Mesothelioma
Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos. Unlike lung cancer, there is no association between mesothelioma and smoking.[1] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis can be made with chest X-rays and a CT scan, and confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
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Thursday, September 18, 2008
Mesothelioma
The tissue that lines your lungs, stomach, heart and other organs is called mesothelium. Mesothelioma is cancer of that tissue. It is a rare but serious type of cancer. It usually starts in the lungs, but can also start in the abdomen or other organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles. It can take a long time - 30 to 50 years - between being around asbestos and getting the disease. Treatment includes surgery, radiation, chemotherapy or all three.
National Cancer Institute
The tissue that lines your lungs, stomach, heart and other organs is called mesothelium. Mesothelioma is cancer of that tissue. It is a rare but serious type of cancer. It usually starts in the lungs, but can also start in the abdomen or other organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles. It can take a long time - 30 to 50 years - between being around asbestos and getting the disease. Treatment includes surgery, radiation, chemotherapy or all three.
National Cancer Institute
Mesothelioma
Definition
Malignant mesothelioma (me-zo-thee-le-O-muh) is a rare cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).
Doctors divide mesothelioma into different types based on what part of the mesothelium is affected, including:
Pleural malignant mesothelioma, which affects the tissue that surrounds the lungs and is the most common form of mesothelioma.
Peritoneal mesothelioma, which occurs in the tissue in your abdomen.
Pericardial mesothelioma, which affects the tissue surrounding the heart.
Mesothelioma of the tunica vaginalis, which occurs in the lining around the testicles.
Between 2,000 and 3,000 people are diagnosed with mesothelioma in the United States each year, according to the American Cancer Society.
Symptoms
Signs and symptoms of mesothelioma vary depending on where the cancer occurs.
Pleural mesothelioma signs and symptoms may include:
Shortness of breath
Painful breathing (pleurisy)
Painful coughing
Chest pain under the rib cage
Unusual lumps of tissue under the skin on your chest
Unexplained weight loss
Dry (nonproductive) cough
Peritoneal mesothelioma signs and symptoms may include:
Abdominal pain
Abdominal swelling
A change in your bowel habits, such as more frequent diarrhea or constipation
Lumps of tissue in the abdomen
Unexplained weight loss
Other forms of mesothelioma
Signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are unclear. These forms are so rare that not much information is available. Pericardial mesothelioma signs and symptoms may include difficulty breathing or chest pains. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle
Definition
Malignant mesothelioma (me-zo-thee-le-O-muh) is a rare cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).
Doctors divide mesothelioma into different types based on what part of the mesothelium is affected, including:
Pleural malignant mesothelioma, which affects the tissue that surrounds the lungs and is the most common form of mesothelioma.
Peritoneal mesothelioma, which occurs in the tissue in your abdomen.
Pericardial mesothelioma, which affects the tissue surrounding the heart.
Mesothelioma of the tunica vaginalis, which occurs in the lining around the testicles.
Between 2,000 and 3,000 people are diagnosed with mesothelioma in the United States each year, according to the American Cancer Society.
Symptoms
Signs and symptoms of mesothelioma vary depending on where the cancer occurs.
Pleural mesothelioma signs and symptoms may include:
Shortness of breath
Painful breathing (pleurisy)
Painful coughing
Chest pain under the rib cage
Unusual lumps of tissue under the skin on your chest
Unexplained weight loss
Dry (nonproductive) cough
Peritoneal mesothelioma signs and symptoms may include:
Abdominal pain
Abdominal swelling
A change in your bowel habits, such as more frequent diarrhea or constipation
Lumps of tissue in the abdomen
Unexplained weight loss
Other forms of mesothelioma
Signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are unclear. These forms are so rare that not much information is available. Pericardial mesothelioma signs and symptoms may include difficulty breathing or chest pains. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle
Wednesday, September 17, 2008
What is mesothelioma?
Mesothelioma is a rare type of tumor that arises in the mesothelium, a membrane that lines the cavities of the body (such as the chest and abdomen) and also covers and protects most of the body's internal organs. In the chest, the mesothelium is known as the pleura, where it covers the lungs ('visceral pleura') and lines the internal chest wall ('parietal pleura'). There is a 'potential space' between the visceral and parietal pleura, which normally contains about 10 mls of lubricating fluid that reduces friction between the chest wall and the lungs. In the abdomen, the mesothelium is called the peritoneum, while that surrounding the heart is called the peritoneum.
Mesothelioma can be either benign or malignant. Benign mesothelioma may occur wherever there is mesothelium, is localized, and does not invade nearby tissues. It may cause problems because of a mass effect with compression or blockage of adjacent structures but can usually be managed by surgical removal. Unlike malignant mesothelioma, benign mesothelioma has no association with asbestos exposure.
Malignant mesothelioma is a cancerous tumor that is closely correlated to asbestos exposure. Most malignant mesothelioma occurs in the pleura (65-70%) but may also arise in the peritoneum (25%), the ovaries and scrotum, or the pericardium. All forms of mesothelioma have a very poor prognosis (outlook), and are usually rapidly fatal. Asbestos manufacturers and their insurers have been aware of the dangers associated with asbestos since the 1930s. However these groups have not only failed to protect workers and the public, but have conspired to prevent the health risks of asbestos from becoming widely known.
Risk factors for malignant mesothelioma
Epidemiology (disease frequency)
Mesothelioma is a rare type of tumor that arises in the mesothelium, a membrane that lines the cavities of the body (such as the chest and abdomen) and also covers and protects most of the body's internal organs. In the chest, the mesothelium is known as the pleura, where it covers the lungs ('visceral pleura') and lines the internal chest wall ('parietal pleura'). There is a 'potential space' between the visceral and parietal pleura, which normally contains about 10 mls of lubricating fluid that reduces friction between the chest wall and the lungs. In the abdomen, the mesothelium is called the peritoneum, while that surrounding the heart is called the peritoneum.
Mesothelioma can be either benign or malignant. Benign mesothelioma may occur wherever there is mesothelium, is localized, and does not invade nearby tissues. It may cause problems because of a mass effect with compression or blockage of adjacent structures but can usually be managed by surgical removal. Unlike malignant mesothelioma, benign mesothelioma has no association with asbestos exposure.
Malignant mesothelioma is a cancerous tumor that is closely correlated to asbestos exposure. Most malignant mesothelioma occurs in the pleura (65-70%) but may also arise in the peritoneum (25%), the ovaries and scrotum, or the pericardium. All forms of mesothelioma have a very poor prognosis (outlook), and are usually rapidly fatal. Asbestos manufacturers and their insurers have been aware of the dangers associated with asbestos since the 1930s. However these groups have not only failed to protect workers and the public, but have conspired to prevent the health risks of asbestos from becoming widely known.
Risk factors for malignant mesothelioma
Epidemiology (disease frequency)
If you've been exposed to asbestos
If you are concerned that you or someone you know may have been exposed to asbestos, there are a number of actions you can take.
If you smoke, perhaps the most important first step is to STOP SMOKING. While smoking does not increase the chances of developing malignant mesothelioma or asbestosis, it greatly increases the likelihood of developing lung cancer in the asbestos-exposed by 50-90 times!
Further asbestos exposure should be avoided at all costs.
You should consult your doctor about your concerns and consider taking legal action.
Health monitoring
Legal action
If you are concerned that you or someone you know may have been exposed to asbestos, there are a number of actions you can take.
If you smoke, perhaps the most important first step is to STOP SMOKING. While smoking does not increase the chances of developing malignant mesothelioma or asbestosis, it greatly increases the likelihood of developing lung cancer in the asbestos-exposed by 50-90 times!
Further asbestos exposure should be avoided at all costs.
You should consult your doctor about your concerns and consider taking legal action.
Health monitoring
Legal action
Alimta
In February 2004, Alimta (pemetrexed) was approved by the US Food and Drug Administration (FDA) for the treatment of pleural malignant mesothelioma that cannot be removed surgically, when given with cisplatin (another chemotherapy drug). It is the only such drug approved for this indication.
Alimta works by blocking an enzyme necessary in the growth of the tumor. It is given by injection every 21 days, followed by administration of cisplatin. Folate and B12 must also be given, and corticosteroids are also prescribed to decrease skin side effects. As with other types of chemotherapy, there are side effects associated with Alimta, including fatigue, nausea and vomiting, diarrhea, and blood problems.
Alimta does not cure malignant mesothelioma, but it does improve survival. In the study that prompted its approval by the FDA, patients treated with Alimta and cisplatin had a median survival almost 3 months greater than those treated with cisplatin alone.
See Useful resources for links to information about Alimta
In February 2004, Alimta (pemetrexed) was approved by the US Food and Drug Administration (FDA) for the treatment of pleural malignant mesothelioma that cannot be removed surgically, when given with cisplatin (another chemotherapy drug). It is the only such drug approved for this indication.
Alimta works by blocking an enzyme necessary in the growth of the tumor. It is given by injection every 21 days, followed by administration of cisplatin. Folate and B12 must also be given, and corticosteroids are also prescribed to decrease skin side effects. As with other types of chemotherapy, there are side effects associated with Alimta, including fatigue, nausea and vomiting, diarrhea, and blood problems.
Alimta does not cure malignant mesothelioma, but it does improve survival. In the study that prompted its approval by the FDA, patients treated with Alimta and cisplatin had a median survival almost 3 months greater than those treated with cisplatin alone.
See Useful resources for links to information about Alimta
Heat therapy
Heat therapy uses heat to improve the effects of chemotherapy agents. In hyperthermic chemotherapy, agents such as cisplatin or doxorubicin are heated and injected at temperatures as high as 109° F, because tumor cells are more susceptible to the toxic effects of the drugs at higher temperatures. In an early study, patients with malignant mesothelioma showed good tolerance to hyperthermic cisplatin given into the pleural space.
In chemohyperthermia, the pleural cavity is heated before chemotherapy is given directly into it. Although proved safe, it has not demonstrated improved survival
Heat therapy uses heat to improve the effects of chemotherapy agents. In hyperthermic chemotherapy, agents such as cisplatin or doxorubicin are heated and injected at temperatures as high as 109° F, because tumor cells are more susceptible to the toxic effects of the drugs at higher temperatures. In an early study, patients with malignant mesothelioma showed good tolerance to hyperthermic cisplatin given into the pleural space.
In chemohyperthermia, the pleural cavity is heated before chemotherapy is given directly into it. Although proved safe, it has not demonstrated improved survival
Gene therapy
Various forms of gene therapy are being investigated for use in malignant mesothelioma; some predict gene therapy will be a key approach to treatment in future. Suicide gene therapy involves genetic manipulation of a virus (such as a common cold virus) so that tumor cells invaded by the virus become susceptible to antiviral drugs and/or to the body's own immune system. This type of gene therapy is useful in localized tumors -- and so has been trialled with some success in early malignant mesothelioma
Various forms of gene therapy are being investigated for use in malignant mesothelioma; some predict gene therapy will be a key approach to treatment in future. Suicide gene therapy involves genetic manipulation of a virus (such as a common cold virus) so that tumor cells invaded by the virus become susceptible to antiviral drugs and/or to the body's own immune system. This type of gene therapy is useful in localized tumors -- and so has been trialled with some success in early malignant mesothelioma
Shortness of breath
Shortness of breath in malignant mesothelioma may arise for various reasons. Many patients develop a pleural effusion with malignant mesothelioma; this fluid collection prevents the lung inflating fully on the affected side. If the tumor extends directly into the lung tissue, breathing difficulties can occur. In addition, around 20% of patients with pleural malignant mesothelioma also have asbestosis (replacement of lung tissue with fibrous tissue), another cause of breathlessness in those exposed to asbestos.
Pleural effusions tend to persist in malignant mesothelioma once they have developed. The can be drained by thoracentesis (insertion of a needle between the ribs and into the pleural space), but they usually return rapidly after this. Repeat thoracentesis is not helpful and diuretics (medications that promote loss of fluid from the body) do not prevent re-accumulation of fluid.
The two layers of the pleura can be fused together by to prevent a further collection forming, in a procedure known as pleurodesis. With pleurodesis, a substance is injected into the pleural space via a chest tube placed between the ribs, which then causes the lung and its overlying visceral pleura to adhere to the parietal pleura lining the chest wall. The procedure requires that the lung is inflated enough to allow it adhere to the parietal pleura; this may be difficult in malignant mesothelioma if there is a thick rind of tumor preventing the lung from expanding fully. In such cases, patients may be referred for pleurectomy instead.
An alternative to pleurodesis and pleurectomy in patients who are suitable for these procedures is the placement of a pleuroperitoneal shunt. This drains the fluid from the pleural effusion into the abdominal cavity, with the aim of allowing the patient to breathe more easily.
Radiation therapy has also been used to reduce pleural effusions.
When breathlessness persists, it is often managed symptomatically with opioid drugs and supplemental oxygen therapy.
Shortness of breath in malignant mesothelioma may arise for various reasons. Many patients develop a pleural effusion with malignant mesothelioma; this fluid collection prevents the lung inflating fully on the affected side. If the tumor extends directly into the lung tissue, breathing difficulties can occur. In addition, around 20% of patients with pleural malignant mesothelioma also have asbestosis (replacement of lung tissue with fibrous tissue), another cause of breathlessness in those exposed to asbestos.
Pleural effusions tend to persist in malignant mesothelioma once they have developed. The can be drained by thoracentesis (insertion of a needle between the ribs and into the pleural space), but they usually return rapidly after this. Repeat thoracentesis is not helpful and diuretics (medications that promote loss of fluid from the body) do not prevent re-accumulation of fluid.
The two layers of the pleura can be fused together by to prevent a further collection forming, in a procedure known as pleurodesis. With pleurodesis, a substance is injected into the pleural space via a chest tube placed between the ribs, which then causes the lung and its overlying visceral pleura to adhere to the parietal pleura lining the chest wall. The procedure requires that the lung is inflated enough to allow it adhere to the parietal pleura; this may be difficult in malignant mesothelioma if there is a thick rind of tumor preventing the lung from expanding fully. In such cases, patients may be referred for pleurectomy instead.
An alternative to pleurodesis and pleurectomy in patients who are suitable for these procedures is the placement of a pleuroperitoneal shunt. This drains the fluid from the pleural effusion into the abdominal cavity, with the aim of allowing the patient to breathe more easily.
Radiation therapy has also been used to reduce pleural effusions.
When breathlessness persists, it is often managed symptomatically with opioid drugs and supplemental oxygen therapy.
