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Pleural mesothelioma

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pleura Mesothelioma - Tumor Computed tomography scans-one of the shows (yellow arrows) the presence of mesothelioma.1 - right lung, 2 - back, 3 - left lung, 4 - ribs, 5 - aorta, 6 - spleen, 7 - left kidney, 8 - right kidney , 9 - liver

Pleural mesothelioma - a malignant tumor derived from cells of the lining of the pleural cavity.

Anatomy

The pleurais the serous membrane covering the lungs. Each lung has its own pleura, acting kind of bag in which it is found. The pleura consists of two plaques:

  • visceral pleura (Latin pleura visceralis) - covering the lung;
  • pleural wall (Latin pleura parietalis) - contact with the chest wall.

Visceral pleura międzypłatowe penetrates into the gaps of the lungs, reaching down to the bottom. Both lamellae pass into each other at bay, lung and pulmonary ligament. Between the two plates is a pleural cavity (Latin cavitas pleuralis).

The term pleural cavity has been applied somewhat exaggerated, since in physiological conditions, the space between two plates is a small gap. In pathological conditions, however, between the two plates can accumulate fluid and then this space is growing.

Pleura emits a small amount of serous fluid, which facilitates the sliding of the two plaques to each other, reducing friction.

Epidemiology

Pleural mesothelioma is a rare cancer, the estimated incidence is 1 in 120 thousandth The number of diagnoses recorded in Poland is about 100[1]

Most cases (> 70%) of mesothelioma is associated with exposure to asbestos.

Most ill men (ratio M / F: 3-5:1), aged 35-45 years, employees of establishments producing, processing asbestos, shipyard workers, railroad workers, car mechanics, construction workers and heating industry.

The average age of diagnosis is approximately 60 years.

Racial predilection has not been demonstrated.

Pathology

There are two basic types of mesothelioma:

  • Form a limited, usually has włóknikowate texture, usually develops only within one pleural sac. Can develop in the gap between the lobes of lung, may create a stalk or no solution is in the shape of the flap covering the lung. This figure does not give metastases, grows relatively slowly. Applied surgical treatment, guaranteed cure.
  • The form of extensive form is particularly pernicious. It grows quickly, resulting in a short time to wytapetowania, and even obstruction throughout the pleural cavity. Most of the tumor tissue accumulates over the diaphragm and within furrows międzypłatowych. Expanding tumor compressing the lung, limiting its mobility, and sometimes even lead to the mass movement of the mediastinum, on the opposite side. Metastases occur quickly and are spreading through the lymph nodes and vessels that supply the pleura very well.

Histopathologically, there are three types: epithelial form, mięsakowatą and mixed.

Symptoms and Diagnosis

Both forms of mesothelioma is characterized by the recurrent and persistent despite many bloody pleural puncture, within which you can always find the cancer cells. The basis for the diagnosis of mesothelioma is the puncture of the pleura and the statement contained therein flows in tumor cells. Qualification for the puncture is based on radiographs, computed tomography, ultrasound, in which notes the presence of fluid in the pleural cavity and the characteristics of tumor growth. Cytological diagnosis of mesothelioma is extremely difficult because of the morphological diversity of cells. According to some authors, mesothelioma cells are the most morphologically variable cells in the body. They can take various shapes: wałeczkowaty, kostkowy, fusiform. Usually have little good staining in the nucleus. Immunohistochemical analysis can be helpful in identifying mesothelioma. Not yet found a characteristic immunohistochemical staining allowing 100% confirmed mesothelioma and exclusion at the same time another type of cancer. Mesothelioma show positive reaction with antibodies against cytokeratin 5 / 6. Most shows a negative reaction with antibodies against glycoproteins (CEA, BerEP4, leu-M1, B72.3), which allows them to be distinguished from metastatic adenocarcinoma.

Besides the typical symptoms associated rozrostom cancer (eg weight loss), a proliferation nowotworowemu mesothelioma may be accompanied by chest pain, associated with infiltration of the nerves and structures of the chest wall. In connection with the appearance of the pleural effusion and chest wall invasion may occur due to the oppression of shortness of breath, chest weaker chattel and inferior expansion of the lungs, and a drop in efficiency of the organism, associated with hypoventilation. You may experience problems in swallowing associated with infiltration, compression of the esophagus. Maybe you also hemoptysis.

Degrees

In order to adjust the stage of the disease shall be called. stageing. In the case of mesothelioma most commonly used and so-called TNM system. Brigham System - is based on criteria of the operational capabilities of tumor removal and lymph nodes. Sometimes you can find also the oldest known. Butchart System.

TNM classification of pleural mesothelioma
degreeDescription
1
cancer takes a pleural plaque
2
cancer of the pleural plaque is both within a single bag pleural
3
cancer of the chest wall, esophagus, lymph nodes takes (on the same side of the chest)
4
there are distant metastases (liver, brain, bone, lymph nodes on the opposite side of the chest)
The Brigham staging system
degreeDescription
1
Mesothelioma may be deleted in its entirety, lymph nodes were not occupied.
2
Mesothelioma can be surgically removed, the lymph nodes are busy.
3
Mesothelioma can not be removed surgically because it invades the chest wall, heart, diaphragm, or peritoneum.
May not be present metastases in lymph nodes.
4
There are distant metastases (bone, brain, liver).

Treatment

In cases where it is possible surgical removal of tumor and no evidence of contraindications to perform surgery, surgical treatment is the most effective method.

Pleurektomia - generally used as a palliative treatment, designed to reduce pain and shortness of breath caused by fluid accumulation. Involves the removal of the pleura sometimes together with the adjacent tissues. The aim of treatment is not completely remove the tumor.

Pneumonectomy - a more radical surgery, involving removal of the tumor tissue along with the lung. Sometimes, in order to achieve better results partially removed after the busy side of the diaphragm with a portion of the pericardium.

Chemotherapy - multidrug combination therapy (cisplatin, doxorubicin, bleomycin, mitoxantron) or (gemcitabine, cisplatin). Relatively good results were obtained using pemetrexatu (antyfolianu) in combination with cisplatin (Clinical Trials). New drug, which are tied high hopes for a Onconaza (Ranpirnase), showing greater efficacy than the standard applied doxorubicin. Although initial results are encouraging, it should be noted that this drug is only used in clinical trials.

Radiation therapy - often used before surgery to reduce tumor mass. Can also be used palliative care.

Experimental Therapies

Dynamic phototherapy (PTD). The general rule of therapy is to introduce into the body photosensitizers, drugs which, in light of a specific wavelength, emit toxic compounds damaging the cell. Reducing damage to healthy cells may be achieved by placing the compounds selectively accumulating in the cells of malignant and amended only by exposure to the area.

Brachytherapy - the type of radiation therapy involving the delivery of ionizing radiation sources directly into the tumor. Allows use of higher doses of radiation with fewer side effects and less damage to surrounding tissue.

Immunotherapy - therapy designed to stimulate the body's immune system to fight cancer.

Pleural mesothelioma
 

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