What is Mesothelioma?

Mesothelioma is a cancer that affects the lining around the lungs, heart, and abdominal cavities - called the mesothelium - which is primarily caused by chronic exposure to asbestos or asbestos related products. As asbestos fibers enter the body, either by breathing or swallowing, they cause normally healthy cells to mutate into cancer. This exposure can come directly, such as working in an asbestos processing center, or indirectly by inhalation of residual asbestos particles remaining on clothing or building materials. Studies show that exposure as short as one year can cause a variety of asbestos-related illnesses, including mesothelioma.
Three Types of Mesothelioma:

There are three main types of mesothelioma: Pleural, Peritoneal, and Pericardial. Each affects a different area of the body, and can cause different symptoms.

Pleural mesothelioma:
Affects the lining around the lungs. Microscopic and jagged asbestos fibers shred these delicate cells, and over time causes scarring and mutations that will eventually lead to cellular plaques. These plaques prevent proper lung function and can lead to cancer.

Peritoneal mesothelioma:
This equally dangerous cancer affects the lining in the gut that surrounds the stomach and the intestines. Asbestos particles can travel through the body and pierce these cells and cause tumors to develop.

Pericardial mesothelioma:
This rarest form of cancer affects the sack that surrounds the heart. The pericardial sack provides the lubrication for the heart to beat properly, and when cancerous tumors and plaques develop it can cause a number of serious health problems.
Symptoms of Mesothelioma Types:

* Symptoms of pleural mesothelioma:
o Chest pain
o Fluid in the lungs
o Shortness of breath
o Sustained cough
o Hoarseness
o Wheezing

* Symptoms of peritoneal mesothelioma
o Abdominal pain
o Fluid in the gastrointestinal tract or abdomen
o Lumps in the abdomen
o Bowel movement difficulties
o Weight loss
o Nausea

* Symptoms of pericardial mesothelioma:
o Persistent cough
o Chest pain
o Heart palpitations
o Shortness of breath

Mesothelioma and Cell Mutations.

Mesothelioma causes the cells of the mesothelium to mutate and multiply infinitely. This mutation causes tumors that can prevent proper lung and heart function. Because the cells of the mesothelium are responsible for providing fluid lubrication for the body’s internal organs, mesothelioma is particularly insidious because it can affect multiple organs simultaneously, usually without major symptoms or pain. Mesothelioma can also invade parts of the immune system, including bone marrow, lymph nodes, and spleen, where it continues to mutate and destroy healthy cells.
Development Time of Mesothelioma:

The cancerous cells also lie dormant for many years, and it is not uncommon for the first effects of mesothelioma to appear 20 to 30 years after initial exposure. Unfortunately, there is no cure for mesothelioma, and treatment ranges from preventive surgery to chemotherapy and radiation treatments. By the time symptoms manifest, it is quite often too late. Because mesothelioma lays dormant for so long, post diagnosis survival ranges from 1-5 years depending on the stage of the cancer and the age and condition of the victim.
Other Studies of Mesothelioma and Numbers of Asbestos Related Deaths:

Studies show that there are 10,000 asbestos-related deaths in the United States every year. These 10,000 people are not just a statistic; they are grandfathers and grandmothers, mothers and fathers, friends and neighbors. Very often asbestos companies knew the risks involved with their products, but chose to ignore the danger for the sake of profits. If you or a loved one has contracted Mesothelioma because of negligent use of asbestos, then you have a duty and obligation to seek restitution for your loss. Knowledgeable attorneys in your state are ready to take your case. Contact one today.

Other people that get mesothelioma.

here are other people that get mesothelioma besides other workers and their family members. Because asbestos was used in thousands of different industries in thousands of different locations, people with no exposure to asbestos in the workplace are now suffering from this disease. Asbestos insulation in churches, schools, recreation centers, and shopping centers can be responsible for a mesothelioma, asbestosis, or lung cancers.
Victims of Mesothelioma.

