The most common symptoms of pleural mesothelioma is, shortness of breath, chest pain and persistent cough. However, some patients show no symptoms. A common sign is pleural effusion (water on the lungs).

Some symptoms of peritoneal mesothelioma include weight loss, abdominal pain and swelling and intestinal obstruction. If the cancer has spread to other parts of the body, some other common symptoms can include difficulty swallowing, swelling of face or neck, blood clotting problems, anemia, and fever.

Also the diagnosis may be difficult due to the nonspecific nature of the symptoms of mesothelioma, symptoms that often seem far less serious diseases.

The diagnostic process usually begins with a compilation of a complete medical history and work history, including any exposure to asbestos. We performed a medical examination and if you suspect a problem ask several diagnostic tests. These typically include medical imaging tests such as X rays, CT and MRI, and biopsy procedures that test samples of fluid and tissues by the presence of cancer cells. Diagnostic tests are also used to determine how far the cancer has spread, and if progress has been made elsewhere in the body.

For patients with the drug so far as little as a controllable current malignant pleural mesothelioma, there is now a treatment option. Studies have shown that the antifolate pemetrexed in combination with cisplatin can prolong the survival of these patients.

Pemetrexed (Alimta ®) was approved in September for the indication for pleural mesothelioma and second-line chemotherapy in advanced cancer. It is the first drug that has an approval in Europe for the treatment of patients with malignant pleural mesothelioma.

In a large Phase III trial survived the patients who received pemetrexed and cisplatin had an average of twelve months. Untreated patients with malignant pleural mesothelioma usually die within months after diagnosis. Just over half the patients treated with pemetrexed and cisplatin was, after a year still alive. Of the patients in the control group who received only cisplatin, at that time lived only 38 percent.

“In combination with cisplatin, pemetrexed has become the standard for the treatment of patients with malignant pleural mesothelioma”, said Professor Christian Manegold of Heidelberg University oncologist at the European Congress in Vienna. could the first time, patients with a disease, its abundance in the western world because of its association with a 20 to 40 years back lying to asbestos grow strongly for several years, will be offered chemotherapy.

Manegold highlighted the good tolerability of pemetrexed treatment. The substance, which is administered once every three weeks along with vitamin B12 and folic acid come, the ideal of a quality of life only slightly debilitating chemotherapy very near, Manegold at the event supported by the company Lilly

There is a percentage of people that the tumor is asymptomatic and therefore diagnosis is more often than by chance for this is the most serious.
The symptoms are:
shortness of breath, chest pain or swelling in the abdominal region.
Usually the first means of diagnosis are an abdominal ultrasound and chest X-ray but sometimes not enough and then if the RX is a good thing can also be used as an examination to confirm or deny, CT or MRI, bronchoscopy, biopsy.

Removal a fragment of tissue which is then subjected to cytology, or thoracoscopy, a test that allows you to see the internal structures of the chest through a small incision in the chest wall is introdrodotto an instrument through two coasts. The thoracoscopy is normally done in hospital using a locale.

Mentre anesthesia for abdominal cavity can be viewed with peritoneoscopia, a procedure through which you enter through the abdominal wall also this check is performed in hospital under local anesthesia.
The prognosis depends on the magnitude of the tumor and where it is located.
The stages of cancer are under the spread of the tumor when the tumor is confined to the pleura or invade the diaphragm is called stage I;

when the tumor over the pleura, also includes the regional lymph nodes and stage II;
but when it spread to the chest wall, the central part of the chest, heart, through the diaphragm or peritoneum, and in some cases even to nearby lymph nodes is already at stage III, whereas when you have had metastases that is when the tumor is arrived Insone that are far and which may be different from the bodies’ origins of cancer is stage IV.
The stage II to stage IV sie already in a advanced state of the tumor.

The treatments are:
surgery, taking out the cancer when it is in advanced state;
radiation therapy using high doses of X-rays to kill cancer cells;
chemotherapy, which consists of the administration of drugs to kill cancer cells.
Lately, we use a new therapy called: Intraoperative photodynamic therapy is that it uses special drugs and light to kill cancer cells during surgery. This type of therapy that is preparing a few days before surgery, is administered intravenously a drug that makes cancer cells more sensitive to light. During the operation, a beam of light will be focused particularly on the pleura in order to view and, therefore, destroy as many cancer cells. This type of treatment is used on an experimental basis for the early stages of pleural mesothelioma.
It may happen that the tumor recurrence is called relapsing Mesothelioma.

