Malignant Pleural Mesothelioma; Symptoms, Diagnosis & Treatments. When my father was hospitalized, I was told that there was water in my chest. I was told that there is a possibility of malignant pleural mesothelioma. Malignant pleural mesothelioma is cancer that begins in the pleural mesothelial cells that cover the surface of the lungs and chest wall. Since it occurs 20 to 40 years after handling asbestos, there are many elderly patients, and it is expected to increase for some time due to demolition work accompanying the aging of buildings.
Undertreatment for malignant pleural mesothelioma. I drain the water every day.
Where will the water collect?
Malignant pleural mesothelioma is a disease that arises from the pleura. The pleura is composed of two membranes (yellow line in the figure): the outer wall side pleura and the visceral pleura covering the lung surface. Malignant pleural mesothelioma arising from the parietal pleura spreads and thickens in the visceral pleura. Water collects in a place called the thoracic cavity between the wall-side pleura and the visceral pleura. If a large amount of water accumulates and is difficult, you must take measures to drain the water.
Asbestos is one of the minerals existing in nature, and it is a substance in the form of cotton-like so-called asbestos. It is very easy to process, inexpensive and has been widely used for insulation, refractory materials and friction materials due to its physicochemical properties.
The medical examination was re-examined and malignant pleural mesothelioma was diagnosed.
I don’t have any subjective symptoms so far, what are the symptoms?
Symptoms may not be observed at an early stage, and the patient may be aware of the presence of the disease by starting to point out that water has accumulated in the chest. The most common symptoms are chest pain/back pain, breathing difficulty, and symptoms such as fever and cough are also observed.
A malignant pleural mesothelioma was suspected by a medical checkup, and I was told to do a detailed examination.
What inspections do you have?
For definitive diagnosis, pleural effusion cytology, which examines cells by draining the water accumulated in the chest, and pleural biopsy, in which a part of the pleura is sampled using a CT guide or thoracoscope, are performed. In order to investigate the spread of the disease, chest CT and PET / CT examinations are performed to determine the degree of progression of the disease and to consider the appropriate treatment. However, it can be difficult to differentiate from benign pleural disease or other malignant tumors (lung adenocarcinoma, metastatic adenocarcinoma, etc.) and can be time-consuming.
It seems that his father was recommended to have surgery for malignant pleural mesothelioma.
What kind of surgery will it be?
Surgery is indicated when the lesion has little spread to the surroundings and can be cured by resection. An operation called “total pneumonectomy” is performed to remove all tumor cells in the lungs and chest wall. This is a major operation to remove the lung on one side and the surrounding pleura. As shown in the figure, one lung is removed from the large surgical wound, including the pleura.
Is there any treatment other than surgery?
Treatments other than surgery include radiation therapy and anticancer drug treatment, which may be multimodality treatments alone or in combination. Elderly patients who are concerned about complications and side effects may not be treated aggressively and may be treated mainly for symptom relief.