Mesothelioma of peritoneum

Mesothelioma of the peritoneum is a fairly rare form of malignant neoplasms affecting peritoneal tissues. Fertilization occurs due to the degeneration of mesothelium, which refers to the serous layer of cells covering the abdominal cavity.

[1], [2], [3], [4]

Causes of peritoneal mesothelioma

This rare form of cancer, mainly, is diagnosed in the strong half of humanity, whose age has passed the 50-year-old barrier. The causes of peritoneal mesothelioma, which could be established, confirm their pathological effect on the body are reduced to one source of nucleation and growth of a malignant tumor - this is a negative effect of asbestos vapor with its close enough contact with the human body, and more specifically with its respiratory system.

Predominantly after a prolonged work of a man with such material, oncologists diagnose pleural mesothelioma, much less often, but they still have to establish such a disease as peritoneal mesothelioma.

Asbestos is a chemical mineral of a series of silicates, having a fibrous, brittle structure. This material is widely used in many industries and construction. And everywhere people work, mostly men.

At the same time, asbestos, in the process of working with it, releases vapor and asbestos dust. It is particularly dangerous for the human body and can cause mesothelioma of the peritoneum or pleura, trigger the development of cancerous lesions of lung tissue and asbestosis (lung disease caused by inhalation of asbestos fibers).

All the danger and insidiousness of such a dust is that its harmful influence on the organism working with it is not immediately apparent. To show pathological symptoms is possible after several years, and even decades.

Such a time interval between the source and development of the disease, for a long time did not allow doctors to understand the causes of the pathology in question. And only recently this connection was established.

To date, doctors assume that asbestos dust is not the only source that provokes the progression of this pathology. Suspicions cause:

• Paraffin fractions and other substances belonging to silicate structures.
• Ionizing radiation - electromagnetic wave structures, which are formed due to radioactive decay, nuclear transformations, when the charged particles in the substance are tormented.
• Infectious and viral lesions of the body.

To date, a sufficient number of facts confirming or refuting the data of suspicion of physicians has not yet been collected. Therefore, the answer to the question under consideration remains open.

[5], [6], [7], [8]

Symptoms of peritoneal mesothelioma

Physicians, according to the form of the tumor and the scale of spread, differentiate two different types of the disease under consideration: nodal (or local) tissue damage and diffuse pathology. Tumor formation of the first species is presented in the form of a knot that is predominantly located in the parietal and / or visceral zone of the peritoneum.

Diffuse type of tumor, which occurs most often, captures the entire inner layer of the abdominal cavity, enveloping it as if in a kind of case. In the case of a void unfilled in the abdominal cavity, hemorrhagic or fibrinous-serous fluid (exudate) begins to accumulate in the abdominal cavity.

The results of histology most often show the adenocarcinoma character of the structure of the tumor.

At an early stage of the pathology, the symptomatology of the disease under consideration is not very specific. Over time, when the disease is significantly progressing, the symptoms of peritoneal mesothelioma begin to appear, which include:

• Abdominal pain (related to abdominal area).
• Nausea.
• Weakness.
• Occurrence of urge to vomit.
• Ascites (or as it is also called abdominal edema) is the accumulation of free fluid in the peritoneal cavity.
• The patient begins to lose weight.
• There are violations in the desire to eat (loss of appetite).
• Gradually the exudate accumulates in the peritoneum, increasing its size, which leads to an increase in the dimensional parameters of the abdomen.
• There is a violation of digestion: constipation is loosened by loosening the chair and vice versa.
• There is shortness of breath.
• Become visible swelling.
• If the patient suffers from nodal mesothelioma, the oncologist with palpation is able to recognize a very mobile tumor tumor.
• Sometimes there are signs of partial intestinal obstruction.
• There are cases of exacerbation of arthralgia - isolated pain symptoms arising in small joints.
• When the clinical picture is launched, metastases can be found both in the nearby lymph nodes, and in the bone or brain, liver, heart, lungs, intestines.
• A permanent subfebrile condition is a persistent increase in body temperature.

Diagnosis of peritoneal mesothelioma

When a certain complex of symptoms is manifested, the doctor may suspect a presence in the patient's anamnesis of the disease in question. Diagnosis of peritoneal mesothelioma is a fairly extensive complex examination, which includes both instrumental techniques and laboratory studies.

