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Mesothelioma is a deadly disease that affects the mesothelial cells, which form the lining over the lungs (pleura), heart (pericardium) and abdominal organs (peritoneum).
Mesothelioma is commonly seen on the pleura, which forms the covering of the lung. Two layers of mesothelial cells called parietal and visceral pleura cover the lung. In between the pleura these is a pleural cavity, which is moistened by a fluid called pleural fluid. The main function of pleura is protection. It helps to create a negative pressure in chest cavity, which is essential for the process of respiration. The movement of lungs during respiration is made frictionless by the presence of pleura and pleural fluid. Mesothelioma may also affect the peritoneum, which is a mesothelial tissue in the abdomen. The peritoneum covers the abdominal organs. It is also having two layers. The outer parietal peritoneum is attached to the inner wall of the abdomen. Inner visceral peritoneum is attached to the abdominal organs. In between the two layers there is a cavity called peritoneal cavity. Very rarely mesothelioma affects the pericardium. It is the covering seen around the heart. It is also having two layers, fibrous pericardium and serous pericardium.
Mesothelioma may be benign or malignant but rarely is it benign. Malignant Mesothelroma is relatively rare but for those who are affected, it is a disaster.
70% of all the cases of malignant Mesothelioma are pleural. 10 to 20% are abdominal affecting the peritoneum. Pericardial mesothelioma is very rare. Mesothelioma is an extremely malignant and incurable cancer.
There are three main types of malignant mesothelioma.
1) Epitheloid: Affects the covering surrounding the internal organs and internal surface of the body. 70% of all cases of mesothelioma are epitheloid.
2) Sarcomatoid: This type affects bones, muscles, and cartilages. 5 to 20 % of cases are of this type. It is more serious than epitheloid type.
3) Mixed type: This type contains both sarcomatoid and epitheloid varieties 20 to 35% are of this type.
Regardless of the area it affects mesothelioma is fatal. The tumor cells may spread to heart and abdominal organs.
Asbestos mesothelioma can have 15 to 30 years latency period. Many cases are dormant for years. Symptoms usually emerge 20 to 30 years after initial exposure. This will allow the cancer to grow and metastasise to distent parts, which in turn reduces survival rate.
Statistics:
- Asbestos is used extensively from 1930
- Mortality is 100% within five years.
- Because asbestos has been used in over 3000 modern products, most people have suffered some degree of exposure at one point in their lives.
- 10000 people die because of Mesthelioma annually.
- The risk of developing cancer is 7 times greater for people who have been exposed to asbestos.
- 80% of people diagnosed with pleural mesothelioma have been exposed to asbestos.
- Every year 2000 new cases are reported in US.
- By 2030 the cases will be 300000
- Over 100000 cases are reported all over the world.
- UP to 8 million people in US are still exposed to asbestos.
- Average Mesothelioma patient survives 4 to 18 months beyond the date of diagnosis
- If diagnosed earlier 50% chance of surviving 2 years.
- More than one million construction workers are still at risk of dangerous asbestos exposure.
Signs and symptoms of Mesothelioma:
Men are more affected. Age is usually over 40. The symptoms of mesothelioma are some times confused with that of common cold or allergic lung disorders. The signs and symptoms may vary according to the parts affected.
Pleural Mesothelioma:-
Initially the patient may complain about constant chest pain. Gradually he will develop breathlessness with cough. The chronic cough worsens over time. Recurrent lung infection is seen in some patients. Patient may complain about shortness of breath with bloody expectoration.
Other general symptoms like loss of appetite, fatigue, fever, weight loss etc are also seen.
Abdominal Mesothelioma:-
It is also known as peritoneal mesothelioma. The Mortality rate is high. 50% to 70% of all cases are men. One fifth of all abdominal Mesothelioma cases are women. Abdominal pain with distention of abdomen is seen. The distention is due to collection of fluid in the peritoneal cavity. Bowel obstruction with nausea and abdominal weakness are also reported. Anemia with blood clotting abnormalities is also present. Patient will have weight loss but waist may increase in size.
General symptoms live loss of appetite, weakness fever etc are also common.
If the cancer spreads (Metastasis) towards the sites beyond mesothelium the symptoms depend on the area affected.
Course and progresses of Mesothelioma:-
Once the case is diagnosed the patient will survive for few months. Even after the introduction of modern treatment techniques the disease is fatal. The tumor spread by local invasion in the pleural cavity and chest wall and by the lymphatics and blood stream to other organs reaches the regional lymph nodes by lymphatics. The cancer cells can also go to brain.
