Pleural Mesothelioma

A share about tumors including the pleural and in explicit threatening Pleural Mesothelioma, as revealed by dr. Alex Farber – a Thoracic Surgeon at the Swedish Cancer Institute and Medical Center in Seattle, Washington.

Below he shared about what the pleural is and possible treatment options for cancer involving the pleural.

The entirety of the data and substance contained are proposed for general clinical and wellbeing data and instructive reason just, and are not planned to be utilized as a substitute for proficient clinical counsel, treatment of care.

"With respect to anatomy of the pleura, each lobe of the lung is covered by a double layer sac, that we term pleura. This covers the lung, it lines the chest wall, diaphragm and mediastinum.

We call the layer that covers the lung; the Visceral Pleura. We term the layer that covers the chest wall; the Parietal Pleura.

Pleura also lines the diaphragm as well as the pericardium, the sac around the heart. The space between the two pleural layers is termed the pleural space.

There are approximately two to three thousand new cases of primary cancers of the pleura or malignant pleural Mesothelioma that are diagnosed each year in the United States.

We know that remote exposure to asbestos is a risk factor for developing Mesothelioma. Tumors of the pleura can also be in our most often secondary to metastases from cancer involving distant parts of the body, such as colon prostate and ovary.

While primary pleural malignancies and this is defined as tumors that arise from the pleura itself are fairly uncommon.

Therefore, physicians tend to have a difficult time making the initial diagnosis of Mesothelioma.

We continue to learn more about Malignant Pleural Mesothelioma with respect to the diagnosis, management and possible treatment options.

We now know that for a subgroup of patient’s multi-modality therapy or the combined use of chemotherapy radiation and surgery is associated with better outcomes than the use of any single one of those treatment options alone.

Therefore, survival of our patients with Mesothelioma is beginning to improve. Up to 80% of cases of Mesothelioma are associated with asbestos exposure.

The remaining cases can be related to family contact as well as non-asbestos type causes. People most often are diagnosed with Mesothelioma and their 50s to 70s, and males are affected more often than females.

It can be difficult to differentiate a malignant pleural Mesothelioma from a different type of cancer that we call Metastatic Adeno Carcinoma. These are two completely different types of cancer with vastly different treatment options.

As I mentioned before, pleural tumors are more frequently metastatic cancers than Mesothelioma, and so we utilize many different tests to accurately make that distinction.

It is crucial that we have enough tissue sample or a large enough biopsy specimen to adequately characterize – not only the tumor as a Mesothelioma, but also to distinguish which subtype of Mesothelioma we have in specific epithelioid, sarcoma toyed, or mixed.

Epithelioid Mesothelioma is the more favorable subtype of Mesothelioma and carries a greater chance of survival after surgical, and multi-modality therapy.

Sarcoma Toid Mesothelioma is composed of spindle-shaped cells, and these tumors tend to have a less favorable outcome.

Part of the difficulty in making a diagnosis of Mesothelioma are there subtle symptoms that a patient exhibit.

Dyspnea or difficulty with breathing is the most common symptom and that is usually due to the presence of a pleural effusion, characterized in blue.

This accumulates in the spaces between the Visceral Pleura and the Parietal Pleura, in between the lung and the chest wall.

Chest pain can also be common, other symptoms include cough, loss of appetite, weight loss, night sweats, and even hemoptysis or spitting up blood. On physical exam, there may be decreased breath sounds on the affected side. There can also be a mass in the chest wall and this could be painful.

There are a number of Radiologic tests that we order while trying to establish a diagnosis.

The stage which tells us how advanced the cancer may be in determine if surgery is feasible, and in the best interest of the patient.

CT scans of the chest are usually one of the first tests that we order. It is readily available and it provides some very useful data. PET scans help determine if there's any suggestion of disease in the other lung in the abdomen or in other areas of the body. At times MRI can suggest invasion into the chest wall, mediastinum or across the diaphragm into the abdomen. This usually indicates that surgery would not be an option that would benefit the patient.

All the information we gather including CT, PET, MRI, as well as histology from the tissue biopsy, is used to gain a better idea of the anatomy of one's Mesothelioma. And whether surgery will be of potential benefit for the patient.

The first invasive tests used in an attempt to make a diagnosis of Mesothelioma is typically a Thoracentesis or when fluid is removed from the pleural space.

A Thoracentesis is the use of a small catheter to drain pleural fluid that is sent for analysis to a pathologist to see if cancer cells are indeed present.

it is not uncommon that the pleural fluid is analyzed and does not indicate a diagnosis of Mesothelioma, or even cancer at all. Even if cancer is present in that space.

Oftentimes, the next step is the use of a CT scan to guide a pleural biopsy.

This heals a diagnosis of mesothelioma approximately 30 to 50 percent of the time. Better, but still not great with respect to making a definitive diagnosis of Mesothelioma.

Lastly, an operation can be performed usually through a single small incision in the chest wall.

A video scope is introduced into the pleural space and multiple biopsies are taken of the pleural surfaces.

This is often a diagnostic intervention that results in a definitive diagnosis of malignant Pleural Mesothelioma. At this point the patient typically is referred to a Thoracic surgeon with experience and treating patients with Mesothelioma.

As is true with any cancer we treat, we stage every patient with Mesothelioma. In other words, we determine how advanced we believe the cancer to be, when we attempt to determine the best treatment option possible.

We utilize all the data available to us including the CT, PET, MRI, tissue biopsy and eventually add a procedure in the operating room called a cervical mediastinal Skippy.

This is a procedure where a small incision is made at the base of the neck and mediastinal lymph nodes are biopsied.

We now know that if the mediastinal nodes are negative for cancer, meaning no cancer is present that these patients live longer, than if the nodes are involved with cancer.

If we suspect the possibility of Mesothelioma existing in the abdomen, we may perform a laparoscopy to assess. This involves going to the operating room, where a small incision and cameras are used to obtain tissue to prove the presence or not of mesothelioma in the abdomen.

There are two operations that thoracic surgeons may consider performing for patients with mesothelioma. These are named Cleric tome in Decortication or Extra Pleural Pneumonectomy.

Cleric tome in Decortication is a surgical procedure that involves removing both the viscera and parietal pleura. This leaves the lung in place. This can be a potential option for patients with a very minimal or very advanced disease.

An Extra Pleural Pneumonectomy is the complete removal of the lung with its visceral pleura, the parietal pleura, the diaphragm, and the sac around the heart, termed the pericardium.

We then reconstruct both the pericardium as well as the diaphragm, using prosthetic material. We believe Extra Pleural Pneumonectomy to be the better choice for people who are strong, or younger, or who have more bulky disease.

There is no gold standard therapy for Mesothelioma. Your treatment plan depends on the anatomy of your tumor in your overall status. Sometimes chemotherapy is done before surgery.

Our thoracic group from Swedish has a recent publication describing our treatment philosophy and results and patients with mesothelioma treated with chemotherapy first, followed by surgery and then radiation.

Patients with Mesothelioma are better managed in centers where there is experience and treating this type of cancer as well as what the complex surgical procedures required for removal of the entire tumor.

Only by centralizing the care for the small number of new patients with Mesothelioma seen every year to a limited number of Medical Centers can we continue to study, learn and improve outcomes for our patients. fighting this cancer.

In the past, Mesothelioma was considered to be a disease that could not be treated in which only pain management should be offered.

We have come a long way from those days. We now know there are interventions that can help certain patients live longer and more comfortably.

The surgeries that we offer to patients have improved our ability to make accurate diagnosis before we head to the operating room.

We continue to experiment, do research and study our results critically."

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