Mesothelioma

You can find the questions asked by the patients about mesothelioma and the answers they received at the bottom of the page. If you have any questions about mesothelioma of the pleura, I suggest that you ask them by giving detailed information about the patient.

Pulmonary Mesothelioma

Tumors originating from the lung membrane (pleura).

It usually occurs in people who have been exposed to substances called asbestos and erionite for many years.
In our country, especially in the Central and Southeastern Anatolia Regions, “white soil”; Many mesothelioma patients have emerged as a result of the use of the substance known as erionite in whitewashing the interior of the houses.
Many patients do not have any exposure to asbestos or erionite.
Familial predisposition has been reported.
After the use of asbestos in industry was banned, there was a significant decrease in the disease.
Frequently, patients present with severe chest pain, weakness, and cough. Usually, water collects in the chest cavity and shortness of breath may occur with the effect of this water.

Diagnosis of Mesothelioma in the Lung Membrane

Patient history

Especially in our country “white soil” Mesothelioma is more common in patients who have lived in the so-called regions. In addition, conditions that occur in the pleura of those who have a profession with asbestos exposure suggest mesothelioma.

Mesothelioma Symptoms

The most important symptom that occurs in patients is chest pain. This is followed by symptoms such as shortness of breath, fatigue and weakness during exertion.

Examination in Mesothelioma

There is no special examination finding of mesothelioma. Findings detected in all kinds of lung diseases are detected: such as decreased breath sounds on the patient’s lung side.

Radiological Examinations and PET-CT

Normal chest radiographs are not sufficient for the diagnosis of mesothelioma. In cases where there is a suspicion of mesothelioma in the history and thickening or fluid is detected in the pleural membrane on the chest X-ray, further examination is definitely performed.

Mesothelioma Diagnosis with Computed Tomography and MRI

As can be seen in the picture below, areas of thickening or fluid collection are detected on the pleural membrane in computed tomography. The red arrow in the picture indicates areas with mesothelioma.

MRI, on the other hand, is useful for showing the tumor’s position on the diaphragm and heart in more detail. If there is any doubt in this respect in computed tomography, MRI should be performed. Otherwise, MRI is not required.

A mesothelioma that extends below the diaphragm, towards the abdomen or has crossed the pericardium passes into stage 3.

Determining the stage of the disease is critically important for choosing the appropriate treatment. Therefore, detailed investigations are essential before choosing the appropriate treatment.

Diagnosis of Mesothelioma with PET-CT

If mesothelioma is suspected in a lesion that occurs in the lung membrane, PET-CT is performed and it is investigated whether this lesion consumes energy or not. If an increased energy consumption (involvement) is not observed in the diseased areas of the pleura in PET-CT, the probability of this lesion being a mesothelioma is extremely low.

PET-CT is also important to reveal whether mesothelioma has spread to other parts of the body.

No matter which treatment will be applied, a mesothelioma treatment should not be started without PET-CT.

Diagnosis of Mesothelioma with Biopsy

If fluid is present, taking a sample of the fluid with the help of a needle (thoracentesis), needle biopsy to take tissue from the tumor, or thoracoscopic (VATS) biopsy are methods used in the diagnosis of malignant mesothelioma. Pathology examination should not only diagnose mesothelioma, but also specify which type of mesothelioma it is. The type of mesothelioma to be determined (epiteloid, sarcomatoid or mixed type) helps to determine the treatment to be applied.

What are the Treatment Methods for Malignant Mesothelioma?

(The information contained herein is taken from the conclusion part of the International Mesothelioma Symposium held in Catania, Italy on April 16, 2015.)

Chemotherapy is applied in the vast majority of patients.
Among the drugs, Pemetrexed (Alimta) has had significant success. Successful results are obtained in patients who use this drug together with Cisplatin.
Because chemotherapy has important side effects, a detailed evaluation is made by an oncologist before its use.
The chemotherapy regimen, which is applied in the form of heated chemotherapy drugs in the chest cavity, is a method that has been applied for about 10 years. There is no significant success in long-term results.
Surgery is used only in a certain type of mesothelioma (Epithelial type) and in the very early stages (Stage I and sometimes Stage II cases).
Radiotherapy is a method that is often applied to organs such as bone and brain where the disease metastasizes. In some cases, radiotherapy can also be given to mesothelioma itself. However, it should be kept in mind that the application of radiotherapy to a widespread area may cause negative results and should be applied with very careful patient follow-up.
Methods called Cyberknife or IMRT are particularly beneficial when they are applied locally to the areas where the disease has relapsed (in terms of reducing the patient’s complaints).

In Which Situations Should Surgery Be Applied in Mesothelioma?

In patients with mesothelioma in stage 1 (and some patients in stage 2) and
Mesothelioma “Epithelial type” There are scientific studies showing that surgery prolongs the life of the patient in cases where it is present. Therefore, surgical treatment is recommended for this group of patients as a selected group.
Surgery is definitely harmful for the patient in sarcomatous or mixed type malignant mesotheliomas or in Stage III and Stage IV patients!

What are the Methods of Mesothelioma Surgery?

Surgical treatment consists of two main groups:

Curative, that is, surgical intervention aimed at completely treating the disease
Treatments aimed at improving the patient’s quality of life and making breathing easier during the illness

1. Therapeutic (Curative) Mesothelioma Surgery

A) Removal of only the pleura, diaphragm and pericardium diseased areas (Pleurectomy-Decortication). It is the more preferred method today.

B) In addition to the above, removal of the lung (Extra Pleural Pneumonectomy). This method is used in rare cases.

Which method should be applied is decided according to both the detailed examinations before the operation and the findings during the operation.

2. (Palliative) Mesothelioma Surgery to Improve the Patient’s Complaints

In patients with mesothelioma, the fluid collected in the chest cavity should be drained if severe shortness of breath causes.
This procedure should be performed by endoscopic (VATS) method in all patients with suitable general condition, and treatment to prevent recurrence of fluid should be applied at this time.
After this procedure with VATS, the probability of recurrence of the fluid is extremely low

What are the Risks of Surgery?

The risks in pleurectomy decortication operations performed for therapeutic purposes are generally in the form of prolonged bleeding drainage, air leakage from the lung, increased heart rate and heart rhythm disorders. 3% of the operated patients die within 30 days.
In operations where the lung is also removed (Extra Pleural Pneumonectomy), there is a requirement to stay in the intensive care unit for a longer period of time, unlike the above situations. Death occurs within 30 days in 5% of the operated patients.
The risks are low in the palliative procedure called VATS pleurodesis. death is almost non-existent.

How Many Days Should I Stay in the Hospital for Surgery?

After curative surgery, an average of 6-7 days of hospitalization is required, and after VATS pleurodesis, an average of 3 days of hospitalization is required.

Is Radiotherapy / Chemotherapy Necessary After Mesothelioma Surgery?

Chemotherapy is usually required. Radiotherapy application is not always necessary.

Post-operative treatment decisions are made by the hospital tumor board based on the pathology examination of the surgery.

Mesothelioma is a rare disease. Its treatment must be carried out in centers experienced in this disease.