WHAT IS MESOTHELIOMA CANCER
Mesothelioma is a type of cancer that occurs in the thin layer of tissue which covers many of our internal organs like the lungs, abdomen, heart, and testis. The most affected area from this disease is the lining of the lungs and the chest wall. The lining of abdomen and sac surrounding the heart and testis is the least affected area.
The greater exposure of mesothelioma is of asbestos which is more than 80%. This disease occurs in people who have exposed to asbestos at work, live with worker those were doing a job with asbestos, work with the asbestos product.
According to the researcher, these diagnoses occur after at the age of 65 and mostly death around at the age of 70 years old. Rates are higher in the United Kingdom, Australia, United States, and Japan. In last year’s 70 thousand people had mesothelioma and 40 thousand of them were died because of this disease.
Rates of diseases are varying in different areas of the world. It occurs more in men than women.
Mesothelioma is a very deadly and aggressive type of cancer, treatment is available, but for some people with this disease, a cure is not possible. Sometimes is also called fibrous tumor or benign mesothelioma. It is easier to treat than the deadly form of cancer, in most of the cases it’s successfully treated.
Mesothelioma divided into four different types
1) Pleural Mesothelioma
2) Peritoneal Mesothelioma
3) Pericardial Mesothelioma
4) Testicular Mesothelioma
Pleural Mesothelioma it occurs in the lining of lungs and is the most common form of the disease, it approximates 80% of new cases of this type of infection.
Peritoneal Mesothelioma it develops in the surrounding of the abdomen and spread throughout the abdominal area like liver, spleen, and bowel. Abdominal pain is the most common symptom of this type of disease, and the survivor depends upon the individual situation and their distinguishing factors.
Pericardial Mesothelioma which originates at the pericardium the lining of the heart cavity, it is the rare case of cancer less than 1% of cases. The heart is unable to deliver the oxygen that brings breathing difficulty, pain in the chest.
Testicular Mesothelioma it develops on the lining of testicles, which is an extremely rarest type of diseases. This is not completely understood how it grows, and yet not a standard course of treatment available.
CAUSES OF MESOTHELIOMA
Asbestos is the naturally found minerals in the environment. These fibers are durable and resistant to heat, they are useful in brakes, shingles, flooring, insulation and many other products. Generally, cancer begins when a series of genetic mutations occur within a cell, which causing the cell to grow and multiply.
It isn’t clear yet about what causes the initial level of genetic mutations that lead to mesothelioma cancer, though researchers have identified some factors that may increase the risk. It’s likely that cancers form because of an interaction between many factors, such as inherited conditions, environment, health conditions and the choices of lifestyle.
How does asbestos exposure occur?
- Asbestos exposure is a big factor for developing mesothelioma diseases. The most common and primary exposure is the workplace environment and secondary is school, homes, construction sites, refineries, shipyards, railroad, mining, firefighting, power plant etc.
- Living in the residential area of the asbestos mine, or contaminated site by asbestos.
- In many cases, second-hand exposure is a big factor from the family member coming into contact with their clothing and materials that have collected very fine and microscopic asbestos fibers.
- This has been found commonly in household items like talcum powder, paints, and potting soils.
- Those people who Do-it-yourself activities (DIY), home renovation activity, as well as those who worked in the construction site, may expose themselves to asbestos material.
In studies, it proved that inhaling and swallowing of microscopic asbestos fibers can start a chain reaction and leads to several types of cancer. Asbestos can cause DNA damage directly or indirectly both the ways. Straight through the mitosis process and cause cellular damage, indirectly mesothelial cell to release mutagenic reactive oxygen and nitrogen which produce genetic mutation.
Such as this type of cancers form with the interaction between many factors environment, health condition, lifestyle, inherited diseases. It takes 10 to 40 years and more to develop mesothelioma disease after the exposure of asbestos.
Other risk factors
- Directly exposed to the asbestos fiber at your home or a workplace the risk factor of mesothelioma disease increased
- Living with someone who exposed to asbestos on a daily basis, may carry that fiber on their clothes, hairs, and skin. So for reducing the risk, they may take a shower and change clothes before leaving the workplace.
