Response:

Pleural mesothelioma has two forms: primary and secondary. Primary pleural mesothelioma originates in the cells of the pleura, with pleural mesothelial carcinoma being the most common type. Secondary pleural mesothelioma occurs when cancer cells from another part of the body spread to the pleura. This is most commonly seen with cancers originating in the lungs, breasts, ovaries, or stomach.

Symptoms often develop subtly and are easily mistaken for other respiratory illnesses. Difficulty breathing, chest pain, a feeling of chest heaviness, shoulder and back pain radiating to the neck, persistent cough, weight loss, fatigue, and exhaustion typically appear only as the tumor grows larger. Pleural effusion (fluid buildup around the lungs) is another common symptom.

Pleural mesothelioma is dangerous because it can easily spread to and invade nearby organs. Without prompt diagnosis and intervention, it can lead to respiratory failure, chronic pain, pleural effusion compressing the lungs, reduced quality of life, and death.

Diagnosing pleural mesothelioma requires a combination of methods to accurately determine the nature of the tumor, its extent, and to develop a suitable treatment plan. Patients undergo X-rays to detect abnormalities like pleural effusion or tumors. CT scans provide more detailed images of the pleura and surrounding structures, helping to determine the tumor's size and the degree of invasion into the chest wall, mediastinum, or diaphragm. This assists in planning a biopsy. A pleural fluid sample is then collected for cytological examination to identify malignant cells.

Pleural fluid aspiration and biopsy sample collection. Photo: *Tam Anh General Hospital*

Treatment for pleural mesothelioma depends on the type of cancer cells, the stage of the disease, the patient's overall health, and the extent of the tumor's spread. Doctors often combine several methods for optimal results. These include draining pleural fluid to alleviate symptoms, radiation therapy to shrink the tumor, chemotherapy to kill cancer cells, and immunotherapy to help the immune system recognize and destroy cancer cells.

Pleural mesothelioma has various causes, the most prominent being asbestos exposure. Asbestos is a fibrous mineral once widely used in construction, insulation, and industrial equipment. When asbestos fibers are inhaled, they can remain in the pleura for years, causing cellular damage and increasing the risk of pleural mesothelial carcinoma. Chronic respiratory diseases can also contribute to the formation of malignant cells in the pleura. Long-term smokers, those with a family history of pleural mesothelial carcinoma, or those with lung cancer are at increased risk.

Individuals with a BAP1 gene mutation, associated with cell growth control, have a higher risk of developing pleural mesothelial carcinoma, even without asbestos exposure or other risk factors. People with a BAP1 mutation should have regular lung and respiratory checkups. Your father, having been diagnosed with this disease, should adhere to the doctor's treatment plan and quit smoking.

MSc. Dr. Phan Anh Thu

Respiratory Department, Tam Anh General Hospital, Hanoi