The leading cause of mesothelioma is workplace exposure to asbestos. Certain industries still manufacture products that contain asbestos, or rely on equipment or facilities that contain it. Below is a list of industries with the largest number of employee deaths due to mesothelioma in 1999 according to the National Center for Health Statistics. Also included is the percentage of the total number of mesothelioma deaths accounted for by each industry.
Construction – 14.2 Non-paid workers, workers at home – 7.0 Elementary and secondary school teachers – 3.7 Industrial and miscellaneous chemicals – 3.5 General government work – 2.4 Agriculture – 1.9 Nonspecific manufacturing 1.9 Electric light and power – 1.9 Railroads – 1.7 Hospitals – 1.7 Unreported industries – 4.3 All other industries combined – 56
vendredi 1 février 2008
international mesothelioma
Mesothelioma International is dedicated to the fight against mesothelioma – a worldwide health crisis with roots in humanity's use of asbestos. Although the use of asbestos has now been banned in the European Union, it is estimated that 250,000 workers in Western Europe alone will have died from mesothelioma by 2029. It is our hope that this website will be helpful to those throughout Europe who have been affected by this epidemic.
Mesothelioma is a rare and virulent form of cancer that affects the lining of the lung, lining of the abdominal cavity or lining around the heart. Mesothelioma is caused by exposure to asbestos, and occurs in those who have breathed in asbestos fiber, in many cases 20 to 50 or more years ago. Some were exposed on their jobs; others were exposed secondarily through family members who without their knowledge, brought fiber home on their work clothes or on their hair or skin.
Despite the serious nature of the disease, there is hope. Every year, doctors and scientists worldwide are developing new treatments and making new discoveries that help to improve the chance of survival and the patient’s quality of life. This website, Mesothelioma International, helps patients and their family members connect with the resources they need to be informed and make the best decisions on their potential treatment and care.
The first section of our website answers common questions about mesothelioma and its cause and discusses those at risk. In the next section, the most common symptoms are discussed, as well as the various testing procedures which may be used to come to a diagnosis. The treatment section discusses types of aggressive treatment such as surgery, chemotherapy, radiation and clinical trials being conducted by cancer facilities throughout the world, as well as the palliative care option for those who either can not or choose not to be treated. Every year, progress is being made.
It is Mesothelioma International’s goal to consolidate the most up to date, concise mesothelioma information available today, and our resource co-ordinators are always available to help you and your family find the answers for your particular questions.
Mesothelioma is a rare and virulent form of cancer that affects the lining of the lung, lining of the abdominal cavity or lining around the heart. Mesothelioma is caused by exposure to asbestos, and occurs in those who have breathed in asbestos fiber, in many cases 20 to 50 or more years ago. Some were exposed on their jobs; others were exposed secondarily through family members who without their knowledge, brought fiber home on their work clothes or on their hair or skin.
Despite the serious nature of the disease, there is hope. Every year, doctors and scientists worldwide are developing new treatments and making new discoveries that help to improve the chance of survival and the patient’s quality of life. This website, Mesothelioma International, helps patients and their family members connect with the resources they need to be informed and make the best decisions on their potential treatment and care.
The first section of our website answers common questions about mesothelioma and its cause and discusses those at risk. In the next section, the most common symptoms are discussed, as well as the various testing procedures which may be used to come to a diagnosis. The treatment section discusses types of aggressive treatment such as surgery, chemotherapy, radiation and clinical trials being conducted by cancer facilities throughout the world, as well as the palliative care option for those who either can not or choose not to be treated. Every year, progress is being made.
It is Mesothelioma International’s goal to consolidate the most up to date, concise mesothelioma information available today, and our resource co-ordinators are always available to help you and your family find the answers for your particular questions.
houston mesothelioma Lawyer
Three of the most common questions that mesothelioma victims often ask prior to hiring an attorney so that a law suit may be filed are: 1) How much will it cost to file law suit? 2) If no money is won, who is responsible for the legal bills? 3) Will the money that is won all go to pay the court costs and other legal expenses?
The answers to these questions will vary by individual state within the United States and by law firm. However, most Houston mesothelioma lawyers will not charge a dime to help a victim file a law suit. Because mesothelioma law suits are normally won more times that they are lost, mesothelioma attorneys normally remain confident that they can win most of their cases. In most cases, attorneys take a percentage of the compensation that is awarded to the victim as their payment.
Many people who have been diagnosed with mesothelioma, or their loved ones who are thinking about filing a law suit on the behalf of a mesothelioma victim, are under the impression that they will have to pay a huge amount of money to a law firm - even if they do not win any money from the asbestos company. The truth is that in most cases, attorneys will NOT charge people who file mesothelioma law suits, unless the law suit is won.
If a law suit or settlement is won, the law firm will normally take a percentage of the money that is granted. The percentage should be discussed and agreed upon prior to the beginning of the law suit. Victims must be aware of this and make sure to get all of these financial details written on signed documents before the case begins. In addition, if the percentage sounds too high or there is an uncomfortable feeling between the victim and the attorney, it is smart to seek a second or even a third opinion from other attorneys. Basically, attorneys offer the "You will not be charged unless we win your case," option to mesothelioma victims because they are almost 100 percent sure that they will win the case.
So if you have mesothelioma symptoms, or been diagnosed with mesothelioma. Please call one of our mesothelioma lawyers at 1-888-311-5522
The answers to these questions will vary by individual state within the United States and by law firm. However, most Houston mesothelioma lawyers will not charge a dime to help a victim file a law suit. Because mesothelioma law suits are normally won more times that they are lost, mesothelioma attorneys normally remain confident that they can win most of their cases. In most cases, attorneys take a percentage of the compensation that is awarded to the victim as their payment.
Many people who have been diagnosed with mesothelioma, or their loved ones who are thinking about filing a law suit on the behalf of a mesothelioma victim, are under the impression that they will have to pay a huge amount of money to a law firm - even if they do not win any money from the asbestos company. The truth is that in most cases, attorneys will NOT charge people who file mesothelioma law suits, unless the law suit is won.
If a law suit or settlement is won, the law firm will normally take a percentage of the money that is granted. The percentage should be discussed and agreed upon prior to the beginning of the law suit. Victims must be aware of this and make sure to get all of these financial details written on signed documents before the case begins. In addition, if the percentage sounds too high or there is an uncomfortable feeling between the victim and the attorney, it is smart to seek a second or even a third opinion from other attorneys. Basically, attorneys offer the "You will not be charged unless we win your case," option to mesothelioma victims because they are almost 100 percent sure that they will win the case.
