Mesothelioma Information Malignant

Mesothelioma Treatments Making Significant Progress

2009-01-19T19:47:00.000-08:00

Mesothelioma is a rare form of cancer that is most notably caused by exposure to asbestos. Such industries that have been known for exposing people to the toxic substance include the shipyard, automotive, mining and construction industries.
In the majority of cases, exposure occurs when someone has disturbed asbestos-containing materials and have either inhaled or ingested the microscopic fibers that make up asbestos. Once in the body, these fibers typically attach themselves to the lining of the lungs and remain there since the body has difficulty in expelling them.

In years past, the majority of treatment options for malignant mesothelioma have unfortunately been more palliative than curative. This is largely attributable to the severe latency period associated with the disease. The development of mesothelioma can take anywhere from 20 to 50 years, and patients are usually diagnosed when the disease has already reached the advanced stages.

Common treatments for mesothelioma have included surgery, chemotherapy, and radiation therapy. Lately though, hospitals, universities, and pharmaceutical companies have pushed for increased research on asbestos and asbestos-related diseases to enhance treatments options.

Alfacell is one company that has recently made significant strides in developing a new treatment. Their product is called Oncanase, which works in a similar way to RNA interference (RNAi). Oncanase is a therapeutic medication that is derived from the leopard frog. It has been proven to kill cancerous cells while sparing normal cells at the same time.

Another discovery concerning a potential mesothelioma cure has come from researchers at the National Centre for Asbestos Related Diseases at Sir Charles Gairdner Hospital. Their findings involve a skin cancer cream called Aldara, which was first proven to be successful in mice.

The method of treatment requires the skin cancer cream to be injected into the patient’s mesothelioma tumor. In addition to the cream, a stimulant drug called anti-CD40 is also directly injected into the tumor.

Experimental treatments and clinical trials such as these are being carried out on a regular basis around the world. Today, progress with mesothelioma treatment is being made with the help of increased funds and awareness towards the disease. Continued research on asbestos and related cancers will hopefully bring curable treatment options for mesothelioma patients in the future.

We Know: All About Mesothelioma What is mesothelioma?

2009-01-19T03:02:00.000-08:00

Mesothelioma is a cancerous lung disease in which nano-sized particles of a non-degrading substance such as asbestos dust have worked their way into the lining of the lungs and formed hard nodules, reducing the capacity of the lungs to function. It is incurable, and is very likely to lead to death.

What is the history of mesothelioma?

In 1999, ten percent of the population of a small town in Montana was diagnosed with a rare, deadly, and hard-to-detect lung disease called mesothelioma. The disease was known to be caused by asbestos, and the town's economy was built around the mining of asbestos. As investigators and physicians gradually pieced together information, it became very clear that the mining company had lied to the citizens of the town for decades, slowly poisoning the air, the ground, and the water of the community. It's projected that by the time cases of mesothelioma and related lung diseases have been fully diagnosed, as many as one-third of the long-term citizens of the town will be in treatment.

How Do You Get Mesothelioma?

Mesothelioma can only be contracted if you have inhaled or ingested nano-sized dust particles of a particular size, shape, and consistency, usually a particular type of asbestos. In addition, research indicates that it must trigger your immune system in a particular way. While not everyone exposed to asbestos and a few similar substances gets mesothelioma, the more extensive your exposure is, the more likely you'll develop it. While it's most common to contract mesothelioma from work directly exposing you to asbestos, like mining or construction, wives washing work clothes or children playing in contaminated areas may also get the disease.

How Is Mesothelioma Diagnosed?

For most people, the first signs of mesothelioma are a shortness of breath, a cough that won't go away, and a feeling of choking, as if your airway is being obstructed. Though mesothelioma is caused by exposure to asbestos as much as fifteen years before the onset of symptoms, it's often diagnosed only three or four months after the first onset of symptoms. Unfortunately, the cancer has generally metastasized, or spread to other parts of the body, by this time.

While lungs in pre-mesothelioma stages have few if any symptoms, once mesothelioma has developed symptoms crop up at an alarming pace. In the beginning, asbestos particles invade the tiniest sacs of the lungs, and then work outward into the lung lining, which contains the lungs in a flexible sac. The particles irritate this lining and cause an immune system reaction that builds scar tissue up around the asbestos. Lungs with a little of this scar tissue aren't usually affected in a negative manner. However, the more extensive the scarring the less flexible your lungs become. Ultimately, the sac changes from the consistence of a thick balloon to the consistency of an orange peel -- and this means it cannot properly expand to contain your lungs. It also makes these nodules very susceptible to a particular type of cancer.

