Mesothelioma: specialists & information

Mesothelioma is a malignant cancer that forms on the mesothelium, a special layer of tissue. It usually affects the pleura and is then referred to as pleural mesothelioma. In the following article, we therefore refer to pleural mesothelioma.

Here you will find further information as well as selected mesothelioma specialists and centers.

What is mesothelioma?

The mesothelium is a special layer of tissue that lines various organs and cavities in the body. The pleura is by far the most commonly affected area - this is known as pleural mesothelioma. Mesothelioma develops much less frequently in the pericardium, for example.

The pleura is covered with a film of fluid. This ensures that the lungs move smoothly in the chest cavity when breathing. If certain cells of the pleura, the so-called mesothelial cells, degenerate, pleural mesothelioma can develop.

Degeneration of the pleural cells is mainly caused by contact with asbestos (asbestos exposure). People who have had occupational contact with asbestos have about a thousand times higher risk of developing this cancer.

There is usually 30 to 50 years between contact with asbestos and the development of cancer (latency period). This is why those affected are usually over 50 years old.

Pleural mesothelioma is rare overall. In Germany, around 1600 people are newly diagnosed with it every year. On average, men are affected four times more often than women.

The pleura consists of the pulmonary pleura and the diaphragm. It delimits the chest cavity to the outside © bilderzwerg | AdobeStock

The symptoms of pleural mesothelioma

The clinical picture is very unspecific at the beginning. This is why three to six months often pass between the onset of the first symptoms and the diagnosis.

Pleural mesothelioma typically presents with the following symptoms:

• Shortness of breath, especially on exertion (approx. 90 percent of cases)
• Cough or dry irritating cough
• Dull chest pain that is difficult to locate
• fatigue, tiredness and weight loss (approx. 15 percent of cases)

In addition, so-called pleural effusions occur repeatedly in around 30 percent of those affected. These are accumulations of fluid in the pleura that are difficult to treat.

In the advanced stage, there is often

• Coughing up blood (hemoptysis),
• difficulty swallowing (dysphagia),
• hoarseness and
• the so-called Hornersyndrome

are also common.

Horner's syndrome describes nerve damage that is characterized by the three symptoms

• drooping eyelid,
• significant constriction of the pupil and
• pupil and an eyeball that sinks into the eye socket.

into the eye socket.

Diagnosis of pleural mesothelioma

Occupational history and evidence of asbestos exposure play a decisive role in the diagnosis. The doctor therefore needs to know whether and when the affected person may have had contact with asbestos.

The physical examination usually reveals

• a weakened breath sound and
• a muffled tapping sound when tapping the lungs with the fingers.

In the advanced stage, there may also be

• a pain-related relieving posture,
• palpable lumpy masses,
• an asymmetrical chest cavity (thorax),
• restricted or absent movement of the chest cavity when breathing in and out and
• an enlargement of the lymph nodes in the area of the collarbone

can be detected.

In addition, various imaging and other diagnostic procedures are used to better assess the cancerous tumor:

• Chest X-ray: a conventional X-ray shows whether there is a pleural effusion and whether the lump is diffuse or nodular (nodular). The latter is important for the prognosis, as diffuse tumors are more likely to spread to other organs (metastasis).
• Computed tomography (CT): Chest computed tomography is used to better assess the tumor and its extent.
• Magnetic resonance imaging (MRI): If the findings are unclear, an additional magnetic resonance imaging scan can be performed.
• Ultrasound (sonography): A so-called pleural sonography can make even small pleural effusions visible. Ultrasound imaging can also be used to check the extent of the cancerous tumor and its invasion into adjacent chest wall structures such as the diaphragm or abdomen.
• Pleural puncture: A pleural puncture is used to obtain cell material from a pleural effusion, which is then tested for the presence of cancer cells.
• Thoracoscopy: A sample of material is taken during a thoracoscopy. As the examination takes place under visualization, suspicious foci can be specifically removed and examined.

Pleural mesothelioma: multimodal therapy approach

Surgical removal of the tumor as part of a so-called radical operation is the only curative treatment measure. This is the only way to achieve a cure.

This involves removing the pleura and the lung as a whole (extrapleural pleuropneumectomy). In addition to the pleura and lungs, the pericardium and diaphragm may also have to be removed (P3D operation).

In addition, a combination of chemotherapeutic agents is usually used during or after the operation. These include

• Carboplatin and paclitaxel,
• cisplatin and
• permetrexed.

These can improve the quality of life and survival rate, particularly when combined.

In addition, the affected half of the chest cavity and the connective tissue space in the middle of the chest cavity (mediastinum) are irradiated to control the tumor locally.

Possible new therapeutic methodscurrently under consideration are

• gene therapy approaches,
• photodynamic therapy,
• immunotherapy and
• immunotherapy and the use of so-called VEGF inhibitors

are currently being tested in clinical trials.

Palliative treatment

In most patients, the cancerous tumor cannot be operated on(inoperable tumor). Only palliative and symptomatic treatment is therefore possible for these patients. This means that the cancer cannot be cured, but treatment improves the patient's quality of life.

Chemotherapy may be appropriate in individual cases of severe symptoms. According to studies, chemotherapeutic measures can

• pain in 79 percent of cases,
• cough in 67 percent of cases and
• 54 percent of cases breathing difficulties

can be reduced.

Before using chemotherapeutic agents, the doctor always weighs up the benefits and possible side effects, taking into account

• age and general condition,
• additional concomitant diseases,
• the symptoms present and
• the development of the tumor

development.

Local radiation or partial removal of the pleura can also lead to an improvement in pain and breathing difficulties.

If effusions occur repeatedly, a so-called pleurodesis may also be useful. In this procedure, the pleural sheets are glued together by the doctor inserting talcum powder into the pleura.

In some cases, patients with end-stage cancer benefit from permanent drainage of the effusion fluid via a drainage system.

Pleural mesothelioma: prognosis and healing process

The prognosis for pleural mesothelioma is extremely unfavorable. The 5-year survival rate is between five and ten percent. The average survival time is around one year after diagnosis.

Most of those affected die as a result of lung weakness(respiratory insufficiency). The main reason for this negative prognosis is the late diagnosis. People with occupational exposure should therefore undergo early detection examinations.