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Pleural Mesothelioma Facts

Mesothelioma is the commonest primary tumor of the pleura.

Causes There is a strong correlation between asbestos exposure and the development of mesothelioma, although a history of exposure is not always obtainable in patients who have mesothelioma. There are 2 types of asbestos fibres based on crystalline structure; a-serpentine {chrysolite} and b-amphibole. Included within the amphibole are amosite, tremolte, crocidolite and anthophyllite. The most harmful is the crocidolite or better known as blue asbestos.

Localised Benign Mesothelioma

These characteristically arise from the inner layer of the pleura Symptoms and signs;

-chest pain

-shortness of breath

-most of the times there are no symptoms {asymptomatic}, these tumors are usually discovered on routine chest x-ray -hypoglycaemia {low blood sugar} is sometimes associated

Treatment Surgery is the main stay of treatment, the tumor is removed by the surgeon and reccurence is rare and when it happens transition to malignant form of tumor should be suspected.

Localised Malignant Mesothelioma Symptoms and Signs; -chest pain -cough -fever -shortness of breath Treatment Surgery is also the treatment of choice, although prognosis is very poor

Diffuse Malignant Mesothelioma This type of mesothelioma can arise form any part of the pleura and often extend into the peritoneum as well as into the ribs and chest wall {peritoneal mesothelioma and pericardial mesothelioma}. It also spreads commonly to the liver, brain and adrenal glands. Histologically malignant mesothelioma have both fibrous {sarcomatous mesothelioma} and epithelial {papillary} components.

Investigations

-CT scan of the chest is extremely useful in diagnosing the extent of the tumor.

-Needle biopsy {the surgeon inserts a special needle into the pleura to take samples of the tumor which is taken to the laboratory to see under the microscope} of the pleura is a must.

-Pleural fluid is aspirated and taken to the lab for microsopic examination.

Staging of Malignant Pleural Mesothelioma

-Stage 1:Involvement of ipsilateral pleura and lungs {affecting just one lung either left or right lung}

-Stage 2-Invlovment of chest wall, mediastinum {structure at the middle of the heart}, pericardium or contralateral {opposite side} pleura

-Stage 3-Distant blood spread into other organs eg brain, adrenals

Treatment Treatment is discouragingly ineffective and survival rarely longer than 2 years with an average of 10-14 months. In selected cases with stage 1 a radical surgery-pleuropneumonectomy may be effective, but long term survival is rare. Primary radiation therapy may be used also. Combination chemotherapy using either single agent or combination protocols have also been used but the outcome remains dismal.

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