Pain management
Malignant mesothelioma is a particularly painful cancer, so that good pain management is essential for the comfort of its victims. It is important that someone suffering from malignant mesothelioma informs his physicians and carers about the characteristics of his pain, so that the best treatment can be offered. Pain characteristics include:
Duration. Chronic (long-lasting), acute (lasting a short time, often sudden in onset) or breakthrough (episodes of more severe pain 'breaking through' a background level of pain)
Severity. Mild, moderate or severe.
There are various methods of managing pain in malignant mesothelioma. Radiation therapy to the tumor area is often quite successful at relieving pain from tumor spread into the chest wall. It is given in lower doses than have been applied (with little success) to remove the tumor.
Many medications are available to relieve cancer pain. Mild pain may be treated with over-the-counter drugs such as acetaminophen (e.g. Tylenol) or non-steroidal-anti-inflammatory agents (NSAIDs, e.g. ibuprofen, Advil). These drugs may also be useful for treating breakthrough pain in patients receiving opioids. Opioids are narcotic drugs used to relieve moderate-to-severe pain; the most commonly used opioid is morphine. These drugs can be given in many different ways, such as:
by mouth
by intramuscular or intravenous injection
by skin patch
use of an intravenous 'pain pump'
by epidural catheter (a thin tube inserted near the spinal cord).
Opioids produce certain certain side effects; these should be discussed with the prescribing doctor.
Occasionally, patients may undergo neurosurgery to relieve pain; one such technique (percutaneous cervical cordotomy) severs the nerves from the spinal cord that carry pain sensation.
Pain may also be managed by many non-medical techniques. These range from physical methods (e.g. heat packs and massage) to psychosocial interventions (e.g. relaxation, massage, and support groups). For information about these and other pain management techniques, see the pain management links in Useful resources
Malignant mesothelioma is a particularly painful cancer, so that good pain management is essential for the comfort of its victims. It is important that someone suffering from malignant mesothelioma informs his physicians and carers about the characteristics of his pain, so that the best treatment can be offered. Pain characteristics include:
Duration. Chronic (long-lasting), acute (lasting a short time, often sudden in onset) or breakthrough (episodes of more severe pain 'breaking through' a background level of pain)
Severity. Mild, moderate or severe.
There are various methods of managing pain in malignant mesothelioma. Radiation therapy to the tumor area is often quite successful at relieving pain from tumor spread into the chest wall. It is given in lower doses than have been applied (with little success) to remove the tumor.
Many medications are available to relieve cancer pain. Mild pain may be treated with over-the-counter drugs such as acetaminophen (e.g. Tylenol) or non-steroidal-anti-inflammatory agents (NSAIDs, e.g. ibuprofen, Advil). These drugs may also be useful for treating breakthrough pain in patients receiving opioids. Opioids are narcotic drugs used to relieve moderate-to-severe pain; the most commonly used opioid is morphine. These drugs can be given in many different ways, such as:
by mouth
by intramuscular or intravenous injection
by skin patch
use of an intravenous 'pain pump'
by epidural catheter (a thin tube inserted near the spinal cord).
Opioids produce certain certain side effects; these should be discussed with the prescribing doctor.
Occasionally, patients may undergo neurosurgery to relieve pain; one such technique (percutaneous cervical cordotomy) severs the nerves from the spinal cord that carry pain sensation.
Pain may also be managed by many non-medical techniques. These range from physical methods (e.g. heat packs and massage) to psychosocial interventions (e.g. relaxation, massage, and support groups). For information about these and other pain management techniques, see the pain management links in Useful resources
Photodynamic therapy
Photodynamic therapy involves injection of light-sensitive molecules into the pleural space. These are taken up by the tumor cells, which then have intense light beams directed at them, resulting in their death. In good-risk patients with small malignant mesotheliomas, photodynamic therapy has been moderately successful, although complications may occur with poorly directed light.
In combination with surgical procedures, photodynamic therapy has not improved survival or local disease control. Furthermore, it has damaging effects on normal and healing tissues, and the post-operative death rates may be high. It is therefore not likely to become standard treatment for malignant mesothelioma
Photodynamic therapy involves injection of light-sensitive molecules into the pleural space. These are taken up by the tumor cells, which then have intense light beams directed at them, resulting in their death. In good-risk patients with small malignant mesotheliomas, photodynamic therapy has been moderately successful, although complications may occur with poorly directed light.
In combination with surgical procedures, photodynamic therapy has not improved survival or local disease control. Furthermore, it has damaging effects on normal and healing tissues, and the post-operative death rates may be high. It is therefore not likely to become standard treatment for malignant mesothelioma
New treatments
Only 20-30% of patients are suitable candidates for surgical procedures in malignant mesothelioma, and chemotherapy and radiation therapy has met with limited success. However, many new treatments have been tried in the management of this disease, using various approaches. Some of these have proved more successful than others, and many are part of ongoing clinical trials. See Useful resources for links to clinical trials in malignant mesothelioma.
Immunotherapy
Heat treatments
Gene therapy
Photodynamic thera
Only 20-30% of patients are suitable candidates for surgical procedures in malignant mesothelioma, and chemotherapy and radiation therapy has met with limited success. However, many new treatments have been tried in the management of this disease, using various approaches. Some of these have proved more successful than others, and many are part of ongoing clinical trials. See Useful resources for links to clinical trials in malignant mesothelioma.
Immunotherapy
Heat treatments
Gene therapy
Photodynamic thera
Chemotherapy
Alimta
In February 2004, Alimta (pemetrexed) was approved by the US Food and Drug Administration (FDA) for the treatment of pleural malignant mesothelioma that cannot be removed surgically, when given with cisplatin (another chemotherapy drug). It is the only such drug approved for this indication.
Alimta works by blocking an enzyme necessary in the growth of the tumor. It is given by injection every 21 days, followed by administration of cisplatin. Folate and B12 must also be given, and corticosteroids are also prescribed to decrease skin side effects. As with other types of chemotherapy, there are side effects associated with Alimta, including fatigue, nausea and vomiting, diarrhea, and blood problems.
Alimta does not cure malignant mesothelioma, but it does improve survival. In the study that prompted its approval by the FDA, patients treated with Alimta and cisplatin had a median survival almost 3 months greater than those treated with cisplatin alone.
Alimta
In February 2004, Alimta (pemetrexed) was approved by the US Food and Drug Administration (FDA) for the treatment of pleural malignant mesothelioma that cannot be removed surgically, when given with cisplatin (another chemotherapy drug). It is the only such drug approved for this indication.
Alimta works by blocking an enzyme necessary in the growth of the tumor. It is given by injection every 21 days, followed by administration of cisplatin. Folate and B12 must also be given, and corticosteroids are also prescribed to decrease skin side effects. As with other types of chemotherapy, there are side effects associated with Alimta, including fatigue, nausea and vomiting, diarrhea, and blood problems.
Alimta does not cure malignant mesothelioma, but it does improve survival. In the study that prompted its approval by the FDA, patients treated with Alimta and cisplatin had a median survival almost 3 months greater than those treated with cisplatin alone.
Radiation therapy
Radiation therapy involves the use of x-rays to kill tumor cells, but it also affects healthy cells nearby. It can be given externally, or by placing radioactive substances within the pleural space. External radiation therapy used alone does not extend survival in malignant mesothelioma, although it may cause the tumor to shrink. Effective doses in malignant mesothelioma would require very large doses of radiation to a wide area of the body -- with associated damage to nearby structures, including the lungs and esophagus.
Lower doses of radiation therapy (external or internal) have been used in combination with surgical treatments (especially pleurectomy) to prevent local tumor recurrence. Low doses have also been used to prevent tumor spread along wound tracts left from invasive diagnostic procedures. For patients with inoperable disease, lower dose radiation therapy may be helpful in reducing the size of the tumor and to provide pain relief.
Radiation therapy involves the use of x-rays to kill tumor cells, but it also affects healthy cells nearby. It can be given externally, or by placing radioactive substances within the pleural space. External radiation therapy used alone does not extend survival in malignant mesothelioma, although it may cause the tumor to shrink. Effective doses in malignant mesothelioma would require very large doses of radiation to a wide area of the body -- with associated damage to nearby structures, including the lungs and esophagus.
Lower doses of radiation therapy (external or internal) have been used in combination with surgical treatments (especially pleurectomy) to prevent local tumor recurrence. Low doses have also been used to prevent tumor spread along wound tracts left from invasive diagnostic procedures. For patients with inoperable disease, lower dose radiation therapy may be helpful in reducing the size of the tumor and to provide pain relief.
Pleurectomy
Pleurectomy is a technique to remove the parietal pleura from the lung. The chest wall is opened on the side of the tumor by making a cut at the back and side of the chest. A rib may be removed to help the surgeon gain access to the affected lung. The parietal pleura is then stripped from the top of the lung down to the bottom. Large tubes are inserted between the ribs to drain blood and manage any air leaks from the lungs; these are usually left in place for around 5-6 days.
Pleurectomy is not without risks. About 2% of patients die during surgery, and there are a number of complications that may occur, including:
Bronchopleural fistula (development of an abnormal connection between the breathing tubes and the pleura, allowing air to leak out from the lungs).
Massive bleeding.
Subcutaneous emphysema (an air leak from the lungs into the overlying tissues, under the skin).
Pneumonia.
Incomplete tumor removal (resulting in local recurrence).
Breathing difficulties.
The median survival after pleurectomy for malignant mesothelioma ranges from 6-21 months, and 9-40% of patients survive to 2 years. These wide ranges are reported in trials by different research groups using various treatment combinations (surgery performed with or without radiation therapy or chemotherapy). Patients should seek information about the experience and results at the facility where they are being treated.
Pleurectomy is only considered if the normal space between the parietal and visceral pleurae remains, and the two layers of the pleura have not fused together. In cases where the pleural layers have fused, stripping would also involve removal of underlying lung tissue (decortication). This is difficult in malignant mesothelioma, because a clear plane between the tumor and lung is hard to define, so that stripping the lung would damage it. In cases where the tumor has caused such fusion, an extrapleural pneumonectomy would usually be more appropriate.
Website Index:
Home page
What is mesothelioma?
Features of malignant mesothelioma
Diagnosis of malignant mesothelioma
Treatment options for malignant mesothelioma
Surgical procedures
Pleurectomy
Extrapleural pneumonectomy
Radiation therapy
Chemotherapy
Alimta
New treatments
Immunotherapy
Heat therapy
Gene therapy
Photodynamic therapy
Supportive treatment
Pain management
Shortness of breath
Which therapy?
Other conditions associated with asbestos exposure
What is asbestos?
If you've been exposed
Useful resources
Glossary
Bibliography
Contact Information
Pleurectomy is a technique to remove the parietal pleura from the lung. The chest wall is opened on the side of the tumor by making a cut at the back and side of the chest. A rib may be removed to help the surgeon gain access to the affected lung. The parietal pleura is then stripped from the top of the lung down to the bottom. Large tubes are inserted between the ribs to drain blood and manage any air leaks from the lungs; these are usually left in place for around 5-6 days.
Pleurectomy is not without risks. About 2% of patients die during surgery, and there are a number of complications that may occur, including:
Bronchopleural fistula (development of an abnormal connection between the breathing tubes and the pleura, allowing air to leak out from the lungs).
Massive bleeding.
Subcutaneous emphysema (an air leak from the lungs into the overlying tissues, under the skin).
Pneumonia.
Incomplete tumor removal (resulting in local recurrence).
Breathing difficulties.
The median survival after pleurectomy for malignant mesothelioma ranges from 6-21 months, and 9-40% of patients survive to 2 years. These wide ranges are reported in trials by different research groups using various treatment combinations (surgery performed with or without radiation therapy or chemotherapy). Patients should seek information about the experience and results at the facility where they are being treated.
Pleurectomy is only considered if the normal space between the parietal and visceral pleurae remains, and the two layers of the pleura have not fused together. In cases where the pleural layers have fused, stripping would also involve removal of underlying lung tissue (decortication). This is difficult in malignant mesothelioma, because a clear plane between the tumor and lung is hard to define, so that stripping the lung would damage it. In cases where the tumor has caused such fusion, an extrapleural pneumonectomy would usually be more appropriate.
Website Index:
Home page
What is mesothelioma?
Features of malignant mesothelioma
Diagnosis of malignant mesothelioma
Treatment options for malignant mesothelioma
Surgical procedures
Pleurectomy
Extrapleural pneumonectomy
Radiation therapy
Chemotherapy
Alimta
New treatments
Immunotherapy
Heat therapy
Gene therapy
Photodynamic therapy
Supportive treatment
Pain management
Shortness of breath
Which therapy?
Other conditions associated with asbestos exposure
What is asbestos?
If you've been exposed
Useful resources
Glossary
Bibliography
Contact Information
Surgical procedures
There are two main surgical procedures used in the treatment of malignant mesothelioma, pleurectomy and extrapleural pneumonectomy. These procedures are both major operations requiring prolonged anesthesia. Therefore, if a person is being considered for surgery, they will require certain tests to determine their ability to withstand the actual surgical procedure and anesthesia, the recovery period, and the consequences of surgery (which may include the removal of a lung). These include assessments of heart and lung function, overall health and nutritional status.
There are three main indications for surgery:
To take biopsy specimens to confirm a diagnosis, if other invasive techniques have failed.
In early disease, to attempt a cure by cutting out all diseased areas.
If a cure is not likely, to provide palliative therapy (by fusing the two layers of the pleura together, to prevent recurrence of a pleural effusion).
Only 20-30% of patients with malignant mesothelioma prove to be suitable candidates for a surgical procedure. Anyone with distant metastases, certain heart problems (such as a recent heart attack, irregular heart rhythms, or poor function) and poor lung capacity should not be considered for surgery. CT and MRI scans have been used to help define which tumors are likely to be successfully removed by an operative procedure, but this can often only be discovered during the surgery itself.
Because the surgical procedures for malignant mesothelioma are major operations, there is a long recovery time afterwards. Patients usually have pain, breathlessness, weakness and fatigue for weeks or even months later.
Pleurectomy
Extrapleural pneumonectomy
There are two main surgical procedures used in the treatment of malignant mesothelioma, pleurectomy and extrapleural pneumonectomy. These procedures are both major operations requiring prolonged anesthesia. Therefore, if a person is being considered for surgery, they will require certain tests to determine their ability to withstand the actual surgical procedure and anesthesia, the recovery period, and the consequences of surgery (which may include the removal of a lung). These include assessments of heart and lung function, overall health and nutritional status.
There are three main indications for surgery:
To take biopsy specimens to confirm a diagnosis, if other invasive techniques have failed.
In early disease, to attempt a cure by cutting out all diseased areas.
If a cure is not likely, to provide palliative therapy (by fusing the two layers of the pleura together, to prevent recurrence of a pleural effusion).
