Pleural Mesothelioma Diagnosis, Symptoms and Treatment

Pleural Mesothelioma

In this post, we are going to cover the most common types of mesothelioma like pleural mesothelioma that are generally defined as per their cell types.

These cell types include epitheliod, biphasic and sarcomatoid mesothelioma. Please note that each of the above cell type plays a crucial role in ascertaining a patient’s treatment and prognosis.

Please note that there are as many as 4 types of mesothelioma known to occur. All these forms of tumour are known to be malignant in nature based on their location, following their exposure to asbestos. They develop at different locations of the body like in the linings of the lungs (pleura), abdomen (peritoneal lining), heart (pericardial) or testicles (testicular).

Further to their characterization based on their location, mesothelioma is also categorized by different cell types as well.

Here, they have a tendency to largely impact prognosis, diagnosis and all other treatment options available. Please note that the most common mesothelioma cell types include epithelioid and sarcomatoid.

Please take a look at all the four types of mesothelioma along with their percentage of occurrence:

  • Types of mesothelioma (80% cases)
  • Pleural mesothelioma (15-20% cases)
  • Peritoneal mesothelioma
  • Pericardial mesothelioma
  • Testicular mesothelioma

 

Types of Mesothelioma by Location

The main cause of mesothelioma is after a person gets exposed to asbestos fibers. Well, this happens to be the primary or first stage in the overall development process of mesothelioma cancer.

Now, after the initial exposure to the asbestos fibers has occurred, abnormal cells start growing and multiplying in the mesothelium which is a thin layer of cells found surrounding various internal organs like heart, lungs, testicles and abdomen.

Now, in order to determine the mesothelioma type, the most common method used is to determine the location. After the location of tumour is analysed, further line of treatment is decided. Therefore, it is quite necessary to first unleash the exact location of these cells so as to start the treatment as early as possible.

The location of the tumours is the primary method for determining the type of mesothelioma.

As you might have understood that the location of tumour happens to be the primary method to determine the exact type of mesothelioma, please find some more details about them in the later section of this post:

 

Pleural Mesothelioma (Lungs)

Pleural mesothelioma is one of the types of mesothelioma that basically forms in pleura, which is also known as the lining of the lungs. It happens to be the most aggressive form of the disease that develops inside the lining of the lungs.

 

pleural mesothelioma

 

As per the research done in this regard, it is the most common form of mesothelioma, comprising as many as 80% of all diagnosed cases.

The sad part is that the disease is most commonly detected after it has progressed into the advanced stages. In other words, the symptoms of the disease start arising only after the disease has been progressed into the later stages.

Now, talking about the symptoms of pleural mesothelioma that include coughing, breath-shortness, fatigue and chest pain. In addition to this, there can also be some non specific symptoms that may arise in the latency period itself.

This is the time when the disease is in the stage of development but does not show its symptoms or hidden. These developments start taking place soon after exposure to asbestos.

Patients suffering from pleural mesothelioma generally survive up to 12 months after they are diagnosed with the disease. Close to 73% of cases have a survival rate of one year and only 5% patients suffering from pleural mesothelioma have a survival rate of five year or more.

 

What’s Pleural Mesothelioma?

Pleural mesothelioma is a tumour of the linings of the lungs. It’s caused by inhaling asbestos fibres that stick into the lungs for years and transform into the form of pleural mesothelioma. It’s one of the most common types of mesothelioma.

Before we move further, we would like to update you with some more related information about pleural mesothelioma that you should know.

As we have already discussed that it is a rare form of cancer that initially starts developing in pleura. Please know that pleura are a thin membrane of cells that basically lines outside the lung and your chest wall. Pleural mesothelioma has become the most common and vibrant type of disease that accounts up to 80-90% of overall mesothelioma related cases.

As per the latest facts and figures in this regard, more than 2,500 people are dignosed with pleural mesothelioma alone in the United States. The most common factor that comes forth in the diagnosis is none other than the exposure to asbestos.

Those who are diagnosed with this form of disease generally survive up to 12 months. However, after undergoing treatments like some kind of surgery and chemotherapy, their life expectancy can be increased.

