From the limitations of the reasons for mesothelioma

Although this benign tumor, but potentially malignant or low grade.

Although this benign tumor, but potentially malignant or low grade.

Often from the dirty floor of the pleura, or between the pleura. Duocheng round or oval-shaped solid Huihuang Se nodules. Surface smooth, mild-leaf, a capsule. Tumor size ranging in diameter from a few millimeters to several centimeters, may occupy the side of the chest. Pleural tumor contact with the broad, convex to the pleural cavity; few short stem-based connected with the pleura, the change in position when the mass mobile. By the Organization of spindle cell and collagen fibers from intertwined, in glass-like change and calcification.

A summary of diffuse mesothelioma

Pleural mesothelioma have a better prognosis of healthy fiber of diffuse malignant mesothelioma and pleural mesothelioma, which is considered the worst prognosis of breast cancer, so far there is no effective treatment measures.

Pleural mesothelioma have a better prognosis of healthy fiber of diffuse malignant mesothelioma and pleural mesothelioma, which is considered the worst prognosis of breast cancer, so far there is no effective treatment measures.

Diagnosis and treatment of malignant pleural mesothelioma progress

Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis.

Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis. In recent years many countries, especially in Western industrial countries showed an upward trend in the incidence of major health threat, to be aroused our attention, is on the clinical treatment of MPM progress summarized below.

1 incidence

2 O in the early MPM was the first report, 6 O in contact with asbestos and the relationship between the MPM was confirmed that the report of its incidence rate increased gradually, because the incubation period MPM incidence can be achieved for decades, so strictly limit the use of asbestos 30 ~ 4O years of time, the incidence rate will continue to increase. In the United Kingdom, is expected in 2010 and 2020 the incidence will reach the peak between each of the MPM led to the death toll could reach a maximum of about 2,700 people. Now the United States each year about 3,000 patients were diagnosed with MPM E. Zhang Jianguo, such as the domestic from 1980 to 1999 reported 382 cases of MPM 1 for statistical analysis: Men 908 cases, 474 cases of women, men and women ratio was 1.92:1, the age of 15 to 83-year-old, of which 45 ~ 6 O-year-old accounted for 61.2, Average 47-year-old.

2 causes

MPM 2.1 asbestos exposure and about the relationship between the 8 O MPM cases were considered in the environmental and occupational exposure on all kinds of asbestos fibers, blue: brown asbestos: chrysotile ratio of 500:100:1 E. MPM led to the current asbestos on the mechanism although there are physical stimulation theory, theory and the dissolution of molecular mechanisms, but the exact mechanism is unclear, and 2 O cases without a clear professional reasons, was considered the relevant factors and the etiology: including non-contact Industrial fibers such as wool and zeolite contact monkey virus 40 (SV40), and so on.

2.2 SV40 and the relationship between SV4O MPM is a monkey-derived within the DNA tumor virus believed to be infected by the spread of polio vaccine to humans in recent years, the human MPM specimens found SV40 in the homologous gene sequences And experimental animals can be induced by subcutaneous injection of SV40 is a MPM], there are studies that SV4O and the people of asbestos in the mesothelial cells malignant transformation may have synergies. MPM now SV4O in the etiology of great concern, and that this may have developed a new treatment methods. But there are many recent results indicate that SV40 was infected with the polio vaccine and there was no correlation between MpM relations.

2.3 MPM other factors lead to other possible factors tuberculous pleural scarring, chronic inflammation, infection, radiation, non-specific history of exposure to industrial compounds and genetic factors. On the relationship between smoking and MPM is generally believed that smoking does not increase the incidence of MPM, but will the deterioration.

3 pathological type

Because of skin on the morphology of the characteristics of two-way division, mesothelioma cells can differentiate into shape, but also can be turned into fibroblasts morphological usually based on tumor growth mode and the whole shape will pleural mesothelioma into localized and Diffuse, according to cytology morphology and biological behavior is divided into benign and malignant. Is generally believed that localized tissue from the pleura, more benign, a small number of low-grade, vicious coverage ratio varies from diffuse pleural itself, almost all high grade. Limitations of benign pleural mesothelioma often divided into fiber types, epithelial and mixed, diffuse type MPM into sarcoma (12.1), E-(60.6) and mixed.

4 diagnosis

4.1 MPM clinical diagnosis diverse and have a cough, Bieqi, chest pain and other symptoms, imaging examination showed pleural effusion, pleural thickening or pleural nodules, but less specific, the time of diagnosis to be considered, confirmed the need to rely on Histological examination. Percutaneous pleural biopsy and pleural effusion cytology easy, but the diagnosis rate is not high, were reported in the literature for 6 to 38 _8 and 0 to 22 _9], or B-CT-guided pleural more to puncture, The positive rate of increase, but the result is still not satisfactory. Thoracoscopy can peep the whole chest, directly observed lesions the size, distribution and the approach of the organs of the situation and look to take adequate biopsy specimens, literature positive rate of up to 91 ~ 100 Do3, is the diagnosis of MPM The best means

4.2 As early diagnosis of MPM high degree of malignancy, treatment, many patients already in advanced, in recent years, MPM in the early diagnosis and differential diagnosis also had a lot of exploration. Robinson, and so _ I detected 44 cases of patients with MPM of soluble inter-related protein Paper (sol-uble mesothelin-related proteins, SMR) found that 37 cases (84) in patients with elevated concentrations of SMR, and 16 O in the case of cancer or other diseases pleural Patients, only three cases (2) increased, the authors suggest that SMR concentration and the tumor size and progress on, can be used to monitor tumor growth, further study showed that SMR can also be used to infer the incidence of MPM crowd. Although chemical organizations have been widely applied, but there are still 1 O ~ 15 cases of MPM in cancer diagnosis and difficult to distinguish between _ I2]. Malle, such as "MPM found in the effusions, N cadherin increased significantly, but adenocarcinoma of the effusions do not have this expression, and about 9 o cases of adenocarcinoma of E-cadherin protein, the authors also found that healthy seepage Out of CD44 (one of the adhesion molecule) than the expression of malignant effusion increased, those found to be MPM, cancer and benign oozed from the differential to provide a new approach.

5 treatment

5.1 surgery and radiation therapy treatment MPM is the main means of treatment, pleura, lung resection and pleural removal (stripping) is the most commonly used for the surgical method of pleural pneumonectomy mainly refers to the same side of the pleural and removal Lung, pericardium transfer of a surgical approach. Mediastinal to request as much as possible with all the visceral pleural masses, including some pericardium. Resection of part of the pleura range from the thorax after lateral incision, stripping Feijian to the majority of pleural diaphragm and pericardium. More than that of the current limitations of the pleural mesothelioma (benign or malignant) suitable for surgical treatment, diffuse and widespread disease due to frequent malignant pleural effusion, generally unsuitable for surgical treatment, but treatment can significantly ease symptoms. AisnerE1 4] reported pleura, lung resection and pleural after the two-year survival rate was 10 percent to 37 and 11 to 35. Radiation therapy is generally used after surgery or not the adjuvant therapy, to reduce symptoms, especially pain relief is effective, but its application by the size of tumors and normal cells to the toxic effect of the restrictions.

5.2 single-drug chemotherapy traditional single-drug chemotherapy on MPM are less efficient, such as Adriamycin treatment efficiency of about 15 l1, others such as carboplatin, cyclophosphamide and ifosfamide, the chemotherapy drug Taxol, and so the average single - Treatment efficiency of not more than 1 O ~ 2O. In recent years the emergence of a new chemotherapy drugs such as Adriamycin liposome anthracycline, gemcitabine and Pei Mei Qu Cypriot disodium (Pemetrexed disodium, trade names: Alimta) single-drug efficacy is not satisfactory. Pemetrexed is a more targeted folic acid inhibitors, which inhibit the enzyme dependent on a variety of folic acid play a role, is the primary mechanism of inhibition of purine and pyrimidine in the course of three enzymes: thymine nucleotide synthase, Dihydrofolate reductase and Gan ammonia amide ribose nucleotides A acyltransferase, there is no other drug can also inhibit the three enzymes, but a separate application Pem-etrexed chemotherapy The total efficiency is only about 14, The median survival time is about 1 O.7 months, the addition of folic acid and vitamin B. increase after five months]. In short, the current application of a single chemotherapy drug, whether it is efficient in the median survival time or have not achieved satisfactory results.

