D'Mesothelioma

Malignant mesothelioma is a rare form of cancer that begins in the mesothelium, the membrane that protects most internal organs of the body and covered. In the chest, the mesothelium has two layers, of which surrounds a lung itself and the other forms the inner lining of the chest wall. Between these two layers, usually a small amount of liquid is produced which serves the greater mobility of the organs. If the normal cells of the mesothelium can share uninhibited caused mesothelioma. The most common form of mesothelioma is "pleural" mesothelioma. These occur in the lung lining. Other forms are "peritoneal" mesothelioma, affecting the abdominal lining and pericardial "mesothelioma, affecting the heart lining.

What causes mesothelioma?
Mesotheliomas are caused in 80% of cases by exposure to asbestos fibers. Many people were exposed during their work with these fibers, and still others were secondary at risk through contact with exposed workers. Because the latency of this cancer may occur only 20 to 30 years after asbestos exposure.

How common is mesothelioma?
Mesotheliomas are rare tumors. According to epidemiological studies from the UK will experience the incidence peak between 2010 and 2020 Western Europe. Asbestos is now banned as a material, the effects of the ban will, however, recorded only from 2030 onwards.

Mesothelioma Treatment
The current treatment for mesothelioma is comprised of various options. Patients should discuss each option thoroughly with us before you can make a treatment decision.

Surgical therapy
If the disease is not advanced, and the patient can be performed a radical surgery in good physical condition.

There are two surgical methods for treatment of mesothelioma, the pleurectomy / decortication (PD) and the extrapleural pneumonectomy (EPP), also called pleuropneumonectomy. These are highly specialized operations that are not available in all hospitals. The ultimate goal of these interventions is to remove all tumor tissue, with the knowledge that residual microscopic Tumorgewebsteilchen probably remain in the body. An additional therapy (chemotherapy / o radiation) usually has the goal to eliminate these residual Tumorgewebsteilchen. The timing of additional treatment is determined individually.

The pleurectomy / decortication is the less radical method because it only reflects the removal of the pleura (lung lining) and includes the resection of the underlying lung. In some cases, the pericardium (pericardium) and the diaphragm are also removed, which depends on the size of the tumor. The advantage of this method is generally faster recovery time. Disadvantages include an increased risk of disease recurrence due to the inability to remove all cancerous tissue, as well as the inability to use because of potential harm to the underlying lung high doses probably necessary additional irradiation.

The extrapleural pneumonectomy is a more radical procedure, the removal of the lung, pleura (lung lining), pericardium (pericardium) and the diaphragm includes on the affected side. Pericardium and diaphragm are restored at the end of the operation with a Kunstoffnetz similar or substitute materials. Patients eligible for this operation in question only if they meet certain criteria staging (early stage) and an adequate pulmonary and cardiac function have to be prepared for this procedure.

If the disease progressed u / o the general condition of the patient bad, get radical surgical procedures in the treatment of the question. A Talkpleurodese (bonding of pleural sheets using talcum powder) can at present effusion (fluid in the pleural space) bring about a significant improvement of symptoms.

To the extent and security is to enable the diagnosis of pleural mesothelioma is often a thoracoscopy (chest mirroring) is necessary on this occasion, a Talkpleurodese are also performed. A mediastinal reflection (mediastinoscopy) is necessary to a possible involvement of lymph nodes to determine.

Chemotherapy
Chemotherapy involves the use of drugs that act by preventing the proliferation of cancer cells. In most cases, drug combinations are used to increase effectiveness. Chemotherapy can be used aggressively to shrink the tumor, or palliative, to relieve symptoms such as shortness of breath or pain. Some of the most commonly used drugs in pleural mesothelioma are:

Cisplatin
Carboplatin
Pemetrexed
Gemcitabine

The appropriate treatment for the patient will be developed individually by our colleagues in oncology using the latest scientific information and personal preferences.

Radiotherapy
Radiation therapy involves the use of X-rays with high energy to kill cancer cells. You can be aggressive, be used to remove microscopic tumor tissue is still present or in conjunction with palliative surgery for the treatment of pain. Radiation therapy is therefore particularly as an additional option for local control of the tumor to achieve. It is generally not suitable for the tumor metastasis (spread) to be treated in distant organs, not for the whole body can be irradiated.

