Types of Radiation Therapy for Mesothelioma Patients

Radiation therapy is the application of ionizing radiation to destroy tumor cells. When ionizing radiation moves through cells, the radiation strikes some of the molecules, changing them. These molecules become ions and free radicals, which are toxic to living cells. The cells in the treated area then break apart, die, or become dysfunctional. Ideally, the ionizing radiation is directed toward tumor cells rather than healthy cells.

During radiation therapy, a team of specialists including a radiation oncologist, medical physicists, and other healthcare providers will create a treatment plan and conduct radiation therapy. The team will carefully review x-rays, CT scans, and MRI studies to view the mesothelioma as it is situated next to healthy tissue. These radiological images will be used to make precise measurements, and the team will identify the best dose of radiation for the given patient.

Several issues are considered during radiation therapy. The medical professionals will attempt to avoid directing the beam at healthy tissues that surround the tumor, but will calculate a radiation dose that should be toxic to the entire diseased area. Since mesothelioma rarely forms a discrete tumor and grows near many sensitive areas (e.g., spinal cord, heart, esophagus, liver, and the opposite lung), every effort is made to direct the beam at the cancer cells and limit damage to healthy tissues. Specialized radiation delivery techniques have been developed to more precisely target mesothelioma cells.
Read more: How Does Radiation Therapy Work for Mesothelioma?

External Beam Radiation

The traditional method of radiation therapy for mesothelioma is external beam radiation therapy. In external beam radiation therapy, a radiation source outside the patient’s body is pointed at the tumor. Positioning of the radiation delivery device is critical. During the first treatment, a small tattooed dot (the size of a freckle) or semi-permanent ink dots may be applied to the skin to mark a location for the current and subsequent radiation treatments. A precise dose of radiation is delivered by a radiation beam to the tumor. Since the beam is outside of the body, healthy tissue such as skin, muscle, and bone may receive some radiation as well.

Because the positioning and radiation dose must be precise, the preparation for a radiation therapy treatment takes longer than the radiation exposure itself. The actual exposure to radiation takes a few minutes, but the positioning and preparation may take 20 minutes or more. The exposure to radiation is painless, much like having an X-ray or CT scan is painless. Standard external beam radiation therapy is administered five days a week over the course of several weeks.

3D-CRT

3D-CRT stands for three-dimensional conformal radiation therapy. 3D-CRT is a form of external radiation that matches the radiation beam to the shape of the tumor. In traditional external beam radiation therapy, treatment is provided based on a two-dimensional representation of the body. In 3D-CRT, specialized software is used to convert two-dimensional images into a three-dimensional representation of the body and the tumor. Therefore, the radiation treatment specialists can direct the radiation to the tumor in three-dimensional space. The result of this process is that more radiation is delivered to the tumor and less radiation is delivered to healthy tissue.

Like traditional external beam radiation, the 3D-CRT treatment is painless. Since targeting in 3D-CRT is more precise than in the traditional approach, higher doses of radiation can be used. Thus, the cancer-killing potential of the treatment is higher.

IMRT

IMRT stands for Intensity Modulated Radiation Therapy. Like 3D-CRT, IMRT delivers radiation precisely to areas with tumors while mostly sparing surrounding tissue. Unlike 3D-CRT, IMRT delivers different intensities of radiation to the tumor. For example, a high-intensity beam can be directed at areas of large, solid tumor mass while lower intensity energy can be directed at thinner or smaller collections of cancer cells. Because of this enhanced precision, very high doses of ionizing radiation can be used with IMRT.

IMRT may be more effective than external beam radiation therapy and may cause fewer side effects. When IMRT is compared to 3D-CRT, however, the differences in effectiveness are less impressive. IMRT is able to deliver higher amounts of radiation to the mesothelioma, but it still puts healthy organs at risk.

Recently, enhancements have been made to IMRT that may make it even safer. When IMRT is delivered with a technology called helical tomotherapy, high-dose radiation can be delivered more precisely to cancer cells and relatively little strikes healthy tissue. Just as computed tomography (CT) takes X-ray images in “slices,” helical tomotherapy delivers radiation therapy in horizontal “slices” of the body. The intensity of the beam changes with the size of the tumor in each slice. The result is an even higher level of precision than typical IMRT treatments.