So if you have mesothelioma symptoms, or been diagnosed with mesothelioma. Please call one of our mesothelioma lawyers at 1-888-311-5522
houston mesothelioma attorney
Mesothelioma, being a cancer of the rare kind, is caused by the inhalation of asbestos dust. The asbestos manufacturing companies have been making profits at the cost of the general public ever since the 1940’s. The symptoms emerged only after 30-50 years of exposure. Your Texas mesothelioma attorney will help you get compensations that could take care of your medical bills. Your Houston mesothelioma attorney should be well versed with the nuances of such cases so as to be able to get a quick and fair settlement.
Houston Mesothelioma Attorney (Texas Mesothelioma Attorney)
Asbestos exposure and its inhalation can lead to a type of cancer called Mesothelioma. It causes the un-controlled division of the cells of the mesothelium. In most cases it begins from the pleura or the peritoneum. This can affect the lining of the lungs, heart or abdominal cavity.
Some of the symptoms of this form of cancer include weight loss, abdominal pain and swelling due to fluid accumulation. The person may also suffer from bowel obstruction, blood-clotting abnormalities, anemia and fever. It can also spread to different areas and so may result in pain, trouble in swallowing or swelling of the face or neck. the companies, who have been manufacturing and marketing asbestos were making profits at the cost of the workers health. So if the person has a history of asbestos exposure and has been diagnosed with mesothelioma, he has the right to claim compensation. If the spouse or children of the person are diagnosed with mesothelioma, they too can claim compensation on various grounds.
Your mesothelioma attorney in Houston will represent such victims of this rare and avoidable disease. He gets the families the dues they deserve. It may not help cure the disease, but may provide financial support to the affected.
The first lawsuit on mesothelioma was registered in 1966. Since then, the mesothelioma lawyers have been able to get rightful compensations for many such unfortunate cases. In Houston or any place for that matter, finding a mesothelioma lawyer can be a long drawn and tiresome process. You need to select a lawyer with whom you can have a good rapport. You need to meet a variety of lawyers before you can choose your right Houston mesothelioma lawyer. Start your search in bar associations, Martindale-Hubbell Law directory, yellow pages and the Internet. Then contact them by phone and explain your legal issue to them and ask how best they can handle the case. You need to seek clarifications regarding their initial consultation fee and the approximate cost to handle a mesothelioma lawsuit. Then meet the prospective mesothelioma attorney in Houston, Texas and confirm yourself about his ability, knowledge and experience in handling such cases. After a brief introspection, you can make your decision regarding your lawyer.
It was Texas, in United States, where the first product liability cases against the manufacturer was recorded. Texas provides speedy trial settings for the mesothelioma victims and this ensures the chances that the victims will live to enjoy their compensations. Get a ‘no risk, free evaluation’ at your earliest convenience once you have decided on a Texas mesothelioma attorney.
To help your Houston mesothelioma attorney, you could give him the work history, names of co-workers and types of asbestos brands and products being used over the years. Procuring this information is not very difficult for it can be readily obtained by browsing through the catalogues and advertisements from 1940’s to 1970’s.
When you are filing for a mesothelioma case in Houston, Texas, be assured of the rest because the laws in Texas are public friendly and your mesothelioma attorney in Houston or mesothelioma attorney anywhere in Texas, will get you the best compensation possible
Houston Mesothelioma Attorney (Texas Mesothelioma Attorney)
Asbestos exposure and its inhalation can lead to a type of cancer called Mesothelioma. It causes the un-controlled division of the cells of the mesothelium. In most cases it begins from the pleura or the peritoneum. This can affect the lining of the lungs, heart or abdominal cavity.
Some of the symptoms of this form of cancer include weight loss, abdominal pain and swelling due to fluid accumulation. The person may also suffer from bowel obstruction, blood-clotting abnormalities, anemia and fever. It can also spread to different areas and so may result in pain, trouble in swallowing or swelling of the face or neck. the companies, who have been manufacturing and marketing asbestos were making profits at the cost of the workers health. So if the person has a history of asbestos exposure and has been diagnosed with mesothelioma, he has the right to claim compensation. If the spouse or children of the person are diagnosed with mesothelioma, they too can claim compensation on various grounds.
Your mesothelioma attorney in Houston will represent such victims of this rare and avoidable disease. He gets the families the dues they deserve. It may not help cure the disease, but may provide financial support to the affected.
The first lawsuit on mesothelioma was registered in 1966. Since then, the mesothelioma lawyers have been able to get rightful compensations for many such unfortunate cases. In Houston or any place for that matter, finding a mesothelioma lawyer can be a long drawn and tiresome process. You need to select a lawyer with whom you can have a good rapport. You need to meet a variety of lawyers before you can choose your right Houston mesothelioma lawyer. Start your search in bar associations, Martindale-Hubbell Law directory, yellow pages and the Internet. Then contact them by phone and explain your legal issue to them and ask how best they can handle the case. You need to seek clarifications regarding their initial consultation fee and the approximate cost to handle a mesothelioma lawsuit. Then meet the prospective mesothelioma attorney in Houston, Texas and confirm yourself about his ability, knowledge and experience in handling such cases. After a brief introspection, you can make your decision regarding your lawyer.
It was Texas, in United States, where the first product liability cases against the manufacturer was recorded. Texas provides speedy trial settings for the mesothelioma victims and this ensures the chances that the victims will live to enjoy their compensations. Get a ‘no risk, free evaluation’ at your earliest convenience once you have decided on a Texas mesothelioma attorney.
To help your Houston mesothelioma attorney, you could give him the work history, names of co-workers and types of asbestos brands and products being used over the years. Procuring this information is not very difficult for it can be readily obtained by browsing through the catalogues and advertisements from 1940’s to 1970’s.