- Family history like parents, siblings, or child has mesothelioma that increased the risk of this disease
- Talc powder is a naturally occurring silicate mineral which mainly used in cosmetics and toiletries item. The talc in its own is safe, but when found near and among asbestos deposits, they contaminated with the asbestos fibers. Talc miners are at the higher risk of asbestos exposure baby products, women using talc tested has been found to contain asbestos.
- Some other minerals zeolite of erionite used in the gravel of road surfacing in the United States and Turkey it is used to construct homes. Erionite is associated with mesothelioma a well known human carcinogen.
- Irradiation of the chest or abdomen, intrapleural thorium dioxide or thorotrast as a contrast medium.
- Receiving a polio vaccine between 1955 and 1963 that contaminated with simian virus 40 or SV40
- Found in people with a germline mutation in their BAP1 genes are at higher risk of developing mesothelioma and uveal melanoma.
SIGN AND SYMPTOMS OF MESOTHELIOMA
As we all know that cancer doesn’t show any symptoms until those tumors grown and spread or multiply. Similarly, in mesothelioma, early signs in cancer development is nearly impossible because this disease doesn’t produce any early symptoms to identify.
Cancer usually shows at the stage of 3 and 4 when the tumor begins to multiply against the lung or abdominal cavity.
Early diagnosis happens by accident through routine checkup like X-ray, blood test.
On the primary basis inform your Doctor about the early history of asbestos exposure and cancer screening can help lead to early diagnosis of mesothelioma.
Most common mesothelioma symptoms are:
- Respiratory problem
- Shortness of breath
- Pleural effusion
- Muscle weakness
- Pain in chest or abdomen
Some common symptoms according to types of mesothelioma
It develops in the outer lining of the lungs, and inner lining of the chest cavity causes signs and symptoms that may include
- Chest pain
- Shortness of breath
- Pleural effusion
- A dry cough
- Fatigue or body aches
- Blood in sputum
- Weight loss
- formation of tissue lumps under the skin of the chest
- Reduced chest expansion
Cancer form at the abdominal lining causes signs and symptoms that may include
- Unexplained weight loss
- Abdominal distention or fluid/gas accumulation
- Loss of appetite
- Bowel obstruction
- Lumps of tissue in the abdomen
- Feeling of fullness
This type of cancer develops in the lining around the heart, causes signs and symptoms that may include
- Orthopnea (shortness of breath when lying flat)
- Heart failure
- Constrictive Pericarditis (limiting the heart function frequently)
- Pulmonary Embolism (artery blockage in the lungs)
- Cardiac tamponade (build up fluid in pericardium)
- Dyspnea (difficulty breathing at rest)
- Arrhythmia (heart palpitations)
- Night Sweating and fever
- Heart murmur
Testicular Mesothelioma (Tunica Vaginalis)
Cancer develops on the lining of testicles, causes signs and symptoms that may include
- Testicular pain
- Lump in scrotum
- Swollen testicles
- Hydrocele (fluid in the scrotum)
End Stage Mesothelioma
Once the mesothelioma has metastasized, it spread all other parts of the body like the liver, adrenal gland, and kidney. Some sign and symptoms are the following:-
- Hemoptysis – coughing up blood
- Laryngeal nerve palsy – a paralysis of the voice or hoarseness
- Low blood sugar level
- Severe ascites (accumulation of fluid in abdomen & Liver)
- Jaundice (yellowing of the eyes and skin
- Disseminated intravascular coagulation (bleeding in many body organs)
- Thrombophlebitis (Blood clots in the veins)
DIAGNOSIS OF MESOTHELIOMA
There is no any clear path for diagnosis of mesothelioma cancer for every patient because this disease is rare and have many common symptoms which may confuse it for less or severe illness. As part of this progress, the doctor will obtain the complete medical history of patients and usually perform a series of tests such as scanning, blood test, and X-ray.