5.3 combined with chemotherapy in a long time, combined with chemotherapy in the treatment response rate, in essence, no more than single-drug chemotherapy, in recent years as new chemotherapy drug research and development and joint exploration of different drugs, combined with chemotherapy has encouraging results , For the treatment of MPM has brought new hope. In 2002 the American Society of Clinical Oncology (A-merican Society of Clinical Oncology, AS-CO) annual meeting. Vogelzang, and other reports and in 2003 issued a formal currently the largest MPM for the random single-blind clinical stage Ⅲ l The results caused strong concern. In 456 cases of inappropriate operation of MPM patients, 226 cases with Pemetrexed + cisplatin (PC programme, Pemetrexed 500 mg / m, cisplatin 75 mgm, are every 21 days 1) .222 with cisplatin alone (75 mg / m, every 21 days 1), eight cases do not have any medicine, before the results of the two groups are intravenous injection, the results showed that the combined group compared with single-drug treatment can significantly improve the efficiency MPM (41.3 than 16.7), Median survival time (12.1 months than the 9.3 months), time to tumor progression (5.7 months than the 3.9 months), the quality of life and lung function, statistically significant difference. In the beginning of the experiment, 25 cases of serious side effects and the addition of folic acid and vitamin B. oral vaccination, the results show that in the two experimental groups in the application of folic acid and vitamin Bt z can significantly reduce the side effects of chemotherapy, and The survival time without adverse effects.

February 5, 2004, the U.S. Food and Drug Administration (FDA) approved Pemetrexed and cisplatin can not be combined with chemotherapy as the standard surgical treatment of MPM. Pemetrexed is received FDA approval of a drug treatment MPM, but with folic acid and vitamin B also be used to reduce adverse reactions. Byrne, such as 1: 21 patients had gemcitabine and cisplatin combination of observation, the treatment efficiency of 47.6, but only in the median survival time was 9.4 months. Favaretto, such as "Application of gemcitabine and carboplatin joint 5 O patients on the study, the rate was 26, the median survival time for a 6.5, 46 patients with breathing difficulties to improve, 4 O weight gain, alleviate pain 26. In the case of 7 O In the mine for the song Cypriots (raltitrexed) and oxaliplatin combined with the experiment, the average effective rate of 2 o, time to tumor progression for 18 weeks, but the median survival time of about 12 months]. At present, one pair of 240 cases of patients with cisplatin + raltitrexed combined with chemotherapy with cisplatin alone in the stage Ⅲ randomized controlled experiment in progress.

5.4 neoadjuvant chemotherapy although many researchers believe that MPM surgery on the cure rate is very low, but I and Phase Ⅱ patients should consider. Kestenholz, such as 0 for 16 cases of patients with a new adjuvant chemotherapy experiments, first with cisplatin and gemcitabine combined with chemotherapy after a pleura, lung resection, the overall median survival time for a 9.4 months, one year overall survival Rate was 72, the results suggest that advanced the exercise of tumor cells to reduce the chemotherapy to surgery may be a promising treatment methods.

5.5 Although the molecular target for the current understanding of the biological characteristics of MPM relatively small, but a lot of research, including angiogenesis, signal transduction and cell receptor, and other factors, many of the exploration, in order to find a new treatment MPM Target, which is more study of vascular endothelial growth factor (vascular endothelialgrowth factor, VEGF) signaling pathway and the epidermal growth factor receptor (epidermal growth factor

Receptor, EGFR). VEGF is a self-secreting growth factors, the most characteristic of promoting angiogenesis factor, with the endothelial cells on the receptor-binding, a cascade Larger signal so as to stimulate the formation of blood vessels in the MPM invasive growth and the transfer of play Important role, so can be considered by inhibiting the activity of VEGF treatment of MPM. Another possible treatment is to VEGF inhibitor and now the cells of the poison used in the study of the anti-VEGF drugs mainly SU5416, tha-lidomide, PTK787/ZK222584, Bevacizumab, and so on.

EGFR is another cause of concern and angiogenesis-related goals, MPM often over-expression of EGFR, 68 MPM embedded in paraffin sections of the report found its expression. Gefitinib is the EGFR tyrosine kinase inhibitors, which inhibit cell proliferation and MPM in the EGFR phosphorylation, but Govindan, such as ¨ 2 43 cases of patients with advanced research shows that, although the 97 patients with EGFR-positive for performance, but Gefitinib The treatment is not satisfactory, with only one case of patients achieved complete remission, 1 (2) in patients with partial remission, 21 patients (49) unchanged, 15 (35) progress, five cases (12) early death, the results show that MPM EG-FR expression and no recurrence survival has nothing to do.

5.6 immune therapy, including systemic or local chest to interferon or interleukin, in the clinical treatment of MPM reported mixed results. Astoul, such as' two nail on the chest of 23 patients given IL-2, of which 11 cases of partial remission, one case of complete remission, the median survival time for 18 months. Many of the interferon and a combination of chemotherapy drugs, although there have been reports that efficiency can achieve 36, but most single-drug chemotherapy and similar, but also increased the toxicity. Because SV40 may be the cause of MPM, Imperiale, such as considering whether SV40 in the vaccine can be applied to treatment of MPM, the study has been carried out.

6 prognosis

Is generally believed that, MPM tissue types, E-best prognosis, the worst-sarcoma, a mixed-type center, disease stage and the history of exposure to asbestos is an important factor affecting the prognosis. Although the use of the tumor stage to speculate the prognosis of patients with MPM has been widely accepted, but only a very small number of patients suitable for surgery, its clinical application are largely limited. There are reports a study of cancer and leukemia group B (Cancer and Leukemia Group B, CALGB) and the European Cancer Treatment and Research Organization (Eu-ropean Organization for Research andTreatment of Cancer, EORTC) advocated by the way to a better prognosis Judgement. EORTC poor prognosis that the factors include: the tumor function score (Performance Status, PS) poor, interleukin increase, organizations diagnosis is not clear, male patients or organization for the type of sarcoma. CALGB poor prognosis that the factors include: male, PS poor, aged> 75-year-old, chest pain or difficulty in breathing, platelets and elevated LDH, lower hemoglobin. Curran, etc. [2 EORTC adopted the method of analysis of 204 cases of patients, patients with poor prognosis in the median survival time was 5.5 months, no 2-year survival, and the prognosis is good for the group 1 O.8 months and 14.

7 MPM monitoring of new technologies

With the in-depth study of MPM, how to MPM before and after treatment to monitor the changes become more important. Armato, etc. [2, a new study in the semi-automatic computer-aided measurement technology, it can use the computer through the CT scan on the scope of MPM quantitative measurement, this technology can scan the 22 cases of patients with continuous, can reproduce The measurement. In short, in the diagnosis and treatment of MPM, has made great progress, combined with chemotherapy has been established for its important position. As people MPM molecular biological characteristics of the constant deepening of understanding and a new diagnosis, treatment methods will continue to emerge, I believe there will be more encouraging results, the MPM will ease or even bring new hope for recovery.

Read carefully before using anticancer drugs

A common diseases as cancer, serious harm human health, increasing the concern of the community. This stage of the cancer research while at the molecular and cell biology has made great progress, but still failed to answer many basic questions, the etiology and pathogenesis is not entirely clear.

It has been demonstrated that a tumor from the normal control of the unlimited potential for growth, local spread to surrounding normal tissue and the body transferred to the ability of distant organs, each tumor has its own unique history and the proliferation of types. So bring extremely difficult to treat, not only is the experience of specialists is also a great challenge.

First of all has been confirmed in the circumstances, should develop a comprehensive, practical and feasible treatment plans, most important of these is the planned objective, namely, treatment targets to be achieved by what is. Radical is still tolerated, if radical, if possible, treatment should be positive, usually take surgical resection is often strive for a tumor cells do not stay. Palliative care is generally the maximum extent possible to lift the suffering of patients, the organ to maintain close to normal function, increase the survival of the patient's life time, that is to provide the benefits to patients over the risks arising from the treatment. At present the main cancer treatment are surgery, radiotherapy and chemotherapy. In actual clinical work, these three methods is not an independent, in most cases at or before or after the primary and secondary, we are here to discuss the key is commonly used oral anticancer drugs. Anticancer drug to the tumor diseases have systemic effects, many of the current clinical application, has accumulated a wealth of experience, it is reasonable to specialists for the use of these drugs, and is joint use.

The purpose of chemotherapy to tumor cells in a selective toxic effect, to maximize the killing, and the host cells without harm, or at least damage to host cells. But the reality is not the human imagination, because the tumor cells with normal cells the difference is very small, usually anticancer drugs not only inhibit cell proliferation, but also to split the toxic effects of normal cells, it is common anti-cancer chemotherapy The results, sometimes because of drugs on the body's normal lead to toxic effects of chemotherapy were forced to be suspended. So we need to anticancer drugs have a correct understanding and grasp the principle of good administration, that is, the dose of drugs to both died of cancer cells and allow normal cell proliferation rehabilitation.

Elderly cancer: prone refractory

Dongfang Wang February 22: Information shows that the city's existing 110,000 people with cancer, the incidence rate of close to Europe and the United States. Epidemiological data show that in addition to cancer and genetic and environmental factors, and also has a lot to the age factor. In addition to the central nervous system tumors, leukemia and other childhood in the high, the majority of the incidence of cancer increases with age increases, such as breast, stomach, liver, lung, colon cancer, and so on.

According to hospital on August 5 tumor hyperthermia Section 2005 statistics, the first consultation treated 360 cancer patients, more than 60 percent over the age over the age of 50 in elderly patients.

