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Mesothelioma: Causes, Symptoms, Treatment, and Prevention

by Doni Wulandari (2020-07-13)

Mesothelioma is a cancer that attacks the mesothelium, which is a thin layer of tissue that covers most of the internal organs. Some organs that have mesothelium, including the lungs (pleura), stomach (abdomen), heart (pericardial), and testicles (tunica vaginalis). This cancer is classified as aggressive and many sufferers who are not successfully treated.

Mesothelioma most often attacks the lung mesothelium (called pleural mesothelioma) and the chest wall. Another type of mesothelioma that is more rarely found is peritoneal mesothelioma, which attacks the mesothelium of the abdominal cavity. Mesothelioma is different from the benign mesothelioma in the chest which is also called a solitary fibrous tumor.

Causes of Mesothelioma
Cancer that attacks the organs of the body starts from cell mutations that cause growth to be out of control until then multiply. Experts are still unable to ascertain the cause of these cell mutations. However, the interaction between lifestyle, hereditary conditions and the environment can be allegedly a trigger factor for cancer.

Although the exact cause of mesothelioma is unknown, the main risk factor for mesothelioma is asbestos. This disease is relatively rare before commercial use of asbestos begins. Asbestos is a mineral used as material to make brakes, floors, roofs and insulation.

Asbestos dust that is inhaled or swallowed will accumulate in the lungs and stomach for a long time, usually around 20-50 years, before eventually developing into mesothelioma. Mesothelioma is also more often diagnosed in men than women, and in someone over 65 years old.

Some other factors that can trigger this disease, namely:
- Environment where the soil has asbestos content.
- Living in an area or living with someone who has a job related to Asbestos exposure can also stick to the skin and clothing so as to bring asbestos into the house or other environment.
- Have been exposed to asbestos or have family members suffering from mesothelioma.

Symptoms of Mesothelioma
Symptoms of mesothelioma can vary based on the location of cancer cells. Pericardial mesothelioma may cause chest pain and difficulty breathing, while mesothelioma tunica vaginalis will show symptoms of swelling of the testicles.

Pleural mesothelioma has the following symptoms:
- Cough accompanied by unbearable pain.
- Shortness of breath due to accumulation of fluid in the chest.
- Unusual lumps in the tissue behind the chest skin.
- Weight loss for no apparent reason.
- Often hit by excessive fatigue.
- Fever accompanied by sweat especially at night.
- Swollen fingertips.
- Chest pain that feels under the rib cage.

Peritoneal mesothelioma has the following symptoms:
- Pain in the stomach area.
- There is a lump in the stomach tissue.
- Swelling in the abdominal area.
- Weight loss without cause.
- Diarrhea or constipation.
Given the mesothelioma symptoms that are not specific and can be associated with other conditions, then you should immediately see a doctor so feel the symptoms above, especially if there is a history of exposure to asbestos.

Diagnosis of Mesothelioma
The examination will begin with anamnesa about the symptoms suffered, personal and family medical history. Anamnesa is a conversation conducted by the doctor to the patient directly as a way to get data about the conditions and medical problems being experienced by the patient. In addition to the history, the doctor will do a physical examination to check for lumps or other abnormal signs.

Furthermore, the doctor may instruct to be investigated as part of an effort to diagnose the disease. Common tests are performed to diagnose mesothelioma, including X-ray to check for abnormalities in the chest and CT scan to examine the chest and abdomen area.

Biopsy or other tests can also be done to determine what diseases are causing the symptoms to appear. Biopsy is a laboratory examination of a small amount of tissue that can be taken from different parts of the body, depending on the location of the disease suffered. The tissue is then examined in a laboratory to find out what type of cell is causing the abnormality, and to know what type of cancer it has. As for several types of biopsies that may be recommended for the mesothelioma diagnosis process, namely:
- Biopsy uses a small fine needle to draw tissue or fluid samples from the chest or stomach.
- Laparoscopy Biopsy by making small incisions in the abdominal area to take tissue. This procedure is aided by a surgical instrument as well as a very small camera.
- Laparotomy Biopsy by opening the abdomen open to take tissue to be examined for the presence of diseases or other abnormalities.
- Thoracoscopy or VATS (video-assisted thoracoscopic surgery) Biopsy by making a small incision between the ribs to insert a camera and a small surgical instrument into the chest cavity and take a small sample of tissue to be examined.
- Thoracotomy Biopsy by dissecting an area between the ribs to examine the area, whether there are signs of disease and taking tissue samples if needed.

After the diagnosis is obtained, the doctor will conduct further tests on the patient's body, such as MRI imaging tests and PET mapping, to determine the stages of the disease and the steps that treatment can take. There are four stages (stages) in pleural mesothelioma, while the stage of spread in other types of mesothelioma which is more rare is still not known with certainty. The four stages of pleural mesothelioma consist of:
- Stage I The condition of cancer is still local, that is only in one area in one layer of the chest.
- Stage II The cancer has spread outside of the chest lining to the area of the lungs or diaphragm.
- Stage III Cancer has spread to other areas in the chest or has invaded the nearest lymph node. Some of the locations of lymph nodes in humans are in the neck, armpits, and around the groin,
- Stage IV Advanced cancer that has spread throughout the chest or other body areas, such as the brain and liver.

