PLEURAL MESOTHELIOMA PROGNOSIS

The prognosis of mesothelioma refers to the possible outcome of mesothelioma. Malignant pleural mesothelioma is a lethal disease and little is known about prognostic factors. A few have survived as long as 5 years, with rates of 14% for all types and 46% for the epithelial type. However, there are long term pleural mesothelioma survivors who have survived more than 10 years (although very rare).

In a recent mesothelioma study, doctors writing about the prognosis of pleural mesothelioma explained that long-term mesothelioma survivors do exist and their prognosis may be independent of the treatment or therapies used.

Age, stage of disease, gender and histological subtype are factors that are considered when prognosis of pleural mesothelioma is being carried on. With trimodality treatment, some patients have survived 16-19 months. However, numbers are small. Despite a ban on asbestos (major cause) use in Western countries, the incidence of malignant pleural mesothelioma is increasing, due to the long delay between asbestos exposure and diagnosis.

Moreover, asbestos is still used in developing countries.Without treatment, mesothelioma is fatal within 4-8 months.

Mesothelioma news; Adelaide mum defies odds surviving mesothelioma

The World Today - Thursday, 13 December
ELEANOR HALL: The asbestos disease, mesothelioma, is usually a death sentence, killing its victims within a year But an Adelaide mother has defied the medical odds by not only surviving the deadly asbestos-related disease mesothelioma but having a child 10 years after her diagnosis।39-year-old Belinda Dunn took part in a gene therapy trial soon after she received the news she had mesothelioma।But medical experts are still baffled by her survival, as Nance Haxton reports from Adelaide.

NANCE HAXTON: Belinda Dunn is a medical mystery. Her only contact with deadly asbestos dust was as a small child when she played on a pile of fibro while her parents were extending their house. The 39-year-old Adelaide mother of one was diagnosed with mesothelioma soon after the birth of her first child, Nathan, 10 years ago, and told she had little chance of living beyond a year. But a decade on, not only has she survived the disease, but she is pregnant as well.

BELINDA DUNN: It's a very daunting thought, actually. Where I was 10 years ago to where I am now.

NANCE HAXTON: Belinda Dunn took part in an experimental gene therapy trial in the United States soon after her diagnosis. But she says she doesn't credit her current good health exclusively to that treatment.

BELINDA DUNN: I've taken lots and lots of vitamins at the time of - under the guidance of my naturopath - with the gene therapy trial, and I'm just wondering if it was because my immune system was in good shape when I had the trial that perhaps that's helped it

NANCE HAXTON: And you've had no complications with the pregnancy from the mesothelioma so far?

BELINDA DUNN: Well, not from - not anything I've had normally for the last 10 years, because I suffer, still, like an arthritic type pain, like shoulder tip pain and I know when my mesothelioma is active, if you want to call it that, or it's my chest is inflamed and basically, I just live with that. And that's part of being pregnant and having mesothelioma.

NANCE HAXTON: Professor Doug Henderson from the Flinders Medical Centre in Adelaide was the doctor who initially diagnosed Belinda Dunn with mesothelioma. He says he never would have thought 10 years on from that day that he would be talking about her still being alive and well.

DOUG HENDERSON: I certainly didn't - it's a very unexpected but very positive and good outcome

NANCE HAXTON: But Professor Henderson says sadly, Belinda Dunn's recovery cannot be explained by science, and therefore has little significance at this stage for other sufferers.

DOUG HENDERSON: I have seen other rare cases of mesothelioma that have gone into apparently spontaneous complete remission and one patient whom I remember very vividly was alive with a completely normal chest X-ray and otherwise well, eight years after the diagnosis had been made.

NANCE HAXTON: What can this be put down to?

DOUG HENDERSON: We don't know the reasons for spontaneous regression like this in tumors. It might be due to some altered cellular dynamics within the tumor itself, but why that should happen we really have no clear idea. The other theory is that the immune system of a body somehow gains a boost and gains ascendancy over the tumor and puts it into remission.

NANCE HAXTON: So are there any ramifications from these rare cases that could be applied to other victims of this disease?

DOUG HENDERSON: I don't think so, these are the exceptions rather than the rule and I'm not sure that one could use these people or any factor from these people to treat other patients, because we don't know what the factors that are involved in this type of remission really are. I think only time will tell the eventual outcome but I hope that Belinda will have a virtually normal life expectancy, taking into account that she's now been in apparently complete remission with no evidence of progressive disease for some 10 years.


NANCE HAXTON: While Ms Dunn is grateful for her health, she struggles with losing many of the friends she has made through asbestos disease support groups, including Bernie Banton. She hopes that her case, while something of a miracle, gives hope to other people with mesothelioma - which it does not have to be a death sentence.

