Mesotheliomas blogs.Mesothelioma information blogs

Asbestos:The number one risk factor for mesothelioma

2008-07-04T08:27:00.000-07:00

Risk Factors.The number one risk factor for mesothelioma is working with asbestos. A history of asbestos exposure is present in nearly all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos (rare).

Asbestos. Asbestos is the name of a group of metamorphic minerals that occur naturally as masses of strong, flexible fibers made up of hydrous magnesium silicate. The natural resistance to fire is the major reason why asbestos has been exploited for a variety to uses. Asbestos has been widely used in many industrial products, including cement mats and fabrics, brake shoes and gaskets, roof tars and shingles, flooring plasters and stuccos, adhesive textiles, and fireproofing insulation.

During the manufacturing process, tiny asbestos particles may be inhaled or swallowed, causing serious health problems. Exposure to asbestos increases the risk of lung cancer, asbestosis (noncancerous), mesothelioma and other cancers in the airway passage. Smoking does not appear to increase the risk of mesothelioma itself. However, the combination of smoking and asbestos exposure significantly increases the risk of developing cancer of the lungs.

Types of Asbestos. Asbestos is typically categorized into 2 subgroups. The serpentine group is derived from serpentine rocks that yield curled, corkscrewed fibers that are more soluble. The amphibole group is straight and needle-like.

Serpentine Group. Chrysotile is the white asbestos that is most often used in the United States. Because chrysotile is less friable that other asbestos types, it is less likely to be inhaled. There is some controversy to whether chrysotile fibers, when inhaled, can cause mesothelioma. It is now thought that this form of white asbestos is indeed harmful but not to the level that amphiboles are hazardous.
Amphibole Group. The amphibole group of asbestos fibers include amosite (brown asbestos), crocidolite (blue asbestos), tremolite, actinolite and anthophylite. These asbestos types are easily friable. For this reason, a single, large amphibole rock can easily break into millions of smaller needle-like fragments that are primed for inhalation. The crocidolite form from Africa and Australia is considered to be the most dangerous type of asbestos. Due to the deadly nature of these fibers, asbestos from the amphibole group was banned in the U.S. in the mid-1980s. However, due to the ready supply and cheaper cost, some unscrupulous companies continued to use amphiboles for construction pipes, casings for communications, and thermal insulations. This has lead to expansion of mesothelioma litigation in the United States

Some History. Since the late 1800s, asbestos has been mined and used commercially. With more industrialization, its use greatly increased (especially during World War II). Since the early 1940s, millions of American workers have been exposed to asbestos fibers when the risks associated with asbestos exposure were not known. Over time, an increased risk of developing mesothelioma was found among shipyard workers, people who worked in asbestos mines, producers of asbestos products, and workers in the heating and construction industries. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace.

Epidemiology. Studies have associated exposure to asbestos with the development of lesions in the airway. Though not completely clear in all cases, it is thought that asbestos contributes as insoluable foreign bodies that the body forms a reaction to. The result is often a series of physical signs such as asbestos bodies in the sputum, pleural plaques, diffuse pleural fibrosis, asbestosis, carcinoma of the lung, gastrointestinal tumours and diffuse mesothelioma of the pleura and peritoneum.

The duration, the intensity and the reoccurance of exposure is thought to play a role in increasing the risk of developing mesothelioma. This is sometimes misleading, however, as there have been cases in which incidental, short-term exposure has resulted in mesothelioma. Likewise, not all people that have been exposed to asbestos have developed disease. This just goes to show that the development of mesothelioma may not necessarily have a risk threshold.

Evidence has shown that some family members (as well as other co-inhabitants) of asbestos workers have an increased risk of developing mesothelioma. It is thought that this increased risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

How Asbestos Causes Disease

2008-07-04T08:21:00.000-07:00

How Asbestos Causes Disease

When inhaled, asbestos fibers in the amphibole group travel down the respiratory passage and embed themselves into the parenchyma of the lung. Because these fibers are not very soluble in the body, they often dig themselves in and can puncture into the deeper tissue.

This penetration of tissue usually starts off locally in the lower lungs and develops into noticeable plaques in the lung pleura. After the deposition of a plaque in the mesothelium, unresolved asbestos fibers can spread further than this primary site. Though the mechanism remains unclear, it is thought that these fibers travel through the lymphatic system (much like many other cancers) to disperse themselves in other areas and associated organs.

Once these asbestos fibers reach their target destinations, the actual conversion of healthy tissue into malignant tissue remains unclear. Several lab experiments and clinical trials that have introduced amphibole fibers to the pleura have yield mixed results. Further research is being done to see if there are other factors necessary for the essential transformation and progression step.

Histologically, the deposition of asbestos seems to mimic a foreign body reaction. Initially, polymorphonuclear neutrophils (PMNs) act as the “first responders” at the scene. These important immune system cells can further trigger response by recruiting other immune system cells to the region. Through a process using chemotaxis, large amounts of macrophages are recruited to the specific areas. These macrophages build up quickly in a matter of days. Over time, the unresolved asbestos lesions can continue to attract and accumulate larger groups of macrophages. Experimental evidence suggests that asbestos acts as a cancer causing agent with the development of mesothelioma occurring sequentially in stages of initiation and promotion. Specific molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers is still not known. In general, asbestos fibers are thought to exert their carcinogenic effects via direct physical interactions with the cells of the mesothelium in a foreign body affect that elicits indirect interaction, recruitment and accumulation of inflammatory cells such as macrophages.

Of curious note, asbestos fibers that have been phagocytosed have shown an interesting interaction with the nucleus. Within the nucleus, there exists the vital information for the well-being of the cell. Specifically, the DNA within the cell seems to be affected by asbestos fibers. Normally, during replication, DNA is tightly wrapped around proteins called histones. On a larger scale, these wrapped DNA strands make up what we call chromosomes. It seems that asbestos fibers can interact with chromosomes and can cause losses, rearrangements and in some cases, unwanted duplications. At that level, small abnormalities can have devastating effects that are often irreparable. Some common gene abnormalities in mesothelioma cell lines include deletion of various tumor suppressor genes.

In a process called transformation used in molecular biology, asbestos has been shown to mediate the entry of foreign DNA into target cells. Successful incorporation of this foreign DNA in key regions and areas can lead to mutations and other changes that specifically promote cancer in a process referred to as oncogenesis. Some possible mechanisms include:

Inactivation of tumor suppressor genes (eliminating genes that help suppress tumors)
Activation of oncogenes (genes that can potentially cause cancer)
Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region (transformation)
Activation of telomerase (an enzyme crucial for the length, stability and lifespan of DNA)
Prevention of apoptosis (programmed cell death)

Compare laboratory tests and imaging modalities utilized in the diagnosis of Mesothelioma.

2008-07-02T09:51:00.001-07:00

Compare laboratory tests and imaging modalities utilized in the diagnosis of Mesothelioma.

Thoroscopy and pleuroscopy are utilized to confirm the diagnosis and obtain samples for pathological analysis and tumor staging. Special stains and electron microscopy may be needed for the diagnosis. Fluoroscopically guided biopsy is diagnostic in 98% of cases. Pleural fluid is often exudative and hemorrhagic although it is not usually diagnostic except in occasional cases where malignant mesothelial cells are found.

Imaging studies included chest radiographs, CT, MRI, and PET scans. Chest films may show obliteration of the involved diaphragm and a ground glass appearance, pleural thickening, pleural encasement, and decreased size of the involved hemithorax.

TMN classification of the International Mesothelioma Interest Group stages mesothelioma as follows:
Stage I – Completely contained without adenopathy
Stage II – Intrapleural adenopathy
Stage III – Local extension into the chest wall
Stage IV – Distant metastases

What is the mortality rate for mesothelioma (localized and diffuse)?

2008-07-02T09:50:00.001-07:00

What is the mortality rate for mesothelioma (localized and diffuse)?

Localized:
a. Benign – with appropriate surgical resection (1 cm surgical margins), most patients have no further complications of the disease. Transformation from a benign to a malignant mesothelioma is a possibility without proper surgical resection.
b. Malignant – these rates very greatly across literature. Generally speaking, without treatment the disease will be fatal in 4-8 months. With multi-modality treatment (surgery, radiation therapy, and chemotherapy), most patients survive from 8-14 months with some surviving up to two years.

Diffuse:
Diffuse mesothelioma has the poorest prognosis, with an overall average life span after diagnosis of 1 year – with or without treatment. In general, the extent of tumor invasion (chest wall, mediastinum, and diaphragm being common) correlates with length of survival.

Analyze the complications and prognosis for patients with Mesothelioma.

2008-07-02T09:49:00.001-07:00

Analyze the complications and prognosis for patients with Mesothelioma.

Although the onset of the disease is insidious, once established, malignant mesothelioma progresses rapidly by local extension to the pericardium, mediastinum, and contralateral pleura. Pain and dyspnea become progressive. Extension to other thoracic structures creates superior vena cava syndrome, hoarseness, and dysphagia. Abdominal extension is common and involves the abdominal lymph nodes and organs. Mesothelioma is associated with the development of paraneoplastic disorders, which include thrombocytosis, hemolytic anemia, Disseminated Intravascular Coagulation, and migratory thromboplebitis. Tumor recurrence rate after surgery is as high as 50%.

Death results from respiratory failure and local extension to other organs. Untreated mesothelioma is fatal in 4-8 months. Patients who receive multimodality care may survive 16-19 months. The five-year survival rate is less than 5%.

What is the incidence/prevalence of mesothelioma?

2008-07-02T09:47:00.000-07:00

What is the incidence/prevalence of mesothelioma?

There are approximately 2,000-3,000 new cases diagnosed per year in the United States. It is most often seen in men over age 65, although any
age may be affected. According to OSHA, 1.3 million employees face significant asbestos exposure (most common cause of mesothelioma) in the
workplace. People with mesothelioma often show no signs or symptoms for 30-50 years. Once a person begins to show signs and symptoms, the disease
is usually quite progressed, with an average life expectancy of a few months to a couple of years remaining. Those who are at greatest risk of
developing mesothelioma are in contact with asbesstos, particularly in a dust form, like during asbestos removal. Workers who are most at risk are
miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers and construction workers. The families of
these workers are also at risk if the worker brings home asbestos dust on his or her clothing or hair.

List and describe the four stages of mesothelioma, as described by the Butchart Staging System.

2008-07-02T09:46:00.000-07:00

List and describe the four stages of mesothelioma, as described by the Butchart Staging System.

Stage I mesothelioma is used to describe disease progression characterized by the presence of mesothelioma within the right or left pleura, which is the membrane that covers the lungs. The cancer may also be present, on the same side only, in the lung, pericardium, or diaphragm.
Stage 2 mesothelioma describes the state in which the cancer spreads to the extent of invading one or more additional areas, including the pleura on both sides, the chest wall, esophagus, heart, and/or lymph nodes in the chest.
Stage 3 mesothelioma indicates further spread of the cancer, involving penetration through the diagram into the peritoneum, which is the lining of the abdomen. This state my also involve additional lymph nodes beyond the chest area.
Stage 4 mesothelioma is the final state of mesothelioma, in which the cancer cells have gained entry to the bloodstream, enabling the disease to spread to other organs throughout the body. The process of spreading via the bloodstream is referred to as distant metastes.

2008-07-02T09:38:00.000-07:00

Explain the staging of mesothelioma.

Staging allows the patient and doctor to determine treatment options. Staging is divided into 3 areas, designated by the capital letters TNM:

• T refers to whether the original tumor has exceeded its margins.

• N stands for lymph nodes that are affected.

• M refers to metastasis to other areas of the body.

Pleural mesothelioma is further divided into overall stages:

Stage I -The cancer is present only on the pleura of the chest wall and the outer lining of the lungs.

Stage II-The cancer has spread into the lining of the lung, the internal lung tissues, or the diaphragm.

Stage III-The cancer has invaded chest lymph nodes, or has not yet invaded lymph nodes but has spread to the mediastinum or the outer layer of the heart.

Stage IV-The cancer is present in adjacent structures, with or without spread to remote areas of the body.

Describe mesothelioma and who would be at the greatest risk for its development.

2008-07-02T09:37:00.000-07:00

Describe mesothelioma and who would be at the greatest risk for its development.

Mesothelioma is a malignant neoplasm that affects the mesothial surface of pleural and peritoneal cavities, most commonly the lung, but has also been found in the pericardium and tunica vaginalis. It has been linked with asbestos exposure in up to 70 % of the cases and generally presents in people 50 to 70 years old. Asbestos is still used for cement, ceiling and pool tiles, brake lining and ship building so taking a good history is important to establishing the diagnosis.

Malignant pulmonary mesothelioma differentiated from bronchogenic carcinoma.

2008-07-02T09:35:00.000-07:00

Malignant pulmonary mesothelioma differentiated from bronchogenic carcinoma.

