Mesothelioma a type of (Lung Cancer)
December 6, 2019
They are tumors originating from the pleura. It usually occurs in people who have been exposed to asbestos and erionite for many years. Many mesothelioma patients have emerged in our country, especially in the Central and Southeastern Anatolia Regions as a result of the use of the substance known as “white soil and containing erionite in the interior of the houses. Many patients do not have any exposure to asbestos or erionite. Familial predisposition has been reported. After the use of asbestos in the industry was prohibited, a significant reduction in the disease was observed. Often, patients have severe chest pain, slimming and coughing. Water is usually collected in the chest cavity, which can cause shortness of breath.
Mesothelioma Diagnosis of Lung Membrane
Mesothelioma meme is more common especially in patients living in the so-called toprak white soil Especially in our country. In addition, the conditions that occur in the lung membrane in patients with asbestos exposure suggest mesothelioma.
Symptoms of Mesothelioma
The most important symptom in patients is chest pain. This is followed by symptoms such as shortness of breath, weakness and weakening during exercise.
Examination of Mesothelioma
There is no special examination of the mesothelioma meme. Findings detected in all types of lung disease are detected: reduction in respiratory sounds on the patient’s lung side.
Radiological examinations and PET-CT
Normal chest radiographs are not sufficient for the diagnosis of mesothelioma. In case of suspicion of mesothelioma in the history and thickening of the lung membrane or fluid detected on the chest X-ray, examination is performed with more advanced methods.
Mesothelioma Diagnosis by Computed Tomography and MRI
As shown in the picture below, computed tomography shows thickening areas or fluid collection on the lung membrane. The red arrow in the picture points to the mesothelioma areas. MRI is useful for demonstrating the tumor’s status on the diaphragm and heart. If computed tomography is suspicious in this respect, MRI should be performed. Otherwise, MRI is not required. A mesothelioma, which extends below the diaphragm, towards the abdomen, or that has passed the heart membrane, enters stage 3. Determining the stage of the disease is critically important for selecting the appropriate treatment. Therefore, detailed examinations are essential before selecting the appropriate treatment.
Mesothelioma Diagnosis with PET-CT
In case of suspicion of mesothelioma meme in a lesion arising in the lung membrane, PET-CT is taken to determine whether this lesion consumes energy. If PET-CT does not show increased energy consumption (involvement) in diseased areas of the lung membrane, this lesion is extremely unlikely to be a mesothelioma. PET-CT is also important in determining whether mesothelioma has spread to other parts of the body. Regardless of the treatment, a mesothelioma treatment should not be started without PET-CT.
Mesothelioma Diagnosis by Biopsy
If a fluid is present, a needle sampling (thoracentesis), needle biopsy to remove tissue from the tumor or thoracoscopic (VATS) biopsy are methods used to diagnose malignant mesothelioma. Pathology examination should not only diagnose mesothelioma, but also indicate which type of mesothelioma it is. The type of mesothelioma to be identified (epitheloid, sarcomatoid, or mixt type) helps determine the treatment to be administered.
What are the treatment methods for malignant mesothelioma?
Chemotherapy is used in the majority of patients. Among the drugs, Pemetrexed (Alimta) has achieved significant success. Successful results are obtained in patients taking this drug together with Cisplatin. Since chemotherapy has significant side effects, the oncology specialist is thoroughly evaluated before use. The chemotherapy regimen, which has been applied in the form of the administration of heated chemotherapy drugs into the thoracic cavity, is a method that has begun to be used for approximately 10 years. There is no significant success in long-term results. Surgery is used only in a certain type of mesothelioma meme (Epithelial type) and in very early stages (Stage I and sometimes Stage II). Radiotherapy is often applied to organs such as bone and brain where the disease metastasizes. In some cases, mesothelioma itself can also be given radiotherapy. However, it should be kept in mind that the application of radiotherapy to a common area may have negative consequences and should be applied with very careful patient follow-up. The so-called Cyberknife or IMRT methods are particularly good when applied locally to the relapse of the disease (in terms of reducing the patient’s complaints).
In which situations should surgery be performed in mesothelioma?
Mesothelioma patients in the first stage (and some patients in stage 2) and There is scientific research showing that the surgery prolongs the patient’s life span when mesothelioma is ”epithelial type”. Therefore, surgical treatment is recommended as a selected group. Surgery in sarcomatous or mixed malignant mesotheliomas or in Stage III and Stage IV patients is absolutely harmful to the patient!
What are the Mesothelioma Surgery Methods?
Surgical treatment consists of two main groups: Curative, ie, surgical intervention to fully treat the disease Palliative treatments that improve the patient’s quality of life and facilitate breathing during illness.
1. Curative Mesothelioma Surgery
A) Removal of diseased areas of pleura, diaphragm and pericardium only (Pleurectomy-Decortication). Nowadays it is more preferred method.
B) Removal of the lung in addition to the above (Extra-Pleural Pneumonectomy). This method is applied in rare cases.
Which method should be applied is determined according to both preoperative detailed examination and intraoperative findings?
2. Palliative Mesothelioma Surgery
In patients with mesothelioma, the fluid collected in the thoracic cavity should be drained if severe dyspnea occurs. This procedure should be performed by the endoscopic (VATS) method in all patients whose general condition is appropriate, and treatment should be applied to prevent the recurrence of the fluid. After this procedure performed with VATS, the likelihood of fluid recurrence is extremely low.
What are the risks of surgery?
Risks in therapeutic pleurectomy decortication operations are usually prolonged haemorrhagic drainage, lung air leakage, increased heart rate and heart rhythm disorders. 3% of patients who undergo surgery have died within 30 days. In the operations where the lung is also taken (Extra Pleural Pneumonectomy), it is necessary to stay in the intensive care unit longer than the above conditions. 5% of patients who undergo surgery have died within 30 days. In the palliative procedure called VATS pleurodesis, the risks are low. death is almost non-existent.
How Many Days Should I Stay In Hospital For Surgery?
After curative surgery, hospitalization is required for an average of 6-7 days and after VATS without pleurisy, for an average of 3 days. Is Radiotherapy / Chemotherapy Needed After Mesothelioma Surgery? Usually chemotherapy is required. Radiotherapy is not always necessary. Postoperative treatment decisions are made by the hospital tumor board according to the pathology examination of the surgery. Mesothelioma is a rare disease. Treatment should be performed in centers experienced in this disease.