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Home > Types of mesothelioma > Mesothelioma pleural

Mesothelioma pleural

There are some types of mesothelioma. Among them - malignant pleural mesothelioma (MPM).

Malignant pleural mesothelioma is a rare type of cancer that begins in the mesothelial cells of the pleura, which is a membrane that surrounds the lungs and lines the chest cavity. The pleura consists of the visceral pleura, which covers the surface of the lungs and the parietal pleura, which lines the walls of the chest cavity and covers the upper surface of the diaphragm and lung.

Pleural Mesothelioma, pleura mesothelioma or malignant pleural mesothelioma is mesothelioma cancer in the lining of the lungs. This is different from lung cancer, which refers to any type of malignant tumor that originates in the lungs.

There are 2 pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the 2 pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.

Mesotheliomas of the pleural cavity are relatively rare tumors. Generally, two types of pleural tumors can be referred to as mesotheliomas. The less common is the solitary (or localized) fibrous tumor of the pleura, previously known as "benign mesothelioma." This slow-growing, commonly benign, well-circumscribed tumor is pedunculated on a pleural-based pedicle and often is cured by resection.

The tumor appears to originate from submesothelial rather than mesothelial or epithelial cells.1 The more common variety is the diffuse malignant pleural mesothelioma (DMPM), a true mesothelial malignancy that is locally aggressive, invasive, and almost universally fatal. This multicentric tumor infiltrates the pleural space, results in a pleural effusion, and mechanically compresses the surrounding structures.

Though distant metastatic lesions may be seen in up to 30% of cases in autopsy series, most patients die of locoregional invasion and compression of vital structures. The median survival for patients with DMPM is between four and 12 months, depending on the stage at presentation.

Prognosis

Median survival is poor, varying from 8 to 14 months in different studies, similar to other types of lung cancer. Epithelioid tumours have a better than average prognosis.

Diagnosis

The importance of a detailed occupational history cannot be overemphasised. Any patient in whom mesothelioma is suspected should be promptly referred to a respiratory physician for further assessment. Pathological confirmation of the diagnosis is recommended, unless the patient is frail or has extremely advanced disease. Negative pleural biopsy and cytology results do not exclude mesothelioma and should lead to further investigation. CT scanning plays a key role in the diagnosis of mesothelioma.

Diagnostic Tests

Bronchoscopy: During a bronchoscopy, a surgeon inserts a bronchoscope (thin, lighted tube) through the nose or mouth into the trachea (windpipe) and bronchi (air passages that lead to the lung). Through this tube, the surgeon can examine the inside of the trachea, bronchi and lung and collect cells or small tissue samples.

Aspiration: During this procedure, a surgeon inserts a needle through the chest into the area suspected of cancer in order to remove a tissue sample for examination under the microscope.

Thoracotomy: A thoracotomy is a major surgery, which involves opening the chest in order to remove a sample of tissue.

Sputum Cytology: Sputum cytology is a procedure used to examine mucus that is coughed up from the lungs or breathing tubes. The mucus is examined under a microscope in order to detect cancer cells.

Thoracentesis: During a thoracentesis, a needle is inserted through the chest wall into the pleural space in order to remove a sample of the fluid that surrounds the lungs in order to check for the presence of cancer cells.

Stage I-III Pleural Mesothelioma: Patients with stage I-III disease have cancer that can potentially be removed with surgery.

Stage IA: Patients with stage IA disease have cancer limited to the pleura on one side of the chest with no involvement of lymph nodes and no spread to other sites.

Stage IB: Patients with stage IB disease have cancer that has spread to the parietal pleura, including mediastinal and diaphragmatic pleura on one side of the chest and can have scattered foci of tumor also involving the visceral pleura. There is no involvement of lymph nodes or distant spread.

Stage II: Patients with stage II disease have cancer involving both parietal and visceral pleura and can have involvement of diaphragmatic muscle or extension into the lung. There can be lymph node involvement, but there is no distant spread.

Stage III: Patients with stage III cancer have locally advanced but potentially surgically resectable cancer. They have cancer involving parietal, mediastinal, diaphragmatic, and visceral pleura. They can also have spread to fascia, mediastinal fat, and soft tissue of the chest wall or involvement of the pericardium. These patients can have spread to the bronchopulmonary or hilar lymph nodes or to subcarinal or mediastinal lymph nodes, including the internal mammary nodes. They do not have spread to the opposite side of the chest or distant metastasis.

Stage IV Pleural Mesothelioma: Patients with stage IV disease have cancer that cannot be typically removed with surgery. They have spread of cancer to the mediastinal, internal mammary or supraclavicular lymph nodes on the side of the chest opposite to the original cancer. Distant metastasis can also be present.

Recurrent Pleural Mesothelioma: Patients with recurrent cancer have disease recurrence after primary treatment or failed primary treatment.

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