Mesothelioma
Dr. med. Mira Seidel is a freelance writer for the medical team.
More about the experts All content is checked by medical journalists.Mesothelioma is a tumor that originates, for example, from cells of the lung membrane, the peritoneum or the pericardium and envelops the lungs in the shape of a jacket. It occurs particularly in people who have been in contact with asbestos for a long time. Mesothelioma can be benign or malignant (pleural cancer, pleural cancer). Treatment usually consists of an operation combined with chemotherapy. Find out more about mesothelioma here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. D19C45
Mesothelioma: description
Mesothelioma is a growth (tumor) of the mesothelium. This is a single layer of epithelial tissue that defines body cavities such as the pleura, pericardium and peritoneum. It usually covers the lungs as an extensive tumor.
Like most tumors, mesothelioma can occur in benign (benign) and malignant (malignant) forms. The latter is often the result of exposure to asbestos. The latency period is long: around 35 years pass between exposure to asbestos and the appearance of the first symptoms. If you have been exposed to asbestos at work and develop malignant mesothelioma, this is a recognized occupational disease.
More than 80 percent of malignant mesotheliomas are pleural mesotheliomas, i.e. tumors that originate in the pleura (pleura: pleura and pleura). One speaks here of pleurisy or pleural cancer.
About 20 people per million inhabitants in Germany fall ill with mesothelioma every year. Asbestos has been banned in many industrialized countries, but the incidence appears to be increasing. Men are three to five times more likely to develop mesothelioma than women. The higher the age, the higher the risk of disease.
Mesothelioma: symptoms
The pleural cancer symptoms can vary widely. It can take up to six months between the first symptoms appearing and the final diagnosis.
Most people with pleural mesothelioma report shortness of breath as the first symptom. In addition, chest pain can occur if the intercostal nerves are irritated or the chest wall is infiltrated.
In rare cases, an elevated diaphragm or a dry cough can occur. Pleura cancer also rarely shows so-called paraneoplastic symptoms such as anemia, weight loss, fever or spontaneous pneumothorax (sudden penetration of air into the gap between the pleura and the pleura).
Unilateral pleural effusions or thickening of the lung membrane with simultaneous chest pain can be further indications of a mesothelioma.
Mesothelioma: causes and risk factors
Up to 90 percent of pleural mesothelioma cases can be traced back to asbestos exposure. Asbestos has been banned in Germany since 1993. Asbestos has been banned in the EU since 2005. Nevertheless, asbestos continues to be used on a massive scale worldwide, for example as an insulating material in the construction industry. No limit has yet been set below which there is no risk of mesothelioma.
About ten to twenty percent of mesothelioma diseases are not caused by asbestos but, for example, by zeolite (erionite), an asbestos-like fiber. In addition, other factors are also suspected of being able to trigger mesothelioma. These include, for example, the so-called SV-40 viruses, repeated inflammations and a genetic predisposition to mesothelioma.In addition, experts are currently examining whether nanomaterials such as nanotubes can also lead to malignant mesothelioma.
Mesothelioma: examinations and diagnosis
If there are signs of pleural mesothelioma, you should see a general practitioner or a pulmonologist. To diagnose mesothelioma, the doctor will ask carefully about the symptoms and your medical history. Typical questions from the doctor would be, for example:
- Since when and how often have you had symptoms such as a cough?
- Is it difficult for you to breathe?
- Do you have thick sputum when you cough?
- Did you also have a fever? Do you sweat heavily at night?
- Do you have professional or private contact with asbestos?
- Do you live or work in the vicinity of factories that process asbestos?
- Have you stayed in areas with natural asbestos?
- Do you live in an old building with asbestos-containing components?
If a mesothelioma is suspected, a referral to an experienced lung center makes sense. Further physical examinations follow to confirm the suspected diagnosis. Imaging techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can be performed to determine the size of the tumor. Ultimate certainty in the event of a suspected mesothelioma is provided by a fine-tissue examination of the changed tissue.
Imaging procedures
To determine whether water has accumulated between the pleura and pleura (pleural effusion), the chest is examined using ultrasound (transthoracic ultrasound). A pleural puncture (see below) is also performed under ultrasound control.
Computed tomography (CT) is the best way to diagnose mesothelioma and determine its extent. In addition, CT can be used to determine whether the tumor has already formed daughter tumors (metastases) in the lymph nodes.
If the tumor is suspected to have spread to the diaphragm or chest wall, magnetic resonance imaging (MRI) may be done. So-called positron emission tomography (PET) can also be used, especially to detect distant metastases.
Pleural puncture
During a pleural puncture, the doctor inserts a fine needle past the ribs into the pleural space and pulls out fluid. Cancer cells can be detected in the pleural effusion in more than half of all pleural cancer patients. However, a negative result does not rule out pleural mesothelioma.
