Disease name and definition

Posted by Unknown Wednesday, 15 May 2013 0 comments
Malignant mesothelioma is a fatal asbestos-associated malignancy originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis. The exact prevalence is unknown but it is estimated that mesotheliomas represent less than 1% of all cancers. Its incidence is increasing, with an expected peak in the next 10–20 years. Pleural malignant mesothelioma is the most common form of mesothelioma. Typical presenting features are those of chest pain and dyspnoea. Breathlessness due to a pleural effusion without chest pain is reported in about 30% of patients. A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations. Mesothelioma is directly attributable to occupational asbestos exposure with a history of exposure in over 90% of cases. There is also evidence that mesothelioma may result from both para-occupational exposure and non-occupational "environmental" exposure. Idiopathic or spontaneous mesothelioma can also occur in the absence of any exposure to asbestos, with a spontaneous rate in humans of around one per million. A combination of accurate exposure history, along with examination radiology and pathology are essential to make the diagnosis. Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement. Involvement of a multidisciplinary team is recommended to ensure prompt and appropriate management, using a framework of radiotherapy, chemotherapy, surgery and symptom palliation with end of life care. Compensation issues must also be considered. Life expectancy in malignant mesothelioma is poor, with a median survival of about one year following diagnosis.

Malignant mesothelioma is a cancer originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis [1]. Its distribution may be uni- or multifocal or may involve the lining cells in a continuous manner.

Stage 3 Mesothelioma Prognosis

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A prognosis of stage 3 mesothelioma means that the cancer is now in its advanced stage of development. The asbestos cancer has now spread from the mesothelium, which is the point of origin, to other nearby tissues or organs. The asbestos cancer has spread to the lymph node group closest to the primary tumor location. When the lymph nodes past the chest area are affected, this causes the disease to spread at a faster pace.
Signs and symptoms of stage 3 mesothelioma include:
  • Difficulty in breathing
  • Low vitality
  • Fatigue
  • Depression

The Butchart System: Mesothelioma Staging System

The spread of the mesothelioma in the body is assessed by one of the oldest cancer staging system – the Butchart System. The Butchart System is often used for staging pleural mesothelioma. It places an individual case of mesothelioma cancer in categories based on the size of the primary tumor and whether lymph nodes are affected.

Diagnosis of Stage 3 Mesothelioma

A stage 3 mesothelioma prognosis is very poor. At this stage, the disease is considered too far advanced for any type of curative surgery. The survival rate at this point is extremely low. Because the cancer has now spread to other locations beyond the primary location makes it extremely difficult for any type of curative surgery. And even if the main tumor is removed, the spread of the cancer cannot be contained.

Treating Stage 3 Mesothelioma

Treatments during a stage 3 mesothelioma prognosis are palliative in nature. Treatments at this stage are designed to keep the patient as comfortable as possible be relieving symptoms rather than to improve the prognosis of patients. However, if the patient is in excellent health and young, large tumors can be removed to ease discomfort in nearby organs or fluid buildup by mesothelioma paracentesis or thoracentesis. Radiation therapy and chemotherapy may also be used to relief any discomforts. Patients may also choose to participate in clinical trials which are used to test new drugs and therapies.

Four Stages of Mesothelioma

There are four stages of mesothelioma: Stage I, Stage II, Stage III and Stage IV. Staging is the process used to tell how far the mesothelioma has spread. Imaging studies such as x-rays, CT scans, and MRI scans are often used during the staging process. The type of treatment given and the prognosis for the patient will be determined by the stage of their cancer. The staging system often used includes the Butchart System, TNM, and Brigham Staging System.

Legal Help for Mesothelioma Victims Due to Asbestos Exposure

If you or a loved one has been exposed to asbestos, and is suffering from mesothelioma or any asbestos-related illnesses, you should contact an experienced mesothelioma lawyer in your area as soon as possible. Mesothelioma lawyers will almost certainly be able to help you obtain the monetary compensation you deserve for your pain and suffering.

