The pleura consists of 2 sheets (layers); the inner layer is the visceral pleura covering the surface of the lung and the outer layer is the parietal pleura covering the mediastinum and diaphragm surface of the inner part of the chest. Therefore, this pleural disease is adjacent to the inner part of the chest wall of the lung, mediastinal structures and diaphragm. This makes it impossible to leave a safe margin in the surgical treatment of this disease.

Why does mesothelioma occur?

Exposure to asbestos is the most important known cause of mesothelioma. Asbestos is a mineral found in nature, in rocks and soil. Its structure consists of long and thin fibers. These fibers are so small in size that they can only be seen with the use of a microscope. Asbestos fibers are strong and flexible and resistant to fire and flame. Hence, they have been used industrially, especially in the past years, in various areas such as insulation materials, the shipping industry, brake linings, etc. and is still used partially. Asbestos fibers can fly in the air in small pieces and are taken into the lungs by the breathing tiny asbestos fibers that move to the outer part of the lungs and pass into the pleura cause cancer development as a result of irritation and chronic inflammation. People exposed to asbestos are 40 times more likely to develop cancer than the rest of the population. Even the relatives of people exposed to asbestos are known to be at risk for mesothelioma, as they can get these fibers indirectly (when removing asbestos-contaminated clothes, etc.).

Another cause of mesothelioma in our country and in some neighboring countries is erionite, an asbestos-like mineral found naturally in soil. It is found in the white soil used for plastering and painting adobe houses in some provinces. Erionite causes mesothelioma through an asbestos-like mechanism.

What are the symptoms of mesothelioma?

In mesothelioma, at beginning pleural fluid accumulation occurs, causing lungs to shrink and then thickining of pleural layers occurs which restrict the lungs. Patients have symptoms of;

– shortness of breath and

– blunt chest pain. It may be accompanied by some coughing.

Some of the consequences of progressive disease are:

– weakness,

– loss of appetite,

– weight loss

How is mesothelioma diagnosed?

The patient’s asbestos exposure should be questioned at every shortness of breath. Fluid in the lung membrane on chest X-ray is suspicious. Computed tomography provides a better view of the lung membrane and the presence of fluid collection, thickening of the membrane and nodules due to mesothelioma should be highly suspicious. For a definitive diagnosis, a biopsy of the pleura or a sample of the fluid should be taken for pathological examination. Failure to see cancer cells in the fluid sample does not rule out the disease. A piece of the membrane of the lung must be taken. Although this biopsy can be taken blindly from outside the chest or with a needle under tomography, the success rate is not very high. The most valuable method, albeit a bit laborious, is the videothoracoscopic method, in which a camera is inserted through a single hole, the membrane is observed and a piece is taken from the nodules and from the membrane visually.

How is mesothelioma most successfully treated?

Mesothelioma has a very poor prognosis and there it is not correct to prioritize a single best treatment. In general, the following 3 treatment options are used solely or in combination.

 -Surgery

 -Chemotherapy and immunotherapy

 -Radiotherapy

Based on various factors such as the patient’s age, general condition, stage of the disease, subcellular type of mesothelioma, the treatment option or pathway is determined according to the joint decision of specialists from different disciplines in the oncology council.

How is mesothelioma surgery performed?

In the diagnostic stage of mesothelioma, surgical intervention for biopsy, videothoracoscopy (single hole VATS) can be performed. In addition, palliative surgeries such as pleural fluid drainage or pleurectomy + pleurodesis may be necessary in order to relieve the patients’ symptoms if persistent massive fluid accumulates in the pleura despite prior treatment.

 If radical surgery is decided to treat the disease, there are two ways:

– Radical pleurectomy+decortication surgery in which only the inner membrane (visceral pleura) and the outer membrane of the lung (parietal pleura) are peeled off without removing the lung itself,

-Pleuropneumonectomy surgery in which all membranes are removed togather with the lung.

Since it is often not possible to peel off the diaphragm muscle and the pleura covering the pericardium, when removing the outer membrane of the lung, the pericardium and the diaphragm muscle must also be removed during these surgical operations.

Surgical treatment alone is not sufficient. Chemotherapy, immunotherapy and radiotherapy (multimodal treatment) must be performed after surgery as well.

What is the life expectancy in mesothelioma?

Mesothelioma is a cancer with a very poor prognosis. The possibility of cure is very low. Only in the early stages of disease it is possible to perform a surgery. The treatments,  prolong life expectancy in most patients.