Lower Back Pain Is Rarely a Cancer Sign—But It Can Be
A National Mesothelioma Registry To Combat Misdiagnosis In Veterans
(Veterans at the National Congress of American Indians convention in Las Vegas on Oct. 28, 2024. (Photo/Levi Rickert)
Native Vote 2024. Mesothelioma is a rare cancer caused by asbestos exposure, with military personnel being among the groups at highest risk due to service-related exposure. In the U.S., there are over 16.2 million veterans, of whom 183.000 are Native Americans. Although mesothelioma is one of the rarest forms of cancer, veterans account for around 30% of all diagnosed cases. Native American veterans, in particular, also seem to experience poorer health outcomes and face greater exposure to hazardous conditions.
Across all ethnic groups, once a mesothelioma diagnosis is made, survival rates at 5 years post-diagnosis range between 7% to 24% with treatment. However, without treatment, the survival expectancy is about six months. This significant difference in survival rates makes early diagnosis crucial to receiving adequate medical care.
What makes pleural mesothelioma hard to diagnose?
Pleural mesothelioma has an insidious onset with symptoms that can mimic conditions like the common cold, and the flu, or overlap with symptoms of pulmonary and cardiac disease, for which some may already be receiving treatment. This symptomatology, combined with the rarity of the condition makes doctors less likely to consider it. At the same time, mesothelioma can emerge 20 to 60 years post-exposure, further hindering patent history taking simply because people may not even consider a link between past exposure and their symptoms.
Clinical practice is also plagued by some limitations in diagnosis. As mesothelioma is so rare, not much attention is given to considering the gold standards for diagnosis and clinicians are not adequately trained to recognized differentiating symptoms. Moreover, current diagnosis standards apply to usual presentations, while disregarding earlier stages of the condition and atypical manifestations. Current research on mesothelioma diagnosis indicates that around 14% of cases are still misdiagnosed in developed nations, and more research is needed to fully understand pathological mechanisms that may help refine diagnosis methods.
A National Mesothelioma Registry to Improve Diagnosis
At present, there is a pressing need for significantly more research to be carried out on mesothelioma, not only in diagnosis methods but also in terms of new therapeutic pathways. Yet access to participants that may facilitate this research process is significantly limited for scientists. New cases diagnosed take up to two years to reach national statistics, where researchers can identify and contact patients for taking part in new studies. As survival rates are very low, by the time a case is reported through national statistics, and thus becomes available to researchers, the patient is no longer alive.
A National Mesothelioma Registry would in effect eliminate this problem, as patient information would become instantly available to healthcare research professionals under a case-finding methodology system. This would enable researchers to build more accurate pathology models for disease prediction and progression, which in return may result in refined diagnosis methods and better treatment options.
Better Diagnosis for Native Americans
In the Native American population, several types of cancers are more prevalent when compared to other populations. While a genetic predisposition has been considered, this has been mostly dismissed. Nevertheless, the illegal disposal of asbestos onto tribal lands, also known as fly-tipping, is a massive contributor to increased mesothelioma occurrence in this population.
In this context, mesothelioma in Native Americans seems to be highly dependent on the social determinants of health, rather than genetics. Yet building a complete picture of these risk factors is necessary for informing patient history taking and diagnosis procedures. If data from a National Mesothelioma Registry becomes available, social risk factors and exposure can be analyzed in more depth in this population.
These data can then inform healthcare interventions in local communities, such as patient awareness campaigns, support regular clinical testing for exposed populations, as well as develop educational campaigns and seminars for healthcare staff to recognize at-risk groups. Without timely access to patient data, none of these approaches are possible, which makes the creation of a National Mesothelioma Registry crucial for improving diagnosis, healthcare and treatment.
Jonathan Sharp is a key figure at Environmental Litigation Group, P.C. (ELG Law), specializing in financial operations and client relations. With a deep commitment to helping individuals affected by environmental hazards, Sharp plays a crucial role in supporting families and communities impacted by toxic exposures, including asbestos and other dangerous substances.
About the Author: "Levi \"Calm Before the Storm\" Rickert (Prairie Band Potawatomi Nation) is the founder, publisher and editor of Native News Online. Rickert was awarded Best Column 2021 Native Media Award for the print\/online category by the Native American Journalists Association. He serves on the advisory board of the Multicultural Media Correspondents Association. He can be reached at levi@nativenewsonline.Net."
Contact: levi@nativenewsonline.Net
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All About Keytruda
Keytruda (pembrolizumab) is a prescription drug that's used to treat certain forms of cancer. Keytruda comes as an intravenous (IV) infusion (an injection into your vein given over time).