BELINDA DUNN: I really hope, you know, that that's what it's doing because, you know, if it's worked for me, surely someone will start thinking about what I had been doing with the vitamins when I had my trial and perhaps they can move on to do some research into what I was taking when I had the gene therapy, and perhaps someone else might be lucky and live with mesothelioma.
That's the mystery mesothelioma survivor, Belinda Dunn.

PLEURAL MESOTHELIOMA DIAGNOSIS

Presently there seems to be no cure for mesothelioma, but its early diagnosis can provide doctors the opportunity to relieve the patients of a great deal of suffering, and prolong their lives thus improving their general health outlook। These treatment options depend on the stage and the overall progession of the disease. The pleural form of mesothelioma, which represents more than 90% of all cases, presents on x-ray as diffuse unilateral or bilateral pleural thickening that appears to encase the lungs, usually producing blunting of the costophrenic angles. Pleural effusions are present in 95% of cases and are typically unilateral, massive effusions.

Diagnosis is majorly based on pleural fluid cytology or open pleural biopsy and, if these are nondiagnostic, biopsy by video-assisted thorascopic surgery (VATS) or thoracotomy is used.
Staging is done with chest CT, mediastinoscopy, and MRI. Sensitivity and specificity of MRI and CT are comparable, although MRI is helpful in determining tumor extension into the spine or spinal cord. PET may have better sensitivity and specificity for distinguishing benign from malignant pleural thickening.
Using Bronchoscopy rules out coexisting endobronchial malignancies। Increased hyaluronidase levels in pleural fluid are suggestive but not diagnostic of disease. Soluble mesothelin-related proteins released into the serum by mesothelial cells are being studied as possible tumor markers for disease detection and monitoring.

Mesothelioma स्टील remains an incurable cancer.

MESOTHELIOMA NEWS; Diagnostic Tools For Lung And Mesothelioma Cancers To Be Developed

In our quest to finding a lasting solution to mesothelioma, hope seems not to be lost.

Earlier this year Rosetta Genomics, Ltd. announced that it had partnered with NYU Medical Center with the aim of developing a line of early detection diagnostic products for lung and mesothelioma cancers.
The early detection test will mainly target over 45 million Americans who are at an increased risk of lung cancer due to smoking, as well as those who have been exposed to asbestos fibers. The test will utilize Rosetta Genomics' proprietary protocol to extract microRNAs from a simple blood draw.

"A test that will be able to detect cancer at an early stage using a simple blood draw will have far reaching implications on the fight against cancer," noted Dr. Harvey Pass, Professor and Chief, Division of Thoracic Surgery and Thoracic Oncology at NYU Medical Center.

"MicroRNAs have been shown to hold great potential as effective biomarkers for various cancers, and I believe that NYU Medical Center's vast experience with lung cancer and Mesothelioma, coupled with Rosetta Genomics' expertise in the microRNA field, will allow us to successfully advance this much needed test forward."

This new development will help in future diagnoses and for lasting treatment for the rare deadly disease. Other firms are also developing new treatment options, but for now, I think one has to avoid asbestos as possible as one can, to prevent contacting this disease.

SYMPTOMS OF PLEURAL MESOTHELIOMA

Pleural mesothelioma is a disease whose symptoms are not easily noticeable. Although at the early stages of the disease patients do complain of recurring heart and chest pains.



Generally the symptoms are always mild at the initial stages but do get serious and complicated as soon as it reaches its matured that is when it becomes visible. Chest pain is the most common. Other symptoms include; coughs, weight loss and anorexia. Others are persistent coughing, difficulty in swallowing, facial swelling, weight loss, fever, rasping, and coughing up blood.



In some cases patients do complain of shortness of breath. This is as a result of the thickening of the pleura as the tumour begins to spread. This makes it to be filled with fluid. This fluid leads to the discomfort or pain associated with first detection of the disease.



Pleural mesothelioma patients display all three types of mesothelioma cancer cells: epithelioid mesothelioma, sarcomatoid mesothelioma and biphasic mesothelioma

PLEURAL MESOTHELIOMA

When the famous Australian anti-racism activist Bob Bellear died in 2005 of mesothelioma, not until then did the disease started becoming popular. Mesothelioma occurs in different forms of which pleural mesothelioma is one.

Pleura mesothelioma is a form of mesothelioma that occurs around the lungs and respiratory area of the chest region. It attacks the cell and the linings of the lungs which are known as the pleura, hence the name pleura.