Furthermore, more studies emphasize how the Tri-modal approach is the most effective therapy against mesothelioma. This treatment uses chemotherapy, surgery and radiotherapy, and has tripled survival.

From the surgical point of view – Alloisio says – a statement is now being represented by extra pleural penumonectomia, which allows the removal of the pleura, the lung and the pericardium and diaphragm.

It is a very complex operation, performed only in a few specialized centers including Humanitas, which has the third Italian case study for the number of interventions.

Malignant pleural mesothelioma is a rare but very aggressive tumor. The disease affects the pleura, the membrane covering the lung, and less commonly the peritoneum. The onset of this tumor is closely linked to exposure to asbestos, mineral fiber commonly known as asbestos. Millions of people have been exposed to asbestos over the past 30 years: directly, if they worked with the extraction of this substance. Indirectly, if you have worked with asbestos in shipyards or cement, or if they lived close to affected areas such as mining or processing asbestos mines or industries. The cases of mesothelioma have increased alarmingly in recent years and are destined to grow further. But compared to just a few years ago, the prognosis of this disease has improved significantly increase the prospects coming to see life.

The incidence of mesothelioma in European countries varies from 15 to 33 cases per million inhabitants (in Italy is 19 cases per million inhabitants). A study by the New England Journal of Medicine, in the next 40 years are expected 250,000 deaths from mesothelioma in Europe, 72.000 in the United States, 103,000 in Japan and 30,000 in Australia. Worrying data come mainly from developing countries such as India, where the mining and processing of asbestos still affect a significant number of employees, and where only recently been undertaken stringent preventive measures. In Italy was imposed cessation of asbestos exposure but also occurred 30 years ago can cause the onset of this disease. Geographical areas where you are concentrating more mesothelioma are industrial areas and shipyards.

The research group of Professor Alfonso Baldi, Department of Biochemistry and Biophysics of the Second University of Naples, in collaboration with the Cancer Institute Regina Elena, was the first to characterize the role of HtrA1 as a tumor suppressor, as the high HtrA1 expression in tumor cells reduces the proliferation and migration capacity of these cells.

In collaboration with the Cancer Center at the Mayo Clinical Rochester (USA), Professor Baldi showed that HtrA1 acts as an endogenous mediator of the action of cisplatin in cancer cells and that levels of expression are able to predict response to treatment with cisplatin in tumors of the ovary and stomach.

These findings have led scientists to analyze expression of HtrA1 in a large group of mesotheliomas treated at the Istituto dei Tumori Regina Elena and the Second University of Naples, this new research demonstrating that the higher the expression of HtrA1, more is the survival of patients. This observation allows HtrA1 counted among the few prognostic molecular marker of mesothelioma.

It can be assumed that modifying the levels of expression of HtrA1 in tumor cells, we can make these cells less aggressive and more sensitive to treatment with cisplatin. Further studies are currently underway at the Regina Elena and meanwhile all cancer patients hope to soon have more effective treatment to preserve their health. Comment on this article on the forums and subscribe to the newsletter, you will receive every week the news that matters to your health.

The FDA has approved pemetrexed (Alimta) in combination with cisplatin for the treatment of malignant pleural mesothelioma, a rare form of cancer.

This form of cancer is usually associated with exposure to asbestos (asbestos).
When the patient feels the symptoms, the cancer is already well advanced, and survival is only 9-13 months.

The efficacy of pemetrexed has been demonstrated during a clinical trial.
Patients treated with pemetrexed and cisplatin survived longer than patients treated only with cisplatin (12 months versus 9, respectively).

To reduce the incidence and severity of side effects, patients receiving pemetrexed should also take supplements of vitamin B12 and folic acid.

