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Understanding Malignant Epithelial Mesothelioma | Causes, Symptoms, and Treatment Options

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Introduction

Malignant epithelial mesothelioma (MPM) is a rare but aggressive cancer that arises from the mesothelial cells lining the body’s internal cavities, primarily the pleura (lining of the lungs), peritoneum (lining of the abdomen), and pericardium (lining of the heart). It is almost exclusively caused by exposure to asbestos, a naturally occurring fibrous mineral once widely used in various industrial applications. Despite its rarity, MPM poses a significant threat to public health due to its high mortality rate and poor prognosis. This article will delve into the complexities of MPM, exploring its causes, symptoms, diagnosis, treatment options, and the ongoing struggle to prevent this devastating disease.

What is Malignant Epithelial Mesothelioma?

Understanding Malignant Epithelial Mesothelioma | Causes, Symptoms, and Treatment Options

Mesothelioma is a type of cancer that affects the thin layer of tissue (mesothelium) that covers and protects the internal organs of the body. There are three main types of malignant mesothelioma – epithelioid, sarcomatoid, and biphasic – based on the specific type of cell affected. Epithelial mesothelioma is the most common subtype, accounting for approximately 50-70% of all cases. This type of mesothelioma develops from the epithelial cells that make up the inner lining of the body’s cavities.

Causes of Malignant Epithelial Mesothelioma

Understanding Malignant Epithelial Mesothelioma | Causes, Symptoms, and Treatment Options

As mentioned earlier, malignant epithelial mesothelioma is almost exclusively caused by exposure to asbestos, a group of six naturally occurring fibrous minerals – chrysotile, amosite, crocidolite, tremolite, actinolite, and anthophyllite. Asbestos was once considered a wonder material due to its exceptional heat resistance, strength, and insulating properties, making it an ideal component in various industrial and commercial products. It was widely used in the construction, shipbuilding, manufacturing, and automotive industries until the late 20th century.

The most common route of exposure to asbestos is through inhalation or ingestion. When asbestos fibers are disturbed, they become airborne and can be inhaled into the lungs. Over time, these fibers can accumulate and cause scarring and inflammation, leading to genetic changes that can trigger the development of MPM. The latency period between asbestos exposure and the appearance of symptoms can range from 20-50 years, making it a silent and insidious disease.

Although asbestos exposure is the primary cause of MPM, other factors such as genetics, radiation, and simian virus 40 (SV40) have also been suggested to play a role in the development of this cancer. However, these factors are yet to be clearly established.

Symptoms of Malignant Epithelial Mesothelioma

Symptoms of MPM usually do not appear until the disease has reached an advanced stage. This is because it takes several decades for the cancer to develop after asbestos exposure, and the initial symptoms may be mild and easily attributed to other conditions. Some of the common symptoms of malignant epithelial mesothelioma include:

  • Shortness of breath
  • Chest pain
  • Persistent dry cough
  • Fatigue
  • Unexplained weight loss
  • Difficulty swallowing
  • Abdominal pain and swelling
  • Nausea and vomiting
  • Bowel obstruction

These symptoms may vary depending on the location of the cancer. For example, if the pleura is affected, the patient may experience chest pain and difficulty breathing, whereas abdominal pain and swelling may occur if the peritoneum is affected. In some cases, patients may also develop fever, night sweats, and muscle weakness.

Diagnosis of Malignant Epithelial Mesothelioma

Diagnosing MPM can be challenging as its symptoms are nonspecific, and it is often mistaken for other respiratory or abdominal conditions. Furthermore, the long latency period between asbestos exposure and the appearance of symptoms makes it difficult to trace the cause of the disease accurately. The diagnosis usually involves a combination of imaging tests, biopsies, and laboratory tests.

Imaging tests such as X-rays, CT scans, and MRI scans can help detect any abnormal masses or fluid accumulation in the affected area. However, these tests alone cannot confirm the presence of MPM. A biopsy is necessary to obtain a sample of tissue for examination under a microscope to confirm the diagnosis. The type of biopsy performed will depend on the location of the suspected cancer.