Differentiation of mesothelioma from bronchogenic carcinoma is necessary to determine the optimal treatment strategy, and often requires histologic and/or histochemical examination of tissue samples collected by tumor biopsy. Mesothelioma can be primarily sarcomatoid or epithelial, and the epithelial type histology resembles that of bronchogenic adenocarcinoma. Acid mucopolysaccharide-positive, perinuclear keratin-positive, and CEA/Leu-M1-negative samples favor diagnosis of mesothelioma over adenocarcinoma. Clinical and radiologic presentation as well as gross appearance of the different tumor types can be markedly similar. While smoking history has a different impact on the risk for development of mesothelioma versus bronchogenic carcinoma, it is not helpful in distinguishing the two entities clinically.

Common diagnostic methods:

2008-07-02T09:27:00.000-07:00

There are currently about 3000 new cases of Mesothelioma diagnosed per year, mostly in men over the age of 40.

The earlier mesothelioma is detected, the better your chances are for an effective treatment. To determine whether a person has mesothelioma, doctors may use one or more of these diagnostic methods:

Chest X ray
CAT scan - CT or Computerized Tomography
MRI - Magnetic Resonance Imaging
PET scan - Positron Emission Tomography
PFT - Pulmonary Function Test
Transbronchial biopsy - A flexible, lighted scope is passed down the trachea to the bronchi area of the lungs.
Thoracotomy - During surgery, the chest is opened and examined, usually between two of the lower ribs on one side.
Thoracoscopy - A thoracoscope with a video camera is sent through an incision between the ribs.
Centesis - Pleural, peritoneal, or pericardial fluid is drained and evaluated. This technique is used both for diagnosis and to relieve pressure, pain, and fullness in the chest or abdominal areas.

Describe the 3 different locations a mesothelioma can be found, and the most common imaging techniques used diagnosis in each location.

2008-07-02T08:22:00.000-07:00

Describe the 3 different locations a mesothelioma can be found, and the most common imaging techniques used diagnosis in each location.

A mesothelioma is a benign or malignant tumor found in either the chest (75% are pleural, 2-3% pericardial) or abdomen (20% peritoneal, 1% scrotal). The word comes from “meso” (middle) and “epithelium” (covering/lining). Tumors develop when cells of the mesothelium (the middle layer of cells of the tissue) proliferate to cause abnormal thickening of the sack-like tissues found in the pleural, pericardial and peritoneal cavities.

There are 3 types of mesothelioma based on anatomical location (pleural, pericardial and peritoneal) and 3 sub-types of malignant mesotheliomas based on cell morphology (60% are epitheloid, 20% are sarcomatoid and about 25% are mixed). Sarcomatoid has the worst prognosis while epitheloid carries the best results.

Mesotheliomas are often discovered by finding excess fluid in the chest (chest x-ray), around the heart (echocardiography) and in the abdomen (ultrasound). Ultimately diagnosis comes from examination of mesothelial cells under the microscope. Treatment and prognosis are based on the type, sub-type and stage of the illness.

Discuss the epidemiology and etiology of Mesothelioma

2008-07-02T08:16:00.000-07:00

Discuss the epidemiology and etiology of Mesothelioma

Mesotheliomas are tumors that arise in the pleural or peritoneal mesothelium as a result of exposure to asbestos. Mesothelium is a membrane that lines and lubricates body cavities. Mesothelioma arises when these cells become abnormal and divide uncontrolled. Pleural tumors compromise about 80% of mesotheliomas, whereas peritoneal tumors occur in 20% of cases. There are two distinct types of pleural mesotheliomas; diffuse, which are usually malignant, and localized, which are mostly benign.

There is a 3:1 male to female ratio and there is an 8% lifetime risk of developing the disease. Asbestos exposure usually occurs more than 20 years before the development of the disease. About 75% of patients with malignant mesothelioma have a know exposure to asbestos. Exposure may occur in the mining, milling, building and demolition, and automobile industries, which use asbestos products. There are about 2500-3000 new cases reported each year.

Cigarette smoking is known to exacerbate those with asbestosis, however there is no link between smoking and the development of mesothelioma.

Patterns of failure following surgical resection for malignant pleural mesothelioma.

2008-06-22T09:37:00.000-07:00

Patterns of failure following surgical resection for malignant pleural mesothelioma.

The optimum therapeutic strategy for patients with localized malignant mesothelioma continues to evolve. For patients who are eligible candidates, surgical resection plays an important role. An encouraging 45% 5-year survival rate has been reported for patients with early-stage disease who undergo EPP and have the favorable features of epithelial histology and the absence of mediastinal lymph node involvement.

Most patients present with more advanced disease, however, and the optimum local and systemic treatment for these patients has not been defined. No randomized trials evaluating the various surgical or adjuvant therapeutic approaches have been performed. Evaluation of treatment efficacy based on observed patterns of failure may suffer from treatment selection biases. Most studies also do not separate out the failure patterns based on the initial stage (clinical or pathologic) of the disease.

Consequently, it is difficult to discern the potential impact of a given adjuvant therapy. Given these limitations, however, some consistent observations from the available data can be made. For patients who undergo P/D, local recurrence (within the surgically operated hemithorax) is the most common form of recurrence. Efforts to decrease the chance of local recurrence after P/D have included the use of intrapleural and intravenous chemotherapy, brachytherapy, and external beam radiation therapy. None of these adjuvant treatment trials was randomized, and when compared with historical controls, none of the treatments used suggested a consistent outcome benefit. After P/D, the use of radiation is limited by the potential toxicity of the underlying organs, most importantly, the intact lung. Doses required to treat mesothelioma effectively are above the doses that would lead to damage to the lung parenchyma. Cisplatin and mitomycin have been used as agents have modest activity against mesothelioma. The doses of cisplatin used may not have been optimal, although they were based on prior pharmacokinetic studies.

Alternative approaches for patients who undergo P/D, such as the use of escalating doses of heated intrapleural cisplatin (given with a renal protecting agent, sodium thiosulfate, which provides the opportunity to deliver higher doses of chemotherapy), are being pursued by Sugarbaker et al. The availability of more active systemic chemotherapy agents or other intrapleural agents also may offer better therapeutic options for patients who undergo P/D.

Recently, Vogelzang et al presented the findings of a large randomized study that compared cisplatin/premetrexed to cisplatin and demonstrated an improvement in response rate (41% for cisplatin/pemetrexed versus 19% for cisplatin) and median survival (12.1 versus 9.3 months, respectively; P = 0.020). Other chemotherapy regimens with encouraging activity in mesothelioma include the combination of cisplatin and gemcitabine, with response rates ranging from 16% to 48%.

From a review of available data, patients with mesothelioma who have undergone P/D (with or without intrapleural chemotherapy) who are evaluated at the Dana Farber Cancer Institute and Brigham and Women's Hospital are offered therapy with systemic chemotherapy alone. After P/D, radiation is used only for palliative treatment. Patients who have undergone P/D are also appropriate candidates to receive chemotherapy or other novel therapeutic strategies being evaluated in clinical trials.

For patients who have undergone EPP, the pattern of recurrence is predominantly a combination of local and distant failure (Table 1). The local recurrence rates, however, seem to be lower than rates seen after P/D. This observation may represent a shift of the natural history of the disease. Metastatic mesothelioma is often seen late in the course of the disease, but it may become the dominant source of disease after aggressive local surgical management.

Many studies define abdominal recurrence as a site of distant recurrence, although this may represent transdiaphragmatic extension of the pleural mesothelioma. Advances in local therapy also may decrease the rate of abdominal recurrences. True distant recurrences (bone, central nervous system, contralateral hemithorax) remain less common. The lowest rate of local recurrence (13%), with a 4% local-only recurrence rate, was seen in the study by Rusch et al, who used 54 Gy hemithorax radiation as adjuvant therapy. This is the lowest rate of local recurrence after an EPP that has been reported. Baldini et al reported a 50% local recurrence rate, with a 13% local-only rate, after trimodality therapy.

One possibility for the differences between these two reports is the lower dose of radiation (30.6 Gy) used in the latter study. In the study by Rusch et al, distant failures predominate, and the patients are appropriate candidates for systemic chemotherapy, which could be administered either as neoadjuvant or adjuvant therapy. Kestenholz et al currently are performing a phase II clinical trial of neoadjuvant cisplatin and gemcitabine administered for three cycles followed by EPP and adjuvant radiation therapy.

A similar approach also is being pursued in an ongoing clinical trial using neoadjuvant cisplatin/pemetrexed for four cycles before EPP followed by 54 Gy of adjuvant hemithorax radiation. Alternatively, patients who have undergone EPP could be treated with adjuvant chemotherapy in addition to adjuvant radiation therapy.

Currently, patients evaluated at the Dana Farber Cancer Institute and Brigham and Women's Hospital who have undergone EPP are offered adjuvant chemotherapy followed by hemithorax radiation to 54 Gy in an effort to maximize local and distant control rates. Further clinical studies are needed for all patients with mesothelioma to define the optimum surgery and duration and types of adjuvant therapy. The appropriate multimodality approaches most likely will differ based on disease stage, histology, and patient performance status. intrapleural chemotheraphy treatments.

Advances in the treatment of malignant pleural mesothelioma.

2008-06-22T09:36:00.001-07:00

Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA. sterman@mail.med.upenn.edu

Advances in the treatment of malignant pleural mesothelioma.

Malignant pleural mesothelioma is a neoplasm that is commonly fatal and for which there are no widely accepted curative approaches. Mesothelioma is unresponsive to most chemotherapy and radiotherapy regimens, and it typically recurs even after the most aggressive attempts at surgical resection. Multimodality approaches have been of some benefit in prolonging survival of very highly selected subgroups of patients, but they have had a relatively small impact on the majority of the patients diagnosed with this disease. As the incidence of pleural mesothelioma peaks in the United States and Europe over the next 10 to 20 years, new therapeutic measures will be necessary. This review will discuss the roles of chemotherapy, radiotherapy, surgery, and combined modality approaches in the treatment of pleural mesothelioma, as well as scientific advances made in the past decade that have led to the development of experimental techniques, such as photodynamic therapy, immunotherapy, and gene therapy, that are currently undergoing human clinical trials. These promising new avenues may modify the therapeutic nihilism that is rampant among clinicians dealing with mesothelioma.

Treatment of malignant pleural mesothelioma

2008-06-22T09:35:00.001-07:00

Treatment of malignant pleural mesothelioma

In Japan, it is predicted that mesothelioma will rapidly increase in the future. Malignant pleural mesothelioma that accounts for approximately 90% of mesothelioma as a whole has a median survival time of approximately nine months which is considered a poor prognosis. As for the treatment of this disease,extrapleural pneumonectomy or pleurectomy/decortication are available for those patients who can be surgically operated on. However, since a complete cure rate is low when only surgical treatment is performed, generally a multimodality treatment is performed wherein chemotherapy and/or radiotherapy are combined. For chemotherapy, a large-scale randomized phase III study demonstrated that a treatment using two agents: pemetrexed, which is a new multitargeted antifolate, and cisplatin is effective. Pemetrexed will be the drug of first choice for mesothelioma in the future. As other treatment methods, chemohyperthermia, treatments using various kinds of cytokines and angiogenesis inhibitors, genetic treatment and photodynamic therapy have been attempted. The current treatment results for this disease are very poor, and there has been a strong demand for establishing an effective treatment method.

Peritoneal mesothelioma: treatment approach based on natural history.

2008-06-22T09:33:00.000-07:00

Peritoneal mesothelioma: treatment approach based on natural history.

A more modern treatment strategy for diffuse malignant peritoneal mesothelioma may be suggested (figure 3). Clinical suspicion of diffuse malignant mesothelioma (peritoneal carcinomatosis) calls for laparoscopy with evaluation of parietal and visceral peritoneum and multiple biopsies sufficient for definitive histologic diagnosis. Cytologic examination of ascitic fluid is not likely to be of benefit. CT of chest, abdomen, and pelvis is needed for evaluation of visceral involvement and the presence of distant metastases. Contrast enhancement of the gastrointestinal and urinary tract is necessary with the CT. Additional radiologic techniques for detection of distant metastases should be used if there are clinical or laboratory signs of extraperitoneal spread. After histologic diagnosis and extent of tumor spread have been documented, and if no symptoms of intestinal obstruction are present, the patient may be subjected to two to three courses of induction intraperitoneal chemotherapy. This will provide the clinician with important information on tumor response to chemotherapy, minimize tumor accumulation on bowel surfaces, and provide time for surgical conditioning. The time devoted to induction chemotherapy will allow occult distant metastases to be detected. In patients with a response or stable disease, cytoreductive surgery is attempted approximately 2 months after completion of induction chemotherapy. Surgery must be aimed at achieving complete or near-complete cytoreduction through the use of peritonectomy procedures [46,47]. Additional intraperitoneal chemotherapy should be administered intraoperatively and in the early postoperative period (figure 3). This treatment strategy may be the most feasible one according to existing knowledge of the natural history of diffuse malignant peritoneal mesothelioma. Only further phase II clinical trials can reveal the extent to which it is beneficial. Because of the rare occurrence of this disease, the quickest answer would come as a result of cooperative study by several groups experienced in these treatment modalities.