The most common side effects seen with the use of pemetrexed were: reduction of white blood cell count, nausea, vomiting, tiredness, rash and diarrhea

In the asymptomatic phase, diagnosis is done randomly, following a chest x-ray. Diagnostic imaging is divisive for the characteristic features, clearly visible on x-rays and the computed tomography. The radiological examination of the chest is essential for the precise diagnostic definition, and radiological aspects are variable in relation to the configuration assumed by the neoplastic process.

Localized forms (Fig. 2) show an area of intense opacities more or less, a polycyclic contours from whose context is different, the outer parietal and visceral pleura, mammellonature prominent. It ‘very often, after thoracentesis, detect radiographically lung parenchyma greatly retracted, veiled by an extensive opacity, the lung is unable to riespandersi, as the visceral pleura become rigid and inestensibile.Per confirming diagnostic pleural biopsy is needed, transparietale pleuroscopia or by histological examination supported by electron microscopy and by immunohistochemistry for the detection of CEA and the marker MPG 2. The needle biopsy transparietale is useful only if positive, otherwise we must resort to more invasive methods.

The fine needle aspiration of pleural fluid and subsequent exfoliative cytology hardly possible to make a diagnosis of mesothelioma for the high percentage of false negatives is due to the reduced tendency all’esfoliazione mesothelial cells, both false positives because of the difficulty in differentiating neoplastic mesothelial cells. Profit is the determination of hyaluronic acid, produced by the tumor stroma, in the pleural fluid, pathognomonic if less than 1 mg / ml.

The thoracoscopy is the best-invasive investigation; it reaches a positivity in more than 94% of patients, having the possibility to explore the whole pleural cavity and to obtain, under the supervision of view, large areas of tissue samples that appear pathological.

The thoracoscopy should be performed early in the presence of a payment to clear liquid, not dependent on causes inflammation, which is rebuilding quickly. The appearance is typical with mammellonature (a bunch of grapes). If the pleural cavity obliterated and appears to be impossible to introduce the thoracoscopy, pleural biopsy is necessary to resort to thoracotomy

The risk factors of mesothelioma is exposure (and in particular inhalation), asbestos, asbestos, exposure to thorium dioxide (thorotrast) for diagnostic purposes and the zeolite. In particular, the majority (70%) of inhaled fibers being eliminated in the sputum or feces.

The remaining 30% through the endothelium by penetrating into the interstitial tissues. The fibers tend to accumulate mostly at the lower third of the lung in a position contiguous to the visceral pleura. The alveolar macrophages are able to transform into carcinogenic polycyclic assets.

The activation of alveolar macrophages leads to production of cytokines and the de-regulation of some proto-onocogeni, including PDGFB, with subsequent proliferation of mesothelial cells. Dose and exposure time are directly related to the risk. The tumor can develop within 20 years after first exposure, with a peak incidence between 35 and 45 years.

Dffusione Mesothelioma
In Italy there are every year a thousand deaths from mesotheliomas: it affects every year, two Italian males per 100,000, while the rate is halved for women (one in every 100,000).
In the past we created a national registry that allows you to monitor new cases and five regions (Piedmont, Liguria, Tuscany, Puglia, Emilia-Romagna region) is very efficient.

The Director of the Department of Environmental Epidemiology Institute of Health: “Even at international level, it discusses the increase of mesotheliomas. In the U.S. cases were significantly increased between the sixties and late eighties, when she came to a head the massive exposure to asbestos suffered especially during the Second World War, especially among the workers of the shipyards where they were built aircraft carriers and battleships.

The cases are, however, declined since the late nineties: this suggests that the peak of the epidemic curve has already been achieved, the maximum number of cases for years has already seen and now, thanks to the banning of asbestos timely, has begun the downward slope.
“The mesotheliomas are tumors that have a low propensity to expand and develop metastases in the body, but they are difficult to heal because – being very aggressive at the local level – are able to determine devastating damage already in the place of occurrence, ie the membrane surrounding the lungs, “says Ugo Pastorino, Director of Thoracic Surgery National Cancer Institute of Milan.