If you are an unfortunate victim of asbestos-related mesothelioma, regardless of how you developed it, you may be entitled to take legal action against those responsible for your condition. Asbestos litigation is one of the most potent legal tools for victims of mesothelioma to reclaim the life stolen from them by the greed and deception of asbestos companies. Contact a dedicated and experienced mesothelioma attorney today.

Who gets Mesothelioma?

Who Gets Mesothelioma?

Who gets mesothelioma can depend greatly in a number of conditions. Asbestos exposure is not limited to manufacturing work sites. Schools, churches, office buildings, and recreational centers contained significant amounts of asbestos until only a few decades ago. While those who worked in asbestos quarries and manufacturing centers are the most at risk, significant amounts of unrelated people were indirectly endangered. Furthermore, asbestos contamination affected many occupations not directly involved in the asbestos production or construction industries.
Mesothelioma in Military War Veterans – Navy personnel

Military war veterans – Navy personnel in particular - are at risk of developing mesothelioma because they were exposed to significant levels of asbestos in shipbuilding, insulation, and fire retardant materials on ship and at base. Military necessity outweighed health concerns, and thousands of innocent people and their families are now paying the price for this oversight. Even though veterans of the military cannot sue the government because of asbestos-related diseases, there are other ways to take action against those responsible. Furthermore, civilian military workers are also covered by the provisions of many special mesothelioma legal actions.
Mesothelioma in Mechanics and other Workers

Workers are the people at most risk of developing mesothelioma, because they worked directly or indirectly with the deadly materials. There are dozens of at risk jobs, but some are more dangerous than others. These include:

• Automotive mechanics
• Boiler makers
• Bricklayers
• Building Inspectors
• Carpenters
• Electricians
• Insulators
• Iron workers
• Laborers
• Longshoremen
• Maintenance workers
• Merchant marines
• Millwrights
• Painters
• Plasterers
• Plumbers
• Roofers
• Sheet metal workers
• Tile setters
• Welders

MESOTHELIOMA

, an asbestos-related cancer of the lining of the lung (pleura) or the lining of the abdominal cavity (peritoneum), finding a credible source of information about the disease itself and the medical options available, is of the highest priority. After years of research and synthesis of information, we have assembled a web site and packet for patients and their loved ones. We hope you find this web site helpful.

A mesothelioma diagnosis can be overwhelming, and we are here to answer any questions you might have, and to help you take the steps necessary to find the options that are best suited to your individual needs.

Our staff is experienced and knowledgeable in dealing with mesothelioma patients and their family members, and the service we provide is always with appreciation for the difficult time you are facing. Although you have found us on the Internet, rest assured there are real people here to help. Please feel free to contact us at any time at 1-877-FOR-MESO (367-6376). (Please read disclaimer at bottom of page before proceeding.)
HOPE

"Hope is the companion of power, and the mother of success; for who so hopes strongly, has within him the gift of miracles." -- Samuel Smiles

This segment begins with more information about malignant mesothelioma, including the causes of the disease and characteristic symptoms. Our comprehensive section on mesothelioma treatment options discusses surgery, chemotherapy, and radiation therapy as well as new types under investigation. We discuss ways to find specialists who treat mesothelioma and some advice on choosing your doctor . The Clinical Trials segment details current clinical studies and links to information specific to those trials.
SUPPORT

"Too often we understimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around." --Dr. Leo Buscaglia

Start planning with Comprehensive Cancer Centers, how to find places to stay near treatment facilities and how to get there in the Travel & Lodging section. Relevant medical journal and mesothelioma news articles are updated regularly. Our SUPPORT segment ends with Survivors & Fighters who have uplifting stories to tell.
HELP

"Knowledge is power."-Francis Bacon

This segment provides Leading Cancer Links. In Your Peace of Mind you’ll find resources to help you and your family feel secure in the weeks, months and years ahead. Here you can find links to information on financial assistance, compensation, and legal options.