At Risk Jobs and Locations

2008-06-20T02:20:00.000-07:00

At Risk Jobs and Locations

It is inhalation of asbestos fibers which can cause mesothelioma or asbestos lung cancer. Even low exposure levels of the tiny fibers or asbestos dust are very dangerous. After the 1980's workplace exposure to asbestos became more rare, but it can take up to 40 years for signs of mesothelioma asbestos lung cancer are noticed.

Most patients were exposed to asbestos fibers on the job or in the workplace in what is known as occupational exposure. Another form of exposure is called paraoccupational exposure. This form of asbestos exposure can be harder to determine the source, but it is usually contracted by a family member of someone who has been exposed in the workplace.

Typically the family member is exposed to asbestos dust or fibers from the worker's clothing, and when the clothing is handled the dust is released and inhaled. Family members that are exposed in this way, may be exposed to smaller amounts, but are still very much at risk.

In the same way, those that have homes or work work near facilities that have asbestos may also be at risk even though there is not obvious direct contact. The fine asbestos dust can easily be carried by the wind over long distances.

In the past, some of the industries that could have been a source of asbestos were factories, shipyards, power plants, oil refineries, steel manufacturing plants, and any company or job site involved with construction or the removal of old building materials. Often the demolition of buildings that contain asbestos can release the dust into the environment, and trucks hauling the materials can further spread the fine asbestos fibers.

Likewise, people who live near these types of sites likely to have asbestos around the facility are also at risk: refineries, power plants, factories, shipyards, steel mills and building demolition are types of work sites that can release asbestos fibers into the environment and contaminate nearby residential neighborhoods.

Trades:

* Manufacturing of asbestos products (insulation, roofing, building, materials)
* Vehicle repair (brakes & clutches)
* Construction workers and contractors
* Maritime workers
* Miners and drillmen
* Offshore rust removals
* Oil refinery workers
* Power plants
* Railway workers
* Sand or abrasive manufacturers
* Shipyards / ships / ship builders
* Steel mills
* Tile cutters

Occupations:

* Auto Mechanics
* Boiler makers
* Bricklayers
* Building Inspectors
* Carpenters
* Drywallers
* Electricians
* Floor Coverings
* Furnace Workers
* Glazers
* Grinders
* Hod carriers
* Insulators
* Iron workers
* Laborers
* Longshoremen
* Maintenance workers
* Merchant marines
* Millwrights
* Operating Engineers
* Painters
* Plasterers
* Plumbers
* Roofers
* Sand blasters
* Sheet metal workers
* Steam fitters
* Tile setters
* Welders
* United States Navy veterans
* Welders

Many occupations have an increased risk for developing lung cancer. For example, asbestos insulation workers have 92 times the risk of developing of lung cancer, and smelter workers have 3-8 times the risk of developing lung cancer. The risk of lung cancer is also increased in people who work in the manufacturing of certain industrial gases, pharmaceuticals, soaps and detergents, paints, inorganic pigments, plastics, and synthetic rubber. The risk of developing lung cancer is related to the amount of exposure to the cancer-causing agent.

For example, the risk of lung cancer in humans is proportional to the number of cigarettes smoked. The risk of developing lung cancer is 8-20 times greater in smokers compared to people who have never smoked. A smaller, but real risk exists for cigar and pipe smokers. Some lung cancer causing agents react together to significantly worsen the risk of developing cancer. The combined exposure to asbestos and tobacco smoke clearly multiplies the risk of developing lung cancer.

The risk of lung cancer is greater for those living in urban areas. This risk is approximately 1.2 to 2.3 times that of people living in rural areas. There is also an increased risk of lung cancer in smokers whose close relatives have had lung cancer. Scarring in the lungs from previous infections or injury can be associated with and increased risk of cancer.

How Alimta play an important role in Mesotheliomas treatment?

2008-06-20T02:17:00.000-07:00

Alimta for Mesothelioma

There are a number of mesothelioma treatments that can be used to help treat the symptoms of Mesothelioma and to deal with this illness. While there is no cure for mesothelioma, other methods can be used to help lengthen the expected lifespan of the person afflicted with the disease.

Alimta is a drug that has been used to help stop the rapid growth of mesothelioma cancerous cells within your body. This drug was brought about during 2004 and, since then, it has been helping patients that have Mesothelioma improve and stop the spread of this deadly disease. It has successfully helped patients live longer and happier lives just by taking Alimta. This particular medication has undergone careful and rigorous scrutiny successfully, which has allowed it to be approved by the FDA.

Alimta does more than simply work well for Mesothelioma - this drug has also been used to treat other various cancers. It has helped particularly well in lung cancers, among others and has starkly improved the quality of treatment that cancer treatments can receive since 2004. It can also be very helpful to anyone who is already taking other medications for their mesothelioma as Alimta can be combined with other treatment options.

While Alimta is not going to completely make your Mesothelioma go away, it will halt the progress of any cancerous cells within your body. This is why Alimta is a perfect to use as a medication because people that have mesothelioma may not have long to live. Once they have been diagnosed with Mesothelioma, most patients with the cancer are not likely to survive very long once the symptoms start to show. Hence, Alimta has been extremely helpful to people who are suffering from Mesothelioma - Alimta helps by halting the progress of the cancer, allowing the patient to live a longer and more fulfilled life than they normally could have.

Commonly, another drug that often goes well with Alimta is Cispltain, which is another form of cancer fighting medication. Often, Cisplatin is used in combination with Alimta because these two cancer-fighting agents complement themselves well when working to fight off mesothelioma. This is one element where two medications can be used in combination with each other to improve the health of a patient with Mesothelioma.

If you are wondering how the new drug Alimta will help you, then you should know that this cancer fighting medication could work for you in helping to destroy cancerous cells. Alimta actually works on the cancer cells themselves, decreasing their ability to grow at their natural rate. This actually provides you with less cancer cells in your body, which will give you a longer life but without this medical assistance you could be left with the 6-12 months that people who are diagnosed with mesothelioma have. Alimta has been tested and proven to help patients who are suffering with mesothelioma and this medication is currently being tested on other cancers to try to stop the growth of other cancerous diseases.

Your doctor should know several things before treating you with Alimta. It is important that you tell your doctor if you have any previous medical problems. In most cases, they will run you through a rigorous pre-screening process. Your doctor will want to know everything possible about both your full medical history and the medical history of your family before you start treatment for Alimta.
Make sure that you tell the doctor if you are allergic to any medications, even though a doctor should have your full medical chart. There are may be instances when not all allergies that you have are written down and getting this sorted out is important prior to starting the treatment. If the doctor gave a patient a medication that he or she was allergic to, that patient could get sick or even die from this allergic reaction. It is also a good idea that, prior to taking Alimta, the doctor be well informed of a complete and exhaustive list of each of the medications that you take, how frequently, and how much at a time, including both prescribed and over the counter medications. This will help the doctor make sure that Alimta will not have a bad side effect with another one of your medications that you are currently taking.

Alimta is not a simple medication to take. It is far more than just taking a pill with some water. In this particular treatment, specific guidelines must be followed in order to have a successful treatment. Before taking Alimta, it is important to also take two other supplements with this medication, Vitamin B-12 and folic acid. The combination of these two supplements with the medication can create the best possible beneficial situation for the patient. These supplements are taken primarily because there is also a chance of a small skin inflammation after you first start taking the Alimta. Make sure to ask your doctor in which way you could lower the chance of having this outbreak, it is recommended that your doctor should put you on a steroid to lessen the chance of a bad skin reaction when taking Alimta.

The side effects of any medication are important to be aware. Hence, you should know all of the side effects of any medication prior to deciding to use it as a treatment for your cancer. Most cancer medications have a wide list of side effects, but that is because all of these cancer-destroying medications work on killing the cancerous cells within your body. It is quite frequent that these medications will also damage healthy cells, which is why there is such a chance for side effects. A few of the side effects that Alimta has are loss of hunger, sores inside the mouth, rashes throughout the body, exhaustion, depression, general weakness, and other similar side effects. These may sound bad, however it is much preferred that a patient deal with such minor side effects in order to extend his or her life. The benefits outweigh the risks.

Mesotheliona Clinical Trials

2008-06-20T02:13:00.000-07:00

Mesotheliona Clinical Trials

In order to one day find a mesothelioma cure, doctors engage in clinical trials where they test new mesothelioma drugs to determine the if they are effective.

Mesothelioma clinical trials follow a plan of very strict scientific guidelines, which is called a protocol. The protocol explains everything that will happen in the study. It must be approved by review boards made up of health care professionals and other qualified people before the study can enroll patients.

When a potential mesothelioma drug is first identified, preclinical studies, which are conducted in a laboratory setting, help to find out whether the drug is safe to test in humans. During this stage, the drug is usually studied in animals to answer questions about how a drug works and how the body changes and disposes of it. Humans do not participate in preclinical studies. There are four possible phases of cancer clinical trials in humans, each designed to answer different questions about the treatment being studies.

In Phase I mesothelioma clinical trials, doctors are primarily studying the safety of giving mesothelioma drugs to humans, while also looking for the best way to give a medication (for example, as a pill, an injection, or an infusion). They will usually study how the mesothelioma drug is eliminated from the body in humans. Also, doctors are trying to find the right doses for further testing. They carefully watch for any side effects. Phase I study drugs are usually given to small groups of humans. During this phase, for drugs used to treat mesothelioma cancer, investigators may be able to find out which tumors a treatment works best in.

In Phase II mesothelioma clinical trials, the mesothelioma drug is studies in a larger group. The primary purpose of these studies is to see how well the drug or treatment shrinks tumors in patients with specific types of cancer. The investigator will watch closely for side effects and will also watch how the disease responds to the treatment.

In Phase III mesothelioma clinical trials, the new cancer treatment is generally compared to a standard existing treatment. Patients are usually randomly assigned (that is, a process similar to flipping a coin is used to determine which treatment the patient receives) to receive either a standard treatment or the new treatment. During the trial, patients may or may not be told which treatment they are getting but are told what to expect and what to watch for. Occasionally, even the doctor will not know which treatment each patient is getting so that he or she can remain unbiased about how the disease is responding to the treatment. (This is uncommon in cancer clinical trials). Phase III studies are designed to ensure that any side effects that patients experience are identified treated according to local standards of care.

Phase IV mesothelioma clinical trials study a drug that has already been approved by the Food and Drug Administration. Drug companies often sponsor these trials to study even more uses of drugs already available

Clinical Trials: Mesothelioma

California

Duarte; City of Hope National Medical Center
A Double-Blind Placebo Controlled Randomized Phase II of Gemcitabine & Cisplatin With Or Without the VEGF Inhibitor Bevacizumab in Patients with Malignant Mesothelioma

San Diego; Sharp Clinical Oncology Research
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Colorado

Aurora; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

Aurora; University of Colorado Cancer Center
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Florida

Miami; Oncology / Hematology Group of South Florida
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Tampa; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

Illinois

Chicago; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

Chicago; University of Chicago Medical Center, Section of Hematology / Oncology
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Indiana

South Bend; Northern Indiana Cancer Research Consortium
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Maryland

Baltimore; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

Massachusetts

Boston; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

Michigan

Grand Rapids; Spectrum Health, Cook Research Department
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

New Jersey

Somerville; Somerset Medical Center
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

New Mexico

Albuquerque; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

New York

New York; Columbia-Presbyterian Medical Center
ALIMTA Plus Gemcitabine as Front-Line Chemotherapy for Patients with Malignant Pleural or Peritoneal Mesothelioma. A phase II Clinical Trial.

New York; Columbia-Presbyterian Medical Center
Open - Label Study of Alimta (pemetrexed) Combination with Cisplatin for Chemonaive Patients with Malignant Pleural Mesothelioma.

New York; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

New York; Columbia Presbyterian Medical Center
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

New York; Columbia University Medical Center
A phase II, open-label, non-randomized, multicenter, single agent study of intravenous sdx-102 for the treatment of patients with MTAP - deficient cancers.

New York; Columbia-Presbyterian Medical Center
Phase II trial of combined resection, intraperitoneal chemotherapy, and whole abdominal radiation for treatment of peritoneal mesothelioma.

New York; Columbia-Presbyterian Medical Center
Phase II trial of perioperative gemcitabine and cisplatin chemotherapy in resected pleural mesothelioma

New York; Biomedical Research Alliance of New York
Cancer in the Lungs- Caused by exposure to asbestos

Oklahoma

Tulsa; Southwestern Regional Medical Center
Open-Label Study of ALIMTA (pemetrexed) and Cisplatin in chemonaive patients with malignant Pleural Mesothelioma.

