Malignant Mesothelioma is a rare growth of mesothelial cells form the lining layers of the viscera; strongly associated with asbestos exposure.
Mesothelioma can occur at any mesothelial layer for example the peritoneum or pericardium; The pleural layer is by the far the most commonly affected, giving rise to malignant pleural mesothelioma.
The subtypes of asbestos strongly associated with malignant mesothelioma are the amosite and crocidolite asbestos.
Etiology
Malignant mesothelioma is primarily linked to asbestos exposure, with some suggesting that asbestos inhalation causes repeated pleural inflammation, interference with mitosis, activation of proto-oncogenes, and free radical production.
Other reports indicate associations with ionizing radiation, such as mantle radiation for Hodgkin lymphoma, or a germline mutation of BRCA 1 Associated Protein (BAP1).
Smoking and alcohol is directly linked with malignant pleural mesothelioma.
Pathophysiology
The three types of mesotheliomas are epithelioid, sarcomatous, and mixed.
The epithelioid type is associated with better outcomes. The tumor is often multifocal, forming multiple nodules starting with the parietal pleura. Spread occurs locally in the visceral pleura before extending to the chest wall, diaphragm, or mediastinum. Regional lymph node spread begins with the bronchopulmonary or hilar lymph nodes before moving to the carinal, internal mammary or peri diaphragmatic nodes.
The pattern of nodal metastases is different from that seen in lung cancer. With malignant pleural mesothelioma, there is a direct local invasion of the lymph nodes. Overall, the involvement of lymph nodes in malignant pleural mesothelioma is not common.
Histopathology of Malignant Mesothelioma
Analysis of excised tissue usually reveals large nodules on the pleural surface. Three histological subtypes that are involved in malignant pleural mesothelioma include sarcomatous, mixed, and epithelial which has the best prognosis.
Symptoms and Physical
Malignant pleural mesothelioma usually presents with an abdominal pain, chest pain and dyspnea. Dyspnea suggests the presence of pleural effusion, the most common initial finding, seen in about 90% of patients.
Nonspecific symptoms such as unintentional weight loss, appetite loss, cough, fatigue, and chest wall mass may also occur.
Diagnosis of Malignant Mesothelioma
Diagnosis includes a thorax CT scan with intravenous contrast, a thoracoscopy pleural biopsy, and thoracentesis of pleural effusion, if present, with cytologic analysis.
Malignant pleural mesothelioma needs to be distinguished from other conditions. These conditions include benign pleural diseases as well as metastasis of other tumors such as lung adenocarcinoma or chest wall sarcoma.
A chest CT scan will show focal areas of pleural thickening, with a large invasive mass present in late-stage disease. PET scans may be used to screen for metastatic disease, while MRI and laparoscopy can be used to evaluate diaphragmatic invasion.
Megakaryocyte potentiating factor is used as a serum biomarker for malignant pleural mesothelioma.
Staging Malignant Mesothelioma
- Stage I: A totally resected mass confined within the capsule of the parietal pleura. There is no lymphadenopathy.
- Stage II: Has all the features of a stage I lesion, but the margins are positive after resection. There may be intrapleural lymphadenopathy.
- Stage III: There is a local invasion of the mass into the mediastinum, pericardium, chest wall or peritoneum. Lymphadenopathy is common.
- Stage IV: The presence of distant metastatic disease.
Differential Diagnosis
The differential diagnosis for malignant pleural mesothelioma includes:
- Non-small cell lung cancer
- Small cell lung cancer
- Drug-induced lung complications
- Benign pleural mass
- Lung infection
- Lung fibrosis
Allopathic treatment for Management Malignant Mesothelioma
Using National Comprehensive Cancer Network Guidelines, treatment depends upon tumor staging for the feasibility of surgical resection with Stage III-IV malignant pleural mesothelioma being considered unrespectable. Ultimately less than a third of patients are candidates for definitive resection. It is recommended that mesothelioma be treated by a multidisciplinary team at a high volume Homeopathic center.
For different types of cancers and mesotheliomas treatment click the following links:
Homeopathic treatment for malignant Mesothelioma
Phosphorus, Calceria carb, Sulphur, and Arsenicum Album are top grade Homeopathic remedies for Mesothelioma. They help in particular during the chronic stage of the disease.
