The Crucial Role of Initial Tests in Mesothelioma Treatment

Mesothelioma diagnosis and treatment begin with a series of initial tests to determine the specific type of the disease. A recent study explored these tests and their accuracy in predicting mesothelioma types.

Discover why getting it right from the start can be a matter of life and death for mesothelioma patients.

Prognosis and Treatment

Mesothelioma is a type of cancer that affects the lining of the lungs and other organs. Doctors often use surgery to remove the cancer. In some cases, they also use chemotherapy before the surgery to shrink the tumor. Before starting treatment, doctors conduct tests to figure out what type of mesothelioma their patient has.

A recent study looked at how accurate the initial tests were in predicting the type of mesothelioma. They also looked at how this affected the survival of patients.

There are three types of mesothelioma that are based on the shape of the cancer cells. One type is called epithelioid, which accounts for about half of mesothelioma cases. This type tends to have a better prognosis than the other two types of mesothelioma.

About 10% of mesotheliomas are sarcomatoid. This type generally has the worst prognosis with standard treatments. The third type of mesothelioma is called mixed or biphasic mesothelioma. This type is made up of both epithelioid and sarcomatoid cells. About 30% to 40% of mesotheliomas are this mixed type.

Challenges of A Complex Diagnosis

The researchers studied 129 patients who had surgery for mesothelioma over five years. They wanted to see if the first tests matched the results after surgery. They also wanted to know how this affected how long the patients lived after the surgery.

They found that in about 21% of cases, the initial assessment didn’t match what they found during surgery. This means that sometimes they thought it was one type of mesothelioma, but it turned out to be a different type. This could be important because different types of mesothelioma may need different treatments.

They also noticed that in some cases where the initial test was wrong, the patients had received chemotherapy before the surgery. This might have caused the cancer to change, making it harder to identify during surgery.

The study showed that patients who had chemotherapy before the surgery and had a wrong initial assessment tended to live for a shorter time after the surgery compared to those who didn’t have chemotherapy. On average, they lived for about 11 months, while those who didn’t have chemotherapy lived for about 19 months after surgery.

The researchers think that giving chemotherapy before surgery might make it harder to predict the type of mesothelioma during surgery correctly. This could lead to worse outcomes for patients.

Because of this, the researchers suggest that for patients whose mesothelioma can be removed with surgery, it might be better to do the surgery first, without chemotherapy. This approach could lead to better outcomes and longer survival for these patients.

Source

Ventura L, Lee M, Baranowski R, Hargrave J, Sheaff M, Waller D. Perioperative discordance in mesothelioma cell type after pleurectomy/decortication-a possible detrimental effect of neoadjuvant chemotherapy due to epithelial to mesenchymal transition? [published online ahead of print, 2023 Oct 18]. Interdiscip Cardiovasc Thorac Surg. 2023;ivad145. doi:10.1093/icvts/ivad145. https://pubmed.ncbi.nlm.nih.gov/37851340/