Only 20-30% of patients with malignant mesothelioma prove to be suitable candidates for a surgical procedure. Anyone with distant metastases, certain heart problems (such as a recent heart attack, irregular heart rhythms, or poor function) and poor lung capacity should not be considered for surgery. CT and MRI scans have been used to help define which tumors are likely to be successfully removed by an operative procedure, but this can often only be discovered during the surgery itself.
Because the surgical procedures for malignant mesothelioma are major operations, there is a long recovery time afterwards. Patients usually have pain, breathlessness, weakness and fatigue for weeks or even months later.
Pleurectomy
Extrapleural pneumonectomy
Treatment options for malignant mesothelioma
Although a diagnosis of malignant mesothelioma is often met with dread, there are a number of treatment options available -- depending on the stage of the disease. In the past, treatment has focused on (often aggressive) surgical procedures; nowadays surgery may be combined with radiation therapy or chemotherapy. In addition, there are many new treatment options available also.
The treating physician should discuss the treatment options available to someone with malignant mesothelioma, and help decide which is most suitable, depending on:
the stage of the disease
the functional status of the patient
the side effects of treatment
discomfort associated with surgery
the wishes of the patient.
Many treatment options are associated with considerable side effects, discomfort, or disfigurement. For some patients, these may be more than they are willing to bear, so that they choose to forgo active treatment and seek palliative treatment only.
For links to sites with lists of current clinical trials in malignant mesothelioma, see Useful resources.
Surgical procedures
Radiation therapy
Chemotherapy
New treatments
Supportive treatment
Which therapy?
Although a diagnosis of malignant mesothelioma is often met with dread, there are a number of treatment options available -- depending on the stage of the disease. In the past, treatment has focused on (often aggressive) surgical procedures; nowadays surgery may be combined with radiation therapy or chemotherapy. In addition, there are many new treatment options available also.
The treating physician should discuss the treatment options available to someone with malignant mesothelioma, and help decide which is most suitable, depending on:
the stage of the disease
the functional status of the patient
the side effects of treatment
discomfort associated with surgery
the wishes of the patient.
Many treatment options are associated with considerable side effects, discomfort, or disfigurement. For some patients, these may be more than they are willing to bear, so that they choose to forgo active treatment and seek palliative treatment only.
For links to sites with lists of current clinical trials in malignant mesothelioma, see Useful resources.
Surgical procedures
Radiation therapy
Chemotherapy
New treatments
Supportive treatment
Which therapy?
Invasive procedures
There are various invasive procedures that may be performed to help diagnose and stage malignant mesothelioma. These procedures are more complicated than non-invasive tests, usually require some form of anesthesia, and may involve a stay in hospital.
Thoracentesis. This is the drainage of fluid from a pleural effusion, using a fine needle (passed through the skin of the chest wall, between the ribs), which is often guided using ultrasonography. The fluid is then looked at under a microscope, to determine the type and characteristics of the cells present (cytology). However, in malignant mesothelioma, cytology often gives negative or indeterminate results. Thoracentesis may relieve symptoms of breathlessness caused by a pleural effusion.
Thoracoscopy or pleuroscopy involve the use of an endoscope to look inside the chest or within the pleural space and see how widespread the suspected tumor is. The examining doctor may see nodules on the parietal pleura (in early disease) or in more advanced disease, diffuse areas of tumor or even a thick 'cake' of tumor spreading over the surface of the lung. These procedures also allow the doctor to take multiple biopsies from throughout the pleura/tumor, to confirm if the tumor is malignant mesothelioma or some other cancer, and what type of malignant mesothelioma it is. Thoracoscopy is said to be nearly 95% as accurate as open thoracotomy.
Open lung biopsy. This is a major procedure that involves opening the chest wall (thoracotomy) to access the lungs. Multiple biopsies are then taken from the tumor and any involved lungs. It is recommended that normal lung specimens are also taken, so any asbestos fibers can be counted (for litigation purposes).
Bronchoscopy is the use of a rigid endoscope, which is passed into the airways of the lungs. It is used to define the anatomy within the lung, and to make sure there is no cancer within the lung airways (bronchogenic carcinoma) in patients being considered for aggressive surgical therapy. (Surgery is not suitable for those with disease within the airways).
Laparoscopy. This is use of an endoscope to visualize the abdominal cavity, to assess whether tumor has spread through the diaphragm and across the peritoneum. It is sometimes performed before patients undergo aggressive surgery, because spread of tumor into the abdominal cavity rules out surgery.
Many of these procedures carry a risk of 'seeding' tumor along the needle tract. For this reason, radiation therapy is often given before they are performed, to prevent this from happening.
There are various invasive procedures that may be performed to help diagnose and stage malignant mesothelioma. These procedures are more complicated than non-invasive tests, usually require some form of anesthesia, and may involve a stay in hospital.
Thoracentesis. This is the drainage of fluid from a pleural effusion, using a fine needle (passed through the skin of the chest wall, between the ribs), which is often guided using ultrasonography. The fluid is then looked at under a microscope, to determine the type and characteristics of the cells present (cytology). However, in malignant mesothelioma, cytology often gives negative or indeterminate results. Thoracentesis may relieve symptoms of breathlessness caused by a pleural effusion.
Thoracoscopy or pleuroscopy involve the use of an endoscope to look inside the chest or within the pleural space and see how widespread the suspected tumor is. The examining doctor may see nodules on the parietal pleura (in early disease) or in more advanced disease, diffuse areas of tumor or even a thick 'cake' of tumor spreading over the surface of the lung. These procedures also allow the doctor to take multiple biopsies from throughout the pleura/tumor, to confirm if the tumor is malignant mesothelioma or some other cancer, and what type of malignant mesothelioma it is. Thoracoscopy is said to be nearly 95% as accurate as open thoracotomy.
Open lung biopsy. This is a major procedure that involves opening the chest wall (thoracotomy) to access the lungs. Multiple biopsies are then taken from the tumor and any involved lungs. It is recommended that normal lung specimens are also taken, so any asbestos fibers can be counted (for litigation purposes).
Bronchoscopy is the use of a rigid endoscope, which is passed into the airways of the lungs. It is used to define the anatomy within the lung, and to make sure there is no cancer within the lung airways (bronchogenic carcinoma) in patients being considered for aggressive surgical therapy. (Surgery is not suitable for those with disease within the airways).
Laparoscopy. This is use of an endoscope to visualize the abdominal cavity, to assess whether tumor has spread through the diaphragm and across the peritoneum. It is sometimes performed before patients undergo aggressive surgery, because spread of tumor into the abdominal cavity rules out surgery.
Many of these procedures carry a risk of 'seeding' tumor along the needle tract. For this reason, radiation therapy is often given before they are performed, to prevent this from happening.
Staging
Staging is the process of assessing how severe malignant mesothelioma is. It has been used to estimate a victim's prognosis (outlook), and to determine the most suitable therapy -- especially whether he is a suitable candidate for aggressive surgical procedures.
Staging is based on a number of characteristics of the disease, many of which need to be determined by invasive diagnostic procedures. There have been various staging systems proposed for malignant mesothelioma. Those in use now consider three main aspects of the disease (the TNM system):
T: primary tumor and the extent of its spread (no spread/local spread only/more distant but direct spread)
N: involvement of lymph nodes (nil/spread to nodes on the same side of the chest/spread to more nodes in the other side of the chest or more distantly)
M: whether there are metastases (distant spread of tumor via blood or lymph, not by direct extension).
Staging is commonly expressed from I (early disease, localized disease) to IV (widespread tumor, with involvement of lymph nodes and metastases
Staging is the process of assessing how severe malignant mesothelioma is. It has been used to estimate a victim's prognosis (outlook), and to determine the most suitable therapy -- especially whether he is a suitable candidate for aggressive surgical procedures.
Staging is based on a number of characteristics of the disease, many of which need to be determined by invasive diagnostic procedures. There have been various staging systems proposed for malignant mesothelioma. Those in use now consider three main aspects of the disease (the TNM system):
T: primary tumor and the extent of its spread (no spread/local spread only/more distant but direct spread)
N: involvement of lymph nodes (nil/spread to nodes on the same side of the chest/spread to more nodes in the other side of the chest or more distantly)
M: whether there are metastases (distant spread of tumor via blood or lymph, not by direct extension).
Staging is commonly expressed from I (early disease, localized disease) to IV (widespread tumor, with involvement of lymph nodes and metastases
Mesothelioma Awareness
About Asbestos Lung Cancer
Diagnosis of malignant mesothelioma
When someone presents to a doctor with complaints of chest pain and/or breathlessness, the physician should seek a full history from that person -- not only about the symptoms themselves, but also about his work history, and any possible exposure to asbestos. A physical exam should be performed, and the patient referred for a chest x-ray in the first instance.
The typical abnormalities seen on chest x-ray in patients with malignant mesothelioma are a pleural effusion (a collection of fluid in the space between the two layers of the pleura), or pleural thickening.
If the chest x-ray is suggestive of malignant mesothelioma, it is likely that further investigations will be ordered, especially if compensation may be sought. These investigations may include additional imaging studies, blood tests, bone scans, and lung-function tests, as well as more invasive procedures such as thoracentesis, thoracoscopy, pleuroscopy or a lung biopsy.
The purpose of such investigations is to confirm the diagnosis, to determine the type of mesothelioma, to 'stage' the disease (measure how severe it is), and so to assess whether the disease is operable.
Staging
About Asbestos Lung Cancer
Diagnosis of malignant mesothelioma
When someone presents to a doctor with complaints of chest pain and/or breathlessness, the physician should seek a full history from that person -- not only about the symptoms themselves, but also about his work history, and any possible exposure to asbestos. A physical exam should be performed, and the patient referred for a chest x-ray in the first instance.
The typical abnormalities seen on chest x-ray in patients with malignant mesothelioma are a pleural effusion (a collection of fluid in the space between the two layers of the pleura), or pleural thickening.
If the chest x-ray is suggestive of malignant mesothelioma, it is likely that further investigations will be ordered, especially if compensation may be sought. These investigations may include additional imaging studies, blood tests, bone scans, and lung-function tests, as well as more invasive procedures such as thoracentesis, thoracoscopy, pleuroscopy or a lung biopsy.
The purpose of such investigations is to confirm the diagnosis, to determine the type of mesothelioma, to 'stage' the disease (measure how severe it is), and so to assess whether the disease is operable.
Staging
Symptoms associated with local or distant spread
In addition to the general symptoms suffered by victims of malignant mesothelioma, there may be a number of other conditions arising from the disease. These include:
Difficulty swallowing (from invasion into the esophagus).
Nerve problems (from compression of the spinal cord or nerves).
Spinal column distortion (scoliosis).
Superior vena cava syndrome (obstruction of the main vein that returns blood to the heart from the arms/head, which passes through the mediastinum). Characterized by swelling of the face or arms, head fullness/headache, hoarseness, nasal stuffiness, nausea, light headedness.
Symptoms associated with spread to distant organs; these vary according to which organ is involved
In addition to the general symptoms suffered by victims of malignant mesothelioma, there may be a number of other conditions arising from the disease. These include:
Difficulty swallowing (from invasion into the esophagus).
Nerve problems (from compression of the spinal cord or nerves).
Spinal column distortion (scoliosis).
Superior vena cava syndrome (obstruction of the main vein that returns blood to the heart from the arms/head, which passes through the mediastinum). Characterized by swelling of the face or arms, head fullness/headache, hoarseness, nasal stuffiness, nausea, light headedness.
Symptoms associated with spread to distant organs; these vary according to which organ is involved
Symptoms
General symptoms
Besides the usual presenting symptoms of chest pain and shortness of breath, those with malignant mesothelioma may suffer a number of other clinical features, including:
Pleural effusion. This is a collection of fluid in the space between the parietal and visceral pleura. At the time of presentation, >50% of those with malignant mesothelioma have a large pleural effusion.
Fever, chills and sweats.
Weakness and malaise.
Weight loss.
Deteriorating 'performance status'.
Clotting disorders and pulmonary embolus (a blood clot in the lungs).
Anemia.
General symptoms
Besides the usual presenting symptoms of chest pain and shortness of breath, those with malignant mesothelioma may suffer a number of other clinical features, including:
Pleural effusion. This is a collection of fluid in the space between the parietal and visceral pleura. At the time of presentation, >50% of those with malignant mesothelioma have a large pleural effusion.
Fever, chills and sweats.
Weakness and malaise.
Weight loss.
Deteriorating 'performance status'.
Clotting disorders and pulmonary embolus (a blood clot in the lungs).
Anemia.
Symptoms
People with malignant mesothelioma usually present to their doctors complaining of one or more of the following symptoms:
Chest pain. This is described as 'non-pleuritic chest pain' and is often referred to the upper abdomen or shoulder (if there is involvement of the diaphragm).
Shortness of breath (in ~40% of patients). At first this may only occur with exertion.
In addition, malignant mesothelioma produces both general symptoms, and those associated with local invasion or distant spread
People with malignant mesothelioma usually present to their doctors complaining of one or more of the following symptoms:
Chest pain. This is described as 'non-pleuritic chest pain' and is often referred to the upper abdomen or shoulder (if there is involvement of the diaphragm).
Shortness of breath (in ~40% of patients). At first this may only occur with exertion.
In addition, malignant mesothelioma produces both general symptoms, and those associated with local invasion or distant spread
Symptoms
People with malignant mesothelioma usually present to their doctors complaining of one or more of the following symptoms:
Chest pain. This is described as 'non-pleuritic chest pain' and is often referred to the upper abdomen or shoulder (if there is involvement of the diaphragm).
Shortness of breath (in ~40% of patients). At first this may only occur with exertion.
In addition, malignant mesothelioma produces both general symptoms, and those associated with local invasion or distant spread
People with malignant mesothelioma usually present to their doctors complaining of one or more of the following symptoms:
Chest pain. This is described as 'non-pleuritic chest pain' and is often referred to the upper abdomen or shoulder (if there is involvement of the diaphragm).
Shortness of breath (in ~40% of patients). At first this may only occur with exertion.
In addition, malignant mesothelioma produces both general symptoms, and those associated with local invasion or distant spread
Development of malignant mesothelioma
The development of malignant mesothelioma is thought to relate to the physical structure of asbestos. Asbestos occurs as two forms, serpentine chrysotiles, or straight, sharp, needle-like amphiboles (crocidolite, amosite, anthophyllite, tremolite and actinolite). Chrysotiles are not thought to be directly cause malignant mesothelioma, because their curled, flexible structure means they are likely to become trapped in the upper airways, and removed by usual physiological actions. Also, if they do become trapped in the lungs, the more soluble chrysotiles are gradually leached from the lung tissue. However, chrysotiles are commonly associated with malignant mesothelioma, probably because they are usually contaminated with amphiboles.
