Mesothelioma is a rare form of cancer in the mesothelium, the protective lining that covers many of the body's internal organs. A number of epidemiology studies have been conducted in a number of different countries and have found that exposure to asbestos is the primary cause of mesothelioma. It can also be caused by radiation treatment (used for other types of cancer) or virus SV40 (originating with monkeys). Mesothelioma has a higher incidence among men.
Types of Mesothelioma:
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50%-60% of cases are malignant mesothelioma epithelial type
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30% are mixed type or biphasic malignant mesothelioma
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10% are malignant mesothelioma fibrous type (sarcomatoid type)
Symptoms include chest pains, and shortness of breath.
Tests
Hadassah now performs the Mesotholiene test in the Immunology Laboratory. This laboratory is headed by Prof. Vivienne Barak. The marker isn’t specific to mesothelioma and does not appear among all patients, however high level in the blood of a patient who may have mesothelioma is important in order to track their response to treatment.
Another marker which can help doctors track the disease is a protein called SMRP. Additionally, thrombocytes in the blood can get up to two times the normal amount.
Imaging
CTs are the most common type of imaging tests used to monitor mesothelioma. MRIs are used in a few cases, to determine if surrounding organs have been affected. PET scans are rarely used, mainly to determine the existence of metastases farther away from the primary cancer site.
Treatment
Mesothelioma is a relatively rare disease and only a small number of studies have been performed on different types of treatment methods. In most cases, there are no guidelines for most patient treatment.
There a few medical centers where mesothelioma is treat via resection surgery. In some cases, this resection removes an entire lung. To be successful, this operation needs to remove the tumor in its entirety.
Among most patients, mesothelioma is discovered at a relatively advanced stage and the chances of a successful resection are extremely slim.
To date, radiation treatment has not proven itself very successful for most patients. A combination of radiation and chemotherapy has not been extremely successful either. Most patients treated at Hadassah were subject to radiation to treat pain and not as part of the overall treatment strategy.
Chemotherapy Treatment
Currently, the most accepted treatment strategy for mesothelioma is a combination of a drug called Premetexed-Alimta and Carbopalatin. Other medications have been used for mesothelioma patients, but have been proven to be less effective. Most are not covered by the public health funds. Other drug combinations include Cispalatin with Doxil. This combination has been used successfully at Hadassah Ein Kerem.
For patients with peritoneal mesothelioma, there is an option of a radical resection of the tumor, using chemotherapy during the operation.
Physicians
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Prof. Uzi Yizhar – Cardiothoracic Department
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Prof. Rephael Breuer – Pulmonology
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Prof. Dorit Shaham – Imaging
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Prof. Aviram Nissan (HIPED) – Surgery
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Dr. Rina Rubenstein – PET scans; nuclear medicine
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Prof. Nechushtan Hovav - Oncology