Texas

Austin; Lone Star Oncology Consultants, PA
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Houston; S. R. Burzynski Clinic
Phase II Study Of Antineoplastons A10 And AS2-1 In Patients With Mesothelioma

Wisconsin

Madison; Research Center
ALIMTA Plus Gemcitabine (Gemzar) for Patients with Malignant Pleural or Peritoneal Mesothelioma who have not had previous chemotherapy

International

D-14109 Berlin, Germany; Pneumologie II, Zentralklinik Emil von Bering
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

D-21075 Hamburg, Germany; Allgemeines Krankenhaus Harburg
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

D-22927 Grosshansdorf, Germany; Krankenhaus Grosshansdorf, Zentrum fur Pneumologie und Thoraxchirurgie, Pneumo.- Onkolog. Abteilung
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

D-81675 Munchen, Germany; TU Munchen, Klinikum Rechts der Isar, Med. Klinik Hamatologie und Onkologie
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

D-82131 Gauting, Germany; Asklepios Fachkliniken, Zentrum fur Pneumologie und Thoraxchirurgie
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Alessandria, Italy; Azienda Osped. Nazion Antonio e Biagio e Cesare Arrigo, Divisione di Pneumologia
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Genova, Italy; Struttura Semplice di Pneumotisiologia, Ospedale San Marino
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Pavia, Italy; IRCCS - Policlinico San Matteo, Clinica Malattie dell Apparato Respiratorio
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Pavia, Italy; IRCCS - Policlinico San Matteo, Divisione di Pneumologia
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen.

Venezia, Italy; Ospedale Civile di Venezia, Unita Operativa Oncologia Medica
ONCONASE ® plus doxorubicin vs. doxorubicin for patients with Malignant Pleural or Peritoneal Mesothelioma who have had no more than one prior chemotherapy regimen

What are the General information about Mesothelioma?

2008-06-20T02:11:00.000-07:00

General Information / Anatomy / Function / Statistics

Mesothelioma are tumours originating from the lining of the body cavities; this includes the chest and abdomen. Although the most common type of mesothelioma begins within the chest, this cancer should not be confused with lung cancer. Mesotheliomas arise from the serosal lining outside of the lungs within the chest or outside the bowel within the abdomen.
About 100 new cases of malignant mesothelioma appear in Canada each year
30-40 cases are seen at the BC Cancer Agency each year
Malignant mesothelioma is usually not curable

Symptoms / Signs

Symptoms and signs from mesotheliomas depend upon location of the mesothelioma, its size and whether it is benign or malignant
Benign forms of the disease are generally asymptomatic
The symptomatology of malignant mesotheliomas is due to tumour growth resulting in invasion of surrounding structures and/or the production of fluid (pleural effusion, ascites, or pericardial effusion). Chest pain may be caused by invasion of the chest wall. Pleural effusion causes collapse of adjacent lung and shortness of breath.
Symptoms of distant spread are possible, but uncommon since the tumour is usually a local problem and blood borne spread is uncommon
Patients with more advanced disease may be ill generally with fever, night sweats and weight loss
Involvement of the membrane around the heart (pericardium) may cause heart rhythm disturbances

Etiology / Carcinogens / Risks

There is a definite association between asbestos and mesothelioma. The risk associated with asbestos exposure has been shown by many investigators and inhalation of asbestos poses the most serious hazard.
In approximately 30% of mesotheliomas, no asbestos exposure can be traced
Crocidolite (Cape blue asbestos), the main cancer causing form of asbestos, is associated with over 90% of pleural and peritoneal mesotheliomas. Other types of asbestos fibre have been associated in a less significant way.
Individuals at highest risk are those employed in the asbestos industry; dockyard workers, especially if they dismantle asbestos-insulated steam piping; those who handle and manufacture asbestos compounds; insulators and steam fitters; and those in demolition and construction industries
Spouses and children of asbestos workers are also at risk
The latent interval between exposure to asbestos and development of tumour is long (15-25 years)
Mesothelioma is not caused by cigarette smoking but asbestos exposure and cigarette smoking both increase the risk of lung cancer

Prevention

The only method of prevention is avoidance of asbestos exposure
Cigarette smoking should be avoided by all persons and asbestos exposed individuals should avoid cigarette smoke in particular because asbestos plus cigarette smoking can cause lung cancer

Diagnosis / Screening / Staging / Grading / Types

The chest X-ray is a very helpful test, usually showing thickening of the pleura or pleural effusion in patients with pleural mesothelioma. Sometimes a CT scan of the chest may be required for further information.
A pleural biopsy is essential for pathological confirmation of the disease. Although pleural fluid cytology may be abnormal, this is often difficult to interpret.
Patients having peritoneal mesothelioma may require an abdominal surgery for exploration of the peritonial surfaces and biopsy of any lesions observed

Types

Mesotheliomas may be of epithelial or sarcomatous. Sarcomatous types are more malignant and tend to be resistant to treatment.

Treatment

Treatment unsatisfactory with no recent advances
Malignant mesotheliomas are serious illnesses and cure of the disease is rare
Survival with this type of cancer obviously varies with the extent of the disease, but overall it is in the region of one year

Surgery

Because of the large area of pleural surfaces, complete surgical removal is rarely technically feasible. The advisability of resection is always considered at diagnosis, but only a small minority of cases are eligible for an attempted resection. Spread of disease to the chest wall, heart, or esophagus often rules out the possibility of an operation.

Radiation

Radiation may be given for control of symptoms in a localized area. Radiation therapy does not have the power to cure this disease. Radiation cannot be given to the entire tumour because this would involve the treatment of large volumes of normal tissue and the dose of radiation required for tumour control is too high for this to be tolerated. Radiation can, however, be of value in controlling pain in a localized area.

Chemotherapy

Benefits from chemotherapy treatments for mesothelioma are uncertain as the tumour is often resistant. The best available treatment programs do not have the power to cure any patients with mesothelioma. 20% of patients may have a temporary shrinkage of the disease with currently available drugs.

General Support and Symptom Control

If pain is associated with mesothelioma, good drug prescriptions are available that can control this. Pleural effusions (fluid build up) can be treated by a small surgical procedure that removes the fluid, permitting re-expansion of the lung and improvement in shortness of breath. Some patients with mesothelioma may have very slow growing tumours and if symptoms are not present, it is often advisable to follow the patient with regular chest X-rays without specific therapy. When symptoms do occur, they should be assessed on an individual basis.
Chemotherapy may be considered for treatment of recurrent thymoma

Treating Malignant Pleural Mesotheliomas: An Uphill Climb

2008-06-18T09:18:00.000-07:00

Treating Malignant Pleural Mesotheliomas: An Uphill Climb

Introduction

Malignant pleural mesothelioma (MPM) seems to be on the increase worldwide and especially in the United States, with 2000 to 3000 new cases reported annually. Individuals who have been exposed to asbestos carry a 20% lifetime risk for acquiring MPM; smoking exacerbates the disease.

As MPM is a universally fatal cancer at present, with patients dying from pulmonary complications and infections, more effective treatment strategies are desperately needed. A somber series of presentations at the 9th World Conference on Lung Cancer in Tokyo suggested, however, that no potential breakthrough treatments seem to be on the horizon. Indeed, as the presentations suggested, there still is no standard treatment regimen for MPM.

Theories of Negativity

Triple Combination: Methotrexate (MTX) Plus Interferon Alpha and Gamma

Dr. Ola Brodin, from South Hospital, Stockholm, Sweden, reviewed results from a phase 2 multicenter Northern European trial in which patients received triple combination therapy, consisting of high-dose MTX, alpha interferon, and gamma interferon.^[1] Previously, single institutional trials reported response rates of 37%, 12%, and 24% for single-agent high-dose MTX, interferon alpha, and interferon gamma, respectively. The investigators designed this study to ascertain whether the 3 agents together would behave synergistically, or at least prove to be additive, as a previous in vitro Finnish study had suggested that MTX and interferon alpha behaved in a synergistic fashion.

MTX 3000 mg, followed by leucovorin rescue every 2 weeks, with interferon alpha 3 million units subcutaneously on days 3 to 8, and interferon gamma 40 mcg on days 3, 7, and 11 were given for 3 cycles every 2 weeks. Patients who showed responses were then given 3 more courses of therapy every 3 weeks at lower doses. Most patients (27) received all 6 planned cycles, whereas 4 patients received 5 cycles, 2 patients received 4 cycles, 7 patients received 3 cycles, and 3 patients received only 1 cycle.

A total of 49 patients were enrolled, but 6 were not included in the final analysis, because 4 patients were not treated, 1 was found to have peritoneal disease, and an additional patient had been previously treated. Among the 43 treated patients, 39 were evaluable. The overall response rate of 19% consisted of 8 partial remissions (PRs). There were 22 patients (51%) with stable disease and 9 patients (21%) with progressive disease. Median survival time was 15 months, with longer survival seen among those patients achieving a PR. Toxicity was primarily hematologic, with 4 grade 3 neutropenias noted. Rather than enhance the effect of the other drugs, it seems that this triple combination led to competition among the various compounds, resulting in a worse response rate than with each agent used separately. The investigators concluded that interferon would not be included in the development of future chemotherapy combination strategies for treatment of MPM.

Vinorelbine plus Oxaliplatin

A second combination approach, combining vinorelbine and oxaliplatin, was reviewed by Dr. Jeremy Steele of the London Lung Cancer Group.^[2] Building on previous data in which a 20% to 25% response rate was achieved with single-agent vinorelbine in the treatment of poor-prognosis MPM,^[3] Dr. Steele and colleagues from St. Bartholomew's Hospital in London paired oxaliplatin with vinorelbine. A total of 21 patients were given vinorelbine 30 mg/m² on days 1 and 8 with oxaliplatin 130 mg/m² on day 1 every 3 weeks for a total of 6 cycles. Seventeen patients have completed treatment while 4 continue on therapy. To date, only 2 partial responses (11.8%) were seen, with stable disease in 13 (76%) and progressive disease in 2 patients. Toxicity was significant, with 61% grade 3 and 4 neutropenia. Phlebitis (9%) was the most common nonhematologic complication.

While this low level of activity was disappointing, Dr. Steele suggested that the low response rate might be due to the large number of stage 4 patients included in the study (62%), the higher proportion of less favorable histologic subtypes (sarcomatoid 33%, mixed 24%), as well as a higher proportion of performance status (PS)-2 patients (24%). Additionally, he suggested, it might be necessary to increase the dose of vinorelbine. For the present, oxaliplatin does not seem to contribute significantly to the treatment of MPM and should probably not be included in further clinical trials.

Weekly Vinorelbine Therapy

In a separate presentation, Dr. Steele updated last year's American Society of Clinical Oncology (ASCO) results on the weekly vinorelbine therapy mentioned before.^[4] A total of 64 patients, 64% with epithelioid tumors, 9% with sarcomatous tumors, and 27% with biphasic disease were given vinorelbine 30 mg/m² weekly for 6 weeks (constituting 1 cycle). A median of 2 cycles were administered (range 1-10), with 4 patients receiving ongoing treatments between cycles 4 and 6. Distribution by stage included 3% of patients in stage 1, 28% in stage 2, 28% in stage 3, and 39% in stage 4.

There were 12 PRs (21%), 36 patients (63%) with stable disease, and 9 patients (16%) with progressive disease. Quality of life, as measured by the Rotterdam Symptom Checklist, was enhanced significantly, with 49% of patients reporting improvements in lung-related symptoms, whereas 56% reported general physical improvements. Toxicity was primarily hematologic, with 63% asymptomatic grade 3 and 4 neutropenia, and an 18% incidence of neutropenic fevers. Other toxicities included phlebitis, malaise, anorexia, nausea, and vomiting, all reported in 12% of cases.

Dr. Steele concluded that use of vinorelbine correlated with significant improvements in quality of life, with acceptable toxicity and a respectable (20%+) response rate. He also suggested that this agent warrants further study with a best supportive care control arm. Postpresentation questioners were skeptical about the degree of improvement in patient quality of life and suggested that perhaps the mere fact that patients were seen on a weekly basis could account in large part for their enhanced well being. It was also suggested that the addition of pulmonary function studies would more accurately reflect the degree of response to treatment beyond chest x-rays and CT scans.

Gemcitabine Plus Cisplatin

J.W. van Haarst,^[5] from University Hospital Rotterdam in The Netherlands, reviewed data from a multicenter phase 2 trial that sought to validate a previous single institutional study that had reported a response rate of 48% in MPM with a combination of gemcitabine and cisplatin.^[6] Given as single agents, gemcitabine and cisplatin have shown response rates ranging from 7% to 14% in MPM, and in vitro studies have suggested a synergistic interaction between these 2 compounds.

