A rare lung cancer (Pleural Mesothelioma): Let's talk about this

Do you have persistent chest pain or difficulty breathing? You may have been exposed to asbestos at work when you were young. Today we are talking about a rare but very serious cancer that can develop years later from such exposure. This is called Pleural Mesothelioma in medical terms. Although the name may sound complicated, let's keep it simple.

What exactly is Pleural Mesothelioma?

Simply put, there is a thin membrane, like a covering, around the inner wall of our lungs and chest cavity. This is what we call the pleura in medicine. This membrane is made up of a special type of cell called mesothelium . So when cancer develops in these mesothelium cells, it is called Pleural Mesothelioma (or malignant pleural mesothelioma).

The main and most common cause of this is exposure to a mineral called asbestos . You may know that in the past, asbestos sheets were used as a building material, especially for roofs. When this asbestos decomposes, breaks, or is worked on, very small, invisible particles are released into the air. When these are inhaled, they go into the lungs and settle. The most dangerous thing is that our body cannot dissolve or remove these particles. So over the years, they damage the membranes surrounding the lungs, causing inflammation, and eventually mutating the cells and turning them into cancer.

Are there main types of this cancer?

Yes, the World Health Organization (WHO) has divided this cancer into three main types based on the nature of the cancer cells. Some types spread quickly, while others grow more slowly. The treatment also varies depending on the type.

Once your doctor has determined exactly what type you have, they will be able to give you a good idea of ​​what treatments are best for you and what the future holds.

What are the symptoms of this disease?

One problem with this is that symptoms appear very slowly . It may take 20, 30, or even 50 years after exposure to asbestos for symptoms to appear. The initial symptoms are similar to those of a common cold or other minor illness, so many people don't pay much attention to them. It's only when the disease is a little more severe that they go to see a doctor.

The two main symptoms are:

• Persistent chest pain
• Difficulty breathing (shortness of breath)

In addition, you can also see these symptoms:

• Persistent cough and hoarseness
• Difficulty swallowing (dysphagia)
• Lower back pain
• Swelling of the face and hands
• Weight loss for no reason
• Night sweats
• Fatigue
• Fever that makes you feel weak

Are there other causes besides asbestos?

Asbestos exposure is the cause of 70% of diagnosed cases. However, in some cases, people who were not exposed to asbestos can also develop this cancer. Scientists are still researching this. Some other possible causes are:

• Having previously received radiation therapy to the chest area.
• Genetic changes that are inherited (for example, the absence of the gene BAP1).
• Exposure to a material called carbon nanotubes (which are now used to strengthen things like vehicles and sports equipment).

Who is most at risk?

This disease often occurs in people who have been exposed to asbestos for years through their jobs. Many of these people are now retired (over 65 years old). They were working in asbestos-related jobs when they were young, before laws came into effect regarding the dangers of asbestos.

Even in Sri Lanka, those who engage in such jobs are at greater risk:

• People engaged in building construction and demolition work
• People who work in shipyards
• People who work in garages and factories
• Manufacturers and installers of insulation materials
• Firefighters
• Plumbers
• Miners

In addition,

• People who live in the same house as someone who works with asbestos are also at risk, because those particles can come into the house from their clothes and shoes.
• People who live near an asbestos mine or where old buildings containing asbestos are being demolished are also at risk.

How to diagnose this disease?

When you go to see a doctor, he or she will first ask about your symptoms, medical history, and especially about your occupation and possible exposure to asbestos. Then, they may recommend some tests, such as:

• Imaging tests: A chest X-ray can look for changes in the lungs, thickening of the pleura, or fluid around the lungs (pleural effusion). In addition, an MRI, CT scan, or PET scan may be ordered to see where the tumor is and whether the cancer has spread.
• Blood tests: Some blood tests look for elevated levels of certain substances (such as fibulin-3 and soluble mesothelin-related peptides) in the blood that are linked to this cancer.
• Thoracentesis: This involves removing a small sample of fluid from around the lungs and testing it for cancer cells. This can help relieve chest tightness and breathing difficulties.
• Biopsy test:

What are the stages of cancer?

Like any cancer, it is classified into stages 1 to 4 depending on the spread of the disease. Treatment is planned based on this stage.

What are the treatments for this?

Pleural mesothelioma is a difficult cancer to treat because it can spread easily through nerves, blood vessels, and tissues. Therefore, oncologists usually plan treatment using a combination of treatments.

• Surgery: Surgery may be performed in the early stages of the disease. This may involve removing the entire lung with the cancer (extrapleural pneumonectomy - EPP) or removing only the cancerous tissue and pleura (pleurectomy with decortication - P/D).
• Radiation Therapy: This is the use of high-energy rays to destroy cancer cells. This treatment is used to kill any remaining cells after surgery or to reduce symptoms (such as chest pain).
• Chemotherapy: This involves giving the body drugs that kill cancer cells or stop them from growing. Pemetrexed, carboplatin, and cisplatin are the most commonly used drugs.
• Immunotherapy: This is a relatively new treatment method that stimulates our own immune system to identify and destroy cancer cells.
• Palliative Care: The goal is not to cure the cancer. Instead, it is to control the patient's symptoms (pain, shortness of breath) and make daily life as comfortable and pain-free as possible.
• Clinical Trials: These are studies that test the safety and effectiveness of new treatments. These are used to test new treatments, such as gene therapy. You can talk to your doctor about whether you can participate in one of these trials.

Is there a way to avoid this disease?

The best and only way to prevent pleural mesothelioma is to avoid inhaling asbestos particles. Although most countries have now banned the use of asbestos, it may still be present in old buildings and vehicles built before 1980. You can do the following to reduce your risk:

• If you have old asbestos in your home, have it inspected by a knowledgeable expert before making any repairs.
• If you are removing asbestos, entrust the task to a trained company. Never try to do it yourself.
• If you are exposed to asbestos through your job, be sure to wear appropriate protective clothing and face masks. Be careful not to carry the particles home on your clothes or shoes when you go home after work.