Intraoperative Radiation

Intraoperative radiation is the application of ionizing radiation to tumor cells during the course of surgery. The theoretical advantage of intraoperative radiation is that the beam of radiation can be directed on the tumor itself rather than first traveling through healthy tissue. Another possible advantage of intraoperative radiation is the radiation will kill all mesothelioma cells within the chest cavity since, during surgery, the treating physician can see the tumor directly.

Unfortunately, intraoperative radiation has not shown much success. One research group deemed the treatment “prohibitively toxic” and reported serious complications when intraoperative radiation was combined with extrapleural pneumonectomy. It is not known whether intraoperative radiation is beneficial when combined with pleurectomy and decortication, however.

Benefits of Radiation Therapy

Your specific diagnosis will determine which type of radiation therapy will be most beneficial in terms of improving prognosis. It’s important that you refer to a mesothelioma specialist in order to determine if the benefits will outweigh the risks under your specific circumstances. If your doctor recommends radiation therapy as part of your mesothelioma treatment plan, it means they believe the benefits outweigh the possible side effects.

Sources:
1. Buduhan G, Menon S, Aye R, Louie B, Mehta V, Vallières E. Trimodality Therapy for Malignant Pleural Mesothelioma. Ann Thorac Surg. 2009.
2. Rosenzweig KE, Fox JL, Zelefsky MJ, Raben A, Harrison LB, Rusch VW. A pilot trial of high-dose-rate intraoperative radiation therapy for malignant pleural mesothelioma. Brachytherapy. 2005.
3. Lee TT, Everett DL, Shu HK, et al. Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. Dec 2002.

4. https://www.maacenter.org/treatment/radiation/types-of-radiation-therapy/

Symptoms of Mesothelioma Cancer

Early symptoms of mesothelioma are often confused with other diseases.

Mesothelioma symptoms do not usually manifest themselves until anywhere from 20 to 50 years after exposure to asbestos, at advanced stages of the disease. This makes the disease extremely difficult to diagnose until the disease has advanced, limiting treatment options. Additionally, many symptoms of mesothelioma are commonly associated with other diseases and ailments, making diagnosis even more complicated.

Common Symptoms of Mesothelioma

• Shortness of breath or difficulty breathing
• Coughing
• Fluid in the chest, lungs, or abdomen
• Weight loss
• Loss of appetite
• Inability to sleep
• Husky voice
• Difficulty swallowing

Symptoms by Type of Mesothelioma

Symptoms vary according to the type of mesothelioma.

Because the three major types of the disease are similar but originate in different parts of the body, the patient is likely to have symptoms that overlap. For example, nearly all mesothelioma patients suffer from shortness of breath and fatigue, but the pain may be more apparent in the abdominal/stomach area for peritoneal patients and in the chest for those with pleural or pericardial mesothelioma.

The growing tumors cause the pleura, pericardium, or peritoneum to expand, allowing fluid to enter. That generally causes pain – acute to severe – in the affected regions, such as the chest or abdomen. Breathing difficulties also make it hard to sleep and often result in loss of appetite and, eventually, weight loss.

Pleural Mesothelioma Symptoms by Stage

Pleural mesothelioma is staged similar to other types of cancers. Symptoms vary according to the stage of the disease, and generally don’t appear until the tumors are quite advanced. Many symptoms are caused by the physical presence of the tumors, meaning that until they have grown to sufficient size, symptoms are relatively minor and/or generalized. As tumors grow and eventually metastasize, symptoms become more severe.

Shortness of breath and persistent coughing, most common in later stages of pleural mesothelioma, generally bring a patient to the doctor’s office. Both difficulty breathing and persistent coughing are caused by the lungs’ inability to expand properly due to tumors in the pleural region.

Recognizing Symptoms

Symptoms of mesothelioma vary from case to case and with the severity of the illness.The general overall health of the individual, as well as his/her age, may also play a role in how the patient is affected by the disease and which symptoms are most bothersome.

One of the most difficult problems with diagnosing mesothelioma and connecting the symptoms with the disease is the fact that so many of the symptoms can easily be mistaken for other more common (and less serious) chest or respiratory diseases like flu, pneumonia, bronchitis, heart disease, and others.