 

Pleural Mesothelioma Prognosis

Prognosis generally means the likely course of the medical condition in the future. If we have to consider the prognosis of pleural mesothelioma, then it is reported to be poor among all other kinds of mesothelioma cases.

Now, for those who do not get any kind of treatment for the dreaded disease, the survival rate is often lower that is 6 months. But if the patient gets the required treatment, then the survival rate can drastically improve as well.

This looks quite evident from the recent studies done in this regard. It shows how two types of surgeries decortications, pleurectomy or extra-pleural pneumonectomy can drastically improve the survival rates in patients up to 36-38 months, especially after they are combined with radiation and chemotherapy.

Now, please take a look at some of the most crucial factors that are responsible to affect the prognosis of pleural mesothelioma:

  • Cell type or histopathology
  • Age and gender of the patient
  • Cancer stage

In addition to what we updated you so far, please know that most pleural mesothelioma patients are also diagnosed with epitheliioid cell type as well. It’s counted among other dangerous forms as the treatment possesses so many challenges for physicians. At the same time, it’s also known as the most common form as well.

Now, let’s discuss about epithelioid cells. As per the recent updates in this regard, epithelioid cells have a tendency to cluster together at a fast pace. They do not seem to metastasize as quickly. Along with that, these cells are also known to be so much responsive towards the line of treatment.

Regarding the survival rate of these patients, most patients of pleural mesothelioma with the epithelioid cell type tend to survive up to 19 months. However, with the help of latest treatment that includes surgery and other medication (chemotherapy), the survival rate can be longer as well.

There are two more cell types biphasic and sarcomatoid that are known to have worse prognosis. For example, sarcomatoid mesothelioma is not a good condition to treat as it does not respond well towards the line of treatment offered to the patient.

One of the main reasons why it becomes difficult to treat sarcomatoid mesothelioma is due to the fact that it metastasis quite aggressively and therefore leaves hundreds of patients of pleural mesothelioma with an average prognosis of 8-10 months.

However, patients suffering from biphasic mesothelioma tend to experience a median life span as it solely depends on the type of cells (sarcomatoid or epithelioid) that are being more dominant.

 

What the latest research says?

As per the recent research done in this regard, patients suffering from pleural mesothelioma are being able to survive longer in the presence of best treatment procedures that involve some kind of surgeries along with chemotherapy.

 

Pleural Mesothelioma Symptoms

It’s one of the crucial types of mesothelioma that you should know about. The symptoms of pleural mesothelioma generally appear after a long gap of asbestos exposure.

After the patient is exposed to asbestos fibers, they simply stick to the internal lining of lungs, causing scarring and inflammation with the passage of time. Now, as the scaring further worsen and develop into tumour, most patients start noticing most of the symptoms.

 

Pleural Mesothelioma

 

After the symptoms begin to appear for the first time, they start appearing in the respiratory system and in the chest.

Out of the several different types of mesothelioma infection, one of the most common infections appears in the form of pleural effusion which is the building of fluid within the pleural cavity. The accumulation of excess fluid may impact lungs and other organs as well and my end up with chest pain.

In the due course of time, patients may also start having a few other symptoms that may include fever or weight loss. After the disease becomes more prolonged and progressive, some more worsening and new symptoms may arise.

Most common Symptoms

  • Dry cough
  • Chest pain
  • Breathe shortness (dyspnoea)
  • Fluid in the lungs (pleural effusion)

Lesser Known Symptoms

  • Weight loss
  • Fatigue
  • Fever
  • Night sweat

In addition to the above symptoms that are encountered in pleural mesothelioma patients, there some other symptoms that could also display of their own. Please have a look at some of them below:

  • Diffused Pleural Thickening (DPT)- Accompanied with somewhat gray, fibrous tissue that are known to fill or capture the pleural spaces
  • Pleural Plaques- Also known as calcification where a chalky substance is formed on the lining of lungs (pleura)
  • Fibrosis- Also known as asbestosis. Also known as scarring of lungs

Well, these symptoms are not restricted only in those suffering from pleural mesothelioma but may also accompany in those who have no signs of this medical ailment.

 

How Is Pleural Mesothelioma Diagnosed?

As you know, there are several forms of mesothelioma, the line of treatment for all of them happen to be different. This is due to several factors including the kind of response towards different lines of treatments.

