间皮瘤 | |
---|---|
同义词 | 恶性间皮瘤 |
电脑断层影像显示左侧间皮瘤合并纵膈淋巴结肿大。 | |
症状 | 呼吸困难、腹部肿胀、胸壁疼痛、咳嗽、感觉疲惫、体重下降[1] |
并发症 | 肋膜积液[1] |
常见始发于 | 渐发性[2] |
肇因 | 暴露于石棉之后约40年[3] |
风险因子 | 遗传学、感染猿猴空泡病毒40(SV40)[3] |
诊断方法 | 医学影像、恶性积液检验、活体组织切片[2] |
预防 | 减少石棉暴露[4] |
治疗 | 外科手术、放射线疗法、化学疗法、肋膜黏连术[5] |
预后 | 五年存活率:约8%(美国)[6] |
盛行率 | 60,800(2015年)[7] |
死亡数 | 32,400(2015年)[8] |
分类和外部资源 | |
医学专科 | 肿瘤学 |
间皮瘤(Mesothelioma)是一种源自于覆盖内脏表面的薄层组织(间皮细胞)的癌症[9]。最常患病的部位是胸膜[1][3]。腹膜也有,但较少见。在罕见的情下会出现在心包膜[10]或睾丸鞘膜[1][11]。间皮瘤的症状有因肺中液体潴留造成的呼吸困难、腹部肿胀、胸壁疼痛、咳嗽、疲倦,以及体重减轻[1]。这些症状出现的速度一般而言较为缓慢[2]。
超过80%的间皮瘤是由暴露在含石棉的环境中所导致的[3]。暴露程度越高,风险越大[3]。截至2013年,约有1.25亿人曾在工作环境中接触石棉[12]。患病比例较高的族群有:石棉矿的矿工、将石棉加工制做成产品的人、工作时会接触石棉制品的人、和以上这些人同住的人,以及在含有石棉的建筑物中工作的人[3]。从暴露石棉到癌症出现大约相隔40年[3]。清洗石棉工作者的衣物也会增加清洗者的罹病风险[12]。其他风险因子包含遗传以及被SV40病毒感染[3]。间皮瘤可以用胸部X光及X射线计算机断层成像进行初步诊断,再用细胞生物学或是活体组织切片来确诊[2]。
预防的重点为减少石棉暴露[4]。间皮瘤的治疗通常包括手术、放射线疗法,及化学疗法[5]。有一种称为肋膜黏连术的术式,是用滑石之类的物质使胸膜产生疤痕并沾黏在一起,可用来防止肺部积水增加[5]。化疗一般会用顺铂及培美曲塞[2]。在美国,患者的五年存活率平均而言为8%[6]。
在2015年,约有60800人罹患间皮瘤,其中32000人因此死亡[7][8]。世界各地的间皮瘤发生率依地区而不同[3],在澳洲及英国的发生率较高,在日本则较低[3]。在美国,每年约有3000个人得到此病[13],男性得到此病的比率比女性高[3]。自1950年起,此病的发生率便呈现上升的趋势[3]。被诊断出此病时病患大多年过65,且大多在七十岁左右死亡[3]。在石棉的商业化应用问世以前,这个疾病非常罕见[3]。
预防
香港于2008年修订了《肺尘埃沉着病(补偿)条例》(正名为《肺尘埃沉着病及间皮瘤(补偿)条例》),给予间皮瘤患者相当于尘肺病患者的补偿待遇,理据是两者同是暴露于石棉环境的后遗症。
参考资料
- ↑ 1.0 1.1 1.2 1.3 1.4 Malignant Mesothelioma Treatment–Patient Version (PDQ®). NCI. 2015-09-04 [2016-04-03].
