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Mesothelioma is a rare form of cancer that is almost always caused by prolonged exposure to asbestos. The disease affects tissue in and around your lungs, heart, abdomen, and even your testicles. Although it’s still quite uncommon (about 2 out of every 100,000 people are diagnosed with mesothelioma each year), it’s also incredibly deadly – about half of those who have been diagnosed with mesothelioma are deceased within one year. While treatments like chemotherapy can prolong survival for some patients suffering from mesothelioma, many cases are not survivable and those who do survive may suffer from long-term complications such as infertility or loss of their voice box.
Epithelial mesothelioma is the most widely known mesothelioma of the three cell types of mesothelioma cancer. This abnormal cell type involves cuboid cells with low movement that gather together and have clear nuclei. Epithelial and epithelioid both refer to this kind of asbestos based cancer.
Above 50% and up to 70% of mesothelioma cases are epithelioid in nature. Epithelial cells line the portion of the airway known as the bronchus, this a region susceptible to asbestos inhalation. The breathing tract lining consists of pseudostratified columnar ciliated epithelium, which is used as a protective barrier.
People with this kind of cancerous cell type live about six months longer than patients with other cancer cell types. It has the best prognosis of the three mesothelioma cell types because it is the most responsive to treatment. Due to this higher response rate, epithelioid cancer outbreak tend to qualify for more aggressive and effective treatment plans.
Mesothelioma tumor cells location has a more significant effect than cell type on the type of treatments a patient will receive. Notwithstanding, cell types such as epithelial sarcomatoid or biphasic affect whether patients are good for specific aggressive therapies.
BEHAVIOURS OF EPITHELIAL CELLS:
Epithelial mesothelioma cells join together in groups. Ever cell is square, cubed, columnar or squamous in nature. It’s nucleus, the central cellular space that holds genetic materials, is noticeably seen clearly in each cell type.
Because epithelioid cells can not move freely and stick closely together, they are less likely to spread and acquire more cells than sarcomatoid cells. This particular behaviour is one of the reasons why epithelial mesothelioma has a better prognosis than other cell types.
EPITHELIAL MESOTHELIOMA SYMPTOMS:
Mesothelioma signs and symptoms are always the same even though the cells that make up tumors differs. Cancerous cell types mainly affect treatment response and multiplication rate, but they do not change the symptoms. Epithelioid cancerous cells do not cause other signs and symptoms different from other cell types. When the cancerous cells multiply and accumulate, symptoms appear when organs such as the lungs, heart or kidneys are affected. Initial symptoms of pleural or peritoneal mesothelioma include cough, shortness of breath and lack of appetite. As the disease progresses, more severe symptoms may surface.
1. Breathe shortness
2. Constant dry cough
4. Blood in cough
5. Less level of blood oxygen.
8. Night sweats
9. Instant weight loss
10. Feeling full without food in the stomach.
11. Lack of appetite and nausea
12. Fatigue plus extreme weakness.
EPITHELIAL MESOTHELIOMA PROGNOSIS:
In line with the research findings published in 2018 from the National Mesothelioma Virtual Bank, the median survival of epithelioid patients is 18 months. This life span measures the time from diagnosis until mortality. Patients with biphasic cell type have a median survival of 10 months, and life span is 7 months for patients with sarcomatoid cells.
In comparison with other cell types, people with epithelioid cells had an enhanced prognosis of average of 200 additional days of to live. This enhanced survival rate can add years to a patient’s life span if they get an early-stage diagnosis with an immediate follow up treatment.
Considering the research carried out in 2020 and published in Oncology Reports, epithelioid mesothelioma prognosis rely greatly on a protein called CTGF, or connective tissue growth factor. People with lower levels of this protein experience a better prognosis and more prolonged life span.
Epithelial cell type gives room for patients to get more aggressive treatment plans, such as surgery, and innovative clinical trials, mostly when treated at a mesothelioma specialty hospital.
DIAGNOSIS OF EPITHELIAL MESOTHELIOMA:
Properly diagnosing epithelioid mesothelioma needs multiple procedures. Most patients experience important setbacks between the beginning of symptoms and getting an accurate and precise diagnosis.
Whenever the symptoms first manifest, such as cough or shortness of breath, the patieni can be vague and prompt general practitioners to request for several tests to rule out other diseases. Eventually, after radiology laboratory testing and a biopsy procedure, a mesothelioma specialist can confirm a diagnosis with a tumor cell type.
SOME CHALLENGES ENCOUNTERED:
Several obstacles may delay your physician from obtaining a tissue sample. Mesothelioma patients wait approximately three months after symptoms appear before they receive a diagnosis.
Only a tumor biopsy, collected through a procedure such as a thoracoscopy or fine-needle aspiration, leads to accurate identification of epithelioid mesothelioma.
Initial symptoms such as cough and fatigue mimic less severe respiratory conditions, according to research in the 2019 Expert Review of Respiratory Medicine.
