Internal Medicine

Pleural mesothelioma

introduction

Pleural mesothelioma is a medical term for cancer of the chest cavity after several years of inhalation of asbestos.

It affects the pleura, i.e. the lung membrane, and describes a mostly malignant tumor of the cell layer that lines the chest cavity. It is the most common type of cancer caused by asbestos damage in the lungs. Unfortunately, this is a particularly aggressive type of cancer that kills over 1,000 people in Germany every year.

causes

Even 1-2 years of exposure to asbestos are enough to trigger cancer decades later.

The small asbestos fibers are deposited in the lungs and cannot be broken down. However, they can migrate into the lung membrane over time. In addition, these asbestos fibers cause irritation and inflammation on the spot. This leads to the remodeling of the cells in the tissue and can ultimately cause a gene change with the development of cancer through the constant remodeling. 9 out of 10 cases of pleural mesothelioma are caused by asbestos damage.

Mesothelioma can also be preceded by asbestosis, i.e. an occupational disease of the lungs caused by exposure to asbestos. Affected patients experience difficulty breathing when moving and cough with sputum. It doesn't just have to be people who have worked with asbestos. The wives of these men, for example, who had to wash clothes contaminated with asbestos, can suffer from the consequences years later.

Symptoms

Since pleural mesothelioma is a cancer, the typical symptoms that a malignant change in the body causes are also shown here.

These include a reduction in general health, weakness, fatigue, night sweats, weight loss and fever. Typical symptoms of pleural mesothelioma are also shortness of breath, breathing problems, chest pain or difficulty swallowing. It is not uncommon for a persistent cough without sputum or coughing up blood to occur.

Furthermore, the patient may complain of pain in the back or stomach, show water retention in the limbs and also swollen lymph nodes in the chest area can be felt. At the doctor's, the clinical examination often shows an effusion in the chest cavity with reduced breathing noise. Patients also often report pain when breathing. The lung borders that follow the breathing in healthy people are now immobile. This is mainly explained by the rapid growth of the malignant tumor, which causes adhesions of the lung membrane to develop. As a result, the filling volume of the lungs is reduced and the patient cannot breathe more easily. Pain can be caused by an increase in the size of the tumor or by metastases in other organs.

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diagnosis

Unfortunately, in the majority of cases the diagnosis of pleural mesothelioma is only made at an advanced stage. Then it is usually too late for the disease to be cured. The findings can be confirmed by a CT examination, which reveals nodular thickening in the lung membrane. You can also puncture these foci with a thin needle. However, this can easily lead to metastases in the needle prick canal due to the spread of tumor cells.

Tumor markers of pleural mesothelioma

The well-known tumor markers for pleural mesothelioma are fibulin-3 or mesothelin-related protein in medical terminology.

A tumor marker can be used to monitor the progression of cancer. The histological examination of the cancer cells can provide further information about the prognosis of the disease. In doing so, one examines which cells are present and to what extent the tissue exhibits characteristic cancer features. This examination is particularly important for pleural mesothelioma, as many different types of cancer cells can occur and these in turn are related to very different disease courses.

Stages

Normally, after exposure to asbestos, small plaques are found in the lungs first, then fluid can be deposited in the chest cavity and then the pleural thickened.

The stages of pleural mesothelioma consist of stage 1, when the cancer is localized. Stage 2 describes the spread to regional lymph nodes. The third stage is characterized by the growth of malignant cells in the surrounding tissue and in the fourth stage metastases are found in distant organs.

End-stage pleural mesothelioma

At the beginning of this malignant cancer, there are often unspecific symptoms such as weakness and weight loss. Because of this, no further examinations may be carried out for the time being.

Often only with severe symptoms, when an effusion has formed, there is a justified suspicion of pleural mesothelioma. Then, unfortunately, the cancer cells have often already spread to neighboring organs, lymph nodes and distant organs. This makes breathing difficult and the function of the liver and kidneys can also be restricted.

treatment

The treatment of pleural mesothelioma can be precisely adjusted after detailed examinations and determination of the specific cancer cell type.

If the disease is recognized early enough, the aim is to cure the disease. For this purpose, lung membrane, part of the lungs, part of the pericardium and the diaphragm are removed in an operation. Then chemotherapy and radiation are carried out. Unfortunately, this can only rarely be implemented in this way, as the majority of patients only receive the diagnosis in the final stage, when only life-prolonging measures can be achieved.

In most cases, a combination of two chemotherapies is used. In addition, an operation or radiation can be carried out. Since one wants to give the patient the best possible quality of life, the doctors try to help the patient by alleviating the symptoms. This can be done, for example, through pain therapy, medication for nausea or stimulation of the appetite. Emotional support from self-help groups or psychotherapeutic treatment can also be important for the course of pleural mesothelioma.

Prognosis and life expectancy

Unfortunately, in most cases, the prognosis for pleural mesothelioma is not good. This is mainly due to the fact that the malignant cancer is recognized and treated so late. The disease is usually so advanced that only life-prolonging measures can be carried out. The statistics say that most patients die 1 year after diagnosing pleural mesothelioma.

Bad signs for a statement about life expectancy are when there is anemia but the white and red blood cells are increased. In addition, one can determine the LDH parameters in the blood, which give an indication of the tumor cell decay if they are elevated. Overall, it can be said that patients in a poor general condition also have a poorer prognosis. That is why it is extremely important to use supportive therapy to improve the patient's condition as much as possible.

In addition, it should be said that the decisive factor for a prognosis is the cell type, which is determined in the histological examination of the tissue.

Course of disease

The course of the disease of pleural mesothelioma is particularly rapid and, in the case of a malignant cell type, also very aggressive in its growth.

In most cases, long-term inhalation of asbestos occurred, which may have triggered asbestosis. Decades later there is usually a decrease in the general condition and then the specific symptoms. Unfortunately, when the disease is diagnosed, it is often so advanced that the cancer cells have spread and spread to the surrounding tissue. In the majority of cases, the cause of death is such massive local growth in the lung membrane that it is no longer compatible with life.