Mesothelioma is the same as asbestosis
Pleural mesothelioma is a malignant growth of the pleura, which can usually occur with a delay of usually more than 15 years after contact with asbestos fibers. Inhaling asbestos fibers, which are produced when processing asbestos (sawing, drilling, etc.), is a clear risk factor for the development of the disease. Since the disease begins very insidiously and is often only discovered when therapeutic measures can no longer lead to a cure, everyone who has been in contact with asbestos as described above is asked to take regular x-rays of the lungs. The illness is one of the longest recognized occupational diseases and the treatment costs are covered by the Swiss accident insurance or the employers' liability insurance association. The assessment of the X-ray images carried out as part of this screening is not trivial and should be carried out by a specialist who specializes in this. Every pleural effusion in people with asbestos exposure urgently needs clarification. Until a different diagnosis can be made, it is considered to be mesothelioma-related.
However, due to the practically no symptoms, we see very few patients in the early stages. However, since one also wants to help patients at an advanced stage, various treatment concepts have been developed. If the tumor is no longer operable and the effusion, i.e. the resulting shortness of breath, is the main symptom, a minimally invasive pleurodesis can be performed. If the tumor is in a locally operable stage, the patient should be treated as part of a study, as the optimal treatment regimen has not yet been developed. A tumor that is in principle operable is considered to be curable. First of all, the diagnosis must be confirmed and the patient prepared for a multimodal approach. A thoracoscopic sample is taken from several parts of the pleura and a so-called pleurodesis is carried out, i.e. the pleura is glued to the lungs so that the tumor cannot secrete fluid during the subsequent treatment, which can lead to shortness of breath and possibly to discontinuation of therapy . Then a combination of chemotherapy with subsequent surgery and, if necessary, radiation is carried out. This aggressive approach can result in significant life extension. From a statistical point of view, this means that the average survival can be extended from approx. 1 year after diagnosis to over three years after diagnosis. In other words, the probability of being alive 5 years after diagnosis increases from approx. 10% to 30-40%. This applies to patients who have responded well to chemotherapy, have had the tumor completely removed and no lymph node involvement can be detected.
As part of this concept, surgery is usually performed 6 weeks after the end of chemotherapy. The lungs in the pleura are dissected out of the chest and removed with part of the adhering pericardium and diaphragm. The pericardium and diaphragm are replaced by plastic nets. The external appearance of the rib cage hardly changes noticeably after the operation. The recovery phase after this procedure takes about 2 weeks. Rehabilitation is then followed up before further treatment is carried out. The quality of life of the patients is satisfactory after the treatment and has been restored to such an extent that the interventional therapy is entirely justified from this point of view.
Resettlement of the tumor in distant organs is rare. The tumor, however, tends to recur in the same place and grows into the neighboring internal organs, the failure of which it thus initiates.
The results in the treatment of pleural mesothelioma have improved significantly in recent years. In addition to the modern concepts, this is primarily due to the fact that the patients are treated at specialized centers that have well standardized the complex treatment process.
Thoracic surgery at the University Hospital Basel is part of such a center and contributes to improving treatment results by treating every patient with pleural mesothelioma in an interdisciplinary study.
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