A doctor well versed in mesothelioma treatment will take time to investigate a patient’s history and hopefully connect past exposure to asbestos with the symptoms. Patients can also assist their doctor if they were knowingly exposed. Anyone that was ever exposed to asbestos, even if it was decades ago, should inform their doctor of the exposure. That information will not only aid the doctor in diagnosis but will also help eliminate the need for many costly and uncomfortable tests that may be ordered while attempting to arrive at a conclusive determination.

Source:
1.“Malignant Mesothelioma.” American Cancer Society.Web.

http://www.cancer.org/acs/groups/cid/documents/webcontent/003119-pdf.pdf.
2. Malignant Mesothelioma Treatment (PDQ®).” National Cancer Institute.

web. http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/patient/page2.
3. Suman, S. “Primary Pericardial Mesothelioma Presenting as Pericardial Constriction: A Case Report.”Heart 90.1 (2004): 4e-4.

Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767997/.
4. “Symptoms, Diagnosis and Treatment.” American Lung Association.

Web. http://www.lung.org/lung-disease/mesothelioma/symptoms-diagnosis.html.
5. https://www.maacenter.org/mesothelioma/symptoms/

Pericardial Mesothelioma

Pericardial mesothelioma is the rarest of the three types of the disease. Accounting for an estimated 1 percent of all mesothelioma cases worldwide, pericardial mesothelioma affects the lining of the heart, also known as the pericardium. While most types of mesothelioma are caused by asbestos, medical experts are still researching how asbestos manages to reach the pericardium.

Pericardial mesothelioma is one of the most difficult types to treat because of the delicate location of tumor growth within the lining of the heart. The pericardium consists of two layers:

• The outer layer is known as the parietal layer or heart sac.
• The inner layer is called the visceral layer or epicardium.

Like the other types of mesothelioma, pericardial mesothelioma has a long, 50-70 year latency period and is usually diagnosed in its later stages, often making for a poor prognosis.

Causes of Pericardial Mesothelioma

Prolonged exposure to asbestos is the only known cause of of most mesothelioma cancers, including pericardial mesothelioma — though the causal relationship in this case is less clear.

Generally speaking, loose asbestos particles are inhaled and gather in or near the internal organs. It is unclear, however, as to how an individual develops pericardial mesothelioma and how the dangerous asbestos fibers make their way into the pericardium. Researchers theorize that asbestos fibers, once they are broken into smaller pieces in the lungs, are carried from the lungs into the bloodstream. As the fibers are pumped through the heart, they may become lodged in the heart lining.

Once lodged in the pericardium, chronic inflammation leads to the formation of cancerous cell growth, thickening of the heart lining, and tumors, similar to what occurs in the more common pleural mesothelioma.

Read more: How Asbestos Makes You Sick?

Symptoms of Pericardial Mesothelioma

A majority of patients exhibit no symptoms at the onset of pericardial mesothelioma. When symptoms are present, it’s difficult to distinguish them from more common illnesses, such as heart disease. As with both the pleura and the peritoneum, the growth of tumors in the pericardial region causes the expansion of tissue and allows fluid to accumulate around the heart. The fluid and thickened membrane increases pressure, interfering with the functioning of the heart. It is this fluid that is responsible for most of the symptoms of pericardial mesothelioma. These symptoms include:

• Chest pain, ranging from uncomfortable to severe
• Shortness of breath or difficulty breathing
• Heart palpitations or an irregular heartbeat
• Persistent coughing
• Extreme fatigue after minimal activity or exertion

Pericardial mesothelioma resembles the other types of asbestos-caused mesothelioma in that the symptoms are often mistaken for something more common. In this case, heart attack or some other sort of heart disease is suspected, especially when the patient begins complaining of persistent chest pains. Other common heart illnesses pericardial mesothelioma has been mistaken for include:

• Tuberculosis pericarditis
• Constrictive pericarditis
• Cardiac tamponade
• Intra-atrial myxoma
• Cardiomyopathy

Symptoms can vary with each patient and can be affected by a number of variables, including:

• Location and size of the tumors
• Overall health of the patient
• Age of the patient

A thorough patient history is the key to the proper diagnosis of the disease. Anyone who worked with asbestos or asbestos-containing products, particularly in shipyards or in the construction field, should always mention their exposure to their doctor. Because this is a rare disease, other diagnoses are usually considered before doctors investigate the possibilities of mesothelioma.

Diagnosis

All forms of mesothelioma are often difficult to diagnose, including pericardial. After assessing symptoms, medical history and current health, a physical examination is performed. Then, imaging tests and a biopsy are performed to locate the tumors and determine whether they are benign or malignant.

