Malignant pleural mesothelioma : Symptoms, diagnosis & treatment in Turkey 2024

Malignant pleural mesothelioma: An overview

Mesothelioma is a rare and aggressive cancer that develops in the cells of the mesothelium, a thin membrane that surrounds most of our internal organs, such as the lungs (pleura),abdomen (peritoneum),and heart (pericardium).

Pleural mesothelioma, the most common form, occurs when cancer cells multiply in the pleura, a double-walled membrane that surrounds the lungs. Normally, these two layers slide over each other, allowing the lungs to inflate and deflate freely. But in mesothelioma, the pleura thickens, becomes irregular and can fill with fluid, compressing the lungs and making breathing difficult.

Risk factors for pleural mesothelioma

Pleural mesothelioma is a rare but serious cancer caused primarily by the inhalation of mineral fibers, of which asbestos is the best known. Understanding the risk factors associated with this disease is essential for prevention and early detection.

Asbestos: the main risk factor

• Occupational exposure: Occupational exposure to asbestos, particularly in mines, shipyards, construction and industry, is the main risk factor. The duration and intensity of exposure are directly related to the risk of developing mesothelioma.
• Environmental exposure: People living near industrial sites that use or have used asbestos may be exposed by inhaling airborne fibers.
• Family exposure: Family members of asbestos workers may be exposed through contact with contaminated clothing.

Other risk factors

• Other mineral fibers: In addition to asbestos, erionite (found in certain regions of Turkey) and fluoroedenite (found in volcanic lavas) are also recognized risk factors for mesothelioma.
• Radiation: A history of thoracic or abdominal radiation therapy may increase the risk of developing mesothelioma.
• Thorium dioxide: Past use of thorium dioxide as a radioactive contrast agent is associated with an increased risk of mesothelioma. It is now banned.
• Genetic factors: Genetic mutations, particularly in the BAP1 gene, may predispose to the disease.

Latency period

Several decades may elapse between exposure to asbestos and the appearance of pleural mesothelioma.

Diagnosis is often delayed due to the nonspecific nature of the initial symptoms (shortness of breath, chest pain).

Symptoms and diagnosis

Symptoms of pleural mesothelioma can include:

• Shortness of breath.
• Persistent cough.
• Chest pain.
• Fatigue and unexplained weight loss.

If these symptoms persist, you should seek immediate medical attention. A thorough evaluation by a physician, including imaging scans, biopsies, and blood tests, is essential to confirm the diagnosis.

These diagnostic steps will allow the doctor in Turkey to assess the extent of pleural mesothelioma and determine the most appropriate treatment plan.

Increasing awareness of these signs and promoting early treatment are essential to improving clinical outcomes in the treatment of pleural mesothelioma.

Treatment options for pleural mesothelioma in Turkey

When it comes to treating pleural mesothelioma, a multidisciplinary approach including surgery, chemotherapy, and radiation therapy is often recommended. In Turkey, the specific treatment plan will depend on several factors. We take into account the stage of cancer, the patient's overall health, and individual preferences.

Surgery: Removal of cancerous tissue

Surgery is crucial in the management of pleural mesothelioma, aiming to remove as much cancerous tissue as possible. Surgical options vary depending on the stage of the disease and may include the following:

• Pleurectomy/Decortication (P/D): This procedure removes the pleura affected by the cancer while sparing the underlying lung. P/D may help relieve symptoms and improve quality of life.
• Extrapleural pneumonectomy (EPP): In cases where the cancer has spread widely, EPP may be performed. This involves removing the affected lung, pleura, and surrounding tissue. EPP is a more extensive procedure and is generally reserved for selected patients.

Chemotherapy: Targeting cancer cells

Chemotherapy is a common treatment for pleural mesothelioma. It can be given intravenously or directly into the chest cavity. The goal of chemotherapy is to kill cancer cells, reduce the size of the tumor, and control the spread of the disease. Although side effects are possible, advances in chemotherapy drugs have improved both their effectiveness and their tolerability.

Radiation therapy: localized treatment

Radiation therapy uses high-energy beams to target and kill cancer cells. It is often used in conjunction with surgery or chemotherapy to increase the effectiveness of the treatment. In the case of pleural mesothelioma, radiotherapy is usually delivered externally and targeted to the specific areas affected by the disease. Despite potential side effects, radiation therapy can provide significant relief by reducing pain and slowing tumor growth.

Life expectancy and prognosis

Pleural mesothelioma has a generally poor prognosis, with a median survival rate of about 12–21 months. However, advancements in treatment options and early detection have shown promise in improving life expectancy and quality of life for patients. Factors such as the stage of the disease, overall health, and response to treatment can influence a patient's prognosis.

Early detection and intervention play a vital role in improving the outlook for pleural mesothelioma patients. Therefore, it is crucial to prioritize regular medical check-ups, particularly for individuals who have a history of asbestos exposure.