Mesothelioma and Malignant Pleura Issues
I would like to talk to you today about tumors involving the
plural and in specific malignant plural mesothelioma in this podcast we will
talk about what the plural is. Impossible treatment options for cancer
involving the plural with respect to anatomy of the plural each lobe of the
lung is covered by a double layer sack. we term plural. This covers the lung it
lines the chest wall diaphragm and media stadium.
We call the layer that covers the lung the visceral plural. We
term the layer that covers the chest wall the parietal plural. Plural also
lines the diaphragm as well as the pericardium the sack around the heart. The
space between the two plural layers. Is termed the plural space. There are
approximately two to three thousand new cases of primary cancers of the plural
or malignant plural mesothelioma that are diagnosed each, year, in, the, United
States.
we know that remote exposure to asbestos is a risk factor
,for ,developing ,Mesopotamia. Tumors of the plural can also be in our most
often secondary to metallic disease from cancer involving distant parts of the
body such ,as colon prostate and ovary. While primary plural malignancies and
this is defined as tumors that arise from the plural itself. Are ,fairly
uncommon.
Therefore physicians tend to have a difficult time making the
initial diagnosis of mesothelioma we continue to learn more about malignant
plural mesothelioma ,with respect to the diagnosis. Management and, possible
treatment options. we now know that for a subgroup of patients multi modality
therapy or the combined use of chemotherapy radiation and surgery. is
associated with better outcomes than the use of any single one of those
treatment options alone.
Therefore survival of our patients with mesothelioma is
beginning to improve. up to eighty percent of cases of muscle theology are
associated with asbestos exposure the remaining cases can be related to family
contact as well as non ,asbestos type causes. People most often are diagnosed
with mesothelioma in their fifties to seventies and males are affected more
often than females. it can be difficult to differentiate a malignant plural
muzzle thallium from a different type of cancer that we call metastatic Atlanta
carcinoma.
These are two completely different types of cancer with
vastly different treatment options. as i mentioned before plural tumors are
more frequently metastatic cancers than mesothelioma and so we utilize many
different tests to accurately make that distinction. it is crucial that we have
enough tissue sample or a large enough biopsy specimen to adequately
characterize ,not ,only ,the ,tumor asymmetry. But also to distinguish which
subtype of mezzo thallium that we have.
Unspecific epithelial sarcoma toy or mixed. Epithelial
mesothelioma is the more favorable sub type of mesothelioma and carries a
greater chance of survival after surgical and multi modality therapy. Sarcoma
Todd mizo thiele yo ma is composed of spindle shaped cells and these tumors tend
to have a less favorable outcome. Part of the difficulty in making a diagnosis
of mesothelioma are the subtle symptoms that a patient exhibits espania or
difficulty with breathing is the most common symptom.
And that is usually due to the presence of a plural effusion
characterized in blue. This accumulates in the spaces between the visceral plural
and the parietal plural in between the lung and the chest wall. Chest pain can
also be common other symptoms include cough loss of appetite weight loss night
sweats and even moldy or spitting up blood.
On physical exam there may be decreased breath sounds on the
affected side there can also be a mass in the chest wall, and this could be
painful. There are a number of radio logic tests that we order while trying to
establish the diagnosis the stage which tells us how, advanced the cancer may be.
And determine if surgery is feasible and in the best interest of the patient.
C t scans of the chest are usually one of the first tests
that we order it is readily available and it, provides some very useful data. Pet
scans help determine if there's any suggestion of disease in the other lung in
the abdomen or in other areas of the body. at times M R I can suggest invasion
into the chest wall.
Media stadium or across the diaphragm into the abdomen.this
usually indicates that surgery would not be an option that would benefit the
patient all the information we gather including c t.
MRI pet as well as histology from the tissue biopsy is used to gain a better idea of the anatomy of one's mesothelioma and whether surgery will be. Essential benefit for the patient. the first invasive tests used in an attempt to make a diagnosis of mesothelioma is typically a thorough synthesis or when fluid is removed. from the plural space. Authors and thesis is the use of a small catheter to drain plural fluid
T is sent for analysis to a pathologist to see if cancer
cells are indeed present. it is not uncommon that the plural fluid is analyzed
and does not indicate a diagnosis of mesothelioma or even cancer at all even if
cancer is present ,in that space. Oftentimes the next step is the use of a ct
scan to guide a plural biopsy. this yields a diagnosis of mizi the Ohio and
approximately thirty to fifty percent of the time.
Better but still not great with respect to making a
definitive diagnosis of mesothelioma. lastly an operation can be performed
usually through a single small incision in the chest wall a video scope is
introduced ,into ,the plural space. And multiple biopsies are taken of the
plural surfaces this is often the diagnostic intervention that results in a
definitive diagnosis of malignant plural mesothelioma.
at this point the patient typically is referred to a thoracic
surgeon with experienced and treating patients with mesothelioma. as is true
with any cancer we treat. we stage every patient with mesothelioma in other
words we determine how advanced we believe the cancer to be when we attempt to
determine the best treatment option possible. we utilize all the data available
to us including the c t pet c t MRI tissue biopsy and eventually a day
,procedure in the operating room.
Called a ,cervical media corp. this is a procedure where a
small incision is made at the base of the neck and ,meteorite ,lymph nodes are
biopsied. We now know that if ,the ,media ,style nodes. Are negative for cancer
meaning no cancer is present that these patients live longer than if the nodes
are involved with cancer.
if we suspect the possibility of mesothelioma existing in the
abdomen we may perform a laparoscopy to assess. this involves going to the
operating room where a small incision and cameras are used to obtain tissue to
prove to prove the presence or not of ,mesothelioma ,in the abdomen. There are
two operations that thoracic surgeons may consider performing for patients with
mesothelioma.
These are named pleuritic mechanism and decoration or
extraterrestrial new mannequin. Plethora to me and decoration is a surgical
procedure that involves removing both the ,visceral and parietal. Plural. this
leaves the lung in place this can be a potential option for patients with very
minimal or very advanced. Disease.
An extra plural new anatomy is the complete removal of the
lung. With its visceral plural. the parietal plural. the diaphragm. in the sack
around the heart. Term ,the paragraph. We then reconstruct both, the
pericardium. As ,well ,as ,the diaphragm. Using prosthetic material. we believe
extra plural new mannequin to be the better choice for people who are strong. are
younger or who have more bulky disease.
There is no gold standard therapy for mesothelioma your
treatment plan depends on the anatomy of your tumor and your overall status. Sometimes
chemotherapy is done before surgery. Our thoracic group from Swedish has a
recent publication describing our treatment philosophy and results and patience
with Mizar them treated with chemotherapy first. Followed by surgery and then
radiation.
Patients with mesothelioma are better managed in centers
where there is experience in treating this type of cancer as well as with, the,
complex, surgical procedures required. for removal of the entire tumor. Only by
centralizing the care for the small number of new patients with mesothelioma seen
every year to a limited number of medical centers can we continue to study. Learn
and improve outcomes for our patients fighting this cancer. In the past
mesothelioma was considered to be a disease that could not be treated in which
only pain management should be offered we have come a long, way, from, those
days.
We now know there are interventions that can help certain patients live longer and more comfortably the surgeries that we offer to patients have improved our ability to make accurate diagnoses. Before we head to the operating room. We continue to experiment do research and study our results critically. Thank you for listening to the plugged into your health cancer podcast program risotto Loma and malignant, plural, issues, and, domestic surgeries. For more information please contact your theoretic surgeon. Come often to read new articles www.lkbly.com