Amphiboles behave differently to chrysotiles, and are therefore much more carcinogenic. Their straight, stiff structure tends to align in the airstream, and they are then delivered deep into the lungs, where they cannot be easily cleared. They penetrate into the lung tissue and then to the pleura, where they initiate tumors by various chemical and mechanical processes.
Long, thin amphibole fibers are more injurious than short, thick ones, because short fibers are more likely to be cleared.
It is likely that asbestos fibers act both as a tumor initiator and a tumor promoter, because they adsorb potentially toxic chemicals (including tobacco smoke), which they then 'transport' with them into the body.
The development of malignant mesothelioma is thought to relate to the physical structure of asbestos. Asbestos occurs as two forms, serpentine chrysotiles, or straight, sharp, needle-like amphiboles (crocidolite, amosite, anthophyllite, tremolite and actinolite). Chrysotiles are not thought to be directly cause malignant mesothelioma, because their curled, flexible structure means they are likely to become trapped in the upper airways, and removed by usual physiological actions. Also, if they do become trapped in the lungs, the more soluble chrysotiles are gradually leached from the lung tissue. However, chrysotiles are commonly associated with malignant mesothelioma, probably because they are usually contaminated with amphiboles.
Amphiboles behave differently to chrysotiles, and are therefore much more carcinogenic. Their straight, stiff structure tends to align in the airstream, and they are then delivered deep into the lungs, where they cannot be easily cleared. They penetrate into the lung tissue and then to the pleura, where they initiate tumors by various chemical and mechanical processes.
Long, thin amphibole fibers are more injurious than short, thick ones, because short fibers are more likely to be cleared.
It is likely that asbestos fibers act both as a tumor initiator and a tumor promoter, because they adsorb potentially toxic chemicals (including tobacco smoke), which they then 'transport' with them into the body.
Pathology (disease features)
Types of malignant mesothelioma
There are three types of malignant mesothelioma, differentiated by their cell types and appearance under the microscope (their 'histology'). These are:
epithelial type
sarcomatous type
mixed epithelial and sarcomatous type
Cell types are determined by taking a biopsy specimen from the tumor. The most common kind of malignant mesothelioma appears to be the epithelial type (half the cases in one series), then mixed (~one-third of cases) and sarcomatous. Within the tumor, there may be great variation in cell types, however. Some experts say that the more biopsy specimens taken, the greater the likelihood of calling the tumor 'mixed type'.
The epithelial type of malignant mesothelioma may be hard to distinguish from a type of lung cancer, and the sarcomatous form may resemble other sarcomatous-type cancers. However, special laboratory techniques can be used to confirm the diagnosis of malignant mesothelioma, which may be important for litigation purposes.
There is some evidence that the epithelial type of malignant mesothelioma is associated with a better outcome.
Types of malignant mesothelioma
There are three types of malignant mesothelioma, differentiated by their cell types and appearance under the microscope (their 'histology'). These are:
epithelial type
sarcomatous type
mixed epithelial and sarcomatous type
Cell types are determined by taking a biopsy specimen from the tumor. The most common kind of malignant mesothelioma appears to be the epithelial type (half the cases in one series), then mixed (~one-third of cases) and sarcomatous. Within the tumor, there may be great variation in cell types, however. Some experts say that the more biopsy specimens taken, the greater the likelihood of calling the tumor 'mixed type'.
The epithelial type of malignant mesothelioma may be hard to distinguish from a type of lung cancer, and the sarcomatous form may resemble other sarcomatous-type cancers. However, special laboratory techniques can be used to confirm the diagnosis of malignant mesothelioma, which may be important for litigation purposes.
There is some evidence that the epithelial type of malignant mesothelioma is associated with a better outcome.
Mesothelioma Awareness
About Asbestos Lung Cancer
Features of malignant mesothelioma
Pathology (disease features)
Malignant mesothelioma develops in the mesothelial cells that form the pleura, the peritoneum, and coverings of other organs. Most cases arise in the pleura, the thin membrane that covers the lungs and lines the chest wall; right-sided involvement is more common. In these cases, malignant mesotheliomas first look like multiple, tiny, round, gray, flat or slightly raised spots on the pleura. These spots fuse together over time, so that the pleural surface becomes progressively thicker and bumpy. The tumor spreads in all directions, forming a continuous thick, soft, 'rind' encasing the lung, and contracting it.
As the tumor advances, other nearby organs are invaded, including the lungs themselves, chest wall, the mediastinum and its structures, and ribs. There may be direct invasion through the diaphragm into the abdominal cavity, and so to the liver. In many cases, the tumor may also grow along wounds or tracts left by diagnostic or therapy procedures; this can be avoided by the use of radiation therapy at the time of the procedure.
Eventually, there may be distant spread to other parts of the body (metastases). These are found in 50% of autopsy cases, but usually don't cause any symptoms
About Asbestos Lung Cancer
Features of malignant mesothelioma
Pathology (disease features)
Malignant mesothelioma develops in the mesothelial cells that form the pleura, the peritoneum, and coverings of other organs. Most cases arise in the pleura, the thin membrane that covers the lungs and lines the chest wall; right-sided involvement is more common. In these cases, malignant mesotheliomas first look like multiple, tiny, round, gray, flat or slightly raised spots on the pleura. These spots fuse together over time, so that the pleural surface becomes progressively thicker and bumpy. The tumor spreads in all directions, forming a continuous thick, soft, 'rind' encasing the lung, and contracting it.
As the tumor advances, other nearby organs are invaded, including the lungs themselves, chest wall, the mediastinum and its structures, and ribs. There may be direct invasion through the diaphragm into the abdominal cavity, and so to the liver. In many cases, the tumor may also grow along wounds or tracts left by diagnostic or therapy procedures; this can be avoided by the use of radiation therapy at the time of the procedure.
Eventually, there may be distant spread to other parts of the body (metastases). These are found in 50% of autopsy cases, but usually don't cause any symptoms
Features of malignant mesothelioma
Malignant mesothelioma has been described as a 'horrible disease' with 'awful' symptoms and a 'dismal' outlook. These descriptions are fairly accurate. Once diagnosed or even suspected, patients often have a feeling of hopelessness -- with good cause: after diagnosis, patients survive on average from 4-18 months (6-8 months without treatment). In fact, within 12 months of diagnosis, 50% of patients are dead, and few survive beyond 2 years.
Treatment options are limited, often involve aggressive surgery, radiotherapy and/or chemotherapy, and generally prolong life rather than cure mesothelioma. However, perhaps because of the expected 'epidemic' in cases of mesothelioma expected in the next decade, there has been much research into new therapies (see Treatment options).
Some people with malignant mesothelioma do respond to therapy. Features that are associated with a better survival include:
younger age
good performance status
early disease stage
type of mesothelioma (epithelial, see pathology)
lack of chest pain
normal platelet count (the cells in the blood responsible for clotting)
Malignant mesothelioma is a slow growing cancer that develops gradually over time, decades after first exposure to asbestos. During this time, the patient is usually unaware that he has the disease. By the time symptoms develop, the cancer is often widespread throughout the pleura (or peritoneum) or has directly invaded adjacent organs, such as the lungs, heart and diaphragm.
Pathology (disease features)
Symptoms
Malignant mesothelioma has been described as a 'horrible disease' with 'awful' symptoms and a 'dismal' outlook. These descriptions are fairly accurate. Once diagnosed or even suspected, patients often have a feeling of hopelessness -- with good cause: after diagnosis, patients survive on average from 4-18 months (6-8 months without treatment). In fact, within 12 months of diagnosis, 50% of patients are dead, and few survive beyond 2 years.
Treatment options are limited, often involve aggressive surgery, radiotherapy and/or chemotherapy, and generally prolong life rather than cure mesothelioma. However, perhaps because of the expected 'epidemic' in cases of mesothelioma expected in the next decade, there has been much research into new therapies (see Treatment options).
Some people with malignant mesothelioma do respond to therapy. Features that are associated with a better survival include:
younger age
good performance status
early disease stage
type of mesothelioma (epithelial, see pathology)
lack of chest pain
normal platelet count (the cells in the blood responsible for clotting)
Malignant mesothelioma is a slow growing cancer that develops gradually over time, decades after first exposure to asbestos. During this time, the patient is usually unaware that he has the disease. By the time symptoms develop, the cancer is often widespread throughout the pleura (or peritoneum) or has directly invaded adjacent organs, such as the lungs, heart and diaphragm.
Pathology (disease features)
Symptoms
Epidemiology (disease frequency)
The conditions caused by exposure to asbestos are reaching epidemic proportions in the USA and other parts of the world, because of the long time span from initial exposure to disease state -- and there was peak use of this toxic substance in the 1970s. It is estimated that around 3,000 Americans die each year from malignant mesothelioma (and another ~7000 from other cancers and conditions associated with asbestos exposure).
Between 1979 and 2001, there were at least 43,000 deaths from mesothelioma -- and these deaths are probably much less than the actual number, because this type of cancer was often misdiagnosed and it was only tracked as a cause of death in 1999.
A recent study has concluded that after 20 years of increasing incidence of mesothelioma, the disease may have already peaked in the USA, but other sources predict that mesothelioma deaths are expected to peak in ~2016 in the USA. This peak is expected to occur later in countries such as the United Kingdom and Australia (which regulated asbestos use later than the USA). Already, the death rate is high -- asbestos-related diseases cause more deaths each year than skin cancer, and almost as many deaths as assault by gunfire. In the United Kingdom, twice as many people die from mesothelioma each year than die from cervical cancer.
Malignant mesothelioma affects men more than women (with around a 3-to-1 ratio), because men were more likely to be employed in industries that mined or milled asbestos, or used asbestos-containing materials. The median age at presentation of mesothelioma is 60 years or more, with most presenting between 50 and 70; this is due to the long latency of this cancer.
The conditions caused by exposure to asbestos are reaching epidemic proportions in the USA and other parts of the world, because of the long time span from initial exposure to disease state -- and there was peak use of this toxic substance in the 1970s. It is estimated that around 3,000 Americans die each year from malignant mesothelioma (and another ~7000 from other cancers and conditions associated with asbestos exposure).
Between 1979 and 2001, there were at least 43,000 deaths from mesothelioma -- and these deaths are probably much less than the actual number, because this type of cancer was often misdiagnosed and it was only tracked as a cause of death in 1999.
A recent study has concluded that after 20 years of increasing incidence of mesothelioma, the disease may have already peaked in the USA, but other sources predict that mesothelioma deaths are expected to peak in ~2016 in the USA. This peak is expected to occur later in countries such as the United Kingdom and Australia (which regulated asbestos use later than the USA). Already, the death rate is high -- asbestos-related diseases cause more deaths each year than skin cancer, and almost as many deaths as assault by gunfire. In the United Kingdom, twice as many people die from mesothelioma each year than die from cervical cancer.
Malignant mesothelioma affects men more than women (with around a 3-to-1 ratio), because men were more likely to be employed in industries that mined or milled asbestos, or used asbestos-containing materials. The median age at presentation of mesothelioma is 60 years or more, with most presenting between 50 and 70; this is due to the long latency of this cancer.
Consumer products
Asbestos has been used in a huge range of consumer products -- and continues to be used in many today. (Although asbestos is no longer mined in the USA, it is still imported.)
Products that exposed consumers to asbestos include the following (and others):
electric blankets
hair dryers (which have been reported to blow a find dust of asbestos into the air)
curling irons
heat guns
molding clays
deep fryers
slow cookers
frying pans/grills
toasters
fake fireplace logs
dry wall patch (for consumer use)
pipe wrap insulation
heat-proof wall and floor protection
high-temperature wallboard
Although many asbestos-containing products have been banned by the Consumer Products Safety Commission, many goods may still contain asbestos, especially roofing products, friction products, and gaskets. What's more, most such items are not labeled as containing asbestos.
One product that was never banned is vermiculite attic insulation. This was manufactured from vermiculite produced at a mine in Libby, Montana. Although vermiculite is a non-asbestos containing mineral silicate, the mine in Libby was contaminated with tremolite, one of the amphibole types of asbestos. Attic insulation and other products manufactured from the Libby vermiculite mine were produced through 1992 and distributed throughout the USA (often sold as 'Zonolite'). The Environmental Protection Agency estimates there are 30 million homes containing vermiculite attic insulation -- which could produce significant asbestos exposure if disturbed (for example, in home renovations). Vermiculite attic insulation sold today is not from the Libby mine.
Asbestos has been used in a huge range of consumer products -- and continues to be used in many today. (Although asbestos is no longer mined in the USA, it is still imported.)
Products that exposed consumers to asbestos include the following (and others):
electric blankets
hair dryers (which have been reported to blow a find dust of asbestos into the air)
curling irons
heat guns
molding clays
deep fryers
slow cookers
frying pans/grills
toasters
fake fireplace logs
dry wall patch (for consumer use)
pipe wrap insulation
heat-proof wall and floor protection
high-temperature wallboard
Although many asbestos-containing products have been banned by the Consumer Products Safety Commission, many goods may still contain asbestos, especially roofing products, friction products, and gaskets. What's more, most such items are not labeled as containing asbestos.
One product that was never banned is vermiculite attic insulation. This was manufactured from vermiculite produced at a mine in Libby, Montana. Although vermiculite is a non-asbestos containing mineral silicate, the mine in Libby was contaminated with tremolite, one of the amphibole types of asbestos. Attic insulation and other products manufactured from the Libby vermiculite mine were produced through 1992 and distributed throughout the USA (often sold as 'Zonolite'). The Environmental Protection Agency estimates there are 30 million homes containing vermiculite attic insulation -- which could produce significant asbestos exposure if disturbed (for example, in home renovations). Vermiculite attic insulation sold today is not from the Libby mine.
Passive asbestos exposure
The widespread use of asbestos in the construction of public, commercial and residential buildings (especially in the 1970s) has exposed millions of adults and children to asbestos passively. Indeed, in 1982, it was estimated that there were more than 720,000 public buildings with asbestos in them. Older buildings may slowly release decaying asbestos into the air, but its removal is dangerous and must be done professionally.
Such passive exposure confers a much lesser risk of developing asbestos-related conditions than direct exposure -- with the exception of custodians and others responsible for maintenance. (Custodians may in fact become directly exposed when performing maintenance duties.) Nevertheless, in one analysis of mesothelioma deaths, five of the ten most commonly recorded occupations on the death certificates were not in industries associated with asbestos exposure. (It should be noted, though, that the death certificates do not record past work history.)