And the high incidence of cancer aged major factor in roughly the following points: 1. Contact with carcinogenic substances a long time, 2. Cells in vivo gene mutation, 3. Immune function decline, 4. Endocrine disorders and hormone imbalance, 5. Long-term adverse life Way of life and behavior "over time" 6. Divorced from society, living alone Outlier, a withdrawn, depression, paranoia of the "cancer personality."

Shanghai has taken the lead in entering an ageing society. The high incidence of cancer is not only seriously endanger the physical and mental health of older persons, also affected family harmony and social stability, combating the elderly become a top priority tumor. However, the elderly decreased immunity, the body recovery is weak, conventional means of treatment in a large number of anti-tumor cells, the body will usually normal immune function and cause greater damage. Cancer treatment makes it easy for elderly patients to accept, not simply rely on surgery, radiotherapy and chemotherapy, Chinese medication, may also have biological treatment, immunization and treatment is not surgery, not narcotic, non-toxic side effects of ultrasound massage and body heat Highlights Treatment.

Try to change bad habits to avoid a "cancer personality" and early prevention, early detection, early treatment, I believe that the harm will be away from the tumor elderly.

Limited treatment of mesothelioma

Surgical excision is the only means of treatment, the removal of the so thoroughly and as soon as possible suitable.

Although this benign tumor, but potentially malignant or low grade.

Surgical excision is the only means of treatment, the removal of the so thoroughly and as soon as possible suitable. Although due to the benign tumor, but potentially malignant or low-grade, recurrence, transfer, often with complete cure. So the prognosis is good.

How to diagnosis and treatment of malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma (Malignant Peritoneal Mesothelioma, MPM) is a rare tumor, since we July 2003 2004 August diagnosis and treatment of a total of three cases, the combination of literature review report are as follows.

Malignant peritoneal mesothelioma (Malignant Peritoneal Mesothelioma, MPM) is a rare tumor, since we July 2003 2004 August diagnosis and treatment of a total of three cases, the combination of literature review report are as follows.

1, information and methods of this group three cases, aged 26-47 years old, the median age of 38-year-old. Occupational distribution: 1 workers, farmers, a bank employee who had no history of direct contact with asbestos. The first symptoms of abdominal distention, abdominal pain, abdominal mass. Supplementary examination: three cases were done B-examination, inspection practices and ascites from falling cytology, a routine peritoneal biopsy. Ascites for the yellow exudate, cytology both see a lot of skin cells and lymphocytes, inflammatory cells. In all three cases laparotomy surgery for pathologically confirmed. Pathological type: E-two cases, one case of fiber types. General types: one case of localized, diffuse type 2 cases. Postoperative to chemotherapy, one case of follow-up, survival for more than 18 months.

2, to discuss MPM is the only primary peritoneal cancer, originated in mesothelial cells and / or to the skin cell differentiation between the mesothelioma cells. Low incidence of the disease, non-specific clinical performance, disease occult, clinical diagnosis difficult, high mortality. MPM is not clear the cause, reported in the literature of its occurrence may be related to asbestos dust exposure, chronic inflammation of stimulation, radioactive substances, viruses, genetic susceptibility. Recently, Teixeira, etc. [1] reported chromosome t (3; 3) (p14; q29) and some malignant peritoneal mesothelioma on the pathogenesis. Three cases of this group had no history of exposure to asbestos, one case of tuberculosis was the exact history of peritonitis, the anti-tuberculosis treatment of mitigation or "cured."

The lack of specific clinical manifestations, when the tumor growth to a certain size or involved gastrointestinal symptoms after. Diagnosis rely mainly on clinical features, imaging examination, inspection ascites exfoliated cells, peritoneal biopsy, laparoscopy and laparotomy.

Clinical characteristics: mainly for abdominal pain, abdominal distention, abdominal mass and ascites. The diverse nature of abdominal pain, intractable is the common characteristics. The patients were abdominal distention, abdominal pain, abdominal mass.

Supplementary examination: blood: platelets often abnormal increase. Tumor-associated antigen: CA125 often abnormal increase. B-: accurate tips ascites, tumor size, intra-abdominal adhesions fixed Enterovirus mix, irregular thickening of the wall and abdominal tumor planting. The Group B-3 routine inspection: both tumor size, ascites, part of a mix of intra-abdominal adhesions fixed Enterovirus, irregular thickening of the wall and the cultivation of intra-abdominal tumor. x-examination: abdominal plain film visible signs of intestinal obstruction; gastrointestinal contrast shows that a broad gastrointestinal pressure, deformation, with displacement and abnormal changes and mucosal surface chop no obvious damage. CT and MRI examination: Tips pots of ascites, lesions, tumors cr value of different levels. Ascites check: ascites Changcheng bloody serous or cellulose, hyaluronic acid increased. Smear see a large number of films and special-shaped mononuclear cells of the skin between the diagnosis has important significance. Laparoscopy: the ability to directly peep abdominal appearance, that peritoneal nodules and surface covered with plaques and desirable living seized, confirmed MPM is a reliable method to one. Peritoneal biopsy: MPM is confirmed one of a reliable method. This method is simple, traumatic small, to improve the diagnosis rate can be repeated many times to take samples, or B-ultrasound, CT-guided conduct. Laparotomy: MPM naked eye often observed that the visceral peritoneum was dense white tumor coverage, the organ into a "frozen" status, abdominal tumor and digestive organs in particular, mutual Nien连成一体the other a rare situation Retroperitoneal tumor in the organ is a nodular surface, sometimes together integration of multiple nodules. The group of three routine laparotomy, in the view of ascites 1000 ~ 3000 m1, pots abdominal peritoneal surface and mesentery, diaphragmatic widely distributed grey, Huihuangzhicui size nodules. Omentum was Bingzhuang, Zhicui, rugged, normal omentum organizations disappear. Most of pots of abdominal organ surface Zhicui nodules organizations covering cultivation, and with the surrounding tissue, organs adhesion.

MPM now called for a comprehensive treatment to surgery, combined with chemotherapy, radiation, immunotherapy and Chinese medicine treatment. MPM is doubtful whether the limitations or diffuse, in the absence of surgery contraindications, should be laparotomy, to the extent possible tumor resection. The group of three routine laparotomy, with the exception of one case of the transfer has been widely planted, small intestine, rectal tumor only full line of switches, while two cases were reduced to eliminate cancer and tumor resection, after supplemented by chemotherapy. MPM reported in the literature on the effective chemotherapy for the 0% to 40% [2]. This group three cases, intravenous chemotherapy and underwent abdominal chemotherapy. Different chemotherapy, doxorubicin and cisplatin, cyclophosphamide combined with chemotherapy, cisplatin or carboplatin, mitogen mycophenolate cable, VCR combined with chemotherapy. One case of follow-up, survival for more than 18 months. In recent years advocated by chemical injection drug peritoneal cavity to enhance the local drug concentration and reduce the toxicity of systemic. Ma [3], and other authors of the reports of continued high temperatures abdominal infusion of cisplatin treatment MPMl0 cases, follow-up of 10 months, the results of seven cases of disappearance of ascites, eight cases of non-recurrence of the inspection, and the local no apparent toxic effects, cisplatin unique Pharmacokinetics in high-temperature continuous infusion of additional anti-tumor effect.

Immunotherapy: adoptive immune cell therapy can mobilize, improve and enhance the host immune function; ascites and quickly dissipated, the recent good effect. We TIL increases based on r-IL2 coordinated anti-tumor and the principle of lifting immunosuppressive role in the application of the former TIL plus r-IL2 in the treatment of MPM with massive ascites in patients with one cases, supplemented by postoperative chemotherapy, the effect of significantly. Tani, etc. [4] reported by chemical substances sensitive choice of chemotherapy with cytotoxic drugs lymphocyte immune to the chemical treatment of MPM, the results were satisfactory.

MPM poor prognosis, diagnosed in more than one or two years after the death. The prognosis and clinical stage at diagnosis, and treatment of pathological type methods. Diffuse peritoneal mesothelioma very poor prognosis, there is no cure reported in the literature. Epithelial mesothelioma than the hybrid fiber-better prognosis. One case of follow-up of this group, survival for more than 18 months, then for the E-.

Diffuse mesothelioma treatment

Until today, the malignant pleural mesothelioma Shangfu effective treatment, but after some treatment, are a small number of patients live at home and abroad over five years, the longest of 22, most people think could be the natural survival of tumor And the stage. By Butchart stage, malignant pleural mesothelioma is divided into four (Table 1).

Until today, the malignant pleural mesothelioma Shangfu effective treatment, but after some treatment, are a small number of patients live at home and abroad over five years, the longest of 22, most people think could be the natural survival of tumor And the stage. By Butchart stage, malignant pleural mesothelioma is divided into four (Table 1).

