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Mesothelioma and medical thoracoscopy

Mesothelioma is a malignant tumour commonly occurring in the pleura (lining of the lung) and in the UK usually caused by exposure to asbestos. It often develops 30-40 years after the original asbestos
exposure. Even though there have been legal regulations controlling asbestos use for over 40 years, because of the time-lag we would not expect the peak of disease to occur for another 15 years or so. Even after this time, it is unlikely the disease will cease as there are millions of homes in the UK
built, in part with asbestos and as such we are seeing a new wave of disease in different occupations. Previously mesothelioma was common in dockyard workers and is now becoming common in
builders and decorators. There are three main potential arms of treatment; firstly radiotherapy which can help with pain and also prevents spread through the chest wall following interventional procedures; secondly, chemotherapy can help relieve some symptoms and may improve quality of life to some degree; thirdly there is the option of surgery, but very few patients are eligible for radical surgical procedures as they are extremely extensive and in fact at the present time are not yet of proven benefit. To this end, there is a trial being conducted currently (MARS trial) which compares extensive surgery against other forms of treatment. Of the current regimes, neither chemotherapy nor radiotherapy in general prolong a patients life expectancy and surgery may be of benefit only in a very few select patients, so this treatment is yet unproven. The average time from diagnosis to death of mesothelioma patients is often less than one year. Symptoms generally come on insidiously and because of the nature of the disease, often present when the tumour is already advanced. In order for us to confirm the diagnosis of mesothelioma, we somehow need to obtain biopsy samples from the pleura and these can be done in a number of different ways. Firstly they can be done by the physician under local anaesthetic and these are done "blindly" through the chest wall to the suspected affected area but because the disease is often patchy this may often not confirm the diagnosis. The second option is for a CT or ultrasound guided biopsy which can improve the proportion of patients getting a positive result but very often, this again does not confirm the diagnosis. For each of these procedures there is always a short waiting time of a couple of weeks and once the samples are obtained a further wait for the samples to be processed. These individual procedures can add up to a significant delay in getting the diagnosis. The final option is normally to send the patients to a thoracic surgeon where they require a general anaesthetic for an operation to obtain biopsies. This entails travelling to London for patients who are already debilitated with respiratory compromise. Because of the age and frailty of many Mesothelioma patients they are not fit enough for general anaesthetic and under these circumstances the diagnosis may have to be made post mortem. There are now at least ten centres in district general hospitals across the UK that are providing a "medical thoracoscopy service". Thus, when patients present with signs and symptoms that may be consistent with a malignancy of the pleura they proceed directly to thoracoscopy. This is performed, simply under local anaesthetic and does not require general anaesthesia. The thorascope is passed through the chest wall and this allows the pleural effusion (excess fluid) that accumulates in the chest to be instantly drained. This fluid compresses the lung and causes the symptoms of breathlessness. Once this fluid is removed biopsies of the lining of the chest cavity can be taken under direct vision therefore giving a diagnostic rate of in excess of 90%. Once this has been done an agent can be put into the chest wall to stick the lining of the lung to the chest wall to prevent the fluid re-accumulating. The patients normally need to be in hospital for just over a day.
This can provide considerable symptomatic relief. So thoracoscopy can be performed in all ages of people and even in patients who are more frail. It provides a "three in one" treatment i.e. removal of fluid, biopsy and prevention of fluid re-accumulation all at one sitting and therefore allows the patient to have a diagnosis possibly as quickly as within two to three weeks from the moment that they have seen their general practitioner. Currently without medical thoracoscopy it takes on average at least three months
to make a diagnosis of Mesothelioma in this country. Because in general patients have less than a year to live this is an extremely valuable time and medical thoracoscopy can give them a greatly
increased quality of life for a longer period of time. Medway Maritime Hospital is hoping to be able to set up this service as we sadly have a great number of Mesothelioma patients per annum due to our proximity to Chatham Dockyards. Unfortunately the purchasing of the equipment costs in the order of £15,000-£20,000, and although a fund has been set up to try and raise this money we are less than a
quarter of the way towards our target. We feel that the provision of this service would greatly enhance the care of our patients. The Kent On Sunday (23/07/06) reported that hospital managers at
Medway Maritime have agreed to fund the balance of monies needed to purchase the thorascope following initial donations of £5000 from the public. It is hoped that the thorascope will be in use
in the very near future which will enable patients to be treated locally rather than referred to London.

For further enquiries please contact Peter Flory (view full profile) on 01892 701323 or email pflory@ts-p.co.uk.

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