Mesothelioma is cancer of the mesothelium, the membranes that line various organs in the body. This condition is classified as a type of cancer that is dangerous and can be fatal.
Mesothelioma is classified as an aggressive type of cancer, but it is quite rare. This condition does not cause symptoms until decades after the sufferer is exposed to asbestos. In most cases, people diagnosed with mesothelioma are aged 60-80 years.
Although it can be treated, most cases of mesothelioma are already at an advanced stage making it difficult to treat. Therefore, it is important to carry out periodic prevention and checks to prevent this condition.
Types of Mesothelioma
There are four types of mesothelioma cancer, namely:
- Mesothelioma pleura ( pleural mesothelioma ), which is cancer that attacks the lining of the lungs (pleura) and is the most common type
- Mesothelioma peritoneum ( peritoneal mesothelioma ), namely cancer of the lining of the abdominal cavity (peritoneum)
- Mesothelioma pericardium ( pericardial mesothelioma ), namely cancer in the protective lining of the heart organ
- Mesothelioma testicles ( testicular mesothelioma ), which is cancer that attacks the protective lining of the testicles or testicles
Apart from the types above, there are also benign mesothelioma in the lungs and chest cavity which are called solitary fibrous tumors . However, this condition is not included in the type of mesothelioma that will be discussed.
Causes of Mesothelioma
The cause of mesothelioma is not known with certainty. However, mesothelioma is often associated with exposure to asbestos or asbestos. Asbestos is a mineral that is widely used as a building construction material, such as roofing, due to its heat-resistant and fire-resistant properties.
Asbestos that is destroyed, both in the mining process and in building renovations, will produce fibers or fine dust. These fibers are very easily inhaled, then enter and settle in the organs of the body, especially the lungs.
If it is swallowed, asbestos fibers can also spread through the lymphatic system, then settle and cause cancer in the lining of the abdominal cavity (peritoneum).
Mesothelioma risk factors
Mesothelioma can happen to anyone, but the risk is higher in people with the following factors:
- Working in areas that are prone to asbestos exposure, such as mineral mining, construction sites, the automotive industry, power plants, the textile industry, and steel mills
- Residing in an old building or environment where the soil contains asbestos
- Having a family member who works in an environment that is prone to asbestos exposure so that asbestos dust sticks to the skin or clothes and is carried into the house
- Having a family with mesothelioma or a genetic disorder that increases the risk of developing cancer
- Exposure to the mineral erionite or radiation from thorium dioxide
- Infected with simian virus (SV40)
Mesothelioma develops gradually and usually takes 20–60 years for symptoms to appear. Therefore, patients may not feel any symptoms when mesothelioma is still in its early stages. However, cancer cells will grow over time and press on nerves or other organs, causing symptoms.
Symptoms of mesothelioma depend on the organs affected. In pulmonary mesothelioma, symptoms that may appear include:
- Fever and sweats, especially at night
- The body feels very tired
- Cough accompanied by unbearable pain
- Shortness of breath due to fluid buildup in the lungs
- Weight loss for no apparent reason
- Chest pain
- Difficult to swallow
- Pain in the shoulder or upper arm
- Swelling or deformity of the fingertips (clubbing)
- A lump appears in the tissue under the skin surface of the chest
Meanwhile, abdominal (peritoneal) mesothelioma can cause the following symptoms:
- Fever or sweats at night
- Loss of appetite
- Weight loss
- Abdominal pain
- Nausea and vomiting
- Lump or swelling in the stomach area
- Disorders of defecation and urination
Pericardial and testicular mesothelioma is a very rare type of mesothelioma. Pericardial mesothelioma usually causes symptoms in the form of chest pain and breathing difficulties, while testicular mesothelioma is characterized by swelling or lumps in the testicular area.
When to see a doctor
Mesothelioma symptoms can mimic symptoms of other conditions. Therefore, immediately check with your doctor if you experience the above symptoms, especially if you have a history of exposure to asbestos.
In order to determine the diagnosis of mesothelioma, the doctor will conduct a question and answer regarding the patient's symptoms and medical history, especially the possibility of exposure to asbestos. A physical examination will also be carried out to detect lumps or other symptoms.
To confirm the diagnosis, the doctor will perform scans, such as:
- X-rays, to detect thickening in the lining of the lungs, fluid in the pleural space, or changes in the shape of the lungs
- CT scan , to examine the chest and abdomen area, as well as detect the presence of cancer and check whether the cancer has spread to other organs of the body
- PET scan, to get a detailed picture of the tissue suspected of being cancerous
- MRI , to get a more detailed picture of the organs and determine the location of the tumor
Based on the test results, the doctor may also suggest further examinations in the form of:
Blood tests are performed to detect increased levels of fibulin-3, osteopontin, and peptides in the blood. Levels of these three substances are usually higher in people with mesothelioma.
Examination of fluid samples
If the patient has a buildup of fluid in the body due to mesothelioma, the doctor will take a sample of the fluid and examine it in the laboratory to detect the presence of cancer cells.