Imaging

The traditional x-ray gives doctors a cursory glance at the heart. Because the diagnostic abilities of traditional x-rays are limited, doctors will usually order a more sophisticated test that gives them a better look at the internal organs, such as a CT scan or MRI.

The CT scans and MRIs can lead doctors to their next step in diagnosing the disease. If these tests seem to indicate the presence of mesothelioma, the physician will most likely order a tissue biopsy.

Biopsy

A biopsy is a medical procedure that uses a thin needle to remove tissue from the affected area. In this case, a biopsy of the pericardium – the lining around the heart – would be performed. While the test may sound frightening and can be uncomfortable, it takes just a few minutes and doctors will do everything possible to lessen any discomfort. Results of the biopsy can sometimes take more than a week, but will confirm or deny the diagnosis of mesothelioma.

After receiving a heart illness diagnosis, seeking a second opinion is often recommended due to their similarities to pericardial mesothelioma.

Treatment

If tests are positive for mesothelioma, patients will probably be given a choice of just a few treatment options given the fact that many traditional treatments can so easily damage the heart. Also, because the disease is usually diagnosed in its late stages, due to the fact that it can lay dormant for up to 40 or 50 years, options are less than for cancers that can be diagnosed early. Generally, the primary treatment options include:

• Surgery
• Palliative Care
• Chemotherapy

Surgery

Surgery is rarely recommended in the case of pericardial mesothelioma due to the location of the tumors. It may, however, be suggested for an appropriate candidate. If it is suggested, a pericardiectomy may be performed, where part or all of the affected pericardium is removed. This procedure can also reduce fluid buildup and pressure, helping the heart function more optimally.
Read more: Mesothelioma Surgery

Palliative Care

Because there is no cure for this or any type of mesothelioma, oncologists will usually suggest mesothelioma treatment options that relieve symptoms, reduce pain, or improve the overall quality of life for the patient. As part of a palliative treatment plan to help minimize discomfort and pain, procedures that remove excess fluid are often performed, including pericardiocentesis and fine needle aspiration. Removing the excess fluid aids in reducing pain and pressure around the heart.
Read more: Mesothelioma Treatment

Chemotherapy

Treatments traditionally used for the other forms of mesothelioma, including chemotherapy and radiation, have been less successful in treating pericardial mesothelioma. Patients will want to consider chemotherapy as an option carefully as it can greatly compromise one’s quality of life while providing little or no chance for a cure.
Read more: How Chemotherapy Fights Mesothelioma?
Read more: How Does Radiation Therapy Work for Mesothelioma?

Prognosis

Doctors and research scientists are still searching for a way to cure mesothelioma or at least extend the life of those suffering from all types of the disease. Because it is almost always diagnosed in its late stages and due to limited treatment options, more than half of pericardial patients pass away within six months of a diagnosis.

Diagnostic aids that will result in earlier diagnosis of mesothelioma are currently being tested and other forms of treatment are being surveyed in clinical trials, all in hopes that the lives of mesothelioma patients can someday be prolonged.

Source:

• Warren WH: The clinical manifestations and diagnosis of mesothelioma. Mesothelioma: Diagnosis and Management. Edited by Kittle CF. Chicago: Year Book; 1987: 31.
• 
  
  Pass HI: Emerging translational therapies for mesothelioma. Chest 1999, 116:455S-460S.
• 
  
  Kralstein J: Malignant pericardial diseases: diagnosis and treatment. Am Heart J 1987, 113:785-790.
• https://www.maacenter.org/mesothelioma/types/pericardial-mesothelioma/

Peritoneal Mesothelioma

As one of the several types of mesothelioma, peritoneal mesothelioma is a malignant tumor that develops in the lining of the abdominal cavity (known as the peritoneum). Peritoneal mesothelioma accounts for about 15% to 20% of all mesothelioma cases diagnosed throughout the world, making it the second-most common form of this variety of cancer. It is almost always fatal.

Due to its location in the body, peritoneal mesothelioma is sometimes referred to as abdominal mesothelioma.

Causes of Peritoneal Mesothelioma

As with any form of mesothelioma, exposure to asbestos has been shown to be the cause of nearly all peritoneal mesothelioma cases. A very small number of people with a specific genetic predisposition may also develop peritoneal mesothelioma after prolonged exposure to erionite, a naturally occurring mineral similar to asbestos.

