Thank you everyone for last night's work.
One question that was asked last night about Mesothelioma and how it differs from other cancers.
Mesothelioma:
Usually sudden in onset in previously unusually healthy non-smoking active individuals.
Very shocking because, in women particularly, very unexpected – presents commonly with increasing breathlessness. Frequently, GP thinks ‘chest infection’ and treats with anti-biotics for some weeks and then chest x-ray requested revealing pleural effusion (fluid in the chest cavity) this prompts admission for investigation as to the cause.
The fluid is drained, or aspirated off and biopsies taken from suspicious areas if any can be seen. At this point the breathlessness improves and the patient feels almost back to ‘normal’.
The patient is then likely to be referred to a thoracic surgeon for a ‘VATS’ (Video Assisted Thoracoscopy) this involves a general anaesthetic, a small incision in the chest and video viewing of the chest cavity. Further biopsy material is taken, and then a spray of talcum to the surfaces to cause adherence and obliteration of the space where the fluid collected (this is called a pleurodesis).
When this has been done and the incision healed, radiotherapy is given to the site to try and prevent the mesothelioma from ‘tracking up’ the wound and causing a lump on the site.
When June was diagnosed this was the accepted standard of treatment, it still is, but recently chemotherapy in many forms and with little success is being offered to patients with mesothelioma. Also, very early diagnosed patients may be offered extensive surgery called a ‘pleuro-pneumonectomy’ – this is the removal of the entire lung, part of the diaphragm, the inner linings of the chest wall and around the heart. The five year survival rate for this operation is still very poor. Most of this surgery is done by a very few experienced thoracic surgeons.
How the disease progresses:
The mesothelioma usually starts at the bottom of the lung (more commonly the right lung) and spreads from this point in all directions affecting the surfaces of the organs i.e. the lining round the lung, the diaphragm, the inner chest wall (it may invade the ribs) the heart, the oesophagus and trachea. It may track down past the diaphragm and affect the abdomen. In some cases this is where people get the disease to begin, then called ‘peritoneal mesothelioma’. Depending upon the cell-type (there are aggressive, medium, and slow types – June’s was the slow type) the person may live anything from 4 months to 3 years the average being 8 to 16 months. I think June lived about three years from diagnoses.
Particular problems associated with meso:
1. Pain control can be particularly difficult in a percentage of people. They experience complex pain involving nerve compression or erosion, this often requires expert help to keep control of, as it can be intermittent and very variable. The level of analgesics required for people with meso is on average double that of most other cancer sufferers. June suffered difficult pain problems when her disease was advanced and when she was dying.
2. Breathlessness is common to all sufferers, becoming worse gradually as the disease progresses, until towards the very end they are likely to be unable to get out of a chair or bed without assistance and require 24 hour care.
3. There may be problems with swallowing if the mesothelioma encases the oesophagus. This sometimes requires surgical intervention and the use of stents (not common).
4. If the meso encases the heart muscle is may cause a wildly erratic heart-beat which is itself a life-threatening situation.