• The first thing that is assigned to such a patient is a consultation of an oncologist and a gastroenterologist.
• The patient's anamnesis is being studied, especially if the patient has had prolonged contact with asbestos. This can concern both the work with this material, accommodation near the asbestos cement enterprise, the presence of asbestos material in the home environment, and the like.
• Mandatory ultrasound examination (ultrasound) of the abdominal cavity.
• Multispiral computed tomography (MSCT) is a technique for nondestructive layer-by-layer abdominal examination. It makes it possible to establish the presence of tumor signs and the presence of ascites in the body.
• Laparoscopy is a surgical method of treatment, as well as visual examination and seizure for analysis of biological material, conducted through a small hole in the peritoneum. The result of the study is the detection (or not finding) of atypical cells, which can be present in both tissue layers (biopsy) and ascitic fluid.
• A biopsy is performed - the lifetime extraction of small tissue sections for subsequent examination under a microscope (morphological analysis of the contents).
• Laparocentesis is a puncture of the peritoneal wall, the purpose of which is to extract the pathological contents of the abdominal cavity.
• Paracentesis - drainage of fluid located in the abdominal cavity.
• Conducted and standard laboratory tests of urine, stool and blood.

Proper recognition of the histological character of the peritoneal mesothelioma is essential for an adequate selection of therapeutic techniques, as well as short-term and long-term prognosis of the patient's life.

[9], [10], [11]

Treatment of peritoneal mesothelioma

The primary method of treating the nodal kind of the disease under consideration is the excision of the cancerous tumor by surgical means. In the absence of metastases, this method gives an excellent result, after the operation and subsequent recovery therapy, the patient is quite normally able to continue his life after this terrible diagnosis.

The situation is more complicated when diagnosing a diffuse tumor. Treatment of peritoneal mesothelioma with this type of disease is much more difficult and less predictive.

Having received a complete clinical picture of the disease, the oncologist - gastroenterologist raises the question of the effectiveness of surgical intervention. The doctor can decide to prescribe the operation on the basis of a set of facts:

• Cancer of the peritoneum is not so significant.
• Metastases are absent or occupy a limited area.
• Age of the patient. Cancellation of the operation may be the advanced age of the patient.
• "Bouquet" of concomitant diseases. For example, if a patient suffers a severe heart attack, then it simply does not help to transfer anesthesia.

And yet, primarily with the diffuse nature of pathological changes, surgery is not performed. Such a patient is prescribed chemotherapy and / or radiation therapy.

To carry out chemotherapy for peritoneal mesothelioma, pharmacological agents such as vinorelbine, cisplatin, methotrexate, doxorubicin and some others are mainly used.

The cytostatic drug of the group of vinca alkaloids, vinorelbine differs from similar alkaloids by a structural modification of the remainder of the catarrhantine.

This drug is injected with the patient's body intravenously (or directly into the peritoneum - intraperitoneally). The procedure itself should be performed by an experienced medical professional. Before you put a dropper on the drug, it's worth making sure that the injection needle is in the vein. This warning is due to the fact that even with a small ingestion of medicinal fluid into neighboring tissues, the patient begins to feel a burning sensation and the necrosis starts to develop in a short period of time - the cells affected by the drug die off.

If the health care provider observes signs of an extravagant fluid intake, the drug should be stopped and the remaining amount of the medicine must be gently delivered through another vein.

The dosage of the drug is selected strictly individually in each case.

If the treatment protocol provides for monotherapy with vinorelbine, the recommended starting dose is prescribed in the range of 25 to 30 mg per one square meter of the body surface of the patient. The injection is carried out once a week.

Before the procedure begins, the drug is diluted with 125 ml of isotonic sodium chloride solution. Vinorelbine is fed into the vein very slowly, the entire procedure takes 15 to 20 minutes.

If the protocol of treatment provides for polychemotherapy and, therefore, several diverse pharmacological agents enter into it, the dosage is adjusted, and the frequency of drug administration depends on the schedule of the antitumor treatment that depends on the stage of the disease, the level of hematopoiesis.

If a history of the patient has a violation of hepatic and renal function, the dosage of the drug is prescribed slightly lower than the recommended dosage.

