What is Mesothelioma?
What Mesothelioma?
Mesothelioma is a cancer that attacks the mesothelium, which is a thin layer of tissue that covers most of the internal organs. Some organs of the body that have mesothelium, including the lungs (pleura), stomach (abdomen), heart (pericardial), and testicles (tunica vaginalis) are classified as aggressive.
Mesothelioma is classified as an aggressive type of cancer, but it is quite rare. This condition does not cause symptoms until decades after the patient is exposed to asbestos. In most cases, patients diagnosed with mesothelioma are aged 60–80 years.
Although it can be treated, most cases of mesothelioma are at an advanced stage, making it difficult to treat. Therefore, it is important to carry out prevention and regular check-ups to prevent this condition.
Types of Mesothelioma
There are four types of mesothelioma cancer, namely:
1. Pleural mesothelioma (pleural mesothelioma), which is cancer that attacks the lining of the lungs (pleura) and is the most common type
2. Peritoneal mesothelioma (peritoneal mesothelioma), which is cancer of the lining of the abdominal cavity (peritoneum)
3. Pericardial mesothelioma (pericardial mesothelioma), which is cancer in the protective lining of the heart organ
4. Testicular mesothelioma (testicular mesothelioma), which is cancer that attacks the protective lining of the testes or testicles
In addition to the above types, there are also benign mesothelioma in the lungs and chest cavity called solitary fibrous tumor. However, this condition is not included in the type of mesothelioma that will be discussed.
What is Mesothelioma Symptoms?
Symptoms of mesothelioma vary based on where the cancer cells are located. Pericardial mesothelioma causes chest pain and difficulty breathing, while tunica vaginalis mesothelioma will show symptoms in the form of swelling of the testicles.
Mesothelioma most commonly affects the mesothelium of the lungs (called pleural mesothelioma). Pleural mesothelioma has the following symptoms:
1. Cough with unbearable pain.
2. Shortness of breath due to accumulation of fluid in the chest.
3. An unusual lump in the tissue under the skin of the chest.
4. Weight loss for no apparent reason.
Mesothelioma develops gradually and usually takes 20–60 years for symptoms to appear. Therefore, patients may not feel any symptoms when mesothelioma is still in its early stages. However, cancer cells will continue to grow over time and press on nerves or other organs, causing symptoms.
Symptoms of mesothelioma depend on the organ affected. In pulmonary mesothelioma, symptoms that may appear include:
Fever and sweating, especially at night
Body feels very tired
Cough with unbearable pain
Shortness of breath due to fluid buildup in the lungs
Weight loss for no apparent reason
Chest pain
Hoarseness
Difficult to swallow
Pain in the shoulder or upper arm
Swelling or deformity of the fingertips (clubbing finger)
A lump appears in the tissue under the skin surface of the chest
Meanwhile, abdominal (peritoneal) mesothelioma can cause the following symptoms:
Fever or night sweats
Loss of appetite
Weight loss
Diarrhea
Constipation
Stomach pain
Nausea and vomiting
Lumps or swelling in the abdominal area
Disorders of defecation and urination
Pericardial and testicular mesothelioma is a very rare type of mesothelioma. Pericardial mesothelioma usually causes symptoms in the form of chest pain and breathing problems, while testicular mesothelioma is characterized by swelling or lumps in the testicular area.
What is Mesothelioma Caused by
Although the exact cause of mesothelioma is not known, the main risk factor for mesothelioma is asbestos. This disease was relatively rare before the commercial use of asbestos began. Asbestos is a mineral that is used as a material to make brakes, floors, roofs, and insulation. Several other risk factors are men, age >65 years and the environment exposed to asbestos.
The exact cause of mesothelioma is not known. However, mesothelioma is often associated with exposure to asbestos or asbestos. Asbestos is a mineral that is widely used as a building construction material, such as roofing, because of its heat resistance and fire resistance.
