Mesothelioma is a cancer that attacks the mesothelium, the tissue that lines various organs of the body. There are four types of mesothelioma cancer, namely:
- Pleural mesothelioma (pleural mesothelioma), which is cancer that attacks the mesothelium lining the lungs (pleura). This type is the most common type.
- Peritoneal mesothelioma (peritoneal mesothelioma), namely mesothelioma in the lining of the abdominal cavity (peritoneum).
- Pericardial mesothelioma (pericardial mesothelioma), namely mesothelioma that attacks the protective layer of the heart organ.
- Testicular mesothelioma (testicular mesothelioma), namely mesothelioma that attacks the protective layer of the testes or testicles.
There is a benign tumor in the chest called solitary fibrous tumor which is sometimes called benign mesothelioma. These conditions are not included in mesothelioma which will be discussed.
Causes of Mesothelioma
The exact cause of mesothelioma is not known. However, mesothelioma is always 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-resistant and fire-resistant properties. The use of asbestos has been officially banned since 1999.
When asbestos is destroyed, either during the mining process or building renovations, asbestos will produce fine fibers or dust. Asbestos fine fibers are very easily inhaled, then enter and settle in the organs of the body, especially the lungs. Ingested asbestos fibers can also move through the lymphatic system, settle, and infect cells in the lining of the abdominal cavity (peritoneum).
Exposure to asbestos can also affect the function of the reproductive organs and the heart. However, it is not known with certainty the process of spreading it because it is very rare.
In general, there are several factors that increase the risk of mesothelioma, namely:
- Work environments that are prone to exposure to asbestos, such as mineral mines, construction sites, automotive industry, power plants, textile industries, and steel factories.
- Living in an old building or environment where the soil contains asbestos.
- Having family members who work in an environment prone to asbestos exposure. Asbestos can stick to skin and clothing, so asbestos can be carried into homes or other environments.
- Have a history of mesothelioma or genetic disorders that increase the risk of cancer.
In addition to asbestos, there are several other factors that can increase the risk of mesothelioma, although they are rare. Among them are exposure to the mineral erionite, radiation exposure from the chemical thorium dioxide used in X-ray examinations until the 1950s, and infection with simian virus (SV40).
Mesothelioma Symptoms
Symptoms of mesothelioma develop gradually and usually take 20-30 years for symptoms to appear. Patients may not feel any symptoms when mesothelioma is in its early stages. But over time, cancer cells will grow and press on nerves or other organs, causing symptoms.
Mesothelioma symptoms vary depending on the location of the presence of cancer cells. In pulmonary mesothelioma, the symptoms that may appear are as follows:
- Fever with sweating, especially at night.
- Excessive fatigue.
- Cough with unbearable pain.
- Shortness of breath due to fluid buildup in the lungs, precisely in the pleural cavity, which is the space between the two layers of the pleura that line the lungs.
- Weight loss for no apparent reason.
- Chest pain.
- Swelling and deformity of the fingertips (clubbing finger).
- A lump appears in the tissue under the skin surface in the chest area.
Meanwhile, abdominal (peritoneal) mesothelioma has the following symptoms:
- Loss of appetite.
- Weight decreased drastically.
- Diarrhea.
- Constipation.
- Pain in the abdomen.
- Swelling in the abdominal area.
- A lump appears in the stomach.
- Disturbances in 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 the appearance of a lump in the testicular area.
Symptoms of mesothelioma are non-specific and can be caused by other conditions. Therefore, immediately see a doctor if you feel the above symptoms, especially if you have a history of exposure to asbestos.
Mesothelioma Diagnosis
The doctor will suspect a patient has mesothelioma, if there are symptoms, which are confirmed by a physical examination. However, to be sure, imaging tests need to be done. Among others are:
- X-ray Photo, to detect abnormalities, such as thickening of the lining of the lungs, fluid in the pleural space, or changes in the shape of the lungs.
- CT scan, to examine the chest and abdomen area, as well as detect signs of cancer, determine the location of the cancer, and check whether the cancer has spread to other organs of the body.
- PET (Positron Emission Tomography). Examination using compounds containing radioactive atoms that are injected into the body to get a detailed picture of the tissue suspected of having cancer cells.
- MRI, To get a more detailed picture of the tissue determine the location of the tumor.
In addition, the doctor may also suggest further examinations in the form of:
- Examination of fluid samples. If the patient has fluid buildup in the body related to mesothelioma, the doctor will take a fluid sample using a needle that is inserted through the skin into the area where the fluid is. Next, the fluid will be analyzed in a laboratory to detect the presence of cancer cells. There are several types of fluid and tissue sample tests, namely:
- Thoracentesis, collection of fluid samples in the pleural space.
- paracentesis, fluid collection in the abdominal cavity.
- pericardiocentesis, uptake of fluid in the lining (membrane) around the heart.
- Biopsy, namely the procedure of removing tissue samples from certain body parts for later analysis in the laboratory. There are several types of biopsy examination, namely:
- Needle biopsy. A type of biopsy in which a long needle is inserted through the skin into the chest or abdomen to take a sample of tissue.
- Thoracoscopy, laparoscopy and mediastinoscopy. This type of biopsy uses an elastic tube with a camera and a special surgical instrument that is inserted through one or more small incisions to collect tissue samples. The type of sample removal procedure generally depends on the area of the body undergoing examination, namely:
- thoracoscopy, to examine the space between the lung and the chest wall.