You should also be aware that mesothelioma can grow very painful as the lungs fill with fluid and infection. Persons with mesothelioma should be prepared to begin pain medications in short order. Treating the pain can actually help you fight the disease better.

What Are the Treatments?

Unfortunately, there are few treatments that are effective against mesothelioma. Primary treatment generally includes oxygen, to allow the parts of your lungs that still function properly to have a better chance of supplying adequate oxygen to your bloodstream. Antibiotics are used to treat secondary infections, and sometimes airway-dilating medicines, like those used for bronchitis or asthma, have proven useful.

This, however, only treats the symptoms. To treat the mesothelioma itself, the cancer must be removed or eliminated to the extent possible, and then lung functions must be restored. This isn't quite as bad as it sounds. Like all cancers, mesothelioma can be treated with surgery, radiation, and chemotherapy. New drugs and techniques to treat mesothelioma are cropping up every day.

Most mesothelioma is treated with a combination of the three approaches. The less metastasizing that has occurred, the more likely surgery will be your primary treatment. Before choosing a course of treatment, though, discuss all your options with your medical team. When you begin one route of treatment, you may be eliminating the options of others. But start treatment as quickly as you can. Early treatment has the best prognosis, with seventy-five percent of those having mesothelioma treated prior to metastazation living at least two more years (compared to forty percent after the cancer has spread).

Is Mesothelioma Curable?

Mesothelioma is not curable. Because the particles that have invaded your body are so very tiny, it's impossible to eradicate them all.

The best chance for a sufferer from mesothelioma is early, aggressive treatment. Pain control and a positive attitude will improve a patient's prognosis. If you have mesothelioma, your best course of action is to seek treatment immediately, and continue with all the daily activities you love as long as you can. Take prescribed and over the counter painkillers as your doctor recommends.
Other Things to Look For

Though lung mesotheliomas are the most likely, peritoneal mesothelioma sometimes appears as well. This is a mesothelioma where the particles have been ingested, and have caused damage to the peritoneal sac containing the internal organs in your abdomen. If you've been exposed to asbestos in the past and are having symptoms like abdominal pain, weight loss, nausea, and vomiting not ascribable to any other cause, you may have peritoneal mesothelioma. Other symptoms include herniation, abdominal fluid, and a mass in the abdomen, or constipation, diarrhea, or blood in the stool. Peritoneal mesothelioma is generally deadlier than that of the lungs. If you think you may have this condition, seek medical treatment immediately.

Mesothelioma

2009-01-18T03:22:00.000-08:00

Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart,[1] the pericardium (a sac that surrounds the heart) or tunica vaginalis.

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing mesothelioma.[2] Unlike lung cancer, there is no association between mesothelioma and smoking.[3] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Mesothelioma Law

2009-01-18T00:53:00.001-08:00

Litigation is, unfortunately, a required element to secure speedy, just compensation.

For individuals stricken with asbestos related mesothelioma, there may be substantial compensation available if they act quickly to engage an experienced mesothelioma lawyer who is proficient in asbestos legal issues and proving asbestos exposure. Most often mesothelioma lawsuits end up with a settlement without ever going to trial or even into a court. In our experience, this is the preferred scenario for most families with a mesothelioma case.

Since the only known cause of mesothelioma in the United States is asbestos, the key to successful case is proving exposure to the product(s) responsible for the injury. That is why you need to hire an experienced asbestos related disease attorney.

This is not to say that the asbestos industry will simply give away any money. The large corporations that we routinely go up against will hire some of the best attorneys that money can buy to defend and delay against paying compensation to you. This is why retaining an experienced mesothelioma lawyer with a background in this type of case can help you and your family get the asbestos settlement or verdict you deserve.

Coady law firm attorneys have represented many hundreds of clients stricken from asbestos related mesothelioma with compassion, diligence and success. They began their works in mesothelioma case 25 years ago, and they are still hard at it today.

