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Mesothelioma Mesotheliomas


MESOTHELIOMA, Causes, Signs and Symptoms, Diagnosis and Treatment.

today's topic is mesothelioma

mesothelioma is a type of cancer arising

from the mesothelium the mesothelium is

the thin layer of protective tissue that

covers the outer surface of many

internal organs such as the heart

abdomen and the lungs mesothelioma is an

aggressive form that progresses and

spreads quickly mesothelioma is divided

into many different types depending on

the part of the mesothelium affected

mesothelioma that occurs in the pleura

or in the lining of the lungs is called

pleural mesothelioma it is the most

common form mesothelioma that occurs in

the lining of the abdomen called

peritoneum is referred to as a

peritoneal mesothelioma it is the second

most common form mesothelioma that

occurs in the protective layer of the

heart is referred to as pericardial

mesothelioma this type is the rarest it

occurs more in males than in females in

2015 about 60,000 800 people had the

disease and 32,000 deaths were recorded

only about 9% of people diagnosed with

the condition live longer than five

years causes the most common cause of

mesothelioma

is an exposure to asbestos asbestos

refers to a set of six types of silicate

mineral that are naturally occurring

asbestos is made up of fibers that are

soft and flexible yet resistant to heat

fire and several chemicals asbestos is

used in a wide variety of applications

such as insulation brakes shingles

flooring and many other products when

asbestos is broken down such as when

removing asbestos insulation or during

the mining process dust is created

the fibers can be airborne they can then

be inhaled or swallowed and can settle

permanently in the lungs or stomach

where they cause irritation that causes

mesothelioma after asbestos exposure it

can take 20 to 40 years before

mesothelioma can develop factors that

may increase the risk of mesothelioma

include personal history of asbestos

exposure such as is seen in people who -

bestest work with asbestos products

produce products from asbestos or work

in a building containing asbestos living

with an asbestos worker symptoms

symptoms vary depending on the type of

mesothelioma pleural mesothelioma

shortness of breath unintended weight

loss

coughing often painful chest pain under

the ribcage fatigue in severe cases

pneumothorax lung collapse tumor under

the skin of the chest peritoneal

mesothelioma abdominal swelling pain in

the abdomen weight loss fever night

sweats poor appetite

constipation vomiting in cases where the

cancer has spread to other parts of the

body trouble swallowing swelling of the

neck and face pericardial mesothelioma

shortness of breath low blood pressure

chest pain extreme fatigue heart

palpitations diagnosis diagnosis is

suspected with imaging scans but biopsy

is used for confirmation the doctor will

review your medical history and carry

out a physical examination to check for

lumps or any unusual signs followed by

chest x-ray and lung function tests a CT

scan or MRI is also usually used to

check for abnormalities a biopsy can be

used to confirm the diagnosis the type

of biopsy depends on where the symptoms

are options include fine needle

aspiration thoracoscopy laparoscopy

thoracotomy laparotomy diagnosis will

check if cancer is present and how far

it has spread the stage of the cancer is

between stage 1 to stage 4 stage 1

mesothelioma the cancer is confined to

the mesothelium and has not spread in

stage 4 mesothelioma cancer has spread

around the chest and to different organs

treatment treatment options depend on

the location the stage age and patients

general health for most people a cure

isn't possible because the condition is

usually diagnosed at the late stage when

it is impossible to remove the cancer

with surgery the only remaining option

in many cases is trying to control

cancer to make you more comfortable

treatment options may include surgery

when the condition is diagnosed early

surgeons work to remove the tumor in

cases where it is impossible to remove

the tumor surgery may help to reduce

symptoms surgical options may include

surgery to decrease fluid buildup

surgery to remove the tissue around the

lungs or pleura t'me or the tissue

lining the abdominal cavity pair o to

neck t'me radiation therapy that uses

powerful energy beams such as x-rays to

kill the cancer cells chemotherapy that

involves using medication injected

intravenously or taken orally to kill

the cancer cells.