Depending on its size can be classified into two forms:
Solitary forms
Solitary forms are silent for a long period of time. At this stage are frequent paraneoplastic syndromes such as osteopathy , platelets, low blood sugar. The first symptoms that appear are due to an increase of volume compression causes symptoms including pain and heaviness.
Diffuse forms
Even the forms are spread undetected for a long period of time. With the progression of the disease appearing chest pain (often radiating to the back-end), dyspnea on exertion first and then even at rest, cough, fever, weight loss and hemorrhagic pleural effusion free or bag. In advanced stages with mediastinal involvement may have vocal cord paralysis, Horner’s syndrome and compression of the veins quarries.

Causes: asbestos and other mineral fibers
The outbreak appears to be highly correlated long-term exposure to mineral fibers, particularly asbestos and fluoroedenite. All steps in the processing of minerals from which they derive, extraction is sorted by carding to spinning fibers, and manipulation of derivatives to perform insulation, are considered highly risky for the development of cancer cells, damage mineral fibers are not immediate, but occur on average after three decades.

It is not yet known the mechanism by which the microscopic mineral fibers are able to migrate passively from bronchioles to the alveoli to the pulmonary pleural space, and perpetrators of thickening, calcification and asbestosis, ignite the oncogenic process. They may act as agents of inflammation from mechanical, chemical, or as free silicic acid which has similar necrotizing, or again, can act as catalysts of reactions from which they develop carcinogens.

The incidence of mesothelioma of the pleura is particularly high in Western Europe, where currently there are about five cases a year, specialists provide a peak around 2020, caused by the latency of the disease, followed by a rapid decrease resulting the rules in the early nineties banned the use of asbestos (in Italy, this happened with the law 257/92). In our country the death rate is among the highest in the world, especially in Northern Italy and Campania, ie where, before the entry into force of the law, it was massive use of mineral fiber insulation: in the shipyards, railway workshops, workers used in building material, however, were also at risk family members of workers who breathed the tiny fibers deposited on clothing of these.

Other causes
In the absence of un’accertata exposure to asbestos, the cause of mesothelioma can be sought from pleurisy, chronic smoking and exposure to ionizing radiation. Recent studies have shown a possible link between the disease and the virus SV-40 that in the sixties was used for the preparation of polio vaccine. Again, it is believed that the thin fibers, migrated from the lung tissue to the pleural membrane, are engulfed by macrophages in which induce biochemical changes and abnormal cells, development of cancerous cells.

Symptoms and Treatment
Mesothelioma causes a significant thickening of the pleural membranes, including those of several centimeters, and the gradual closing of the gap between the two layers, which over time creates thick deposits of fluid, gray. The tumor ends up mechanically forcing the lungs, which tends to collapse, losing its functionality (atelectasis). The first symptoms are pleural effusion, chest pain, difficult breathing, disease progression leads to fever, cough, loss of weight and chest deflection where the pleura is affected.

Therapy
Although pleural mesothelioma not now gives hope of complete recovery, its evolution depends, as for many types of cancer, timeliness of diagnosis and aggressiveness of treatment that can prolong patient survival. Therapeutic results depend greatly on the stage of disease, the patient’s age, the amount of lymph nodes involved by the tumor. The techniques used are surgery, with removal of the pleura (pleurectomia) of the pleura and lung (pleuropneumonectomia) with talc or closing of the gap between the two pleura to avoid payments (pleurodesis), radiotherapy or chemotherapy. More recent studies suggest that only one type of therapeutic approach has not resulted in satisfactory changes in survival are more favorable prognosis could be expected following combination therapy, which embraces all three approaches mentioned. Are also ongoing trials of photodynamic therapy applied to mesothelioma.

* Shaped or preformed coatings used for thermal insulation of pipes and boilers
* Asbestos spray used as fire protection in ducts, fender in the margins, in the panels in the walls, in the axes of the floor, ceiling panels and around structural steel
* Assi insulation used for fire protection, thermal insulation, the partitions and pipes
* The coatings used in the margins of asbestos in the fender and the ceiling cavity
* Double-pressed cardboard, paper and paper products used for the insulation of electrical equipment, asbestos paper may also be used as flame-retardant coating on the panels of wood fiber
* The products of asbestos cement, corrugated sheets or plates that are used for roofing or cladding of the walls, and supplies of cement were also used in the gutters, downpipes and tanks in the water
* Textured finish (such as Artex)
* Material of cover based on bitumen
* Tile vinyl or thermoplastic