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Malignant Pleural Mesothelioma (MPM)
Pleural mesothelioma takes over 60% of all mesothelioma patients. This kind of mesothelioma is seen through problems with respiration, like troubles while breathing or a prolonged coughing. The reduction of the lungs space caused by pleura thickening leads to severe breathing troubles. Sometimes patients start feeling strong chest cover pain or the abdominal cover pain. This is the sign of tumor growing.
The aims of attack for this kind of mesothelioma are respiratory areas of the body along with the lungs. The lining of the ribs and lungs, also known as pleura, gets affected by the cancer. This kind of mesothelioma, like any other kind shows its symptoms only in two or three decades, sometimes even longer, that mostly doesn't allow to find out the disease until it is too much advanced by the moment it is too late to apply any treatment.
Malignant Pleural Mesothelioma (MPM) symptoms
The symptoms of Pleural mesothelioma may include
Types of Malignant Pleural Mesothelioma
Mesotheliomas have three various histologic patterns, which are: epithelioid, sacomatoid, and mixed-type. The most wide-spread pattern, taking from 60 up to 70 percent of all mesothelioma patients is epithelioid. There are some special tests that are required to specify the diagnosis because this pattern can be confused with adenocarcinoma - another variation of lung cancer. The most aggressive and, happily, the least frequent tumor (10-20% of all cases) that doesn't give more than 6 month to survive for the patient after being diagnosed is sarcomatoid type. The third kind, a mixed-type, taking from 20 to 30% has both epithelioid and sarcomatoid features.
Malignant pleural mesothelioma has got six stages by now, which are: IA, IB, II, III, IV and Occult.
- Stage IA: The cancer of the IA stage is pleura- and one side of the chest-limited tumor that is not spread to lymph nodes as well as to any other sites.
- Stage IB: The cancer at the stage IB is extended to the parietal pleura, as well as to including mediastinal and diaphragmatic pleura located on one side of the chest and there is a possibility of a tumor to make scattered foci that affects visceral pleura as well. Lymph nodes or distant spread are not involved into the disease so far.
- Stage II: Stage II involves parietal and visceral pleura into the tumor development. It can also spread on diaphragmatic muscle or extend into lung. The lymph can possibly be involved on this stage but not distant spread.
- Stage III: The cancer of the stage III is still surgically resectable being advanced locally. The cancer affects parietal, mediastinal, diaphragmatic, and visceral pleura on this stage. The spread to mediastinal fat, fascia, soft tissue of the chest wall is possible, as well as the affection to the pericardium. An extension to the bronchopulmonary or hilar lymph nodes, to subcarinal or mediastinal lymph nodes as well as internal mammary nodes is possible for stage III patients. Distant metastases, as well as the affection to the second side of the chest are not observed. - Stage IV: The locally advanced cancer is unresectable on this stage. Mediastinal, internal mammary or supraclavicular lymph nodes on the opposite chest side get affected by the stage IV tumor. There is a possibility of distant metastasis.
- Recurrent: The disease recurrence can be seen at patients who underwent a primary treatment or suffered a failed primary treatment.
There are a plenty of aspects on which pleural mesothelioma treatment depends. The doctor recommends the treatment course basing on his awareness of the disease and the results of the tests. The doctor may take into consideration such facts as: the age of the patient, his medical records, general wellbeing of the patient, sometimes even the weight. Factors of a different kind, also taken into consideration are: the level of the cancer advance and the location of the tumor.
Different kinds of mesothelioma are in most cases treated in approximately same ways, but still, depending on the location of the tumor within the body.
Possible treatments are:
This way concerns moving a part, or the entire lung, as well as the tissue located nearby for the purpose of the cancerous and tumor cells removal. Sometimes the drain of the liquid out of lungs eases the patient's wellbeing. The amount of surgery interference depends directly on how much the tumor has extended. The importance of radical surgery can hardly be established due to the absence of the randomized control trials.
The only situation when radical surgery may be applied is the case of epithelioid mesothelioma positive diagnosis. Only the centres interested in extrapleuropneumonectomies performing and have the adequate experience should carry out such surgery. The results of surgery are, according to the limited amount of the available evidence, only a piece of the whole multimodal strategy of treatment.
Pleurectomy and decortication held open, despite their effectiveness in pleural effusions regulation, should be applied in difficult situations because of their high morbidity and considerable rate of operative mortality (approximately 30%). Though, most of thoracic surgical centres nowadays have an opportunity to hold VATS (video-assisted thoracic surgery).
VATS procedures reduce the mortality rate down to 1.5% and the operative morbidity while applying partial pleurectomy and cytoreductive surgery. The recurrence rate in also lower even for the patients who didn't succeed in other types of treatment. 30 The described procedure is considered as a randomised trial, that's why it needs to be evaluated even further.
The surgical operations applied to malignant mesothelioma give the high risk of the following tumor seeding through port sites and drains. Early local radiotherapy can make such risk much lower.
Trapped lung and persisting pleural fluid that do not allow achieving apposition of the surfaces of pleura may force doctors to use pleuroperitoneal shunts for some patients. The shunts are placed at laparotomy and mini-thoracotomy or with minimal invasion. Nevertheless, there is a high rate of complication and failure, such as shunt blocking or peritoneal seedings.
Drugs are the basis of this therapy, used for destruction cancerous cell as well as for the reduction of the tumor size. These chemicals may be swallowed as tables or inserted directly through the muscle or vein through the needle. These drugs flow across the body with the blood streams killing any cancerous cell they face.
All mesothelioma patients should have an access to either an oncologist or respiratory specialist to consult about pluses and minuses of chemotherapy. The comparison of survival or symptom control in patients treated with either best supportive care or chemotherapy is not published in any randomized trials. Chemotherapy is to be scheduled as a clinical trial at places where it is applied. Clinics should encourage their employees to apply suitable trials to patients.
This way of treatment applies high-energy x-ray emission to the tumor either externally (outside the body) or internally( when the rays are internally aimed at the source) to destroy cancerous cells and decrease the tumor size. Plastic tubes are used for internal radiotherapy. Furthermore, the doctor can add drugs through this procedure. Prophylactic radiotherapy is applied for the reduction of the chest wall implantation that is followed by some invasions. Approximately half of all patients feel pain relief after applying palliative radiotherapy. Palpable masses of almost one half of all patients react to the radiotherapy. Responds are received quite seldom from superior vena caval and breathlessness.
Experimental treatment for pleural mesothelioma
The role of such therapies as gene therapy, photodynamic therapy, and immunotherapy is not found out yet.
A lot of patients require the palliation of symptoms while the diagnosis is being determined. The aim of palliative care is to ease the pain along with other physical symptoms. It also tries to meet any psychological, emotional, social and spiritual need.
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