Mesothelial and Mesothelioma Cell Lines

2009-01-18T00:40:00.000-08:00

Primary cultures of mesothelial cells have been established from rats, rabbits,
mice, and humans (Table 5.1). Mesothelial cell lines provide several advantages
for experimental studies: they provide a large number of cells isolated from a
single donor, cell lines can be isolated from genetically engineered mice, and
primary cell lines limit the number of animals required for experiments.
However, cell lines have several disadvantages: variability among donors,
variability in culture conditions in different laboratories, potential
phenotypic and genetic instability, and a limited life span in vitro (reviewed
in ref. 1). Some of these disadvantages can be overcome by quality control
procedures. For example, cell lines should not be passaged indefinitely; frozen
stocks should be maintained and thawed at regular intervals to prevent
phenotypic and genetic instability (reviewed in ref. 2). As in all cell cul¬ture
models, precautions are required to prevent cross-contamination and
contamination with bacteria or viruses. DNA profiles could be use¬ful to
identify cell lines; for example Manning et al (3) established initial genetic
profiles for their panel of human malignant mesothelioma cell lines. All
cultures should be screened for Mycoplasma and other pathogens (2).

MESOTHELIOMA RADIATION THERAPY

2009-01-18T00:39:00.000-08:00

Radiation therapy, also called radiotherapy, treats cancer by using penetrating beams of high energy or streams of particles called radiation. In treating mesothelioma, radiation may be used aggressively in combination with surgery, or palliatively to control symptoms.

In an aggressive combined modality approach, radiation is used to attack microscopic or residual disease remaining in the chest cavity after extrapleural pnuemonectomy. An example of this is Intensity Modulated Radiation Therapy (IMRT), which uses x-rays of varying intensities in conjunction with computer generated images to deliver targeted radiation directly to cancer cells while reducing the amount of radiation to surrounding healthy tissue. More on Intensity Modulated Radiation Therapy (IMRT).

Used palliatively, radiation can help control metastases (spread) of the tumor along tracks left by invasive procedures such as thoracoscopy, needle biopsy and chest tube drainage, or to control disease symptoms, such as pain or shortness of breath.

An exciting new development in radiation oncology is tomotherapy. A brief description of steps in the helical tomotherapy process.

Mesothelioma Cancer - Overview

2009-01-17T18:45:00.000-08:00

Mesothelioma is a rare type of cancer that develops in the mesothelial cells that lines many organs and body cavities. The mesothelium (composed of mesothelial cells) is the membrane that lines three of the body's cavities, and depending on what cavity it lines it is given a specific name: the thoracic cavity (pleura), abdominal cavity (peritoneum), and the heart sac (pericardium).

Mesothelioma is a rare cancer that can develop in the mesothelium of the thoracic cavity in the lungs.
The mesothelium that covers the internal organs is called the visceral mesothelium, while the layer that covers the body wall is called parietal mesothelium.

Mesothelium tissue also surrounds the male internal reproductive organs and covers the internal reproductive organs in women.

Mesothelioma is an aggressive cancer of this mesothelium, in which cells of the mesothelium become abnormal and divide uncontrollably and without order. They can invade and damage nearby tissues and organs. Most cases of mesothelioma begin in the thoracic cavity (pleura) or the abdominal cavity (peritoneum).

Approximately 2,000 to 3,000 cases of mesothelioma are diagnosed each year in the United States, comprising around 3 percent of all cancer diagnoses. This cancer occurs more frequently in men than in women, about four times more frequent. All forms of mesothelioma, except for benign mesothelioma, are invariably fatal. The prognosis for mesothelioma is almost always poor and most studies report a median survival of less than one year, but the prognosis really depends on how early it is diagnosed and aggressively it is treated.

Mesothelioma Asbestos: The Silent Killer

2009-01-17T00:44:00.000-08:00

Asbestos is a silent killer that has destroyed thousands of lives. For decades, millions of unsuspecting Americans were exposed to toxic levels of asbestos on their jobs, in their homes, at school, and numerous other places. The following video details the dangers of asbestos and the options available to victims of asbestos poisoning.

Individuals who incur significant asbestos exposure are at risk of developing asbestosis, lung cancer, mesothelioma (a fatal cancer that attacks the lining of the chest cavity and internal organs), and other serious illnesses.

In fact, the only proven cause of mesothelioma is asbestos. Individuals who worked in shipyards, including Navy facilities, are among those who are most frequently stricken with mesothelioma. The disease begins when the tiny fibers of asbestos are let loose in the air, where they are inhaled and become lodged in the lungs. There is no cure for mesothelioma.