NEW: A clinical trial for a lung-sparing combined modality protocol is recruiting mesothelioma patients.

You will probably want to come back to this site in the future, so remember to bookmark this page. For instructions on how to bookmark, click here.

MESOTHELIOMA'S CAUSE - ASBESTOS EXPOSURE

At some point in our lives, nearly all of us have been exposed to asbestos in the air we breathe and the water we drink; from natural deposits in the earth, and from the deterioration of asbestos products around us. Most of us, however, do not become ill as a result of our exposure. More commonly, those who at some point are diagnosed with asbestos disease, have worked in jobs where more substantial exposure occurred over longer periods of time. Nevertheless, cases of mesothelioma have been documented as the result of lesser exposure, affecting family members of workers who came into contact with asbestos and brought it home on their clothing, skin or hair, or affecting those who lived in close proximity to asbestos manufacturing facilities. Symptoms of asbestos disease usually are not be apparent until decades after exposure.

Asbestos was used commercially in North America as early as the late 1800s, but its use increased dramatically during the World War II era when shipyards produced massive numbers of ships for the war effort. Since that time, asbestos-containing products were used by the construction and building trades, the automotive industry and the manufacturing industry. All told, more than 5,000 products contained asbestos.

For more than 50 years, products containing asbestos remained unregulated, and the manufacturers of those products continued to prosper, knowing full well that many of the millions of workers who came into contact with their products would ultimately suffer as the result of their actions. Finally, in the late 1970s, the Consumer Products Safety Commission banned the use of asbestos in wallboard patching compounds and artificial ash for gas fireplaces because the fiber could easily be released during use. In 1989, the Environmental Protection Agency banned all new use of asbestos, but uses established prior to that time were still allowed. Although awareness of the dangers of asbestos and public concern over the issue have led to a decline in domestic consumption over the years, a total ban on asbestos has not come to fruition. Asbestos is still imported, still used and still dangerous.

Although it is suggested that the number of mesothelioma cases in the U.S. has reached its peak and has begun to drop, a forecast released by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER), in April, 2003, projected the total number of American male mesothelioma cases from 2003-2054 to be approximately 71,000. This number, however, does not take into consideration events such as the World Trade Center disaster on September 11, 2001, when millions of New Yorkers were potentially exposed to air filled with carcinogenic asbestos particles. When the latency period for asbestos disease is factored in, cases of mesothelioma will continue to be diagnosed for years to come. See our page on mesothelioma risk factors.

MESOTHELIOMA SYMPTOMS

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

PLEASE KEEP IN MIND THAT THESE SYMPTOMS MAY BE CAUSED BY MESOTHELIOMA OR BY OTHER LESS SERIOUS CONDITIONS. ONLY A DOCTOR CAN MAKE A DEFINITIVE DIAGNOSIS.

Information on the symptoms, diagnosis, staging, and treatment of peritoneal mesothelioma.

Information on the symptoms, diagnosis, staging, and treatment of pleural mesothelioma.
Pleural Effusion

One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these membranes are covered with mesothelial cells which, under normal conditions, produce a small amount of fluid that acts as a lubricant between the chest wall and the lung. Any excess fluid is absorbed by blood and lymph vessels maintaining a balance. When too much fluid forms, the result is an effusion.
Types

Pleural effusion is broken down into two categories, transudates and exudates. A transudate is a clear fluid that forms not because the pleural surfaces are diseased, but because of an imbalance between the normal production and removal of the fluid. The most common cause of transudative fluid is congestive heart failure. An exudate, which is often cloudy and contains many cells and proteins, results from disease of the pleura itself, and is common to mesothelioma. To determine whether a fluid is a transudate or exudate, a diagnostic thoracentesis, in which a needle or catheter is used to obtain a fluid sample, may be conducted.
Symptoms