Diagnosis of Mesothelioma:-
Even with best techniques mesothelioma often evades diagnosis. Early and constant screenings are paramount for those who have suffered asbestos exposure.
The diagnosis is not so easy because;
1) First of all there are few outward symptoms until the condition is gravely advanced.
2) The time between exposure and clinical manifestation takes decades.
3) Mesthelioma often continues even after the exposure has ended.
4) Many sumptoms are common to other less serious diseases.
X-ray: X-ray can show the presence of tumor in the lung and abdomen. It is also helpful to see the presence of fluid in the peritoneal or pleural cavity.
CT scan: This will give more details regarding the tumor and other pathological lesions. CT scan is helpful to exclude other similar diseases.
MRI: Nowadays MRI is used because of the detailed information on the nature of tissues affected.
Aspiration: Aspirated peritoneal or pleural fluid will show malignant cells.
Thoracoscopy: Here an instrument called thoracoscope is introduced into the chest through a small wound. It also helps for taking a sample for pathological study.
Peritoneoscopy: Peritoneoscopy is used for this procedure. The tumor can be visualized with this instrument.
Biopsy: It is the final test for diagnosing a cancer. The biopsy sample is taken with the help of endoscopy and histopathological examination is done with the help of microscope. The cancer cells are identified by this method.
Early detection and treatment improve length and quality of life for many victims but can't cure this horrific disease.
Treatment of Mesothelioma:-
The line of treatment is based upon the stage of cancer, location of the tumor and the general condition of the patient.
The usual treatment plans are radiation surgery and chemotherapy. New treatments like photodynamic therapy, angiogenesis therapy and gene therapy etc provide new hope for mesothelioma patients.
Nowadays multimodal therapy is also done to extend the life of affected patient.
Chemotherapy:
Mesothelioma does not respond well to the chemotherapy due to the presence of layers of dead cells around the tumor. Hence the medicine will not reach the cancer cells. Anti cancerous drugs are given in the form of pills or intravenous injections or directly into the affected site. These drugs can kill the cancer cells to some extent. The drugs can also produce some side effects like hair loss, nausea, diarrhoea, anemia, haemorrhages and some toxic reactions. Chemotherapy can suppress the immune system, which will create a chance for infections.
Surgery:
The aim of surgery is to give some relief to the patient. By the removal of tumor pressure effects on other organs can be removed.
a) Pleurectomy: Here the affected part is removed.
b) Pneumonectomy: Affected lung is removed.
c) Thoracenteses and Paracentesis: The procedures are required to remove the fluid collection.
d) Extra pleural pneumonectomy: This method can potentially extend life for a few more years but cannot a cure the disease.
Radiotherapy:
Radiation can shrink the tumor to a manageable size. It can also give relief to pain. Radiation is usually combined with chemotherapy and surgery. Radiation wires, tubes, catheters and needles are used nowadays. Radiation can kill the healthy cells near the tumor, which is a drawback.
Multimodel therapy: It is the combination of radiotherapy, chemotherapy and surgery.
Photodynamic therapy: It is one of the modern methods of treatment. Here a special drug is introduced into the tumor cells. When a laser or high intensity light is shined on it the drug will become active and will kill the cancer cells. This method is also having some limitations. The laser can't penetrate deep in to the body. This method can also kill the healthy cells in which the special drug is absorbed.
Immunotherapy: Immunotherapy concentrates on boosting the immune system to fight against cancer cells. By stimulating the immune system the spread of cells can be prevented.
Angiogenesis therapy: Cancer cells need more blood supply than other normal cells. For this purpose number of capillaries is formal around a tumor. This pathological process is called angiogeness. The angiogenesis promoters secreted by the tumor cell indicate this. By introducing an angiogenesis inhibiting factor angiogenesis can be prevented. When the blood supply to the tumor reduces naturally the tumor size and growth will reduce. This method is in the initial stage of trial and is a new hope for cancer patients.
Role of Holistic Medicine:-
Holistic medicine deals with the treatment of an individual as a whole rather than treating a disease. Here the whole metal and physical symptoms are considered for treatment. This includes systems like Naturopathy, Yoga, Homoeopathy and herbal medicine.
Meditations also come under this category.
All above mentioned systems stimulate the body's natural mechanisms to fight against diseases and can improve the quality of life to a great extend.
Psychotherapy: It is said that the general health of a cancer patient declines when the case is diagnosed as cancer. He will be collapsed mentally leading to further derangement of his health. Hence moral support, assurance and psychological counseling etc are very essential to improve the general health. Meditation can also help to achieve this goal.
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