Pleural mesothelioma (malignant mesothelioma) is a rare malignant tumor originating from the superficial cells of the pleural lining. Sometimes it can also develop in the pericardium and peritoneum. Pleural mesothelioma is most often diagnosed in men over 60 years of age. Unfortunately, due to the low characteristic symptoms, it is diagnosed late and treatment is usually not satisfactory. Is pleural mesothelioma always fatal?
The observed increase in morbidity and deaths in the last decade most likely results not from actual higher morbidity, but from the improvement of diagnostic methods, both in the possibility of collecting material for testing and precise pathological assessment allowing differential diagnosis with metastatic adenocarcinoma. The availability of computed tomography and videotoracoscopy, as well as the possibility of immunohistochemical assessment significantly improved the effectiveness of diagnosis, and the awareness of the existence of therapeutic options in the treatment of cancer, including mesothelioma, is an additional stimulus for doctors diagnosing the patient.
Diagnosis of pleural mesothelioma
Diagnosis of lung cancer should aim to diagnose pleural disease, confirm the neoplastic nature of the lesions and differentiate with metastasis of another cancer, as well as assess the extent of the disease. Due to diagnostic difficulties of pleural mesothelioma, close cooperation between oncologist, pathologist, radiodiagnostic and clinician is necessary. Appropriate volume of material should also be obtained for molecular diagnostics. In most patients, malignant pleural mesothelioma is diagnosed at the local stage. Metastases in distant organs are rare. Subject examination includes an interview for asbestos exposure and lung cancer symptoms associated with the location of the primary lesion and local spread along the pleural surface (chest wall pain, shortness of breath, symptoms of a threatening cardiac tamponade). The physical examination includes a typical assessment of the respiratory system and chest. Conventional chest X-ray may suggest a suspicion of pleural mesothelioma, but the most accurate imaging method is computed tomography. For patients who are potentially eligible for complete surgical treatment, magnetic resonance imaging may be helpful. PET-CT examination is not applicable.
Treatment of pleural mesothelioma
Pleural mesothelioma is a serious cancer that is a sentence for most patients, but you can try to treat it. The methods of treatment are total resection – i.e. complete removal of the tumor is the only chance of complete recovery. However, it is possible in a few patients, only less than 10% of patients qualify for such surgery.
Most often, however, surgery is performed to reduce the tumor mass or reduce the discomfort associated with its growth. These types of operations are called palliative procedures and are not intended to extend life, but to improve its quality.