As far as the diagnosis of pleural mesothelioma comes forth, it can be a lengthy process. The first step looks quite viable in itself as it involves performing one or more imaging tests that may include CT scans, x-ray, MRI or PET scan. It’s basically done to identify potential tumors.

All the above tests are capable of identifying any other malformation of healthy cells in the form of tumour. For example, PET scan is one of the best imaging techniques known to identify any such malformation of cells in the entire body.

In short, all the above imaging techniques that are employed towards the diagnosis actually tend to give the direction to the future treatment options.

 

What Happens When a Tumour is Detected?

What happens if a tumour is detected after performing these imaging tests? Well, if this happens, the next step is to perform one or more blood tests to identify certain bio-markers.

They are nothing but some high quantity of specific elements in the blood. After performing these blood tests, physicians are able to differentiate mesothelioma from other conditions prevailing in the body.

These tests also help them giving the right line of treatment and also the farther course of action that is required to be taken.

 

Role of Biopsy for Malignant Pleural Mesothelioma Diagnosis

At present, the only way to diagnose and verify one of the types of mesothelioma, known as malignant pleural mesothelioma is by undergoing a biopsy.

The procedure is quite simple where a sample tissue or fluid is taken for the complete analysis. This technique is called thoracentesis or thoracoscopy.

For example, thoracentesis is a procedure where your physician has to insert a fine needle to take the fluid accumulating in the chest. On the other hand, a thoracoscopy happens to be far more invasive.

In this technique, physicians have to insert a thorascope (viewing tube) into the chest to investigate lungs precisely along with surrounding pleura.

In the entire procedure, they need to remove a sample tissue or fluid for a complete analysis. Now, in case of the entire process of biopsy, a pathologist has to intervene to basically study the cell type.

This eventually helps physicians to come out for a conclusion that could help them start the process of treatment.

In the course of his study, the pathologist has to study the cell type and the overall progress of the medical ailment.

 

Pleural Mesothelioma Stages

As we just mentioned that biopsy happens to be one of the procedures that is being done to verify the cause of most malignant tumours, it is the only way to not only test but also to verify the diagnosis of a malignant pleural mesothelioma.

Well, you might have come across through mesothelioma commercial about the kind of approach you need to take towards the treatment.

In this section, we are going to discuss about different stages of pleural mesothelioma. As per the general procedure, it is the duty of the concerned physician to investigate the medical ailment thoroughly.

Now, as part of the diagnostic procedure, a specialist physician has to determine the exact stage of the disease.

This is the first thing that a doctor has to confirm so as to start the treatment as soon as possible. By determining the exact stage of the disease, it helps to determine the prognosis along with the various treatment options available.

Please know that pleural mesothelioma happens to be the only form of the condition that has been accepted widely as per the international standards of the staging system.

Some of the most common systems being used to detect the exact stage is node, metastasis, tumour or TNM staging system.

In order to come to the exact stage of the disease, doctors have to use the above system or procedure so as to score a specific body area/location (based on the tumour size).

There are certain other things that help determine the cancer stage like if it has already been spread to the lymph nodes or to some other distant organs.

Here, we would like to help you with some indication of different stages of this kind of metastatic cancer. Please know that stage 1 and stage 2 pleural mesothelioma mainly indicates little or no metastasis.

However, the advanced forms spread to the different body locations like lymph nodes and other body organs. The line of treatment of the disease is determined only after the actual stage is determined. After this is done, the entire medical team try to develop a strategic plan to defeat the disorder.

 

Pleural Mesothelioma Treatment

The treatment of pleural mesothelioma is quite complicated as compared to various other types of metastatic cancers.

Therefore, a multi-modal approach is adopted by physicians to handle the menace. The entire treatment procedure includes a combination of radiation and surgery with chemotherapy.

The line of treatment basically goes as per the cell stage and type and does not approach (in any case) with a curative intent.

For example, surgery is often used as an aggressive approach to not only treat the disease but also enhance the life expectancy of the patient concerned.

For example, one common surgical treatment or method used as an aggressive approach against the disease is Pleurectomy/decortication. In this procedure, the lining of the chest wall and the lung is removed along with some other impacted organs and tissues.