Malignancy that involves the mesothelial cells of the human body, including the pleura, peritoneum, pericardium, and testis, known as malignant mesothelioma, either local or diffuse. Most, but not all, cases of malignant mesothelioma (malignant mesothelioma) in the pleural (lung cancer) is usually associated with exposure to asbestos. Patients with malignant pleural mesothelioma, 77% had been exposed to asbestos in the past. Diagnosis of mesothelioma is difficult to enforce because of the results of the analysis of pleural fluid from cancer usually does not diagnostic. Mesothelioma is more common in males than females and it occurs most often in the fifth decade of age until the 7th decade. Most cases (about 90%) of malignant mesothelioma in the pleura.

From histology picture there are 3 types of mesothelioma are sarcomatous mesothelioma, epithelial, and mixed (mixed). Pleural mesothelioma usually begins as plaques and nodules that combine to produce sheetlike neoplasm. Tumor growth usually begins at the bottom of the chest. Tumors can invade the diaphragm and blanketing the surface of the lungs and slit interlobaris.

As the disease progresses, often extends into the lung parenchyma, chest wall and the wall of the mediastinum. Pleural mesothelioma can spread to the esophagus, ribs, spine, brachial plexus, and superior vena cava.

Asbestos, amphibole asbestos, asbestos-crocidolite, and amosite asbestos in particular, is a major carcinogen involved in the pathogenesis. Chrysotile asbestos exposure is associated with a lower incidence of mesothelioma. Industrial area that is often dikaitakan with the occurrence of mesotheliomas due to asbestos exposure include mining industry, ship building which involves the use of asbestos, the manufacture of asbestos cement, ceramics, paper mill, auto parts, and repair factory train.

Clinical manifestations / phenomenon that occurs in mesothelioma clinics are:
-Dyspnea and chest pain nonpleuritic wall is the most common symptom in malignant mesothelioma. (Approximately 60-90% of patients had symptoms of chest pain or dyspnea.

-In patients with malignant mesothelioma, pleural effusions physical findings are usually known by percussion and auscultation.

-In rare cases, malignant mesothelioma manifests as cord compression, brachial plexopathy, Horner syndrome, or superior vena cava syndrome. Death is usually caused by infection or respiratory failure of the development of mesothelioma.

-The main area that often occurs in the pleura (87%), peritoneum (5.1%), and pericardium (0.4%).

Hyperthermia therapy (also called termoterapi, then we call hyperthermia alone) is a cancer treatment by heating the tissue until it reaches 44o even 45oC. Research shows that high temperatures can destroy and kill cancer cells, with minimal damage to normal tissue. By destroying the structure of proteins and cells, hyperthermia can kill cancer cells and reduce tumor size.

Hyperthermia is usually used in conjunction with other therapies, such as radiotherapy, chemotherapy, or immunotherapy, because hyperthermia can make cancer cells more sensitive, even to directly destroy cancer cells that can not be destroyed by radiation.

There are many methods used for hyperthermia. Based on the treated area, consisting of local hyperthermia, regional hyperthermia, and hyperthermia total (whole body).
Local Hyperthermia

In local hyperthermia heating performed on a limited area, in this case the cancer tissue. Heat source is used, among others, microwave (microwave), radio waves (radio frequency), and high-frequency sound waves (ultrasound).

For cancers located on the surface of the body or near the skin, heat-producing equipment placed near the tumor, then the wave beam is directed to an area you want heated. If the cancer is located in or around the holes of the body (eg, esophagus or rectum), the heat source is inserted into it using a special tool for direct heating of the target. This technique is called intraluminal or endocavitary hyperthermia.

Medium if the location of the tumor deep within the body, for example in brain cancer, the technique used is interstitial. The patient was sedated, then a special needle or injected into the middle of the heater cancer tissues with ultrasound or CT guidance equipment (computed tomography). The radio waves emitted would heat and kill cancer cells in the vicinity.