Another study reported that malignant mesothelioma occurred in 16 teachers from different parts of the United States, only 4 of whom had a history of exposure outside of school employment. One 1970s estimate is that 2-6 million school children and 100,000 to 300,000 teachers had been exposed to asbestos in schools.
Other cases of passive exposure include office workers (where asbestos was sprayed on ceilings) and those employed in hospitals.
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Domestic exposure
Environmental
Passive exposure
Consumer products
Epidemiology (disease frequency)
Features of malignant mesothelioma
Diagnosis of malignant mesothelioma
Treatment options for malignant mesothelioma
Other conditions associated with asbestos exposure
What is asbestos?
If you've been exposed
Useful resources
Glossary
Bibliography
Contact Information
The widespread use of asbestos in the construction of public, commercial and residential buildings (especially in the 1970s) has exposed millions of adults and children to asbestos passively. Indeed, in 1982, it was estimated that there were more than 720,000 public buildings with asbestos in them. Older buildings may slowly release decaying asbestos into the air, but its removal is dangerous and must be done professionally.
Such passive exposure confers a much lesser risk of developing asbestos-related conditions than direct exposure -- with the exception of custodians and others responsible for maintenance. (Custodians may in fact become directly exposed when performing maintenance duties.) Nevertheless, in one analysis of mesothelioma deaths, five of the ten most commonly recorded occupations on the death certificates were not in industries associated with asbestos exposure. (It should be noted, though, that the death certificates do not record past work history.)
Another study reported that malignant mesothelioma occurred in 16 teachers from different parts of the United States, only 4 of whom had a history of exposure outside of school employment. One 1970s estimate is that 2-6 million school children and 100,000 to 300,000 teachers had been exposed to asbestos in schools.
Other cases of passive exposure include office workers (where asbestos was sprayed on ceilings) and those employed in hospitals.
Website Index:
Home page
What is mesothelioma?
Risk factors for malignant mesothelioma
Asbestos as a risk factor
Those directly at risk
Those indirectly at risk
Bystander exposure
Domestic exposure
Environmental
Passive exposure
Consumer products
Epidemiology (disease frequency)
Features of malignant mesothelioma
Diagnosis of malignant mesothelioma
Treatment options for malignant mesothelioma
Other conditions associated with asbestos exposure
What is asbestos?
If you've been exposed
Useful resources
Glossary
Bibliography
Contact Information
Environmental exposure
Environmental exposure refers to that occurring in the neighborhood of asbestos milling or manufacturing plants. Vermiculite (a non-asbestos mineral silicate) mined at Libby Montana was heavily contaminated with asbestos (tremolite). Mesothelioma and other asbestos-related conditions have developed in children who played in the vermiculite slag heaps throughout the town. Furthermore, 28 sites throughout the USA that received most of the Libby mine vermiculite have been identified for community-wide evaluation of asbestos disease.
Non-industrial environmental exposure may also occur, because of soil contamination with various fibers (parts of Eastern Europe) or the use of fibrous rock types (erionite) in buildings or stucco (Cappadocia in Turkey).
The use of asbestos-contaminated vermiculite fire-proofing products (see consumer products) in the construction of the World Trade Centers may have contributed to the dangerously high levels of asbestos
Environmental exposure refers to that occurring in the neighborhood of asbestos milling or manufacturing plants. Vermiculite (a non-asbestos mineral silicate) mined at Libby Montana was heavily contaminated with asbestos (tremolite). Mesothelioma and other asbestos-related conditions have developed in children who played in the vermiculite slag heaps throughout the town. Furthermore, 28 sites throughout the USA that received most of the Libby mine vermiculite have been identified for community-wide evaluation of asbestos disease.
Non-industrial environmental exposure may also occur, because of soil contamination with various fibers (parts of Eastern Europe) or the use of fibrous rock types (erionite) in buildings or stucco (Cappadocia in Turkey).
The use of asbestos-contaminated vermiculite fire-proofing products (see consumer products) in the construction of the World Trade Centers may have contributed to the dangerously high levels of asbestos
Domestic exposure
Men working with asbestos often brought it home with them as dust, because laundering facilities for coveralls were not usually provided by their employers.
Family members of asbestos workers are therefore also at risk of developing malignant mesothelioma, especially women laundering asbestos-dust laden clothes, or those cleaning dust shed into furnishings, carpets, drapes and upholstery.
Domestic exposure has been reported to occur in up to 15% of malignant mesothelioma cases according to one source, although in another study 26% of cases were in family members of asbestos work
Men working with asbestos often brought it home with them as dust, because laundering facilities for coveralls were not usually provided by their employers.
Family members of asbestos workers are therefore also at risk of developing malignant mesothelioma, especially women laundering asbestos-dust laden clothes, or those cleaning dust shed into furnishings, carpets, drapes and upholstery.
Domestic exposure has been reported to occur in up to 15% of malignant mesothelioma cases according to one source, although in another study 26% of cases were in family members of asbestos work
Bystander exposure
Bystander exposure is also knows as indirect occupational exposure. It occurs in those working near people using asbestos, for example, alongside insulators or laggers who were mixing asbestos on site, often in closed spaces.
Examples of those affected as bystanders include:
carpenters
plumbers
welders
boiler makers
scrap metal workers
electricians
Bystander exposure is also knows as indirect occupational exposure. It occurs in those working near people using asbestos, for example, alongside insulators or laggers who were mixing asbestos on site, often in closed spaces.
Examples of those affected as bystanders include:
carpenters
plumbers
welders
boiler makers
scrap metal workers
electricians
Those indirectly at risk
The majority of malignant mesotheliomas occur in those people directly exposed to asbestos, either in its mining and transportation, the production of the many asbestos-containing products, or its uses in the construction, ship building, engineering and other industries. In addition, however, malignant mesothelioma may develop indirectly, in those working alongside asbestos workers, in family members of asbestos workers, in locations near asbestos mines and mills, and passively.
Bystander exposure
Domestic exposure
Environmental exposure
Passive exposure
Consumer products
The majority of malignant mesotheliomas occur in those people directly exposed to asbestos, either in its mining and transportation, the production of the many asbestos-containing products, or its uses in the construction, ship building, engineering and other industries. In addition, however, malignant mesothelioma may develop indirectly, in those working alongside asbestos workers, in family members of asbestos workers, in locations near asbestos mines and mills, and passively.
Bystander exposure
Domestic exposure
Environmental exposure
Passive exposure
Consumer products
Mesothelioma Awareness
About Asbestos Lung Cancer
What is mesothelioma?
Risk factors for malignant mesothelioma
Those directly at risk
The majority of malignant mesotheliomas occur in those people directly exposed to asbestos, either in its mining and transportation, the production of the many asbestos-containing products, or its uses in the construction and ship building industries. The list of those directly exposed includes:
People involved in the mining and transportation of asbestos.
Workers at plants manufacturing asbestos products.
Users of asbestos products:
Brake mechanics. Brake shoes routinely contained asbestos, exposing brake mechanics to asbestos dust when repairing and replacing brake shoes. Four percent of products that still contain asbestos are 'friction products' (2003 data).
Boilermakers. Asbestos was routinely used in boilers, for its insulating properties.
Laggers/Insulators. Because of its heat resistance, asbestos was used to make insulating products for a variety of industrial uses, including coverings for furnaces, pipes and ovens.
Maintenance workers. Because of the widespread use of asbestos in buildings (wall board, insulation material, etc), maintenance workers are at risk of exposure.
Pipe fitters. The use of asbestos for gaskets and insulating pipes exposed pipe fitters to it.
Ship fitters and naval mechanics. The ship-building, -refitting and repair industries were a major source of asbestos exposure in World War II, insulating products being used for pipes, boilers and furnaces. In addition, naval mechanics were exposed.
Steel workers. As with boilers, asbestos was commonly used with other steel products such as steam pipes and ovens.
In addition to the direct exposure risks listed, malignant mesothelioma may develop indirectly in bystanders, in family members of workers or by passive exposure.
Website Index:
Home page
What is mesothelioma?
Risk factors for malignant mesothelioma
Asbestos as a risk factor
Those directly at risk
Those indirectly at risk
Bystander exposure
Domestic exposure
Environmental
Passive exposure
Consumer products
Epidemiology (disease frequency)
Features of malignant mesothelioma
Diagnosis of malignant mesothelioma
Treatment options for malignant mesothelioma
Other conditions associated with asbestos exposure
What is asbestos?
If you've been exposed
Useful resources
Glossary
Bibliography
Contact Information
contact us · webmaster · disclaimer
About Asbestos Lung Cancer
What is mesothelioma?
Risk factors for malignant mesothelioma
Those directly at risk
The majority of malignant mesotheliomas occur in those people directly exposed to asbestos, either in its mining and transportation, the production of the many asbestos-containing products, or its uses in the construction and ship building industries. The list of those directly exposed includes:
People involved in the mining and transportation of asbestos.
Workers at plants manufacturing asbestos products.
Users of asbestos products:
Brake mechanics. Brake shoes routinely contained asbestos, exposing brake mechanics to asbestos dust when repairing and replacing brake shoes. Four percent of products that still contain asbestos are 'friction products' (2003 data).
Boilermakers. Asbestos was routinely used in boilers, for its insulating properties.
Laggers/Insulators. Because of its heat resistance, asbestos was used to make insulating products for a variety of industrial uses, including coverings for furnaces, pipes and ovens.
Maintenance workers. Because of the widespread use of asbestos in buildings (wall board, insulation material, etc), maintenance workers are at risk of exposure.
Pipe fitters. The use of asbestos for gaskets and insulating pipes exposed pipe fitters to it.
Ship fitters and naval mechanics. The ship-building, -refitting and repair industries were a major source of asbestos exposure in World War II, insulating products being used for pipes, boilers and furnaces. In addition, naval mechanics were exposed.
Steel workers. As with boilers, asbestos was commonly used with other steel products such as steam pipes and ovens.
In addition to the direct exposure risks listed, malignant mesothelioma may develop indirectly in bystanders, in family members of workers or by passive exposure.
Website Index:
Home page
What is mesothelioma?
Risk factors for malignant mesothelioma
Asbestos as a risk factor
Those directly at risk
Those indirectly at risk
Bystander exposure
Domestic exposure
Environmental
Passive exposure
Consumer products
Epidemiology (disease frequency)
Features of malignant mesothelioma
Diagnosis of malignant mesothelioma
Treatment options for malignant mesothelioma
Other conditions associated with asbestos exposure
What is asbestos?
If you've been exposed
Useful resources
Glossary
Bibliography
Contact Information
contact us · webmaster · disclaimer
Asbestos as a risk factor for malignant mesothelioma
The likelihood of developing malignant mesothelioma relates to how long an individual has been exposed to asbestos (duration), how much they were exposed to (severity of exposure) and the type of asbestos. However, unlike other conditions associated with asbestos (which are associated with cumulative exposure), mesothelioma can follow very short-term exposures. In fact, in about 3% of cases, workers had less than 3 months exposure to asbestos. After exposure, there is a very long latent period between first exposure and development of malignant mesothelioma, usually of 30-45 years.
There are two main forms of asbestos: serpentine and amphibole. Chrysotile (or white asbestos) is the only form of serpentine asbestos; it is curly and flexible and accounts for 90% of commercial asbestos. There are various types of amphibole asbestos, which occur as microscopically thin, sharp rods that can penetrate deeply into the lungs. The risk of developing malignant mesothelioma is greatest with crocidolite (blue asbestos) and amosite (brown asbestos), and least with tremolite and chrysotile. There is some suggestion that chrysotile has only a low association with malignant mesothelioma, and that the disease occurs in chrysotile workers either when there are high levels or because of contamination with the more dangerous forms.
Amongst the non-exposed, malignant mesothelioma is very rare, affecting 2-17 people per million; however the risk increases more than 1000 times in those exposed to asbestos. The life-time risk in the heavily exposed is 7-10%. In all, 1 in 10 asbestos workers die from malignant mesothelioma (pleural or peritoneal) -- although 1 in 5 die from the more common bronchogenic lung cancer.
Men are more at risk for malignant mesothelioma, because they were more typically involved in industries mining or using asbestos. The male-to-female ratio is thus around 3 to 1. Race is not a factor in the development
The likelihood of developing malignant mesothelioma relates to how long an individual has been exposed to asbestos (duration), how much they were exposed to (severity of exposure) and the type of asbestos. However, unlike other conditions associated with asbestos (which are associated with cumulative exposure), mesothelioma can follow very short-term exposures. In fact, in about 3% of cases, workers had less than 3 months exposure to asbestos. After exposure, there is a very long latent period between first exposure and development of malignant mesothelioma, usually of 30-45 years.
There are two main forms of asbestos: serpentine and amphibole. Chrysotile (or white asbestos) is the only form of serpentine asbestos; it is curly and flexible and accounts for 90% of commercial asbestos. There are various types of amphibole asbestos, which occur as microscopically thin, sharp rods that can penetrate deeply into the lungs. The risk of developing malignant mesothelioma is greatest with crocidolite (blue asbestos) and amosite (brown asbestos), and least with tremolite and chrysotile. There is some suggestion that chrysotile has only a low association with malignant mesothelioma, and that the disease occurs in chrysotile workers either when there are high levels or because of contamination with the more dangerous forms.
Amongst the non-exposed, malignant mesothelioma is very rare, affecting 2-17 people per million; however the risk increases more than 1000 times in those exposed to asbestos. The life-time risk in the heavily exposed is 7-10%. In all, 1 in 10 asbestos workers die from malignant mesothelioma (pleural or peritoneal) -- although 1 in 5 die from the more common bronchogenic lung cancer.
Men are more at risk for malignant mesothelioma, because they were more typically involved in industries mining or using asbestos. The male-to-female ratio is thus around 3 to 1. Race is not a factor in the development
Mesothelioma Awareness
About Asbestos Lung Cancer
What is mesothelioma?
Risk factors for malignant mesothelioma
Risk factors are those activities that increase the chance of getting a particular condition or disease. Malignant mesothelioma is a very rare cancer, and the vast majority of cases are associated with exposure to asbestos (either its production or use in various industries). In fact, because asbestos is used so widely in the building and other industries, even in those cases where a history of asbestos exposure is not evident, it is likely that the victim was exposed without his/her knowledge. Other risk factors that are associated with malignant mesothelioma less often include:
Radiation. Cases of malignant mesothelioma have been reported after exposure to radiation, but the association is not very strong. The use of Thorotrast (thorium dioxide), a radioactive substance used for 'contrast' x-ray studies in millions of people between 1930 and 1955, has also been associated with malignant mesothelioma (particularly peritoneal mesothelioma).
Polio vaccine. Between 1955 and 1963, some batches of polio vaccine were contaminated with the Simian Virus 40, which has been detected in certain rare cancers, including malignant mesothelioma.