According to clinical manifestations, Ⅰ epithelial type of malignant pleural mesothelioma may have long-term survival, the proposal for these patients radical pleural pneumonectomy. The Ⅱ, Ⅲ and Ⅳ E-pathological and other types of cases, regardless of governance and died, a radical or palliative surgery and the use of chemotherapy and radiation effects or not, after treatment the survival curve is basically the same, the average survival time for 18, approximately 10% of patients survive for three years.

Table 1 malignant pleural mesothelioma clinical stage

Ⅰ pleural tumors confined to the layer, only involved the same side pleura, lung, pericardium and mediastinal

Ⅱ tumors of the chest wall or involved mediastinal structure, that is, esophagus, heart and contralateral pleura. Lymph node involvement only in the chest (N2)

Ⅲ period through the diaphragm involved retroperitoneal tumor, and bilateral pleural violations of the contralateral breast, chest, involving the lymph nodes

Ⅳ period distant blood-borne bone metastases

1. Palliative treatment of malignant pleural mesothelioma patient's pleural effusion, puncture aspiration will be there soon after, using chemical injection pleural cavity, causing pleural adhesions, the majority of patients with pleural effusion under control, so if the pleural fixation failure or To be in line diagnostic thoracotomy patients should consider stripping of pleural done.

Malignant pleural mesothelioma can along the puncture hole, home Xiongguan access and dissemination thoracotomy incision, but the skin caused by sediment rarely cause symptoms, there is no need treatment if the treatment given to patients, they also can be used as subcutaneous nodules Clinical observation of the target.

Malignant pleural mesothelioma patient's chest pain is the most difficult to deal with the symptoms, especially in the late serious, sustained non-stop all day, did not respond to radiotherapy, should be given adequate sedation analgesics, including opiates to relieve pain preparation, crossing the last moment of life .

2. Surgical treatment there are all kinds of surgical treatment of malignant pleural mesothelioma, is the first expansion of the pleural pneumonectomy, which was involved with radical part of the chest wall, lung, diaphragm and pericardium and mediastinum. This procedure applies only to stage Ⅰ functional E-malignant pleural mesothelioma cases. Serious heart and lung damage was the taboo of this card. In the fourth intercostal do a standard posterolateral thoracotomy incision, tenacity and pleural thickening layer and the tumor together, blunt dissection from the chest wall, this action will cause extensive bleeding, oppression, and electrocautery Suture carefully completely stop bleeding. Then, mediastinal pleura from the top of hilar separate, adjacent lymph nodes removed trachea. In front of the Feijian, ligation mammary artery and vein, with the past, chest wall and pleura of these vessels and lymph nodes that all together. Behind, with esophagus and trachea eminence area next to the lymph nodes. Left behind from the corresponding part of pericardial incision. At this time to decide to cut lung resection or first diaphragm, this sequence depends on the tumor site and the extension of the scope. Transverse hilar and vascular and bronchial, as in any way deal with pericardial (widening), like lung resection. Pleural lower than low, as the diaphragm, may be free after the pleura, the lower part of the pleural fold, with the diaphragm. In order to fully exposed, generally the same side in the 8 to 10 intercostal for the first two incision. Because of in-home patients in the lateral, with the diaphragm, liver preferred by the shift to the mediastinum, the oppression of IVC, resulting in heart rate and blood flow obstacles. With the diaphragm, the defect can be used Maxlex siliceous material in polyester fibre network or repair, it was also used epidural repair. Whether the use of any material and technology must be closely not leak, to prevent blood from the chest or pleural effusion into the abdominal cavity of Agriculture Council; should be continuous suture, the diaphragm will be a substitute for the residual solid suture diaphragm edge, so that intra-abdominal organs can not be Or into the hernia into the chest. Commissioner of the front should be connected to attract Xiongguan with suction. Expansion of the pleura of the lung resection surgery mortality rate of 10% to 25%, but the effect is no less than pleural resection of good, it does not recommend wider use.

The second surgical treatment for pleural resection, in this non-radical, often tired because of cancer of the lung and below. This operation can not improve the malignant pleural mesothelioma patient's survival time, but it seems to control pleural effusion, improving the patient's quality of life. In addition, the malignant pleural mesothelioma caused by chest pain, sometimes with ease after the pleura, the membrane static suspected to be malignant mesothelioma cases, intended for the diagnosis of thoracic biopsy, consideration should be given at the same time do pleural resection. A large number of pleural effusion, and the chemical pleurodesis failure of the case, could also consider doing pleural resection. From the above, the pleural resection of the palliative operation, with the aim of pleural layer with some visceral pleura and to prevent the recurrence of pleural effusion and reduce chest pain symptoms. The general rule for the first six intercostal posterolateral thoracotomy incision, blunt or sharp free layer of the tumor and part of the visceral pleura involved, from the separation of the chest wall and lungs removed, this action will cause the spinal cord caused by heat conduction or arm Plexus damage, in the thoracic spine Pangji top tumor resection, it is best to use high-frequency argon knife. In particular must be careful to retain the top and mediastinal chest nerve and vascular areas, as far as possible, with tumors, reducing its volume and is conducive to postoperative radiotherapy and chemotherapy. Completed the purchase of closed thoracic drainage suction.

3. Anthracycline-chemical treatment of Pharmacy is considered to be effective malignant pleural mesothelioma, followed by cisplatin, mitomycin, cyclophosphamide, fluorouracil, methotrexate, Navelbine amide, the current use of , Anthracycline-based integrated chemotherapy. In recent years, the statistics at home and abroad to doxorubicin-based chemotherapy, overall response rate was 20 percent, of which Azerbaijan is a better new base (CAO); non-anthracycline type of treatment the overall efficiency 21% of which is better mitomycin plus cisplatin (MP). Cisplatin increase the dose methotrexate. Chemotherapy does not continue to increase until illness.

4. Radiotherapy for external radiation therapy for malignant pleural mesothelioma very disappointed, but the expansion of radiotherapy in vitro were considered effective, can mitigate some cases of chest pain and control of chest fluid, but the disease does not have the effect of the disease. 40 Gy in vitro exposure of more than a palliative effect, 50 ~ 55 Gy irradiation remission rate was 67%, a small number of patients survive five years, almost all patients still die of recurrence or metastasis.

Cavity radiotherapy on a small number of malignant pleural mesothelioma have some response, and a small number of patients long-term effect, it appears that a glimmer of hope. Mainly by the radioactive isotope is, cover it with serous cavity of the affinity of the cell, particularly suitable for the treatment of diffuse tumors, such as mesothelioma. Its main effect is due to the treatment of radioactive β plasmid, the penetrating power of 2 ~ 3 mm, the most effective in the early tumor, but difficult to find early cases of malignant pleural mesothelioma. Early application of colloidal 198 into the pleural cavity, live five years a small number of cases, because of difficulties in protection, is now rarely applied.

Comprehensive treatment and surgery or radiation isotope 132 I, 192Ir, 32P cavity and implanted after in vitro measures such as radiotherapy and chemotherapy, who had no long-term cure.

5. Comprehensive treatment in recent years, a comprehensive treatment measures, in the pleural pneumonectomy letter and CAP chemotherapy (cyclophosphamide 600 mg/m2, doxorubicin 60 mg/m2,, cisplatin 75600 mg/m2, with five consecutive treatment Each treatment interval for three weeks). After the original tumor site or the location of residual tumor in vitro for 55 Gy irradiation. Analysis of 53 cases of patients receiving comprehensive treatment, perioperative complication rate of 17%, 5.8% operative mortality. The average survival time of 16 months (1 to 8 years). E-31 cases of patients 1, 2, 3-year survival rates were 7%, 50% and 2% mixed and sarcoma-1, 2 years after the patient's survival rate was 45 per cent and 7.5 per cent, with no live Than 25 months. Local mediastinal lymph node metastasis survival time than those without metastasis short, E-lymph node-negative, their 5-year survival rate of 45%, early treatment is important.

Diffuse mesothelioma treatment

Until today, the malignant pleural mesothelioma Shangfu effective treatment, but after some treatment, are a small number of patients live at home and abroad over five years, the longest of 22, most people think could be the natural survival of tumor And the stage. By Butchart stage, malignant pleural mesothelioma is divided into four (Table 1).

Until today, the malignant pleural mesothelioma Shangfu effective treatment, but after some treatment, are a small number of patients live at home and abroad over five years, the longest of 22, most people think could be the natural survival of tumor And the stage. By Butchart stage, malignant pleural mesothelioma is divided into four (Table 1).

According to clinical manifestations, Ⅰ epithelial type of malignant pleural mesothelioma may have long-term survival, the proposal for these patients radical pleural pneumonectomy. The Ⅱ, Ⅲ and Ⅳ E-pathological and other types of cases, regardless of governance and died, a radical or palliative surgery and the use of chemotherapy and radiation effects or not, after treatment the survival curve is basically the same, the average survival time for 18, approximately 10% of patients survive for three years.

