoscopy, and mediastinoscopy. This type of biopsy uses elastic camcorders and special surgical instruments that are inserted through one or more small incisions to take tissue samples. The kind of sample removal procedure generally depends on the area of ​​the body undergoing the examination, namely:

Thoracoscopy, to check the space between the lungs and the chest wall.

Laparoscopy, to examine the inside of the abdominal organs.

Mediastinoscopy, to examine the area around the heart.

• Surgery biopsy. For some conditions, the doctor will carry out invasive procedures to take larger tissue samples to determine the diagnosis. Sometimes, the doctor will also perform the process to remove all tumors if possible. There are two types of biopsy procedures through surgery, namely:
• Thoracotomy, which is a type of biopsy performed through open surgery on the chest.
• Laparotomy, which is a type of biopsy that is done through open surgery in the abdomen.
• Bronchoscopic biopsy. The procedure for removing tissue samples using a long, thin elastic tube that is inserted through the throat to examine the respiratory tract.

Stadium Mesothelioma
Based on the level of spread, mesothelioma is divided into four stages. This division of the scene allows the doctor to identify the development of cancer cells in the body and determine the treatment steps to be taken. The four stages of mesothelioma, namely:

• Stage 1: The tumor is still local, which is only in one area of ​​the body, and mesothelioma cells have not spread to other tissues or organs. Surgery is performed to remove the tumor. The life expectancy of patients diagnosed with stage 1 mesothelioma is 21 months or more.
• Stage 2: The tumor size is more significant, and mesothelioma cells begin to spread to the nearest area. Surgical removal of the tumor can still be done, although the results are not very useful. Life expectancy for stage 2 mesothelioma patients is 19 months or less.
• Stage 3: Mesothelioma cells have spread to surrounding organs. Surgery is no longer valid because some cancer cells have spread to other areas. The life expectancy of patients with stage 3 mesothelioma is around 16 months.
• Stage 4: Mesothelioma cells have spread to various areas throughout the body through the bloodstream. Treatment that is still in the research phase will be offered to patients to extend the patient's life opportunity. Life expectancy for late-stage mesothelioma patients is very low, which is around 12 months.

Mesothelioma Treatment
Mesothelioma is a type of cancer that is rare and has not been cured until now. Treatment is done to control or reduce the symptoms experienced and extend the patient's chance of life. Treatment steps are generally determined based on several factors, namely:

• Age and overall health condition of the patient.
• Type and location of mesothelioma.
• Stage or spread of cancer cells in the body.
• Size of mesothelioma

Based on the above considerations, several treatment steps might be recommended by doctors, namely:

• Chemotherapy, treatment therapy with anticancer drugs to destroy or inhibit the growth of cancer cells which cannot be removed through surgery. Chemotherapy can be done before or after surgery to shrink the tumor, facilitate the tumor removal process, and reduce the risk of cancer reappearing.
• Radiation therapy (radiotherapy), treatment therapy with X-rays and proton rays that are focused on specific areas of the body. Radiotherapy is usually done after the patient undergoes a surgical procedure to remove the remaining cancer cells. This therapeutic treatment is also done to reduce the symptoms of advanced cancer when surgery is not possible to do.
• Surgery. Surgery was performed while the mesothelioma was still in the early stage. There are several possible actions doctors may take during surgery. These include:

1. Appointment of cancer cells as much as possible from the patient's body. This action can support the treatment of patients with radiotherapy to reduce pain and inhibit cancer growth.
2. Fluid suction due to a buildup of fluid in the chest area that can interfere with breathing. This action is done by inserting a catheter tube into the chest to suck up liquid. The doctor can also inject drugs to glue the pleural cavity so that the fluid cannot accumulate any more. This action is known as pleurodesis.
3. Removal of tissue around the abdominal cavity, ribs, or lungs affected by cancer cells.
4. Removal of the affected lung organ and surrounding tissue. This procedure is usually followed by radiotherapy.

• Multimodality therapy. This therapy is a combination of three or more treatment steps, for example, surgery, postoperative chemotherapy, and radiation therapy to increase the success rate of treatment.
• Research stage. The doctor will inform the patient about the method of treatment that is still in the research phase. However, the possibility of the patient recovering is not yet known with certainty, so it needs to be carefully considered. On the other hand, this treatment method can increase the chance of doctors to learn more about mesothelioma treatment. Several treatment methods are still in the research stage that can be done by patients, namely:

1. Biological therapy - uses the patient's immune system to fight cancer, also called immunotherapy.
2. Gene therapy - changes the genes found in cancer cells to stop the disease.
3. Target therapy - use drugs to attack abnormalities/abnormalities that occur in cancer cells.

• Supporting treatment. This treatment can help sufferers in controlling the signs and symptoms of mesothelioma, such as:
• Breathing exercises to control breathing when sufferers experience symptoms of difficulty breathing.
• Body relaxation exercises to reduce respiratory muscle tension so that sufferers can breathe more easily.

Prevention of Mesothelioma
The primary preventive measure of mesothelioma is to avoid contact with anything containing asbestos. If you work in high-risk environments exposed to asbestos, then follow the occupational safety rules set by the company. These include:

• Use a self-defense tool while in a vulnerable area exposed to asbestos.
• Dispose of the remaining asbestos material in a safe place and not endanger the surrounding environment.
• Do not bring home the clothes and shoes used during work.

Also, several things can be done to reduce the risk of mesothelioma, namely:

1. Perform routine health checks to detect symptoms or signs of disease related to asbestos.
2. Stop smoking. Cigarettes do not directly cause mesothelioma, but smoking is a trigger factor and can increase the risk of various types of cancer, including mesothelioma.
3. Learn and follow the instructions regarding the safe handling of asbestos in the surrounding environment. Do not move material that contains asbestos carelessly.

Ref:

1. Mott, FE. (2012). Mesothelioma: A Review. The Ochsner Journal, 12(1), pp. 70-79.
2. Weder, W. Opitz, I. (2012). Multimodality Therapy for Malignant Pleural Mesothelioma. Annals of Cardiothoracic Surgery, 1(4), pp. 502-507.
3. American Cancer Society (2016). Malignant Mesothelioma.
4. American Lung Association (2018). Mesothelioma.
5. Cancer Research UK (2018). About Cancer. Mesothelioma.
6. CancerNet (2017). Mesothelioma: Treatment Options.
7. Whitmer, M. Asbestos (2018). Mesothelioma.
8. Selby, K. Asbestos (2018). Mesothelioma Stages.
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