Erionite. This is a type of zeolite silica stone containing fibrous/wool-like strands that is widely used for house construction in the Cappadocian region of Turkey, where ~1% of the population dies from malignant mesothelioma each year.
Chronic pleural disease. In one study of 35 patients with malignant mesothelioma, 3 had evidence of long-term pleural tuberculosis, but not of asbestos exposure.
Note that smoking tobacco does not appear to increase the risk of developing malignant mesothelioma in those exposed to asbestos. However, smoking does greatly increase the risk of developing bronchogenic lung cancer (i.e. arising in the breathing tubes/airways).
Asbestos as a risk factor
Those directly at risk
Those indirectly at risk
About Asbestos Lung Cancer
What is mesothelioma?
Risk factors for malignant mesothelioma
Risk factors are those activities that increase the chance of getting a particular condition or disease. Malignant mesothelioma is a very rare cancer, and the vast majority of cases are associated with exposure to asbestos (either its production or use in various industries). In fact, because asbestos is used so widely in the building and other industries, even in those cases where a history of asbestos exposure is not evident, it is likely that the victim was exposed without his/her knowledge. Other risk factors that are associated with malignant mesothelioma less often include:
Radiation. Cases of malignant mesothelioma have been reported after exposure to radiation, but the association is not very strong. The use of Thorotrast (thorium dioxide), a radioactive substance used for 'contrast' x-ray studies in millions of people between 1930 and 1955, has also been associated with malignant mesothelioma (particularly peritoneal mesothelioma).
Polio vaccine. Between 1955 and 1963, some batches of polio vaccine were contaminated with the Simian Virus 40, which has been detected in certain rare cancers, including malignant mesothelioma.
Erionite. This is a type of zeolite silica stone containing fibrous/wool-like strands that is widely used for house construction in the Cappadocian region of Turkey, where ~1% of the population dies from malignant mesothelioma each year.
Chronic pleural disease. In one study of 35 patients with malignant mesothelioma, 3 had evidence of long-term pleural tuberculosis, but not of asbestos exposure.
Note that smoking tobacco does not appear to increase the risk of developing malignant mesothelioma in those exposed to asbestos. However, smoking does greatly increase the risk of developing bronchogenic lung cancer (i.e. arising in the breathing tubes/airways).
Asbestos as a risk factor
Those directly at risk
Those indirectly at risk
Mesothelioma Awareness
About Asbestos Lung Cancer
What is mesothelioma?
Mesothelioma is a rare type of tumor that arises in the mesothelium, a membrane that lines the cavities of the body (such as the chest and abdomen) and also covers and protects most of the body's internal organs. In the chest, the mesothelium is known as the pleura, where it covers the lungs ('visceral pleura') and lines the internal chest wall ('parietal pleura'). There is a 'potential space' between the visceral and parietal pleura, which normally contains about 10 mls of lubricating fluid that reduces friction between the chest wall and the lungs. In the abdomen, the mesothelium is called the peritoneum, while that surrounding the heart is called the peritoneum.
Mesothelioma can be either benign or malignant. Benign mesothelioma may occur wherever there is mesothelium, is localized, and does not invade nearby tissues. It may cause problems because of a mass effect with compression or blockage of adjacent structures but can usually be managed by surgical removal. Unlike malignant mesothelioma, benign mesothelioma has no association with asbestos exposure.
Malignant mesothelioma is a cancerous tumor that is closely correlated to asbestos exposure. Most malignant mesothelioma occurs in the pleura (65-70%) but may also arise in the peritoneum (25%), the ovaries and scrotum, or the pericardium. All forms of mesothelioma have a very poor prognosis (outlook), and are usually rapidly fatal. Asbestos manufacturers and their insurers have been aware of the dangers associated with asbestos since the 1930s. However these groups have not only failed to protect workers and the public, but have conspired to prevent the health risks of asbestos from becoming widely known.
Risk factors for malignant mesothelioma
Epidemiology (disease frequency)
About Asbestos Lung Cancer
What is mesothelioma?
Mesothelioma is a rare type of tumor that arises in the mesothelium, a membrane that lines the cavities of the body (such as the chest and abdomen) and also covers and protects most of the body's internal organs. In the chest, the mesothelium is known as the pleura, where it covers the lungs ('visceral pleura') and lines the internal chest wall ('parietal pleura'). There is a 'potential space' between the visceral and parietal pleura, which normally contains about 10 mls of lubricating fluid that reduces friction between the chest wall and the lungs. In the abdomen, the mesothelium is called the peritoneum, while that surrounding the heart is called the peritoneum.
Mesothelioma can be either benign or malignant. Benign mesothelioma may occur wherever there is mesothelium, is localized, and does not invade nearby tissues. It may cause problems because of a mass effect with compression or blockage of adjacent structures but can usually be managed by surgical removal. Unlike malignant mesothelioma, benign mesothelioma has no association with asbestos exposure.
Malignant mesothelioma is a cancerous tumor that is closely correlated to asbestos exposure. Most malignant mesothelioma occurs in the pleura (65-70%) but may also arise in the peritoneum (25%), the ovaries and scrotum, or the pericardium. All forms of mesothelioma have a very poor prognosis (outlook), and are usually rapidly fatal. Asbestos manufacturers and their insurers have been aware of the dangers associated with asbestos since the 1930s. However these groups have not only failed to protect workers and the public, but have conspired to prevent the health risks of asbestos from becoming widely known.
Risk factors for malignant mesothelioma
Epidemiology (disease frequency)
Mesothelioma Awareness
About Asbestos Lung Cancer
Mesothelioma
This website provides resources about mesothelioma, a type of lung cancer that is typically related to exposure to asbestos. Here you'll find information about:
mesothelioma and its various forms
its diagnosis and treatment
who is at risk of asbestos exposure
asbestos in general
other conditions associated with asbestos exposure
your legal rights
a glossary of medical terms
Malignant mesothelioma has been referred to as the 'signature cancer' of asbestos, a toxic substance that was widely used for industrial, construction and domestic purposes through most of the 20th century. (In fact, although it is no longer actively mined in the USA, asbestos continues to be widely used.) Although asbestos was identified as a health concern in the 1930s, companies involved with asbestos mining and manufacturers (and their insurers) sought to conceal this knowledge from workers and the public. In addition, they failed to protect their workers: workplace safeguards were not instituted until the 1980s, and even today, many workers are still at risk of exposure to asbestos. Those affected by mesothelioma and other asbestos-related diseases have a right to knowledge about these preventable conditions and what they can do to seek compensation; we hope this website helps provide such knowledge.
About Asbestos Lung Cancer
Mesothelioma
This website provides resources about mesothelioma, a type of lung cancer that is typically related to exposure to asbestos. Here you'll find information about:
mesothelioma and its various forms
its diagnosis and treatment
who is at risk of asbestos exposure
asbestos in general
other conditions associated with asbestos exposure
your legal rights
a glossary of medical terms
Malignant mesothelioma has been referred to as the 'signature cancer' of asbestos, a toxic substance that was widely used for industrial, construction and domestic purposes through most of the 20th century. (In fact, although it is no longer actively mined in the USA, asbestos continues to be widely used.) Although asbestos was identified as a health concern in the 1930s, companies involved with asbestos mining and manufacturers (and their insurers) sought to conceal this knowledge from workers and the public. In addition, they failed to protect their workers: workplace safeguards were not instituted until the 1980s, and even today, many workers are still at risk of exposure to asbestos. Those affected by mesothelioma and other asbestos-related diseases have a right to knowledge about these preventable conditions and what they can do to seek compensation; we hope this website helps provide such knowledge.
Mesothelioma Information: Definition
Mesothelioma is a rare form of cancer. In mesothelioma, malignant cells are found in the sac lining of the chest (the pleura) or the abdomen (the peritoneum). In this disease, malignant (cancerous) cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart. The majority of people with mesothelioma have a history of jobs that exposed them to asbestos, an insulation material or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products.
Mesothelioma Information: Description
In the chest and abdominal cavities, as well as in the cavity around the heart (pericardial sac), there is a layer of specialized cells called mesothelial cells. These cells also surround the outer surface of most internal organs. These cells form tissue called mesothelium. The mesothelium performs a protective function for the internal organs by producing a lubricating fluid that permits the organs to move around. For example, this fluid makes it easier for the lungs to move inside the chest while a person breathes. The mesothelium of the abdomen is known as the peritoneum, and the mesothelium of the chest is called the pleura. The pericardium refers to the mesothelium of the pericardial cavity. There are three primary types of malignant mesotheliomas: Epithelioid. About 50% to 70% of mesotheliomas are of this type and have the best outlook for survival. Sarcomatoid. Approximately 7% to 20% of cases are of this type. Mixed/biphasic. From 20% to 35% of mesothelioma cases fall into this category. Approximately three fourths of all mesotheliomas begin in the chest cavity and are known as pleuralmesotheliomas. Peritoneal mesotheliomas begin in the abdomen, and make up around 10% to 20% of all cases. Mesotheliomas arising in the cavity around the heart are quite rare.
Mesothelioma Information: Signs and symptoms
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 pleural space are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma Information: Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of occupational exposure to asbestos may increase clinical suspicion for mesothelioma. A doctor should be seen if a person experiences shortness of breath, chest pain, or pain or swelling in the abdomen. If these symptoms are present, the doctor may order an x ray of the abdomen or chest. The doctor will do a complete physical examination and take a thorough medical history. Then, one or more of the following methods may be used to ascertain whether mesothelioma is present: A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Diagnosing mesothelioma is often difficult, even with tissue biopsies. Microscopically, mesothelioma is often difficult to distinguish from several other forms of cancer. For this reason, certain laboratory tests are performed to help correctly diagnose mesothelioma. Some of these tests involve using antibodies to distinguish lung cancer from mesothelioma. Sometimes the tissue samples must be viewed under an electron microscope in order to get the correct diagnosis.
Mesothelioma Information: Treatment
A person with symptoms of mesothelioma will most likely seek help from a primary physician initially. During the diagnostic phase, various technicians will perform the imaging studies. A specially trained physician—a thoracic surgeon or, rarely, a pulmonologist— performs other diagnostic tests like pleural biopsy and thoracoscopy. A pathologist will view the tissue samples and make the tissue diagnosis. Following diagnosis, the patient will be offered some form of treatment, which may entail surgery, radiation therapy, chemotherapy, or a combination of these. The patient may receive care from a thoracic surgeon, an anesthesiologist, medical and radiation oncologists, and specially trained nurses who administer chemotherapy.
Treatment of MM using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies has proved disappointing with a 5 year survival rate of less than 10%. It is most useful for palliation.
Radiation
Although the tumor is highly resistant to radiotherapy and chemotherapy, these regimens are sometimes used to relieve symptoms arising from tumour metastases such as obstruction of a major blood vessel.
Chemotherapy
In February 2004, the Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guerin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48 C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained. This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
Alternative and complementary therapies
There are no proven effective alternative therapies for mesothelioma. Because the prognosis is often poor, many patients may be interested in trying other avenues of treatment. Patients should first consult with their physicians prior to trying any of these methods. There are many well-studied complementary treatments that may increase a patient's comfort and sense of well-being. These may include meditation to aid in relaxation, massage to decrease pain, and guided imagery to help prevent nausea.
Mesothelioma Information: Prevention
The best method of preventing mesothelioma is to avoid or limit exposure to asbestos. People who might experience asbestos exposure at work include miners, insulation manufacturers, construction workers, ship builders, and factory workers.
Mesothelioma is a rare form of cancer. In mesothelioma, malignant cells are found in the sac lining of the chest (the pleura) or the abdomen (the peritoneum). In this disease, malignant (cancerous) cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart. The majority of people with mesothelioma have a history of jobs that exposed them to asbestos, an insulation material or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products.
Mesothelioma Information: Description
In the chest and abdominal cavities, as well as in the cavity around the heart (pericardial sac), there is a layer of specialized cells called mesothelial cells. These cells also surround the outer surface of most internal organs. These cells form tissue called mesothelium. The mesothelium performs a protective function for the internal organs by producing a lubricating fluid that permits the organs to move around. For example, this fluid makes it easier for the lungs to move inside the chest while a person breathes. The mesothelium of the abdomen is known as the peritoneum, and the mesothelium of the chest is called the pleura. The pericardium refers to the mesothelium of the pericardial cavity. There are three primary types of malignant mesotheliomas: Epithelioid. About 50% to 70% of mesotheliomas are of this type and have the best outlook for survival. Sarcomatoid. Approximately 7% to 20% of cases are of this type. Mixed/biphasic. From 20% to 35% of mesothelioma cases fall into this category. Approximately three fourths of all mesotheliomas begin in the chest cavity and are known as pleuralmesotheliomas. Peritoneal mesotheliomas begin in the abdomen, and make up around 10% to 20% of all cases. Mesotheliomas arising in the cavity around the heart are quite rare.
Mesothelioma Information: Signs and symptoms
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 pleural space are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma Information: Diagnosis
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of occupational exposure to asbestos may increase clinical suspicion for mesothelioma. A doctor should be seen if a person experiences shortness of breath, chest pain, or pain or swelling in the abdomen. If these symptoms are present, the doctor may order an x ray of the abdomen or chest. The doctor will do a complete physical examination and take a thorough medical history. Then, one or more of the following methods may be used to ascertain whether mesothelioma is present: A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Diagnosing mesothelioma is often difficult, even with tissue biopsies. Microscopically, mesothelioma is often difficult to distinguish from several other forms of cancer. For this reason, certain laboratory tests are performed to help correctly diagnose mesothelioma. Some of these tests involve using antibodies to distinguish lung cancer from mesothelioma. Sometimes the tissue samples must be viewed under an electron microscope in order to get the correct diagnosis.
Mesothelioma Information: Treatment
A person with symptoms of mesothelioma will most likely seek help from a primary physician initially. During the diagnostic phase, various technicians will perform the imaging studies. A specially trained physician—a thoracic surgeon or, rarely, a pulmonologist— performs other diagnostic tests like pleural biopsy and thoracoscopy. A pathologist will view the tissue samples and make the tissue diagnosis. Following diagnosis, the patient will be offered some form of treatment, which may entail surgery, radiation therapy, chemotherapy, or a combination of these. The patient may receive care from a thoracic surgeon, an anesthesiologist, medical and radiation oncologists, and specially trained nurses who administer chemotherapy.
Treatment of MM using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies has proved disappointing with a 5 year survival rate of less than 10%. It is most useful for palliation.
Radiation
Although the tumor is highly resistant to radiotherapy and chemotherapy, these regimens are sometimes used to relieve symptoms arising from tumour metastases such as obstruction of a major blood vessel.