When you are filing for a mesothelioma case in Houston, Texas, be assured of the rest because the laws in Texas are public friendly and your mesothelioma attorney in Houston or mesothelioma attorney anywhere in Texas, will get you the best compensation possible
sarcomatoid mesothelioma
Sarcomatoid mesothelioma
accounts for only about 10 to 15% of the mesothelioma cancer cells and it is the least common form of mesothelioma. These cells are typically oval shaped, but more irregular, and with the nucleus not as clearly visible under an electron microscope as the nuclei of the epithelioid mesothelioma cancer cells. Because the oval irregular shape is a common form of a cancer cell type, sarcomatoid mesothelioma can be confused with sarcomatoid carcinoma and with sarcoma.
sarcomatoid mesothelioma Versus Sarcomatoid CarcinomaSarcomatoid mesothelioma is often confused with a wide variety of other types of cancer because of the sarcomatoid appearance, including sarcomatoid carcinoma. Although sarcomatoid cancer appears in other parts of the body, such as the kidney, sarcomatoid cancer is relatively rare in the lungs. Up to 1.3% of lung carcinomas are of the sarcomatoid type.
Pulmonary sarcomatoid carcinoma is the type most often confused with sarcomatoid mesothelioma. Similar to sarcomatoid mesothelioma, lung sarcomatoid carcinomas are much more likely in men (four times more likely than in women) and there is a strong association with smoking. Also, patients can present with similar symptoms, such as chest pain, pleural effusions and respiratory difficulty.
Sarcomatoid Mesothelioma Versus SarcomaSarcomatoid mesothelioma can also be confused with high-grade sarcoma. Sarcoma is a form of cancer that arises in the supportive tissue, such as bone, cartilage, fat or muscle. (This is as opposed to carcinoma, which arises from the epithelium.) If the sarcoma becomes involved with the pleural surface, then it can be difficult to differentiate sarcoma from sarcomatoid mesothelioma.
Appearance of the cells can be similar under an electron microscope and the staining of the tumor cells can provide similar results. In these cases, the pathologist must be careful to compare the appearance and staining of the cells, along with the overall appearance (localized versus diffuse pleural-based mass) and regularity of the tumor when making a definitive diagnosis of malignant mesothelioma.
If you or a loved one has been diagnosed with high grade sarcoma of the lungs or pulmonary sarcomatoid carcinoma and you have had previous asbestos exposure, it may be best to seek a second thorough examination from your current physician or from an oncologist who specializes in mesothelioma.
accounts for only about 10 to 15% of the mesothelioma cancer cells and it is the least common form of mesothelioma. These cells are typically oval shaped, but more irregular, and with the nucleus not as clearly visible under an electron microscope as the nuclei of the epithelioid mesothelioma cancer cells. Because the oval irregular shape is a common form of a cancer cell type, sarcomatoid mesothelioma can be confused with sarcomatoid carcinoma and with sarcoma.
sarcomatoid mesothelioma Versus Sarcomatoid CarcinomaSarcomatoid mesothelioma is often confused with a wide variety of other types of cancer because of the sarcomatoid appearance, including sarcomatoid carcinoma. Although sarcomatoid cancer appears in other parts of the body, such as the kidney, sarcomatoid cancer is relatively rare in the lungs. Up to 1.3% of lung carcinomas are of the sarcomatoid type.
Pulmonary sarcomatoid carcinoma is the type most often confused with sarcomatoid mesothelioma. Similar to sarcomatoid mesothelioma, lung sarcomatoid carcinomas are much more likely in men (four times more likely than in women) and there is a strong association with smoking. Also, patients can present with similar symptoms, such as chest pain, pleural effusions and respiratory difficulty.
Sarcomatoid Mesothelioma Versus SarcomaSarcomatoid mesothelioma can also be confused with high-grade sarcoma. Sarcoma is a form of cancer that arises in the supportive tissue, such as bone, cartilage, fat or muscle. (This is as opposed to carcinoma, which arises from the epithelium.) If the sarcoma becomes involved with the pleural surface, then it can be difficult to differentiate sarcoma from sarcomatoid mesothelioma.
Appearance of the cells can be similar under an electron microscope and the staining of the tumor cells can provide similar results. In these cases, the pathologist must be careful to compare the appearance and staining of the cells, along with the overall appearance (localized versus diffuse pleural-based mass) and regularity of the tumor when making a definitive diagnosis of malignant mesothelioma.
If you or a loved one has been diagnosed with high grade sarcoma of the lungs or pulmonary sarcomatoid carcinoma and you have had previous asbestos exposure, it may be best to seek a second thorough examination from your current physician or from an oncologist who specializes in mesothelioma.
treatment of mesothelioma
The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope and the patient’s age and desires.
TIME MATTERS
People diagnosed with this disease are often told the expected survival rate is only eight to twelve months. However, specialists in treating malignant mesothelioma at the leading cancer centers often have better statistics.
For instance, the five-year survival rate has approached 40% for selected patients of Dr. David Sugarbaker at Brigham and Women’s Center in Boston. To qualify for Dr. Sugarbaker’s treatment you must meet certain criteria. One of them is being in the early stages of the disease, so time is of the essence. To find out more about Dr. Sugarbaker and other physicians and cancer centers specializing in mesothelioma click on Finding Specialists.
Click here for an article by Dr. David J. Sugarbaker that appeared in the The Journal of Thoracic and Cardiovascular Surgery, January 1999 (12 pages in Adobe PDF format).
TRADITIONAL CARE
There are three traditional kinds of treatment for patients with malignant mesothelioma:
Surgery (taking out the cancer) Chemotherapy (using drugs to fight the cancer) Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) Often two or more of these are combined in the course of treatment.
MESOMARK BLOOD TESTNEW!
In January 2007, the Food and Drug Administration (FDA) approved the MESOMARK assay to help monitor response to treatment in epithelial and bi-phasic malignant mesothelioma patients. A specific protein, or biomarker, called Soluble Mesothelin-Related Peptide (SMRP), may be released into the blood by mesothelioma cancer cells. By measuring the amount of SMRP in a blood sample, doctors may be able to better monitor a patient's progress. Based on the limited amount of data currently available, use of this test may be beneficial, but effectiveness has not been determined at this time. The MESOMARK blood test has NOT yet been approved for the early diagnosis of mesothelioma.
This test has been approved as a Humanitarian Use Device (HUD), meaning that physicians must follow certain procedures to qualify their patients for testing. Once the physician is certified, informational brochures will be sent to be distributed to each applicable patient.
Those wishing to take part in MESOMARK testing will be asked to provide one or more samples of blood. The blood samples will then be sent to a national reference laboratory for testing. In conjunction with other clinical and laboratory data obtained by your doctor, decisions regarding your treatment and care may be simplified. You may discontinue testing at any time.
The costs associated with the MESOMARK blood test may not be covered under health insurance, therefore, you may be required to pay all or part of the costs out of pocket. It is recommended that you check with your insurance carrier to determine whether coverage is available under your policy.