Primary care doctors perform in-office exams and tests to rule out common causes of symptoms before referring a patient for more thorough chest scans.
Even with a referral, X-rays, CT scans or MRI tests can take weeks to schedule.
Radiological imaging can reveal visual abnormalities, but does not determine the cause of diseased chest areas.
Once imaging results are available, it may still take several more weeks to schedule an appointment for a biopsy.
One of the most important things you can do to minimize diagnostic delays is to share any history of asbestos exposure with your health care provider.
If your doctor knows you have a history of asbestos exposure, they are more likely to consider mesothelioma or another asbestos-related condition.
Immunohistochemistry is a laboratory test to detect proteins on the surface of cells. These proteins help classify cancer cell types.
Pathologists use immunohistochemistry to identify epithelioid mesothelioma and differentiate it from another type of cancer called adenocarcinoma.
According to the 2018 ASCO pleural mesothelioma treatment guidelines, immunohistochemistry is the recommended test for suspected mesothelioma tumors.
This analysis will confirm the absence or presence of mesothelioma cell markers, leading to the most accurate diagnosis possible.
Your pathology results will show the specific cell type of your cancer. If you don’t have a record of your cell type, be sure to ask your doctor and request a copy of the pathology report for your records.
Epithelial Mesothelioma Cell Subtypes:
When a pathologist outlines their report for your treating physician, they provide a wide breadth of information. These details include the biopsy site where the sample originated, how the surgeon collected the sample, cell characteristics, the distribution of cells in the tissue and an overall diagnosis.
Epithelial cells can vary in many different ways, leading to several additional cellular subtypes within this group. These subtypes can inform your doctor how your cancer might progress and which treatments may be most appropriate.
This subtype of epithelioid mesothelioma is the most common. Most tubulopapillary mesotheliomas contain well-differentiated cells. Doctors without mesothelioma experience can mistake this for adenocarcinoma that has spread to the pleura.
2. Glandular Mesothelioma Cells:
Mucus-secreting glandular cells stained for microscopic evaluation.
Tumors with the glandular pattern are primarily composed of gland-like (acinar) structures. This subtype usually develops in the pleural lining. It may be confused with adenocarcinoma that has spread to the pleura. Epithelial mesothelioma cells under a microscope. Rare adenomatoid mesothelioma cell pathology.
Adenomatoid mesothelioma, also known as the microglandular cell type, accounts for 6% of pleural mesothelioma cases. These tumor cells appear flat or cube-like with a lining of small gland-like structures. Adenomatoid cells often combine with other kinds of epithelial cells inside a tumor. Doctors may mistake it for benign adenomatoid tumors or metastatic adenocarcinoma of the pleura.
5. Solid Cell Variant:
The solid subtype has two patterns: Well-differentiated and poorly differentiated. Solid, well-differentiated epithelial type is more common. It has round cells in nests, cords or sheets. The poorly differentiated pattern has relatively unorganized cells that are polygonal (having straight sides) to round in appearance. A pathologist without relevant experience may mistake solid, well-differentiated mesothelioma for benign reactive mesothelial hyperplasia. The poorly differentiated pattern looks like lymphoma and large cell carcinoma.
6. Deciduoid Mesothelioma Cell Type:
Deciduoid mesothelioma is a rare epithelial subtype. This pattern features large round to polygonal cells with sharp borders. Deciduoid mesothelioma may be mistaken for squamous cell carcinoma, anaplastic large cell lymphoma, gastrointestinal autonomic nerve tumor, pseudotumoral deciduosis, trophoblastic neoplasia and the oxyphilic variant of ovarian clear cell carcinoma.
i. well-differentiated papillary mesothelioma
ii. well-differentiated papillary mesothelioma.
iiii. Well-Differentiated Papillary Mesothelioma
This cell type grows slowly and features small bumps or protrusions lined by a single layer of thin cells. This type of mesothelioma is primarily benign and responds well to surgery. It occurs mainly in younger and older adult women with peritoneal mesothelioma.
AVAILABLE TREATMENT FOR EPITHELIAL MESOTHELIOMA:
Patients have a better chance of improving life expectancy when they seek out specialized mesothelioma care and treatments tailored to their diagnosis. The first step in finding the best mesothelioma treatment is to seek the advice of an expert physician.
Of the three mesothelioma types, epithelial responds best to treatment. Patients diagnosed with the epithelial variant tend to have more treatment and clinical trial options, such as immunotherapy and radiation therapy.
Early-stage epithelioid mesothelioma is treated aggressively with a combination of surgery, chemotherapy and radiation therapy. According to a 2019 report in The Annals of Thoracic Surgery, combination therapy resulted in significantly better outcomes for patients with epithelial malignant pleural mesothelioma.
As cancer progresses it has a higher chance of spreading and metastasizing to other areas, making surgery less beneficial. Late-stage cases respond better to chemotherapy, immunotherapy and Tumor Treating Fields therapy