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MESOTHELIOMA



today's topic is mesothelioma
mesothelioma is a type of cancer arising
from the mesothelium the mesothelium is
the thin layer of protective tissue that
covers the outer surface of many
internal organs such as the heart
abdomen and the lungs mesothelioma is an
aggressive form that progresses and
spreads quickly mesothelioma is divided
into many different types depending on
the part of the mesothelium affected
mesothelioma that occurs in the pleura
or in the lining of the lungs is called
pleural mesothelioma it is the most
common form mesothelioma that occurs in
the lining of the abdomen called
peritoneum is referred to as a
peritoneal mesothelioma it is the second
most common form mesothelioma that
occurs in the protective layer of the
heart is referred to as pericardial
mesothelioma this type is the rarest it
occurs more in males than in females in
2015 about 60,000 800 people had the
disease and 32,000 deaths were recorded
only about 9% of people diagnosed with
the condition live longer than five
years causes the most common cause of
mesothelioma
is an exposure to asbestos asbestos
refers to a set of six types of silicate
mineral that are naturally occurring
asbestos is made up of fibers that are
soft and flexible yet resistant to heat
fire and several chemicals asbestos is
used in a wide variety of applications
such as insulation brakes shingles
flooring and many other products when
asbestos is broken down such as when
removing asbestos insulation or during
the mining process dust is created
the fibers can be airborne they can then
be inhaled or swallowed and can settle
permanently in the lungs or stomach
where they cause irritation that causes
mesothelioma after asbestos exposure it
can take 20 to 40 years before
mesothelioma can develop factors that
may increase the risk of mesothelioma
include personal history of asbestos
exposure such as is seen in people who -
bestest work with asbestos products
produce products from asbestos or work
in a building containing asbestos living
with an asbestos worker symptoms
symptoms vary depending on the type of
mesothelioma pleural mesothelioma
shortness of breath unintended weight
loss
coughing often painful chest pain under
the ribcage fatigue in severe cases
pneumothorax lung collapse tumor under
the skin of the chest peritoneal
mesothelioma abdominal swelling pain in
the abdomen weight loss fever night
sweats poor appetite
constipation vomiting in cases where the
cancer has spread to other parts of the
body trouble swallowing swelling of the
neck and face pericardial mesothelioma
shortness of breath low blood pressure
chest pain extreme fatigue heart
palpitations diagnosis diagnosis is
suspected with imaging scans but biopsy
is used for confirmation the doctor will
review your medical history and carry
out a physical examination to check for
lumps or any unusual signs followed by
chest x-ray and lung function tests a CT
scan or MRI is also usually used to
check for abnormalities a biopsy can be
used to confirm the diagnosis the type
of biopsy depends on where the symptoms
are options include fine needle
aspiration thoracoscopy laparoscopy
thoracotomy laparotomy diagnosis will
check if cancer is present and how far
it has spread the stage of the cancer is
between stage 1 to stage 4 stage 1
mesothelioma the cancer is confined to
the mesothelium and has not spread in
stage 4 mesothelioma cancer has spread
around the chest and to different organs
treatment treatment options depend on
the location the stage age and patients
general health for most people a cure
isn't possible because the condition is
usually diagnosed at the late stage when
it is impossible to remove the cancer
with surgery the only remaining option
in many cases is trying to control
cancer to make you more comfortable
treatment options may include surgery
when the condition is diagnosed early
surgeons work to remove the tumor in
cases where it is impossible to remove
the tumor surgery may help to reduce
symptoms surgical options may include
surgery to decrease fluid buildup
surgery to remove the tissue around the
lungs or pleura t'me or the tissue
lining the abdominal cavity pair o to
neck t'me radiation therapy that uses
powerful energy beams such as x-rays to
kill the cancer cells chemotherapy that
involves using medication injected
intravenously or taken orally to kill
the cancer cells



hello my name is dr. Shand a Blackman
and I'm a thoracic surgeon at Mayo
Clinic along with the Department of
Surgery the division of thoracic surgery
the division of pulmonary medicine and
medical oncology and radiation oncology
and radiology we've put together an
individual patient education video for
patients who have been diagnosed with
malignant mesothelioma we'll be talking
about ways that the tumor is caused
different treatment options different
opportunities for enrollment into
clinical trials and ways that you can
get different types of surgery we hope
that you find this educational and we
look forward to seeing you malignant