Table 1 malignant pleural mesothelioma clinical stage

Ⅰ pleural tumors confined to the layer, only involved the same side pleura, lung, pericardium and mediastinal

Ⅱ tumors of the chest wall or involved mediastinal structure, that is, esophagus, heart and contralateral pleura. Lymph node involvement only in the chest (N2)

Ⅲ period through the diaphragm involved retroperitoneal tumor, and bilateral pleural violations of the contralateral breast, chest, involving the lymph nodes

Ⅳ period distant blood-borne bone metastases

1. Palliative treatment of malignant pleural mesothelioma patient's pleural effusion, puncture aspiration will be there soon after, using chemical injection pleural cavity, causing pleural adhesions, the majority of patients with pleural effusion under control, so if the pleural fixation failure or To be in line diagnostic thoracotomy patients should consider stripping of pleural done.

Malignant pleural mesothelioma can along the puncture hole, home Xiongguan access and dissemination thoracotomy incision, but the skin caused by sediment rarely cause symptoms, there is no need treatment if the treatment given to patients, they also can be used as subcutaneous nodules Clinical observation of the target.

Malignant pleural mesothelioma patient's chest pain is the most difficult to deal with the symptoms, especially in the late serious, sustained non-stop all day, did not respond to radiotherapy, should be given adequate sedation analgesics, including opiates to relieve pain preparation, crossing the last moment of life .

2. Surgical treatment there are all kinds of surgical treatment of malignant pleural mesothelioma, is the first expansion of the pleural pneumonectomy, which was involved with radical part of the chest wall, lung, diaphragm and pericardium and mediastinum. This procedure applies only to stage Ⅰ functional E-malignant pleural mesothelioma cases. Serious heart and lung damage was the taboo of this card. In the fourth intercostal do a standard posterolateral thoracotomy incision, tenacity and pleural thickening layer and the tumor together, blunt dissection from the chest wall, this action will cause extensive bleeding, oppression, and electrocautery Suture carefully completely stop bleeding. Then, mediastinal pleura from the top of hilar separate, adjacent lymph nodes removed trachea. In front of the Feijian, ligation mammary artery and vein, with the past, chest wall and pleura of these vessels and lymph nodes that all together. Behind, with esophagus and trachea eminence area next to the lymph nodes. Left behind from the corresponding part of pericardial incision. At this time to decide to cut lung resection or first diaphragm, this sequence depends on the tumor site and the extension of the scope. Transverse hilar and vascular and bronchial, as in any way deal with pericardial (widening), like lung resection. Pleural lower than low, as the diaphragm, may be free after the pleura, the lower part of the pleural fold, with the diaphragm. In order to fully exposed, generally the same side in the 8 to 10 intercostal for the first two incision. Because of in-home patients in the lateral, with the diaphragm, liver preferred by the shift to the mediastinum, the oppression of IVC, resulting in heart rate and blood flow obstacles. With the diaphragm, the defect can be used Maxlex siliceous material in polyester fibre network or repair, it was also used epidural repair. Whether the use of any material and technology must be closely not leak, to prevent blood from the chest or pleural effusion into the abdominal cavity of Agriculture Council; should be continuous suture, the diaphragm will be a substitute for the residual solid suture diaphragm edge, so that intra-abdominal organs can not be Or into the hernia into the chest. Commissioner of the front should be connected to attract Xiongguan with suction. Expansion of the pleura of the lung resection surgery mortality rate of 10% to 25%, but the effect is no less than pleural resection of good, it does not recommend wider use.

The second surgical treatment for pleural resection, in this non-radical, often tired because of cancer of the lung and below. This operation can not improve the malignant pleural mesothelioma patient's survival time, but it seems to control pleural effusion, improving the patient's quality of life. In addition, the malignant pleural mesothelioma caused by chest pain, sometimes with ease after the pleura, the membrane static suspected to be malignant mesothelioma cases, intended for the diagnosis of thoracic biopsy, consideration should be given at the same time do pleural resection. A large number of pleural effusion, and the chemical pleurodesis failure of the case, could also consider doing pleural resection. From the above, the pleural resection of the palliative operation, with the aim of pleural layer with some visceral pleura and to prevent the recurrence of pleural effusion and reduce chest pain symptoms. The general rule for the first six intercostal posterolateral thoracotomy incision, blunt or sharp free layer of the tumor and part of the visceral pleura involved, from the separation of the chest wall and lungs removed, this action will cause the spinal cord caused by heat conduction or arm Plexus damage, in the thoracic spine Pangji top tumor resection, it is best to use high-frequency argon knife. In particular must be careful to retain the top and mediastinal chest nerve and vascular areas, as far as possible, with tumors, reducing its volume and is conducive to postoperative radiotherapy and chemotherapy. Completed the purchase of closed thoracic drainage suction.

3. Anthracycline-chemical treatment of Pharmacy is considered to be effective malignant pleural mesothelioma, followed by cisplatin, mitomycin, cyclophosphamide, fluorouracil, methotrexate, Navelbine amide, the current use of , Anthracycline-based integrated chemotherapy. In recent years, the statistics at home and abroad to doxorubicin-based chemotherapy, overall response rate was 20 percent, of which Azerbaijan is a better new base (CAO); non-anthracycline type of treatment the overall efficiency 21% of which is better mitomycin plus cisplatin (MP). Cisplatin increase the dose methotrexate. Chemotherapy does not continue to increase until illness.

4. Radiotherapy for external radiation therapy for malignant pleural mesothelioma very disappointed, but the expansion of radiotherapy in vitro were considered effective, can mitigate some cases of chest pain and control of chest fluid, but the disease does not have the effect of the disease. 40 Gy in vitro exposure of more than a palliative effect, 50 ~ 55 Gy irradiation remission rate was 67%, a small number of patients survive five years, almost all patients still die of recurrence or metastasis.

Cavity radiotherapy on a small number of malignant pleural mesothelioma have some response, and a small number of patients long-term effect, it appears that a glimmer of hope. Mainly by the radioactive isotope is, cover it with serous cavity of the affinity of the cell, particularly suitable for the treatment of diffuse tumors, such as mesothelioma. Its main effect is due to the treatment of radioactive β plasmid, the penetrating power of 2 ~ 3 mm, the most effective in the early tumor, but difficult to find early cases of malignant pleural mesothelioma. Early application of colloidal 198 into the pleural cavity, live five years a small number of cases, because of difficulties in protection, is now rarely applied.

Comprehensive treatment and surgery or radiation isotope 132 I, 192Ir, 32P cavity and implanted after in vitro measures such as radiotherapy and chemotherapy, who had no long-term cure.

5. Comprehensive treatment in recent years, a comprehensive treatment measures, in the pleural pneumonectomy letter and CAP chemotherapy (cyclophosphamide 600 mg/m2, doxorubicin 60 mg/m2,, cisplatin 75600 mg/m2, with five consecutive treatment Each treatment interval for three weeks). After the original tumor site or the location of residual tumor in vitro for 55 Gy irradiation. Analysis of 53 cases of patients receiving comprehensive treatment, perioperative complication rate of 17%, 5.8% operative mortality. The average survival time of 16 months (1 to 8 years). E-31 cases of patients 1, 2, 3-year survival rates were 7%, 50% and 2% mixed and sarcoma-1, 2 years after the patient's survival rate was 45 per cent and 7.5 per cent, with no live Than 25 months. Local mediastinal lymph node metastasis survival time than those without metastasis short, E-lymph node-negative, their 5-year survival rate of 45%, early treatment is important.

How can effectively prevent lung cancer

Of the world's lung cancer incidence and mortality in the first, and the incidence of lung cancer in China is first in the world. Male lung cancer incidence rate than women, but in recent years the incidence of women increased rapidly, making the incidence ratio of men and women gradually narrow (about 2:1).
These people susceptible to lung cancer:

1.40 and above, especially 50 to 70 years in the elderly, and a history of smoking.

2. AIDMO workers, long-term exposure to radioactive substances and a family history of cancer who.

Lung cancer clues:

Cough about 2 / 3 of lung cancer patients have such symptoms. Can be a mild cough, it can also be a serious cough, sputum ranging from the number. Once the long-term patients with chronic cough cough nature of change, such as the frequency or a dry cough irritation, it is necessary to guard against lung cancer.

Hemoptysis about half of the lung cancer patients have such symptoms. 40-year-old man was smoking more than once the bloody sputum, Blood-streaked phlegm or small blood clots, lung cancer is the possibility of a large, this is also one of the early symptoms of lung cancer.

Intermittent chest pain is not keen Duntong drilling or pain, and sustainable for a few minutes to a few hours. Such as cancer and pleural invasion is more intense pain, continuous and fixed.

Fever male smokers over the age of 45 long-term lung inflammation fever, poor treatment of lung cancer are particularly alert to the possibility.

Pestle-like means, also known as the dark Chui means, for that performance, the first toe joint mast, the nail bends change processes, often accompanied with pain. Foreign reports, 21 percent of lung cancer early with pestle fingers, and most of the disappeared after lung cancer surgery.

And pestle-like arthritis often refers to co-exist. Performance for the migration of arthritis symptoms, elbow, knee, wrist, ankle, means burning palm-like joint pain, activities obstacles may arise edema and tibia, fibula bone hyperplasia, after lung cancer surgery pain can disappear.

