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Types of mesothelioma

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Mesothelioma is a potentially deadly cancer which affects the mesothelium, which is the protective sac that covers the body’s internal organs. This cancer is developed from exposure to asbestos and those at high risk are people who have worked with asbestos and had regular exposure to it. Ingestion of the dust and fibers from asbestos is what causes the cells to corrupt and become malignant. Mesothelioma has a very long latency period, which means that it can be decades from exposure to asbestos before any symptoms become evident. Therefore, many people who worked with asbestos and have the disease don’t realize for 30 or 40 years.

Mesothelioma can be benign, but the most common form is the malignant one. It is a notoriously difficult disease to diagnose for a couple of reasons. First, because of its long latency period the symptoms do not manifest until much later in the victim’s life so it is often too late to help by the time a diagnosis is made. Secondly, even when the symptoms do present themselves, they are so non-specific that even the most experienced doctor could put them down to any number of more common illnesses that display the same symptoms.

For this reason, it is extremely important for people that have worked with asbestos at any time during their lives to let their doctor know. This way, the doctor can make a more accurate diagnosis based upon this information should any of the symptoms manifest. Detecting the disease early on can make all the difference between effective treatment and a very short life span.

The three main types of mesothelioma are pleural mesothelioma, peritoneal mesothelioma, and pericardial mesothelioma. These are so called depending upon the part of the body in which the cancer forms.

Pleural mesothelioma is a cancer that affects the pleura, or the lining around the outside of the lungs and the inside of the ribs. Pleural mesothelioma is believed to be caused by inhalation of asbestos or asbestos containing materials. The vast majority of mesothelioma cases (about 80%) are pleural in nature. Pleural mesothelioma can be either benign, which is localized and non-cancerous, or malignant, which is diffuse and cancerous.

Pleural mesothelioma affects the lining of the lung cavity (pleura) and is often misdiagnosed as viral pneumonia (a result of symptomatic similarities). One of the more common types of mesothelioma, pleural mesothelioma is normally detected from a buildup of fluid inside the pleural space (pleural effusion). A typical presenting symptom of pleural mesothelioma is chronic chest pain (a result of pleural effusion), with additional symptoms that include shortness of breath, a persistent cough, weight loss / muscle wasting (cachexia) and fever.

Peritoneal mesothelioma is a cancer of the membrane surrounding the abdomen. This type of cancer can also be benign or malignant. It is believed that peritoneal mesothelioma is a result of ingesting asbestos fibers in the mucus, the protective layer of saliva that works to expel foreign agents from the body. Peritoneal mesothelioma is extremely rare, occurring in only one-fifth of diagnosed cases.

Peritoneal mesothelioma affects the lining of the abdominal cavity (peritoneum) and is one of the more common types of mesothelioma. Inhaled asbestos fibers are often trapped in mucous lining the trachea and swallowed, eventually passing through the intestinal walls and lodging in the peritoneal space. Common symptoms of peritoneal mesothelioma include swelling, abdominal pain, weight loss, blood clotting abnormalities, anemia, fever, and bowel obstructions.

Pericardial mesothelioma is a very rare form of mesothelioma and accounts for approximately 5% of all mesothelioma cases. This form of mesothelioma affects the lining that surrounds the heart and is a deadly cancer if not treated agressively in its early stages. The cause of pericardial mesothelioma is exposure to asbestos dust and fibres. As little as a couple of months of exposure to asbestos fibres can lead to pericardial mesothelioma between 30-50 years later.

Tumors of the mesothelium can be benign (noncancerous) or malignant (cancerous). A malignant tumor of the mesothelium is called a malignant mesothelioma. Because most mesothelial tumors are cancerous, malignant mesothelioma is often simply called mesothelioma.

Malignant mesothelioma is an uncommon, but no longer rare, cancer that is difficult to diagnose and poorly responsive to therapy. Malignant mesothelioma is the most serious of all asbestos-related diseases.

A layer of specialized cells called mesothelial cells lines the chest cavity, abdominal cavity, and the cavity around the heart. These cells also cover the outer surface of most internal organs. The tissue formed by these cells is called mesothelium.

The mesothelium helps protect the organs by producing a special lubricating fluid that allows organs to move around. For example, this fluid makes it easier for the lungs to move inside the chest during breathing. The mesothelium of the chest is called the pleura and the mesothelium of the abdomen is known as the peritoneum. The mesothelium of the pericardial cavity (the "sac-like" space around the heart) is called the pericardium.

To understand mesothelioma is to understand cancer. Cancer is essentially uncontrolled cellular growth. Under normal circumstances, body cells in the hair, bone, organs, or blood grow to a certain point, die off, and are replaced by newer, healthier cells. Unfortunately, most cancer cells are damaged to some degree, and as the body reproduces them they begin to take over for healthy cells, leading to eventual system failure.

Cancers like mesothelioma can affect virtually any type of cells in the body, often radically affecting the prognosis and treatment options for patients. The tragedy of mesothelioma is that it takes decades before most symptoms appear, and by the time the cancer is discovered it is too entrenched in the system to treat. Mesothelioma cells are divided into three main categories: epithelioid, sarcomatoid cells, and a mix of the two types called biphasic mesothelioma.

The most common and relatively treated easily form of the cancer is Epithelioid mesothelioma. Under a microscope this type of the disease is seen as a papillary or tubular growth and generally affects membranes and tissues that cover organs and other internal bodily surfaces. Between 50-70% of mesothelioma cases fall into this category, and this type is most likely to respond to treatment.

Sarcomatoid mesothelioma is the most serious form of the disease, as it rarely responds to any treatment whatsoever. Fortunately it is also the rarest, as it only strikes 10-20% of patients with mesothelioma. It appears as spindle-shaped pattern of cells that overlap one another, and generally arises from support tissues such as bone, cartilage, muscle, and fat. Death usually occurs within six months of diagnosis of sarcomatoid mesothelioma. Like epithelioid mesothelioma, sarcomatoid mesothelioma has a somewhat unique cellular pattern when viewed under high magnification.

Biphasic mesothelioma is not a condition unto itself, but rather it is a combination of the other two types. It can take on both the good and bad aspects of sarcomatoid and epithelioid mesotheliomas and 20-35% of all mesothelioma cases are mixed or biphasic. Unlike sarcomatoid and epithelioid mesothelioma, biphasic mesothelioma does not have a unique cellular pattern unto itself; rather, biphasic mesothelioma consists of a mixture of epithelioid and sarcomatoid mesothelioma cells.

The diagnosis of mesothelioma cannot be specifically by lung x-rays or other types of imaging, because many different types of cancer can be present in the lungs. The images show only that a tumor may be present, but does not provide an indication of whether the tumor is mesothelioma. A biopsy must be performed where the mesothelioma cancer cell types are used to distinguish mesothelioma from other types of cancer, such as lung cancer.

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