Regional hyperthermia
Regional hyperthermia aims to heat larger areas of the body such as the arms, legs, organs, and the channels of the body. There are several techniques used. The first technique for cancers near the hole or along the lines of the body such as cancer of the mouth / neck of the uterus, uterine cancer, bladder cancer, etc.. Heater placed near the hole or in the channel and heat emission of microwaves or radio waves are directed into the targeted cancerous tissue.

The second technique of regional perfusion, to treat cancer in the arms and legs, or in organs such as liver and lung. How, some patients blood removed, heated, then pumped back into the arms, legs, or organs. This technique is usually performed in conjunction with chemotherapy.

The third technique is CHPP (continuous hyperthermic peritoneal perfusion), used to treat cancer in the abdominal cavity as peritoneal mesothelioma. During surgery, chemotherapy drugs are heated and then poured into the abdominal cavity, so that its temperature reaches 41.1 to 42.2 oC.
Hyperthermia Total

For cancer that has metastasis (spread) throughout the body, hyperthermia is a total (whole body hyperthermia). Patients covered with electric blankets or hot water, or inserted into the heat chamber (a kind of incubator) to make its body temperature rises to 41.7 to 43.8 oC.

Hyperthermia therapy proven to improve the effectiveness of radiotherapy or chemotherapy. Many locations that can be achieved, among other things in the head and neck cancer, breast cancer, lung, liver, stomach, cervix, colon, uterus, prostate, skin, bone. Type of cancer that can be treated also all kinds, from adenocarcinoma, melanoma, carcinoma, thymoma, mesothelioma, lymphoma, sarcoma, squamous cell, alkaline cell.

Hyperthermia treatment carried out 2-3 times a week, and each series consists of 6-10 times the therapy. Its effectiveness depends on the extent of body temperature had increased, how long successfully defended, while also depending on the characteristics of the treated cells and tissues. During the treatment temperature is continuously monitored using a thermometer mini, for the desired temperature can be achieved but not exceeded. Artificial heat is maintained for one hour.

Side Effects of Hyperthermia
Hyperthermia therapy is generally not cause damage to normal tissue / healthy if the temperature does not exceed 43.8 oC. But the difference in the character of the network can lead to temperature differences or side effects on body tissues are different. What often happens is feeling the heat (like fire), swollen with fluid (mlenthung-Jw), uncomfortable, even sick.

Perfusion techniques can cause tissue swelling, blood clotting, bleeding, or other disturbances in the area treated. But side effects are temporary. Moderate whole body hyperthermia can cause more serious side effects are rare-but-such as heart and blood vessel abnormalities. Sometimes the side effects appear even diarrhea, nausea, or vomiting.

Treatment for malignant mesothelioma has not been found, but the people affected by this disease still prefer to undergo treatment with a mixture of methods or participate in various clinical trials. Various kinds of mesothelioma treatment techniques regularly performed with surgical procedures, drug therapy, and radiation therapy.

Although this treatment is most often found, you can find other treatment options that are now growing in popularity. Several treatment options, which are gene therapy, immunotherapy, and photodynamic therapy.

The different surgical procedures performed on patients with malignant mesothelioma there are 3 types of palliative surgical procedures, surgical procedures diagnostic, curative surgical procedure. Palliative surgery aimed at reducing the symptoms and eliminate all cancer cells. However, this type of operation is not recommended.

The purpose of curative surgery is to remove as much mesothelioma cancer, hoping this type of therapy to fully heal. Curative surgery is usually followed by chemotherapy or radiation therapy.

Diagnostic surgical approach intended to do with finding facts or not the existence of cancer in patients. This procedure is an addition that can help identify where the location of the cancer, if found, the diagnosis of mesothelioma is usually still in the form of non-invasive.

Chemotherapy drug given intravenously with the aim to destroy cancerous tissue. Mesothelioma Cancer cells grow very fast and chemotherapy would be more effective if given promptly.

Radiation therapy is done by comparing drug therapies, which aim to destroy cancerous tissue and limit the spread of cancer cells are much as possible. This is also called "ionizing radiation" and is usually used after surgery. The mechanism works with palliative care are also aimed to relieve pain caused by disease.