All asbestos-related diseases can wreak havoc in the lives of individuals and their families, resulting in the loss of jobs, health, and often lives. If asbestos exposure or one of its related diseases has affected your life, your greatest resource is information.

Please take a moment to watch this video and learn all that you can about the silent epidemic of asbestos exposure and the ravages of mesothelioma and other asbestos-induced diseases. The more that you know about asbestos, the better prepared you will be to fight for your rights and those of your loved ones.

MESOTHELIOMA STAGES

2009-01-16T18:13:00.000-08:00

Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use for pleural mesothelioma and each one measures somewhat different variables; peritoneal mesothelioma is not staged.

Staging is the term used to describe the extent of a patient's cancer, based on the primary tumor and its spread in the body. It can help the medical team plan treatment, estimate prognosis and identify clinical trials for which the patient may be eligible.

Staging is based on a knowledge of how the cancer develops, from the primary tumor, to the invasion of nearby organs and tissues, to distant spread or metastasis. Staging systems have evolved over time, and they continue to change as scientists learn more about cancer. Some staging systems cover many different types of cancer, while others focus on more specific cancers. The TNM (primary tumor, regional lymph nodes, distant metastasis) is the most common staging system for mesothelioma.

Some elements common to most staging systems are:

* Location of the primary tumor.
* Size and number of the tumors.
* Lymph node involvement.
* Cell type and tumor grade.
* Metastasis.

Many cancer registries, such as the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER) use summary staging, a system used for all types of cancer. Summary staging groups cancer into five main categories:

* In situ - cancer that is present only in the layer of cells in which it began.
* Localized - cancer that is limited to the organ in which it began with no evidence of spread.
* Regional - cancer that has spread from the primary site to nearby lymph nodes or organs.
* Distant - cancer that has spread from the primary site to distant lymph nodes or organs.
* Unknown - cases where not enough information exists to indicate stage.

Several types of testing may be used to help doctors determine stage, and to formulate a treatment plan.

* Physical examinations. The doctor examines the body by looking, feeling and listening to anything out of the ordinary.
* Imaging techniques. Procedures such as x-rays, CT scans, MRIs and PET scans may show the location, size of the tumor and whether the cancer has spread.
* Laboratory tests. Studies of blood, urine, fluid and tissue can provide information about the cancer. Tumor markers, sometime elevated when cancer is present, may provide information.
* Pathology reports. Results of the examination of tissue samples can include information about the size of the tumor(s), extension into adjacent structures, type of cells and grade of the tumor. Results of the examination of cells in fluid, such as that from a mesothelioma-related pleural effusion, may also provide information.
* Surgical reports. Observations about the size and appearance of the tumor(s), lymph nodes and nearby organs.

Staging information should be provided to the patient by his doctor so that potential treatment plans can be discussed. Stage of the mesothelioma, as well as consideration of other factors such as age, health status and the patient's wishes may dictate different treatment options.

The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages. The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.

Butchart System – extent of primary tumor mass

* Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
* Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
* Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
* Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.

TNM System -- variables of T (tumor), N (lymph nodes), M (metastasis)

* Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
* Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
* Stage III: Mesothelioma is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
* Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

Brigham System: (variables of tumor resectability and nodal status)

* Stage I: Resectable mesothelioma and no lymph node involvement
* Stage II: Resectable mesothelioma but with lymph node involvement
* Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
* Stage IV: Distant metastatic disease

Mesothelioma Malignant

2009-01-16T16:09:00.000-08:00

Mesothelioma Treatment

2009-01-16T16:06:00.000-08:00

Pericardial Mesothelioma

2009-01-16T08:24:00.001-08:00

Malignant pericardial mesothelioma is a type of cancer that originates in the mesothelium, a thin wall of cells that surround the body's organs and internal body structures. Pericardial mesothelioma originates in the lining of the heart. Other locales of the disease are malignant pleural mesothelioma, which occurs in the lining of the lungs and malignant peritoneal mesothelioma, which occurs in the abdomen wall. Pericardial mesothelioma is the rarest of these malignancies and accounts for only an estimated 10 percent of all mesothelioma incidences annually.
What Causes Pericardial Mesothelioma?

