MALIGNANT PLEURAL MESOTHELIOMA

Malignant Pleural Mesothelioma General Information

Diagnosing and managing the Malignant Pleural Mesothelioma is quite a challenge for the both patients and doctors. The prolonged exposure to different forms of asbestos fibers is one of the most important risk factor that is known concerning the Western Europe and the North America. There are also other types of mineral fibers that have been also associated with Malignant Pleural Mesothelioma in some volcanic tuffs of central Anatolia, Turkey. Moreover, it has been recently taken into consideration the existence of other potential factors such as the genetic predisposition and the presence of the simian viruses However, these latest discoveries have eased the understanding of Malignant Pleural Mesothelioma. Hence, great improvements have been made, such as diagnostic and therapeutic methods.

The first cases of this illness were reported in an asbestos mining community in South Africa in 1960. And, since then, data has been collected from wide-spread databases such as in United Kingdom, Western Europe, United States and so on.

 The disease is generally diagnosed to people between fifty and seventy years of age with a significantly bigger incidence to males who have had exposure to asbestos. For instance 2,000 of the 2,500 cases annually reported in US are in men aged 75 or above. There is also an alarming increase of cases in Europe where the average number of deaths raised from 5000 in 1998 to approximately 9000 predicted for 2018, with a higher incidence to men aged sixty to seventy.

Malignant Pleural Mesothelioma Symptoms

In most cases the symptoms of Malignant Pleural Mesothelioma are ignored by people as a result of their generic nature. The explanation to this fact is that at its first stage the disease may lead to the confusion with some common diseases. Furthermore, it was proved by recent researches that this illness may develop to a patient that has been exposed to asbestos even after twenty to forty years of asbestos encounter. Consequently, the patients show a certain disregard of the possibility to develop this disease due to a thing that happened years ago.

The main symptoms are:

• Shortness of breath;
• Pleural effusions;
• Hoarseness;
• Loss of appetite;
• Excessive coughing;
• Paralysis;
• Pain in chest;
• Back pain;
• Problem in swallowing;
• Weight loss;
• Swelling;
• Fever;
• Coughing up blood;
• Weakness;

In more severe cases, a patient suffering from this illness may develop pneumothorax or lung failure (cancer). Nevertheless, some patients may be asymptomatic.

The span between the malignant stages is about a year long, depending on various aspects such as the prognostic factors. As the illness progresses, the chest pain and the shortness of breath become worse, often accompanied by night sweats and weight problems such anorexia. When the chest wall and the surroundings structures are invaded, the pain intensifies and it may trigger some functional abnormalities including Horner syndrome, dysphagia, diaphragmatic paralysis, and superior vena cava syndrome. Yet, death rarely occurs as a result of metastatic disease, being more often associated with a respiratory failure, or a different type of infection along with other constitutional symptoms.

Malignant Pleural Mesothelioma Treatment

There is no consensus in specialized literature about guidance in how the patients with Malignant Pleural Mesothelioma should be managed. The main cause is the lack of necessary data identifying the proper treatment or combination of treatments that might offer a greater improvement in its efficacy.

However, many people think that the radical surgical resection is the only chance for complete healing or meaningful improvement in surviving chances; most of the patients are not suitable for this kind of treatment as a consequence of the advanced stage of the disease or of the comorbid medical illness. Moreover, this type of intervention is widely associated with quite a high risk of mortality.

 Another type of treatment, involving radiation, has also not showed clear survival benefits, as it required a too large a field taking into account that the entire pleura was at risk. The Joint Center for Radiation therapy in Boston made a report that suggested that in order to achieve palliation, a minimum dose of forty Gy was necessary. It also recommended a higher dose only in the post-extrapleural pneuctomy, as this way there it would a significantly decrease in the risks of local recurrence. Other studies also showed up that the dose applied to smaller fields was highly effective in some cases. Therefore, the radiation therapy seemed useful only in the palliation of the symptoms but with not a real impact on survival. Another alternative in cancer treatment is the chemotherapy. Almost every single agent was tested but the average response rate was under twenty per cent and hence no single-agent chemotherapy was suggested. In spite of the fact that a lot of other older and newer agents were tested in combination, the treatment of this illness with the already-existing agents remains inadequate.

On the other hand, novel approaches in treating the Malignant Pleural Mesothelioma supposing combined chemotherapeutic, biological and targeted therapies are now developing. For instance there is a multitargeted antifolate, pemetrexed which inhibits some of the enzymes with importance in folate metabolism. The key enzymes for pemetrexed  are thymidylate synthetase(TS), dihydrofolate reductase (DHFR) and glycinamide ribonucleotide formyltransferase(GARFT).A dose of 500mg/m² every twenty one days showed quite promising activity in several cancer forms such as Breast Cancer, colorectal cancer, cancer of the head and neck and so on.
To patients with Malignant Pleural Mesothelioma though, there was a partially response in eight of the twenty five situations, a percentage of about thirty two.

In conclusion despite the long history of unsuccessful attempts in the treatment of this disease, the recent developments brought a new brief of enthusiasm for managing it in an aggressive way, in all stages.