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MesotheliomaMesothelioma is a form of cancer that is almost always caused by exposure toasbestos. In this disease, malignant cells develop in the mesothelium, aprotective lining that covers most of the body's internal organs. Its most commonsite is the pleura (outer lining of the lungs and internal chest wall), but it mayalso occur in the peritoneum (the lining of the abdominal cavity), the heart,thepericardium (a sac that surrounds the heart) or tunica vaginalis.Most people who develop mesothelioma have worked on jobs where they inhaledasbestos particles, or they have been exposed to asbestos dust and fiber in otherways. It has also been suggested that washing the clothes of a family member whoworked with asbestos can put a person at risk for developing mesothelioma.Unlikelung cancer, there is no association between mesothelioma and smoking, but smokinggreatly increases risk of other asbestos-induced cancer.Compensation via asbestosfunds or lawsuits is an important issue in mesothelioma (see asbestos and thelaw).The symptoms of mesothelioma include shortness of breath due to pleural effusion(fluid between the lung and the chest wall) or chest wall pain, and generalsymptoms such as weight loss. The diagnosis may be suspected with chest X-ray andCT scan, and is confirmed with a biopsy (tissue sample) and microscopicexamination. A thoracoscopy (inserting a tube with a camera into the chest) can beused to take biopsies. It allows the introduction of substances such as talc toobliterate the pleural space (called pleurodesis), which prevents more fluid fromaccumulating and pressing on the lung. Despite treatment with chemotherapy,radiation therapy or sometimes surgery, the disease carries a poor prognosis.Research about screening tests for the early detection of mesothelioma is ongoing.Signs and symptoms Of MesotheliomaSymptoms of mesothelioma may not appear until 20 to 50 years after exposure toasbestos. Shortness of breath, cough, and pain in the chest due to an accumulationof fluid in the pleural space are often symptoms of pleural mesothelioma.Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominalswelling and pain due to ascites (a buildup of fluid in the abdominal cavity).Other symptoms of peritoneal mesothelioma may include bowel obstruction, bloodclotting abnormalities, anemia, and fever. If the cancer has spread beyond themesothelium to other parts of the body, symptoms may include pain, troubleswallowing, or swelling of the neck or face.These symptoms may be caused by mesothelioma or by other, less serious conditions.Mesothelioma that affects the pleura can cause these signs and symptoms:* Chest wall pain* Pleural effusion, or fluid surrounding the lung* Shortness of breath* Fatigue or anemia* Wheezing, hoarseness, or cough* Blood in the sputum (fluid) coughed up (hemoptysis)In severe cases, the person may have many tumor masses. The individual may developa pneumothorax, or collapse of the lung. The disease may metastasize, or spread,
 
to other parts of the body.Tumors that affect the abdominal cavity often do not cause symptoms until they areat a late stage. Symptoms include:* Abdominal pain* Ascites, or an abnormal buildup of fluid in the abd omen* A mass in the abdomen* Problems with bowel function* Weight lossIn severe cases of the disease, the following signs and symptoms may be present:* Blood clots in the veins, which may cause thrombophlebitis* Disseminated intravascular coagulation, a disorder causing severe bleeding inmany body organs* Jaundice, or yellowing of the eyes and skin* Low blood sugar level* Pleural effusion* Pulmonary emboli, or blood clots in the arteries of the lungs* Severe ascitesA mesothelioma does not usually spread to the bone, brain, or adrenal glands.Pleural tumors are usually found only on one side of the lungs.Diagnosis of MesotheliomaDiagnosing mesothelioma is often difficult, because the symptoms are similar tothose of a number of other conditions. Diagnosis begins with a review of thepatient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed bychest X-ray and often lung function tests. The X-ray may reveal pleural thickeningcommonly seen after asbestos exposure and increases suspicion of mesothelioma. ACT (or CAT) scan or an MRI is usually performed. If a large amount of fluid ispresent, abnormal cells may be detected by cytology if this fluid is aspiratedwith a syringe. For pleural fluid this is done by a pleural tap or chest drain, inascites with an paracentesis or ascitic drain and in a pericardial effusion withpericardiocen tesis. While absence of malignant cells on cytology does notcompletely exclude mesothelioma, it makes it much more unlikely, especially if analternative diagnosis can be made (e.g. tuberculosis, heart failure).If cytology is positive or a plaque is regarded as suspicious, a biopsy is neededto confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue forexamination under a microscope by a pathologist. A biopsy may be done in differentways, depending on where the abnormal area is located. If the cancer is in thechest, the doctor may perform a thoracoscopy. In this procedure, the doctor makesa small cut through the chest wall and puts a thin, lighted tube called athoracoscope into the chest between two ribs. Thoracoscopy allows the doctor tolook inside the chest and obtain tissue samples.If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtaintissue for examination, the doctor makes a small incision in the abdomen andinserts a special instrument into the abdominal cavity. If these procedures do notyield enough tissue, more extensive diagnostic surgery may be necessary.
 
Screening of MesotheliomaThere is no universally agreed protocol for screening people who have been exposedto asbestos. Screening tests might diagnose mesothelioma earlier than conventionalmethods thus improving the survival prospects for patients. The serum osteopontinlevel might be useful in screening asbestos-exposed people for mesothelioma. Thelev el of soluble mesothelin-related protein is elevated in the serum of about 75%of patients at diagnosis and it has been suggested that it may be useful forscreening.Doctors have begun testing the Mesomark assay which measures levels ofsoluble mesothelin-related proteins (SMRPs) released by diseased mesotheliomacells.StagingMesothelioma is described as localized if the cancer is found only on the membranesurface where it originated. It is classified as early (stages I or II) iflocalized to a single organ surface, usually the lining of the lungs or kidney.Advanced classification is defined (stages III or IV) if it has spread beyond theoriginal membrane surface to other parts of the body.Treatment of MesotheliomaTreatment of malignant mesothelioma using conve ntional therapies in combinationwith radiation and or chemotherapy on stage I or II Mesothelioma have proved onaverage 74.6 percent successful in extending the patients life span by five yearsor more [commonly known as remission][this percentage may increase or decreasedepending on date of discovery / stage of malignant development] (Oncology Today,2009). Treatment course is primarily determined by the staging or development.This is unliketraditional treatment such as surgery by itself which has proved only be 16.3percent likely to extend a patient's life span by five years or more [commonlyknown as remission]. Clinical behavior of the malignancy is affected by severalfactors including the continuous mesothelial surface of the p leural cavity whichfavors local metastasis via exfoliated cells, invasion to underlying tissue andother organs within the pleural cavity, and the extremely long latency periodbetween asbestos exposure and development of the disease.SurgerySurgery, by itself, has proved disappointing. However, research indicates variedsuccess when used in combination with radiation and chemotherapy (Duke, 2008) Apleurectomy/decortication is the most common surgery, in which the lining of thechest is removed. Less common is an extrapleural pneumonectomy (EPP), in which thelung, lining of the inside of the chest, the hemi-diaphragm and the pe ricardiumare removed.Radiation for MesotheliomaFor patients with localized disease, and who can tolerate a radical surgery,radiation is often given post-operatively as a consolidative treatment. The entirehemi-thorax is treated with radiation therapy, often given simultaneously withchemotherapy. This approach of using surgery followed by radiation withchemotherapy has been pioneered by the thoracic oncology team at Brigham & Women'sHospital in Boston.Delivering radiation and chemotherapy after a radical surgeryhas led to extended life expectancy in selected patient populations with some
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