Mesothelioma of the pleura
Last reviewed: 23.04.2024
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[What causes pleural mesothelioma?
The lifetime risk of developing the disease in people working with asbestos is approximately 10%, with an average latency of 30 years. The risk does not depend on smoking. Mesothelioma can spread locally or metastasize to the pericardium, diaphragm, peritoneum, and, rarely, into the vaginal envelope of the testicle.
Symptoms of pleural mesothelioma
Patients most often notice shortness of breath and non-pleural pain in the chest. Symptoms of pleural mesothelioma, indicating the generalization of the process, are rarely found during the clinical manifestation of the disease. Invasion of the chest wall and other adjacent structures can cause severe pain, dysphonia, dysphagia, Horner's syndrome, shoulder plexopathy or ascites. Extrathoracic spread occurs in 80% of patients, usually including lymph nodes of the roots and mediastinum, liver, adrenal and kidney.
Where does it hurt?
What's bothering you?
Diagnosis of pleural mesothelioma
The pleural form of mesothelioma, which is more than 90% of all cases, is revealed on the roentgenogram as a diffuse one-sided or bilateral pleural thickening, which seems to cover the lungs, usually leading to an increase in the rib-diaphragmatic angles. Pleural effusion is present in 95% of cases and is usually unilateral, massive. The diagnosis is based on pleural fluid cytology or pleural biopsy and, if they are non-diagnostic, biopsies with video-assisted thoracoscopy (BAT) or thoracotomy. The staging is determined using chest CT, mediastinoscopy and NMR. The sensitivity and specificity of NMR and CT are comparable, although NMR is useful for determining the spread of a tumor in the vertebral column or spinal cord. PET may have better sensitivity and specificity for a differential diagnosis of benign and malignant pleural thickening. Bronchoscopy allows to identify concomitant endobronchial malignant tumors. An increased level of hyaluronidase in the pleural fluid is suspicious, but not diagnostic for this disease. Soluble mesotheliene-bound proteins secreted into the serum by mesothelial cells are studied as possible tumor markers for the detection and control of the disease.
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Treatment of pleural mesothelioma
Mesothelioma of the pleura remains non-cancerous. Surgery to remove the pleura; one-sided pulmonectomy, removal of the diaphragmatic nerve and half of the diaphragm; removal of the pericardium with chemotherapy or radiotherapy is considered as possible treatment methods, but they do not significantly change the prognosis or survival time; cases of prolonged survival are rare. In addition, complete surgical resection is not feasible in most patients. The combination of pemetrexed (antimetabolite antifolate) and cisplatin gives encouraging results, but requires further study.
The main goal of maintenance therapy is to reduce pain and shortness of breath. Given the diffuse nature of the disease, radiation therapy is usually impossible, except for indications for the treatment of local pain and metastases, but should not be used to treat radicular pain. Pleurodesis or pleurectomy can be used to reduce shortness of breath caused by pleural effusion. Adequate analgesia is difficult, but it must be achieved, usually with the help of opioids, using both percutaneous and epidural catheters to control pain. Chemotherapy using cisplatin with gemcitabine can reduce the symptoms of pleural mesothelioma in most cases and demonstrates tumor reduction in half of the patients studied. Some authors suggest multimodal treatment of pleural mesothelioma. Intrapleural administration of granulocyte-macrophage colony-stimulating factor or interferon gamma, intravenous rupirnase (ribonuclease) and gene therapy are at the research stage.
Drugs
What prognosis does pleural mesothelioma have?
Mesothelioma of the pleura has an unfavorable prognosis. No treatment of pleural mesothelioma showed a significant increase in life expectancy. Survival from the time of diagnosis is an average of 8-15 months, depending on the type of cells and localization. A small number of patients, usually younger, having a shorter duration of symptoms, have a more favorable prognosis, sometimes remain alive for several years after diagnosis.