Photodynamic therapy is usually used if the cancer is malignant mesothelioma is still small and less effective for metastasis.Therapyi photodynamic cancer therapy requires intravenous drug that cancer cells will be killed due to certain vulnerable.

This gene treatment is still experimental d? N requires a person to be infected by an h? virus that will make a change genetically. The virus gets into the cause of mesothelioma cancer cell protein production. Some time after the virus infects a person who has changed genetically, will be given a chemotherapy drug that does not damage normal cells, but was able to kill cancer cells.

Immunotherapy is given under on the immune system of individuals trying to destroy cancer cells. With the Active Immunotherapy of individuals, malignant mesothelioma cells to be removed which is then used to produce vaccines. The person who injected the vaccine, will have an immune system capable of recognizing "malignant mesothelioma cell vaccine" as a hazardous substance, so that the cancer cell itself is known as hazardous substances.

Chemotherapy can be an exhausting experience for most mesothelioma patients, most of the anti-cancer drugs have horrible side effects you will experience during therapy. The following steps will help you overcome the stress of chemotherapy:

-Focus on your treatment goals in your mind. This will help you keep a positive attitude in the days when the going gets rough.

-Try and eat good food, although small and moderate amounts, your body needs all food nutrients necessary for rebuilding tissue and stay strong.

-Learn as much as you want to know about mesothelioma cancer and its treatment. This will help you to cope better with the fear of the unknown and increase feelings of control.

-Keep a journal or diary while you're being treated. A note about the activities and thoughts can help you understand the feelings you have as you go through treatment. It can also help you highlight the questions you should ask your doctor or nurse. You can also use the journal to record side effects. This will help you when you talk about them with doctors and nurses. You can write the steps you take to overcome the side effects and how the steps work fine too. That way, you will know how to work the best for you if you have the same side effects again.

-Do not push yourself physically, you have to do things the easy because your strength will be depleted by the effects of powerful drugs that we use, so try to get as much rest as possible. Let the little things slide and just do the things most important to you.

-Try a new hobby and learn new skills.

-Exercise if you can and if your doctor says you can. Exercise helps to make you feel better about yourself, helps you get rid of tension or anger, and build your appetite.

-Plan how to cope with stress and relax. There are simple techniques that you can practice that can help you cope with stress and help you relax. You should discuss with your doctor before you start using these techniques, especially if you have lung problems.
These are some techniques that can help you cope with stress and relax:

Lying in a quiet room.

Take a slow, deep breaths.

When you breathe in, tense muscles or muscle groups. For example, clench your teeth or stiff arms or legs.

Keep your muscles tense for a second or 2 while holding my breath.

Then breathe out, release tension, and let your body relax completely.

Repeat the process with another muscle or muscle group.
Another way to do this is called progressive relaxation. You work your way your body starts with the toes of one foot. The contract then relax all the muscles of the leg. Do the same with the other foot. Work your way to your body, the contractor and then relax each muscle group in your body, including the neck and your face. Remember to hold your breath while briefly to contract muscles and to breathe when it releases tension.

Respiratory rhythm:

Get a comfortable position and relax all your muscles.

Close your eyes or focus on distant objects if you prefer to keep them open.

Breathe in and out slowly and comfortably through the nose. If you like, keep the rhythm steady by saying to yourself, "In, one, two. Out, one, two."

Feel yourself relax and loose every time you breathe out.

You can continue only for a few seconds or up to 10 minutes.

Other forms of relaxation techniques that you can use, including biofeedback, distraction, mental picture, visualization and hypnosis.

In industrialized countries, lung cancer is one of the main causes of death from all cancer deaths. Lung cancer mostly affects those aged 40 to 70 years. Smoking is one risk factor in lung cancer and 80% of lung cancer cases occur in smokers. Exposure to certain chemicals in the workplace is also clearly associated with the development of lung cancer.