Van Haarst and colleagues enrolled 32 patients with stage 2 through 4 MPM, 28 of which were stage 3 and 4. Histologically, 25 patients had epithelial tumors, 2 sarcomatous tumors, and 4 mixed tumors. Treatment consisted of gemcitabine 1250 mg/m² on days 1 and 8 with cisplatin 80 mg/m² on day 1. Cycles were repeated at 3-week intervals for a maximum of 6 cycles. A cohort of 25 patients was needed to render the study statistically significant, and a response rate of 20% or greater was needed to establish validity. Ten patients were not evaluable, 5 because they received less than 2 cycles of therapy and 3 because of toxicity. One patient refused treatment and another was lost to follow-up.

Of the 22 patients who were evaluable, only 4 (15%) had a PR. Median survival time was 10 months with a 1-year survival of 30%. There were 2 cases of leukopenias, whereas nonhematologic toxicities were insignificant. Because the observed response rate was less than 20%, the study did not meet its own standard for validity.

Dr. van Haarst speculated that the discrepancy between the single institutional trial results and this multicenter trial was likely due to differences in patient selection, treatment schedules, and methodology in evaluating treatment. Following the presentation, Dr. Byrne, the author of the single institutional study, noted that when a larger number of patients was eventually accrued (55), the response rate dropped from 48% to 32%.^[6]

Docetaxel

Two other studies failed to show any significant improvement over current therapies. The first, presented by Dr. Vorobiof from the Standton Oncology Centre in Johannesburg, South Africa, employed single-agent docetaxel among 31 patients with MPMs.^[7] Docetaxel 100 mg/m² was administered every 3 weeks with standard steroid pre- and posttreatment medication. Patients were evaluated with chest x-rays and CTs after every 3 cycles. Five patients were not evaluable, 3 having died within the first 2 weeks following the first cycle of chemotherapy, 1 from unknown causes, a second from toxicity while receiving alternative medications, and a third from progressive disease. A fourth patient refused treatment and a fifth was diagnosed incorrectly. Four more were not evaluable because treatment was ongoing.

Of the 22 patients who were evaluable, there were 3 PRs. Stable disease was observed in 11 and there were 6 minor responses (25% or less reduction in tumor burden). Median duration of response was longer for those who responded partially compared with those with stable disease (20 weeks vs 11 weeks). Median survival was a little over 12 months. Grade 3 and 4 toxicities included 4 patients with neutropenia, 4 with diarrhea, and 4 with mucositis. A majority of patients (13) experienced no toxic side effects. One individual from the audience pointed out that the results from this trial were less than encouraging, given that the response rate (10%) and the death rate (10%) were the same.

Cisplatin, Ifosfamide, and Mitomycin

Dr. Metinas, from Osmangazi University in Eskisehir, Turkey, reported on a single institutional trial on only 12 patients, that incorporated a control arm of 12 individuals.^[8] Among 16 patients treated with combination chemotherapy, consisting of cisplatin 90 mg/m² over 3 days, ifosfamide 2 g/m² over 3 days, and mitomycin 8 mg/m² on day 1, 4 were not evaluable due to inadequate follow-up. A partial response was seen in 3 patients, while 1 patient experienced tumor "regression," but deemed a minor response. The median survival time was 6 months for the patients who received chemotherapy vs 4 months for the 10 patients who received best supportive care alone. This difference was not statistically significant. Those patients with responsive or stable disease did have a longer and statistically significant median survival time (8.5 months) compared with those with progressive disease (3.5 months). The unusual feature about this trial was the fact that a control arm was established, a difficult proposition in most clinical settings.

Accentuating the Positive

Intrapleural Liposomal NDDP

Two additional presentations were interesting because they discussed new approaches to treat this MPM. Dr. Dong Shin and colleagues,^[9] from the M.D. Anderson Cancer Center in Houston, Texas, studied the intrapleural administration of a liposomal cisplatin analogue (L-NDDP) in 34 patients who were diagnosed with MPM and free-flowing pleural effusions. Various dose levels of L-NDDP were given intrapleurally, ranging from 250 mg/m² to 550 mg/m² every 3-4 weeks. The first 8 patients were treated at the time of thoracoscopy; 2 of them died after 1 and 3 courses of chemotherapy. Subsequently, the remaining patients were treated 1 week after catheter placement with no ensuing complications. Eleven patients were deemed not evaluable, 4 because of nontreatment and 7 due to loss of follow-up, leaving 23 evaluable patients.

Twenty-three patients had both and pre- and posttreatment biopsy samples available for analysis. No evidence of tumor could be found posttreatment in 13 patients (56%). Cytology samples were available in 18 pre- and posttreatment patient specimens, of which 15 (83%) had no evidence for residual tumor following treatment. Dose-limiting toxicity was pleuritic pain, as well as nausea and vomiting. Only 1 grade 4 neutropenia was observed, with 2 grade 3 thrombocytopenias, 1 grade 3 neutropenia, and 1 grade 3 anemia.

The author concluded that this approach was highly effective with an overall response rate of 33%. But he also acknowledged a colleague's assertion that this approach does not address the systemic nature of malignant mesotheliomas, making it unlikely to impact on overall survival. Moreover, so few patients would be able to benefit from this therapeutic modality, given the often widespread nature of disease at time of presentation. Currently, an ongoing phase 2 trial is looking at whether L-NDDP can be given preoperatively, followed by surgery, then radiation therapy.

Carboplatin Plus Pemetrexed Disodium

Dr. A. Calvert, from the Department of Medical Oncology at Newcastle-upon-Tyne, England, discussed the use of pemetrexed disodium (LY231514, MTA), a novel multi-targeted anti-folate that inhibits several folate-dependent enzymes, especially thymidylate synthase (TS).^[10] This phase 1 study enrolled from 3-6 patients at various dosing levels of pemetrexed disodium with carboplatin ranging from 400 mg/m² and area under the curve (AUC) 5, respectively. Pemetrexed disodium was given over 10 minutes intravenously on day 1, followed by infusion of carboplatin. Cycles were repeated every 21 days.

Among 29 enrolled patients with MPM, 27 were treated. Maximum tolerated dose of pemetrexed disodium was established at 500 mg/m². Of 25 patients evaluable for response, 10 achieved PRs (40%) and 15 demonstrated stable disease, all at various dose levels. No patient had progressive disease. Toxic effects were primarily myelosuppression with 60% leukopenia, neutropenia, and thrombocytopenia at the highest dose level. Most patients with grade 3 and 4 hematologic toxicities remained asymptomatic. Mild nonhematologic toxic effects included nausea, vomiting, asthenia, rash, and transitory elevations of liver transaminases. Furthermore, symptomatic improvement was documented in 14 cases, whereas CT scanning detected radiologic improvement in 10 patients. Patients received a median number of 6 courses of treatment. Median time to progression was almost 1 year, whereas median survival time was 410 days, a significant improvement over the 9-12 month survival of historic controls. Phase 2 trials with single agent pemetrexed disodium, as well as a randomized trial with pemetrexed disodium in combination with cisplatin, are currently ongoing.

Implications for Clinical Practice

Clearly, much work needs to be done before a standard treatment for MPM is defined. Until then, clinicians are urged to enroll such patients in randomized clinical trials whenever possible in order to further our understanding and refine our treatment approaches. Expanding our knowledge of the biology and molecular makeup of malignant mesothelioma will likely lead to more selective and specific therapies, even if more promising modalities remain elusive for the time being

Mesothelioma Statistics by Country

2008-06-18T06:52:00.000-07:00

Mesothelioma Statistics by Country

Country/Region	Extrapolated Incidence	Population Estimated Used
Mesothelioma in North America (Extrapolated Statistics)
USA	2,755	293,655,405¹
Canada	305	32,507,874²
Mexico	984	104,959,594²
Mesothelioma in Central America (Extrapolated Statistics)
Belize	2	272,945²
Guatemala	133	14,280,596²
Nicaragua	50	5,359,759²
Mesothelioma in Caribbean (Extrapolated Statistics)
Puerto Rico	36	3,897,960²
Mesothelioma in South America (Extrapolated Statistics)
Brazil	1,727	184,101,109²
Chile	148	15,823,957²
Colombia	397	42,310,775²
Paraguay	58	6,191,368²
Peru	258	27,544,305²
Venezuela	234	25,017,387²
Mesothelioma in Northern Europe (Extrapolated Statistics)
Denmark	50	5,413,392²
Finland	48	5,214,512²
Iceland	2	293,966²
Sweden	84	8,986,400²
Mesothelioma in Western Europe (Extrapolated Statistics)
Britain (United Kingdom)	565	60,270,708 for UK²
Belgium	97	10,348,276²
France	566	60,424,213²
Ireland	37	3,969,558²
Luxembourg	4	462,690²
Monaco	0	32,270²
Netherlands (Holland)	153	16,318,199²
United Kingdom	565	60,270,708²
Wales	27	2,918,000²
Mesothelioma in Central Europe (Extrapolated Statistics)
Austria	76	8,174,762²
Czech Republic	11	1,0246,178²
Germany	773	82,424,609²
Hungary	94	10,032,375²
Liechtenstein	0	33,436²
Poland	362	38,626,349²
Slovakia	50	5,423,567²
Slovenia	18	2,011,473 ²
Switzerland	69	7,450,867²
Mesothelioma in Eastern Europe (Extrapolated Statistics)
Belarus	96	10,310,520²
Estonia	12	1,341,664²
Latvia	21	2,306,306²
Lithuania	33	3,607,899²
Russia	1,350	143,974,059²
Ukraine	447	47,732,079²
Mesothelioma in the Southwestern Europe (Extrapolated Statistics)
Azerbaijan	73	7,868,385²
Portugal	98	10,524,145²
Spain	377	40,280,780²
Georgia	44	4,693,892²
Mesothelioma in the Southern Europe (Extrapolated Statistics)
Italy	544	58,057,477²
Greece	99	10,647,529²
Mesothelioma in the Southeastern Europe (Extrapolated Statistics)
Albania	33	3,544,808²
Bosnia and Herzegovina	3	407,608²
Bulgaria	70	7,517,973²
Croatia	42	4,496,869²
Macedonia	19	2,040,085²
Romania	209	22,355,551²
Serbia and Montenegro	101	10,825,900²
Mesothelioma in Northern Asia (Extrapolated Statistics)
Mongolia	25	2,751,314²
Mesothelioma in Central Asia (Extrapolated Statistics)
Kazakhstan	142	15,143,704²
Tajikistan	65	7,011,556 ²
Uzbekistan	247	26,410,416²
Mesothelioma in Eastern Asia (Extrapolated Statistics)
China	12,187	1,298,847,624²
Hong Kong s.a.r.	64	6,855,125²
Japan	1,194	127,333,002²
Macau s.a.r.	4	445,286²
North Korea	212	22,697,553²
South Korea	452	48,233,760²
Taiwan	213	22,749,838²
Mesothelioma in Southwestern Asia (Extrapolated Statistics)
Turkey	646	68,893,918²
Mesothelioma in Southern Asia (Extrapolated Statistics)
Afghanistan	267	28,513,677²
Bangladesh	1,326	141,340,476²
Bhutan	20	2,185,569²
India	9,993	1,065,070,607²
Pakistan	1,493	159,196,336²
Sri Lanka	186	19,905,165²
Mesothelioma in Southeastern Asia (Extrapolated Statistics)
East Timor	9	1,019,252²
Indonesia	2,237	238,452,952²
Laos	56	6,068,117²
Malaysia	220	23,522,482²
Philippines	809	86,241,697²
Singapore	40	4,353,893²
Thailand	608	64,865,523²
Vietnam	775	82,662,800²
Mesothelioma in the Middle East (Extrapolated Statistics)
Gaza strip	12	1,324,991²
Iran	633	67,503,205²
Iraq	238	25,374,691²
Israel	58	6,199,008²
Jordan	52	5,611,202²
Kuwait	21	2,257,549²
Lebanon	35	3,777,218²
Saudi Arabia	242	25,795,938²
Syria	169	18,016,874²
United Arab Emirates	23	2,523,915²
West Bank	21	2,311,204²
Yemen	187	20,024,867²
Mesothelioma in Northern Africa (Extrapolated Statistics)
Egypt	714	76,117,421²
Libya	52	5,631,585²
Sudan	367	39,148,162²
Mesothelioma in Western Africa (Extrapolated Statistics)
Congo Brazzaville	28	2,998,040²
Ghana	194	20,757,032²
Liberia	31	3,390,635²
Niger	106	11,360,538²
Nigeria	166	12,5750,356²
Senegal	101	10,852,147²
Sierra leone	55	5,883,889²
Mesothelioma in Central Africa (Extrapolated Statistics)
Central African Republic	35	3,742,482²
Chad	89	9,538,544²
Congo kinshasa	547	58,317,030²
Rwanda	77	8,238,673²
Mesothelioma in Eastern Africa (Extrapolated Statistics)
Ethiopia	669	71,336,571²
Kenya	309	32,982,109²
Somalia	77	8,304,601²
Tanzania	338	36,070,799²
Uganda	247	26,390,258²
Mesothelioma in Southern Africa (Extrapolated Statistics)
Angola	103	10,978,552²
Botswana	15	1,639,231²
South Africa	417	44,448,470²
Swaziland	10	1,169,241²
Zambia	103	11,025,690²
Zimbabwe	34	1,2671,860²
Mesothelioma in Oceania (Extrapolated Statistics)
Australia	186	19,913,144²
New Zealand	37	3,993,817²
Papua New Guinea	50	5,420,280²

About extrapolations of prevalence and incidence statistics for Mesothelioma:

These statistics are calculated extrapolations of various prevalence or incidence rates against the populations of a particular country or region. The statistics used for prevalence/incidence of Mesothelioma are typically based on US, UK, Canadian or Australian statistics. This extrapolation calculation is automated and does not take into account any genetic, cultural, environmental, social, racial or other differences across the various countries and regions for which the extrapolated Mesothelioma statistics below refer to. As such, these extrapolations may be highly inaccurate (especially for developing or third-world countries) and only give a general indication (or even a meaningless indication) as to the actual prevalence or incidence of Mesothelioma in that region.

