Diffuse Malignant Pleural Mesothelioma
Diffuse malignant pleural mesothelioma, or DMM, is a rare but highly aggressive type of cancer. It occurs in the thin layer of tissue, the pleura, lining the chest cavity and lungs. Once diagnosed with DMM, most patients do not survive beyond one year. This cancer is more common in men than in women, and in older people.
Most people with DMM have a history of exposure to asbestos; however, if they are not aware that such exposure occurred, they may be unaware that they are at risk. A patient with DMM typically has one or more of the following signs and symptoms: chest pain, shortness of breath, unexplained weight loss, fatigue, fever, or a cough. An x-ray usually shows that the pleural tissue around the lungs has thickened due to the development of a number of nodules or small cancerous growths. Sometimes, there may be a single large growth. When a biopsy of the cancer tissue is done, the types of cells that make up the cancer may be epithelioid, mixed, or sarcomatoid. People with epithelioid cell cancers tend to survive somewhat longer; those with sarcomatoid cancers usually have the shortest survival.
DMM is always treated as aggressively as possible. The type of treatment depends on the dominant cell type the cancer is made of, the extent of spread of the cancer, and the overall health of the person undergoing treatment. Surgery is a preferred option where the bulk of the cancer can be removed. Many anti-cancer drugs are being tried to treat DMM, with varying levels of short-term success. Radiotherapy may also be an option. A number of clinical trials are currently underway to try and find a treatment that may improve the outlook for DMM patients. However, only seven percent of people with DMM survive beyond five years.
Mesothelium is the protective tissue that covers the chest cavity, abdominal cavity and the cavity around the heart and also produces a special lubricating fluid that allows the internal organs of the body to move around. Malignant Mesothelioma can be defined as the cancer of the mesothelial cells which become abnormal and start dividing without any order. Majority of the mesothelioma patients have a prior history of exposure to asbestos.
Types of malignant Mesothelioma
Malignant Mesothelioma or simply Mesothelioma can be divided into 3 main types namely
Of these, Epithelioid is the most common (50% to 70% cases) and stands the best chance of recovery. Sarcomatoid type is seen in 7% to 20% cases whereas mixed/biphasic type is seen in 20% to 35% cases.
Approximately, of the total cases of Mesothelioma originates in the chest cavity (pleura) and is known as pleural mesothelioma. The cancer affecting the lining of the abdomen (peritoneum) is called the peritoneal mesothelioma and that affecting the sac like space around the heart (pericardial cavity) is called the pericardial mesothelioma. Mesothelioma at times also affects the covering layer of the testicles. However, the last two types of cases are quite rare.
The tumors of the mesothelium can either be benign (non cancerous) or malignant (cancerous). So whenever there are symptoms like shortness of breath, pain in chest/abdomen or swelling in the abdomen, you should consult your doctor immediately.
After the initial X-rays and scans, the doctor may look inside the chest cavity (in case of pleural tumor) with an instrument called thoracoscopy and the test is called thoracoscopy. In case of tumor in peritoneum the doctor may go for peritoneoscopy with the help of a tool called peritoneoscope. Finally, if the abnormal tissue is found then a biopsy is done, whereby a piece of the unnatural tissue is cut out and placed under microscope for examination.
After the confirmed diagnosis of Mesothelioma it is also essential to ascertain its stages i.e. whether it is in localized stage or in advanced stage. In the localized stage, the cancer is found in the lining of the chest cavity or in the diaphragm or the lung. Advanced malignant Mesothelioma can again be divided into 3 stages namely stage II, III and IV. In stage II, the cancer spreads beyond the chest lining to lymph nodes and in stage III it spreads into chest wall, center of the chest, heart, through the diaphragm or abdominal lining, etc. The final or the fourth stage is the one in which the cancer has already spread to distant organs.
Depending on the stage of the cancer, its location and the health, age and medical history of the patient, 3 types of treatments are mated out to malignant Mesothelioma patients surgery (to remove the tumor), radiation therapy (application of high energy rays) and chemotherapy (usage of combination of drugs). This apart, if there is any accumulation of fluid in the chest or abdomen, then the doctor needs to drain it out and the process is regarded as thoracentesis and paracentesis respectively.
So be aware of the disease, such that you can prevent it at the very onset.