Pericardial mesothelioma is known only to be caused by exposure to asbestos, a naturally occurring but toxic mineral that was used in industrial capacities. While the precise route by which microscopic asbestos fibers reaches the pericardial lining is not known, physicians surmise that inhaled asbestos fibers are absorbed into the bloodstream and become entangled in the heart's lining as the blood processes through the heart. Mesothelioma occurring in other parts of the body, such as in the pleura or peritoneum, can also metastasize to the pericardial lining.
How is Pericardial Mesothelioma Treated?

Prognoses are poor in cases of pericardial mesothelioma, just as nearly all mesothelioma cases are. However, several treatment options exist to help patients manage the disease and maintain comfort. Chemotherapy and radiation therapy are the most likely treatment options for patients of this disease. Surgery is typically not an option because of the local of the disease and the risk of grave damage to the tumor area.
How is Pericardial Mesothelioma Diagnosed?

Physicians will often suspect pericardial mesothelioma if the patient has trouble breathing, shortness of breath, or chest pain. A comprehensive diagnostic and biopsy process will be undergone through use of multiple body imaging scans.
What a Patient's Options?

Patients of pericardial mesothelioma may be eligible for financial compensation if they were wrongly exposed to asbestos.

Peritoneal Mesothelioma

2009-01-16T08:21:00.000-08:00

Malignant peritoneal mesothelioma is a rare type of cancer that occurs in the thin cell walls which surround the abdominal cavity, known as the peritoneum. Other types of mesothelioma include malignant pleural mesothelioma, occurring in the cell wall surrounding the lungs, and malignant pericardial mesothelioma, which occurs in the pericardial lining of the hearth. Peritoneal mesothelioma is the second rarest form of the disease and accounts for approximately 20% of all mesothelioma cases each year.
What Causes Peritoneal Mesothelioma?

Peritoneal mesothelioma is known only to be caused by exposure to asbestos, a microscopic natural fiber that was used heavily in industry. Asbestos is said to reach the abdominal wall by one of two methods. The first is through ingested asbestos fibers which are processed through digestion and become lodged in peritoneum. These other method is through the lungs and lymph nodes, by inhaled asbestos fibers. Mesothelioma of the pleura is also known to metastasize directly into the abdominal cavity if its spread is not slowed.
How is Peritoneal Mesothelioma Treated?

Prognosis of mesothelioma patients is poor, and peritoneal mesothelioma patients are no exception. Most peritoneal treatment regimens for patients include palliative methods such as chemotherapy and radiation therapy. However, if the disease is diagnosed in its earlier stages, patients may be eligible for surgical resection of the disease, which could potentially add years to initial prognoses.
How is Peritoneal Mesothelioma Diagnosed?

Physicians may suspect peritoneal mesothelioma if the patient complains of stomach, chest, or abdominal pain. Suspicious hernias may actually be a pleural effusion caused by peritoneal tumor growth. Misdiagnosis is common and patients will likely undergo multiple imaging scans and a diagnostic biopsy before an official diagnosis is made.
What are a patient's options?

Patients of peritoneal mesothelioma may be eligible for financial compensation if they exposed to asbestos. Industrial exposures were common and those exposed have collected compensation to finance high treatment costs.

Malignant Mesothelioma

2009-01-16T08:15:00.001-08:00

Malignant Mesothelioma is a rare form of cancer that affects the thin cell wall lining of the body's internal organs and structures. This lining is known as the mesothelium. Malignant mesothelioma has three known varieties. They are malignant pleural mesothelioma, malignant pericardial mesothelioma, and malignant peritoneal mesothelioma. Pleural mesothelioma occurs in the pleura, the lung's lining. Peritoneal mesothelioma occurs in the peritoneum, the abdominal cavity wall. And pericardial mesothelioma occurs in the lining of the hearth, known as the pericardium.
What Causes Malignant Mesothelioma?

Mesothelioma is known only to be caused by asbestos exposure. Asbestos is a nature, yet toxic mineral that was used commonly in heavy industry. Microscopic asbestos fibers enter the body through the lung or ingestion. Once inside, the durable fibers are unable to be broken down or expelled by the body, causing a harmful inflammation and scarring of the mesothelium. This scarring lays the groundwork mesothelioma and other respiratory conditions, such as asbestosis.
How is Malignant Mesothelioma Treated?