Malignant Mesothelioma

and I'm a thoracic surgeon at Mayo


Clinic along with the Department of


Surgery the division of thoracic surgery


the division of pulmonary medicine and


medical oncology and radiation oncology


and radiology we've put together an


individual patient education video for


patients who have been diagnosed with


malignant mesothelioma we'll be talking


about ways that the tumor is caused


different treatment options different


opportunities for enrollment into


clinical trials and ways that you can


get different types of surgery we hope


that you find this educational and we


look forward to seeing you malignant


mesothelioma what is malignant


mesothelioma it is a rare type of cancer


that can develop in the thin layer of


tissue that covers most of your internal


organs that layer of tissue is called


the mesothelium this can be involving


the lungs the abdomen the heart are the


testicles possible causes of


mesothelioma include asbestos and many


other risk factors such as a personal


history of asbestos exposure living with


someone who works with asbestos exposure


to other fibrous materials or a family


history of mesothelioma some of the


symptoms and complications of


mesothelioma include the way that it may


affect tissue that surrounds the lung if


this happens it can cause symptoms such


as chest pain under the rib cage pain


during coughing shortness of breath


unusual lumps of tissue underneath the


skin on your chest or unexplained weight


loss some of the tests and diagnoses


that are available to you if you have


signs and symptoms that might indicate


music the glioma can be ordered by your


physician who will conduct a physical


exam to check for any lumps or unusual


signs he may listen he or she may listen


to your lungs palpate your abdomen and


ultimately a biopsy may be performed


depending on what area of your body is


affected your doctor may


choose one of the following biopsy


options including a needle biopsy a


camera inside the chest which is called


thoracoscopy a camera inside the abdomen


which is called laparoscopy or making an


open abdominal incision which is called


a laparotomy identifying the cancer


stage is one of the most important first


steps for patients who are diagnosed


with mesothelioma typically for patients


who have what's called pleural


mesothelioma which means it's on the


lining of the lung or the inside of the


chest are diagnosed by placing a tiny


single port into the chest it's


important that only one tiny port is


created because in the future that may


seed a tract of tumor that can grow to


the outside of the chest so when


patients go for surgery later on having


it removed by having only one port site


used to diagnose this tumor


it is easily excited at the time of


definitive surgery through this single


port a biopsy might be performed where


either the lining of the chest wall is


stripped away or the lining of the lung


is pulled away any bleeding is typically


treated directly at that time both the


bops the instrument and the camera go


through the same small port other ways


to create a stage to find out how


extensive the mesothelioma is and help


guide therapy include but are not


limited to a cat scan of the chest and


abdomen a magnetic resonance image


positron emission tomography also known


as pet endoscopic ultrasound also called


eus endobronchial ultrasound also called


EB us diagnostic staging laparoscopy


pulmonary function testing and


diagnostic thoracoscopy identifying the


cancer stage


is the most important part of your


treatment from malignant mesothelioma if


you've been diagnosed you want to make


sure that your doctor tells you what


your stage is based on these tests that


have been performed if they are unable


to give you your stage of mesothelioma


then you should seek a second opinion


from a group that can give you your


stage before you make decisions about


treatment when you look at your chest as


if you're looking at yourself reversed


to the left of the screen is your right


lung to the right of the screen is your


left lung the lining on top of your lung


is called the visceral pleura there is


space between the visceral pleura and


the chest wall the lining on the inside


of the chest wall is called the parietal


pleura deep to that you'll see the ribs


and the muscle in between the ribs which


is typically combined to create your


chest wall it is important to make sure


that the mesothelioma has not spread


through the diaphragm into the abdomen


if it begins inside the chest it is also


important to make sure that it has not


spread from the pleural space into the


mediastinum where the trachea and the


heart exists it is also important to


make sure that it has not gone through


the pericardium into the heart


all of these spreaded areas or involved


areas indicate that more advanced


disease may be present and might make


surgery not as feasible as it would have


been if it was not spread identifying


the cancer stage is one of the most


important first steps you may be


diagnosed with anywhere from stage 1 to


stage 4 mesothelioma treatment options


can include but are not limited to key


therapy radiation therapy and surgery


surgery and other treatment that may be


involved can be as limited as placing a


drain inside the chest the tunnels


underneath the skin with a fibrous cuff


allowing fluid to intermittently be


drained as it is connected to a vacuum


bottle this is sometimes referred to as


a pleura catheter but it may have many


other names and many companies make a