Keytruda is used in adults and some children with certain advanced forms of the following types of cancer:
To learn more about Keytruda's uses, see the "What is Keytruda used for?" section below.
Keytruda basicsKeytruda contains the active ingredient pembrolizumab. (An active ingredient is what makes a drug work.)
Keytruda is a biologic medication. A biologic is made from parts of living organisms. It's available only as a brand-name drug.
Keytruda isn't available in a biosimilar form. Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs.
Like most drugs, Keytruda may cause mild or serious side effects. The lists below describe some of the more common side effects that Keytruda may cause. These lists don't include all possible side effects.
Keep in mind that side effects of a drug can depend on:
Your doctor or pharmacist can tell you more about the potential side effects of Keytruda. They can also suggest ways to help reduce side effects.
Mild side effectsHere's a short list of some of the mild side effects that Keytruda can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Keytruda's prescribing information.
Mild side effects of Keytruda that have been reported include:
Mild side effects of many drugs may go away within a few days or a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.
* For more information on this side effect, see the "Side effect focus" section below.
Serious side effectsSerious side effects from Keytruda can occur, but they aren't common. If you have serious side effects from Keytruda, call your doctor right away. But if you think you're having a medical emergency, you should call 911 or your local emergency number.
Serious side effects of Keytruda that have been reported include:
* For more information on this side effect, see the "Side effect focus" section below.
Side effect focusLearn more about some of the side effects Keytruda may cause. You can also refer to this Keytruda side effects article for details.
PneumonitisPneumonitis is inflammation in your lungs. It can occur in people using immunotherapy drugs, such as Keytruda.
Sometimes, it's possible to develop pneumonitis after you stop taking Keytruda.
A variety of symptoms are possible with pneumonitis. In its early stages, some people may not have symptoms. Be sure to tell your doctor if you have:
What might help
If you have pneumonitis with Keytruda, your doctor might prescribe corticosteroid treatment for you.
Additionally, your doctor may recommend that you temporarily or permanently stop taking Keytruda. If you need to temporarily stop taking Keytruda, your doctor may have you restart the drug after your symptoms reduce. But it's possible you may develop pneumonitis again with Keytruda treatment.
Reactions related to infusionSome people may react to infusions of Keytruda. (Infusions are injections of the drug given into your vein over a period of time.)
These reactions may be severe or life threatening. Infusion reactions can also cause severe allergic reactions. (See the section directly below for more information on allergic reaction.)
With an infusion reaction, you may experience:
What might help
During your Keytruda infusions, your doctor will closely monitor you for any symptoms of a reaction.
If you have symptoms of an infusion reaction, your doctor will first rate your symptoms from mild to life threatening.
For a severe or life threatening reaction, your doctor will stop your Keytruda infusion and have you permanently stop Keytruda treatment.
For a milder reaction, your doctor may slow the rate of your Keytruda infusion. Or they'll stop the infusion and have you temporarily pause treatment with Keytruda.
Allergic reaction
Some people may have an allergic reaction to Keytruda.
Symptoms of a mild allergic reaction can include:
A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.
Call your doctor right away if you have an allergic reaction to Keytruda. But if you think you're having a medical emergency, call 911 or your local emergency number.
The costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. You can refer to this Keytruda cost article for details about the cost of your treatment.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. Support options may also be available on the Keytruda manufacturer's website. You can also check out this article to learn more about saving money on prescriptions.
Find answers to some commonly asked questions about Keytruda.
What's Keytruda's mechanism of action? And what are signs that it's working?Keytruda's mechanism of action (how it works) is to promote the activity of your immune system to stop cancer cells from growing.
The drug attaches to a protein called programmed death receptor-1 (PD-1). Keytruda blocks the interaction of this protein with another protein called programmed death ligand-1 (PD-L1).
The interaction between these two proteins stops some specific actions of your immune system. In some cancers, the interaction between PD-1 and PD-L1 is overactive, and your immune system can't detect the cancer cells.
So by blocking the interaction between PD-1 and PD-L1, Keytruda reactivates your immune system. Then your immune system is able to detect cancer cells and stop them from growing and spreading.
Your doctor will monitor your treatment progress with imaging tests. If these tests show that the cancer cells have stopped growing or that the tumor size has shrunk, this is a sign that Keytruda treatment is working. Your doctor will also order blood tests to see how active your immune system is. Side effects like inflammation can sometimes show that Keytruda is working. However, not having certain side effects doesn't necessarily mean the drug isn't working.