There are certain other procedures that are sometimes taken into consideration and may include an Extrapleural Pneumonectomy (EPP). It’s being widely used and recommended in some cases as a more aggressive approach towards the treatment.

EPP undergoes a procedure that involves the removal of a small part of the diaphragm, affected lining of lung and heart.

If you analyze about all these clinical trials that are initiated in the recent past, they help to enhance the overall life expectancy up to 3 years or may be longer.

 

Read More- Epithelioid Mesothelioma Treatment, Symptoms and Life Expectancy

Epithelioid Mesothelioma Treatment, Symptoms and Life Expectancy

epithelioid mesothelioma

Epithelioid Mesothelioma– Before we help you understand about the growing occurrence of epithelioid mesothelioma, let’s take a look at different cancerous cell types.

As you might be aware of, there are as many as 3 different mesothelioma cell types that you come across at the time of studying mesothelioma cancer. It includes:

  • Epithelial (most common)
  • Biphasic
  • Sarcomatoid cell types

Out of the above three cell types, epithelial cells happen to be the most commonly found cell type.

And therefore, Epithelioid mesothelioma is the most commonly found type of mesothelioma cancer. In fact, this cell type makes as much as 70% of all mesothelioma cases.

 

Epithelial Cell Type Has a Tendency to Mutate Into Other Forms

Considering epithelial cells, please note that these cell types are not actually cancerous but mutate into other forms.

Before we move ahead and let you know more on this, you first need to understand the term mesothelium. It’s basically a thin membrane that lines around cavities (organs) of the body.

In other words, all these cavities or body organs are made up of epithelial cells. After any epithelial cell mutates, it gives birth to the mesothelioma of the so called epithelioid cells.

At this stage, you might be interested to know about the cause of the most commonly found epithelial mesothelioma.

Well, it is mainly caused due to the asbestos exposure. In fact, it is the only known reason so far.

Other than this, there are a variety of risk factors that you can’t skip overlooking, especially while taking all of them at once.

 

Epithelioid Mesothelioma Cell Characteristics

Before we move ahead and give you some more inputs on epithelioid mesothelioma, let’s grow our understanding on the basic characteristics or behavior of epithelial cells.

Epithelioid Mesothelioma
Image source: epainassist.com

 

Please know that there is a distinct way to differentiate cancerous cells from the normal ones. The basic criterion to differentiate them is done on the basis of their growth, size and shape. At the same time, it also depends how they are likely to spread.

Please note that epithelial cells are unlike other cells having a tendency to spread locally up to the lymph nodes.

Comparing them with the sarcomatoid cells, they do not spread as fast as epithelial cells.

This is mainly due to their uniform formations and therefore the most common region where their growth has been detected is lymph nodes.

 

What’s the Most Common Location of Epithelioid Mesothelioma?

If you consider the most common location of epithelioid mesothelioma, it is generally found in the linings of the lungs (also called pleura).

However, they are also seen in some other body parts including the genitals, abdomen and other reproductive organs.

 

Epithelioid Mesothelioma Cell Shape

Considering the epithelioid mesothelioma cell shape, the cells are generally found standing apart in the presence of a clearly defined nucleus that can be most effectively used as a core determining factor at the time of undergoing a biopsy.

 

Epithelioid Mesothelioma
Image Source: treatmesothelioma.org

 

To be precise, most epithelioid mesothelioma cells are generally shaped like a cube. At other times, they are somewhat flat in appearance.

This is how they attain their shape in the normal occurrence. After they become cancerous, they change their shape depending on their sub-types.

 

Mesothelioid Mesothelioma

In the next section, we are going to discuss about the sub types of mesothelioid mesothelioma as it helps attaining the proper line of treatment.

The subtypes are based on their location, structure and symptoms and can widely alter their side effects, line of treatment and prognosis for the patient concerned.

Please know that small cell mesothelioma is widely considered as an additional sub-type of this type of lung cancer.

In spite of this, it is generally diagnosed quite comfortably in the cases of biphasic tumours that have both the presence of sarcomatoid and epithelial cell types.

However, in a few cases, you require countless number of biopsies that are crucial for diagnosis.

This is the reason why most physicians have to look for them quite precisely to find the type of tumour that a patient has.