Diagnosis of mesothelioma can be suspected with imaging and finally confirmed it with biopsy.
- Differential diagnosis
The Oncologist performs imaging tests to check for visible signs of tumors. A mesothelioma diagnosis relies on a series of test.
X-ray use to diagnose illness and injuries it can be helpful in finding fluid in the lungs which is an early sign of mesothelioma.
CT-Scans it’s a series of X-ray images to form a 3D image, it spotted a tumor easily
MRI It scans on higher resolution with 3 D model, helpful in diagnosis metastasis of mesothelioma
PET Scans use a radioactive isotope injection to viewed and help to distinguish benign versus malignant tumors.
Blood test or Biomarkers
Immunohistochemical staining plays a vital role for the pathologist who is widely used in the diagnosis of an abnormal cell or cancerous tumor cells. Many blood tests have been performed to identify the substances in the blood to find out the presence of cancer cells, these substances known as biomarkers.
Specific molecular markers are characterized to indicate that mesothelioma or another type of cancer such as breast or a lung is present. Biomarkers are also known as assays, and they provide useful information that biopsy needed for treatment.
Mesothelin is the tumor differentiation antigen ordinarily present on the mesothelial cell lining. N-ERC/ mesothelin are a protein fragment that is soluble in the bloodstream. The protein can act as an antigenic target of a therapeutic cancer vaccine.
A new marker is required to detect pleural mesothelioma at an earlier stage to distinctive treatment strategies. Fibulin-3 is helpful in plasma and effusions may aid in determining the prognosis and diagnosis of pleural mesothelioma.
The Plasma fibulin-3 can distinguish from healthy persons with asbestos exposure patients with mesothelioma.
Osteopontin (OPN) is a glycoprotein which overexpressed in several human cancer such as lung, breast, colon, and prostate.
WT1 protein is commonly found in mesothelioma cells. This protein is helpful for cancer diagnosis, and it may prove useful for developing new cancer treatments. It expressed in almost all epithelioid mesothelioma but less useful for identifying sarcomatoid mesothelioma.
Calretinin can be demonstrated in both benign mesothelioma and malignant mesothelioma and can be used to help differentiate lung tumors and brain tumors.
A biopsy is a diagnostic procedure to confirm the malignant mesothelioma. A Doctor removed a sample of tissue from the particular part of the body and examined under a microscope by a histologist whether the tumor is mesothelioma or any other kind of cancer.
Depending upon the affected area, the doctor selects the right method of biopsy. It can be distinguished by the needle, camera, and surgical technique.
The least chronic method for biopsy is through a fine needle, which helps in draw fluid from the cancerous tissue. Types of needle biopsies are:
• Thoracentesis to remove the fluid from the space between the lungs and chest wall.
• Paracentesis to remove excess fluid around the abdomen.
• Pericardiocentesis to remove excess fluid from the thin space between the heart and pericardium.
Camera assisted Biopsy
In this method doctor generally, use a small tube with a camera to retrieve the tissue sample from the patients. It can be of three types:
• Thoracoscopy: the surgeon makes one or more small incision between the ribs and chest, a tiny camera is inserted into the chest cavity. If the tumor can be seen, the doctor cut away small pieces of tissue for testing
• Laparoscopy allows the surgeon to look inside the abdominal area with the help of light and camera.
• Mediastinoscopy enables the surgeon to view the space between the breastbone and the lungs with the help of mediastinoscopy. This method is done for the pericardial mesothelioma.
By inserting an endotracheal tube through the nose, or the mouth of the patient for breathing and the surgeon make a small incision below the neck immediately where the mediastinoscope will be inserted.
If the surgeon finds a tumor or any lymph nodes a tissue sample will be collected and sent for further examinations.
This method may require an open surgical process to retrieve a tissue sample from the body parts depending upon the location of a tumor. This happens only when the needle and camera-assisted may not be possible. Two types can do it:
• Thoracotomy is an open chest surgical method to between the ribs and allows a surgeon to check for sign and diseases. If the surgeon sees an abnormal tissue, they will collect a sample for analysis. It uses for the patient who’s suspected either pleural mesothelioma or pericardium mesothelioma.
