How Does Asbestos Cause Mesothelioma?

How Does Asbestos Cause Mesothelioma? Asbestos fibers are very carcinogenic so once they get inhaled the body finds very difficult to clear the fibers from the lung and also from the pleura where their fibers tracked down to the outer parts of the lung.

This results in chronic inflammation and over time frequently over many years and decades. This results in genetic damage to the pleural cells what we call the mesothelial the mesothelial cells and this results in mutations and the development of mesothelioma.

Very frequently patients will only complain the symptoms at the time when the disease becomes very advanced and that's due to several factors. But the most likely is lung has a very large reserve so the lung can actually accommodate a significant amount of buildup of inflammation. And also fluid buildup which is a very common way of presenting the fluid on the lung before the patient actually reports feeling breathless very often the disease occurs on and one one side of the lung and of course the other lung can often compensate and this is apparent for example when patients have a lung removed they can function very well on one lung.

Of course it would be much easier if we had a test that could reliably pick up mesothelioma in its very early stages and many people around the world are working on such a blood test. For example there are crude tests available at the moment. But I think in the next 10 years or so we may have a blood test that will pick up the early signs of mesothelioma and then this will lead to earlier intervention and hopefully improved outcomes for our patients who are currently presenting with very advanced disease.

One form of staging is whether it's receptacle or or non receptacle so whether the surgeon can go in and can strip away the mesothelioma. So in terms of treatment defining whether this is surgically disease that can be surgically treated or not.

If the mesothelioma isn't mainly on the outside of the lung then it's usually easier to remove that disease however the more the disease encroaches into the central structure so for example near the heart or deep within the the blood vessels then it's much harder to strip away that disease without causing damage to the blood vessels. 

The median survival without treatment is 9 to 12 months and some patients with the particularly aggressive forms of mesothelioma known as sarcoma toyed and biphasic. Those patients can actually have an even shorter survival the epithelioid group can be very hard to predict some of those patients. In fact our longest at Bart's is currently surviving with disease 15 years having had chemotherapy 15 years ago for his mesotheliomaSo you know we have median statistics but actually some patients can do much much better often going many years with the disease.

Currently there are a few, very few clinical trials in relapse to mesothelioma in the UK but also globally. However there are some trials emerging of new immunotherapy drugs on early data in a small group of patients of around 40 to 50 patients showing that three-quarters of those patients derives benefit about a quarter of those patients actually had shrinkage of their mesothelioma and another 50% had stabilization of disease.

So this is actually unprecedented in a small trial in patients with relapsed mesothelioma in fact one of the patients I know who was accepted on that trial that early trial two years ago recently had a scan showing complete response to her mesothelioma. No mesothelioma has essentially been eradicated following two years of treatment with this immunotherapy drug.

It works through removing a natural break on the immune system we all have this immune therapy immune system break. Otherwise we'd all be developing allergic diseases so we have to have something that keeps that under control. This drug works by blocking a receptor called PD 1 and PDL 1 and releases the immune system to fight the cancer. Adding this drug will basically release the break and allow the t-cells, the white cells to go out and fight the the cancer which at the moment is protected by this sort of force field of PDL one protein which is preventing the immune system from attacking the mesothelioma. This antibody drug blocks that receptor and allows the the white cells to go and fight the music alone.

Download How Does Asbestos Cause Mesothelioma PDF

Source: An Interview with Dr Peter Szlosarek, Clinical Senior Lecturer & Consultant in Medical Oncology Bart's Cancer Institute & St. Bartholemew's Hospital on how asbestos causes Mesothelioma.

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