Male Female Male breast milk that unilateral or bilateral increased as women. A Pei, and other Japanese scholars investigating 267 cases of lung cancer found in men women accounted for 7.5%, milk, often prone to neglect or even misdiagnosed as simple breast hyperplasia was surgical excision.

Multiple Zhoushen Myositis about 85 percent ahead of the typical symptoms of lung cancer, for the performance of sexual Zhoushen weakness, anorexia, can add to difficulties in walking, difficulty from the bed.

Early detection of lung cancer ways:

1. Classified as high-risk groups should focus on the census population of lung cancer, every six months to one year inspection 1.

2. Shiyan, in particular the elderly, such as the above suspicious symptoms, should be timely to go to the hospital for chest X-ray pictures, such as CT or check. It is worth noting that about 15 percent of lung cancer patients have no early symptoms. Therefore, every year for the elderly in a chest X-ray photo inspection, early detection of lung cancer have a positive significance.

Yizhi lung cancer unfavorable factors:

1. Smoking: cigarettes and smoke contains over 3,000 kinds of chemical substances. Of which there are over 40 kinds of carcinogenic substances, more than 10 kinds of cancer induced. Smoking is, the longer the time, the higher the risk of lung cancer, a study that smoking domestic index (that is, daily smokers by smoking count the number of years) in 400 or more, or daily smoking more than 20 of the 45-year-old above the crowd, were considered high-risk population is lung cancer.

2. Occupational factors: epidemiology, etiology and experiment proved to be carcinogenic properties of substances are: inorganic arsenic, asbestos, chromium, nickel, coal tar, dichloro-dimethyl ether, chlorine ether, ethylene dichloride, and so on. And professional environment in contact with the carcinogenic substances and smoking, lung cancer risk of a further increase.

3. Air pollution: With industrial development, atmospheric pollution in many carcinogens the extent of even more serious. Poor indoor ventilation in the circumstances coal-fired cooking or heating food can cause indoor air pollution, indoor smoke and cooking fumes from female lung cancer may be one of the risk factors. The lung cancer incidence rates between rural and urban areas also prompted air pollution and lung cancer related to the occurrence.

4, ionizing radiation: exposure to radon and its sub-ray of the environment within the miners, increased risk of lung cancer.

5, other risk factors: the past suffering from tuberculosis and other lung diseases.

Warning

Of the world's lung cancer incidence and mortality in the first, and the incidence of lung cancer in China is first in the world.

Male lung cancer incidence rate than women, but in recent years the incidence of women increased rapidly, making the incidence ratio of men and women gradually narrow (about 2:1).

About Nutrition tumor

Nutrition is a tumor of the nutrition methods and theories, is a tumor prevention and treatment of a new subject.

Cancer patients in malnutrition and weight loss are many reasons for the main reasons include: reducing consumption, metabolic disorders, such as increased acute inflammatory response. Since surgery, chemotherapy and radiotherapy, and other anti-cancer therapy can cause cancer patients to reduce the consumption, the tumor itself is the cause of the digestive tract obstruction, and so often is to reduce the consumption of one of the reasons why. As the tumor of the evil of the pathogenesis of the constant awareness, it was discovered that cancer patients malnutrition through ordinary means and method of nutritional support is often difficult to correct, but must be stressed that nutritional support for cancer patients at the same time the abnormal metabolism to regulate.

Nutritional support methods can be divided into Parenteral and Enteral Nutrition support the two technologies. The use of nutritional support in principle is that when gastrointestinal function well and can be safely used, the preferred means of enteral nutrition, enteral nutrition with physical, are cheap, easy to operate, and more suitable for family nutrition support the launching. Enteral nutrition through the use of general oral, nasal feeding, stomach stoma and jejunostomy, and so many ways. When cancer patients gastrointestinal dysfunction, such as chemotherapy and radiotherapy lead to serious gastrointestinal side effects, surgery led to short bowel syndrome, abdominal, pelvic lead to cancer metastasis extensive intestinal obstruction, the use of enteral nutrition was not possible. At this time, through the intravenous route parenteral nutrition support is the main choice. Cancer patients within the family nutrition support the implementation and development in recent years have also been people's attention. For further improve the quality of life of cancer patients, reduce the cost of treatment, nutritional support technology within the family plays an important role.

In the application of nutritional support cancer patients in the course of a confused, that is, nutritional support will promote tumor cell growth. Some previous animal experiments found that tumors in mice support the use of parenteral nutrition can promote tumor cell growth, but in clinical cancer patients in the study, few results show that parenteral or enteral nutrition can promote tumor cell. It is encouraging that in recent years, some research shows that the use of immune nutrients, not only do not promote tumor cell growth, but inhibit tumor cell growth, has made some anti-tumor treatment effect. In addition, these nutrients play in the anti-tumor therapeutic effect, no chemotherapy drug caused serious side effects, this is also stimulate the people more and more attention to nutrition in the treatment of cancer one of the important reasons.

At present areas of concern, pain control is to improve the quality of life of cancer patients of the importance, but we also call attention to the control of pain in the same time, they should attach importance to cancer patients of the nutrition problem, because malnutrition will significantly impact The prognosis of cancer patients, leading to the survival of cancer patients shorten the time.

Pleural mesothelioma diet Yiji

Pleural mesothelioma that originated in dirty layer, layer, and diaphragmatic mediastinal pleura the swelling and pain, is a rare, generally fall into localized and diffuse two: ① limitations of mesothelioma: more benign, than the slow growth Generally asymptomatic, more than in X-ray examination found that size, smooth surface or nodules, the scope of limitations, even texture.

Pleural mesothelioma that originated in dirty layer, layer, and diaphragmatic mediastinal pleura the swelling and pain, is a rare, generally fall into localized and diffuse two: ① limitations of mesothelioma: more benign, than the slow growth Generally asymptomatic, more than in X-ray examination found that size, smooth surface or nodules, the scope of limitations, even texture. Potentially malignant, often pleural effusion, easy to relapse after surgical resection. ② diffuse mesothelioma: a major pleural primary tumor, the most vicious, the incidence and the use of asbestos-related substances, such as the inhalation of asbestos dust. Early lack of specificity of the clinical symptoms, diagnosis is difficult, have chest tightness, shortness of breath, chest pain, weight loss and coughing, a handful of hemoptysis. There are a large number of advanced pleural effusion, a viscous fluid, the liquid and then quickly re-suction fluid. The latter part of the disease may appear evil of nature, such as respiratory failure.

[To]

(1) to eat with anti-pleural mesothelioma, enhance immune function of food, such as Sha Chong, jellyfish, sea turtles, blue crab, Qing Xie, clams, squid, rice field eel, needle fish, herring, Pelteobagrus fulvidraco, shrimp, soft-shelled turtles , Ducks, geese blood, lung, such as TAL.

(2) to eat a Huatanzhike role of vegetables, fruits, such as Shepherd's Purse, Chinese cabbage, Jinzhen Cai, rape, mustard, Xiangcong, Malange head, Chrysanthemum coronarium Artemisia, water-oat yam, Yunai, radish, carrots, mushrooms, grinding Mushrooms, ginkgo, fig, Mangosteen, sugar cane, walnuts, olives, Yimi, Lily, kiwifruit, Lee, pears, water chestnuts, pine nuts, such as turbot.

[Bogey]

(1) bogey tobacco, alcohol.

(2) irritation bogey spicy food such as chilli, pepper, and so on.

(3) fatty bogey, Yi Sheng Tan viscosity of food.

(4) bogey fried, Xunkao Zaore, such as blood moving food, such as bacon, ham, and so on.

Diffuse mesothelioma pathological changes

Early in malignant mesothelioma, visible to the naked eye in the normal or opaque layer of dirt or layer on a large number of pleural white or grey particles and nodules or thin plate, with the development of cancer, pleural thickening the surface more and more, covered with Nodules, tumor extended to the Quartet, for a film, encapsulation lungs to shrink the pits and the smaller side of the chest wall collapse involvement.

Early in malignant mesothelioma, visible to the naked eye in the normal or opaque layer of dirt or layer on a large number of pleural white or grey particles and nodules or thin plate, with the development of cancer, pleural thickening the surface more and more, covered with Nodules, tumor extended to the Quartet, for a film, encapsulation lungs to shrink the pits and the smaller side of the chest wall collapse involvement. Late in the tumor may affect the diaphragm, intercostal muscle, mediastinal structures, and contralateral pleural pericardium. An autopsy found that 50 percent of patients have blood-borne transfer, but of little reference.

There are two malignant mesothelioma autopsy type: ① a single fiber of pleural mesothelioma. From visceral pleural growth, with flat or Roujing, tumor caused the clinical symptoms because they expand the development of chest compression within the structure to shift, if early diagnosis and for treatment. ② wide spread of mesothelioma. This type of lung, diaphragm infiltration, intercostal muscle, which can be involved mediastinal pleura pericardium and great vessels.

