Pleural Mesothelioma
What is the life expectancy for pleural mesothelioma? Everything about the causes, symptoms, and most suitable diagnostic methods for this condition.
Symptoms and Causes
Mesothelioma is a rare type of cancer that affects the mesothelium, which is a membrane that lines various cavities in the body. Although it can occur in the peritoneum (abdominal cavity), the pericardium (lining of the heart), or in the tunica vaginalis covering the testicles, the most common form develops in the pleura, the tissue that lines the inside of the chest cavity and the outer surface of the lungs.
Malignant pleural mesothelioma, depending on the affected cells, is divided into three different subtypes:
- Epithelioid Mesothelioma: This is the most common and has the best prognosis. The malignant cells resemble epithelial cells, which line the organs. They have a uniform appearance and are arranged in glandular or tubular patterns.
- Sarcomatoid Mesothelioma: This is the least common. The cancerous cells resemble those of connective tissue, which supports and protects the body. It has a worse prognosis.
- Biphasic Mesothelioma: Also called mixed, it has characteristics of both the above subtypes.
Malignant pleural mesothelioma is a very aggressive cancer that, in most cases, leads to death in the short or medium term, so it is currently considered an incurable cancer. It usually manifests between the ages of 50 and 70. Life expectancy is estimated to be between 4 and 16 months after diagnosis, depending on the cell type, timing of diagnosis, and the patient's overall health.
Symptoms
The symptoms of pleural mesothelioma are quite nonspecific and often appear very slowly and progressively:
- Chest pain.
- Dyspnea: feeling of shortness of breath.
- Cough.
- Weakness.
- Fatigue.
- Hoarseness.
- Difficulty swallowing.
In some cases, especially when shoulder pain is present, pleural effusion may occur.
Causes
The main cause of pulmonary mesothelioma is prolonged exposure to asbestos, also known as asbestosis, a group of minerals that were commonly used in industry until the 20th century, particularly in mining and construction, as well as other sectors, making it a professional disease in a high percentage of cases. The disease may appear up to 40 years after exposure.
Other particles that could be involved in the development of mesothelioma include erionite and fluoroedenite.
Exposure to ionizing radiation also seems to be involved in the development of mesothelioma.
Risk Factors
The likelihood of developing pleural mesothelioma increases under the following circumstances:
- Prolonged exposure to asbestos or asbestosis, erionite, or fluoroedenite.
- Being male.
- Being over 50 years old.
- Having or having had asbestosis.
- Genetic predisposition to the disease. Several gene mutations have been described, with the BAP-1 gene mutation being the most well-known.
Complications
The main complication is pleural effusion, which mainly causes dyspnea and pain. In the long run, the worst complication is death.
Prevention
The best way to prevent pleural mesothelioma is to avoid exposure to risk factors, mainly asbestos. Since 2002, Spanish regulations have banned the use of this material, so cases are expected to decrease significantly. However, it is estimated that new diagnoses resulting from previous exposure will continue until 2040.
What doctor treats pleural mesothelioma?
Oncologists, pulmonologists, thoracic surgeons, and radiation oncologists, among others, are involved in the treatment of pleural mesothelioma.
Diagnosis
The first approach involves taking the patient's medical history, identifying symptoms and possible risk factors. A physical examination is also carried out.
With this initial information, imaging tests are performed to gather more details:
- Chest X-ray: Detects pleural thickening, calcium deposits, or accumulated fluid in the pleural space.
- Computed Tomography (CT) scan.
- Positron Emission Tomography (PET) scan.
If pleural mesothelioma is suspected after imaging tests, a biopsy is performed to confirm the diagnosis and help determine the subtype.
The gold standard for obtaining the biopsy is performing a video-assisted thoracoscopic pleural biopsy in the operating room, although in certain cases, a closed pleural biopsy guided by imaging can be performed.
Pulmonary function tests, such as spirometry and plethysmography, are also commonly conducted to assess the patient's status and determine whether surgery is an option.
Treatment
The treatment of mesothelioma varies based on cell type, the patient's age, functional status, and tumor stage, among other factors. The decision on the optimal treatment plan must be made by a multidisciplinary team of specialists, considering scientific evidence and the patient's preferences. Often, several combinations of the following therapies are used:
- The combined regimen of chemotherapy and immunotherapy is usually the cornerstone of treatment in most cases.
- In certain cases, surgery may be performed, although it is currently reserved for selected cases. The most common surgery is pleurectomy or decortication, which involves removing the pleura along with the tumor from both the chest wall and the lung. There are other more aggressive surgeries, such as extrapleural pneumonectomy (EPP), although this is rarely performed today.
- Radiation therapy.