It do start from the lungs and in some cases spread to other parts of the body including the brain thereby causing more damage than not





Sometimes it occur in two forms- benign (non-cancerous) and malignant (cancerous) but malignant is the most common of the two.
It is the most common form of mestheolima, 7-8 out of every 10 cases of mesothelioma cases are mesothelioma of the pleura. Due to the nature of this disease it might take 30-50years before the symptoms start to surface after being exposed to asbestos. This makes the disease not to be known until when it is too late.

MESOTHELIOMA DIAGNOSIS

The diagnosis of mesothelioma is not always an easy task for doctors and researchers. This is due to the numerous symptoms of mesothelioma which are evidences of the presence of other diseases and the latency between the period of contraption and showing of symptoms.

Hence it is always important to check the medical file of a patient when diagnosing. In most cases mesothelioma is usually in its matured stage which makes it a little bit hard for much to be known. A diagnosis of mesothelioma is obtained firstly, through the assessment of the patient’s medical file, a CT scan (computerized technology) or CAT (computerized axial tomography), MRI (magnetic resonance imaging) and a biopsy. The CT helps to take internal pictures of the internal organs of the body while the MRI allows getting perfect detailed images of the inner body are through a powerful magnet linked to computer.

The scans are followed by a biopsy which is used to confirm the presence of mesothelioma. To perform biopsy, a close examination is made on the fluids surrounding the lungs, when present, by an oncologist. This might not be sufficient, so, a small cut might be made to remove a tissue from the patient with a hollow needle which is inserted into the patient's chest cavity to run biopsy on. This process is known as thorascopy. This is altogether known as open pleural biopsy. The process is known as peritoneoscopy if the tissues are taken from the abdominal cavity.

The disease is declared localized if the cancer is found on the surface of the membrane, but it will be advanced if it has spread to other parts of the body. The early detection of mesothelioma depends on the patients’ awareness of its presence. Diagnosis of mesothelioma is always poor due to the fact that it is rare, the non-specific nature of its symptoms, and the time lag between asbestos exposure and a patient’s symptomatic response, could take 50 years. Despite all this frictions, there are many available procedures or the diagnoses of mesothelioma.

MESOTHELIOMA PROGNOSIS

The prognosis of mesothelioma refers to the possible outcome of mesothelioma. Mesothelioma prognosis and treatment options is determined by the size of of the tumour, the stage of the tumour, the duration of the mesothelioma tumour, the type of the mesothelioma tumour, the overall health and age of the patient, the level of exposure to asbestos and whether cancerous cells could be located in other parts of the body. Chances of recovery, recovery period for mesotholima, the survival rate of mesothelioma, the death rate and all possible outcomes are also entailed in the prognosis of mesothelioma.


Diagnosis is then conducted through physical examination and results which confirms a full mesthelioma prognosis. After this, treatments options are now considered to determine the best treatment option.
Due to the incurability of mesothelioma treatment options are designed to relieve symptoms, prevent metastasis and prolong life expectancy. Diagnosis plays a vital role in mesothelioma prognosis. The earlier the diagnosis, the earlier the better as it becomes worse the longer the cancer is left unknown as there might be no curative treatment. But in most cases, mesothelioma is usually diagnosed in its matured stage, this makes mesothelioma to be a little bit hard to understand, thus the seven percent in five years survival rate. Yet, sufferers do have a reason to hope.


Scientists are already developing new methods and the FDA now allows the pharmaceutical industry to try new compounds o mesothelioma patients which may make the survival rate to be high next year. It is advisable for one when he/she is diagnosed of mesothelioma to contact a doctor for proper care and help.

TYPES OR FORMS OF MESOTHELIOMA CANCER

The type of mesothelioma is determined on the basis where the cancer occurs in the body. Mesothelioma may affect any part or organ of the body depending on the level of exposure to asbestos and the time level over which the patient has been exposed to.
The major types of mesthelioma cancer includes the following;

* Pleural Mesothelioma

*Peritoneal Mesothelioma

* Pericardial Mesothelioma

Pleural Mesothelioma

Pleural mesothelioma, also known as mesothelioma of the pleura is a tumour in which the lining of the lungs, or lung pleura, gets affected by malignant cells. It is one of the most commonly occurring cancers. The pleura is a thin tissue around the lungs and the inside of the chest.
It helps the lungs in breathing (respiration) by producing a serous fluid that lubricates the pleural surfaces to avoid the teasing of the lungs against the chest wall. In order to protect the lungs, the pleura produces a small amount of fluid which helps cushion the lungs, making the lungs move more smoothly during breathing.

Types of pleural mesothelioma cancer

Diffused or Malignant (Cancerous) MESOTHELIOMA

Malignant Pleural mesothelioma is cancerous and can spread to other parts of the body. This rare form of cancer is found in the pleural sac lining of the lung. Exposure to asbestos is considered the primary cause of pleural mesothelioma.