About prevalence and incidence statistics in general for Mesothelioma:

The word 'prevalence' of Mesothelioma usually means the estimated population of people who are managing Mesothelioma at any given time (i.e. people with Mesothelioma). The term 'incidence' of Mesothelioma means the annual diagnosis rate, or the number of new cases of Mesothelioma diagnosed each year (i.e. getting Mesothelioma). Hence, these two statistics types can differ: a short disease like flu can have high annual incidence but low prevalence, but a life-long disease like diabetes has a low annual incidence but high prevalence.

Mesothelioma in the United States

2008-06-18T06:46:00.000-07:00

Mesothelioma in the United States

	ABSTRACT

Using 1973–2000 mesothelioma incidence data released by the Surveillance, Epidemiology, and End Results Program in April 2003, the authors estimated the parameters of a birth-cohort and age model to determine whether previously reported patterns of mesothelioma in the United States have changed. Compared with analyses based on data through 1992, a slower decline was found in male cases immediately after a peak in 2000–2004, but no other notable changes in the time pattern were detected. Analysis confirmed that the annual number of male mesothelioma cases, which increased steeply from the 1970s through the mid-1990s, has leveled off in terms of both the age-adjusted rate and the absolute numbers of cases. After a peak of approximately 2,000 cases, a return to background levels is expected by 2055. The total projected number of male mesothelioma cases in 2003–2054 is approximately 71,000. The maximum lifetime risk for males, which occurs for the 1925–1929 birth cohort, is 1.8 x 10–3. The age-adjusted rate for females is constant, as are the female lifetime mesothelioma risk across birth cohorts (3.6 x 10–4) and the annual risk (3.9 x 10–6). The time pattern of cases for females supports the existence of a threshold exposure for mesothelioma and a quantifiable background rate.

asbestos; incidence; mesothelioma

Abbreviations: Abbreviation: SEER, Surveillance, Epidemiology, and End Results.

	INTRODUCTION

Mesothelioma incidence often is interpreted as an indicator of exposure to asbestos. Projections of the number of mesothelioma cases over time may be used to evaluate various asbestos health management interventions including exposure limits and products bans. Mesothelioma projections also provide a foundation for estimating the number of potential lawsuits from persons claiming occupational exposure to asbestos or exposure resulting from use of previously manufactured asbestos-containing products. Noting recent publications discussing mesothelioma incidence in North America and that projected numbers of future mesothelioma cases in the Netherlands, Sweden, and the United Kingdom have been adjusted based on new data (1–4), we analyzed current Surveillance, Epidemiology, and End Results (SEER) Program data (5) to update mesothelioma trends in the United States.

	MATERIALS AND METHODS

We applied maximum likelihood estimation (6) to SEER data (5) to estimate the parameters of a birth-cohort and age model (7). The SEER database contains information on cancer incidence in the United States by year of diagnosis and age from nine cancer registries for 1973 through 1991 and 11 registries for 1992 through 2000. The SEER registries represent 14 percent of the US population, are similar to the United States regarding measures of poverty and education, and tend to be more urban than the general US population (8–10). For males and females, we extracted counts of mesothelioma cases and corresponding population counts for each year and each 5-year age interval from 0–4 through 85 years or older. These data were realigned into 5-year birth-cohort categories (1885–1889 through 1970–1974).

Incidence estimates calculated from the model were combined with mortality rates for all causes in a survival analysis to calculate, for each birth cohort, the probability of mesothelioma occurring in each 5-year age interval, conditioned on cancer-free survival to that age interval (11). These probabilities were used to calculate the lifetime risk of mesothelioma for each birth cohort.

For all-cause mortality, we created a table of cohort mortality rates by 5-year age interval for each birth cohort. The cohort mortality rates were developed from two sources: 1) cross-sectional mortality rates for 5-year age intervals from the SEER system, years 1969–2000 (12); and 2) cross-sectional mortality rates by 10-year age intervals for individual years 1900 through 1968 (13). We factored the 10-year age intervals into two 5-year intervals and then realigned the results to form a table of cohort mortality rates for birth cohorts 1900–1904 through 1995–1999.

To project the annual number of future mesothelioma cases, we required natality data (14), mesothelioma probabilities for each age interval, and all-cause mortality rates for future birth cohorts. The number of births for all future birth cohorts was set equal to the number of births reported for the most recent birth cohort, 1995–1999.

Future birth-cohort mesothelioma probabilities for females, starting with the 1965–1969 cohort, were set to the average of past probabilities for females, which have been relatively constant since the 1900–1904 birth cohort. Mesothelioma probabilities for males have been declining toward those for females. Therefore, probabilities for males in future birth cohorts starting with 1965–1969 were set equal to the averages for females, which we interpreted as background rates for mesothelioma. All-cause mortality rates for the year 2000 were used for all future birth cohorts.

	RESULTS

Trend in age-adjusted rates
The age-adjusted incidence (figure 1) indicates a consistently higher rate for males versus females across all years, an increasing trend over the years for males, and a virtually constant rate for females. Accounting for a latency period of 20–40 years for mesothelioma, the increased incidence for males reflects the increased use of asbestos (15) in the United States (figure 2) and the high levels of occupational exposure prior to the late 1960s, when formal workplace exposure limits were established. The age-adjusted rate for males was flat from 1990 through 2000. Projections of future male mesothelioma cases, discussed later, indicate that the number of male cases per year has peaked and is declining.

FIGURE 1. Age-adjusted incidence rates of mesothelioma (pleural + peritoneal) in the United States based on Surveillance, Epidemiology, and End Results Program data released in April 2003.

FIGURE 2. Asbestos use (consumption) in the United States and projected numbers of male and female mesothelioma cases based on a birth-cohort and age model estimated from Surveillance, Epidemiology, and End Results (SEER) Program data for two periods, 1973–1992 and 1973–2000..

Comparison of trends: data for 1973–1992 versus 1973–2000
A direct comparison of mesothelioma trends based on current data with trends published by Price (7) would not be meaningful because the SEER data have changed since 1992. Two registries were added starting with 1992 data, and mesothelioma counts for the years 1973 through 1991 have been corrected. Therefore, our modeling is based on the current SEER database, first using cases diagnosed from 1973 through 1992 and then using all cases, 1973 through 2000.

Model fits
For each data set (males, females; two time intervals), the predicted values tracked the observed values reasonably well, although there were a few data points with large deviances. The 1973–1992 data sets had 80 data points; the 1973–2000 data sets had 101 data points. When the large deviances were excluded, the statistical fits were acceptable (p > 0.05 based on total deviance) for each model. The numbers of data points remaining were, for 1973–1992, 79 for males and 80 for females and, for 1973–2000, 92 for males and 99 for females.

Lifetime risk of mesothelioma
For females, the lifetime risk of mesothelioma is approximately constant at 3.6 x 10–4 (figure 3). The lifetime risk for males (1973–1992 data, not shown) is a maximum of 2.1 x 10–3 for the 1925–1929 birth cohort and then declines sharply for subsequent cohorts, except for an isolated increase for the 1940–1944 cohort. Regarding the 1973–2000 data, the maximum risk is 1.8 x 10–3 (figure 3). The trend is relatively flat before starting downward after the 1940–1944 cohort.

FIGURE 3. Lifetime probability (risk) of mesothelioma (pleural + peritoneal) and 95% confidence intervals (vertical bars) based on a birth-cohort and age model estimated from 2003 Surveillance, Epidemiology, and End Results Program data covering 1973–2000

Projected number of mesothelioma cases
For the two data sets, mesothelioma projections for females (figure 2) are virtually identical. Although the age-adjusted rate for females is constant, the number of mesothelioma cases increases slightly over time as a function of population size and shifting age distribution. Currently (2003), the annual estimate of female mesothelioma cases is approximately 560.

The trend for males in both data sets peaks in the 2000–2004 time frame at slightly more than 2,000 mesothelioma cases (figure 2). The 1973–2000 model shows fewer mesothelioma cases than the 1973–1992 model during the peak years, but not overall. The total numbers of male mesothelioma cases projected for 2003 through 2054 are 70,990 for the 1973–2000 data and 73,892 for the 1973–1992 data.

	DISCUSSION

Overall, there have been no substantive changes in the time pattern of mesothelioma incidence in the United States since 1992. This conclusion would not be apparent if the current results using SEER data for 1973–2000 were compared with the results published by Price (7) that were based on SEER data for 1973 through 1992. That estimated model (7) showed a sharper decline in the number of annual male mesothelioma cases, projecting approximately 7,000 fewer cases between 2003 and 2054, than the model based on the most current data. However, a comparison to the Price results (7) would not be meaningful because of changes in SEER data and application of the cohort mortality rates used here. Therefore, it was necessary to reestimate the model using revised data through 1992 for comparison to the model based on current data through 2000. This comparison indicated no substantive change in the time pattern or number of future cases.

In addition to describing the time pattern of mesothelioma incidence, our results contain information about the potential effects of environmental exposures to asbestos and two related issues: 1) the existence of an exposure threshold and 2) the existence and magnitude of a background rate (i.e., mesotheliomas not associated with asbestos exposure). (In this discussion, threshold does not mean an exposure below which the risk of mesothelioma is zero; the threshold is an asbestos exposure level associated with a negligible incremental risk of mesothelioma.)

The constancy alone of the mesothelioma risk for females over time supports the existence of a threshold exposure. The effects, if any, of environmental exposures for the US population as a whole cannot be observed for males; as a group, males experienced high occupational exposures that masked low-exposure effects. In contrast, female exposures to asbestos have been primarily environmental. In the 1930s through the 1960s, women generally did not work in industries in which men experienced high levels of exposure to asbestos. For some women, exposures have been domestic (i.e., they live in households with men who were exposed occupationally), but the number of women with high levels of domestic exposure, although not zero, would have been relatively small. However, all women were exposed to asbestos in the environment, an exposure that would have increased since the 1930s, especially the dramatic increase during the 40-year period from 1930 to 1970 in the amount of asbestos used in US products (figure 2). As use increased, higher environmental exposures would have resulted from asbestos mining, manufacturing, and product use (e.g., vehicle brake systems, construction materials, and other asbestos-containing products) during this period and beyond for as long as the asbestos-containing products were in use.

Nevertheless, the mesothelioma risk for women has not increased. The age-adjusted mesothelioma rate for females was constant at an average of approximately 0.30 per 100,000 between 1973 and 1982, when it showed a one-time increase to 0.40 per 100,000 (figure 1). One might be tempted to interpret this change as a response to increasing environmental exposure. However, the female rate, which should have continued to increase after 1982 if the environmental exposure explanation is correct, remained constant after 1982. Therefore, the one-time mesothelioma increase for females does not indicate increasing exposure to asbestos in the environment but more likely a diagnostic effect. Environmental exposure levels, although increasing, have not triggered a risk response in women. Therefore, those exposure levels must have been below a threshold for mesothelioma.

A threshold higher than typical environmental asbestos exposures, as argued above, implies the existence of background mesotheliomas caused by agents other than asbestos that could account for most, if not all, female cases of mesothelioma. A number of studies provide evidence of background mesotheliomas (16–28). Simian virus 40 (SV40) is one of the nonasbestos agents that has been identified as a possible cause of mesothelioma (29, 30). Simian virus 40 was a contaminant in polio vaccines administered to 10–30 million people in the United States, mostly children, between 1955 and 1963 (30). It has not been determined whether simian virus 40 acting alone can cause mesothelioma (30). Our analysis does not indicate an increased risk in the 1955–1959 or 1960–1964 birth cohorts, those most likely to have received the contaminated vaccine (refer also to Strickler et al. (31)).

If all female cases of mesothelioma were unrelated to asbestos exposure, our analysis indicates that the lifetime background risk would be 3.6 x 10–4 (figure 3) and the current annual risk would be approximately 4 per million (over 5 per million if the population at risk is aged 20 years). These background risk levels would be upper bounds if a portion of female cases of mesothelioma were due to occupational, domestic, or unique high environmental exposures.