Malignant mesothelioma prognoses are poor, as often the disease will be diagnosed in its later stages after symptoms have appeared. However, there are several treatment options for the management of the cancer. Among these are chemotherapy, radiation therapy, and surgical resection. Chemotherapeutic and radiation therapy methods are more likely but surgery is often an option for those whose disease is diagnosed early enough.
How is Malignant Mesothelioma diagnosed?

Malignant Mesothelioma will typically be suspected if the patient complains of chest pain, difficulty breathing, shortness of breath, chronic cough, or difficulty swallowing. While any of these could indicate mesothelioma, they are also associated with many other respiratory conditions so further diagnostic procedures are typically warranted. These may include imaging scans, such as computer topography or magnetic resonance imaging. A diagnostic biopsy is also required for cancer specialist to examine the behavior of these cells before a diagnosis is determined.
What options of patients of Malignant Mesothelioma have?

Patients of malignant mesothelioma or any other asbestos related health complications may be eligible for compensation if they were wrongfully exposed.

Mesothelioma Treatment

2009-01-15T21:44:00.000-08:00

A Patient's OptionsOnce an individual has been diagnosed with mesothelioma, the next step is to discuss mesothelioma treatment options with his/her physician. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing the disease and supporting improved quality of life. Newly diagnosed patients always have many questions about the treatment options that would be most effective for them, including questions about new treatment therapies like Alimta and Cisplatin and other chemotherapy drugs. In addition to these newer drugs that are being used to treat asbestos cancer, mesothelioma patients also have a number of "conventional" treatment options to consider, including chemotherapy, radiation therapy and surgery. Clinical trials and experimental treatments are still other options that some mesothelioma patients may be eligible to participate in. Our site features a comprehensive mesothelioma cancer treatment section that includes important information for patients and families. We’ve included resources on top mesothelioma doctors such as Dr. Sugarbaker, as well as a comprehensive list of questions that you may wish to discuss with your personal physician when preparing a treatment plan. We are always providing new and informative resources regarding mesothelioma treatment including: Clinical Trials, conventional treatments, experimental therapies, and more. Check back often for the most recent advances in mesothelioma treatments.

Peritoneal-Mesothelioma

2009-01-15T15:45:00.000-08:00

Occupational

2009-01-15T15:42:00.000-08:00

Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.

The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.

Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.

Pleural-Mesothelioma

2009-01-15T07:26:00.000-08:00

Exposure

2009-01-15T07:19:00.000-08:00

Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related mesothelioma.

Risk factors

2009-01-15T00:52:00.001-08:00

Working with asbestos is the major risk factor for mesothelioma.[9] Mesothelioma is now known to occur in those who are genetically pre-disposed to it. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.

Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[10]

Malignant

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from the Latin roots mal- = "bad" and -genus = "born") is a medical term used to describe a severe and progressively worsening disease. The term is most familiar as a description of cancer. A malignant tumor may be contrasted with a non-cancerous benign tumor in that a malignancy is not self-limited in its growth, is capable of invading into adjacent tissues, and may be capable of spreading to distant tissues (metastasizing), while a benign tumor has none of those properties. Malignant tumor is synonymous with cancer. Uses of "malignant" in oncology:

* Malignancy, malignant neoplasm, and malignant tumor are synonymous with cancer
* Malignant ascites
* Malignant transformation

Non-oncologic disorders referred to as "malignant":

* Malignant hypertension
* Malignant hyperthermia
* Malignant otitis externa
* Malignant tertian malaria (Malaria caused specifically by Plasmodium falciparum)
* Neuroleptic malignant syndrome

Malignant

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Cancerous a growth that tends to spread into nearby normal tissue and travel to other parts of the body

Lung illustration

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Epidemiology

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Incidence

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year.[7] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[8] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States [4]. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.

Pathophysiology

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The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.

Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).[6] However, there is now evidence that smaller particles may be more dangerous than the larger fibers.[1][2] They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.[3]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

* Neurofibromatosis type 2 at 22q12
* P16INK4A
* P14ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

* Inactivation of tumor suppressor genes
* Activation of oncogenes
* Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
* Activation of DNA repair enzymes, which may be prone to error
* Activation of telomerase
* Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.

Mesothelioma

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Signs and symptoms

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Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss

In severe cases of the disease, the following signs and symptoms may be present:

* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

Typical immunohistochemistry results

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Diagnosis

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Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).

If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.

If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.