- Laparoscopy, to examine the inside of the abdominal organs.
- mediastinoscopy, to examine the area around the heart.
- Biopsy through surgery. For some conditions, the doctor will perform an invasive procedure to take a larger tissue sample to determine the diagnosis. Sometimes, the doctor will also perform a procedure to remove the entire tumor if possible. There are two types of surgical biopsy procedures:
- Thoracotomy, which is a type of biopsy that is done through open surgery in the chest.
- Laparotomy, which is a type of biopsy that is done through open surgery in the abdomen.
- Bronchoscopy biopsy. A procedure for removing a tissue sample using a long, thin, elastic tube that is inserted through the throat to examine the airways.
Mesothelioma stage
Based on the level of spread, mesothelioma is divided into four stages. This staging division allows doctors to identify the development of cancer cells in the body and determine the treatment steps that will be carried out. The four stages of mesothelioma, namely:
- Stage 1:The tumor is still local, which is only in one area of the body and the mesothelioma cells have not spread to other tissues or organs. Surgery is performed to remove the tumor. The life expectancy of patients diagnosed with stage 1 mesothelioma is 21 months or more.
- Stage 2:The size of the tumor is larger and the mesothelioma cells begin to spread to nearby areas. Surgical removal of the tumor can still be done, although the results are not very effective. The life expectancy for patients with stage 2 mesothelioma is 19 months or less.
- Stage 3:Mesothelioma cells have spread to surrounding organs. Surgery is no longer effective because some of the cancer cells have spread to other areas. The survival rate for stage 3 mesothelioma patients is about 16 months.
- Stage 4:Mesothelioma cells have spread to various areas throughout the body through the bloodstream. Treatments that are still in the research stage will be offered to patients to prolong the patient's chances of survival. The life expectancy of end-stage mesothelioma patients is very low, which is around 12 months.
Mesothelioma Treatment
Mesothelioma is a type of cancer that is rare and has not been cured until now. Treatment is done to control or reduce the symptoms experienced and prolong the patient's life chances. Treatment steps are generally determined based on several factors, namely:
- The patient's age and overall health condition.
- Mesothelioma type and location.
- Stage or spread of cancer cells in the body.
- Mesothelioma size
Based on the considerations above, there are several treatment steps that may be recommended by doctors, namely:
- chemotherapy, treatment therapy with anticancer drugs to destroy or inhibit the growth of cancer cells that cannot be removed through surgery. Chemotherapy can be given before or after surgery to shrink the tumor, make it easier to remove the tumor, and reduce the risk of the cancer coming back.
- radiation therapy (radiotherapy), treatment therapy with X-rays and proton beams that are focused on specific areas of the body. Radiotherapy is usually done after the patient undergoes a surgical procedure, to remove residual cancer cells. This treatment therapy is also done to reduce the symptoms of advanced cancer when surgery is not possible.
- Operation. Surgery is performed when mesothelioma is still in its early stages. There are several options for actions that the doctor may perform during surgery. Among others are:
- Removal of cancer cells as much as possible from the patient's body. This action can support the treatment of patients with radiotherapy to reduce pain and inhibit cancer growth.
- Suction of fluids due to fluid buildup in the chest area that can interfere with breathing. This procedure is done by inserting a catheter tube into the chest to suck out the fluid. The doctor may also inject medication to seal the pleural cavity so that fluid can no longer build up. This procedure is known as pleurodesis
- Removal of tissue around the abdominal cavity, ribs, or lungs affected by cancer cells.
- Removal of the affected part of the lung and surrounding tissue. This procedure is usually followed by radiotherapy.
- Multimodality therapy.This therapy is a combination of three or more treatment steps, such as surgery, postoperative chemotherapy and radiation therapy to increase the success rate of treatment.
- Research stage. Doctors will inform patients about treatment methods that are still in the research stage. However, the possibility of patients recovering is not known with certainty, so it needs to be considered carefully. On the other hand, this treatment method can increase the doctor's chance to learn more about mesothelioma treatment. There are several treatment methods that are still in the research stage that patients can do, namely:
- Biological therapy - using the patient's immune system to fight cancer, also known as immunotherapy.
- Gene therapy – changing the genes present in cancer cells to stop the disease.
- Target therapy - use drugs to attack abnormalities / abnormalities that occur in cancer cells.
- Supportive treatment. This treatment can help sufferers control the signs and symptoms of mesothelioma, such as:
- breathing exercises, to control breathing when the patient is experiencing symptoms of difficulty breathing.
- body relaxation exercises, to reduce respiratory muscle tension, so the patient can breathe more easily.
Mesothelioma Prevention
The main preventive measure of mesothelioma is to avoid contact with anything that contains asbestos. If you work in an environment where there is a high risk of exposure to asbestos, then follow the safety regulations set by the company. Among others are:
- Use personal protective equipment while in work areas prone to asbestos exposure.
- Dispose of the remaining asbestos material in a safe place that does not harm the surrounding environment.
- Don't bring home the clothes and shoes used during work
In addition, there are several things that can be done to reduce the risk of mesothelioma, namely:
- Perform regular health checks to detect symptoms or signs of asbestos-related diseases, such as asbestosis.
- Quit smoking. Smoking does not directly cause mesothelioma, but smoking is a trigger factor and can increase the risk of various types of cancer, including mesothelioma.
- Learn and follow instructions for safe handling of asbestos in the environment. Do not move materials containing asbestos carelessly.