Needle biopsy
With a percutaneous needle biopsy, a needle is pushed into the body from outside to take a tissue sample from the affected area. The whole thing is monitored by means of X-rays, ultrasound, CT or MRI in order to check the exact position of the needle.
Thoracoscopy (breastoscopy)
Thoracoscopy (breastoscopy) is often necessary to confirm the diagnosis. The pleural cavity is examined endoscopically. In addition, some tumor tissue can be removed during the examination for fine-tissue diagnostics.
Histological diagnostics
The examination of the tissue sample should be carried out by a specialized pulmonary pathologist. Mesothelioma is histologically divided into different forms:
- Epithelial mesothelioma (50 percent of all mesothelioma cases)
- Sarcomatous mesothelioma (25 percent)
- Biphasic mesothelioma (24 percent)
- Undifferentiated mesothelioma (1 percent)
Mesothelioma: treatment
Mesothelioma should be treated in a specialized center because both diagnosis and treatment are challenging. There is no standardized guideline on how mesothelioma is treated. It is generally known, however, that monotherapy (i.e. a single therapeutic method such as surgery) is not sufficient to combat the aggressive tumor.
Various methods are currently available for the treatment of mesothelioma: Surgical therapy, chemotherapy, radiation and pleurodesis (pleura and lungs are surgically connected to one another).
Usually a combination of surgery and chemotherapy and / or radiation is considered to be the most sensible course of action.
Surgical therapy
Since pleural mesothelioma often develops multifocally, i.e. in several places at the same time and diffusely expands, only large-scale surgical interventions are sensible. A distinction is made between two surgical methods: pleurectomy / decortication (PD) and extrapleural pneumonectomy (EPP).
Pleurectomy / decortication
During pleurectomy / decortication, only the lining of the lungs, i.e. the pleura, is removed. The lungs themselves are preserved. Depending on the size of the tumor, in some cases the pericardium and diaphragm are also removed.
The advantage of this less radical method is that the patient recovers faster. However, since this method does not remove all of the cancerous tissue and tumor tissue still remains in the body, there is a high probability that a new mesothelioma will develop (relapse).
Extrapleural pneumonectomy
In young patients with a good general condition, a so-called extrapleural pleuropneumonectomy can be useful. It is the more radical method, as it removes the lungs along with the pleura and pleura as well as the diaphragm on the affected side. The diaphragm is reconstructed with Gore-Tex-like material.
The extrapleural pleuropneumonectomy is a large five to eight hour operation. It severely restricts the patient's performance. The operation should therefore only be performed in the early stages of mesothelioma and only at specialized centers.
chemotherapy
In chemotherapy, mesothelioma is treated with the help of cytostatic drugs that are administered through the vein at regular intervals. Induction chemotherapy is differentiated from adjuvant chemotherapy. In induction chemotherapy, a high dose of cytotoxic drugs is given at the start of treatment. In around a third of those affected, this means that the mesothelioma partially regresses. Adjuvant chemotherapy is carried out following surgical therapy. It shows similar success rates.
A combination of the two cytostatics cisplatin and pemetrexide is usually used for chemotherapy. This enabled the best chances of survival and the best quality of life to be achieved.
Irradiation
Radiation (radiation therapy, radiation) is used preventively in patients with mesothelioma in the area of puncture canals and after operations so that there is no local recurrence. Radiation can also help reduce pain. In general, however, irradiation is not used, as the tumor usually spreads in a complex manner and thus requires a high dose of radiation. The risk of additional damage to the lungs and heart is too great.
Pleurodesis
If the general condition is poor and the disease is well advanced, talc pleurodesis is useful. The pleura (lung and pleura) are glued together with talcum powder. If there is fluid in the pleural space (pleural effusion), the symptoms can be significantly improved. Pleurodesis can also be performed as part of a diagnostic thoracoscopy.
Mesothelioma: disease course and prognosis
Today, mesothelioma can only be cured in exceptional cases, despite all the means available. Various factors influence the prognosis in individual cases, including age, gender, tumor subtype and tumor stage. Epithelial mesothelioma, for example, has a more favorable prognosis. Younger sufferers (under 75 years of age) and women also have a more favorable prognosis.
For example, whether the patient is restricted in his activity, can still take care of himself and can determine himself (Karnofsky index) also plays a role in the prognosis. Factors such as low hemoglobin levels, high levels of LDH (“bad” cholesterol) or high levels of white blood cells (leukocytes) and blood platelets (thrombocytes) can also affect the prognosis.
Pleural mesothelioma: life expectancy
Survival time for pleural cancer is generally four to twelve months. Only twelve percent of those affected with negative prognostic factors (such as old age) survive the first year.
Aftercare
After completing therapy, mesothelioma patients should have a medical check-up about every two to three months. Tumor-associated symptoms are observed and a physical examination is carried out.
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