As the volume of fluid increases, shortness of breath, known as "dyspnea", and sometimes pain, ranging from mild to stabbing, may occur. Some patients may experience a dry cough. When the doctor listens to the patient’s chest with a stethoscope, normal breath sounds are muted, and tapping on the chest will reveal dull rather than hollow sounds.
Diagnosis

Diagnosis of pleural effusion is usually accomplished with a simple chest x-ray, although CT scans or ultrasound may also be used. A special x-ray technique, called a lateral decubitus film, may be used to detect smaller effusions or to enable the physician to estimate of the amount of fluid present. If the underlying cause of the effusion is readily apparent (such as in the case of severe congestive heart failure), sampling of the fluid may not be necessary, however, because pleural effusion may be symptomatic of a number of disease processes from benign to malignant, a fluid sample is generally taken. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists, however, in up to 85% of cases, the fluid tests negative or inconclusive even though cancer is present. It is ultimately a needle biopsy of the pleura (lining of the lung) or an open surgical biopsy which confirms a mesothelioma diagnosis.
Treatment

Pleural effusion caused by heart failure or infection can usually be resolved by directing treatment at the cause, however, when testing has realized no diagnosis, and fluid continues to build or recur, doctors may recommend chest tube drainage and chemical pleurodesis. Chemical pleurodesis is a technique in which a sclerosing agent is used to abrade the pleural surfaces producing an adhesion between the parietal and visceral pleurae. This will prevent further effusion by eliminating the pleural space. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is administered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution which forms a wet slurry that can roll around the pleural cavity.

Fatigue in Mesothelioma Patients

Mesothelioma Pain

Mesothelioma Stages

MESOTHELIOMA DIAGNOSIS QUESTIONS
Doctor-Patient Communication

An open line of communication between a patient and his or her physician is vital when dealing with a serious disease such as mesothelioma. There will be many questions regarding treatment, whether palliative or aggressive, choices to deal with, and life issues to confront. Being informed and proactive in your care will give you a sense of empowerment.

Although most physicians have limited time to spend with each patient at appointments, it is important to address issues as they occur and resolve them to the satisfaction of all parties involved. Initially, this may mean going to your appointment with a list of symptoms or concerns, or questions regarding specific tests that are recommended. Once mesothelioma has been diagnosed, you may have questions regarding treatment options.

Most questions from patients stem from an initial diagnosis of mesothelioma and subsequent treatment options. Following are some frequently asked questions regarding these two important issues.
What Is My Diagnosis?

There are three types of mesothelioma. Pleural mesothelioma is a cancer of the lining of the lung (pleura), peritoneal mesothelioma is a cancer of the lining of the abdominal cavity (peritoneum), and pericardial mesothelioma is a cancer of the lining surrounding the heart (pericardium). Sub-types (or cell types) of mesothelioma are epithelioid (the most common, and considered the most amenable to treatment), sarcomatous (a much more aggressive form), and biphasic or mixed (a combination of both of the other cell types).

The structural appearance of cells under the microscope determine the cell or sub-type of mesothelioma. Epithelioid is the least aggressive; sarcomatoid, the most aggressive. The biphasic or mixed cell type shows structural elements of both of the other two. More on the histologic subtypes of mesothelioma.



epithelioid mesothelioma tissue




sarcomatoid mesothelioma tissue

Epithelioid mesothelioma tissue


Sarcomatoid mesothelioma tissue



biphasic mesothelioma tissue

Biphasic mesothelioma tissue


MESOTHELIOMA STAGES

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

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

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

Some elements common to most staging systems are:

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

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

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

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

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

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

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

Butchart System – extent of primary tumor mass

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

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

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

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

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


How Was This Diagnosis Determined, and How Accurate Were the Tests?

Although you probably took many different tests leading up to your diagnosis, a tissue biopsy is normally the final determining factor. Following are some tests your doctor may recommend, and what may or may not be concluded from these tests.