Talk with your doctor about how they'll assess whether Keytruda is working for your cancer.
When will I need to stop Keytruda treatment?Your doctor may have you stop Keytruda treatment early if:
But, even if your cancer remains stable and you're tolerating Keytruda's side effects, your doctor may have you stop treatment after a certain amount of time. This is because the long-term effects of Keytruda aren't known.
In studies, the length of Keytruda treatment was limited to about 2 to 3 years. But this depended on the type of cancer being treated.
Talk with your doctor to find out how long you might need to take Keytruda.
What's Keytruda's success rate in treating cancer?Every person may have a different response to Keytruda.
Keytruda may help slow the growth of cancer. The drug's success rate can vary depending on:
In studies of Keytruda, researchers reported how long people lived and how long their cancer remained stable after starting Keytruda. If you'd like to know about these study results and the success rate of Keytruda for your type of cancer, talk with your doctor.
Is Keytruda a chemotherapy drug?No, Keytruda isn't a chemotherapy drug. It's an immunotherapy drug.
Chemotherapy is a type of cancer treatment that kills cancer cells or stops them from multiplying (making more cells). Immunotherapy, on the other hand, works with your immune system to help your body fight off cancer cells.
If you'd like to know more about the difference between chemotherapy and immunotherapy, talk with your doctor.
Does Keytruda treat ovarian cancer or brain cancer such as glioblastoma?Currently, Keytruda isn't used to treat ovarian cancer.
Some studies have shown that Keytruda may be beneficial for a certain type of ovarian cancer. This was seen when Keytruda was used either alone or together with other cancer drugs. But more studies are needed to confirm Keytruda's effectiveness and safety in treating ovarian cancer.
As described in the "What is Keytruda used for?" section above, Keytruda does treat solid tumors with a certain gene mutation that can't be removed by surgery or are spreading. This could include certain types of brain cancer.
For this condition, the drug can be given to adults and children ages 6 months and older. But Keytruda isn't recommended for children ages 6 months and older with brain cancer or spinal cord cancer that has a certain gene mutation.
A study showed that Keytruda isn't beneficial for a type of advanced brain cancer called high-grade glioma. Another study showed that recurring glioblastoma (another form of brain cancer) isn't improved with Keytruda treatment, given either alone or together with another cancer drug.
If you'd like to know more about treatment options for ovarian cancer or brain cancer, talk with your doctor.
Is Keytruda used for prostate or pancreatic cancer?No, Keytruda isn't currently used for prostate cancer or pancreatic cancer.
One study showed that Keytruda may be effective and safe for a specific type of prostate cancer called programmed death ligand 1 (PD-L1)-positive, metastatic castration-resistant prostate cancer. (PD-L1 is a type of protein. With metastatic prostate cancer, the cancer has spread from the prostate to other parts of the body. And with castration-resistant prostate cancer, the cancer doesn't improve with treatment that lowers certain hormone levels.)
But more studies are still needed to look at treating prostate cancer with Keytruda.
For pancreatic cancer, recent studies have looked at using immunotherapy as treatment. (And keep in mind that Keytruda is an immunotherapy drug.) Researchers are currently studying a drug combination that includes pembrolizumab (the active drug in Keytruda) for advanced pancreatic cancer.
Talk with your doctor if you're interested in treatment options for prostate cancer or pancreatic cancer.
If you have a certain type of advanced cancer, your doctor may prescribe Keytruda. It's prescribed for:
Your doctor may perform tests to determine whether Keytruda can treat your specific type of cancer.
Keytruda is an antibody (type of immune system protein). It helps your immune system detect cancer cells in your body and stop their growth. To learn more about how it works, see the first question below in the "What are some frequently asked questions about Keytruda?" section.
* For this use, Keytruda received accelerated approval from the Food and Drug Administration (FDA). Accelerated approval is based on information from early clinical studies. The FDA's decision for full approval will be made after more studies are completed.
Be sure to follow your doctor's instructions about your Keytruda dosage.
Form and strengthKeytruda comes as a solution that your doctor will inject into your vein over a period of time. This type of injection is called an intravenous (IV) infusion. It comes in a strength of 100 milligrams per 4 milliliters (100 mg/4 mL).
Recommended dosagesDepending on the type of cancer you have, your doctor will prescribe the dose of Keytruda that's right for you. You'll take the drug once every 3 weeks or once every 6 weeks.
Children taking Keytruda will receive a dose once every 3 weeks.
To learn more, you can refer to this Keytruda dosage article.
How it's administeredYour IV infusions of Keytruda will each be given over about 30 minutes. You'll receive infusions at a clinic or your doctor's office.