Chemotherapy
In February 2004, the Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guerin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48 C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained. This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
Alternative and complementary therapies
There are no proven effective alternative therapies for mesothelioma. Because the prognosis is often poor, many patients may be interested in trying other avenues of treatment. Patients should first consult with their physicians prior to trying any of these methods. There are many well-studied complementary treatments that may increase a patient's comfort and sense of well-being. These may include meditation to aid in relaxation, massage to decrease pain, and guided imagery to help prevent nausea.
Mesothelioma Information: Prevention
The best method of preventing mesothelioma is to avoid or limit exposure to asbestos. People who might experience asbestos exposure at work include miners, insulation manufacturers, construction workers, ship builders, and factory workers.
Mesothelioma
Review Your Mesothelioma Case
Our sponsor is familar with these complicated cases. Please fill out the form below or call for an honest and obligation free assessment of your situation.
888.573.6331
Describe Your Case Your close relative — perhaps even you yourself — has been diagnosed with mesothelioma, a form of cancer newly affecting 2,000 to 3,000 individuals in the United States each year. A thousand questions run through your mind:
What is mesothelioma?
How dangerous is it?
How long has my relative got to live?
How will this development impact my relative's family?
How did my relative contract mesothelioma?
What kinds of medical treatments are available? How successful have they proven?
Are there any nonmedical alternatives?
What have others done in this situation? What can I do?
What choices do I have?
Is there any hope?
Who can help?
Does anyone care?
Yes, we care! We are here to help you overcome the challenges of this new difficulty in your lives. Because we care, we have created this Web site to help you find the answers you need to understand mesothelioma and respond intelligently to the many concerns which will present themselves to you in the coming months. We hope this resource will serve to reassure you that others really do care, that there are answers.
There is hope! Yes, mesothelioma is a form of cancer. But — 1) there is no cancer from which someone has not been cured, 2) there are promising new treatments for mesothelioma, and 3) there is growing support of many kinds for cancer patients and their families and friends. Link to a letter of encouragement and advice from Dick Bloch, lung cancer survivor and founder of the R.A. Bloch Cancer Foundation, which seeks to help all cancer patients in the process of successfully conquering their disease. (Your browser will open another window for the letter.) And do not be overwhelmed by the statistics of prognosis! Return to this window and link to an article demystifying the claims of statistics by long-time mesothelioma survivor and well-known professor of natural history Stephen Jay Gould. There is hope!
We can help! The Mesothelioma Legal Information Center is an online resource for personal support and up-to-date information on mesothelioma, asbestos, medical treatment, and legal assistance. This center is offered as a free service for victims of mesothelioma and asbestos-related diseases, and members of their families. It is sponsored by law firm(s) long experienced in the prosecution of mesothelioma cases. We understand, however, that legal issues may not be your primary concern at this time. Please use this site as your resource for finding the answers to the pressing questions you have now. Later, if it is appropriate to seek legal counsel, you may wish to contact a sponsor. Also, additional detailed information about mesothelioma and asbestos is available on our sponsor's new website.
Review Your Mesothelioma Case
Our sponsor is familar with these complicated cases. Please fill out the form below or call for an honest and obligation free assessment of your situation.
888.573.6331
Describe Your Case Your close relative — perhaps even you yourself — has been diagnosed with mesothelioma, a form of cancer newly affecting 2,000 to 3,000 individuals in the United States each year. A thousand questions run through your mind:
What is mesothelioma?
How dangerous is it?
How long has my relative got to live?
How will this development impact my relative's family?
How did my relative contract mesothelioma?
What kinds of medical treatments are available? How successful have they proven?
Are there any nonmedical alternatives?
What have others done in this situation? What can I do?
What choices do I have?
Is there any hope?
Who can help?
Does anyone care?
Yes, we care! We are here to help you overcome the challenges of this new difficulty in your lives. Because we care, we have created this Web site to help you find the answers you need to understand mesothelioma and respond intelligently to the many concerns which will present themselves to you in the coming months. We hope this resource will serve to reassure you that others really do care, that there are answers.
There is hope! Yes, mesothelioma is a form of cancer. But — 1) there is no cancer from which someone has not been cured, 2) there are promising new treatments for mesothelioma, and 3) there is growing support of many kinds for cancer patients and their families and friends. Link to a letter of encouragement and advice from Dick Bloch, lung cancer survivor and founder of the R.A. Bloch Cancer Foundation, which seeks to help all cancer patients in the process of successfully conquering their disease. (Your browser will open another window for the letter.) And do not be overwhelmed by the statistics of prognosis! Return to this window and link to an article demystifying the claims of statistics by long-time mesothelioma survivor and well-known professor of natural history Stephen Jay Gould. There is hope!
We can help! The Mesothelioma Legal Information Center is an online resource for personal support and up-to-date information on mesothelioma, asbestos, medical treatment, and legal assistance. This center is offered as a free service for victims of mesothelioma and asbestos-related diseases, and members of their families. It is sponsored by law firm(s) long experienced in the prosecution of mesothelioma cases. We understand, however, that legal issues may not be your primary concern at this time. Please use this site as your resource for finding the answers to the pressing questions you have now. Later, if it is appropriate to seek legal counsel, you may wish to contact a sponsor. Also, additional detailed information about mesothelioma and asbestos is available on our sponsor's new website.
Mesothelioma is one of the deadliest diseases known to man; the average life span of an inflicted person from the time of diagnosis until death is less than 24 months. It’s a disease that strikes approximately 3,000 United States citizens each and every year; hard working people who have labored for a lifetime to provide for their families, doing the work that keeps this country running and a great place to live. They worked in factories, at shipyards, in mines, for the US military, as engineers, as pipefitters, as steel workers, as auto mechanics, and in so many other professions. They came home to their loved ones exhausted and covered in dirt and dust; tired, but content that they had a job and were providing for their family. Content that they were putting food on the table and a house over their loved one’s heads. Content that they were working to make a better life for their families in this generation and the next...
But what they didn’t know was that while they were working so hard, they were not only slowly killing themselves, but those that they were working so hard to help; their family, their loved ones.
Mesothelioma is a disease that is almost 100% preventable; the only known cause is via exposure to the deadly mineral Asbestos. It comes from inhaling the particles of dust as the asbestos degrades; eating away at the lining of your lungs and developing into a deadly cancer. Dust that was inhaled in clouds of white powder, dust that was carried home on the clothes of the men who built this country, dust that was cleaned from the clothes by the wives and children who supported their sole provider at home, dust that was packed around the heating systems in houses and offices and schools, dust that carried a deadly price; and dust made a fortune in blood money for the companies that produced it.
Unfortunately, the effects of asbestos on the human body were known to be deadly for years by the companies who employed the ‘greatest generation’ and made hundreds of millions, if not billions, of dollars off of their backs. But instead of taking simple steps to alleviate the problem and save the lives of thousands of their workers, they choose to do nothing and continue to make a “healthy” profit with a “deadly” product. Many even went so far as to hide the truth from their workers and their families. And because the normal latency period for Mesothelioma (The time from exposure until the patient falls ill) is 20 to 30 years, many got away with this for years. We are only now beginning to see the full effects of the disease, and feel the terrible outcry of the people against those who put profits before human lives to a degree that is simply unfathomable.
MesoLink.org is a site created to provide you with up to date information on the deadly disease Mesothelioma. We strive to provide the most complete overview of the disease and all aspects of it. This includes general information on the disease, breaking news on the search for a cure and perspective legislation designed to limit you as well as all other news on the subject, links to other sites and online resources that can provide important and in-depth Mesothelioma and cancer related information, and a legal guide to help you with the complex legal issues involved with Mesothelioma.
Asbestos Closes Iowa School
June 5th, 2008
Air test results shut down an Iowa elementary school this week amid concerns of asbestos. With only three weeks left in the school year, the superintendent is looking for a place for the 145 students.
Read More >>
Natural Asbestos Causes Health Concern
June 4th, 2008
A park in California has had almost half its 75,000 acres shut to the public after high levels of naturally occurring asbestos was found. The asbestos is in the soil at the park, and can become airbor
Read More >>
But what they didn’t know was that while they were working so hard, they were not only slowly killing themselves, but those that they were working so hard to help; their family, their loved ones.
Mesothelioma is a disease that is almost 100% preventable; the only known cause is via exposure to the deadly mineral Asbestos. It comes from inhaling the particles of dust as the asbestos degrades; eating away at the lining of your lungs and developing into a deadly cancer. Dust that was inhaled in clouds of white powder, dust that was carried home on the clothes of the men who built this country, dust that was cleaned from the clothes by the wives and children who supported their sole provider at home, dust that was packed around the heating systems in houses and offices and schools, dust that carried a deadly price; and dust made a fortune in blood money for the companies that produced it.
Unfortunately, the effects of asbestos on the human body were known to be deadly for years by the companies who employed the ‘greatest generation’ and made hundreds of millions, if not billions, of dollars off of their backs. But instead of taking simple steps to alleviate the problem and save the lives of thousands of their workers, they choose to do nothing and continue to make a “healthy” profit with a “deadly” product. Many even went so far as to hide the truth from their workers and their families. And because the normal latency period for Mesothelioma (The time from exposure until the patient falls ill) is 20 to 30 years, many got away with this for years. We are only now beginning to see the full effects of the disease, and feel the terrible outcry of the people against those who put profits before human lives to a degree that is simply unfathomable.
MesoLink.org is a site created to provide you with up to date information on the deadly disease Mesothelioma. We strive to provide the most complete overview of the disease and all aspects of it. This includes general information on the disease, breaking news on the search for a cure and perspective legislation designed to limit you as well as all other news on the subject, links to other sites and online resources that can provide important and in-depth Mesothelioma and cancer related information, and a legal guide to help you with the complex legal issues involved with Mesothelioma.
Asbestos Closes Iowa School
June 5th, 2008
Air test results shut down an Iowa elementary school this week amid concerns of asbestos. With only three weeks left in the school year, the superintendent is looking for a place for the 145 students.
Read More >>
Natural Asbestos Causes Health Concern
June 4th, 2008
A park in California has had almost half its 75,000 acres shut to the public after high levels of naturally occurring asbestos was found. The asbestos is in the soil at the park, and can become airbor
Read More >>
Mesothelioma Alerts Conventional Treatments Experimental Treatments Mesothelioma Clinical Trials Mesothelioma Treatment by Stage Ask Your Doctor Cancer Centers Leading Mesothelioma Physicians Mesothelioma Articles & Abstracts Mesothelioma Resources
Dr. David Sugarbaker
Boston, MA; Pioneered the "tri-modal" approach to treating malignant pleural mesothelioma...
Dr. Valerie Rusch
New York, NY; Internationally recognized thoracic surgeon has led numerous research efforts to understand how patients respond to mesothelioma treatment...
Enter your information to receive a comprehensive mesothelioma packet free of charge at your doorstep within 24 hours.
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Mesothelioma Treatment | Clinical Trials
Centerwatch -
Find out about current clinical trials near you for mesothelioma treatment.
National Cancer Institute -
Search for clinical trials listed at NCI
Studies of promising new or experimental treatments in patients are known as clinical trials. During a course of treatment for lung cancer, the doctor may suggest that a patient take part in a clinical trial of a new treatment. A clinical trial is only done when there is some reason to believe that the treatment being studied may be of value to the patient. Treatments used in clinical trials are often found to have real benefits.
There are three phases of clinical trials in which a treatment is studied before the treatment is eligible for approval by the FDA (Food and Drug Administration).
The purpose of a Phase I study is to find the best way to give a new treatment and how much of it can be given safely. Physicians watch patients carefully for any harmful side effects. The research treatment has been well tested in laboratory and animal studies, but the side effects in patients are not completely predictable.
Phase II trials determine the effectiveness of a research treatment after safety has been evaluated in a Phase I trial. Patients are closely observed for an anticancer effect by careful measurement of cancer sites present at the beginning of the trial. In addition to monitoring patients for response, any side effects are carefully recorded and assessed.
Phase III trials require entry of large numbers of patients; some trials enroll thousands of patients. One of the groups may receive standard (the most accepted) treatment, so the new treatments can be directly compared. The group that receives the standard treatment is called the "control group. " For example, one group of patients (the control group) may receive the standard chemotherapy for a certain type of cancer, while another patient group may receive another type of chemotherapy that may or may not contain an investigational drug to see if this improves survival. All patients in Phase III trials are monitored closely for side effects, and treatment is discontinued if the side effects are too severe.
Researchers conduct studies of new treatments to answer the following questions:
Is the treatment likely to be helpful?
Does this new type of treatment work?
Does it work better than other treatments already available?
What side effects does the treatment cause?
Do the benefits outweigh the risks, including side effects?
In which patients is the treatment most likely to be helpful?
However, there are some risks. No one involved in the study knows in advance whether the treatment will work or exactly what side effects will occur. That is what the study is designed to discover. While most side effects will disappear in time, some can be permanent or even life-threatening. Keep in mind, though, that even standard treatments have side effects. Depending on many factors, you may decide that a clinical trial may be beneficial in your case.
Enrollment in any clinical trial is completely up to you. Your doctors and nurses will explain the study to you in detail and will give you a form to read and sign indicating your desire to take part. This process is known as giving your informed consent. Even after signing the form and after the clinical trial begins, you are free to leave the study at any time, for any reason. Taking part in the study does not prevent you from getting other medical care you may need.
To find out more about clinical trials, ask your cancer care team. Among the questions you should ask are:
What is the purpose of the study?
What kinds of tests and treatments does the study involve?
What does this treatment do?
What is likely to happen to me with, or without, this new research treatment?
What are my other choices and their advantages and disadvantages?
How could the study affect my daily life?
What side effects can I expect from the study? Can the side effects be controlled?
Will I have to be hospitalized? If so, how often and for how long?
Will the study cost me anything? Will any of the treatment be free?
If I am harmed as a result of the research, what treatment would I be entitled to?
What type of long-term follow-up care is part of the study?
Has the treatment been used to treat other types of cancers
Dr. David Sugarbaker
Boston, MA; Pioneered the "tri-modal" approach to treating malignant pleural mesothelioma...
Dr. Valerie Rusch
New York, NY; Internationally recognized thoracic surgeon has led numerous research efforts to understand how patients respond to mesothelioma treatment...
Enter your information to receive a comprehensive mesothelioma packet free of charge at your doorstep within 24 hours.
First Name:
Last Name:
Address:
City:
ST:
ALAKARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Have you or someone you know been diagnosed with mesothelioma?
Yes No
Mesothelioma Treatment | Clinical Trials
Centerwatch -
Find out about current clinical trials near you for mesothelioma treatment.