catheter such as this the catheter that


is placed in between the lining of the


lung and the lining of the chest wall


has many perforated holes allowing the


fluid that can sometimes cause the lung


to collapse and give you breathlessness


to be evacuated from the chest and


restore your ability to breathe and


allow you to be in control of your


disease chronically draining the fluid


and allowing your lung to re-expand


extended pleura come--and decortication


involves creating a thoracotomy which is


a large incision on the side of the


involved chest and after the ribs are


spread an incision is made between the


lining to enter what is called the


pleural space once the pleural space is


exposed the lining on the lung is


stripped away the lining on the heart


sac called the pericardium is also


removed and the lining on the diaphragm


is also removed


sometimes if an extended pleura t'me and


decortication is performed these


surfaces are completely removed and are


reconstructed with the mesh sometimes a


gore-tex mesh sometimes a bio composite


mesh and sometimes a non-absorbable


woven mesh it depends on your surgeons


preference what type of mesh they may


place you often want to ask your surgeon


what type of mesh they use to recreate


these areas if it was used so that you


know for your records


if an extra plural pneumonectomy is


performed the same surgery that we


talked about in the previous slide is


performed plus the additional resection


of the entire involved lung is removed


the left lung is removed if the


mesothelioma is on the left and the


right lung might be removed if the


mesothelioma is on the right most people


can tolerate having an entire lung


removed on one side once the lung is


removed the diaphragm and the


pericardium are also taken away to


complete the removal of all visible


disease once the visible disease has


been removed the area is reconstructed


and the chest is closed a chronic fluid


filled cavity will now exist where the


lung used to be alternative care options


are available to you and some of these


include but are not limited to


acupuncture for breathlessness relaxed


breathing exercises muscle relaxation


and sitting near a fan many of our pain


specialists and relaxation specialists


at Mayo Clinic can help you coping with


some of the symptoms associated with


advanced mesothelioma some final


thoughts include that a diagnosis of


mesothelioma can be very difficult to


cope with learn about mesothelioma to


make decisions about your care contact a


palliative care team studies have shown


that patients who have a very advanced


cancer who get plugged in early with the


palliative care team sometimes live


longer than if they didn't in the


beginning of their disease surround


yourself with support seek out other


people with cancer or similar cancers to


help support you plan ahead


our mesothelioma pathway is on this


slide and it is not meant to overwhelm


you but it is meant to educate you


patients present


with an effusion may either have a known


diagnosis of mesothelioma at the time


that they come to Mayo Clinic or they


may have a minimally invasive biopsy


through the single port as we showed


earlier there are three different types


of mesothelioma that may be diagnosed at


the time of diagnostic laparoscopy


thoracoscopy or treatment that is


sarcoma toid mesothelioma biphasic


mesothelioma or epithelioid mesothelioma


depending on the histology or the type


of mesothelioma decisions will be made


about your care a multidisciplinary


tumor board which is MD T P will meet to


discuss your care and we will review to


see if you could be enrolled into


clinical trials such as freezing the


mesothelioma a measles vaccine a


protocol called the smart protocol


perhaps a surgery involving extra


pleural pneumonectomy abbreviated by EPP


or cleric t'me and decortication


abbreviated as p and d there is a


staging checklist that we will go


through to make sure that you've had all


of the appropriate staging modalities


when they apply to you and these may


include a pet cat scan an endo bronchial


ultrasound a bronchoscopy a staging


laparoscopy sometimes a media sign osku


P and a video system Dorcas copic biopsy


through a single port approach based on


all the information that's gathered you


will then be given a stage of


mesothelioma your meeting mesothelioma


may create what's called a pleural


effusion and that can be treated by just


simply placing a needle into the chest


and draining the fluid or placing the


chronic drainage catheter as we showed


you earlier or placing a powder inside


the chest there are only very few


situations where we believe the powder


may help you and we recommend that you


refuse to have the powder placed inside


your chest until you've had an


opportunity to discuss your candidacy


for many of the other trials as the


powder will rule out your ability to


have many of these treatment options


offered to you there are many different


stages of mesothelioma and we will go


through this in great detail with you


once you come in to the clinic to be


evaluated we hope that you enjoyed this


discussion we look forward to seeing you


we hope you enjoyed this segment on


mesothelioma we hope you enjoyed hearing


about how to stage mesothelioma the


causes of mesothelioma and some of the


different treatment options if you have


questions feel free to call our office


thank you for this opportunity to visit


with you




Mesothelioma and Malignant Pleural Issues



 I'm


