Mesothelioma Cases and What To Do The First Time?
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Mesothelioma is the very rare tumor that develops in the mesothelium. The tissue lines the surface of the abdominal, thoracic, joint cavities. Most often found in the pleura and peritoneum, at least — in the joints and testicles. Mesothelioma cases are composed of fibrous tissue and spindle-shaped cells, growing a thick layer covering the internal organs. In most cases it is characterized by the malignant growth, early metastasis and infiltration in general surrounding tissue.
If we remember history then mesothelioma cases the first time as cancer, it was described as early as 1870. Since the statistics have changed little — in most mesothelioma cases, the pleura is affected with a prevalence of right-sided; peritoneal mesothelioma is much rarer. There is a clear relationship based on sex — is often more common in males (in the ratio of women 8: 1), usually after 40 years.
Causes: mesothelioma cases
The main risk factor for this cancer mesothelioma cases is exposure to asbestos and erionite mineral used in construction. That is the duration of contact with them, and its intensity depends on the risk of developing mesothelioma cases. The risk is significantly increased by prolonged exposure to asbestos at a young age, are considered the most dangerous amphibole fibers (blue asbestos, crocidolite), which due to its shape (narrow and straight) easily penetrate on limfososudam in the lung parenchyma, and in the subpleural space. Some doctors are not excluded, and the viral nature of the disease (simian virus SV40, which genes are found in 60% of cases).
The pathogenesis of this tumor is not studied enough but found that asbestos fibers have the affinity for the serous membrane. Once in the respiratory tract, they migrate to pleura which accumulates in large quantities and may serve as a trigger for the development of mesothelioma. Lymph flow directed towards the parietal pleura, allowing tumor cells implanted in it and eventually spread across the surface. Since the process involved in the tumor and the parietal and visceral pleura, over time it leads to disruption of lymphatic circulation and, consequently, to the rapid accumulation of fluid in the pleural cavity. Intrigue mesothelioma cases are that it does not develop immediately following exposure to asbestos, and after 20-50 years.
Most often asymptomatic tumor development so identifies it in the later stages. Even with proper and timely treatment, the average survival of patients with no more than 1-2 years after diagnosis mesothelioma cases, but there are exceptions. In some mesothelioma cases, good results can be obtained after radical surgery to limit the further spread of the disease, as well as radiation and chemotherapy.
Early symptoms of mesothelioma are not specific and are often simply ignored by patients or charged to the ordinary manifestations are not cancer. In most mesothelioma cases, the symptoms begin to appear within a few months prior to the detection of this tumor.
The clinical picture: mesothelioma cases
The pleura mesothelioma cases are already beginning to show symptoms of the first stage of the disease. Chest pain, cough, pleurisy — all this is usually perceived and treated as a cold or bronchitis, sometimes charged to smoker’s cough. Radiates in different directions pain sometimes perceived and treated as angina pectoris, myocardial infarction, intercostal neuralgia, renal colic, cholecystitis, etc.
While the patient is trying to cure a «cold», the tumor rapidly increased in size, cancer cells metastasize throughout the body. In the compressed lung tumor, blood circulation worsens, it leads to shortness of breath, the progression of pleurisy.
The peritoneal mesothelioma clinical picture is more blurred. First, the patient may observe a temporary feeling of heaviness in the abdomen, temporary violations of the chair. With the progression of disorders of the chair is becoming more frequent, are beginning to emerge pain, nausea, ascites develops.
At any location mesothelioma almost 95% of mesothelioma cases there is a slight fever, fever. About half of patients say volatile joint pain, especially in the morning.
Classification of mesothelioma cases
- Peritoneal mesothelioma cases are most often diagnosed in men older than 50 years of age. It is shown by nausea, abdominal pain, it increases at a total weight loss. Is registered in 10-20% of mesothelioma cases;
- Testicular Mesothelioma (adenofibroma, adenoma of the testes) — a benign tumor characterized by the emergence of areas;
- Pleural mesothelioma (characterized by the rapid growth of malignant);
- Mesothelioma joint (synovioma) — begins to increase in the synovial cells of mucous bags or tendon sheaths. It may be benign (nodular tenosynovitis, synovioma ksantomatoznaya, sinovioendotelioma, synovioma giant cell) or malignant (sarkoendotelioma synovial sarcoma synovial, sinovialoma malignant).
Pathological classification mesothelioma cases:
- Benign (fibrous) — as a node on a stem with a broad base, it gives metastases;
Malignant (endotelioma sarcomatous, coelomic cancer) — a tumor characterized by rapid and extensive infiltrative growth. According to the WHO histological classification of 1999 can be of three types:
- Epiteliodnaya (having the best prognosis), this tumor has a predominantly papillary or tubular structure, or a combination thereof;
- Sarcomatoid (worst case);
- Mixed (biphasic).
By type of growth distinguish between diffuse and localized mesothelioma cases.
