MESOTHELIOMA

Greater than 80% of mesothelioma cases are caused by exposure to asbestos. The greater the exposure the greater the risk.^[3]As of 2013 about 125 million people have been exposed to asbestos at work.^[7] High rates of disease occur in people who mine asbestos, produce products from asbestos, work with asbestos products, live with asbestos workers, or work in buildings containing asbestos. Often it is around 40 years between exposure and the cancer starting.^[3] Washing the clothing of someone who worked with asbestos also increases the risk.^[7] Other risk factors include genetics and infection with the simian virus 40.^[3] The diagnosis may be suspected based on chest X-ray and CT scan findings, and is confirmed by either examining fluid produced by the cancer or by a tissue biopsy of the cancer.^[6]

                                              

Prevention centers around reducing exposure to asbestos.^[8] Treatment often includes surgery, radiation therapy, and chemotherapy. A procedure known as pleurodesis, which involves using substances such as talc to scar together the pleura, may be used to prevent more fluid from building up around the lungs.^[9]Chemotherapy often includes the medications cisplatin and pemetrexed.^[6]The percentage of people that survive five years following diagnosis is on average 8% in the United States.^[10]
                                                

In 2013 about 50,000 people had mesothelioma and 34,000 died from the disease.^[11][12] Rates of mesothelioma vary in different areas of the world. Rates are higher in Australia, the United Kingdom, and lower in Japan.^[3] It occurs in about 3,000 people per year in the United States.^[13] It occurs more often in males than females. Rates of disease have increased since the 1950s. Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old. The disease was rare before the commercial use of asbestos.^[3]
                                               

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MESOTHELIOMA TREATMENT

Important considerations in determining a mesothelioma treatment plan include the cancer stage, primary site affected and cell type. Treatment options also depend on whether the cancer is localized to the chest or has spread to the chest wall, diaphragm, or lymph nodes as well as your age and overall health. The three standard therapies used to treat mesothelioma include surgery, chemotherapy, and radiation.

                                                  

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  Surgery

  For patients with an early-stage mesothelioma diagnosis, surgery can be used to remove all or most of the tumor(s). Depending on the tumor location, surgery may include removing the mesothelial lining, one or more lymph nodes, or part or all of a lung or other organ.
• 

  Chemotherapy

  Chemotherapy drugs work by attacking fast-growing cells, such as cancer cells. Often used in conjunction with surgery, chemotherapy can kill any remaining mesothelioma cells that the surgeon was unable to remove physically.
• 

  Radiation Therapy

  Through the use of targeted radiation, mesothelioma tumors can often be shrunk, making them easier to be removed through surgery. Depending on the tumor location, the radiation can be delivered using an external or an internal source.
                                    

In many cases, mesothelioma specialists will recommend a multimodal approach, which uses a combination of these three types of treatment. In various studies, multimodal treatment has been shown to be more effective than any of these individual treatments alone. For example, surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has resulted in an increase in the life expectancy of peritoneal mesothelioma patients in recent years.

Multimodal treatment typically consists of a primary treatment used in combination with a neoadjuvant therapy (a “helper” treatment before the primary treatment) or an adjuvant treatment (a helper treatment after the primary treatment).
                                            
 For example, one multimodal approach might include:

• Neoadjuvant therapy: Radiation to shrink the tumor size
• Primary treatment: Surgery to remove the tumor
• Adjuvant therapy: Chemotherapy to kill any remaining cells

The treatment plan will be developed in conjunction with a mesothelioma specialist who can provide details about the specific therapy approach being taken.

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MESOTHELIOMA PROGNOSIS

What Factors Affect Mesothelioma Prognosis?

                                        

There are five primary factors that doctors consider when determining a prognosis for mesothelioma patients.
                                            

Location

Peritoneal mesothelioma (in the abdomen) has a slightly better prognosis than pleural mesothelioma (in the lungs). Pericardial mesothelioma (in the heart) has a very poor prognosis.

Cell Type

Of the three primary cell types of mesothelioma, epithelioid mesothelioma is the most common and also has a better prognosis than sarcomatoid or biphasic mesothelioma.

Stage

Mesothelioma patients diagnosed at an early stage will have a better prognosis than those diagnosed at a later stage. By Stage III and Stage IV, generally only palliative treatments are given to relieve pain and discomfort.

Metastasis

If the mesothelioma has spread to other parts of the body from where it originated (i.e., metastasized), the prognosis is much worse. Once the disease begins to spread, it is much harder to remove the cancer through surgery or kill it with chemotherapy.

Overall Health

Patients who are relatively young and healthy will have a better prognosis, because their bodies are better able to handle the treatments. Older patients also tend to have other conditions that can exacerbate the disease or limit treatment options.
                                                      

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Mesothelioma Histology

Cancer specialists can uncover important microscopic features of your disease with the science of histology. These features play an important role in diagnosis, treatment and your life expectancy.

Histology is a branch of biology and medicine that involves the study of the cells and tissues of animals and plants. Samples of tissue are stained on a slide and observed under a microscope to study the structure and composition of each cell. Because mesothelioma histology involves the study of cancerous mesothelial cells, it is considered a branch of histopathology, which is the study of diseased cells. When diseased cancer cells multiply in the body instead of dying off, they can develop into a mass of tissue that is known as a tumor. Trained medical doctors, usually board-certified pathologists, examine the tumor tissue under a microscope and classify cells by type.
                                      

Histopathology is within the larger field of pathology, which studies the nature, cause and effect of diseases. Pathologists are highly trained medical professionals who examine tissue samples to get an accurate diagnosis, and they’re assisted by histotechnicians and histopathologists, who help with tissue staining to identify diseased cells.

There are several types of mesothelioma cancer cells. Each cellular type responds to different treatments and affects the individual patient's prognosis, so an accurate diagnosis of cancer cell type is essential to develop an effective treatment plan. After treatment is administered, studying tissue samples can also provide insight on the effectiveness of chemotherapy drugs and other treatments.

                                            

Histology also helps prevent mesothelioma misdiagnosis. For example, peritoneal cancer in women and ovarian cancer can be difficult to differentiate without analyzing the cell type through histopathology. If patients are pursuing legal action against an asbestos-producing company that may have caused their cancer, a misdiagnosis can also negatively affect their chances of obtaining compensation.
                                            

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