a thoracic surgeon at the Swedish Cancer


Institute and Medical Center in Seattle


Washington I would like to talk to you


today about tumors involving the pleura


and in specific malignant pleural


mesothelioma in this podcast we will


talk about what the pleura is and


possible treatment options for cancer


involving the pleura with respect to


anatomy of the pleura each lobe of the


lung is covered by a double layer sac


that we term pleura this covers the lung


it lines the chest wall diaphragm and


mediastinum we called a layer that


covers the lung the visceral pleura we


term the layer that covers the chest


wall the parietal pleura pleura also


lines the diaphragm as well as the


pericardium the SAC around the heart the


space between the two pleural layers is


termed the pleural space


there are approximately two to three


thousand new cases of primary cancers of


the pleura or malignant pleural


mesothelioma that are diagnosed each


year in the United States we know that


remote exposure to asbestos is a risk


factor for developing mesothelioma


tumors of the pleura can also be in our


most often secondary to metastases from


cancer involving distant parts of the


body such as colon prostate and ovary


while primary pleural malignancies and


this is defined as tumors that arise


from the pleura 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 pleural


mesothelioma with respect to the


diagnosis management and possible


treatment options we now know that for a


subgroup of patient


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 80% of cases of mesothelioma 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 and their 50s to 70s


and males are affected more often than


females it can be difficult to


differentiate a malignant pleural


mesothelioma from a different type of


cancer that we call metastatic adeno


carcinoma these are two completely


different types of cancer with vastly


different treatment options as I


mentioned before pleural 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 as a


mesothelioma but also to distinguish


which subtype of mesothelioma we have in


specific epithelioid sarcoma toyed or


mixed epithelioid mesothelioma is the


more favorable subtype of mesothelioma


and carries a greater chance of survival


after surgical and multi modality


therapy sarcoma toward mesothelioma 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 there subtle symptoms that our


patient exhibits dyspnea or difficulty


with breathing is the most common


symptom and that is usually due to the


presence of a pleural effusion


characterized in blue this accumulates


in the spaces between the visceral


pleura and the parietal pleura 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


hemoptysis 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 Radiologic tests that we order while


trying to establish the diagnosis


the stage which tells us how advanced


the cancer may be in determine if


surgery is feasible and in the best


interest of the patient CT 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 MRI can suggest invasion


into the chest wall mediastinum 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 CT 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 of potential


benefit for the patient the first


invasive test used in an attempt to make


a diagnosis of mesothelioma is typically


a thoracentesis or when fluid is removed


from the pleural space a thoracentesis


is the use of a small catheter to drain


pleural fluid that is sent for analysis


to a pathologist to see if cancer cells


are indeed present it is not uncommon


that the pleural 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 pleural biopsy


this yields a diagnosis of mesothelioma


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 pleural


space and multiple biopsies are taken of


the pleural surfaces


this is often a diagnostic intervention


that results in a definitive diagnosis


of malignant pleural mesothelioma at


this point the patient typically is


referred to a thoracic surgeon with


experience 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


CT PET CT MRI tissue biopsy and


eventually add a procedure in the


operating room called a cervical


mediastinum skippy this is a procedure


where a small incision is made at the


base of the neck and mediastinal lymph


nodes are biopsied we now know that if


the mediastinal 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 pleure


ectomy in decortication or extra pleural


pneumonectomy cleric t'me and


decortication is a surgical procedure


that involves removing both the viscera


and parietal pleura this leaves the lung


in place this can be a potential option


for patients with very minimal or very


advanced disease an extra pleural


pneumonectomy is the complete removal of


the lung with its visceral pleura the


parietal pleura the diaphragm and the


SAC around the heart termed the


pericardium we then reconstruct both the


pericardium as well as the diaphragm


using prosthetic material we believe


extra pleural pneumonectomy 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 patients with


mesothelioma treated with chemotherapy


first followed by surgery and then


radiation patients with mesothelioma are


better managed in centers where there is


experience and 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 diagnosis


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


mesothelioma and malignant pleural


issues in thoracic surgeries for more


information please contact your thoracic


surgeon


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