There are several types of fluid sample examination, namely:
- Thoracentesis, which is taking a sample of fluid in the chest cavity
- Paracentesis, which is taking fluid in the abdominal cavity
- Pericardiocentesis, which is taking fluid in the lining (membrane) around the heart
A biopsy is done by taking tissue samples from certain parts of the body to be analyzed in the laboratory. There are several types of biopsy examinations , namely:
1. Needle biopsy
Needle biopsies are performed by inserting a long needle into the chest or abdominal cavity.
2. Thoracoscopy, laparoscopy, and mediastinoscopy
This biopsy is performed by inserting an elastic tube with a camera and special surgical tools through one or more small incisions. The type of biopsy performed depends on the area of the body being examined, namely:
- Thoracoscopy, to examine the inside of the chest
- Laparoscopy, to examine the inside of the abdominal organs
- Mediastinoscopy, to examine the area around the heart
3. Biopsy through surgery
In some conditions, the doctor will perform an invasive procedure to take a larger tissue sample to confirm the diagnosis. Doctors can also remove the entire tumor at once if possible.
There are two types of biopsy procedures through surgery, namely:
- Thoracotomy, which is performed through open surgery on the chest
- Laparotomy, which is performed through open surgery in the abdomen
4. Bronchoscopy biopsy
This biopsy is done by inserting a thin tube down the throat to detect tumors in the respiratory tract. If there is, the doctor will take a tissue sample from the tumor for examination.
Based on the size and level of spread, mesothelioma is divided into four stages. This staging division helps doctors to know the development of cancer cells and the patient's life expectancy, as well as determine the right method of treatment.
The following are the stages and life expectancy of people with mesothelioma:
The tumor is still in one area of the body and has not spread to other tissues or organs. At this stage, the life expectancy of sufferers is 21 months or more.
Cancer cells enlarge and begin to spread to nearby areas, with a life expectancy of 19 months or less.
Cancer cells have spread to nearby organs, with a life expectancy of around 16 months.
Cancer cells have spread to various areas throughout the body through the bloodstream. At this stage, the life expectancy of sufferers is very low, which is around 12 months.
Mesothelioma is a type of malignant cancer and cannot be cured. Treatment is limited to relieving symptoms and extending the patient's life expectancy. The method of treatment is determined based on the following factors:
- The patient's age and overall health condition
- Type and location of cancer
- The size and rate of spread of the cancer
Based on the considerations above, several treatment steps that can be recommended by doctors are:
Chemotherapy is the administration of drugs to kill or inhibit the growth of cancer cells. This therapy can be done before surgery to shrink cancer cells for easy removal, or after surgery to reduce the risk of cancer reappearing.
Radiotherapy or radiation therapy is done by shooting X-rays or proton beams on the areas of the body affected by cancer. This therapy is usually done after surgery to remove remaining cancer cells.
Radiotherapy can also be used to relieve symptoms of advanced cancer in patients who cannot undergo surgery.
Surgery can be performed on early-stage mesothelioma. There are several surgical options that doctors can perform, namely:
- Surgery to remove as many cancer cells as possible from the patient's body. This action can be supported by radiotherapy to relieve pain and inhibit cancer growth.
- Surgery to suck up fluid in the chest that interferes with breathing. This action may be accompanied by pleurodesis, which is an injection of medication into the chest to prevent fluid from accumulating again.
- Surgery to remove tissue around the abdominal cavity, ribs, or lungs affected by cancer cells.
- Surgery to remove the affected part of the lung and surrounding tissue. This procedure is usually followed by radiotherapy.
4. Multimodality therapy
This therapy is a combination of three or more treatment methods, such as surgery, postoperative chemotherapy, and radiation therapy, to increase the success rate of treatment.
To help the treatment process, the doctor will advise the patient to do the following:
- Breathing exercises, to control breathing when experiencing symptoms of difficulty breathing
- Body relaxation exercises, to reduce tension in the muscles of the respiratory tract to make it easier to breathe
Mesothelioma that has enlarged or spread can press on the surrounding organs or tissues. This can cause various complications.
In pleural mesothelioma, complications that can occur include:
- Difficulty breathing
- Chest pain
- Difficulty swallowing
- Pain due to pressure on the nerves and spinal cord
- Pleural effusion
While complications due to peritoneal mesothelioma are intestinal obstruction , which can be characterized by nausea, vomiting, constipation, and loss of appetite or feeling full quickly.
The main way to prevent mesothelioma is to avoid contact with anything that contains asbestos. If you work in an environment that is at high risk of exposure to asbestos, then follow the work safety regulations set by the company, for example:
- Use personal protective equipment while in a work area that is prone to asbestos exposure
- Dispose of the remaining asbestos material in a safe place that does not harm the surrounding environment
- Do not bring home clothes and shoes used during work
In addition, there are several other things that can be done to reduce the risk of mesothelioma, namely:
- Conduct periodic health checks to detect symptoms or signs of illness associated with asbestos exposure
- Stop smoking , because smoking can increase the risk of various types of cancer, including mesothelioma
- Follow instructions on how to handle asbestos safely