National Cancer Institute -
Search for clinical trials listed at NCI
Studies of promising new or experimental treatments in patients are known as clinical trials. During a course of treatment for lung cancer, the doctor may suggest that a patient take part in a clinical trial of a new treatment. A clinical trial is only done when there is some reason to believe that the treatment being studied may be of value to the patient. Treatments used in clinical trials are often found to have real benefits.
There are three phases of clinical trials in which a treatment is studied before the treatment is eligible for approval by the FDA (Food and Drug Administration).
The purpose of a Phase I study is to find the best way to give a new treatment and how much of it can be given safely. Physicians watch patients carefully for any harmful side effects. The research treatment has been well tested in laboratory and animal studies, but the side effects in patients are not completely predictable.
Phase II trials determine the effectiveness of a research treatment after safety has been evaluated in a Phase I trial. Patients are closely observed for an anticancer effect by careful measurement of cancer sites present at the beginning of the trial. In addition to monitoring patients for response, any side effects are carefully recorded and assessed.
Phase III trials require entry of large numbers of patients; some trials enroll thousands of patients. One of the groups may receive standard (the most accepted) treatment, so the new treatments can be directly compared. The group that receives the standard treatment is called the "control group. " For example, one group of patients (the control group) may receive the standard chemotherapy for a certain type of cancer, while another patient group may receive another type of chemotherapy that may or may not contain an investigational drug to see if this improves survival. All patients in Phase III trials are monitored closely for side effects, and treatment is discontinued if the side effects are too severe.
Researchers conduct studies of new treatments to answer the following questions:
Is the treatment likely to be helpful?
Does this new type of treatment work?
Does it work better than other treatments already available?
What side effects does the treatment cause?
Do the benefits outweigh the risks, including side effects?
In which patients is the treatment most likely to be helpful?
However, there are some risks. No one involved in the study knows in advance whether the treatment will work or exactly what side effects will occur. That is what the study is designed to discover. While most side effects will disappear in time, some can be permanent or even life-threatening. Keep in mind, though, that even standard treatments have side effects. Depending on many factors, you may decide that a clinical trial may be beneficial in your case.
Enrollment in any clinical trial is completely up to you. Your doctors and nurses will explain the study to you in detail and will give you a form to read and sign indicating your desire to take part. This process is known as giving your informed consent. Even after signing the form and after the clinical trial begins, you are free to leave the study at any time, for any reason. Taking part in the study does not prevent you from getting other medical care you may need.
To find out more about clinical trials, ask your cancer care team. Among the questions you should ask are:
What is the purpose of the study?
What kinds of tests and treatments does the study involve?
What does this treatment do?
What is likely to happen to me with, or without, this new research treatment?
What are my other choices and their advantages and disadvantages?
How could the study affect my daily life?
What side effects can I expect from the study? Can the side effects be controlled?
Will I have to be hospitalized? If so, how often and for how long?
Will the study cost me anything? Will any of the treatment be free?
If I am harmed as a result of the research, what treatment would I be entitled to?
What type of long-term follow-up care is part of the study?
Has the treatment been used to treat other types of cancers
Mesothelioma
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Mesothelioma
Classification and external resources
Large mesothelioma around the right lung (left side of image) on CT scan. See diagnosis for legend.
ICD-10 C45.
ICD-9 163
ICD-O: 9050-9055
OMIM 156240
DiseasesDB 8074
MedlinePlus 000115
eMedicine med/1457
MeSH D008654
Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart) or tunica vaginalis.
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos. Unlike lung cancer, there is no association between mesothelioma and smoking.[1] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Mesothelioma
Classification and external resources
Large mesothelioma around the right lung (left side of image) on CT scan. See diagnosis for legend.
ICD-10 C45.
ICD-9 163
ICD-O: 9050-9055
OMIM 156240
DiseasesDB 8074
MedlinePlus 000115
eMedicine med/1457
MeSH D008654
Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart) or tunica vaginalis.
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos. Unlike lung cancer, there is no association between mesothelioma and smoking.[1] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing
[edit] Epidemiology
[edit] Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year.[5] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[6] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States [4]. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
[edit] Risk factors
Working with asbestos is the major risk factor for mesothelioma. Mesothelioma is now known to occur in those who are genetically pre-disposed to it. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[7]
[edit] Exposure
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related mesothelioma.
[edit] Occupational
Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
[edit] Paraoccupational secondary exposure
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 fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
[edit] Asbestos in buildings
Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
[edit] Environmental exposures
Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in Cappadocia, Turkey, an unprecedented mesothelioma epidemic caused 50% of all deaths in three small villages. Initially, this was attributed to erionite, however, recently, it has been shown that erionite causes mesothelioma mostly in families with a genetic predisposition[8].
[edit] Treatment
Treatment of malignant mesothelioma using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation[citation needed]. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
[edit] Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
[edit] Radiation
Wikibooks has a book on the topic of
Radiation Oncology/Lung/MesotheliomaFor patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[9] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
[edit] Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.
[edit] Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
[edit] Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[9] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
[edit] Notable people who died from mesothelioma
Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.
Bernie Banton was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister-elect Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian Federal Election.
Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits.[10] (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.[citation needed]
United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.[11] His mesothelioma has been attributed to his younger years spent working on building sites in London.[12][13]
Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation died of mesothelioma in 1994.
Scottish Labour MP John William MacDougall died of mesothelioma on August 13th, 2008, after fighting the disease of two years.[14].
[edit] Notable people who have lived for some time with mesothelioma
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the Message"[15] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another twenty years eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma.
Author Paul Kraus was diagnosed with mesothelioma in June 1997 following an umbilical hernia operation. His prognosis was "a few months." He continues to survive using a variety of integrative and complementary modalities and has written a book about his experience.
[edit] Legal issues
Main article: asbestos and the law
The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars. [16] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, Congress has failed to enact significant asbestos reforms. [17]
[edit] Legal History
The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos.[18] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[19] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.
Despite proof that the dust associated with asbestos mining and milling causes asbestos related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.
By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.
[edit] References
The first version of this article was adapted from a public domain U.S. National Cancer Institute fact sheet at http://www.cancer.gov/cancertopics/factsheet/Sites-Types/mesothelioma
[edit] Footnotes
^ Muscat JE, Wynder EL (May 1991). "Cigarette smoking, asbestos exposure, and malignant mesothelioma". Cancer Res. 51 (9): 2263–7. PMID 2015590.
^ "Soluble mesothelin-related protein--a blood test for mesothelioma" by B. W. Robinson, J. Creaney, R. Lake, A. Nowak, A. W. Musk, N. de Klerk, P. Winzell, K. E. Hellstrom and I. Hellstrom in Lung Cancer (2005) volume 49, pages S109-S111 Entrez PubMed 15950789.
^ Beyer, HL; Geschwindt RD, Glover CL et al. (April 2007). "MESOMARK: a potential test for malignant pleural mesothelioma". Clinical Chemistry 53 (4): 666–672. doi:10.1373/clinchem.2006.079327. PMID 17289801.
^ "Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases" by V. L. Roggli, A. Sharma, K. J. Butnor, T. Sporn and R. T. Vollmer in Ultrastruct Pathol (2002) volume 26 pages 55-65 Entrez PubMed 12036093.
^ Bianchi, C; Bianchi T (June 2007). "Malignant mesothelioma: global incidence and relationship with asbestos". Industrial Health 45 (3): 379–387. doi:10.2486/indhealth.45.379. PMID 17634686.
^ "Advances in Malignant Mesothelioma" by Bruce W. S. Robinson and Richard A. Lake in The New England Journal of Medicine (2005) volume 353 pages 1591-1603 Entrez PubMed 16221782.
^ "SV40 in human tumors: new documents shed light on the apparent controversy" by D. S. MacLachlan in Anticancer Res (2002) volume 22, pages 3495-3499 Entrez PubMed 12552945.
^ Carbone M, Emri S, Dogan AU, et al (2007). "A mesothelioma epidemic in Cappadocia: scientific developments and unexpected social outcomes". Nat. Rev. Cancer 7 (2): 147–54. doi:10.1038/nrc2068. PMID 17251920.
^ a b "Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients." by D. Sugarbaker in J Thorac Cardiovasc Surg (1999) volume 117, pages 54-63 Entrez PubMed 9869758.
^ "McQueen's Legacy of Laetrile". New York Times (2005-11-15).
^ RTE radio 1, Playback, 8 December
^ u.tv
^ Irish singer Hennessy dies at 62 - BBC News - 11 December 2007
^ MP MacDougall dies after illness - BBC NEWS
^ Gould, Stephen Jay. "The Median Isn't the Message".
^ ORTIZ V. FIBREBOARD CORP. (97-1704) 527 U.S. 815 (1999) had individual liability from a single corporation and its insurance carriers of nearly $2 billion dollars.
^ ORTIZ V. FIBREBOARD CORP. (97-1704) 527 U.S. 815 (1999)
^ "Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province" by J. C. Wagner, C. A. Sleggs and P. Marchand in Br J Ind Med. (1960) volume 17, pages 260-271 Entrez PubMed 13782506.
^ "Malignant pleural mesothelioma in an asbestos worker" by J. C. McNulty in Med J Aust (1962) volume 49, pages 953-954 Entrez PubMed 13932248.
[edit] See also
Mesothelioma Applied Research Foundation
Mesothelioma Research Foundation of America
Asbestosis
[edit] Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year.[5] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[6] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States [4]. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
[edit] Risk factors
Working with asbestos is the major risk factor for mesothelioma. Mesothelioma is now known to occur in those who are genetically pre-disposed to it. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[7]
[edit] Exposure
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related mesothelioma.
[edit] Occupational
Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
[edit] Paraoccupational secondary exposure
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 fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
[edit] Asbestos in buildings
Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
[edit] Environmental exposures
Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in Cappadocia, Turkey, an unprecedented mesothelioma epidemic caused 50% of all deaths in three small villages. Initially, this was attributed to erionite, however, recently, it has been shown that erionite causes mesothelioma mostly in families with a genetic predisposition[8].
[edit] Treatment
Treatment of malignant mesothelioma using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation[citation needed]. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
[edit] Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
[edit] Radiation
Wikibooks has a book on the topic of
Radiation Oncology/Lung/MesotheliomaFor patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[9] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
[edit] Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.
[edit] Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
[edit] Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[9] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
[edit] Notable people who died from mesothelioma
Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.
Bernie Banton was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister-elect Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian Federal Election.
Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits.[10] (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.[citation needed]
United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.[11] His mesothelioma has been attributed to his younger years spent working on building sites in London.[12][13]
Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation died of mesothelioma in 1994.
Scottish Labour MP John William MacDougall died of mesothelioma on August 13th, 2008, after fighting the disease of two years.[14].
[edit] Notable people who have lived for some time with mesothelioma
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the Message"[15] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another twenty years eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma.
Author Paul Kraus was diagnosed with mesothelioma in June 1997 following an umbilical hernia operation. His prognosis was "a few months." He continues to survive using a variety of integrative and complementary modalities and has written a book about his experience.
[edit] Legal issues
Main article: asbestos and the law
The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars. [16] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, Congress has failed to enact significant asbestos reforms. [17]
[edit] Legal History
The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos.[18] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[19] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.
Despite proof that the dust associated with asbestos mining and milling causes asbestos related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.
By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.
[edit] References
The first version of this article was adapted from a public domain U.S. National Cancer Institute fact sheet at http://www.cancer.gov/cancertopics/factsheet/Sites-Types/mesothelioma
[edit] Footnotes
^ Muscat JE, Wynder EL (May 1991). "Cigarette smoking, asbestos exposure, and malignant mesothelioma". Cancer Res. 51 (9): 2263–7. PMID 2015590.
^ "Soluble mesothelin-related protein--a blood test for mesothelioma" by B. W. Robinson, J. Creaney, R. Lake, A. Nowak, A. W. Musk, N. de Klerk, P. Winzell, K. E. Hellstrom and I. Hellstrom in Lung Cancer (2005) volume 49, pages S109-S111 Entrez PubMed 15950789.
^ Beyer, HL; Geschwindt RD, Glover CL et al. (April 2007). "MESOMARK: a potential test for malignant pleural mesothelioma". Clinical Chemistry 53 (4): 666–672. doi:10.1373/clinchem.2006.079327. PMID 17289801.
^ "Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases" by V. L. Roggli, A. Sharma, K. J. Butnor, T. Sporn and R. T. Vollmer in Ultrastruct Pathol (2002) volume 26 pages 55-65 Entrez PubMed 12036093.
^ Bianchi, C; Bianchi T (June 2007). "Malignant mesothelioma: global incidence and relationship with asbestos". Industrial Health 45 (3): 379–387. doi:10.2486/indhealth.45.379. PMID 17634686.
^ "Advances in Malignant Mesothelioma" by Bruce W. S. Robinson and Richard A. Lake in The New England Journal of Medicine (2005) volume 353 pages 1591-1603 Entrez PubMed 16221782.
^ "SV40 in human tumors: new documents shed light on the apparent controversy" by D. S. MacLachlan in Anticancer Res (2002) volume 22, pages 3495-3499 Entrez PubMed 12552945.
^ Carbone M, Emri S, Dogan AU, et al (2007). "A mesothelioma epidemic in Cappadocia: scientific developments and unexpected social outcomes". Nat. Rev. Cancer 7 (2): 147–54. doi:10.1038/nrc2068. PMID 17251920.
^ a b "Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients." by D. Sugarbaker in J Thorac Cardiovasc Surg (1999) volume 117, pages 54-63 Entrez PubMed 9869758.
^ "McQueen's Legacy of Laetrile". New York Times (2005-11-15).
^ RTE radio 1, Playback, 8 December
^ u.tv
^ Irish singer Hennessy dies at 62 - BBC News - 11 December 2007
^ MP MacDougall dies after illness - BBC NEWS
^ Gould, Stephen Jay. "The Median Isn't the Message".
^ ORTIZ V. FIBREBOARD CORP. (97-1704) 527 U.S. 815 (1999) had individual liability from a single corporation and its insurance carriers of nearly $2 billion dollars.
^ ORTIZ V. FIBREBOARD CORP. (97-1704) 527 U.S. 815 (1999)
^ "Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province" by J. C. Wagner, C. A. Sleggs and P. Marchand in Br J Ind Med. (1960) volume 17, pages 260-271 Entrez PubMed 13782506.
^ "Malignant pleural mesothelioma in an asbestos worker" by J. C. McNulty in Med J Aust (1962) volume 49, pages 953-954 Entrez PubMed 13932248.
[edit] See also
Mesothelioma Applied Research Foundation
Mesothelioma Research Foundation of America
Asbestosis
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