An antineoplastic solution of vinorelbine and sodium chloride is prepared immediately before the procedure and subsequently does not lose its pharmacological characteristics within the next 24 hours after preparation. Store the diluted drug at room temperature.

Therapeutic therapy with vinorelbine, or its analogues, is carried out under the constant supervision of the attending physician, which conducts the strictest monitoring of the blood formula, the level of hemoglobin and the quantitative component of granulocytes and leukocytes.

This control is mandatory before each injection of the medicine.

If the level of granulocytes fell below the figure of 2000 units mm3, the oncologist does not allow the patient to take another medication, and prescribes restorative therapy performed prior to the normalization of the number of neutrophils. The general condition of the patient is monitored.

Contraindication to the use of the drug in question is the individual intolerance of the constituents of the medicine, a severe form of liver failure, in the case of the patient's pregnancy and if the woman feeds her newborn baby with the breast. There are also recommendations on the very handling of drugs of this pharmacological category.

• The fact already mentioned above, when the drug must be introduced with special care into a vein, preventing the non-admission of medicinal fluid, in order to avoid the formation of necrosis.
• During the procedure, you should protect your eyes, if you get into them drugs, you need very quickly rinse them thoroughly in clean running water.
• Before the procedure and during the treatment, constant monitoring of the peripheral blood condition is necessary.
• It is also necessary to constantly monitor the biochemical characteristics of the liver.
• With a decrease in the level of neutrophils, below the critical level, the procedure for the introduction of chemotherapy is not carried out and postponed until the restoration of regulatory parameters.
• In order to avoid the development of a hepatotoxic effect, it is forbidden to take the drug on the background of radiation therapy affecting the area of the kidneys and liver.
• Medical personnel who work with these drugs used for chemotherapy are required to comply with all individual protection requirements that are imposed in close contact with toxic chemicals.

To extract ascitic fluid collected in the abdominal cavity, the doctor is assigned a paracentesis, in which a drainage system is supplied to the exudate accumulation site, with the help of drainage this substance and evacuated.

Radiation therapy can be prescribed by the doctor as an independent treatment technique, or may be a postoperative stage of ancillary treatment that inhibits the growth of cancer cells that have not undergone excision.

Considering all the complexity, insidiousness and danger of this disease, even with minor suspicions of insolvency of health, it is necessary to seek advice from your local therapist. Having become acquainted with the situation and confirmed in suspicions, there is a need for consultation of oncologist doctors, gastroenterologist and surgeon.

Prevention of peritoneal mesothelioma

To maximally protect yourself and your health from the appearance and development of the disease in question, prevention of peritoneal mesothelioma primarily requires completely to exclude contact with asbestos.

• Go to another job.
• Change the place of residence.
• Do in the house repair, removing from it a material such as asbestos.
• Do not ignore preventive examinations by highly specialized specialists.

If for any reason (professional activity and the person does not want to change jobs) this can not be avoided, it is necessary to take all necessary measures for individual protection of the body.

Forecast of peritoneal mesothelioma

When the question arises of predicting tumor therapy, the doctors are somewhat restrained in their conclusions. In view of the fairly rapid dissemination of the process of degeneration, the prognosis of peritoneal mesothelioma is unfavorable.

On average, patients who are diagnosed with this terrible condition live after it is established no more than one or two years. A somewhat optimistic forecast refers to a local type of pathology, less to a diffuse pathology.

There are differences and with different results of histology. If the epithelioid appearance of the mesothelioma affecting the peritoneum is established, the patient is given a longer period of time before the onset of death. If a sarcoma is diagnosed or a mixed type of disease is observed, oncologists state the most rapid development of the disease.

From the first words of the article, which describes the mesothelioma of the peritoneum, you begin to understand how insidious, dangerous and complex the pathology under consideration is. Therefore, in order to protect themselves and their loved ones, it is necessary to pay special attention to choosing a place of residence, avoiding settling near factories for the production of asbestos. You should also remove this material from your house. If your professional activity is related to this material, it is advisable to change the job, removing it from your contact. If the catalyst is started, and pathological changes have already taken place, do not neglect the preventive examinations of specialists. The earlier this disease is revealed, the more likely the patient will live as long as possible.

[12], [13], [14],