- ↑ 2.0 2.1 2.2 2.3 2.4 Kondola, S; Manners, D; Nowak, AK. Malignant pleural mesothelioma: an update on diagnosis and treatment options.. Therapeutic Advances in Respiratory Disease. 2016-02-12, 10 (3): 275–88. PMC 5933604 . PMID 26873306. doi:10.1177/1753465816628800.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Robinson, BM. Malignant pleural mesothelioma: an epidemiological perspective.. Annals of Cardiothoracic Surgery. 2012-11, 1 (4): 491–6. PMC 3741803 . PMID 23977542. doi:10.3978/j.issn.2225-319X.2012.11.04.
- ↑ 4.0 4.1 Whittemore, Alice S. Cancer epidemiology and prevention 3rd. Oxford: Oxford University Press. 2006: 669. ISBN 9780199747979.
- ↑ 5.0 5.1 5.2 Malignant Mesothelioma Treatment–Patient Version (PDQ®). NCI. 2015-09-04 [2016-04-03].
- ↑ 6.0 6.1 Age-Adjusted SEER Incidence and U.S. Death Rates and 5-Year Relative Survival (Percent) By Primary Cancer Site, Sex and Time Period (PDF). NCI. [2016-04-03].
- ↑ 7.0 7.1 GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.. Lancet. 2016-10-08, 388 (10053): 1545–1602. PMC 5055577 . PMID 27733282. doi:10.1016/S0140-6736(16)31678-6.
- ↑ 8.0 8.1 GBD 2015 Mortality and Causes of Death, Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.. Lancet. 2016-10-08, 388 (10053): 1459–1544. PMC 5388903 . PMID 27733281. doi:10.1016/s0140-6736(16)31012-1.
- ↑ Malignant Mesothelioma—Patient Version. NCI. 1980-01 [2016-04-03].
- ↑ Sardar, MR; Kuntz, C; Patel, T; Saeed, W; Gnall, E; Imaizumi, S; Lande, L. Primary pericardial mesothelioma unique case and literature review.. Texas Heart Institute Journal / From the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 2012, 39 (2): 261–4. PMC 3384041 . PMID 22740748.
- ↑ Panou, V; Vyberg, M; Weinreich, UM; Meristoudis, C; Falkmer, UG; Røe, OD. The established and future biomarkers of malignant pleural mesothelioma.. Cancer Treatment Reviews. 2015-06, 41 (6): 486–95. PMID 25979846. doi:10.1016/j.ctrv.2015.05.001.
- ↑ 12.0 12.1 Gulati, M; Redlich, CA. Asbestosis and environmental causes of usual interstitial pneumonia.. Current Opinion in Pulmonary Medicine. 2015-03, 21 (2): 193–200. PMC 4472384 . PMID 25621562. doi:10.1097/MCP.0000000000000144.
- ↑ What are the key statistics about malignant mesothelioma?. American Cancer Society. 2016-02-17 [2016-04-03].
外部链接
- 香港肺尘埃沉着病补偿基金委员会官方网页上的介绍
- ATSDR — Case Studies in Environmental Medicine: Asbestos Toxicity U.S. Department of Health and Human Service (public domain)
- Mesothelioma: Questions and Answers from the U.S. National Cancer Institute
- Cancer.gov: Malignant Mesothelioma from the U.S. National Cancer Institute
- Mesothelioma from the American Cancer Society
- Malignant Mesothelioma review article from the American Cancer Society
- Medlineplus: Mesothelioma from MEDLINE, part of the United States National Library of Medicine
- Worksafe, Western Australia, from Western Australia's Department of Consumer and Employment Protection
- US Nat'l Institute for Occupational Safety and Health , from the Centers for Disease Control
- Australian Mesothelioma Register
- What is Mesothelioma? Research and advocacy from the Mesothelioma Applied Research Foundation
- Radiology of mesotheliomas, with additional examples from Radiopaedia.org
- Information from Cancer Research UK
- UK mesothelioma statistics from Cancer Research UK
- Malignant Pleural Mesothelioma NCCN Patient Guidelines for Malignant Pleural Mesothelioma National Comprehensive Cancer Network