Type of Mesothelioma Cancer

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Type of Mesothelioma Cancer

A Mesothelioma cancer victim’s prospects can be affected depending on the category of the disease they have been diagnosed with. The categories of Mesothelioma include:
  • Pleural
  • Peritoneal
  • Pericardial
  • Testicular Mesothelioma
Records indicate that roughly one out of ten 10 victims of Pleural Mesothelioma will endure past 60 months after discovery of the cancer. When we only look at the numbers, pleural mesothelioma victims have for the most part the best life expectancy.

Patient’s Physical Condition

Mesothelioma cancer victim’s life expectancy and prognosis depend a lot on the patient’s physical condition at the time of diagnosis. Patients that are otherwise fit might have a better response to enduring rigorous treatments. These treatments have side effects and any pre-existing health problems could complicate and exacerbate these side effects. Smokers also seem to have a harder time than those that do not partake in the destructive habit.

Stage of Mesothelioma Cancer

Oncologists in general confer on the severity of a victim’s disease by noting the stage of the cancer. There are four stages of Mesothelioma cancer. Those that are in Stages 3 and 4 of the cancer will usually have an inferior prognosis when compared to those in the other two stages.


Diagnosis and differential diagnosis

Posted by Unknown Tuesday, 14 May 2013 0 comments
The combination of accurate history, examination, radiology and the acquisition of pathology is essential in the diagnosis of mesothelioma. A careful history of asbestos exposure is essential, and the identification of at-risk occupations are strong markers of exposure. However, the delay between exposure and presentation may naturally preclude accurate recall of occupational exposure and working conditions which may have occurred up to 60 years previously.
In those patients with a pleural effusion, sampling of the fluid for cytological examination is the first step in confirming the diagnosis. Pleural fluid cytology is positive for malignant cells in about a third of cases and if the clinical, radiological and cytological results support a diagnosis of mesothelioma then this can be accepted. However, it is uncommon for the definitive diagnosis to be made on pleural fluid cytology alone and pleural biopsy for tissue diagnosis is therefore recommended. A contrast enhanced computed tomogram (CT) scan is essential to both identify the extent of the disease, and help guide a percutaneous biopsy if the pleural fluid cytological analysis is not sufficient.

Radiological findings

Radiological imaging is essential for the diagnosis, staging and management of mesothelioma. X-ray, CT, magnetic resonance imaging (MRI) and positron emission tomography (PET) have all been used to evaluate the disease.

CT

Intravenous contrast-enhanced CT is the primary imaging modality for suspected pleural malignant disease. CT allows visualisation of the whole pleural surface and diaphragm and use of a 45–60 second scan delay enables the pleural surfaces to be studied whilst still allowing assessment of the mediastinal nodes . A standard protocol should include the liver and adrenal glands, but in cases where there is a past history of abdominal or pelvic malignancy, the scan should also include the lower abdomen and pelvis .
Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement . The specificities of these findings were 100%, 94%, 94% and 88% respectively. The sensitivities were 41%, 51%, 36% and 56% respectively. The presence of bilateral pleural calcification on CT is uncommon in malignant mesothelioma . A significant reduction in thoracic volume seen on CT is more common, however, occurring in up to 73% of cases according to some series . Whilst these features have a high positive predictive value, absence of these signs does not reliably exclude the diagnosis of pleural malignancy.

MRI

MRI screening is not used routinely in the assessment of malignant mesothelioma, however in patients with potentially resectable disease, MRI can help to provide additional staging information over and above CT. Using gadolinium enhancement, MRI can improve the identification of tumour extension into the diaphragm or chest wall, allowing better assessment of the individual for surgical treatment. MRI also is the imaging modality of choice in those in whom intravenous iodinated contrast is contraindicated [29].