 

Treating Mesothelioma by Studying Its Cell Type

The best way to treat any type of mesothelioma is by studying its cell type. There have been numerous cases where these cell types are often misjudged, affecting both the diagnosis and the overall treatment.

In short, we can say that If there is an error in gauging the mesothelioma cell type, it will not only affect in determining the line of treatment but also the life expectancy of the patient concerned.

 

Epithelioid Mesothelioma Diagnosis

When it comes to the proper diagnosis of mesothelioma, it becomes extremely jarring at times.

However, the line of treatment goes quite easy after it is diagnosed as early as possible. Not only that, it eventually affects treatment options along with the life expectancy.

In most cases, long latency period along with misdiagnosis are often responsible to prevent the actual diagnosis of this dreaded ailment and its detection.

 

Epithelioid Mesothelioma

 

At the same time, it also prevents the early detection of the tumour. So, it is suggested to seek medical help as soon as an individual starts appearing the symptoms of epithelioid mesothelioma. The best way will be to avoid any delay in getting the proper diagnosis.

 

Epithelioid Mesothelioma Symptoms

While discussing the epithelioid mesothelioma symptoms, please know that they strongly differ. This is because the epithelial cell type generally comes forth with malignant pleural mesothelioma.

Now, the symptoms mainly include dyspnoea (shortness of breath), chest pain and pleural effusion that relates to the building up of fluid around the lungs.

  • Dyspnoea (shortness of breath)
  • Chest pain
  • Pleural effusion

 

How Mesothelioma Symptoms are Affected Due to Various Factors

  • Patient’s Age– Most of the times, it is seen that elderly people are more susceptible to various related health issues.
  • Overall Health– Individuals not keeping well or having related health issues are more prone or susceptible to be affected by these symptoms.
  • Other Factors– In case, the patient has the history of any other related conditions or diseases can worsen symptoms.
  • Tumour Sub-type– It’s often seen that aggressive types of cancers may often lead to somewhat more extreme symptoms.
  • Staging– In case, the tumour has already reached at an advanced stage, the symptoms are likely going to be more severe.
  • Location- The origin of the tumour in terms of its exact location precisely determines the level of severity of nearby tissues and organs.

 

Image Testing

You might be interested knowing about various diagnostic methods of epithelioid mesothelioma.

It most often gets started with different kinds of imaging tests that are done only after physicians take a look at the patient’s medical history, symptoms along with so many other related factors.

Please know that the most common imaging techniques that are often used for any such diagnosis involves a few well known techniques in this regard that includes CT scans, X-rays, PET scans and MRI’s.

  • CT scan
  • X-ray
  • PET scan
  • MRI

Most of the above imaging techniques are done to know the precise growth of the tumour.

In addition to this, these tests are most reliable and happen to be the first step towards the future line of treatment.

For example, PET scan and MRI are one of the most recommended tests to be done before the start of the treatment of epithelioid mesothelioma.

 

Why Image Testing is done for Mesothelioma diagnosis?

We stated earlier that there are so many tests and procedures that come under image testing.

They prove some of the best diagnostic procedures to find the nature of the tumour along with its growth. In fact, these imaging tests are quite helpful to give a direction to the treatment.

Tumour Location and Growth Matters

The tumour location and growth can give physicians a precise way to start the treatment in a more aggressive way that won’t be possible without knowing these basic details.

Also, this is how the exact stage of the tumour is known. In short, these imaging procedures happen to be the only way to guide doctors an exact path to follow or the line of treatment.

Now, please take a look at some of the below mentioned reasons why image testing is widely recommended done for the diagnosis of mesothelioma:

  • Collecting a sample cancerous tissue for the purpose of examination
  • To gauge the exact stage of tumour
  • Get the confirmation about mesothelioma
  • Determination of cell type
  • Identify the exact stage
  • To better evaluate the size and shape of cell nuclei

Biopsies have become one of the most reliable and favorite ways to underline the exact stage and type of the tumour.

The procedure involves taking out a small piece of the cancerous tissue. It further helps investigating about the cancer cells quite precisely before the actual treatment gets started.

The above procedure also helps patient prognosis as it involves some crucial findings about defective cells that relate to cytology and histology.