mesothelioma what is malignant
mesothelioma it is a rare type of cancer
that can develop in the thin layer of
tissue that covers most of your internal
organs that layer of tissue is called
the mesothelium this can be involving
the lungs the abdomen the heart are the
testicles possible causes of
mesothelioma include asbestos and many
other risk factors such as a personal
history of asbestos exposure living with
someone who works with asbestos exposure
to other fibrous materials or a family
history of mesothelioma some of the
symptoms and complications of
mesothelioma include the way that it may
affect tissue that surrounds the lung if
this happens it can cause symptoms such
as chest pain under the rib cage pain
during coughing shortness of breath
unusual lumps of tissue underneath the
skin on your chest or unexplained weight
loss some of the tests and diagnoses
that are available to you if you have
signs and symptoms that might indicate
music the glioma can be ordered by your
physician who will conduct a physical
exam to check for any lumps or unusual
signs he may listen he or she may listen
to your lungs palpate your abdomen and
ultimately a biopsy may be performed
depending on what area of your body is
affected your doctor may
choose one of the following biopsy
options including a needle biopsy a
camera inside the chest which is called
thoracoscopy a camera inside the abdomen
which is called laparoscopy or making an
open abdominal incision which is called
a laparotomy identifying the cancer
stage is one of the most important first
steps for patients who are diagnosed
with mesothelioma typically for patients
who have what's called pleural
mesothelioma which means it's on the
lining of the lung or the inside of the
chest are diagnosed by placing a tiny
single port into the chest it's
important that only one tiny port is
created because in the future that may
seed a tract of tumor that can grow to
the outside of the chest so when
patients go for surgery later on having
it removed by having only one port site
used to diagnose this tumor
it is easily excited at the time of
definitive surgery through this single
port a biopsy might be performed where
either the lining of the chest wall is
stripped away or the lining of the lung
is pulled away any bleeding is typically
treated directly at that time both the
bops the instrument and the camera go
through the same small port other ways
to create a stage to find out how
extensive the mesothelioma is and help
guide therapy include but are not
limited to a cat scan of the chest and
abdomen a magnetic resonance image
positron emission tomography also known
as pet endoscopic ultrasound also called
eus endobronchial ultrasound also called
EB us diagnostic staging laparoscopy
pulmonary function testing and
diagnostic thoracoscopy identifying the
cancer stage
is the most important part of your
treatment from malignant mesothelioma if
you've been diagnosed you want to make
sure that your doctor tells you what
your stage is based on these tests that
have been performed if they are unable
to give you your stage of mesothelioma
then you should seek a second opinion
from a group that can give you your
stage before you make decisions about
treatment when you look at your chest as
if you're looking at yourself reversed
to the left of the screen is your right
lung to the right of the screen is your
left lung the lining on top of your lung
is called the visceral pleura there is
space between the visceral pleura and
the chest wall the lining on the inside
of the chest wall is called the parietal
pleura deep to that you'll see the ribs
and the muscle in between the ribs which
is typically combined to create your
chest wall it is important to make sure
that the mesothelioma has not spread
through the diaphragm into the abdomen
if it begins inside the chest it is also
important to make sure that it has not
spread from the pleural space into the
mediastinum where the trachea and the
heart exists it is also important to
make sure that it has not gone through
the pericardium into the heart
all of these spreaded areas or involved
areas indicate that more advanced
disease may be present and might make
surgery not as feasible as it would have
been if it was not spread identifying
the cancer stage is one of the most
important first steps you may be
diagnosed with anywhere from stage 1 to
stage 4 mesothelioma treatment options
can include but are not limited to key
therapy radiation therapy and surgery
surgery and other treatment that may be
involved can be as limited as placing a
drain inside the chest the tunnels
underneath the skin with a fibrous cuff
allowing fluid to intermittently be
drained as it is connected to a vacuum
bottle this is sometimes referred to as
a pleura catheter but it may have many
other names and many companies make a
catheter such as this the catheter that
is placed in between the lining of the
lung and the lining of the chest wall
has many perforated holes allowing the
fluid that can sometimes cause the lung
to collapse and give you breathlessness