While most asbestos fibers tend to lodge in the lining of the lungs, researchers have a few theories about why some individuals develop peritoneal rather than pleural mesothelioma.

• Some experts believe the asbestos fibers may be inhaled and transported through the lymphatic system to the peritoneal cavity.
• Others hypothesize that after the fibers are ingested and make their way to the intestinal tract, they may work themselves into the peritoneal cavity and peritoneum.
• Some researchers surmise that that the fibers captured and held by the mucus in the trachea or bronchi may eventually be swallowed.

Regardless of how the fibers reach the peritoneum, their presence in the abdominal area causes inflammation and, ultimately, tumors. As the malignancy grows, it covers the abdominal cavity and eventually may spread (metastasize) to other areas of the body.

Symptoms of Peritoneal Mesothelioma

Like all forms of asbestos-caused cancer, peritoneal mesothelioma can lay dormant in the system for up to fifty years. Victims are usually difficult to diagnose, because when the symptoms finally surface, it is often difficult to make connect them to asbestos, especially when the individual has not been exposed to the substance for many years.

Furthermore, the symptoms of peritoneal mesothelioma can be easily confused with those of other more common diseases. Therefore, many victims go undiagnosed or are improperly diagnosed for months before the proper conclusion is determined.

Symptoms of peritoneal mesothelioma include:

• Abdominal pain (acute to severe)
• Swelling of the abdominal region due to fluid accumulation
• Breathing difficulties
• Loss of appetite and/or weight loss
• Bowel obstruction
• Nausea
• Vomiting
• Weakness
• Fever
• Anemia

Symptoms may vary with each patient and may depend on a number of factors, including:

• Tumor location and size
• Patient’s age
• General health of the individual

When presenting symptoms for diagnosis, it’s important for patients to tell the doctor about their exposure to asbestos, even if the exposure occurred many years ago. This knowledge will aid in diagnosis and possibly spare the patient a number of unnecessary tests.

Diagnosis

Diagnosis of this rarer form of mesothelioma is much the same as with pleural mesothelioma. Your doctor may order such tests as a traditional x-ray or perhaps a more sophisticated test, such as an MRI or CT scan.

While imaging technologies can provide some indication of peritoneal mesothelioma, doctors will usually order a tissue biopsy to make a conclusive diagnosis. The biopsy is performed using a peritoneoscopy or laparotomy to take a sample of the tissue around the abdominal cavity, which is then analyzed under a microscope to determine whether tumors are present. The biopsy can be uncomfortable, but it is usually over in just a few minutes.

Read More: Mesothelioma Diagnosis

Treatment

Once a diagnosis is determined, an oncologist will help determine a course of treatment for the patient.

Surgery

Because peritoneal mesothelioma is often diagnosed in its very late stages, tumor removal by surgery is usually not an option. However, if surgery is established as a viable option, it may involve excising a portion of the lining and tissue from the abdominal area to remove the tumor. If the tumor is unusually large, a lung or a section of the diaphragm may need to be removed as well.
Read More: How Does Mesothelioma Surgery Work?

Radiation

Radiation may be aimed directly at the tumors or used as a palliative measure to relieve pain or lessen symptoms. However, radiation therapy will not cure mesothelioma. It is often used alongside chemotherapy treatment.
Read More: How Does Radiation Therapy Work?

Chemotherapy

Common chemotherapy techniques for this kind of mesothelioma include intra-peritoneal chemo, which involves injecting chemotherapy drugs directly into the abdomen. Different drugs in various combinations are recommended, depending on each individual case. Like radiation, chemotherapy can be a palliative measure, relieving uncomfortable symptoms and improving the quality of life for mesothelioma patients.
Read More: How Chemotherapy Fights Mesothelioma?

New Treatments

Clinical trials are offered by researchers through many cancer clinics and health centers for those diagnosed with mesothelioma. These trials usually offer the opportunity to try experimental medications or emerging treatments that have not yet been shown to be completely effective and have not received approval from the FDA and other governmental organizations that oversee health care.

