Lung Mesothelioma

What Is Lung Mesothelioma?

There are dozens of types of lung cancers, but lung mesothelioma is probably the most aggressive and deadly of them all. In most cases, it is also one of the most preventable.

Like lung cancers caused by smoking, mesothelioma starts with exposure to an environmental toxin -- in this case, usually a very fine form of asbestos, amphibole asbestos. Like all asbestos, this mineral flakes off in fibers that can be woven. Unlike the other forms, amphibole asbestos also forms very short, very fine dustlike fibers that are easy to inhale or ingest.

Most people with mesothelioma were exposed to asbestos much earlier in life while working in a construction, mechanical, or mining job. For instance, shipyard workers during World War II were heavily exposed to asbestos sprayed on naval vessels during their construction. Miners for minerals that have nothing to do with asbestos may cut through layers of the mineral during the course of their work. Automobile mechanics who change out brakes may be exposed to asbestos even today from brake pad dust.

Some asbestos exposure is from more mysterious beginnings. Housewives who washed their construction worker husband's clothes may inhale a larger dose of asbestos from their laundry than the husband did on the job. In some regions, the gravel debris from asbestos mines was used, unbelievably, to pave playgrounds and city streets; in one small Australian town, half of all deaths were due to mesothelioma, a result of long-ago gravel paving.

Regardless of how asbestos is ingested, the course of mesothelioma always follows the same general path. The fine asbestos fibers easily penetrate porous lung air sacs, working their way through soft tissues without damage until they reach the mesothelium, a tough leathery sac that contains the internal organs. Here the asbestos is stopped, but because the fibers are so small, the human body recognizes them as bacterial or parasitic invaders. In numerous tiny sites, small pockets of infection form, but the body cannot break down asbestos, so it never goes away. Scar tissue builds up over time, and eventually one or more cells undergoes the genetic changes necessary to form cancer.

Even when cancer does not form, the scar tissue makes the mesothelium tougher over time. Thirty years of scarring makes this flexible and stretchy organ attain the texture of an orange peel. A good CT scan can always detect mesothelioma past a certain point, even if cancer has not developed.

The main complication of mesothelioma, beyond death from cancer, is severe shortness of breath that worsens over time. This is due to the loss of elasticity in the mesothelium, which deteriorates the body's ability to expand and contract the lungs normally. Cancer-free mesotheloma sufferers will need to go on oxygen in order to live a relatively normal life.

Those who do develop cancer have a very grim prognosis. Depending on the type and onset of the mesothelioma, median survival rate after initial diagnosis is about a year. There is no cure for mesothelioma, and because of the location and complexity of all those tiny scar points, it is the hardest of cancers to treat at all.

Initial treatment of mesothelioma involves excision of as much cancer as is feasible through surgery. The mesothelium cannot be entirely removed without killing the patient, and it is very unlikely that all the cancer will be removed, but enough may be excised to make further treatment reasonable.

After surgical excision, most doctors use radiation therapy. A few work with experimental treatments, such as targeted light therapy, but none of the experimental treatments show consistent good effects. Radiation therapy is followed by chemotherapy. The most common chemotherapy drug used for lung mesothelioma today is pemetrexed in conjunction with cisplatin. These two chemo drugs have some nasty side effects, and folic acid is usually administered along with them to try to alleviate some of the negative symptoms.

There are dozens of pharmacies and independent labs working on new lung mesothelioma treatments. Immunotherapy using interferon alpha has shown some promise, though it is still in the very earliest stages of investigation. Radical and innovative treatments like the targeted administration of heated chemotherapy drugs -- sort of soaking the cancers in a soup while they're still in your body -- are also showing some promise. For today's diagnosis, however, the outlook is not good. Most doctors focus on quality of life rather than extended life as an outcome.

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