The microscope can see malignant mesothelioma have its own characteristics, that is, in a single tumor nodules or the naked eye look the same tumor nodules, have markedly different organizations of various components. Cheung malignant skin tumor pathology credits have E-type, fiber (mesenchymal) and mixed three. E-epithelial cells of a variety of different structures, such as papillary, tubular, the papillary, ribbon work sheet. Polygon epithelial cells have many long, thin, the surface branch of the microvilli, desmosome, a bundle of elastic filaments and cell cavity. Fiber-like spindle-shaped cells, equality configuration, or egg shape slender shape of the nucleus, the nucleolus of good. Mixed with both E-and fiber-two organizational structure. From a block from tumor biopsy, from various parts of the specimens from the more, like the more mixed

Limitations of mesothelioma

Although this benign tumor, but potentially malignant or low grade.

[Outlined]

Although this benign tumor, but potentially malignant or low grade.

[Diagnosis]

Clinical and X-ray findings of the lack of specificity, easily misdiagnosed as encapsulated fluid, Tuberculosis-lung, chest wall and mediastinal tumors, such as. In B-or CT-guided percutaneous biopsy, or look under the microscope in the chest multiple biopsies have confirmed the value.

[Treatment]

Surgical excision is the only means of treatment, the removal of the so thoroughly and as soon as possible suitable. Although due to the benign tumor, but potentially malignant or low-grade, recurrence, transfer, often with complete cure. So the prognosis is good.

[Pathological changes:

Often from the dirty floor of the pleura, or between the pleura. Duocheng round or oval-shaped solid Huihuang Se nodules. Surface smooth, mild-leaf, a capsule. Tumor size ranging in diameter from a few millimeters to several centimeters, may occupy the side of the chest. Pleural tumor contact with the broad, convex to the pleural cavity; few short stem-based connected with the pleura, the change in position when the mass mobile. By the Organization of spindle cell and collagen fibers from intertwined, in glass-like change and calcification.

[Clinical]

Misprision of onset, early asymptomatic more often in the physical examination or X-ray examination found. Tumors grow up they have symptoms of oppression, a chest Duntong, dry cough, shortness of breath, weakness, and so on. Pleural effusion rare. Patients with the relevant section of individual pain, pestle-like refers to the performance and low blood sugar. X-ray for the isolation of the spherical or hemispherical pieces shadow, density, a clear edge, and sometimes mildly that the fronds.

From the limitations of the reasons for mesothelioma

Although this benign tumor, but potentially malignant or low grade.

Although this benign tumor, but potentially malignant or low grade.

Often from the dirty floor of the pleura, or between the pleura. Duocheng round or oval-shaped solid Huihuang Se nodules. Surface smooth, mild-leaf, a capsule. Tumor size ranging in diameter from a few millimeters to several centimeters, may occupy the side of the chest. Pleural tumor contact with the broad, convex to the pleural cavity; few short stem-based connected with the pleura, the change in position when the mass mobile. By the Organization of spindle cell and collagen fibers from intertwined, and the change in the glass-like calcium

A summary of diffuse mesothelioma

Pleural mesothelioma have a better prognosis of healthy fiber of diffuse malignant mesothelioma and pleural mesothelioma, which is considered the worst prognosis of breast cancer, so far there is no effective treatment measures.

Pleural mesothelioma have a better prognosis of healthy fiber of diffuse malignant mesothelioma and pleural mesothelioma, which is considered the worst prognosis of breast cancer, so far there is no effective treatment measures

Diagnosis and treatment of malignant pleural mesothelioma progress

Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis.

Malignant pleural mesothelioma (malignant pleuralmesothelioma, MPM) is the primary organization in the pleural mesothelial a rare cancer of the pleura, its high degree of malignancy, the lack of effective treatment and poor prognosis. In recent years many countries, especially in Western industrial countries showed an upward trend in the incidence of major health threat, to be aroused our attention, is on the clinical treatment of MPM progress summarized below.

1 incidence

2 O in the early MPM was the first report, 6 O in contact with asbestos and the relationship between the MPM was confirmed that the report of its incidence rate increased gradually, because the incidence of MPM incubation period can be achieved for decades, so strictly limit the use of asbestos 30 ~ 4O years of time, the incidence rate will continue to increase. In the United Kingdom, is expected in 2010 and 2020 the incidence will reach the peak between each of the MPM led to the death toll could reach a maximum of about 2,700 people. Now the United States each year about 3,000 patients were diagnosed with MPM E. Zhang Jianguo, such as the domestic from 1980 to 1999 reported 382 cases of MPM 1 for statistical analysis: Men 908 cases, 474 cases of women, men and women ratio was 1.92:1, the age of 15 to 83-year-old, of which 45 ~ 6 O-year-old accounted for 61.2, Average 47-year-old.

2 causes

MPM 2.1 asbestos exposure and about the relationship between the 8 O MPM cases were considered in the environmental and occupational exposure on all kinds of asbestos fibers, blue: brown asbestos: chrysotile ratio of 500:100:1 E. MPM led to the current asbestos on the mechanism although there are physical stimulation theory, theory and the dissolution of molecular mechanisms, but the exact mechanism is unclear, and 2 O cases without a clear professional reasons, was considered the relevant factors and the etiology: including non-contact Industrial fibers such as wool and zeolite contact monkey virus 40 (SV40), and so on.

2.2 SV40 and the relationship between SV4O MPM is a monkey-derived within the DNA tumor virus believed to be infected by the spread of polio vaccine to humans in recent years, the human MPM specimens found SV40 in the homologous gene sequences And experimental animals can be induced by subcutaneous injection of SV40 is a MPM], there are studies that SV4O and the people of asbestos in the mesothelial cells malignant transformation may have synergies. MPM now SV4O in the etiology of great concern, and that this may have developed a new treatment methods. But there are many recent results indicate that SV40 was infected with the polio vaccine and there was no correlation between MpM relations.

2.3 MPM other factors lead to other possible factors tuberculous pleural scarring, chronic inflammation, infection, radiation, non-specific history of exposure to industrial compounds and genetic factors. On the relationship between smoking and MPM is generally believed that smoking does not increase the incidence of MPM, but will the deterioration.

3 pathological type

Because of skin on the morphology of the characteristics of two-way division, mesothelioma cells can differentiate into shape, but also can be turned into fibroblast cells normally form the basis of tumor growth pattern and shape will be roughly divided into pleural mesothelioma localized and Diffuse, according to cytology morphology and biological behavior is divided into benign and malignant. Is generally believed that localized tissue from the pleura, more benign, a small number of low-grade, vicious coverage ratio varies from diffuse pleural itself, almost all high grade. Limitations of benign pleural mesothelioma often divided into fiber types, epithelial and mixed, diffuse type MPM into sarcoma (12.1), E-(60.6) and mixed.

4 diagnosis

4.1 MPM clinical diagnosis diverse and have a cough, Bieqi, chest pain and other symptoms, imaging examination showed pleural effusion, pleural thickening or pleural nodules, but less specific, the time of diagnosis to be considered, confirmed the need to rely on Histological examination. Percutaneous pleural biopsy and pleural effusion cytology easy, but the diagnosis rate is not high, were reported in the literature for 6 to 38 _8 and 0 to 22 _9], or B-CT-guided pleural more to puncture, The positive rate of increase, but the result is still not satisfactory. Thoracoscopy can peep the whole chest, directly observed lesions the size, distribution and the approach of the organs of the situation and look to take adequate biopsy specimens, literature positive rate of up to 91 ~ 100 Do3, is the diagnosis of MPM The best means

4.2 As early diagnosis of MPM high degree of malignancy, treatment, many patients already in advanced, in recent years, MPM in the early diagnosis and differential diagnosis also had a lot of exploration. Robinson, and so _ I detected 44 cases of patients with MPM of soluble inter-related protein Paper (sol-uble mesothelin-related proteins, SMR) found that 37 cases (84) in patients with elevated concentrations of SMR, and 16 O in the case of cancer or other diseases pleural Patients, only three cases (2) increased, the authors suggest that SMR concentration and the tumor size and progress on, can be used to monitor tumor growth, further study showed that SMR can also be used to infer the incidence of MPM crowd. Although chemical organizations have been widely applied, but there are still 1 O ~ 15 cases of MPM in cancer diagnosis and difficult to distinguish between _ I2]. Malle, such as "MPM found in the effusions, N cadherin increased significantly, but adenocarcinoma of the effusions do not have this expression, and about 9 o cases of adenocarcinoma of E-cadherin protein, the authors also found that healthy seepage Out of CD44 (one of the adhesion molecule) than the expression of malignant effusion increased, those found to be MPM, cancer and benign oozed from the differential to provide a new approach.