Laboratory tests are also useful in diagnosing MPM. A blood test called the mesothelin-related protein (SMRP) assay can help detect a protein that is produced by mesothelioma cells. Elevated levels of this protein in the blood may indicate the presence of MPM.

Treatment Options for Malignant Epithelial Mesothelioma

Unfortunately, there is no cure for malignant epithelial mesothelioma. The treatment options available are aimed at managing the symptoms, improving the patient’s quality of life, and increasing their life expectancy. Treatment plans for MPM are highly individualized, considering factors such as the stage of cancer, overall health of the patient, and personal preferences.

Surgery

Surgery is usually the first line of treatment for MPM if the cancer is detected in its early stages. The goal of surgery is to remove as much of the cancerous tissue as possible. Depending on the location of the cancer, different surgical procedures may be performed. These include:

  • Thoracotomy: Surgery to remove cancer from the chest cavity.
  • Laparoscopy: A minimally invasive procedure to remove cancer from the abdominal cavity.
  • Pericardiectomy: Removal of the pericardium (lining of the heart) and any cancerous tissue attached to it.

In some cases, a procedure called pleurectomy/decortication (P/D) may be performed. This involves removing the lining of the lung (pleura), along with any visible tumors. In more advanced cases, extrapleural pneumonectomy (EPP) may be recommended. This is a more extensive surgical procedure that involves removing the entire lung affected by the cancer, along with the surrounding tissues and lymph nodes.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells or stop them from multiplying. It may be used before surgery to shrink the tumor, making it easier to remove, or after surgery to destroy any remaining cancer cells. Chemotherapy may also be used as a palliative treatment to ease symptoms and improve the patient’s quality of life. The type of chemotherapy drugs used will depend on the subtype of MPM and the patient’s overall health.

Radiation Therapy

Radiation therapy uses high-energy beams such as X-rays to target and destroy cancer cells. It is usually used in combination with surgery and/or chemotherapy to improve their effectiveness. In some cases, it may also be used as a palliative treatment to relieve pain and other symptoms associated with MPM.

Immunotherapy

Immunotherapy is a relatively new type of treatment that harnesses the body’s immune system to fight cancer. It works by stimulating the immune system to recognize and attack cancer cells. This treatment option is still in its early stages of development, and more research is needed to determine its effectiveness in treating MPM.

Prevention of Malignant Epithelial Mesothelioma

The most effective way to prevent malignant epithelial mesothelioma is to avoid exposure to asbestos. Unfortunately, due to the widespread use of asbestos in the past, many people have already been exposed to this hazardous mineral. However, there are steps that can be taken to reduce the risk of developing MPM.

  • Identification and Removal of Asbestos: If you live or work in a building constructed before the 1980s, it is crucial to identify and remove any asbestos-containing materials from your environment.
  • Protective Gear: If you work in industries that may expose you to asbestos, make sure to follow all safety protocols and wear appropriate protective gear such as masks, gloves, and coveralls.
  • Annual Health Check-ups: If you have a history of asbestos exposure, it is essential to undergo regular health check-ups and inform your healthcare provider about your exposure history. Early detection of any changes in the lungs or other tissues can lead to timely treatment and better outcomes.

Conclusion

Malignant epithelial mesothelioma is a deadly legacy of asbestos exposure. Despite being a rare cancer, its impact on public health is far-reaching due to its high mortality rate and poor prognosis. The long latency period between asbestos exposure and the development of MPM makes it difficult to detect, and by the time symptoms appear, the disease has often reached an advanced stage. Early detection and prompt treatment can help improve the patient’s quality of life and increase their life expectancy. However, the best approach is to raise awareness of the dangers of asbestos exposure and take necessary precautions to prevent it. By understanding the causes, symptoms, and treatment options for malignant epithelial mesothelioma, we can strive towards preventing this deadly disease and protecting ourselves and future generations.

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