SURGERY
Diagnostic Procedures As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.
Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.
VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.
Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.
Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.
Palliative Procedures Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.
Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.
Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.
Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.
Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.
Potentially Curative Procedures These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.
For Pleural Mesothelioma: Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.
General Patient Selection Criteria for Extrapleural Pneumonectomy
Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient=s chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.
Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others. Adequate renal (kidney) and liver function tests; no significant kidney or liver disease. Normal cardiac function per electrocardiogram and echocardiography. Adequate pulmonary function to tolerate the surgery. Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall. Age of the patient is taken into consideration, but may not be as important as their overall status.
Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.
For Peritoneal Mesothelioma: Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma. TOP
CHEMOTHERAPY
Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.
Purposes of ChemotherapyChemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:
To control the cancer by stopping its spread or slowing its growth. To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy. To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy. To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected. The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a new drug recently approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.
The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.
As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.
Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.
Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.
Administration of ChemotherapyThe most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.
Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed. The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary. Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.
Side Effects of ChemotherapyCancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects, the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on anti-nausea treatment for chemotherapy patients.
TIME MATTERS
People diagnosed with this disease are often told the expected survival rate is only eight to twelve months. However, specialists in treating malignant mesothelioma at the leading cancer centers often have better statistics.
For instance, the five-year survival rate has approached 40% for selected patients of Dr. David Sugarbaker at Brigham and Women’s Center in Boston. To qualify for Dr. Sugarbaker’s treatment you must meet certain criteria. One of them is being in the early stages of the disease, so time is of the essence. To find out more about Dr. Sugarbaker and other physicians and cancer centers specializing in mesothelioma click on Finding Specialists.
Click here for an article by Dr. David J. Sugarbaker that appeared in the The Journal of Thoracic and Cardiovascular Surgery, January 1999 (12 pages in Adobe PDF format).
TRADITIONAL CARE
There are three traditional kinds of treatment for patients with malignant mesothelioma:
Surgery (taking out the cancer) Chemotherapy (using drugs to fight the cancer) Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) Often two or more of these are combined in the course of treatment.
MESOMARK BLOOD TESTNEW!
In January 2007, the Food and Drug Administration (FDA) approved the MESOMARK assay to help monitor response to treatment in epithelial and bi-phasic malignant mesothelioma patients. A specific protein, or biomarker, called Soluble Mesothelin-Related Peptide (SMRP), may be released into the blood by mesothelioma cancer cells. By measuring the amount of SMRP in a blood sample, doctors may be able to better monitor a patient's progress. Based on the limited amount of data currently available, use of this test may be beneficial, but effectiveness has not been determined at this time. The MESOMARK blood test has NOT yet been approved for the early diagnosis of mesothelioma.
This test has been approved as a Humanitarian Use Device (HUD), meaning that physicians must follow certain procedures to qualify their patients for testing. Once the physician is certified, informational brochures will be sent to be distributed to each applicable patient.
Those wishing to take part in MESOMARK testing will be asked to provide one or more samples of blood. The blood samples will then be sent to a national reference laboratory for testing. In conjunction with other clinical and laboratory data obtained by your doctor, decisions regarding your treatment and care may be simplified. You may discontinue testing at any time.
The costs associated with the MESOMARK blood test may not be covered under health insurance, therefore, you may be required to pay all or part of the costs out of pocket. It is recommended that you check with your insurance carrier to determine whether coverage is available under your policy.
SURGERY
Diagnostic Procedures As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.
Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.
VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.
Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.
Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.
Palliative Procedures Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.
Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.
Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.
Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.
Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.
Potentially Curative Procedures These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.
For Pleural Mesothelioma: Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.
General Patient Selection Criteria for Extrapleural Pneumonectomy
Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient=s chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.
Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others. Adequate renal (kidney) and liver function tests; no significant kidney or liver disease. Normal cardiac function per electrocardiogram and echocardiography. Adequate pulmonary function to tolerate the surgery. Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall. Age of the patient is taken into consideration, but may not be as important as their overall status.
Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.
For Peritoneal Mesothelioma: Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma. TOP
CHEMOTHERAPY
Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.
Purposes of ChemotherapyChemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:
To control the cancer by stopping its spread or slowing its growth. To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy. To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy. To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected. The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a new drug recently approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.
The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.
As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.
Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.
Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.
Administration of ChemotherapyThe most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.
Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed. The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary. Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.
Side Effects of ChemotherapyCancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects, the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on anti-nausea treatment for chemotherapy patients.
mesothelioma doctor
mesothelioma doctor
When you have been diagnosed with a rare form of cancer such as mesothelioma, finding a doctor who is familiar with the disease and its treatment is an important consideration. Health care available at the local level may suffice if you choose “standard” care options such as chemotherapy, however, if you are looking into surgical evaluation or other specialized forms of treatment, it becomes more important to expand your search for doctors who deal with mesothelioma on a regular basis and have experience in the most up to date protocols available.
Second opinions are common when dealing with a rare cancer, and after listening carefully to your primary doctor’s opinions and treatment plans, you may wish to consult with a more specialized physician before making a treatment decision. By doing this, you can feel comfortable that you have explored every avenue possible and have information on every available option. Your primary doctor may be able to refer you to a specialist, or you can do this on your own as a “self referral”. In either case, you should be sure your primary doctor is aware that you are satisfied with the care you have been given thus far, but because of the rarity of the disease, you would like to be as thoroughly informed as possible. No good doctor should feel threatened that you want to seek a second opinion – it is simply being a good consumer.
A “specialist” is a physician who is licensed to practice medicine, has met certain education and training criteria in a specific field and has passed an examination given by a specialty board. These doctors are then “board certified” in their field. A physician may also choose a “subspecialty” to further increase their expertise and become board certified in the subspecialty as well. Nearly all board certified specialists are members of a medical specialty society that relates to their field of specialization.