Asbestos is destroyed, either in the mining process or building renovations, will produce fine fibers or dust. The fiber is very easily inhaled, then enters and settles in the organs of the body, especially the lungs.
If swallowed, asbestos fibers can also spread through the lymphatic system, then settle and cause cancer in the lining of the abdominal cavity (peritoneum).
Mesothelioma risk factors
Mesothelioma can happen to anyone, but the risk is higher in people with the following factors:
Working in fields prone to exposure to asbestos, such as mineral mines, construction sites, automotive industry, power generation, textile industry, and steel mills
Living in an old building or an environment where the soil contains asbestos
Having family members who work in an environment that is prone to exposure to asbestos so that asbestos dust sticks to the skin or clothes and is carried into the house
Having a family who suffers from mesothelioma or a genetic disorder that increases the risk of developing cancer
Exposure to the mineral erionite or radiation from thorium dioxide
Infected with simian virus (SV40)
Mesothelioma Diagnosis
Apart from the history and symptoms, further examinations are carried out to diagnose mesothelioma, including X-rays to check for abnormalities in the chest and CT scans to examine the chest and abdomen area. Biopsy using a small fine needle or by laparoscopy or thoracoscopy is also very helpful for a fixed diagnosis.
In order to determine the diagnosis of mesothelioma, the doctor will ask questions related to the patient's symptoms and medical history, especially the possibility of exposure to asbestos. A physical exam will also be done to detect lumps or other symptoms.
To confirm the diagnosis, the doctor will perform scans, such as:
X-rays, to detect thickening in the lining of the lungs, fluid in the pleural cavity, or changes in the shape of the lungs
CT scan, to examine the chest and abdomen area, as well as detect the presence of cancer and check whether the cancer has spread to other organs
PET scan, to get a detailed picture of the tissue suspected of having cancer
MRI, to get a more detailed picture of the organs and determine the location of the tumor
Based on the test results, the doctor may also suggest further tests in the form of:
blood test
Blood tests are performed to detect elevated levels of fibulin-3, osteopontin, and peptides in the blood. Levels of these three substances are usually higher in people with mesothelioma.
Liquid sample check
If the patient experiences fluid accumulation in the body due to mesothelioma, the doctor will take a sample of the fluid and examine it in the laboratory to detect the presence of cancer cells.
There are several types of fluid sample examination, namely:
Thoracentesis, which is taking a sample of fluid in the chest cavity
Paracentesis, which is taking fluid in the abdominal cavity
Pericardiocentesis, which is taking fluid in the lining (membrane) around the heart
Biopsy
A biopsy is done by taking tissue samples from certain body parts for later analysis in the laboratory. There are several types of biopsy examination, namely:
1. Needle biopsy
A needle biopsy is performed by inserting a long needle into the chest or abdominal cavity.
2. Thoracoscopy, laparoscopy, and mediastinoscopy
This biopsy is performed by inserting an elastic tube with a camera and special surgical instruments through one or more small incisions. The type of biopsy performed depends on the area of the body being examined, namely:
Thoracoscopy, to examine the inside of the chest
Laparoscopy, to examine the inside of the abdominal organs
Mediastinoscopy, to examine the area around the heart
3. Biopsy through surgery
In some cases, the doctor will perform an invasive procedure to take a larger sample of tissue to confirm the diagnosis. Doctors can also remove the entire tumor at once if possible.
There are two types of surgical biopsy procedures:
Thoracotomy, which is performed through open surgery on the chest
Laparotomy, which is done through open surgery on the abdomen
4. Bronchoscopy biopsy
This biopsy is done by inserting a thin tube through the throat to detect tumors in the respiratory tract. If there is, the doctor will take a tissue sample from the tumor for examination.
Mesothelioma stage
Based on the size and extent of its spread, mesothelioma is divided into four stages. This staging division helps doctors to know the development of cancer cells and the patient's life expectancy, as well as determine the appropriate treatment method.