The reason why this is done is to give a clear direction to the line of treatment and even helps to avoid any sort of misdiagnosis in any way.

 

Epithelioid Mesothelioma Treatment

This is the right time to let you know more about the reason why biopsies happen to be so crucial before the actual treatment starts.

Please note that if epithelioid malignant mesothelioma cells get caught at an early stage, then chemotherapy and surgery become the most desired options for the treatment.

As far as advanced diagnosis of tumour is concerned, this might leave them confined to palliative care as they are most unlikely to handle to the side effects of the treatment.

 

Most Viable Options for the Treatment of Mesothelioma

In this section, we are going to discuss about the most preferable treatment plan for epithelioid mesothelioma.

Please note that a combination of radiation, chemotherapy and surgery are used altogether in the treatment of such tumours. The technique is often known as multimodal treatment.

As mesothelioma is almost having no cure, the main thing that a physician looks for is to alleviate or eliminate related symptoms and offer the patient with the longest possible life expectancy.

What purpose do these treatments solve?

We have already stated above that a patient has to undergo different line of treatment that involves chemotherapy, surgery or radiation therapy.

In fact, all the above treatment options are considered to eliminate mesothelioma symptoms to the most extent. Take a look at them precisely.

Chemotherapy

  • Used palliative or curatively
  • Confines to mesothelioma cells in the body
  • Precisely done to alleviating tumour cells or shrink it eventually eliminating all the associated symptoms

Radiation Therapy

  • Involves targeted treatment
  • Confines to kill cancerous cells at large
  • Helps for comfort in shortness of breath and pain

Surgery

  • can be used both palliative or curatively
  • Acts as a targeted treatment
  • Targets to remove pain and various other symptoms that come in the form of discomfort
  • Removing fluid build up

As we have already stated above that certain treatment options like chemotherapy is known to cause side effects, there are patients who come up at the later stages and are not recommended to undergo such treatments.

However, if the patient comes in early, chemotherapy can be a great way to eliminate cancerous cells up to optimum levels.

 

Palliative Care option for Mesothelioma

There is a common misconception among people that the above treatment is available only for those patients who have come to an end of their lives.

 

Epitheliod Mesothelioma

 

But this is not the fact. Please know that palliative care happens to be a great option for patients as it is known to provide them with all the comfort during their treatment.

Please understand that palliative care varies in significant ways that falls in various categories including yoga, surgery, and chemotherapy along with other supportive groups.

This is the reason why it is mostly recommended that patients should discuss the type of palliative care plan with their physicians that could best address their discomfort and related symptoms.

 

Epithelioid Mesothelioma Prognosis

Today, there is a variety of line of treatment options available towards any sort of mesothelioma patient. Prognosis mainly depends on so many factors.

If we discuss about the general prognosis options, those patients who are specifically undergoing all the multi-modal care are most likely to have more comfort and a better life expectancy.

In addition to this, so many types of drug combination therapies are known to act quite positively. And this impacts in their survival rates as well.

There are a few drugs like cisplatin and pemetrexed that look promising, especially when they are used cumulatively.

 

Epithelioid Mesothelioma Life Expectancy

In this section, we are going to discuss about the epithelioid mesothelioma life expectancy.

Please note that in most epithelioid Mesothelioma cases, the normal life expectancy rate goes up to 18-24 months.

Here, the treatment options have a far greater and positive impact as compared to sarcomatoid mesothelioma.

In the same ways, it also affects the life expectancy in great ways. As much as 60% of such patients have shown a greater survival rate who are in the stage of receiving the treatment.

This is mainly because this type of tumour happens to be quite less aggressive as compared to the sarcomatoid mesotherlioma type patients.

In order to exactly evaluate the life expectancy of epithelioid mesothelioma, Nuclear Grading is most commonly used. As you know that epithelial cells already have a well defined and clear nucleus, they happen to be the best contender for such grading system.

Those patients who fall under the grade 1 list generally have the survival rates up to 24 months. In the same ways, those with grade 2 have a survival rates up to 5 months or longer.

As the life expectancy for most epithelioid mesothelioma cases seem to be bleak, various research and other development techniques continue to pave the way for an extended survival rates.

 

Read More- 4 Most Viable Things to Know About Mesothelioma Commercial