Following are some examples of specialties and subspecialties as applies to mesothelioma treatment:
Surgery is a specialty that pertains to the treatment of disease by surgical operation on any area of the body. Doctors who conduct these types of surgeries are called general surgeons. An example of a surgical subspecialty would be a thoracic surgeon who deals specifically with diseases of the chest area. Medical Oncology is a subspecialty of internal medicine. Medical oncologists treat cancer and most often manage treatment plans such as chemotherapy. They may also consult with or refer to other types of specialists. Radiation Oncology is a subspecialty of radiology. Radiation oncologists specialize in the use of radiation to treat cancer. In order to make an informed decision when choosing your doctor, consider the following questions:
Does the doctor have the education and training necessary to meet my needs, and does he or she have experience in treating mesothelioma? How many cases of mesothelioma has he or she treated in the past year? In their career? Has the doctor given you information on mesothelioma itself, and on the various treatment options you might be eligible for? Does the doctor listen to your concerns and treat you with respect? Does the doctor encourage you to ask questions and explain things in terms that you understand? When choosing a surgeon, considering the following questions:
Is the surgeon board certified? Does the surgeon belong to a medical specialty society such as The American College of Surgeons? How often does the surgeon perform the type of surgery you need? How many such surgeries has the doctor performed? Has the doctor explained the surgical procedure to you, as well as the risk factors, side effects, quality of life and success rates you might expect? It is important to you and your family to have a good working relationship with whichever doctor you choose, and to be able to communicate and be involved in decisions regarding your medical care. Always trust your own feelings
When you have been diagnosed with a rare form of cancer such as mesothelioma, finding a doctor who is familiar with the disease and its treatment is an important consideration. Health care available at the local level may suffice if you choose “standard” care options such as chemotherapy, however, if you are looking into surgical evaluation or other specialized forms of treatment, it becomes more important to expand your search for doctors who deal with mesothelioma on a regular basis and have experience in the most up to date protocols available.
Second opinions are common when dealing with a rare cancer, and after listening carefully to your primary doctor’s opinions and treatment plans, you may wish to consult with a more specialized physician before making a treatment decision. By doing this, you can feel comfortable that you have explored every avenue possible and have information on every available option. Your primary doctor may be able to refer you to a specialist, or you can do this on your own as a “self referral”. In either case, you should be sure your primary doctor is aware that you are satisfied with the care you have been given thus far, but because of the rarity of the disease, you would like to be as thoroughly informed as possible. No good doctor should feel threatened that you want to seek a second opinion – it is simply being a good consumer.
A “specialist” is a physician who is licensed to practice medicine, has met certain education and training criteria in a specific field and has passed an examination given by a specialty board. These doctors are then “board certified” in their field. A physician may also choose a “subspecialty” to further increase their expertise and become board certified in the subspecialty as well. Nearly all board certified specialists are members of a medical specialty society that relates to their field of specialization.
Following are some examples of specialties and subspecialties as applies to mesothelioma treatment:
Surgery is a specialty that pertains to the treatment of disease by surgical operation on any area of the body. Doctors who conduct these types of surgeries are called general surgeons. An example of a surgical subspecialty would be a thoracic surgeon who deals specifically with diseases of the chest area. Medical Oncology is a subspecialty of internal medicine. Medical oncologists treat cancer and most often manage treatment plans such as chemotherapy. They may also consult with or refer to other types of specialists. Radiation Oncology is a subspecialty of radiology. Radiation oncologists specialize in the use of radiation to treat cancer. In order to make an informed decision when choosing your doctor, consider the following questions:
Does the doctor have the education and training necessary to meet my needs, and does he or she have experience in treating mesothelioma? How many cases of mesothelioma has he or she treated in the past year? In their career? Has the doctor given you information on mesothelioma itself, and on the various treatment options you might be eligible for? Does the doctor listen to your concerns and treat you with respect? Does the doctor encourage you to ask questions and explain things in terms that you understand? When choosing a surgeon, considering the following questions:
Is the surgeon board certified? Does the surgeon belong to a medical specialty society such as The American College of Surgeons? How often does the surgeon perform the type of surgery you need? How many such surgeries has the doctor performed? Has the doctor explained the surgical procedure to you, as well as the risk factors, side effects, quality of life and success rates you might expect? It is important to you and your family to have a good working relationship with whichever doctor you choose, and to be able to communicate and be involved in decisions regarding your medical care. Always trust your own feelings
mesothelioma patients
mesothelioma patients
Fatigue refers to a lack of energy that affects a patient’s ability to function and may cause mental distress. Symptoms include feelings of weakness, exhaustion, weariness, tiredness, etc., and may be psychological and emotional as well as physical. A patient may suffer from either acute or chronic fatigue. Acute fatigue is relatively short-lived, with symptoms both beginning and ending quickly. Chronic fatigue lasts much longer, resisting efforts from the patient to rest and recuperate.
Fatigue occurs in a large portion of cancer patients and those who have had cancer in the past, and may be due to a number of cancer-related reasons. Some common factors include medications, weight loss, diet, pain, breathing difficulties, anemia, tumors, fluctuating hormones, and insomnia. Anxiety, depression, and emotional distress may contribute to fatigue, either as a direct result of the cancer and its treatment or due to the psychological reaction to the diagnosis of cancer and the treatments involved.
Fatigue can also be a result of cancer treatments, such as radiation therapy or chemotherapy. Radiation therapy requires increased energy from the body to repair tissue, which can deplete the body’s energy supply. Fatigue can be a result of chemotherapy, in which the patient may suffer from nausea, vomiting and weight loss and subsequent fatigue as a result. Diet and poor appetite may also be factors, as cancer may cause the body to require more nutrients or affect the body’s ability to process food. The patient may not be getting the necessary nutrients if they are eating less, which is often a result of cancer or treatment related nausea, diarrhea, obstructed bowels, or loss of appetite
Fatigue refers to a lack of energy that affects a patient’s ability to function and may cause mental distress. Symptoms include feelings of weakness, exhaustion, weariness, tiredness, etc., and may be psychological and emotional as well as physical. A patient may suffer from either acute or chronic fatigue. Acute fatigue is relatively short-lived, with symptoms both beginning and ending quickly. Chronic fatigue lasts much longer, resisting efforts from the patient to rest and recuperate.
Fatigue occurs in a large portion of cancer patients and those who have had cancer in the past, and may be due to a number of cancer-related reasons. Some common factors include medications, weight loss, diet, pain, breathing difficulties, anemia, tumors, fluctuating hormones, and insomnia. Anxiety, depression, and emotional distress may contribute to fatigue, either as a direct result of the cancer and its treatment or due to the psychological reaction to the diagnosis of cancer and the treatments involved.
