In different countries of the world, the incidence of malignant pleural mesothelioma are quite different from the seven parts per (Japan) annually from one million to one million parts per forty (Australia) range, which is mainly with these countries over the past few the annual consumption of asbestos related. In Europe, the incidence of malignant pleural mesothelioma in about twenty millionths. Western countries from the beginning of the 1980s, a comprehensive ban on the use of asbestos, but asbestos exposure and mesothelioma latency period between the onset of up to 15 to 60 years, so epidemiologists expect the developed countries, the peak incidence of malignant pleural mesothelioma will appear in the next decade, some countries may have reached the peak of incidence ...
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Risk Factors
Asbestos
malignant pleural mesothelioma asbestos is the major risk factors. Asbestos is widely used before the disease is rare. Reports from South Africa in 1960 for the first time confirmed malignant pleural mesothelioma with asbestos and other occupational exposures. 70 to 80% of patients with malignant pleural mesothelioma with asbestos exposure history. Asbestos is a general term for a group of silicate minerals having an inorganic fibrous crystal structure of the naturally occurring, divided into two genera: the genus includes the most common chrysotile chrysotile (white asbestos); genus includes amphibole crocidolite, amosite, anthophyllite, tremolite and actinolite. Chrysotile, crocidolite and amosite are widely used in industry. Most of amphibole fibers, particularly crocidolite, amosite and tremolite, chrysotile fibers have a higher ratio of carcinogenicity ...
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Clinical manifestations
Malignant pleural mesothelioma patients, 80% were male, associated with pleural effusion usually presents dyspnea, often accompanied by (more than 60% of patients) had chest pain. Even if all cytology results are negative, unexplained pleural effusion and pleural pain should be suspected malignant pleural mesothelioma. Malignant pleural mesothelioma usually occurs two or three months after being diagnosed with symptoms, the possibility of low incidence of delayed diagnosis of bigger areas. Routine chest X-ray examination occasionally found malignant pleural mesothelioma. Because the occurrence and development of malignant pleural mesothelioma is more subtle, so the treatment of tumor patients often have widespread violations of the surrounding tissue, tumor metastasis but not the main reason of death in patients ...
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Disease diagnosis
Correct and fast diagnosis of malignant pleural mesothelioma treatment is very important. Diagnosis of the most difficult is how to identify malignant pleural mesothelioma and adenocarcinoma, especially adenocarcinoma infringe pleura after identification more difficult.
1. Imaging diagnosis
routine chest X-ray can be found pleural effusion, pleural tumors occasionally found. Initially patients showed progressive increase enveloped lumps; or the performance of a wide range of leaf base is located in the pleural mass; or both. Pleural plaques (benign pleural fibreboard) is the place on the limitations of the parietal pleura fibrous scar plaque, suggesting that there was asbestos exposure, but not malignant pleural mesothelioma precancerous lesions ...
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Staging and prognosis
Malignant pleural mesothelioma after diagnosis with a median survival of 12 months. Following poor prognosis: male patients, extensive lesions, poor physical condition, white blood cells, anemia, thrombocytosis, sarcomatoid histology or PET-CT and other high metabolic value. Certain biochemical markers such as cyclooxygenase 2 and vascular endothelial growth factor (VEGF) expression, P16 gene hypermethylation, increased angiogenesis and SV40 virus-positive tumors also indicates a poor prognosis. Performance status and histological subtype of the patient is the only important clinical prognostic factors ...
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Disease treatment
Epidemiological : What is mesothelioma
surgery position in the treatment of malignant pleural mesothelioma is still uncertain.
Surgery aimed by removing visceral tumor tissue to relieve pressure caused by atelectasis. By removing the parietal tumor tissue can relieve chest pain and restrictive hypoventilation. This process can be assisted thoracoscopic surgery (VATS) by thoracotomy or closed television to complete, should give priority to VATS ...
2. Chemotherapy
generally considered malignant pleural mesothelioma chemotherapy poor response rate of less than 15% to 20%, due to poor efficacy, it is not recommended in patients with malignant pleural mesothelioma conventional chemotherapy. Recently, a series of multi-center study showed several new chemotherapy achieved some results.
Pemetrexed (pleural effusion metrexed) are more potent inhibitors of protein can be suppressed include thymidylate synthase and dihydrofolate reductase, an enzyme which is essential for DNA synthesis. III clinical study results of a multi-center showed that the joint use of pemetrexed and cisplatin long-term treatment of 448 cases of patients with a median survival time (12.1 months) longer than cisplatin alone (9.3 months) median survival, efficiency 41% (tumor size at least 50%) ...
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Epidemiological : What is mesothelioma