Mesothelioma Treatment
There are several steps to treat mesothelioma that may be recommended by a doctor. The treatment plan chosen will depend on the condition of the disease, the stage of the cancer suffered, and the health of the patient in general. But considering that mesothelioma is a cancer that can not be cured and generally can only be detected at an advanced stage, the treatment step is more aimed at reducing the symptoms felt by patients.

While there are a number of treatment options for pleural and abdominal mesothelioma, it is different with pericardial mesothelioma and tunica vaginalis for which there is no treatment because they are considered more rare. However, cancers that are still in the early stages can be removed through surgery or the patient can still go through other treatments to reduce the symptoms.

Here are some steps to treat mesothelioma that are generally carried out:

Chemotherapy
Chemotherapy is medicines that are used to reduce or inhibit cancer growth. This drug can spread to all parts of the body and can be used before surgery or after surgery. In the case of peritoneal mesothelioma, the drug can be heated and given directly into the abdominal cavity so as not to injure healthy tissue in other parts of the body. This method allows the dose of chemotherapy drugs to be given in high doses.

Chemotherapy given before undergoing a surgical procedure can simplify surgery because cancer cells have been shrunk before being removed. Chemotherapy given after surgery will reduce the risk of cancer returning.

Radiotherapy
Radiotherapy can be done after the surgical procedure to eradicate the remnants of cancer cells or reduce the symptoms of advanced cancer when surgery is not possible to do. In its application, this therapy uses high-energy rays, such as X-rays and proton rays, which are focused on certain areas of the body.

Surgery
Surgery is performed to remove cancer which is generally still in the early stages of disease development, although in some cases it still does not succeed in removing the cancer cells completely. Surgery can also be done to reduce the symptoms of advanced cancer that has spread to other parts of the body with the aim of reducing the symptoms suffered. The following are some of the common surgical options and their uses for mesothelioma sufferers.
- Surgical procedure to remove as many cancer cells as possible from the patient's body. This procedure allows the doctor to continue treatment with radiotherapy to reduce pain and prevent excessive fluid buildup due to mesothelioma.
- Surgical procedures to reduce the buildup of fluid in the chest area that can interfere with breathing. The operation is carried out by inserting a catheter tube into the chest to suck up fluid. The doctor can also inject drugs to prevent the recurrence of fluid buildup, also known as the pleurodesis procedure.
- Surgical removal of tissue around the abdominal cavity, ribs, or lungs that have been affected by cancer cells to help reduce the symptoms and signs of mesothelioma.
- Surgical removal of the affected part of the lungs and surrounding tissue to reduce symptoms in patients with pleural mesothelioma. This procedure is usually followed by high-dose radiotherapy.

Multimodality therapy
This therapy is a combination of three or more treatment steps, for example surgery, postoperative chemotherapy (adjuvant chemotherapy), and radiation therapy to increase the success rate of treatment.

Clinical trial
Several clinical trials are generally available and informed to people with cancer, but the possibility of recovery remains unknown with certainty so it is important to be carefully considered. Also discuss with your doctor about clinical trials that exist and if appropriate for the patient's condition. On the other hand, following a clinical trial will increase the chance for doctors to find a treatment for mesothelioma.

Here are some clinical trials that are being studied for the mesothelioma condition:
- Biological therapy uses the patient's immune system to fight cancer, also called immunotherapy.
- Gene therapy changes the genes contained in cancer cells to stop this disease.
- Therapy uses drugs to attack abnormalities / abnormalities that occur in cancer cells.

Complications of Mesothelioma
The following are complications of pleural mesothelioma that has spread to the chest and caused structural stress in the infected area.
- Pain in the chest area.
- Pain caused by pressure on the nerves and spinal cord.
- Hard to breathe.
- It's hard to swallow
A buildup of fluid in the chest that presses on the lungs and complicates the process of breathing

Prevention of Mesothelioma
The main preventive measure for mesothelioma is to reduce contact with everything related to asbestos, the main cause of developing mesothelioma. People who work or are often exposed to asbestos are high-risk groups of people, for example mine workers, factory workers, manufacturers / makers of insulation equipment, construction workers, and mechanics.

If you are part of one of the risk groups above, then you are required to comply with workplace safety regulations set by the company. Sometimes it is better to leave asbestos in place rather than trying to move it without the help of experts, even though both of these still pose a risk of endangering health. Find out, learn, and follow instructions on how to safely handle asbestos in your environment.

Critical Literacy: Theories and Practices is a non-commercial initiative committed to the ethical dissemination of academic research and educational thinking. CLTP acknowledges the thoughtful dedication of authors, editors and reviewers to develop and promote this open journal initiative. The journal receives copy-editing sponsorship from the Faculty of Education at the University of Oulu, Finland. CLTP has previously received copy editing support from the Centre for the Study of Social and Global Justice at the University of Nottingham, UK.

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