Mesothelioma

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Overview

Mesothelioma is a type of cancer that primarily affects the mesothelium, a thin layer of tissue that covers most of the internal organs. The most common form of mesothelioma occurs in the pleura, which is the lining around the lungs, and is known as pleural mesothelioma. This cancer is strongly associated with asbestos exposure.

Symptoms

Symptoms of pleural mesothelioma may not appear until decades after asbestos exposure and can often be mistaken for other respiratory conditions. Common symptoms include:

• Persistent cough
• Chest pain
• Shortness of breath
• Unexplained weight loss
• Fatigue
• Difficulty swallowing
• Pleural effusion (fluid buildup around the lungs)

Conventional Treatments

1. Surgery

   • Pleurectomy/Decortication (P/D): Involves removing part of the pleura and potentially other affected tissues.
   • Extrapleural Pneumonectomy (EPP): More extensive surgery that removes a lung, part of the diaphragm, and nearby lymph nodes.

2. Chemotherapy

   • Standard chemotherapy for mesothelioma typically involves a combination of pemetrexed and cisplatin. This approach aims to kill cancer cells and shrink tumors.

3. Radiation Therapy

   • Used to target and kill cancer cells, often as a palliative treatment to relieve symptoms.

Emerging and Experimental Treatments

1. Immunotherapy

   • Drugs such as pembrolizumab and nivolumab have been explored for their ability to harness the immune system to attack cancer cells.

2. Gene Therapy

   • Experimental approaches that involve altering genes to combat cancer.

3. Photodynamic Therapy (PDT)

   • Uses light-activated drugs to destroy cancer cells, often used adjunctively with surgery.

4. Targeted Therapy

   • Focuses on specific molecules involved in cancer growth, such as bevacizumab, which inhibits blood vessel formation in tumors.

5. Clinical Trials

   • Ongoing research trials continue to explore new drug combinations, delivery methods, and novel therapies.

Side Effects of Treatments

• Surgery: Risk of infection, blood loss, respiratory complications, and extended recovery time.
• Chemotherapy: Nausea, vomiting, fatigue, hair loss, increased infection risk, and neuropathy.
• Radiation Therapy: Skin irritation, fatigue, and potential lung damage.
• Immunotherapy: Potential for immune-related side effects, such as inflammation in various organs.
• Gene Therapy and PDT: Still largely experimental, with side effects not fully understood.

Timeline of Treatment Developments

• Chemotherapy: The combination of pemetrexed and cisplatin has been a standard since the early 2000s.
• Surgery and Radiation: Techniques have been refined over several decades, with EPP being more radical and P/D being developed to preserve more lung function.
• Immunotherapy: Gained traction in the 2010s, with several drugs approved for use in other cancers now being tested for mesothelioma.
• Targeted Therapy: Research into targeted drugs like bevacizumab started in the 2000s, with ongoing trials for mesothelioma.
• Gene Therapy and PDT: These remain experimental, with studies ongoing into the 2020s.

Conclusion

Mesothelioma, particularly in the pleura, remains a challenging cancer to treat, primarily due to its late presentation and aggressive nature. While traditional treatments like surgery, chemotherapy, and radiation remain the mainstays, emerging therapies offer hope for improved outcomes. Patients are encouraged to discuss experimental options and clinical trials with their healthcare provider to determine the best course of action.