Although riskier than traditional treatments, new treatments may offer hope to those whose cancer does not go into remission using standard therapy techniques.
Read More: Mesothelioma Treatments

Prognosis

Because it takes so long to diagnose peritoneal mesothelioma, the outcome is not positive. As with other forms of the disease, most victims live for less than a year after diagnosis. The longest-known survivor of mesothelioma lived 19 years after diagnosis, but such cases are extremely rare.

Mesothelioma patient prognosis depends on a variety of considerations:

• The individual’s gender and age
• The stage of the disease at diagnosis
• Mesothelioma cell type
• Exact location of tumors in the peritoneum

Read More: Stages and Life Expectancy of Mesothelioma

Doctors and research scientists continue to look for ways to treat and cure mesothelioma and its symptoms, as well as prolong the lives of those who are affected.

Sources:
1 Bridda, Alessio. Peritoneal Mesothelioma: A Review. Medscape General Medicine. 2007; 9(2): 32.
2 Sridhar KS, et al.: New strategies are needed in diffuse malignant mesothelioma. Cancer 1992, 70:2969-2979. doi: 10.1002/1097-0142(19921215)70:123.0.CO;2-A
3 Asensio JA: Primary malignant peritoneal mesothelioma: a report of seven cases and a review of the literature. Arch Surg 1990, 125:477-481.
4 A. Umran Dogan. “Mesothelioma in Cappadocian Villages.” Indoor and Built Environment December 2003 vol. 12 no. 6. 367-375. doi: 10.1177/1420326X03039065
5 https://www.maacenter.org/mesothelioma/types/peritoneal-mesothelioma/

Pleural Mesothelioma

Pleural mesothelioma is a type of cancer that affects the lining of the lungs, otherwise known as the pleura. Caused by exposure to asbestos, pleural mesothelioma is the most common of the three types of mesothelioma, where more than 75% of all diagnosed mesothelioma cases affect the pleura.

The pleura is a sac of soft tissue that contains the lungs as well as a thin membrane known as the mesothelium, which secretes a vital fluid that enables the lungs to expand and contract. While there may be no symptoms present until the later stages of the cancer, first signs of the disease include shortness of breath and chest pain due to the way the cancer affects this area.

The 20 to 50 year latency period between exposure and onset of the disease also accounts for the poor prognosis associated with pleural mesothelioma, which is usually less than 18 months, though this isn’t always the case.

Causes of Pleural Mesothelioma

The primary cause of pleural mesothelioma is asbestos exposure. When inhaled, asbestos fibers become embedded in the lung lining. In time, these sharp fibers irritate the pleural membrane and lead to chronic inflammation and scar tissue.

In individuals who are heavily exposed, 80 percent of whom are older men who worked in industrial jobs, these fibers can lead to the uncontrollable growth of cancerous cells in the pleura, eventually forming tumors.

Following a diagnosis, patients usually exhibit multiple tumor masses affecting both the visceral (further from the lung) and parietal (closer to the lung) surfaces of the pleura. The parietal surface is more often affected than the visceral surface, and the right lung, due to its larger size, often suffers more damage than the smaller left lung. More asbestos tends to settle in the lower lungs than the upper lungs.

These tumors often grow quickly in size and can cover the entire lung cavity, making it very difficult to breathe and causing severe pain. In the advanced stages of pleural mesothelioma, the cancer may spread, or metastasize, to other nearby organs, including the heart, abdomen, and lymph nodes.

Symptoms of Pleural Mesothelioma

Pleural mesothelioma is difficult to diagnose because the symptoms of the disease, if and when present early on, resemble those of other more common illnesses, including the flu, a cold, laryngitis, pneumonia, or whooping cough.

Chest pain and difficulty breathing is usually the first indication of a problem, caused by the growing tumors that enlarge the pleural space and cause it to fill with too much fluid. Such chest pain is often mistaken for heart problems and many yet-to-be-diagnosed mesothelioma victims believe they are having a heart attack or suffering from heart disease. To further complicate diagnosis, symptoms don’t usually develop until stages III or IV of the cancer.