Figures for the incidence of lung was increased in workers exposed to some form of nickel, chromium, and asbestos. Asbestos is widely used for the manufacture of roof (tile) and insulation, asbestos cement, brake linings, electrical devices, and fire-resistant materials and packing materials. Asbestos is the common name of a group of natural silicates which will split into flexible fibers. Exposure can come from natural sources and industrial usage. There are two types of fiber flcksibel, krisotil and krosidolit. Krisotil (3MgO.2SiO, .2 H2O) is a very important role in world trade and 90% of which is composed of asbestos. Krosidolit (blue asbestos), composed of rod-shaped fibers are short and more dangerous than krisotil fiber.

System disease due to exposure to asbestos exposure include asbestosis, lung cancer, and mesotheliomas. Other cancers associated with exposure to asbestos is a cancer of the larynx, esophagus, stomach, colon-rectum, and possibly pancreatic cancer.

Asbestosis is pulmonary fibrosis that develops slowly from inhaling high concentrations of asbestos dust or due to long exposure. Its severity depends on the time span between awitan (initial) exposure and its intensity, then advanced asbestosis is often associated with lung cancer, especially among smokers.

Pleural mesotheliomas is a rare type of cancer. Increased incidence of mesotheliomas associated with the inhalation of asbestos fibers in the working environment. Although initially symptoms slightly, mesotheliomas can be cured if successfully diagnosed. The time between exposure to asbestos and the appearance of first signs of tumors ranging from 20 to 50 years, especially mesotheliomas. The increase in the incidence of mesotheliomas numbers also appear in the population who, although not exposed in occupational, stay home with asbestos workers or living near a strong source of asbestos emissions Although asbestos is no longer used as an insulator, this substance is still in the spotlight because of the danger that comes from building divider using asbestos.

Definition
Asbestosis is a chronic fibrosis interstitialis spread in lung parenchyma due to inhaling asbestos fibers. Examples of other lung diseases related to asbestos are pleural plaques and calcification, lung cancer, and malignant mesotheliomas. This disease may be associated with asbestos, maybe not.

Jobs at risk
The degree of exposure to high asbestos may arise in the manufacture of products made from asbestos cement, mining, and processing of asbestos fibers, building demolition and renovation of buildings by removing material made from asbestos, insulation work such as boiler plating, replacement of furnace insulation, etc.. Other workers are exposed, including a mechanic who replace brake fluid, workers who make asbestos gaskets, repair and maintenance workers in shipyards, oil refineries, power stations, and construction workers.

Clinical features
Patients with asbestosis usually come with shortness of breath during activity and clinical batuk.Temuan including dispnoe, krepitasi in basal lung, and finger percussion. Lung X-ray examination showed extensive fibrosis interstitialis, evidenced by the shadow-striped opaque in the middle lung field and basalt on both sides of the lung. The possibility of pleural plaque. Lung function showed a picture constraints and reduced DLCO.

Flak pleura associated with exposure to ashes found mainly in the parietal pleura. Calcification, if any, may be associated with long occurrence lesions. Plaque can be clustered or spread. Much evidence suggests that in the absence of asbestosis or thickening is widespread, there is no correlation between pleural plaques are isolated with a significant worsening of obstacles. Must address pat that patients with extensive pleural thickening have reduced lung volumes and respiratory resistance presence some evidence, acceptable. Extensive pleural thickening can be distinguished by a limited pleural thickening with loss angle kostofrenikus on lung X-ray examination. It seems there is no direct relationship between pleural plaque with the development of mesotheliomas.

Small airway dysfunction (SAD) may be associated with exposure to asbestos. Trapped air from SAD can explain the occurrence of some reduction in vital capacity in asbestos-exposed workers with normal FEVWFVC ratio.

The development of bronchial cancer in asbestos-exposed workers appear to be associated with exposure dose. It is associated with various types of asbestos fiber, chrysotile misalnva, anthophylite, crocidolite, and amosite. There is an increased risk of lung cancer was significant in asbestos workers who smoke adanva suggesting synergistic effects. Cancer was mainly squamous cell or adenocarcinoma types. Asbestosis and lung cancer often occur together because both are associated with exposure dose.

