Treatment of pleural mesothelioma abroad
Pleural mesothelioma is malignant oncological disease with tumor developed of mesothelial cells. In recent decades, the incidence of its disease has grown by 8 times in the developed countries.
Mesothelioma is diagnosed among elderly people more often. Two thirds of all patients are people over the age of 65. It’s almost impossible to find the illness in people younger than 45 years of age.
Causes of the pleural mesothelioma
Pleural mesothelioma is also called in the majority of cases as the occupational illness. The key risk factor is the exposure to asbestos (mountain cork).
Pleural mesothelioma can usually develop in 20-50 years after the first contact of a person with asbestos. The longer the contact the higher is the risk of the illness. This risk doesn’t go away even when the contact with this material is over.
Various risk factors are:
- SV40 virus
Males get sick with pleural mesothelioma 8 times more often than females. At the same time, male gender cannot be treated as a risk factor by itself. The reason of high frequency of the illness is because men are more exposed to occupational hazards, contacting with asbestos.
Symptoms of the pleural mesothelioma
Symptoms are unspecific on the early stages of pleuralmesothelioma. They are usually barely manifested. Therefore have person to visit a doctor only within several months after subjective sensations appear.
Pleural mesothelioma can be manifested by the following signs:
- Shortness of breath (70% of patients)
- Pain in the chest (65%)
- Fever (30%)
- Weight loss (30%)
- Cough (10%)
Other possible symptoms are:
- Inconsistency of breath
- Difficulty in swallowing
- Swelling of the hands and face
The majority of patients come to the doctor for the first time with the complaints about progressive fatigue and weakness, shortness of breath, pain in the chest.
Diagnostics of the pleural mesothelioma
Methods of visualization (ultrasound, radiography, computed tomography, MRI) are used at different stages of the diagnostics. These methods give a chance to:
- Detect suspicious formation in the chest
- Estimate the prevalence of cancer process
- Evaluate the effectiveness of treatment
During positron emission tomography the radioactive agent is injected into the patient’s blood.Agent is absorbed by malignant cells much quicker than by the healthy ones. This method of research is applied in order to detect metastases of pleuralmesothelioma into the lymph nodes and internal organs.
While performing pleural puncture doctor takes the fluid from pleural cavity(the space between the visceral and parietal pleura). Doctor looks for the abnormal cells with the help of microscope. The method often gives the false negative results (its sensitivity doesn’t go over 50%). Therefore, if pathological cells won’t be detected that doesn’t exclude pleuralmesothelioma.
During needle biopsy a doctor inserts a needle into the tumor - like formation detected with the help of visualization methods. The doctor takes biological material for the following morphological test and then the histological type of tumor is determined.
Pleural mesothelioma can be:
- Epithelioid (65%)
- Sarcomatous (10%)
- Mixed (25%)
Sarcomatous tumor is considered to be unresectable. The best prognosis in the perspective of treatment effectiveness and patients’ survival is characteristic for the epithelioid pleural mesothelioma.
Diagnostic thoracoscopy. Needle biopsy makes it possible to establish a clear diagnosis only in 85% of cases. Besides, this way of diagnostics will not allow taking a lot of biological material for the histological test. This way, there is not always a possibility to determine the tumor type. Here,they use the most informative diagnostics method – a thoracoscopy.
Doctor inserts through a small incision (up to 2 cm) a thoracoport and then a thoracoscope with the surgical instruments. Method allows taking enough of biological material and establishing a certain diagnosis. Also, thanks to thoracoscopy doctor is able to estimate the prevalence of oncological process.
Treatment of the pleural mesothelioma abroad
Only surgical methods of treatment can lengthen the patient’s life expectancy for several years. But in most cases pleuralmesothelioma is unresectable.
Only 10-15% of patients receive surgical treatment. Other patients receive chemotherapy and radiation therapy that give a chance to slow down the tumor growth and lengthen life expectancy for several years.
Favourable prognostic factors, when a person has higher chances to get positive good results from the surgery, are:
- Epithelioid type of tumor
- Less than 50 years old
- Preserved ability to work
- Absence of considerable weight loss
- Normal levels in the clinical blood tests (white blood cells, platelets, red blood cells, hemoglobin)
- Normal level of LDH in the blood
- No pain in the chest
Pleurectomy (decortication) is the operation aimed at the removal of the pleura. Sometimes surgeons remove the diaphragm, pericardium fragments and tumor foci from the lungs. The parietal pleura is removed completely, visceral (adjacent to the lungs) is removed partially.
Pleurectomy helps to achieve two main objectives:
- Lengthening patient’s life expectancy
- Eliminate basic symptoms of the illness associated with the accommodation of the fluid in the pleural cavity (among 95% of patients)
Extrapleural pulmonectomy is rarely performed for pleural methothelioma treatment.This is the most radical surgery. Even its minimal volume it presumesthe removal of the pleura, a lung, half of the diaphragm and a part of the pericardium.
Latest treatment methods of the pleural mesothelioma
The results of pleural methothelioma treatment are not yet satisfactory. Patients’ life expectancy remains on a low level. This level is much lower than for the majority of other malformations.
Nevertheless, new methods of treatment are constantly appearing, traditional methods are being improved. All this allows to gradually increase the average life expectancy of patients with pleural methothelioma.
Latest treatments methods are:
- Photodynamic therapy means an injected intravenously photosensitive substance. It selectively accommodates in the malignant cells. Then the source of red light is inserted into the chest, the medicine activates and destroys the diseased cells.
- Target therapy presupposes the prescription of medicines that influence mesothelioma cells but, in fact, don’t touch the healthy tissues. Medicine called “sunitinib” shows not bad results.
- Gene therapy. Virus is injected into the patient’s pleural cavity. Afterwards, either virus damages the abnormal cells or immune system starts to destroy them depending on the virus type. This treatment method is still on the stage of clinical trials.
Pleural mesothelioma - Prognosis
Median survival is an indicator defining the time frame when 50% of patients die. It starts at the moment of diagnosis establishment.
Median survival for pleural mesothelioma, depending on the stage, is:
- Stage 1 – 21 months
- Stage 2 – 19 months
- Stage 3– 16 months
- Stage 4– 12 months
In general, prognosis for pleural mesothelioma is not favourable. Five-year survival of patients varies from 5 to 10% in different countries.