Benign (Non-Cancerous) pleural mesothelioma

This is the non-cancerous form of pleural mesothelioma, which does not affect all parts of the body but the pleura. However, it constricts the lung causing shortness of breath, and in some severe cases, pneumothorax (lung failure)

Peritoneal mesothelioma

This is the next common type of mesothelioma which affects peritonium which is the lining of the abdominal cavity including the stomach. It is more aggressive than the mesothelioma of the pleura. Its symptoms include the following chest pain, anaemia, breathlessness, loss of appetite and other severe symptoms. It could either be malignant (cancerous) or benign (non-cancerous). Their is a high probability of women being diagnosed with peritoneal mesothelioma than other types of mesothelioma.

Pericardial mesothelioma

This is the rarest and least but deadliest type of mesothelioma because it affects the heart and the cavity surrounding it. It is said to have an average lifespan of less than six months from diagnosis. Due to the rarity of this disease as many patients are ignorant of the presence of this disease in their body until diagnosis is made on their autopsies, it makes it difficult for doctors and researchers to understand the whole logic behind the nature of this disease.

Symptoms might include congestive heart failure, palpitation, night sweat, persistent cough, chest pain and breathing disorder. Pericardial mesothelioma can sometimes be palpatively treated through surgery and further treatment of radiation and chemotherapy.

Every year about 2,000 new cases of mesothelioma are being diagnosed, and the figure might still be increasing. The major cause of mesothelioma has been linked to asbestos inhaling due to being exposed to it. So watch out next time you are out in mining area.

Other treaments for malignant mesothelioma

There are other different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Three types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma:

Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.

Pleurectomy and decortication: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.

Extrapleural pneumonectomy: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.

Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment that are being tested in clinical trials include the following:

Biologic therapy

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

TREATMENTS FOR MALIGNANT MESOTHELIOMA

TREATMENTS OF MALIGNANT MESOTHELIOMA

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, past illnesses and treatments will also be taken.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
The number of red blood cells, white blood cells, and platelets.
The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
The portion of the blood sample made up of red blood cells.

Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.

Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the cells or tissues include the following:

Fine-needle aspiration biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a needle biopsy.

Lung biopsy. The patient lies on a table that slides through the computed tomography (CT) machine which takes x-ray pictures of the inside of the body. The x-ray pictures help the doctor see where the abnormal tissue is in the lung. A biopsy needle is inserted through the chest wall and into the area of abnormal lung tissue. A small piece of tissue is removed through the needle and checked under the microscope for signs of cancer.

Thoracoscopy: An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest.

Peritoneoscopy: An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, lighted tube) is inserted into the abdomen.

Laparotomy: An incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.

Thoracotomy: An incision (cut) is made between two ribs to check inside the chest for signs of disease.

Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.

Bronchoscopy. A bronchoscope is inserted through the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease.

Cytologic exam: An exam of cells under a microscope (by a pathologist) to check for anything abnormal. For mesothelioma, fluid is taken from around the lungs or from the abdomen. A pathologist checks the cells in the fluid.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer.

The size of the tumor.

Whether the tumor can be removed completely by surgery.

The amount of fluid in the chest or abdomen.

The patient's age and general health, including lung and heart health.

The type of mesothelioma cancer cells and how they look under a microscope.
Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Malignant Mesothelioma

After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The stages of malignant mesothelioma are divided into two groups.

Localized malignant mesothelioma (stage I) Advanced malignant mesothelioma (stage II, stage III, and stage IV)

After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the spread of the cancer in order to plan treatment.

The following tests and procedures may be used in the staging process:


Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the chest or abdomen. This procedure is also called nuclear magnetic resonance imaging (NMRI). The stages of malignant mesothelioma are divided into two groups.

Malignant mesothelioma stages are grouped into localized and advanced.

Localized malignant mesothelioma (stage I)

In localized malignant mesothelioma, cancer is found in the lining of the chest wall and may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.

Advanced malignant mesothelioma (stage II, stage III, and stage IV)

Advanced malignant mesothelioma includes stage II, stage III, and stage IV.

In stage II, cancer is found in the lining of the chest wall and the lymph nodes on the same side of the chest. Cancer may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.

In stage III, cancer has spread to any of the following areas: The chest wall. The mediastinum. The heart. Beyond the diaphragm. The peritoneum.

Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest. In stage IV, cancer has spread to distant organs or tissues.

Recurrent Malignant Mesothelioma

Recurrent malignant mesothelioma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the chest or abdomen or in other parts of the body.