This is a guest post by PleuralMesothelioma.com, a medical information site with all of the latest on diagnosis and treatment of pleural mesothelioma.

Danger level: High

What is it?

Pleural mesothelioma is a type of cancer that develops in mesothelial cells (the cells which form the linings that surround and protect the lungs).

Who gets it?

Those who worked in industries that made common use of asbestos (a naturally occurring mineral) are at high risk for developing mesothelioma. Such occupations include shipyard workers, insulators, construction workers, welders, plumbers, electricians, steamfitters, pipefitters, boilermakers, railroad workers, chemical plant workers, power plant workers, miners and auto mechanics.

A shipyard. Workers of shipyards are at increased risk of developing mesothelioma. Photo by cunningba

The average age of a mesothelioma patient has historically been about 65 years old and men are 3 times more likely to develop the disease than women.

What causes it?

A vast amount of scientific and medical evidence has confirmed that malignant mesothelioma is caused by asbestos exposure. Presently, there is no other proven source for this disease. Asbestos is a naturally-occurring fibrous mineral that was widely used in industrial, commercial, and domestic products throughout the twentieth century. Asbestos was touted for its durability, fire resistance, and excellent insulating properties, and was used in several thousand different manufactured “asbestos products,” including construction materials, household appliances, and brake linings.

(We recently covered asbestosis, another disease caused by asbestos exposure).

How does it feel?

The initial symptoms of pleural mesothelioma are often similar to symptoms of other diseases that are much less serious (like influenza or pneumonia). Pleural mesothelioma symptoms include:

· Persistent dry or raspy cough (typically non-productive, meaning there is little or no phlegm)

· Coughing up blood

• Difficulty in swallowing
• Night sweats or fever
• Unexplained weight loss of 10 percent or more
• Fatigue
• Persistent pain in the chest or rib area, or painful breathing
• Shortness of breath that occurs even when at rest
• The appearance of lumps under the skin on the chest

How is it discovered?

Because this type of cancer has a long latency period (anywhere from 25 to 50 years after exposure to asbestos) and because the early symptoms are similar to that of less serious illnesses, pleural mesothelioma is rarely diagnosed in early stages. Unfortunately, like most cancers, mesothelioma is most treatable if diagnosed early.

Doctors use a few different types of diagnostic imaging scans and biopsy tests to identify mesothelioma. The most common type of imaging test used is a chest x-ray, but a doctor may also suggest a CT scan, PET scan or MRI scan.

A mesothelioma on a CT scan. You can see the large tumor on the left side of the picture (the other lung is black, meaning it’s tumor-free). Photo by Tdvorak.

Fluid and tissue biopsies are also a regular part of diagnosing mesothelioma. There are 4 main tests that are most commonly used:

• Fine Needle Aspiration: Mesothelioma cancers cause fluid to build up in affected locations, such as in the pleural membrane of the lungs (the lungs’ coverings). During a fine needle aspiration, a doctor will remove a fluid sample using a very long, thin and hollow needle.
• Thoracoscopy: Thoracoscopy is used in cases where pleural or pericardial mesothelioma is suspected. During this procedure a very small incision is made in the chest wall, through which a sample of tissue is removed.
• Bronchoscopy and Laparoscopy: These procedures are similar to the thoracoscopy, but are performed on different parts of the body. The bronchoscopy is used to view the trachea and airway, while the laparoscopy is used to remove samples of peritoneal tissue.
• Mediastinoscopy: This procedure is used to view lymph nodes in the chest and neck, to determine if cancer has spread from its point of origin.

How is it treated?

There are quite a few types of mesothelioma treatment offered, some recommended more often than others. The most frequently used treatments are surgery, chemotherapy, and radiation therapy. In addition, some experimental treatments are becoming more widely used, or are showing some encouraging results in clinical trials. These treatments include photodynamic therapy, gene therapy, and immunotherapy, among others.

Most of these treatments are not used in isolation. In many cases, treatment may consist of a combination of therapies. For example, surgery to remove as much of the cancer as possible may be followed by radiotherapy or chemotherapy to remove residual cancer cells. This is one of the most common treatment options for mesothelioma among those who are candidates for surgery.

What happens after treatment?

This again depends on what stage the cancer is in when it is diagnosed. Most often it is diagnosed after surgery is no longer an option and other options are very limited. After treatment is completed, doctors will assess the patient’s status with a number of tests to see if any of the cancer is left.

The only known way to avoid mesothelioma is to avoid exposure to asbestos. Asbestos is harmless if left undisturbed. But once damaged, microscopic asbestos fibers are released into the air where they can then be inhaled or ingested. The majority of homes built before 1980 contain asbestos insulation, so if you are ever remodeling be sure to take the proper precautions.

What next?

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