WHAT
The mesothelium is a fibrous membrane that lines various organs and structures including the lungs and the inner part of the rib cage (pleura), the heart (pericardium), the intestine (peritoneum) and the testes (tunica vaginale). Its task is to allow the formation and reabsorption of organic liquids (which become “effusions” when they exceed a certain amount). Neoplasms of the mesothelium are divided into two forms: benign (rare, localized, slow-growing tumors, which usually heal with surgery) and malignant (mesothelioma), the incidence of which has increased over the past thirty years. Among these, the pleural one is the most widespread and constitutes approximately eighty percent of all mesotheliomas. It mainly affects males, with a peak of incidence around the age of sixty. The latency period between exposure to possible causes and the onset of the disease varies from twenty to forty years. Although rare, they are particularly insidious, as they rarely give rise to early signs or symptoms. Much more often the disease manifests itself when it has reached an advanced stage, refractory to any form of therapy. The most frequent symptoms are: shortness of breath due to pleural effusion (dyspnoea), cough and chest pain, difficult swallowing, swelling of the neck and face, which may be associated with general malaise and weight loss.
DIAGNOSIS
To date there are no screening tests aimed at the early diagnosis of mesothelioma. The diagnostic process should begin with a visit to your GP or a specialist (pulmonologist) if the symptoms described above appear. Any occupational exposure to asbestos must necessarily require further investigation, even more so if this is associated with a habit of cigarette smoking. When there is thickening of the pleura in a subject exposed to asbestos and who presents the symptoms described, the diagnosis of mesothelioma becomes probable. The examinations that the specialist may request if there is a diagnostic hypothesis of mesothelioma include: a chest X-ray (to evaluate the thickening of the pleura and / or the presence inside it and the characteristics of calcium deposits), a CT scan thoracic with contrast medium (allows to identify the position of the tumor). The turkeys pet may be required as examination upon completion, providing additional data on the activity of the disease and its extension. The confirmation, however, can only come from a biopsy examination, while remembering that the absence of malignant cells does not completely exclude the presence of a mesothelioma, especially when the patient’s history, clinic and radiological tests are strongly indicative. for the presence of the disease. For this reason it is preferable that the diagnosis is made through a histological examination and on an adequate biopsy sample. The collection of cells can take place through a puncture in the chest (thoracentesis), in the abdomen (paracentesis) or in the cavity around the heart ( pericardiocentesis ) or through a radiological maneuver (CT-guided biopsy) or with a surgical approach.
RISK FACTORS
Eighty percent of mesotheliomas recognize asbestos exposure the cause of cancer, although only five percent of people exposed to asbestos fibers get sick and this suggests that there may also be other contributing causes of the disease. There is no minimum level of exposure that can be considered safe. The carcinogenic mechanism of asbestos fibers is linked to their small size, their physical properties and their persistence in the body. The most commonly affected are shipyard workers, construction workers, car mechanics, insulation, pipe and heating installation workers. The incidence depends on the dose of exposure, in its various forms (occupational, residential, domestic), and on the time elapsed by it. Early exposure later in life therefore confers a higher level of risk. Some studies show that cigarette smoking increases the risk exponentially (probability of dying from mesothelioma equal to 55 times that of non-smokers and without exposure to asbestos).
THERAPIES
The choice of therapy depends on the site and stage of the tumor, the age and general condition of the patient and is in any case the result of a multidisciplinary evaluation.
Surgery
It can have diagnostic and / or curative or palliative purposes. Some possible approaches:
pleurodesis : removal of the pleural effusion with insertion of a substance that reduces its chances of reforming
pleurectomy – the removal of the tumor by freeing the lung from the diseased tissue that surrounds it;
pleuropneumonectomy or removal of the pleura and the entire lung, diaphragm, pericardium and lymph nodes.
Chemotherapy
Chemotherapy treatment involves the administration of drugs (usually intravenously) in order to destroy the cancer cells that have developed in the pleura and in any other affected organs. For mesothelioma, chemotherapy can also be administered intrapleurally , that is, directly into the space between the lungs and the chest wall.
Radiotherapy
This technique uses high-frequency radiation to break down cancer cells and reduce the size of the cancer. In the case of mesothelioma it mainly has a palliative role (or adjuvant after surgery) and is evaluated in a multidisciplinary context.
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