PET

The standardized uptake value (SUV) in PET is a semi-quantitative measure of the metabolic activity of a lesion and the SUV is significantly higher in mesothelioma than in other benign pleural diseases such as pleural plaques or inflammatory pleuritis , and one study found PET scanning to have a 96.8% sensitivity and an 88.5% specificity at distinguishing benign from malignant pleural disease . PET scanning has also increased the accuracy in diagnosing mediastinal nodal metastases and therefore the combination of metabolic and anatomical information provided by PET makes it useful in the staging and preoperative evaluation of mesothelioma. PET may also help as a guide to the optimal site for CT guided pleural biopsy, and there is evidence that changes in the fluorodeoxyglucose (FDG) uptake within the tumour might indicate response to treatment suggesting its role in the assessment of response to both chemotherapy and chemo-radiotherapy .

Staging and assessment of disease response

At least six different staging systems have been suggested for malignant mesothelioma, but none have been accurately shown to predict survival. Currently, a TNM staging system , similar to that used in non-small cell lung carcinoma has been proposed by the International Mesothelioma Interest Group (IMIG) .

How is Malignant Mesothelioma diagnosed?

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How is Malignant Mesothelioma diagnosed?

Malignant Mesothelioma will typically be suspected if the patient complains of chest pain, difficulty breathing, shortness of breath, chronic cough, or difficulty swallowing. While any of these could indicate mesothelioma, they are also associated with many other respiratory conditions so further diagnostic procedures are typically warranted before an accurate malignant mesothelioma diagnosis can be made. These may include imaging scans, such as computer topography or magnetic resonance imaging. A diagnostic biopsy is also required for cancer specialist to examine the behavior of these cells before a diagnosis is determined.
Misdiagnosis is not uncommon in patients of the malignant mesothelioma, because the disease's symptoms so closely resemble those of other related conditions, including lung cancer, and other respiratory ailments. For this reason those who are at high-risk of mesothelioma (including those with asbestos history) should consult with physicians and cancer centers well versed in the treatment and diagnosis of malignant mesothelioma.

How is Malignant Mesothelioma Treated?

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How is Malignant Mesothelioma Treated?

Malignant mesothelioma prognosis is poor, as often the disease will be diagnosed in its later stages after symptoms have appeared. However, there are several treatment options for the management of the cancer. Among these are mesothelioma chemotherapy, radiation therapy, and surgical resection. Chemotherapeutic and radiation therapy methods are more likely but surgery is often an option for those whose disease is diagnosed early enough.
More aggressive therapies are now possible for patients with mesothelioma diagnosed in its earlier stages. For instance, extrapleural pneumonectomy is now possible in many pleural mesothelioma patients who are deemed eligible for aggressive surgery. Extrapleural pneumonectomy involves the removal of the entire affected lung, the pericardium, the pleura, and the diaphragm. This aggressive surgery is performed frequently in early stage mesothelioma patients by Dr. David Sugarbaker at the Brigham and Women's Hospital in Boston, MA.
Patient's who are eligible to receive an aggressive surgery, like an extrapleural pneumonectomy, will have a far more favorable prognosis than those diagnosed with advanced stage inoperable disease. However, there are treatment options for nearly all mesothelioma patients. Chemotherapy cocktails such as the use of Alimta® in conjunction with Cisplatin, as well as numerous other clinical trial being carried out give mesothelioma patients the ability to slow the advance of the disease and extend survival rates.

What Causes Malignant Mesothelioma?

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What Causes Malignant Mesothelioma?

Mesothelioma is known only to be caused by asbestos exposure. Asbestos is a nature, yet toxic mineral that was used commonly in heavy industry. Microscopic asbestos fibers enter the body through the lung or ingestion. Once inside, the durable fibers are unable to be broken down or expelled by the body, causing a harmful inflammation and scarring of the mesothelium. This scarring lays the groundwork for malignant mesothelioma and other respiratory conditions, such as asbestosis.
There is a great deal of latency associated with asbestos exposure and the onset of mesothelioma. Often patients will not encounter mesothelioma symptoms until 30-50 years following exposure to asbestos. In many cases, those diagnosed with mesothelioma are not those who were directly exposed to asbestos in a jobsite setting. Spouses and children of those exposed to asbestos who frequently came into contact with the fibers on the clothing or person of those exposed have also developed malignant mesothelioma as a result.

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