The background rates for females may not apply directly to males because the percentages of pleural and peritoneal mesotheliomas are different for men and women. In the SEER database, peritoneal mesotheliomas account for 7 percent of all mesotheliomas in males but 17 percent of all mesotheliomas in females. It is possible that peritoneal mesotheliomas in women are of two types but cannot be distinguished histologically: 1) those that are similar to mesotheliomas in males and 2) those that are unique, as evidenced in part by longer survival times of the cases (32; Andrew Churg, University of British Columbia, personal communication, 2002). On the basis of the differences between cases of mesothelioma in males and females, an adjustment to the background rates suggested above for females would be required if they were to be applied for males. For example, if all peritoneal mesotheliomas in females were excluded, the annual background rate for males would be 83 percent of the background rate for females.

The mesothelioma epidemic in the United States, which is beginning to recede, has been a consequence of ongoing high-level occupational exposure to asbestos from the 1930s through the 1960s in workplaces populated almost exclusively by males. Asbestos regulations promulgated by the US Occupational Safety and Health Administration (OSHA) in the early 1970s have led to dramatic reductions in exposure. These reductions are reflected in the pattern of mesothelioma incidence in the SEER data and were magnified through our modeling and analysis. It is unlikely that low environmental exposure to asbestos, or any other type of low-level asbestos exposure, is associated with more than a negligible risk of mesotheliom

Symptoms of Mesothelioma

2008-06-16T08:28:00.000-07:00

Seeking Medical help

Mesothelioma can develop between 15 and 40 years or more after an exposure to asbestos. If you have been exposed to asbestos in the past and you start to suffer from any of the following symptoms you should visit your GP and mention your concerns:

* Pains in the lower back, abdomen or chest
* A persistent cough
* Breathing difficulties, shortness of breath or a feeling of tightness in the chest
* Rapid weight loss
* Problems with appetite or difficulty swallowing
* Sweating, fevers, diarrhoea or constipation
* Nausea or vomiting
* Swelling of the abdomen

Some people with mesothelioma have no symptoms at all in the early stages; therefore, if you know that you have been exposed to asbestos in the past and believe it may be the cause of your symptoms, it is always a good idea to visit a doctor for medical advice. Any damage caused by asbestos may be possible to detect with a scan or x-ray

Workers most at risk from developing Mesothelioma

2008-06-16T08:25:00.000-07:00

Professions where asbestos was commonplace

At Thompsons Solicitors, we have helped many victims of asbestos to make mesothelioma claims. Due to the fact that we have dealt with so many of these mesothelioma claims we have seen a pattern develop showing the workers most at risk from developing mesothelioma and some of these are listed below.

Boilermakers and Laggers - It was commonplace for boilers to be insulated with asbestos lagging. Boilermakers also work alongside the contractors (laggers) who install and renew asbestos boiler insulation. This type of work has put boilermakers and laggers at a particularly high risk of developing mesothelioma.

Electricians - are at risk of developing mesothelioma because they also worked alongside laggers. Electricians also often have to cut or drill through asbestos insulation to install cable trays, instruments, switches and wiring systems.

Joiners and Carpenters and Builders - are also at risk of developing mesothelioma as a result of sawing, drilling and fixing or replacing asbestos cement board often used in partition walls, suspended ceilings, flooring, roof tiles and thermal insulation.

Motor Mechanics - may have been exposed to asbestos as it was frequently used in brake pads and clutches. This has put some Motor Mechanics at risk of developing mesothelioma.

Pipe Fitters and Plumbers - install, maintain and repair pipes, boilers and heating systems. The nature of their work means that they have to cut or drill through walls as well as cutting and assembling sections of pipe, removing and replacing damaged sections of pipe, valve and flanges etc. All of these tasks put them at risk of developing mesothelioma as pipes frequently used to be covered with asbestos lagging. As the pipes were cut, fibres from the asbestos lagging were released into the air and inhaled by the pipefitter or plumber.

Victims of mesothelioma are certainly not limited to the professions mentioned above. Our specialist mesothelioma solicitors have helped victims of this asbestos related disease with their mesothelioma claims who have worked in many other professions including fire fighters, teachers, police officers, managers and a professor.

Mesothelioma - Innovations in Treatment

2008-06-08T08:20:00.000-07:00

Mesothelioma - Innovations in Treatment
Doctors and researchers are always on the lookout for new ways to treat malignant mesothelioma. The following innovations in treatment, while not a cure for malignant mesothelioma, show some promise in helping to treat the disease.

Mesothelioma - Alimta

Alimta, when given with another chemotherapy drug called cisplatin, is a chemotherapy drug recently approved by the FDA for the treatment of patients with malignant pleural mesothelioma.

Mesothelioma - Photodynamic Therapy

Photodynamic therapy uses special drugs and a special type of light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into the patient’s vein several days before surgery. During surgery, a special light is used to locate the cancer. This treatment is being studied for early stages of malignant mesothelioma.

Mesothelioma - Immunotherapy

This type of treatment harnesses the power of the body’s own immune system. Immunotherapy is currently being researched as a treatment for malignant mesothelioma.

Mesothelioma - Gene Therapy

In studies of gene therapy for cancer, the goal is to improve the body’s natural ability to fight malignant mesothelioma directly or to make the cancer cells more sensitive to other kinds of therapy.

Mesothelioma - Brachytherapy

Brachytherapy is radiation therapy applied from within the body as opposed to from a machine outside the body. Radioactive sources are placed in or near the tumor, giving a high radiation dose to the tumor while reducing the radiation exposure in surrounding healthy tissues. This precision can help to minimize side effects.

Mesothelioma - Clinical Trials

A clinical trial (also clinical research) is a research study using human volunteers to answer specific health questions. Carefully conducted clinical trials help discover treatments that work in people and ways to improve health. Interventional trials determine whether experimental treatments or new ways of using known therapies are safe and effective under controlled environments. Observational trials address health issues in large groups of people or populations in natural settings. If you are interested in participating in a clinical trial, talk to your doctor about whether a clinical trial may be an appropriate option in your case.

Mesothelioma - Phase I

Phase I trials are considered the first step in testing the safety and efficacy of a new drug. Doctors and researchers are trying to determine many things about the drug’s effect on the disease and on the patient. Among the things that researchers are trying to determine are correct dosage, safety profile, and any side effects.

Mesothelioma - Phase II

At this stage, researchers select a relatively small group of patients to study the specific effects of the pre-determined dosage. Phase II studies also typically focus on a specific type of disease.

Mesothelioma - Phase III

During Phase III testing, researchers compare the effectiveness of the new, experimental drug against already existing therapies. Usually, patients are randomly assigned to therapeutic groups to cut down on the possibility of human bias. Phase III trials can be large, recruiting patients from across the country.

Pain Management

2008-06-08T08:18:00.000-07:00

Here are some suggestions provided by www.cancer-pain.org to help you work effectively with your health care providers in assessing your pain:

* Put it in writing. If possible, written notes about your pain (see Pain Diary, below) are valuable in giving accurate and comprehensive information.
* Plan to ask questions. It’s important that you fully understand what your health care professional says to you about your pain. Ask questions until you are satisfied that you understand.
* Have a notetaker. Sometimes it’s difficult to talk about your pain, ask questions and take notes on what’s being said to you all at the same time, especially if you are in pain. Bringing a friend or family member to take notes during the discussion about your pain can provide a valuable resource for you once the conversation has ended.
* Make your views heard. Don’t hesitate to offer an opinion about what may be causing or contributing to your pain. No one knows your body as well as you, and your insights can be valuable to your health care providers.
* These are points to consider as you prepare to discuss your pain and its management with your health care providers:
o The location of all of your pains.
o How the pain feels (use descriptive words such as dull, aching, throbbing, stabbing, piercing, pinching, sharp, aching, burning, tingling).
o The intensity of your pain (when it is at its worst) and whether the intensity changes throughout the day and night.
o When you have the pain (all the time or occasionally).
o How quickly the pain comes on (suddenly or intermittently), how long it lasts (a few minutes or several hours), and how often it occurs.
o What makes the pain worse? Describe conditions under which the pain becomes more intense, such as moving, walking, talking, coughing, laying down, eating, going to the bathroom, etc.
o What eases the pain? Be ready to discuss anything that has helped you, including medication(s) you have been using, and the amounts you are taking.
* Medications you are taking. Tell them about your pain medications, including any over-the-counter pain relievers, any alternative medications like herbs, and any medications you may be taking for other health conditions not related to cancer.
* Side effects of your pain medications. Tell them what side effects you are experiencing, how the side effects are currently being treated, and if you are satisfied with this treatment.
* Quality of life issues: What impact does the pain have on your quality of life? Can you work, enjoy your family and friends, eat and sleep well? If not, describe how the pain is limiting your activities. Also, tell your health care provider(s) what you want from pain management in terms of quality of life.
* To keep an accurate record of what you are experiencing, consider creating a simple pain diary. You can do this in a notebook, recording information such as the date, time of day, level of pain you are feeling, what you did to remedy or alleviate it (i.e., medications taken, use of ice or heat, and so forth), and the outcome of your efforts to control the pain (Did the medication work? For how long? Were there side effects?)

Many health care professionals also use various “pain assessment scales” to record patients’ levels of pain. You can use this system, as well, in conversation with your health care provider. Make sure you always use the SAME scale when describing your pain, for consistency and clarity. One of the simplest involves describing your pain level in terms of numbers: “0″ means “no pain at all,” and “10″ means “the worst possible amount of pain.” The higher the number, the greater the pain. If your health care provider uses a different assessment measuring approach, you may want to use that one. Ask for an explanation of how she or he records patient pain levels.

Mesothelioma and Asbestos

2008-06-08T08:17:00.000-07:00

Mesothelioma is a rare form of cancer caused by exposure to asbestos. Asbestos is a naturally-occurring fiber that, when released into the air, can be inhaled or swallowed. Asbestos has no smell or taste, and asbestos fibers are so small that they are not visible to the naked eye. Asbestos fibers can “stick” in the lung, abdomen and other body tissues and over time, lead to the development of asbestos-related diseases like mesothelioma. There is a long latency period between asbestos exposure and the development of mesothelioma; in other words, decades may pass after a person’s first exposure to asbestos before he or she becomes ill. A person who has been diagnosed with asbestosis (a non-cancerous scarring of the lungs) is at an increased risk of developing mesothelioma in the future.

Millions of people in the U.S. have been exposed to asbestos, and it is estimated that approximately 3,000 people are diagnosed with mesothelioma each year. In these pages, you will read about asbestos and the common ways in which people have been exposed to asbestos.

Pericardial Mesothelioma: Diagnosis

2008-06-08T08:15:00.000-07:00

Pericardial mesothelioma is also known as mesothelioma of the pericardium or cancer of the sac that holds the heart. Your doctor may diagnose pericardial mesothelioma using a thoracoscope to perform a thoracoscopy, which might also involve opening up the chest cavity to remove the tumor.

Patients who develop excessive fluid around the heart, called an effusion, may have a sample of the fluid taken to diagnose pericardial mesothelioma.

Peritoneal Mesothelioma: Diagnosis

2008-06-08T08:14:00.000-07:00

One way doctors diagnose peritoneal mesothelioma is by looking inside the abdominal cavity with an instrument called a peritoneoscope. In this procedure, a cut is made through the abdomen wall and the peritoneoscope is placed into the abdomen. This test, called a peritoneoscopy, is usually performed in the hospital. Some patients develop excessive fluid in the abdomen. This is called an effusion or ascites. A doctor may take a sample of such fluid to diagnose peritoneal mesothelioma.

Pleural Mesothelioma: Diagnosis

2008-06-08T08:10:00.000-07:00

Your doctor may perform some of the following procedures to diagnose pleural mesothelioma.

CT scan

This type of X-ray provides a very detailed picture of the size and location of the cancer. The images taken are compiled by a computer to create a more complete image of the disease. The procedure is also called a computerized axial tomography (CAT) scan.

PET scan

A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.

Thoracoscopy

The diagnosis of malignant pleural mesothelioma may involve your doctor looking inside the chest cavity with an instrument called a thoracoscope. For this procedure, an incision is made through the chest wall and the thoracoscope is put into the chest between two ribs. This procedure is usually done in the hospital.

Bronchoscopy

A bronchoscopy involves an examination of the lungs and air passages. The doctor places a lighted tube down the patient’s throat and trachea into the lungs. This procedure is called a bronchoscopy, and the instrument used is called a bronchoscope.

Thoracentesis

Some patients develop fluid in their lungs. This is called a pleural effusion. Your doctor might take a sample of this fluid with a needle injected into the chest and test the fluid for cancer cells. Your doctor may also perform this procedure for draining fluid from the lungs to help relieve pain.

Mediastinoscopy

This is a test that examines the mediastinum. This area is in the center of your chest, between your lungs, and contains the heart, blood vessels and lymph nodes.