Fatigue can also be a result of cancer treatments, such as radiation therapy or chemotherapy. Radiation therapy requires increased energy from the body to repair tissue, which can deplete the body’s energy supply. Fatigue can be a result of chemotherapy, in which the patient may suffer from nausea, vomiting and weight loss and subsequent fatigue as a result. Diet and poor appetite may also be factors, as cancer may cause the body to require more nutrients or affect the body’s ability to process food. The patient may not be getting the necessary nutrients if they are eating less, which is often a result of cancer or treatment related nausea, diarrhea, obstructed bowels, or loss of appetite
stages of mesothelioma
stages of mesothelioma
Knowing the stage of your mesothelioma will be a factor in helping your doctor formulate a treatment plan. The most definitive and most widely used system is the TNM International Staging System for Diffuse Malignant Pleural Mesothelioma, also called the International Mesothelioma Interest Group System. This system takes into consideration Primary Tumor (T), Lymph Nodes (N) and Metastases (M). There is no established staging system for peritoneal mesothelioma. Peritoneal patients may be staged according to the general TNM system for cancer, or on the bulk of the tumor present (i.e., minimally bulky, moderately bulky, etc.). Because the TNM system is very in depth, and difficult for interpretation by lay persons, following is a simplified version. Stage I is the earliest stage; Stage IV the most advanced.
Stage IMesothelioma involves the 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 IIMesothelioma 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 IIIMesothelioma has invaded 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 IVMesothelioma 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 in included in this stage
Knowing the stage of your mesothelioma will be a factor in helping your doctor formulate a treatment plan. The most definitive and most widely used system is the TNM International Staging System for Diffuse Malignant Pleural Mesothelioma, also called the International Mesothelioma Interest Group System. This system takes into consideration Primary Tumor (T), Lymph Nodes (N) and Metastases (M). There is no established staging system for peritoneal mesothelioma. Peritoneal patients may be staged according to the general TNM system for cancer, or on the bulk of the tumor present (i.e., minimally bulky, moderately bulky, etc.). Because the TNM system is very in depth, and difficult for interpretation by lay persons, following is a simplified version. Stage I is the earliest stage; Stage IV the most advanced.
Stage IMesothelioma involves the 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 IIMesothelioma 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 IIIMesothelioma has invaded 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 IVMesothelioma 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 in included in this stage
mesothelioma chemotherapy
ChemotherapyChemotherapy involves the use of anti-cancer drugs which work by preventing cancer cells from multiplying. In most cases, combinations of drugs are used in order to increase effectiveness. Chemotherapy may be used aggressively to shrink the tumor, or palliatively to relieve symptoms such as shortness of breath or pain. Administration of chemotherapy may be via injection into a vein or muscle, as an oral medication or may sometimes be administered directly into the pleural or peritoneal cavity. Some of the most commonly used drugs include:
Pemetrexed (Alimta) Cisplatin (Platinol) Carboplatin (Paraplatin) Gemcitabine (Gemzar) Doxorubicin (Adriamycin) Mitomycin Raltitrexed (Tomudex) Vinorelbine (Navelbine) New drugs are constantly being investigated by pharmaceutical companies, so you should always feel free to ask your doctor about the newest and most promising drugs. One such drug, Alimta (pemetrexed) was approved in Europe in September, 2005.
RadiotherapyRadiotherapy involves the use of high energy x-rays to kill cancer cells and shrink tumors. It may be used aggressively in conjunction with surgery to help eliminate microscopic seeding which can cause recurrence of disease, or palliatively to treat pain caused by tumors pressing on nerve endings or on another organ. Radiotherapy has also proven effective in preventing tumor seeding at the sites of biopsy or chest tube drainage.
Clinical TrialsThe purpose of clinical trials is to involve patients in finding new and better treatments for their illnesses. Different clinical trials have different goals which may include the testing of new drugs, comparing various ways to treat an illness or the testing of various techniques for cancer prevention. Clinical trials are divided into three phases. Following are short summaries of what each trial phase seeks to accomplish.
Phase I trials are the earliest phase of the clinical trial system. At this point, drugs have only been tested in the laboratory, but have had an effect on destroying cancer cells. These trials enroll only a limited number of participants, and are only available at limited cancer facilities. The goal of Phase I trials is to find the maximum tolerated dosage of the drug without causing serious side effects, which side effects are most common and whether the drug continues to have anti-cancer activity when administered to humans. If the drug is proven to have an effect on cancer at a safe dosage, the drug will then be tested in Phase II trials.
Phase II trials continue to test the safety of drugs or procedures, but also begin to look more closely at their effectiveness for particular types of cancer. These trials accrue somewhat larger numbers of participants, and may be located at more facilities. These trials may be “randomized”, meaning that different groups of participants are chosen by a computer, rather than by a doctor.
Phase III trials compare promising new drugs or procedures with the current standard of treatment. Large numbers of participants from widespread areas are accrued for these trials, and receive either the new treatment or the standard treatment. One of the primary goals of Phase III trials is to determine whether cancer is reduced or slowed by the drugs, how long patients remain stable without progression of disease and how treatment with the drug affects the patient’s quality of life.
If you are interested in participating in a clinical trial for mesothelioma, your doctor should be able to provide you with information on eligibility and availability in your area.
Pemetrexed (Alimta) Cisplatin (Platinol) Carboplatin (Paraplatin) Gemcitabine (Gemzar) Doxorubicin (Adriamycin) Mitomycin Raltitrexed (Tomudex) Vinorelbine (Navelbine) New drugs are constantly being investigated by pharmaceutical companies, so you should always feel free to ask your doctor about the newest and most promising drugs. One such drug, Alimta (pemetrexed) was approved in Europe in September, 2005.
RadiotherapyRadiotherapy involves the use of high energy x-rays to kill cancer cells and shrink tumors. It may be used aggressively in conjunction with surgery to help eliminate microscopic seeding which can cause recurrence of disease, or palliatively to treat pain caused by tumors pressing on nerve endings or on another organ. Radiotherapy has also proven effective in preventing tumor seeding at the sites of biopsy or chest tube drainage.
Clinical TrialsThe purpose of clinical trials is to involve patients in finding new and better treatments for their illnesses. Different clinical trials have different goals which may include the testing of new drugs, comparing various ways to treat an illness or the testing of various techniques for cancer prevention. Clinical trials are divided into three phases. Following are short summaries of what each trial phase seeks to accomplish.
