Pleural Mesothelioma Cancer| Stages, Treatments, Surgeries

pleural mesothelioma cancer

Pleural Mesothelioma Cancer:

Mesothelioma is a rare malignant tumor that affects the cells of the mesothelium, a protective membrane that covers most of the body’s internal organs including the pleura, peritoneum, and pericardium. Its most common form is malignant pleural mesothelioma cancer. It is a so-called primitive form of pleural cancer, which is characterized by a multiplication of cancer cells in the tissue constituting the pleura. The pleura are a membrane that envelops the lungs, consisting of two layers, one covers the lungs (inner leaflet or visceral pleura), and the other covers the inside of the chest cavity (outer leaf or parietal pleura). When the disease occurs, the pleura thicken takes a scalloped appearance and space between these two leaflets (pleural cavity) can fill with fluid and cause breathing difficulties.

Multiple parameters that influence the appearance of mesothelioma:

  • The time elapsed from the beginning of the exhibition
  • the cumulative dose of asbestos: it is expressed in fibers per milliliter (mL) of air multiplied by the number of years of exposure for occupational exposures, and in fibers per liter of air multiplied by the number of years of exposure for general population exposures;
  • Peaks of exposure

Stages of Pleural Mesothelioma Cancer:

Staging describes or classifies cancer based on the amount of cancer present in the body and its location at the initial diagnosis. This is often called the extent of cancer. The information revealed by the examinations is used to determine the size of the tumor, which parts of the organ are affected by cancer, whether cancer has spread from its place of origin and where he has spread. Your healthcare team uses the stadium to plan your treatment and predict the outcome (your prognosis).

The pleural mesothelioma cancer originates in the lining (membrane) forming a protective cushion around the lungs (called pleura). The most frequently used staging system for pleural mesothelioma is the TNM classification. In the case of this type of cancer, there are 4 stages. For stages, 1 to 4, Roman numerals I, II, III, and IV are often used, but in order to make the text clearer, we will use Arabic numerals 1, 2, 3 and 4. In general, more the number of the stage is high, the more cancer has spread. Talk to your doctor if you have questions about staging.

The TNM classification is used to establish the stage of pleural mesothelioma cancer only. There is no staging system for mesothelioma that appears in the lining of the abdomen (peritoneal mesothelioma) or for rare types of mesothelioma.

Stage 1A

Cancer is present in the lining of the chest wall (parietal pleura) or in the envelope covering the lung (visceral pleura) on the same side of the chest as the tumor.

Stage 1B

The cancer is present in the parietal pleura or in the visceral pleura on the same side of the thorax as the tumor.

It can form at least one of the following structures:

  • Connective tissue (fascia) forming part of the chest wall
  • Fat in the space between the lungs
  • Soft tissues of the chest wall (in one region)
  • Coating of the heart (pericardium) (without crossing it completely)

Stage 2

Cancer is present in the lining of the chest wall or in the envelope that covers the lung on the same side of the chest as the tumor. It may also have invaded at least one of the following structures:

  • Diaphragm
  • Lung tissue
  • Cancer has spread to the lymph nodes of the chest on the same side of the body as the tumor.

Stage 3A

The cancer is present in the parietal pleura or in the visceral pleura on the same side of the thorax as the tumor. It can form at least one of the following structures:

  • The connective tissue forming part of the chest wall
  • Fat in the space between the lungs
  • Soft tissues of the chest wall (in one region)
  • Coating of the heart (without crossing it completely)
  • Cancer has also spread to the lymph nodes of the chest on the same side of the body as the tumor.

Stage 3B

Cancer is present in the lining of the chest wall or in the envelope that covers the lung on the same side of the chest as the tumor. It may also have invaded at least one of the following structures:

  • Diaphragm
  • Lung tissue
  • The connective tissue forming part of the chest wall
  • Fat in the space between the lungs
  • Soft tissues of the chest wall (in one region)
  • Coating of the heart (without crossing it completely)
  • Cancer has spread to the lymph nodes on the other side of the chest as the tumor.

OR

The cancer is present in the parietal pleura or in the visceral pleura on the same side of the thorax as the tumor. It has also invaded at least one of the following structures:

  • Chest wall (may also have invaded the ribs)
  • Peritoneum
  • Parietal pleura or visceral pleura on the other side of the thorax
  • Esophagus, trachea, heart or large blood vessels in the space between the lungs (mediastinum)
  • Bones of the spine (vertebrae)
  • Spinal cord
  • Coating of the heart (crosses it)

Stage 4

Cancer has spread to other parts of the body (distant metastases), such as the lungs on the other side of the body, the liver or bones. There is also talk of metastatic pleural mesothelioma cancer.

Treatments for Pleural Mesothelioma Cancer:

The treatment options for pleural mesothelioma depend on whether cancer can be removed by surgery (it is said to be resectable) or not (it is said to be unresectable). Your healthcare team will offer you treatments according to your needs and will discuss with you to develop a treatment plan.

Surgery is not usually offered to people with pleural mesothelioma of sarcomatoid subtype because it is an aggressive tumor that recurs (recurrence) quickly after treatment.

Depending on the stage of pleural mesothelioma, the following treatment options may be used.

  • Resectable pleural mesothelioma

Resectable pleural mesothelioma includes most stage 1 tumors and may include some stage 2 or stage 3 tumors.

  • Radiotherapy

External radiotherapy is now being administered before surgery to treat resectable pleural mesothelioma, as studies have shown that this significantly improves survival.

If external radiotherapy is not used before surgery, it may be used after extrapleural pneumonectomy.

Radiation is directed to the side of the chest where pleural mesothelioma has been detected.

Radiotherapy is usually not given after a pleurectomy/decortication because it may damage the lung.

  • Surgery

Surgery is more effective when it removes all or most of cancer. The person operated on must be in good enough health to undergo it and recover from it.

The types of surgeries offered are:

  • Extrapleural pneumonectomy
  • Pleurectomy / decortication
  • Chemotherapy

In the case of resectable pleural mesothelioma, chemotherapy is offered after surgery.

The most common chemotherapeutic combinations used to treat pleural mesothelioma are:

  • Cisplatin and Pemetrexed (Alimta)
  • Cisplatin and Raltitrexed (Tomudex)
  • Pemetrexed and Carboplatin (Paraplatin, Paraplatin AQ) – may be available to people who have other health problems and cannot receive cisplatin

Unresectable Pleural Mesothelioma cancer:

Unresectable pleural mesothelioma includes stage 4 tumors and some stage 2 or stage 3 tumors. This cancer has spread too much to be completely removed by surgery.

Treatments for unresectable cancer can also be offered to people who are not healthy enough to undergo surgery to remove mesothelioma or who decide not to have surgery.

Palliative surgeries

Palliative surgeries relieve symptoms, such as pain or difficulty breathing, but they do not treat cancer itself. The palliative surgical procedures offered to treat unresectable pleural mesothelioma may include:

  • Tumor reduction
  • Thoracentesis
  • Pleurodesis
  • Chemotherapy

Mesothelioma recurrence

The recurrence of mesothelioma means that cancer recurs as a result of the treatment. It can reappear in a part of the body where the mesothelioma originates, such as the pleura, peritoneum, pericardium or envelope covering the testicles (tunica vaginalis). If it reappears at the place where it first took birth, it is local recidivism. If it reappears in tissues or lymph nodes near where it first originated, it is called regional recurrence. It can also reappear in another part of the body: it is called recurrence or distant metastasis.

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