Malignant pleural mesothelioma

Malignant pleural mesothelioma

    * Introduction
    * Signs and simtpome
    * Diagnosis
    * Treatment
Malignant Mesothelioma is a cancer that develops in the pleura that lines many body organs-mesothelial. It is usually caused by exposure to asbestos. The most common location is the pleura, but can also be found in the peritoneum, pericardium or tunica vaginalis.
Most people who develop mesothelioma have worked in areas that involve processing of asbestos or were exposed to asbestos dust and fibers in other ways. It was suggested that washing clothes uneui family member who worked with asbestos can put that person at risk of developing mesothelioma. Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking increases the risk of other cancers caused by asbestos.
Mesothelioma symptoms include shortness of breath due to pleurisy, chest pain, and general symptoms such as weight loss. Symptoms or signs may not be evident until 20-50 years after asbestos exposure. Symptoms of peritoneal mesothelioma include weight loss and cachexia, increased abdominal girth and pain due to ascites. Intestinal obstruction, anemia and fever. If the cancer has spread to other parts of mesothelial outside the body, symptoms may include pain, dysphagia sauedemul face and neck.
There is no universally accepted protocol for people who have been exposed to asbestos. Screening can diagnose mesothelioma faster than conventional methods for improving thus the survival of patients. Osteopotina serum may be useful in screening patients exposed to asbestos. Mezotelinei serum level is elevated in up to 75% of patients diagnosed to be useful in screening siugerinduse.
Diagnosis can be suspected on X-rays and CT scan and confirmed by microscopic examination and biospie. Toracoscopia can be used to take biopsies. Allows the introduction of substances such as talc to obliterate the pleural space, preventing the accumulation of fluid pleurodeza by pressing lung.
The prognosis for malignant mesothelioma remains negative although there was modest improvement in prognosis with chemotherapy and new multimodal treatments. Treatment of malignant mesothelioma in forms timprurii has a better prognosis, but the cure is very rare. Clinical behavior of cancer is affected by several factors including the continuous surface pleural cavity which favors local metastasis via exfoliated cells, invasion suiacent tissue and other organs in the pleural cavity and the extremely long latency between asbestos exposure and disease development. Histological subtype and patient age, general health also help to predict prognosis.
Causes and risk factors: The main risk factor for the occurrence of diffuse malignant pleural mesothelioma is exposure to asbestos, which may be occupational, domestic or rexidentiala important as duration and intensity of exposure. However, many cases occur among individuals with occupational exposure and very little or domestic exposure. Prolonged and intense exposure to asbestos occurs in contact czul professional miners, workers in the building materials industry, textile industry, automobile industry, for workers of the shipyards or construction for refinery workers. Permissible limit is 0. 1 fibre/cc/8 hours.
Another form of exposure is inhalation of asbestos in the environment existing in geological structures in some areas of Anatolia, Corsica, Cyprus, Greece or Africa. Maligndifuz mesothelioma incidence is higher in those with continuous exposure than those with intermittent exposure. Occasional reports of familial cases have been associated with exposure to asbestos. Familial occurrence suggest that genetic factors may be important.
There are two types of asbestos fibers: -Amphibole: crocidolite (blue asbestos), amosite, anatofilit, tremolite, actinolite. Amfiboliile are fiber length to diameter ratio greater resistant to dissolution, remain long in tissues with deep penetration in the lung -Coils: chrysotile is less toxic than crocidolite because of the length / diameter smaller, greater tissue solubility and tendency to be stored in large airways.
The mechanism by which asbestos fibers cause diffuse malignant mesothelioma is not yet known. One explanation could be due to a malignant transformation of cells from a foreign body reaction caused by insoluble fiber. Asbestos fibers alters the function and secretory properties of macrophages, generating large amounts of hydroxyl radicals. These oxidants participate in the oncogenic intercationind directly and indirectly with DNA, thereby modifying cell membrane associated events. Asbestos has immunosuppressive properties. Genetic alterations in activated macrophages may release asbestos fibers mesothelial cell mitogen such as platelet-derived growth factor, which induce chronic stimulation and proliferation of mesothelial cells. It is suggested that multiple genetic alterations are required cumulative tumorigenic conversion of mesothelial cells. Long latency period between exposure to asbestos and the development of diffuse malignant mesothelioma suggests that various genetic alterations are necessary for malignant transformation of mesothelial cells. Other etiological factors of diffuse malignant pleural mesothelioma are: exposure to other mineral fibers, chronic inflammation, heredity, iaradierea, non-fibrous mineral exposure or chemicals.
Pathogenesis: In terms of macroscopic diffuse malignant pleural mesothelioma is a pleural tumor lobe gray. They are usually multiple tumor masses affecting more frequently than in the parietal pleura visceral. In general there is a slight preponderance of pleural mesothelioma in the cavity is as straight as greater lung and pleural surface is stretched in May. Also lower lobes are more frequently affected than higher ones due to factors determining the gravitational influence after inhalation of asbestos fibers.
When diffuse malignant pleural mesothelioma diagnosis is composed of small nodules located mutiplii the parietal and visceral pleura associated with pleurisy. While T-Kits are joined and form solid tumors that can obliterate the pleural cavity. Tumor spread along the pleural thickening can cause what it may reduce flexibility and restrictive lung can form a crust. Thus it becomes smaller and less functional to more difficult breathing effort initially and then even at rest.
Diffuse malignant pleural mesothelioma progresses rapidly as the tumor spreads along the pleural surface, affecting the pericardium, myocardium, mediastinum, contralateral pleura invaded the chest wall muscles. Sometimes directly invade the subcutaneous tissues and skin. The tumor may extend outside the chest and lymph nodes, abdominal organs have been damaged. , Lymphatic and hematogenous etastazele found at autopsy in half of cases of malignant pleural mesothelioma. Are affected mediastinal lymph nodes and occasionally hilarious and the celiac, cervical, or axillary. Metastases are reported frequently in the lung, liver, kidneys, adrenal glands and less bone, spleen, pancreas.