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Mesothelioma

German: Mesotheliom

1 Definition

Mesothelioma is a rare, aggressive form of cancer that develops in the thin tissue lining that surrounds and protects the lungs, abdomen, heart, and very rarely, the testicles. This protective tissue lining is known as the mesothelium. The main cause of mesothelioma is from a person being exposed to asbestos and then either inhaling or ingesting it. Asbestos fibers can enter the body via esophageal or tracheal pathways and can become lodged into the protective tissue lining (mesothelium) mentioned above. This lodging disrupts natural cell development, which promotes the growth of abnormal cells, which ultimately leads to either asbestosis or some form of mesothelioma cancer.

Despite common non-favorable prognosis, there has been an increase in survival rates for mesothelioma patients according to the second report by the Royal College of Physicians. The report that launched in 2016 in London indicates an improvement in the individuals that are diagnosed with the disease surviving for over a year. However, despite the improvement, survival rates are still poor.

There was a steep increase in mesothelioma cases and deaths in the past five years. This increase is due to the vast occupational exposure to asbestos and its extensive use between 1950 and 1980. The latest mesothelioma survival rates study used data from more than 2,000 patients who were diagnosed with malignant pleural mesothelioma in England during 2014.

2 Types of Mesothelioma

There are four types of mesothelioma and the name is specifically associated with the location of the tumors. For instance:

Pleural Mesothelioma: Tumors develop in the pleura, which affects the tissue lining that surrounds the lungs.

Peritoneal Mesothelioma: Tumors develop in the peritoneum, which affects the tissue lining that surrounds the abdomen.

Pericardial Mesothelioma: Tumors develop in the pericardium, which affects the tissue lining that surrounds the heart.

Testicular Mesothelioma: Tumors develop in the tunica vaginalis, which affects the tissue lining that surrounds the testis.

3 Treatments for Mesothelioma

According to the second mesothelioma report by the Royal College of Physicians, there are variations regarding the interventions and treatments that are offered to mesothelioma patients. There was a general increase in the use of palliative chemotherapy and anti-cancer treatments between 2014 and 2016. The report indicates an increase in the use of these treatments among mesothelioma patients, which went from 34% to 36.5% over the last two years. [1] For mesothelioma patients with good health, the use of chemotherapy treatment has increased from 41% in 2014 to 53.5% in 2016.

With all these increases, there was a reduction in the use of radiotherapy among pleural mesothelioma patients. In 2014, 29% of mesothelioma patients were receiving radiotherapy treatment and in 2016, this three to 16.5% of patients.

Surgical interventions are relatively uncommon among cancer patients. However, more procedures have been performed since the last audit in 2014. Surgical interventions & procedures have increased from 2.3 percent to 5.2 percent between 2014 and 2016. [2]

4 Survival Rates

Recently, there was a study performed by the University of Maryland Medical Center. This study involved 73 pleural mesothelioma patients with 19 of the patients not having lymphatic node involvement.

Surgery was performed on each patient to remove or attempt to physically remove the cancer. After the surgery, a therapy that uses light and a photosensitizing agent to kill remaining cancer cells was administered. This treatment is called photodynamic therapy. Lastly, chemotherapy was administered but only on 92% of the patients.

The report of this study indicates that all patients had an overall median survival rate of almost 3 years or 35 months. However, this figure was nearly doubled for the 19 patients whose mesothelioma had not yet spread to the lymph nodes.

The median survival rate for malignant pleural mesothelioma patients that are treated with: a type of curative surgery for mesothelioma, photodynamic therapy and chemotherapy is almost three years (35 months). While the patients that did not have malignant mesothelioma lived for more than seven years after the treatment. According to E. Albert Reece, the Medical Affairs Department’s Vice President, the results indicate a prolonged overall survival in some patients and they are quite promising.

Also according to that study that was published in 2016, patients that underwent chemotherapy alone lived for only 12 to 18 months as compared to the patients that lived nearly three years who went the multimodal therapy route using the three types of treatment. [3]

4.1 Survival Rate According To Tumor Volume

On December 16, 2015, the Journal of Cardiothoracic published a study, conducted on 111 patients, found a direct correlation between tumor volume and the survival rate of patients after surgery. Smaller tumors result in longer survival rates.

Below is a chart of the results received based on how long the patient lived after undergoing a common surgery option where the pleura (lining of the lungs) is removed entirely so the tumors can no loger develop there. This surgery is called Extended Pleurectomy/Decortication (EPD). [4]

Tumor Volume Median Survival Rate 0 < 300 ml 2.25 years 301-600 ml 1.62 years 601-900 ml 1.06 years > 900 ml 0.9 years

5 Variation in survival between men and women

A study by The Society of Thoracic Surgeons that was published in the Annals of Thoracic Surgery in 2014 indicates a significant long-term and short-term variation in mesothelioma survival rates between female and male patients. Male patients had a survival rate of 4.5% whereas female patients had a survival rate of 13.4%. [5]

This variation in survival rates between genders is affected by the stage at which the disease is diagnosed as well as the age of the patient. Young patients have better survival rates than older patients with female mesothelioma patients living longer in both young and older patients. It is estimated that about 3,000 people are diagnosed with mesothelioma each year in the United States. Mesothelioma occurs more often in men. The average age for a pleural mesothelioma diagnosis is 69. [6]

There were 2,515 mesothelioma deaths in Great Britain in 2014; 2,101 male deaths and 414 female deaths. [7]

The Australian Mesothelioma Registry recorded 575 mesothelioma patients in 2013. Of these people, 465 were males and 110 were females, and the majority (80.0%) were aged 65 years or over at the time of diagnosis. [8]

6 Variations According to Stage

For the majority of the patients that were diagnosed with mesothelioma in 2014, the stage of the disease was recorded in approximately 42% of the cases. This was an increase compared to 36% of the cases that were recorded in the past years. However, it was still low in some places due to lack of a validated staging system for mesothelioma. Currently, the International Mesothelioma Interest Group (IMIG) recommends the non-validated TNM staging system. [9]

With all facts and statistics considered, the survival rate and life expectancy for mesothelioma patients are improving. Between clinical trials and the combinations of multimodal treatments, mesothelioma patients should not lose hope as these are yielding much better results as compared to past studies.

7 References

  1. https://www.treatmesothelioma.org/mesothelioma/survival-rates/
  2. https://www.rcplondon.ac.uk/file/5514/download?token=VwOiGg6A
  3. https://www.sciencedaily.com/releases/2016/12/161214145608.htm
  4. http://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/1749-8090-10-S1-A48
  5. http://www.annalsthoracicsurgery.org/article/S0003-4975(14)00824-8/pdf
  6. https://www.treatmesothelioma.org/mesothelioma/prognosis/
  7. http://www.cancer.net/cancer-types/mesothelioma/statistics
  8. http://www.hse.gov.uk/statistics/causdis/mesothelioma/index.htm
  9. https://www.treatmesothelioma.org/mesothelioma/life-expectancy/
  10. https://www.mesothelioma-australia.com/media/11828/amr-3rd-data-report-final.pdf

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