to be evacuated from the chest and
restore your ability to breathe and
allow you to be in control of your
disease chronically draining the fluid
and allowing your lung to re-expand
extended pleura come--and decortication
involves creating a thoracotomy which is
a large incision on the side of the
involved chest and after the ribs are
spread an incision is made between the
lining to enter what is called the
pleural space once the pleural space is
exposed the lining on the lung is
stripped away the lining on the heart
sac called the pericardium is also
removed and the lining on the diaphragm
is also removed
sometimes if an extended pleura t'me and
decortication is performed these
surfaces are completely removed and are
reconstructed with the mesh sometimes a
gore-tex mesh sometimes a bio composite
mesh and sometimes a non-absorbable
woven mesh it depends on your surgeons
preference what type of mesh they may
place you often want to ask your surgeon
what type of mesh they use to recreate
these areas if it was used so that you
know for your records
if an extra plural pneumonectomy is
performed the same surgery that we
talked about in the previous slide is
performed plus the additional resection
of the entire involved lung is removed
the left lung is removed if the
mesothelioma is on the left and the
right lung might be removed if the
mesothelioma is on the right most people
can tolerate having an entire lung
removed on one side once the lung is
removed the diaphragm and the
pericardium are also taken away to
complete the removal of all visible
disease once the visible disease has
been removed the area is reconstructed
and the chest is closed a chronic fluid
filled cavity will now exist where the
lung used to be alternative care options
are available to you and some of these
include but are not limited to
acupuncture for breathlessness relaxed
breathing exercises muscle relaxation
and sitting near a fan many of our pain
specialists and relaxation specialists
at Mayo Clinic can help you coping with
some of the symptoms associated with
advanced mesothelioma some final
thoughts include that a diagnosis of
mesothelioma can be very difficult to
cope with learn about mesothelioma to
make decisions about your care contact a
palliative care team studies have shown
that patients who have a very advanced
cancer who get plugged in early with the
palliative care team sometimes live
longer than if they didn't in the
beginning of their disease surround
yourself with support seek out other
people with cancer or similar cancers to
help support you plan ahead
our mesothelioma pathway is on this
slide and it is not meant to overwhelm
you but it is meant to educate you
patients present
with an effusion may either have a known
diagnosis of mesothelioma at the time
that they come to Mayo Clinic or they
may have a minimally invasive biopsy
through the single port as we showed
earlier there are three different types
of mesothelioma that may be diagnosed at
the time of diagnostic laparoscopy
thoracoscopy or treatment that is
sarcoma toid mesothelioma biphasic
mesothelioma or epithelioid mesothelioma
depending on the histology or the type
of mesothelioma decisions will be made
about your care a multidisciplinary
tumor board which is MD T P will meet to
discuss your care and we will review to
see if you could be enrolled into
clinical trials such as freezing the
mesothelioma a measles vaccine a
protocol called the smart protocol
perhaps a surgery involving extra
pleural pneumonectomy abbreviated by EPP
or cleric t'me and decortication
abbreviated as p and d there is a
staging checklist that we will go
through to make sure that you've had all
of the appropriate staging modalities
when they apply to you and these may
include a pet cat scan an endo bronchial
ultrasound a bronchoscopy a staging
laparoscopy sometimes a media sign osku
P and a video system Dorcas copic biopsy
through a single port approach based on
all the information that's gathered you
will then be given a stage of
mesothelioma your meeting mesothelioma
may create what's called a pleural
effusion and that can be treated by just
simply placing a needle into the chest
and draining the fluid or placing the
chronic drainage catheter as we showed
you earlier or placing a powder inside
the chest there are only very few
situations where we believe the powder
may help you and we recommend that you
refuse to have the powder placed inside
your chest until you've had an
opportunity to discuss your candidacy
for many of the other trials as the
powder will rule out your ability to
have many of these treatment options
offered to you there are many different
stages of mesothelioma and we will go
through this in great detail with you
once you come in to the clinic to be
evaluated we hope that you enjoyed this
discussion we look forward to seeing you
we hope you enjoyed this segment on
mesothelioma we hope you enjoyed hearing
about how to stage mesothelioma the
causes of mesothelioma and some of the
different treatment options if you have
questions feel free to call our office