• Laparotomy is an open abdominal method which allows a surgeon to check for the sign and diseases. A surgeon will examine the abdominal organ and collect a sample for analysis. This is helpful for the patients having peritoneal mesothelioma.
TREATMENT OF MESOTHELIOMA
Mesothelioma is a very severely aggressive disease and many of them cure isn’t possible, because most of the time it diagnosed at an advanced stage where surgery or remove of cancer is not possible. Sometimes it may control by some other method.
So basically, undergone treatment of this diseases only depends upon the health and certainty of cancer like stage and location of a tumor. Treatment for mesothelioma involves surgery, chemotherapy and radiation therapy, whereas in some cases some therapy does not exit the patients try some other experimental therapies through clinical trials.
Many of the cases people can do everything to treat their cancer if during any small chance of improvement. Others prefer treatment that makes their self-comfortable so that they can live remaining live symptom-free and happy.
Three standard mesothelioma treatments are-
Surgery is the early stage cancer diagnosis and in some cases, it may cure cancer. This method is to remove the tumor part (as much of cancer as possible) or depend upon the tumor location. It includes removing of mesothelioma lining, lymph nodes, lungs or their parts or any other organ. It helps to reduce the sign and symptoms caused by mesothelioma spreading in all over the body.
Chemotherapy is one of the best treatments for cancer to improve survival in controlled trials. It uses some chemicals to kill the cancer cells. It can be used either before surgery or after surgery, in before surgery called neoadjuvant chemotherapy, to make operation easier and after surgery called adjuvant chemotherapy, to reduce the chance of cancer will back.
Neoadjuvant therapy- to shrink the tumor size by radiation
Primary treatment- to remove the tumor by surgery eg-pleurectomy
Adjuvant therapy- kill any remaining cells by chemotherapy
Chemotherapy travels throughout the body and may shrink the growth of cancer cells and after that will remove using the surgery. This drug attack fast-growing cells such as cancer cells, it can kill remain mesothelioma cells that unable to remove by surgery.
In the case of peritoneal mesothelioma, the drugs used while doing chemotherapy may also heat and administered directly to the abdominal cavity. The drug directly reaches the tumor without injuring to the healthy cell, and this allows a doctor to administer low to higher doses of chemotherapy drugs.
About 70% of patients go for chemotherapy according to research.
It’s helpful in reducing the pain from the growing tumor, helps at any cancer stages. Radiation is the high energy beams source of x-rays and proton which focuses to a specific spot on the body. It generally used to kill remaining cancer cell which left after surgery.
When combining with surgery and chemotherapy it helpful to reduce the risk of reoccurrence of a tumor. When surgery is not the option radiation therapy helps to reduce the sign and symptoms of advanced cancer situation.
Clinical trials and Experimental therapies
Research is continuing on experimental therapies and clinical trials for searching new ways to fight against mesothelioma cancer all over the world. These trails may offer the opportunities for those patients who have not found the best effective treatment for their disease. The participation in the clinical trial may help doctors to understand more about mesothelioma treatment in the future.
Boosting the immune system, which helps to enhance the defenses against cancer
Alters that particular gene which causes cancer because the mutation in cell DNA causes cancer.
Is a combination of two extrapleural treatment pneumonectomy and pleurectomy/decortications. This operation is unique, and it does depend upon the size of tumor inpatient.
A multimodal treatment of peritoneal mesothelioma patients, surgery is to remove them as many as a tumor is possible. Heated chemotherapy is applied to the patient abdominal cavity to kill the remaining tumor cells by the penetration of drugs into the tissues. Heating destroys malignant cells more than the normal cells.
Use of light with the help of photosensitizing drugs, to kill the cancer cells with lesser side effects
The goal is to reduce the pain of suffered cancer patients and helps in improve the quality of life.