Your doctor will explain how Keytruda is given. They'll also explain how much will be given and how often.
Receiving Keytruda with other drugsYou might need to take Keytruda with other medications, depending on the type of cancer you have. Examples of other drugs that may be given with Keytruda include:
Here are answers to some common questions about receiving Keytruda.
Questions for your doctor
You may have questions about Keytruda and your treatment plan. It's important to discuss all your concerns with your doctor.
Here are a few tips that might help guide your discussion:
Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don't be afraid to ask questions or offer feedback on your treatment.
Keytruda and Opdivo are both used for certain types of cancer. But Opdivo has fewer uses than Keytruda does.
Opdivo can be used for:
For a list of Keytruda's uses, see the "What is Keytruda used for?" section above.
Like Keytruda, Opdivo is a programmed death receptor-1 (PD-1) blocking antibody (type of immune system protein). These drugs help your immune system detect cancer cells in your body and stop their growth. Both drugs are given via IV infusion and may be used with chemotherapy depending on the type of cancer.
For an in-depth comparison of these two drugs, see this drug article. And be sure to talk with your doctor if you have questions about which drug is right for you.
Below is important information you should consider before Keytruda treatment.
InteractionsTaking medications, vaccines, foods, and other things with a certain drug can affect how the drug works. These effects are called interactions.
Before taking Keytruda, be sure to tell your doctor about all medications you take (including prescription and over-the-counter types). Also, describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Keytruda.
Interactions with drugs or supplementsSo far, there aren't any known interactions between Keytruda and other medications, vitamins, herbs, or supplements.
But to be safe, talk with your doctor or pharmacist about any drugs, vitamins, herbs, or supplements you may want to start taking.
WarningsKeytruda may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Keytruda. Factors to consider include those in the list below.
For details about Keytruda's warnings and possible interactions, you can refer to this Keytruda interactions article.
Use with alcoholAlcohol isn't known to interact with Keytruda.
If you drink alcohol, before starting Keytruda, ask your doctor or pharmacist if it's safe for you to drink alcohol during treatment.
Pregnancy and breastfeedingKeytruda is not safe if it's given during pregnancy because it can harm a fetus. This is because with Keytruda treatment, your immune system may not recognize the fetus. And your immune system can start to attack the fetus' cells.
During treatment with Keytruda, your doctor may recommend that you use birth control to help prevent pregnancy. You might also need to continue using birth control for up to 4 months following your last dose of the drug.
It's not known for sure whether Keytruda passes into breast milk. If Keytruda does pass into breast milk, it's not known whether it would be harmful to a child who is breastfed.
It's recommended that you avoid breastfeeding during and for up to 4 months after stopping Keytruda treatment. If you have questions about this, talk with your doctor.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Pleurectomy And Decortication
Content
Pleurectomy and decortication is often offered to patients not healthy enough to undergo pneumonectomy or to patients whose tumors require a less extensive amount of resection.
The patient is placed lying on their side, and an S-shaped thoracotomy incision is made. The sixth rib is resected and the space between the lung and the chest cavity is dissected. The tumor is dissected away from the chest wall. After a sufficient area of chest wall has been freed, a chest retractor is inserted.
The pleura now can be moved from the mediastinum. Once the upper portion of the lung is completely detached from the chest wall, the vessels entering the lung are exposed. On the left side, the esophagus and aorta are identified and the dissected. On the right side, the superior vena cava is dissected away from the tissue and tumor being removed. The dissection then continues behind the pericardium.
In some patients, involvement of the diaphragm necessitates a full-thickness resection of the diaphragm muscle.
Once the dissection is completed to expose the vessels connecting the heart and lungs, the space between the lung and chest wall is opened decortication of the visceral pleura (membranous outer layer of the lung) is performed. During decortication, the lung is deflated to reduce blood loss. Most patients require blood transfusion during the procedure. Lymph node is also performed.
Once the tumor is removed, reconstruction of the pericardium (sac around the heart) and diaphragm, if required, is performed. If the diaphragm is largely intact, it can be pulled downward and to prevent upward movement and improve ventilation.
On the right side, reconstruction of the diaphragm is performed with a double layer of mesh. On the left, Gore-Tex is used because thicker, non-absorbable material is required. The prosthesis is secured laterally by placing sutures around the ribs.
An electrocoagulator may be used to help control bleeding from the chest wall. Three chest tubes are placed at the top, and a right-angled tube is placed along the diaphragm to control air leaks that are anticipated and should permit full refilling of the lung.
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