Key takeaways: Hypoxia refers to an area of a tumor that has minimal oxygen supply. Without enough oxygen, mesothelioma cells undergo significant alterations and genetic mutations to adapt. Hypoxic sections of tumors are notoriously more aggressive, and thus more resistant to typical modes of treatment. A non-invasive visualization technique called FMISO can help doctors pinpoint areas of hypoxia in mesothelioma tumors; this can help personalize treatment plans and increase patient prognosis. Keep reading to learn more about hypoxia and mesothelioma.
What is “Hypoxia”?
In the context of mesothelioma (and other cancers), “hypoxia” refers to a tumor that has a localized environment of minimal oxygen. Like healthy body cells, cancerous cells require nutrients, oxygen, and waste removal for their growth; in fact, they usually require more oxygen and nutrients, given their unchecked cellular growth and tendency to override the normal cell cycle. When tumors have a minimal oxygen supply, they are under new selection pressures. This means that the existing cells either have to quickly adapt or they’ll die off.
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The cells that are able to survive with minimal oxygen allocate fewer resources to DNA splicing and replication, meaning that the DNA in their daughter cells has more mutations. More mutations usually lend themselves to more erratic growth, an increased likelihood of metastasis, and a more aggressive tumor, generally. Hypoxia is a positive feedback loop: less oxygen equates to higher mutations and tumor aggression which equates to a lower need for oxygen.
Hypoxia and Mesothelioma
There are a few notable studies that have piloted hypoxia research in mesothelioma patients; however, there’s a notable lack of established literature. What researchers do know: mesothelioma often presents with distinct hypoxic sections, especially in more advanced stages. Hypoxic sections are far away from blood vessels and, on the micro level, have different metabolic and reproductive pathways from other cancerous cells. On the whole, hypoxic tumors are more resistant to traditional therapies–like radiotherapy and chemotherapy–and likely play a role in the poor prognosis of mesothelioma.
Considering Hypoxia for Treatment
Fluoromisonidazole (FMISO) is a non-invasive tracker of oxygenation in mesothelioma tumors. With FMISO, doctors are able to visualize tumors as having discrete sections of hypoxia and regular oxygenation; from there, they are able to make informed and contextual decisions about treatment.
A study conducted in 2015–the first study of its kind to utilize FMISO–found that 17 out of 20 patients had significant areas of detectable hypoxia. Because it’s a relatively new technique, though, FMISO isn’t used often in diagnostic or prognostic settings. Ideally, it will become a commonplace procedure to advance the a.) speed of mesothelioma diagnosis; b.) specificity of a diagnosis; and c.) prognosis of mesothelioma through early and accurate diagnosis.
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