* X-rays, CT scans, and MRIs - See the imaging section for more on these techniques. On conventional x-ray film, mesothelioma appears as a markedly thickened, nodular, irregular pleural-based mass which covers the pleural surface. The tumor often encompasses the involved lung, but is only rarely seen bilaterally. Chest wall, diaphragmatic, and mediastinal invasion may be seen in advanced cases. Moderate to large pleural effusion is often noted on the affected side. On CT scan, pleural thickening greater than 1 cm can be identified in over 90% of cases; thickening which extends into the interlobular fissure is seen in 85% of cases. Absence of pleural thickening does not preclude mesothelioma, and at times, the only CT finding is that of pleural effusion.
* Cytology - Testing of the pleural fluid for malignant cells is considered to have limited value in diagnosing mesothelioma. Negative or inconclusive readings account for nearly 85% of all fluid tested. Even with a positive fluid report, many doctors prefer to perform a confirming tissue biopsy as long as it does not compromise the patient's health.
* Needle Biopsy - In this test, done under local anesthetic, a large hollow needle is inserted through the skin and into the chest cavity. The needle is then rotated, and as it is taken out, tissue samples are collected. Because of the small sample size of the tissue, this type of biopsy is considered to be only 25-60% accurate in diagnosing mesothelioma. Because tumor seeding may occur along the needle tract in approximately 20% of patients, local radiation therapy may be used in conjunction with this test.
* Open biopsy - This type of biopsy is considered to be the most accurate for mesothelioma diagnosis, and is the procedure of choice because it affords the pathologist a larger tissue sample.. It is done in a hospital under general anesthetic. As with a needle biopsy, local radiation may be used because of the possibility of tumor seeding.

Can I Be Treated by the Doctor Who Diagnosed My Mesothelioma?

If the doctor who diagnosed your mesothelioma is your primary physician, he will most likely refer you to a local oncologist for treatment. The oncologist may offer what he or she feels are the best treatment options, or, if their knowledge of this disease is limited, may suggest you seek out a doctor who specializes in mesothelioma. Most often these physicians are located at larger, teaching hospitals such as those listed in the Comprehensive Cancer Center Section. These facilities are ranked as state-of-the-art cancer centers, and are highly respected for their patient care and innovative cancer treatments. If your choice of treatment involves a radical surgical procedure or a clinical trial involving new, as yet unproven drugs, these facilities may be best for you. If your treatment involves an already-approved, standard form of chemotherapy, this can be carried out locally.
What Treatment Options Will I Be Offered?

Treatment options may vary according to the age and over-all health of the patient, and the extent of the disease. It is important to be informed of all available options for your particular case, so that you can make decision on the option you feel most comfortable with. Surgery, chemotherapy, and clinical trials, as well as new approaches such as photodynamic therapy, immunotherapy, and gene therapy may be offered. Speak openly with your doctor regarding suggested procedures. Questions may include:

* Why is this procedure best for me?
* What does the procedure entail?
* What are the advantages/disadvantages of this treatment (i.e, will this procedure limit my eligibility for other treatments)?
* What are the possible risks or adverse side effects?
* What are the response, survival, and mortality rates associated with this procedure?

Is Palliative Treatment an Option?

In some circumstances, age, contributing health problems, or advanced disease may make aggressive treatment impossible. In these cases, palliative care (that which treats the symptoms, but not the disease itself) may be appropriate. If you opt for palliative care, it is doubly important to communicate fully with your doctor. Many symptoms of mesothelioma can be alleviated or substantially lessened if you are completely open with your doctor. Each time you have an appointment, tell your doctor how you feel, what discomfort you are experiencing, and your level of pain. A good doctor should be willing to address your questions and concerns.

Check our mesothelioma glossary.

MESOTHELIOMA TREATMENT OPTIONS

MESOTHELIOMA TREATMENT OPTIONS

The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope and the patient’s age and desires.
TIME MATTERS

People diagnosed with this disease are often told the expected survival rate is only eight to twelve months. However, specialists in treating malignant mesothelioma at the leading cancer centers often have better statistics.