Phase I trials are the earliest phase of the clinical trial system. At this point, drugs have only been tested in the laboratory, but have had an effect on destroying cancer cells. These trials enroll only a limited number of participants, and are only available at limited cancer facilities. The goal of Phase I trials is to find the maximum tolerated dosage of the drug without causing serious side effects, which side effects are most common and whether the drug continues to have anti-cancer activity when administered to humans. If the drug is proven to have an effect on cancer at a safe dosage, the drug will then be tested in Phase II trials.
Phase II trials continue to test the safety of drugs or procedures, but also begin to look more closely at their effectiveness for particular types of cancer. These trials accrue somewhat larger numbers of participants, and may be located at more facilities. These trials may be “randomized”, meaning that different groups of participants are chosen by a computer, rather than by a doctor.
Phase III trials compare promising new drugs or procedures with the current standard of treatment. Large numbers of participants from widespread areas are accrued for these trials, and receive either the new treatment or the standard treatment. One of the primary goals of Phase III trials is to determine whether cancer is reduced or slowed by the drugs, how long patients remain stable without progression of disease and how treatment with the drug affects the patient’s quality of life.
If you are interested in participating in a clinical trial for mesothelioma, your doctor should be able to provide you with information on eligibility and availability in your area.
mesothelioma diagnosis
Diagnosis
A diagnosis of mesothelioma is most often obtained with a careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. Following are some of the tests your specialist may recommend and their value in diagnosing and assessing mesothelioma.Computed Tomography (CT)CT scans are able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease, or differentiate between adenocarcinoma of the lung versus mesothelioma. CT scans may also be of value in guiding fine needle aspiration of pleural masses for tissue diagnosis. This scan usually takes 10-30 minutes, but may vary according to the patient.
Magnetic Resonance Imaging (MRI)MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes which lie between the two lungs, as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy. An MRI scan usually takes 20-40 minutes, but may vary according to the patient.
Positron Emission Tomography (PET)PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. PETs are considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma. Because PET scans are relatively new and may not be available in all locations, it may be necessary to travel to a specialized center to have one.
Fluid AnalysisTesting of the pleural fluid for malignant cells is considered to have limited value in diagnosing mesothelioma. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists. Unfortunately, negative or inconclusive readings account for nearly 85% of all fluid tested. Even in the event of a positive fluid report, doctors may opt to perform a confirming tissue biopsy as long as it is not detrimental to the patient’s health.
Tissue Analysis (Biopsy)In most cases, it is ultimately a needle biopsy of the pleura, or an open surgical biopsy, that yields a confirmed diagnosis of mesothelioma. In a pleural biopsy procedure, the surgeon will make a small incision through the chest wall and insert a thin, lighted tube called a thorascope into the chest between two ribs. He will then remove a sample of tissue to be reviewed under a microscope by a pathologist. In a peritoneal biopsy, the surgeon makes a small incision in the abdomen and inserts a peritoneoscope into the abdominal cavity.
A diagnosis of mesothelioma is most often obtained with a careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. Following are some of the tests your specialist may recommend and their value in diagnosing and assessing mesothelioma.Computed Tomography (CT)CT scans are able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease, or differentiate between adenocarcinoma of the lung versus mesothelioma. CT scans may also be of value in guiding fine needle aspiration of pleural masses for tissue diagnosis. This scan usually takes 10-30 minutes, but may vary according to the patient.
Magnetic Resonance Imaging (MRI)MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes which lie between the two lungs, as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy. An MRI scan usually takes 20-40 minutes, but may vary according to the patient.
Positron Emission Tomography (PET)PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. PETs are considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma. Because PET scans are relatively new and may not be available in all locations, it may be necessary to travel to a specialized center to have one.
Fluid AnalysisTesting of the pleural fluid for malignant cells is considered to have limited value in diagnosing mesothelioma. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists. Unfortunately, negative or inconclusive readings account for nearly 85% of all fluid tested. Even in the event of a positive fluid report, doctors may opt to perform a confirming tissue biopsy as long as it is not detrimental to the patient’s health.
Tissue Analysis (Biopsy)In most cases, it is ultimately a needle biopsy of the pleura, or an open surgical biopsy, that yields a confirmed diagnosis of mesothelioma. In a pleural biopsy procedure, the surgeon will make a small incision through the chest wall and insert a thin, lighted tube called a thorascope into the chest between two ribs. He will then remove a sample of tissue to be reviewed under a microscope by a pathologist. In a peritoneal biopsy, the surgeon makes a small incision in the abdomen and inserts a peritoneoscope into the abdominal cavity.
mesothelioma symptoms
mesothelioma symptoms
Early symptoms of mesothelioma are non-specific in nature, and may lead to a delay in diagnosis. In general, shortness of breath, chest pain and persistent cough are common symptoms of pleural mesothelioma, but in some cases, may not be severe enough to force the patient to seek medical help. Some patients complain of pain in the shoulder blade or lower back. These symptoms most often occur 2-3 months prior to a confirmed diagnosis. In peritoneal mesothelioma, abdominal pain and swelling, nausea or vomiting, bowel obstruction and weight loss are the most common symptoms. Importantly, these symptoms are not unique to mesothelioma, and may be symptoms of other conditions as well. Evaluation by a qualified physician is always suggested.
As mesothelioma progresses, pleural effusion (fluid build up between the two pleural layers) occurs in 95% of patients, and it is this symptom which ultimately leads to patients visiting their GP. During this visit, a chest x-ray is taken which may confirm the effusion. A thickening of the pleura may also be noted at this time. If the GP suspects cancer is a possibility, referral may be made to a hospital consultant who specializes in lung cancer and mesothelioma.
When your GP recommends a referral, you should be given the following information:
Where you are being referred.When the appointment will be scheduled.Who you will see.What testing you can expect.When the results of the testing will be available.
The National Institute for Health and Clinical Excellence has developed the following general referral guidelines for suspected cancer, effective June, 2005. These guidelines may not apply to every individual, and you should always discuss the details of your specific case with your health care team, so you can play a proactive role in your treatment and care.
An assessment of urgency will be made by your GP, and will be based on the following criteria:
Immediate referral: The patient needs to be seen within a few hours. Urgent referral: The patient will be seen within two weeks. Non-urgent: All other referrals. Once urgency is determined, your GP will send all information pertaining to your case to your specialist for evaluation
Early symptoms of mesothelioma are non-specific in nature, and may lead to a delay in diagnosis. In general, shortness of breath, chest pain and persistent cough are common symptoms of pleural mesothelioma, but in some cases, may not be severe enough to force the patient to seek medical help. Some patients complain of pain in the shoulder blade or lower back. These symptoms most often occur 2-3 months prior to a confirmed diagnosis. In peritoneal mesothelioma, abdominal pain and swelling, nausea or vomiting, bowel obstruction and weight loss are the most common symptoms. Importantly, these symptoms are not unique to mesothelioma, and may be symptoms of other conditions as well. Evaluation by a qualified physician is always suggested.
