Mesothelomia Cancer Or Not

[krige33]

hI,

Following a scanner control I get a cancer of the pleura. This may be a metastasis of a former cancer (8 years= thymus) or on new cancer (mesothelomia)Not asbestos exposure knew.

How could doctors determine the difference between the two CA because they do not biopsy and consulted two doctors prescribe chemotherapy

Products used in chemotherapy may be the same for these 2 types of cancer. They said Cisolatin, Adriblastina and endoxan.My doctor in eUROPE said Alimta and cisplatine.

I consulted two doctors but both of Bangkok Hospital.

In addition the price of each chemo session would be 45000 Bahts

I would appreciate your advice or feedback.

Many thanks

[Sheryl]

Mesothelomias can be either benign or malignant and the only way to be 100% sure is by either biopsy of the mass or examination of the pleural fluid which will sometimes (not always) have tumor cells in it. If they "tapped" your chest (withdrew fluid with a needle) then it is possible that was already done. Also in some cases the appearance of the tumor on the scan can strongly suggest malignancy, although it still needs examination of the tumor cells to be totally sure.

Primary malignant mesothelioma is uncommon without asbestos exposure. Metastasis of thymic cancer to the pleura, on the other hand, is relatively common. I think what is happening is because you have a prior history of cancer, they are assuming this is a metastasis of the original cancer, hence the recommendation for chemo. This is statistically amuch more likely thing than an unrelated benign mesothelioma, so the odds are that they are right.

Questions you may want to ask are:

-- 1. Can they be sure that this is not a benign mesothelioma unrelated to your prior cancer? If yes, how? (malignant cells in the pleural fluid? appearance of the tumor on scan?)

-- 2. If not, i.e. if they are just assuming that it is a metastasis, would it be possible to first do a biopsy to be sure? Although the chances that this is a benign tumor are small given your history it might be worth ruling out in order to avoid possibly unnecessary chemo.

If they are right and it is malignant, delays in treatment will worsen your prognosis, so don't drag this out. Ask the above questions and if it seems there is a possibility of a beniogn tumor get a biopsy imemdiately and move on from there.

Lastly I am very sorry to have to warn you that, if they are right and it is malignant, your long term prognosis is poor. Chemo is not curative although it may extend life expectancy somewhat. There are, however, some cases in the literature of longterm survival after aggressive surgery plus radiation, see this link http://www.springerlink.com/content/t5332v3164718764/

And there have been some encouraging results with a combination of surgery and direct application of chemotherapy into the pleural cavity, see this link:

http://cat.inist.fr/?aModele=afficheN&cpsidt=13477495

So you should, if it is clear that this is malignant, ask about that and consult some thoracic surgeons provided you are reasonably young and in otherwise good health. If you are not otherwise healthy then this may not be an option as it would be qyuite extensive surgery.

If it were me I'd first of all thoroughly investigate the options of surgery and surgery plus chemo applied to the pleutral cavity (less side effecst and more effective than chemo given systemically) -- both in Thailand and even abroad.

If it became clear that there were no surgical options then I'd question the doctors closely about percentage odds both with and without chemo before deciding to have it. If the doctors don't give you straight answers, change to ones who do. Ultimately these are decisions only you can make.

Take care and feel free to contact me if I can be of further help.

[krige33]

Mesothelomias can be either benign or malignant and the only way to be 100% sure is by either biopsy of the mass or examination of the pleural fluid which will sometimes (not always) have tumor cells in it. If they "tapped" your chest (withdrew fluid with a needle) then it is possible that was already done. Also in some cases the appearance of the tumor on the scan can strongly suggest malignancy, although it still needs examination of the tumor cells to be totally sure.

Primary malignant mesothelioma is uncommon without asbestos exposure. Metastasis of thymic cancer to the pleura, on the other hand, is relatively common. I think what is happening is because you have a prior history of cancer, they are assuming this is a metastasis of the original cancer, hence the recommendation for chemo. This is statistically amuch more likely thing than an unrelated benign mesothelioma, so the odds are that they are right.

Questions you may want to ask are:

-- 1. Can they be sure that this is not a benign mesothelioma unrelated to your prior cancer? If yes, how? (malignant cells in the pleural fluid? appearance of the tumor on scan?)

-- 2. If not, i.e. if they are just assuming that it is a metastasis, would it be possible to first do a biopsy to be sure? Although the chances that this is a benign tumor are small given your history it might be worth ruling out in order to avoid possibly unnecessary chemo.

If they are right and it is malignant, delays in treatment will worsen your prognosis, so don't drag this out. Ask the above questions and if it seems there is a possibility of a beniogn tumor get a biopsy imemdiately and move on from there.

Lastly I am very sorry to have to warn you that, if they are right and it is malignant, your long term prognosis is poor. Chemo is not curative although it may extend life expectancy somewhat. There are, however, some cases in the literature of longterm survival after aggressive surgery plus radiation, see this link http://www.springerlink.com/content/t5332v3164718764/

And there have been some encouraging results with a combination of surgery and direct application of chemotherapy into the pleural cavity, see this link:

http://cat.inist.fr/?aModele=afficheN&cpsidt=13477495

So you should, if it is clear that this is malignant, ask about that and consult some thoracic surgeons provided you are reasonably young and in otherwise good health. If you are not otherwise healthy then this may not be an option as it would be qyuite extensive surgery.

If it were me I'd first of all thoroughly investigate the options of surgery and surgery plus chemo applied to the pleutral cavity (less side effecst and more effective than chemo given systemically) -- both in Thailand and even abroad.

If it became clear that there were no surgical options then I'd question the doctors closely about percentage odds both with and without chemo before deciding to have it. If the doctors don't give you straight answers, change to ones who do. Ultimately these are decisions only you can make.

Take care and feel free to contact me if I can be of further help.

Many thanks for your complete information