For instance, the five-year survival rate has approached 40% for selected patients of Dr. David Sugarbaker at Brigham and Women’s Center in Boston. To qualify for Dr. Sugarbaker’s treatment you must meet certain criteria. One of them is being in the early stages of the disease, so time is of the essence. To find out more about Dr. Sugarbaker and other physicians and cancer centers specializing in mesothelioma click on Finding Specialists.

Keeping track of your medical treatment is useful and a personal medical records file can help.


TRADITIONAL CARE



There are three traditional kinds of treatment for patients with malignant mesothelioma:

* Surgery (taking out the cancer)
* Chemotherapy (using drugs to fight the cancer)
* Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

Often two or more of these are combined in the course of treatment. (NEW! Click here for the newest trial of trimodal lung-sparing treatment for pleural mesothelioma: The Columbia Protocol.)


MESOMARK BLOOD TEST

In January 2007, the Food and Drug Administration (FDA) approved the MESOMARK assay to help monitor response to treatment in epithelial and bi-phasic malignant mesothelioma patients. A specific protein, or biomarker, called Soluble Mesothelin-Related Peptide (SMRP), may be released into the blood by mesothelioma cancer cells. By measuring the amount of SMRP in a blood sample, doctors may be able to better monitor a patient's progress. Based on the limited amount of data currently available, use of this test may be beneficial, but effectiveness has not been determined at this time. The MESOMARK blood test has NOT yet been approved for the early diagnosis of mesothelioma.

This test has been approved as a Humanitarian Use Device (HUD), meaning that physicians must follow certain procedures to qualify their patients for testing. Once the physician is certified, informational brochures will be sent to be distributed to each applicable patient.

Those wishing to take part in

MESOMARK testing will be asked to provide one or more samples of blood. The blood samples will then be sent to a national reference laboratory for testing. In conjunction with other clinical and laboratory data obtained by your doctor, decisions regarding your treatment and care may be simplified. You may discontinue testing at any time.

The costs associated with the MESOMARK blood test may not be covered under health insurance, therefore, you may be required to pay all or part of the costs out of pocket. It is recommended that you check with your insurance carrier to determine whether coverage is available under your policy.


SURGERY


Diagnostic Procedures

As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Palliative Procedures

Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.

Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.

Potentially Curative Procedures

These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.

For Pleural Mesothelioma:

* Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
* Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.



General Patient Selection Criteria for Extrapleural Pneumonectomy

Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient's chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.
o Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others.
o Adequate renal (kidney) and liver function tests; no significant kidney or liver disease.
o Normal cardiac function per electrocardiogram and echocardiography.
o Adequate pulmonary function to tolerate the surgery.
o Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall.
o Age of the patient is taken into consideration, but may not be as important as their overall status.

Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.



For Peritoneal Mesothelioma:

* Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma.

TOP

CHEMOTHERAPY

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:

* To control the cancer by stopping its spread or slowing its growth.
* To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
* To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
* To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.

The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a drug approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.

* Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.
* The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.

Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.

Side Effects of Chemotherapy

Cancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy. More on peripheral neuropathy. More on anti-nausea treatment for chemotherapy patients.

Click here if you are interested in learning more about chemotherapy for mesothelioma and the types of questions you should ask your doctor.


Chemotherapy Schedules

How often you will receive chemotherapy will be determined by your doctor, taking into consideration factors such as the stage of your cancer, the types of drugs you receive, the anticipated toxicities of the drugs and the time necessary for your body to recover from these toxicities. The doctor may also consider whether the goal of the chemotherapy is to control the growth of the cancer, or to ease symptoms associated with the disease.

In general, chemotherapy treatment is administered in "cycles" — a "cycle" being defined as a period of treatment followed by a period of rest. This cycle allows the cancer cells to be attacked by the drugs, and then allows the body's normal cells time to recover. The combination of drugs used, the length of time to administer the drugs, how often they should be repeated and the number of cycles recommended have been analyzed throughly in clinical trials. For mesothelioma patients, the "standard" treatment is a combination of Alimta and cisplatin, administered IV, with a 10 minute infusion of Alimta followed by two hours of cisplatin, given in 21 day cycles. Modifications to this schedule may be made according to what your doctor feels is appropriate in your particular case.