As mesothelioma progresses, pleural effusion (fluid build up between the two pleural layers) occurs in 95% of patients, and it is this symptom which ultimately leads to patients visiting their GP. During this visit, a chest x-ray is taken which may confirm the effusion. A thickening of the pleura may also be noted at this time. If the GP suspects cancer is a possibility, referral may be made to a hospital consultant who specializes in lung cancer and mesothelioma.
When your GP recommends a referral, you should be given the following information:
Where you are being referred.When the appointment will be scheduled.Who you will see.What testing you can expect.When the results of the testing will be available.
The National Institute for Health and Clinical Excellence has developed the following general referral guidelines for suspected cancer, effective June, 2005. These guidelines may not apply to every individual, and you should always discuss the details of your specific case with your health care team, so you can play a proactive role in your treatment and care.
An assessment of urgency will be made by your GP, and will be based on the following criteria:
Immediate referral: The patient needs to be seen within a few hours. Urgent referral: The patient will be seen within two weeks. Non-urgent: All other referrals. Once urgency is determined, your GP will send all information pertaining to your case to your specialist for evaluation
mesothelioma: questions and Answers
Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body’s internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.
What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. 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.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.
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.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
Asbestos has been mined and used commercially since 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 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. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. 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. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
How is mesothelioma diagnosed?
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, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) 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 peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is mesothelioma treated?
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.
Are new treatments for mesothelioma being studied?
Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.
People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI’s cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI’s Cancer.gov Web site, located at http://www.cancer.gov/clinical_trials on the Internet, provides general information about clinical trials and links to PDQ.
People considering clinical trials may be interested in the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.
What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. 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.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.
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.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
Asbestos has been mined and used commercially since 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 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. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. 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. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
How is mesothelioma diagnosed?
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, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) 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 peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is mesothelioma treated?
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.
Are new treatments for mesothelioma being studied?
Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.
People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI’s cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI’s Cancer.gov Web site, located at http://www.cancer.gov/clinical_trials on the Internet, provides general information about clinical trials and links to PDQ.
People considering clinical trials may be interested in the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.
mesothelioma
mesothelioma is rare form of cancer caused by asbestos exposure. The disease might have been preventable had the asbestos industry acted responsibly decades ago to protect the public from the dangers of asbestos. Unfortunately for the estimated 3,000 Americans diagnosed with mesothelioma each year, the asbestos industry hid the dangers of asbestos from the public for decades after it knew of the risks. seulement 47 euros
In these pages you will learn about the asbestos tragedy in the United States and how it has affected the lives and health of countless American workers and their families. You will also read about how people are exposed to asbestos, including the types of work sites where asbestos was once common and the trades that worked with and around asbestos-containing products. And you will learn how Baron & Budd was one of the first law firms in the country to fight for the rights of asbestos victims and is still widely recognized as a national leader in asbestos litigation to this day.
For nearly three decades, in courtrooms across the country, Baron & Budd has championed the rights of mesothelioma victims. Here are just a few examples of some of the results we have achieved for our mesothelioma clients:
The cases described here reflect the net amounts of the judgments or settlements our clients received after the deduction of attorneys fees and expenses-in other words, what our clients actually received. The actual settlement or verdict would be higher. These cases were all handled by Baron & Budd attorneys serving as lead counsel.
Specific Results Depend on the Facts of Each Case.
$10,603,661.00 Received by Client after Attorney’s Fees and Expenses for a gentleman who developed malignant mesothelioma as a result of his exposure to joint compound as a construction worker. This case went to trial and resulted in a significant verdict in favor of the gentleman, his wife and children that was listed by a national legal publication as one of the top verdicts in the U.S. that year. The case subsequently settled.
$6,356,942.00 Received by Client after Attorney’s Fees and Expenses, for the widow of a man who died at the age of 50 after developing asbestos-related mesothelioma. He was exposed to asbestos while serving in the Navy aboard nuclear submarines during the 1960s. This case went to trial against the manufacturer of an asbestos-containing pipe covering product. The jury awarded a significant verdict, which was affirmed on appeal.
$4,380,755.00 Received by Client after Attorney’s Fees and Expenses, for an ironworker who worked at a number of industrial sites throughout his career and who was diagnosed with mesothelioma
In these pages you will learn about the asbestos tragedy in the United States and how it has affected the lives and health of countless American workers and their families. You will also read about how people are exposed to asbestos, including the types of work sites where asbestos was once common and the trades that worked with and around asbestos-containing products. And you will learn how Baron & Budd was one of the first law firms in the country to fight for the rights of asbestos victims and is still widely recognized as a national leader in asbestos litigation to this day.
For nearly three decades, in courtrooms across the country, Baron & Budd has championed the rights of mesothelioma victims. Here are just a few examples of some of the results we have achieved for our mesothelioma clients:
The cases described here reflect the net amounts of the judgments or settlements our clients received after the deduction of attorneys fees and expenses-in other words, what our clients actually received. The actual settlement or verdict would be higher. These cases were all handled by Baron & Budd attorneys serving as lead counsel.
Specific Results Depend on the Facts of Each Case.
$10,603,661.00 Received by Client after Attorney’s Fees and Expenses for a gentleman who developed malignant mesothelioma as a result of his exposure to joint compound as a construction worker. This case went to trial and resulted in a significant verdict in favor of the gentleman, his wife and children that was listed by a national legal publication as one of the top verdicts in the U.S. that year. The case subsequently settled.
$6,356,942.00 Received by Client after Attorney’s Fees and Expenses, for the widow of a man who died at the age of 50 after developing asbestos-related mesothelioma. He was exposed to asbestos while serving in the Navy aboard nuclear submarines during the 1960s. This case went to trial against the manufacturer of an asbestos-containing pipe covering product. The jury awarded a significant verdict, which was affirmed on appeal.
$4,380,755.00 Received by Client after Attorney’s Fees and Expenses, for an ironworker who worked at a number of industrial sites throughout his career and who was diagnosed with mesothelioma
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