5 treatment

5.1 surgery and radiation therapy treatment MPM is the main means of treatment, pleura, lung resection and pleural removal (stripping) is the most commonly used for the surgical method of pleural pneumonectomy mainly refers to the same side of the pleural and removal Lung, pericardium transfer of a surgical approach. Mediastinal to request as much as possible with all the visceral pleural masses, including some pericardium. Resection of part of the pleura range from the thorax after lateral incision, stripping Feijian to the majority of pleural diaphragm and pericardium. More than that of the current limitations of the pleural mesothelioma (benign or malignant) suitable for surgical treatment, diffuse and widespread disease due to frequent malignant pleural effusion, generally unsuitable for surgical treatment, but treatment can significantly ease symptoms. AisnerE1 4] reported pleura, lung resection and pleural after the two-year survival rate was 10 percent to 37 and 11 to 35. Radiation therapy is generally used after surgery or not the adjuvant therapy, to reduce symptoms, especially pain relief is effective, but its application by the size of tumors and normal cells to the toxic effect of the restrictions.

5.2 single-drug chemotherapy traditional single-drug chemotherapy on MPM are less efficient, such as Adriamycin treatment efficiency of about 15 l1, others such as carboplatin, cyclophosphamide and ifosfamide, such as single-drug paclitaxel chemotherapy average Treatment efficiency of not more than 1 O ~ 2O. In recent years the emergence of a new chemotherapy drugs such as Adriamycin liposome anthracycline, gemcitabine and Pei Mei Qu Cypriot disodium (Pemetrexed disodium, trade names: Alimta) single-drug efficacy is not satisfactory. Pemetrexed is a more targeted folic acid inhibitors, which inhibit the enzyme dependent on a variety of folic acid play a role, is the primary mechanism of inhibition of purine and pyrimidine in the course of three enzymes: thymine nucleotide synthase, Dihydrofolate reductase and Gan ammonia amide ribose nucleotides A acyltransferase, there is no other drug can also inhibit the three enzymes, but a separate application Pem-etrexed chemotherapy The total efficiency is only about 14, The median survival time is about 1 O.7 months, the addition of folic acid and vitamin B. increase after five months]. In short, the current application of a single chemotherapy drug, whether it is efficient in the median survival time or have not achieved satisfactory results.

5.3 combined with chemotherapy in a long time, combined with chemotherapy in the treatment response rate, in essence, no more than single-drug chemotherapy, in recent years as new chemotherapy drug research and development and joint exploration of different drugs, combined with chemotherapy has encouraging results , For the treatment of MPM has brought new hope. In 2002 the American Society of Clinical Oncology (A-merican Society of Clinical Oncology, AS-CO) annual meeting. Vogelzang, and other reports and in 2003 issued a formal currently the largest MPM for the random single-blind clinical stage Ⅲ l The results caused strong concern. In 456 cases of inappropriate operation of MPM patients, 226 cases with Pemetrexed + cisplatin (PC programme, Pemetrexed 500 mg / m, cisplatin 75 mgm, are every 21 days 1) .222 with cisplatin alone (75 mg / m, every 21 days 1), eight cases do not have any medicine, before the results of the two groups are intravenous injection, the results showed that the combined group compared with single-drug treatment can significantly improve the efficiency MPM (41.3 than 16.7), Median survival time (12.1 months than the 9.3 months), time to tumor progression (5.7 months than the 3.9 months), the quality of life and lung function, statistically significant difference. In the beginning of the experiment, 25 cases of serious side effects and the addition of folic acid and vitamin B. oral vaccination, the results show that in the two experimental groups in the application of folic acid and vitamin Bt z can significantly reduce the side effects of chemotherapy, and The survival time without adverse effects.

February 5, 2004, the U.S. Food and Drug Administration (FDA) approved Pemetrexed and cisplatin can not be combined with chemotherapy as the standard surgical treatment of MPM. Pemetrexed is received FDA approval of a drug treatment MPM, but with folic acid and vitamin B also be used to reduce adverse reactions. Byrne, such as 1: 21 patients had gemcitabine and cisplatin combination of observation, the treatment efficiency of 47.6, but only in the median survival time was 9.4 months. Favaretto, such as "Application of gemcitabine and carboplatin joint 5 O patients on the study, the rate was 26, the median survival time for a 6.5, 46 patients with breathing difficulties to improve, 4 O weight gain, alleviate pain 26. In the case of 7 O In the mine for the song Cypriots (raltitrexed) and oxaliplatin combined with the experiment, the average effective rate of 2 o, time to tumor progression for 18 weeks, but the median survival time of about 12 months]. At present, one pair of 240 cases of patients with cisplatin + raltitrexed combined with chemotherapy with cisplatin alone in the stage Ⅲ randomized controlled experiment in progress.

5.4 neoadjuvant chemotherapy although many researchers believe that MPM surgery on the cure rate is very low, but I and Phase Ⅱ patients should consider. Kestenholz, such as 0 for 16 cases of patients with a new adjuvant chemotherapy experiments, first with cisplatin and gemcitabine combined with chemotherapy after a pleura, lung resection, the overall median survival time for a 9.4 months, one year overall survival Rate was 72, the results suggest that advanced the exercise of tumor cells to reduce the chemotherapy to surgery may be a promising treatment methods.

5.5 Although the molecular target for the current understanding of the biological characteristics of MPM relatively small, but a lot of research, including angiogenesis, signal transduction and cell receptor, and other factors, many of the exploration, in order to find a new treatment MPM Target, which is more study of vascular endothelial growth factor (vascular endothelialgrowth factor, VEGF) signaling pathway and the epidermal growth factor receptor (epidermal growth factor

Receptor, EGFR). VEGF is a self-secreting growth factors, the most characteristic of promoting angiogenesis factor, with the endothelial cells on the receptor-binding, a cascade Larger signal so as to stimulate the formation of blood vessels in the MPM invasive growth and the transfer of play Important role, so can be considered by inhibiting the activity of VEGF treatment of MPM. Another possible treatment is to VEGF inhibitor and now the cells of the poison used in the study of the anti-VEGF drugs mainly SU5416, tha-lidomide, PTK787/ZK222584, Bevacizumab, and so on.

EGFR is another cause of concern and angiogenesis-related goals, MPM often over-expression of EGFR, 68 MPM embedded in paraffin sections of the report found its expression. Gefitinib is the EGFR tyrosine kinase inhibitors, which inhibit cell proliferation and MPM in the EGFR phosphorylation, but Govindan, such as ¨ 2 43 cases of patients with advanced research shows that, although the 97 patients with EGFR-positive for performance, but Gefitinib The treatment is not satisfactory, with only one case of patients achieved complete remission, 1 (2) in patients with partial remission, 21 patients (49) unchanged, 15 (35) progress, five cases (12) early death, the results show that MPM EG-FR expression and no recurrence survival has nothing to do.

5.6 immune therapy, including systemic or local chest to interferon or interleukin, in the clinical treatment of MPM reported mixed results. Astoul, such as' two nail on the chest of 23 patients given IL-2, of which 11 cases of partial remission, one case of complete remission, the median survival time for 18 months. Many of the interferon and a combination of chemotherapy drugs, although there have been reports that efficiency can achieve 36, but most single-drug chemotherapy and similar, but also increased the toxicity. Because SV40 may be the cause of MPM, Imperiale, such as considering whether SV40 in the vaccine can be applied to treatment of MPM, the study has been carried out.

6 prognosis

Is generally believed that, MPM tissue types, E-best prognosis, the worst-sarcoma, a mixed-type center, disease stage and the history of exposure to asbestos is an important factor affecting the prognosis. Although the use of the tumor stage to speculate the prognosis of patients with MPM has been widely accepted, but only a very small number of patients suitable for surgery, its clinical application are largely limited. There are reports a study of cancer and leukemia group B (Cancer and Leukemia Group B, CALGB) and the European Cancer Treatment and Research Organization (Eu-ropean Organization for Research andTreatment of Cancer, EORTC) advocated by the way to a better prognosis Judgement. EORTC poor prognosis that the factors include: the tumor function score (Performance Status, PS) poor, interleukin increase, organizations diagnosis is not clear, male patients or organization for the type of sarcoma. CALGB poor prognosis that the factors include: male, PS poor, aged> 75-year-old, chest pain or difficulty in breathing, platelets and elevated LDH, lower hemoglobin. Curran, etc. [2 EORTC adopted the method of analysis of 204 cases of patients, patients with poor prognosis in the median survival time was 5.5 months, no 2-year survival, and the prognosis is good for the group 1 O.8 months and 14.

7 MPM monitoring of new technologies

With the in-depth study of MPM, how to MPM before and after treatment to monitor the changes become more important. Armato, etc. [2, a new study in the semi-automatic computer-aided measurement technology, it can use the computer through the CT scan on the scope of MPM quantitative measurement, this technology can scan the 22 cases of patients with continuous, can reproduce The measurement. In short, in the diagnosis and treatment of MPM, has made great progress, combined with chemotherapy has been established for its important position. As people MPM molecular biological characteristics of the constant deepening of understanding and a new diagnosis, treatment methods will continue to emerge, I believe there will be more encouraging results, will ease the MPM

Or even bring new hope for recovery.