The following is the stage and life expectancy of people with mesothelioma:
Stage 1
The tumor is still in one area of the body and has not spread to other tissues or organs. At this stage, the patient's life expectancy is 21 months or more.
Stage 2
Cancer cells enlarge and begin to spread to nearby areas, with a life expectancy of 19 months or less.
Stage 3
Cancer cells have spread to nearby organs, with a life expectancy of about 16 months.
Stage 4
Cancer cells have spread to various areas throughout the body through the bloodstream. At this stage, the patient's life expectancy is very low, which is about 12 months.
Mesothelioma Treatment
Some mesothelioma treatment steps are generally carried out such as chemotherapy and radiotherapy. Surgery is performed to remove cancer which is generally still in the early stages of disease progression, although in some cases it still does not remove the cancer cells completely.
Mesothelioma is one type of malignant cancer and can not be cured. Treatment is limited to relieving symptoms and prolonging the patient's life expectancy. The method of treatment is determined based on the following factors:
Age and overall health condition of the patient
Type and location of cancer
Size and extent of cancer spread
Based on the considerations above, some treatment steps that can be recommended by doctors are:
1. Chemotherapy
Chemotherapy is the administration of drugs to kill or inhibit the growth of cancer cells. This therapy can be done before surgery to shrink cancer cells so they can be easily removed, or after surgery to reduce the risk of the cancer coming back.
2. Radiotherapy
Radiotherapy or radiation therapy is done by shooting X-rays or proton beams at areas of the body affected by cancer. This therapy is usually done after surgery to remove residual cancer cells.
Radiotherapy can also be used to relieve symptoms of advanced cancer in patients who cannot undergo surgery.
3. Operation
Surgery can be performed in early-stage mesothelioma. There are several surgical options that doctors can perform, namely:
Surgery to remove as many cancer cells as possible from the patient's body. This action can be supported by radiotherapy to relieve pain and inhibit cancer growth.
Surgery to aspirate fluid in the chest that interferes with breathing. This procedure can be accompanied by pleurodesis, which is an injection of medication into the chest to prevent fluid from building up again.
Surgery to remove tissue around the abdominal cavity, ribs, or lungs affected by cancer cells.
Surgery to remove the affected lung and surrounding tissue. This procedure is usually followed by radiotherapy.
4. Multimodality therapy
This therapy is a combination of three or more treatment methods, such as surgery, postoperative chemotherapy, and radiation therapy, to increase the success rate of treatment.
To help the treatment process, the doctor will advise the patient to do the following:
Breathing exercises, to control breathing when experiencing symptoms of difficulty breathing
Body relaxation exercises, to reduce tension in the respiratory tract muscles so that it is easier to breathe
Mesothelioma Complications
Mesothelioma that has enlarged or spread can put pressure on surrounding organs or tissues. This can lead to various complications.
In pleural mesothelioma, complications that can occur include:
Difficulty breathing
Chest pain
Difficulty swallowing
Pain due to pressure on nerves and spinal cord
Pleural effusion
While complications due to peritoneal mesothelioma is intestinal obstruction, which can be characterized by nausea, vomiting, constipation, and loss of appetite or feeling full quickly.
Mesothelioma Prevention
For prevention, especially for factory workers, they must use safety, especially masks and routinely check the body, especially the lungs.
The main way to prevent mesothelioma is to avoid contact with anything that contains asbestos. If you work in an environment that has a high risk of exposure to asbestos, then follow the safety regulations set by the company, for example:
Use personal protective equipment while in a work area that is prone to exposure to asbestos
Dispose of the remaining asbestos material in a safe place that does not harm the surrounding environment
Do not bring home the clothes and shoes used during work
In addition, there are several other things that can be done to reduce the risk of mesothelioma, namely:
Conduct regular health checks to detect symptoms or signs of disease associated with exposure to asbestos
Quit smoking, because smoking can increase the risk of various types of cancer, including mesothelioma
Follow instructions on how to safely handle asbestos