Phosphorus
Phosphorus irritates, inflames and degenerates mucous membranes, irritates and inflames serous membranes, Thirst for cold water especial indication, fatty degeneration of blood vessels and every tissue and organ, tall, slender persons, narrow chested, with thin, transparent skin, weakened by loss of animal fluids, shooting pains, etc. Polycythemia. Blood extravasations; fatty degenerations, cirrhosis, caries, Inflammation of the respiratory tract, Hoarseness; worse evenings. Larynx very painful. Clergyman’s sore throat; violent tickling in larynx while speaking. Aphonia, worse evenings, with rawness.
Cannot talk on account of pain in larynx. Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air. Sweetish taste while coughing. Hard, dry, tight, racking cough. Congestion of lungs. Malignant Mesothelioma. Burning pains, heat and oppression of chest. Tightness across chest; great weight on chest. Sharp stitches in chest; respiration quickened, oppressed. Much heat in chest. Pneumonia, with oppression; worse, lying on left side. Whole body trembles with cough. Sputa rusty, blood-colored, or purulent.
Tuberculosis in tall, rapidly growing young people {Do not give it too low or too frequently here, it may but hasten the destructive degeneration of tubercular masses. Repeated hemoptysis (Acal)}.
Pain in throat on coughing. Nervous coughs provoked by strong odors, entrance of a stranger; worse in the presence of strangers; worse lying upon left side.
Calceria Carb
Swelling of tonsils and submaxillary glands; stitches on swallowing. Hawking-up of mucus, Profuse sweat in head and all over the body, Exhausted easily on exertion. Difficult swallowing. Goiter. Parotid fistula. 
Arsenicum album
Mercurius Solubilis
Thuja Occidentalis
Cannabis sativa (ultra diluted)
Patient can only breathe in standing position, Oppressed breathing, as from a weight on the chest, with wheezing, rattling breathing, sometimes with Loss of voice. Cough – dry, or with green, viscid sputum. Malignant Mesothelioma. Lungs Inflammation with stitches low downward, or with inflammation of the heart, or with vomiting of bile.
Violent palpitation of the heart/ Tachycardia feels shocks and beats in the region of the heart.
Pain in the back, arresting the breathing.
DIGITALIS PURPUREA (ultra diluted)
Comes into play in all diseases where the heart is primarily involved, where the pulse is weak, irregular, intermittent, abnormally slow, and dropsy of external and internal parts. Weakness and dilatation of the myocardium. Its greatest indication is in failure of compensation and especially when auricular fibrillation has set in. Slow pulse in recumbent posture, but irregular and dicrotic on sitting up. Auricular flutter and fibrillation especially when subsequent to rheumatic fever. Heart block, very slow pulse. Other symptoms of organic heart disease, such as great weakness and sinking of strength, faintness, coldness of skin, and irregular respiration; cardiac irritability and ocular troubles after tobacco; jaundice from induration and hypertrophy of the liver, frequently call for Digitalis. Jaundice with heart disease. Faint, as if dying. Bluish appearance of face. Cardiac muscular failure when asystole is present. Stimulates the heart’s muscles, increases force of systole, increases length. Prostration from slight exertion. Collapse.
GRAPHITES (ultra diluted)
CONIUM MACULATUM (ultra diluted) 
NATRIUM SULPHURICUM (ultra diluted)
Duodenal catarrh; hepatitis; icterus and vomiting of bile; liver sore to touch, with sharp, stitching pains, Burning in abdomen and anus, yellow, watery stools, Loose morning stools.
CARCINOSINUM (ultra diluted)
It is claimed the Calcinosis acts favorably and modifies all cases in which either a history of carcinoma can be elicited, or symptoms of the disease itself exist, Carcinoma of the mammary glands with great pain and induration of glands.
P.S: Bryonia, China, Hepar Sulphuricum and Pulsatilla are Homeopathic medicines especially useful in the acute stage of Malignant Mesothelioma.
P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).
For proper consultation and treatment, please visit our clinic.
None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.
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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
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