Common symptoms of pleural mesothelioma, caused by the presence of tumors, include:

• Chest, rub, or lower back pain
• Persistent coughing
• Coughing up blood (hemoptysis)
• Difficulty swallowing (dysphagia)
• Shortness of breath (dyspnea)
• Fluid around the lungs (pleural effusion)
• Hoarseness or difficulty speaking
• Blood clots (less common)

The discomfort caused by the above symptoms can also result in:

• Loss of appetite
• Weight loss
• Fatigue

More about:  Symptoms of Mesothelioma

Diagnosis

It often takes weeks or even months before a correct diagnosis is made, and because the disease usually takes between 20 and 50 years to surface, past exposure to asbestos often doesn’t come to mind when attempting to make a diagnosis or when a patient is giving a medical history. Also, a number of other lung and respiratory diseases, including the flu and pneumonia, have the same symptoms as pleural mesothelioma, making a correct diagnosis even more challenging to confirm.

Ultimately, a definitive diagnosis of malignant pleural mesothelioma is achieved by the use of sophisticated x-rays such as CT scans and MRIs, as well as collecting fluid and tissue biopsies achieved using thoracoscopy, where a doctor can examine the patient’s chest with a small camera. Scans can reveal the presence of pleural effusion and a biopsy, preferably a needle biopsy, can complete the diagnosis. While somewhat uncomfortable, this test is quick and offers a good success rate for accurate diagnosis.

• Chest X-rays are used to detect pleural effusions.
• CT Scans help physicians detect evidence of asbestos exposure.
• PET scans may reveal where the cancer has spread.
• Thoracentesis allow doctors to sample pleural fluid.
• Biopsies are used to collect pleural tissue samples.

After performing a series of the above scans, tests, and biopsies, a treatment plan is the next step.

More about:  Mesothelioma Diagnosis

Treatment

Because pleural mesothelioma is so difficult to diagnose, the disease is most often in an advanced stage when discovered. That makes mesothelioma treatment options limited. Common treatment options for pleural mesothelioma include:

• Surgery
• Chemotherapy
• Radiation
• Multimodal

More about:  Mesothelioma Treatments

Surgery

Only a handful of mesothelioma patients afflicted with this form of the disease are candidates for surgery to remove tumors, especially since the tumors are often large and widespread by the time of diagnosis. Surgical resection may be an option later, if the oncologist thinks the removal of a lung would benefit the patient. Surgical options include pleurectomy/decortication (P/D), where the tumor and diseased pleura are removed, and extrapleural pneumonectomy (EPP), where the pleura, affected lung, diaphragm and pericardium are removed.

More about :  Mesothelioma Surgery

Chemotherapy

More often, pleural mesothelioma patients are treated with radiation or chemotherapy. Chemotherapy involves the use of drugs to both destroy cancer cells shrink tumors. Despite advancements, the success rate of chemotherapy alone is low. A number of clinical trials are attempting to find a combination of chemotherapy drugs that will cure pleural mesothelioma.

More about : How Chemotherapy Fights Mesothelioma? 

Radiation

Radiation therapy, which is also meant to kill cancer cells and reduce tumor size, is often only successful in managing the symptoms of pleural mesothelioma.

Some doctors opt for what is commonly known as multimodal therapy, which is a combination of two or more therapies, usually chemo and radiation and/or surgery. Most experts agree that a multimodal approach provides the best chances of survival. Recent research has also prompted experimentation with different combinations of chemotherapy drugs, resulting in positive outcomes when certain ones are used at the same time.

Once mesothelioma is diagnosed, it’s important for patients to maintain a healthy lifestyle in order to better combat the disease. This includes proper nutrition, exercise, and stress-relieving therapies.

More about : How Does Radiation Therapy Work? 

Prognosis

After a diagnosis and thorough examination of the disease, doctors establish a probable outcome or prognosis, though doing so accurately for pleural mesothelioma is difficult.

Factors that determine prognosis include:

• Patient’s age and gender
• Stage of disease when diagnosed
• Patient’s history of smoking
• Presence of pain when breathing

Currently, the prognosis for those diagnosed with pleural mesothelioma is not good given that diagnosis often occurs in a late, advanced stage. Many patients die within six months of diagnosis; some live up to a year, but survival much beyond that length of time is rare. Clinical trials are constantly underway in hopes of discovering a cure for the disease or a way to further prolong the life of a pleural mesothelioma sufferer.

Sources:
1 American Cancer Society. Detailed Guide: What is Malignant Mesothelioma? 

2 American Cancer Society. Detailed Guide: Radiation therapy for malignant mesothelioma. 

3 Cancer Research UK. The Stages of Mesothelioma 

4 https://www.maacenter.org/mesothelioma/types/pleural-mesothelioma/