The number of treatment cycles, or the length of time between the beginning and end of chemotherapy may vary, however in general, 3 to 4 cycles of treatment are given before response is evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness. After response to the treatment has been determined, the following criteria will be used to decide whether chemotherapy should continue:

* If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
* If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.

The goal of setting a chemotherapy schedule is to make treatment as effective, timely and trouble-free as possible, but while the drugs are working to kill cancer cells, they may also affect healthy cells causing side effects. One of the most common side effects, and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which means your immune system is weakened, therefore leaving you more prone to infection. While this side effect is anticipated when someone is undergoing chemotherapy, it can cause delays in your treatment schedule, or changes in the dosage of the drugs you will receive. Click here for more on understanding your blood counts.

TOP

Note to Patients:

Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.

1. It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
These may include:
* Fever of, or greater than 101 degrees
* Nausea or vomiting
* Diarrhea or constipation
* Fatigue
* Tingling or numbness in the fingers or toes
* Ringing in the ears
* Bruises or rashes
* Sores in the mouth or throat
2. Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.
3. Take extra care with your daily health.
Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.

Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.


4. Be open about your feelings regarding your treatment.
It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.





RADIATION THERAPY

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

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

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

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

Mesothelioma Detection

Early Detection

It is strongly encouraged that anyone who has had past asbestos exposure be checked periodically for asbestos disease. Early detection is vital, since even lung cancers have a higher survival rate if caught early. Non-cancerous disease may be diagnosed through a normal front and side view x-ray (also called a PA and lateral), with the x-ray films read preferably by a radiologist called a Certified B-reader. This should be an adequate diagnostic test to determine if any scarring is present which would be consistent with asbestos exposure. Click here for a current listing of these radiologists. If anything suspicious appears on the x-ray films, the patient would be referred to a specialist for further evaluation. Cancerous disease, although it may be suspected through tests such as an x-ray or CT scan, can only be confirmed through a tissue biopsy. Be sure you understand the significance of your diagnosis.
Non-Cancerous

* Pleural disease - often noted as a scarring of the lining of the lung, and sometimes expressed as "pleural thickening", "pleural plaque" or "pleural calcification".
* Asbestosis - defined as a scarring of the lower lobes of the lungs bilaterally (on both sides); often referred to as "asbestos in the lung".

If you have been diagnosed with a non-cancerous disease, it is important that your doctor monitor your condition with regular x-rays and/or high resolution CT scans, and pulmonary function tests. It is also important to compare new and old radiographic films and review any other pertinent test results to check for progression of disease.

Note: Although these diseases are non-cancerous at the onset, they can be progressive, eventually leading to a need for inhalers or oxygen. They also constitute a significantly greater risk of future cancer in those who have a prior smoking history, or those who continue to smoke.
Cancerous

* Lung cancer - diagnosed as non-small cell (which includes adenocarcinoma, squamous cell or large cell) and small cell (which includes oat cell, lymphocytic, intermediate or combined); lung cancer may be contributed to by asbestos exposure, although it is not normally the sole cause.
* Mesothelioma - a rare form of cancer of the lining of the lung (pleural mesothelioma) or the lining of the abdominal cavity (peritoneal mesothelioma), or in rare cases, the lining of the heart (pericardial mesothelioma); exclusive to asbestos exposure.

If you have been diagnosed with lung cancer, it is important to make a treatment decision, and then follow your doctor's recommendations. Additional information on various types of lung cancer may be obtained through the National Cancer Institute at 1-800-4-CANCER.

Lung Cancer Deaths associated with Smoking and Asbestos Exposure
(Data from Hammond et al., 1979)