Exposure to asbestos in the workplace plays a part as much as 85% of cases of malignant mesotheliomas. Generally, it can be accepted that exposure to crocidolite provide a much greater risk than exposure to chrysotile. This risk is apparently not related to levels of asbestos are inhaled because this risk can be found in subjects with or without asbestosis as Halm: a person who is only exposed on the environment and not exposed to the job. The average latent period of about 35 to 40 years. Asbestos can cause mesotheliomas in the pleura or the peritoneum. Complaints experienced by patients with mesotheliomas in the pleura is chest pain and shortness of breath. Shortness of breath is progressive and is associated with the insistence of tumors in lung or pleural effusion. Patients with peritoneal mesotheliomas in dating with widespread abdominal pain, swelling, and decreased weight of the material.

Diagnosis
The clinical features, lung X-ray images, and history of previous exposure to asbestos will direct the diagnosis of asbestosis or other illnesses associated with asbestos. A biopsy is needed to confirm the diagnosis of malignant disease. Sometimes and difficult to malignant mesotheliomas and metastatic adenocarcinoma on histological picture. History of exposure to asbestos should always be sought for all cases of pleural effusion. The existence of asbestos granules in sputum or lung tissue showed the existence of exposure but not the diseases caused by asbestos.

Management of
Asbestosis, like silicosis, can develop even when removed from exposure. Treatment is symptomatic. Preventive action starts from asbestos substitution measures using other materials, the closure of processing locations, installation of local ventilation, and respiratory protection. Patients who have been exposed are advised to stop smoking to reduce the combined effect of the lung and lung cancer risk.

A mesothelioma article recently published in scientific journals Lung Cancer that examines the benefits and costs of Cisplatin and Pemetrexed in combination with Carboplatin and Pemetrexed for mesothelioma chemotherapy.

PA Photos Mesothelioma Exposure AsbesKemoterapi combination Cisplatin and Pemetrexed is one of several choices of chemotherapy that has proven quite successful for treating patients with malignant pleural mesothelioma / malignant pleural mesothelioma (MPM), but this combination can be very toxic to the body. There is no treatment and treatment for malignant mesothelioma cancer without undesirable side effects.

In the journal the researchers noted that "there are two phases of a randomized study in phase III shows the benefit for the prognosis of mesothelioma with the use of antifolates such as raltitrexed or Pemetrexed, in combination with cisplatin. The study has shown an absolute improvement in overall survival on average 2.6 and 2.8 months, compared with single treatment for cisplatin. This makes a lot of institutions using Cisplatin and Pemetrexed as the standard palliative chemotherapy treatment for malignant pleural mesothelioma. "

Unfortunately, the combination of Cisplatin and Pemetrexed produce unwanted toxic effects and it encourages researchers to study other chemotherapy drugs in combination with Pemetrexed. The researchers said, "Recently, two phase II trials have evaluated the efficacy of Carboplatin and Pemetrexed will in MPM. Both studies showed overall response rates 18.6 and 25%, with a survival rate average of 12.7 and 14 months. As a continuation of these results, we have retrospectively analyzed in patients with MPM who were treated with Carboplatin and Pemetrexed in our institution. "

In an effort to find a combination of chemotherapy mesothelioma with minimal toxicity and side effects, the researchers investigated further by replacing Cisplatin with Carboplatin when paired with Pemetrexed. Using a retrospective approach, researchers evaluated 49 cases malignant pleural mesothelioma who were given a combination of Carboplatin and Pemetrexed and compare the results with data of cisplatin combination chemotherapy with Pemetrexed.

The level of disease control (which is known by the absence of progressive signs of mesothelioma over CT scans) for the patients was 69 percent, and partial response and stable disease percentage of 28 percent and 41 percent. Clinical improvement shown in figure 69 percenths. The researcher argues, "In conclusion, our data sh, the majority of patients reported an increase in profits after two cycles of chemotherapy. Toxicity is generally low and better than the toxicity of cisplatin with Pemetrexed.

The average time of treatment failure was 4.6 months. The average overall survival in this study is 14 months, compared with the cisplatin-pemetrexed for 12.1 montow a combination of Carboplatin and Pemetrexed may be an option in the treatment of mesothelioma, particularly in patients who have problems with the use of cisplatin."