Diffuse form is characterized by the formation of a significant thickening of the serous membrane irritation, often with papillary growths on the surface, its boundaries are not clear. Infiltrative tumor growth, with spread to adjacent organs, is intestines, liver, heart, lungs. Very often mesothelioma cases to regional lymph nodes.
Localized clusters of epithelial-represented mesothelioma cells have a limited view of a node on a broad basis, or on the stem, run malignant. Benign fibrous differs the only option.
Also recovered multicystic form, often recorded at the young and middle age. The tumor containing cysts lined with mesothelium, mainly affects the pelvic peritoneum, mainly in the Douglas space (recto-uterine pouch).
Diagnostics: mesothelioma cases
Diagnosis of this tumor is quite complex, most of its aggressiveness and rapid growth make it possible to put an exact diagnosis only after an autopsy. There should always alert the possible contact with asbestos — work in the past on asbestos production, the presence of asbestos-cement materials in the house, living near asbestos-cement quarries or factories, etc.
To make a correct diagnosis A combination of diagnostic tests — X-rays of the pleura and peritoneum, magnetic resonance or computed tomography, laparoscopic examination. Also, the fence is made of tissue for histological and cytological studies.
As one of the leading symptoms of mesothelioma cases is the accumulation of fluid in the pleural cavity, the diagnosis is necessary to start with the evacuation of the fluid and cytological study of exudate. To increase the number of tumor cells per unit volume is recommended to centrifuge the liquid. But this kind of research is not always informative for the most accurate diagnosis of mesothelioma. If you did not work in such a way to verify the disease, after the removal of fluid from the pleural cavity spend thoracoscopy or thoracotomy with pleural biopsy. Obtained by any of the following methods material is sent for histological and immunohistochemical study.
X-rays can detect thickening of the pleura, the presence of fluid in the pleural cavity.
Computed tomography (CT) determines the stage of development of mesothelioma and helps to choose the most effective treatment.
Magnetic resonance imaging (MRI) to determine whether there is a failure of the diaphragm of the tumor.
Taraskopiya — the study of the pleural cavity endoscopically, it is carried out by special machines. To study the selected piece of pleural fluid or pleural, so you can detect the disease at an early stage. For inspection of the abdominal cavity, laparoscopy is used.
Treatment of malignant mesothelioma cases
The treatment of this cancer is quite complex, and multi-port combination. In the arsenal of the doctor may be chemotherapy, radiation, bioterpiya, surgical removal of the affected organ. The vast majority of patients are receiving chemotherapy, radiation therapy, and symptomatic treatment, surgery produces much less.
Radiation therapy: mesothelioma cases
Since this malignancy is detected in the early stages is very rare, the use of radiation therapy is very limited and not very effective. Radiation therapy reduces pain, but no effect on survival.
The most commonly in patients with mesothelioma used external irradiation. Less commonly used internal radiation when radioactive material is fed directly to the tumor itself.
Supporting radiation therapy is prescribed after non-radical operation for the complete destruction of remaining cancer cells. Also, this type of radiation therapy is used as the primary method of treatment for patients who, because of the severity of the condition cannot move a serious operation.
Another type of radiation (palliative) is used for the relief and relief of symptoms caused by the growth of mesothelioma — pain, shortness of breath, bleeding, and difficulty in swallowing.
Chemotherapy: mesothelioma cases
Depending on the stage of mesothelioma cases chemotherapy may be a subsidiary and main treatment, it is used only as a palliative temporarily relieves the patient.
Chemotherapy is various combinations (cisplatin, doxorubicin, methotrexate, vinorelbine, etc.) Are introduced in various ways — intravenously, intrapleurally, intraperitoneally (directly into the peritoneal cavity) into a mono or combinations. Currently, there is no any sufficiently effective regimen of the tumor, the recovery rate is extremely low. For permanent evacuation of the pleural effusion and the introduction of chemotherapy often set intrapleural port. The evaluation of the effectiveness of the treatment is carried out every 2-3 months.
Surgery: mesothelioma cases
Surgical treatment is usually used to reduce or eliminate the discomfort and pain caused by tumor growth. In the early stages of the disease is carried extrapleural pulmonectomy — en bloc removal of the lung, pleura, pericardium and diaphragm part. But even after timely surgery, the 2-year survival rate after surgery is less than 35%. Depending on the location of mesothelioma oncosurgeon may remove fluid from the pleural space (thoracentesis hold), remove the pleura. Such operations are conducted in mesothelioma cases where because of the serious condition of the patient or the prevalence of the tumor cannot be removed. Radical surgery is carried out in the event that the patient is evaluated not less than satisfactory.
In most mesothelioma cases, the prognosis is poor. Since mesothelioma is very fast growing and aggressive, metastasizing lymphogenous and hematogenous route, the rare mesothelioma cases of cure of this disease. Typically, the average survival rate after the onset of less than 1 year (although there is a documented data about patients who turned 5-year after surgery).