Needle Biopsy

For this procedure, the doctor uses a thin needle to take samples of cells for examination under microscope. This test can be uncomfortable but may take only a few minutes. Small pieces of the tissue are taken and then sent to a laboratory for analysis.

The doctor might also use an X-ray, CT scan or fluoroscopy to guide the needle as it is inserted into the tumor. Fluoroscopy is a diagnostic procedure in which X-rays are passed through the body and then projected onto a screen, providing a continuous image of the body’s internal structures.

Wedge Biopsy

For this procedure, a doctor makes an incision through the skin, and a wedge of tissue or tumor is obtained and sent to a laboratory for analysis. A wedge biopsy is often used when other biopsy methods have been unable to confirm a diagnosis.

Cytology and Pathology

Pathology is a study of a disease, which looks at specific cells and types of a disease process to determine the cause. Pathology tests are performed on samples of body fluid or tissue to determine the cell type (cytology) of a specific disease. The process of looking at these samples may include using microscopes, electron microscopes and various stains. This refers to special cell-staining techniques that identify specific types of malignant mesothelioma tumors. Certain types of dyes or coloring are added to the patient’s biopsy samples. Depending on how the tissue responds to the dye, the doctor can make a better estimate about the outcome of the illness. In making the diagnosis, the more information the doctor has about the tumor, the better he or she can recommend appropriate treatment.

After your biopsy, a sample of the tissue or fluid removed may be sent to a hospital laboratory to be analyzed.

* If fluid is removed during a thorancentesis or thorascopy, it is sent to a Cytology lab for analysis. Your doctor will receive a written report of the results. The doctor may receive an oral report from the lab prior to the written results.

* If a tissue biopsy from a bronchoscopy, needle biopsy or thorascopy is done, it is sent to a surgical pathology lab for analysis. The final report will be sent to your doctor.

* Surgical removal of a tumor, pleura or lung is sent to a surgical pathology lab. In the lab the material is analyzed with special stains. The material may be placed under a microscope for magnification and further review to determine the cell type. After analysis is completed, small pieces of any remaining tissue are preserved in paraffin for future us

Diagnosis of various types of mesothelioma.

2008-06-08T08:00:00.000-07:00

Diagnosis is the process of determining the kind of disease that is present. An accurate diagnosis is important because it helps to determine the type of treatment that you will undergo.

Your doctors may use a number of procedures to aid in the diagnosis of mesothelioma. The most common of those procedures are listed here. Whether one or a combination of these tests are conducted in a given patient’s case will depend on factors unique to the patient. Some tests might first be conducted to determine whether a biopsy should be performed. A biopsy is usually necessary to confirm a diagnosis.

For your reference, a word with “-scopy” at the end refers to the use of a scope or viewing instrument that can be used to look directly inside the body at the abnormal or suspected area. A word that ends in “-ectomy” refers to the removal of tissue through surgery.

Pleural Mesothelioma

Peritoneal Mesothelioma

Pericardial Mesothelioma

Cell Types of Mesothelioma

2008-06-08T07:57:00.000-07:00

A patient’s doctor or medical records may refer to the “cell type” of the malignant mesothelioma. This refers to the type of tissue where the cancer first developed. For example, “epithelial” malignant mesothelioma refers to cancerous cells that develop in the “epithelium,” which is the membrane lining of the lung, heart, or abdomen. In contrast, “sarcomatous” malignant mesothelioma arises in connective tissue. “Biphasic” refers to malignant mesothelioma that arises in two different cell types. Other cell types of malignant mesothelioma are lymphohistiocytoid and desmoplastic.

What is Pericardial Mesothelioma

2008-06-08T07:55:00.000-07:00

Pericardial mesothelioma is also known as mesothelioma of the pericardium or cancer of the sac that holds the heart.

Your doctor may diagnose this cancer using a thoracoscope to perform a thoracoscopy, which might also involve opening up the chest cavity to remove the tumor.

Patients who develop excessive fluid around the heart, called an effusion, may have a sample of the fluid taken to diagnose pericardial mesothelioma. Fluid might also be drained to relieve symptoms of pericardial mesothelioma. The procedure for drawing out this fluid is called “pericardiocentesis.”

For more information about the diagnosis of this disease, click here.

Symptoms

Symptoms can include chest pain and shortness of breath. The tumor and/or fluid that accumulates between the heart and the sac can compress the heart, causing such symptoms

What is Peritoneal Mesothelioma

2008-06-08T07:52:00.000-07:00

Peritoneal mesothelioma, also known as cancer of the peritoneum, is a cancer of the abdominal lining.

One way doctors diagnose peritoneal mesothelioma is by looking inside the abdominal cavity with an instrument called a peritoneoscope. In this procedure, a cut is made through the abdomen wall and the peritoneoscope is placed into the abdomen. This test, called a peritoneoscopy, is usually performed in the hospital.

Some patients develop excessive fluid in the abdomen. This is called an effusion or ascites. A doctor may take a sample of such fluid to diagnose peritoneal mesothelioma. Fluid in the abdomen might also be drained to relieve symptoms of peritoneal mesothelioma. The procedure for drawing out this fluid is called “paracentesis”.

For more information about the diagnosis of this disease, click here

Symptoms

The symptoms of this cancer may include stomach pain, weight loss, nausea, vomiting, hernia, fluid in the abdominal cavity or a mass in the abdomen.

What isn Pleural Mesothelioma

2008-06-08T07:51:00.000-07:00

Pleural mesothelioma, also known as mesothelioma of the pleura, is a tumor of the lining surrounding the lungs. The pleura is a thin tissue around the lungs and the inside of the chest. In order to protect the lungs, the pleura produces a small amount of fluid which helps cushion the lungs, making the lungs move more smoothly during breathing.

Benign (Non-Cancerous) pleural mesothelioma

Benign pleural mesothelioma is a non-cancerous tumor that has not spread to other organs of the body. If the tumor is large, it may squeeze the lung itself and cause shortness of breath and pain.

Malignant Pleural Mesothelioma

Malignant Pleural mesothelioma is cancerous and can spread to other parts of the body. This rare form of cancer is found in the pleural sac lining of the lung. Exposure to asbestos is considered the primary cause of pleural mesothelioma.

Symptoms

Pleural mesothelioma may include shortness of breath, chest pain, back pain, pain in the rib cage, fluid build-up in the lung lining, hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, paralysis and sensory loss.

Types and Symptoms of Mesothelioma

2008-06-08T04:44:00.000-07:00

Mesothelioma is a form of cancer that develops in the lining around the lungs (the “pleura”), abdomen (the “peritoneum”), or heart (the “pericardium”).
Mesothelioma is almost always caused by exposure to asbestos. In contrast, lung cancer refers to a malignancy of the lung itself.

This section is not intended as a tool for self-diagnosis, nor is it intended to be a substitute for consulting with a doctor who specializes in the diagnosis and treatment of mesothelioma. This section is merely designed to help you learn about mesothelioma.

Pleural Mesothelioma

Peritoneal Mesothelioma

Pericardial Mesothelioma

Cell Types of Mesothelioma

Mesothelioma and Lung Cancer

2008-06-08T04:42:00.000-07:00

Pleural mesothelioma and lung cancer are both serious illnesses, but they are not the same. Pleural mesothelioma – sometimes called “asbestos lung cancer” – is really not a form of lung cancer, but a cancer of the lining that surrounds the lung.

A main difference between lung cancer and mesothelioma is that lung cancer is in the tissue of the lung. By contrast, pleural mesothelioma occurs in the lining around the lung.

Smoking is often considered a primary cause of lung cancer, while asbestos exposure is considered a primary cause of mesothelioma. Asbestos exposure may also be associated with lung cancer. Smoking is not linked to mesothelioma, however. Those exposed to asbestos and who smoke are as much as 90 times more likely to be develop lung cancer than those who don’t smoke.

Mesothelioma Treatment and Surviving Mesothelioma and Other Cancers

2008-06-08T04:32:00.000-07:00

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. With rare exceptions, most mesothelioma cancers are considered malignant mesothelioma. The two major types of malignant mesothelioma are pleural mesothelioma, which concerns the mesothelium membrane that surrounds the lungs, and peritoneal mesothelioma which concerns the mesothelium layer that covers the organs in the abdominal cavity. The prognosis, therapy (including types of chemotherapy) and treatment choices are similar whether the cancer is pleural mesothelioma or peritoneal mesothelioma.

Mesothelioma Treatments and Therapies

Standard treatment for all but localized mesothelioma is generally not curative.1 Surgery and radiotherapy have a limited role in highly selected mesothelioma patients and chemotherapy is the only potential treatment option for the majority of people diagnosed with mesothelioma. Sometimes, these mesothelioma therapies are combined. Despite activity of some chemotherapy, the results are still modest, with a median survival of approximately one year. For individual patients, treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. The only FDA approved chemotherapy for malignant pleural mesothelioma (in combination with cisplatin) is pemetrexed (Alimta). In the key clinical trial that led to its approval for mesothelioma, Alimta was combined with another chemotherapy drug (cisplatin) and compared with cisplatin alone. The median survival for the patients who received both chemotherapy drugs was 12.1 months versus 9.3 months for mesothelioma patients who only received cisplatin.2

Mesothelioma Prognosis and Survival

In general the prognosis of mesothelioma is poor and most studies report median survival of less than a year. However, there are long term mesothelioma survivors (both pleural and peritoneal survivors) who have survived more than 10 years. In fact, in one mesothelioma study, doctors writing about the prognosis of mesothelioma explained that long-term mesothelioma survivors do exist and their prognosis may be independent of the treatment or therapies pursued.3 If this is true, it would suggest that mesothelioma prognosis and survival may be more dependent on individual differences among patients (and perhaps the non-conventional therapies they use) and less dependent upon conventional mesothelioma treatments.

Symptoms of Mesothelioma

Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms of mesothelioma may include pain, trouble swallowing, or swelling of the neck or face.

Mesothelioma 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 and a complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A biopsy is often used to confirm a diagnosis of mesothelioma. Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if the mesothelioma has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

Incidence & Risk Factors

Over 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in the majority of cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos and Mesothelioma

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. There is evidence that family members and others living with people exposed to asbestos 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.

New Directions for Treating Mesothelioma

Because conventional therapies are not curative for the overwhelming majority of mesothelioma patients, researchers are investigating new types of mesothelioma treatments and therapies. One approach that may yield promising results is anti-angiogenesis. Anti-angiogenesis is a form of therapy that uses drugs or other substances to stop tumors from making new blood vessels. Without a blood supply, the cancers cannot grow effectively. Today, there are several hundred clinical trials of anti-angiogenesis drugs under way. For example, Veglin is an anti-angiogenesis drug undergoing clinical trials at the University of Southern California's Keck School of Medicine. Under the supervision of Parkash S. Gill, M.D. and financed by grants from the Mesothelioma Research Foundation of America, a Phase I study of Veglin has demonstrated some success in patients suffering from lymphoma, sarcoma, and colon and lung cancers. Phase II studies are on-going with the hope they will demonstrate continued clinical efficacy in mesothelioma and other cancers.

Other Resources

Mesothelioma Treatment Results -The Cancer Monthly database currently has the results (survival, side effects, and more) for over 40 recent treatments and therapies for mesothelioma including immunotherapy, biological therapy, radiation, chemotherapy, and surgery. Click here to search for treatment results.

Surviving Mesothelioma and Other Cancers: A Patient's Guide - This book is written by ten-year mesothelioma survivor, Paul Kraus. He also speaks directly to newly diagnosed mesothelioma patients during frequent teleconferences. Click here for more information.

The Mesothelioma Research Foundation of America's mission is to fund research that will lead to the quickest cure for mesothelioma. Click here to learn more about this organization and the Phase II study of Veglin being supervised by Parkash S. Gill, M.D at the University of Southern California's Keck School of Medicine. Mesothelioma patients may apply to be treated by this novel therapy.

Benign mesothelioma

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There is a form of non cancerous (benign) mesothelioma that can develop in the lining of the lungs, or in the lining of the reproductive organs. It can occur in either men or women. These non cancerous tumours are very rare .

Mesothelioma in the abdomen

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The tissue lining the abdomen is called the peritoneum. It helps to protect the contents of the abdomen. It also produces a lubricating fluid. This helps the organs to move smoothly inside the abdomen as we move around.

Mesothelioma of the tissues lining the abdominal cavity is known as peritoneal mesothelioma. It is much less common than pleural mesothelioma.

It is unusual for mesothelioma to spread to other parts of the body. But if it does, it does not usually cause troublesome symptoms.

Mesothelioma in the chest

2008-06-08T04:15:00.000-07:00

The tissues lining (or covering) the lungs are called the pleura. There are two pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the two pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.

Mesothelioma is most often diagnosed in the pleura. This is known as pleural mesothelioma. Because it is so close, pleural mesothelioma can also affect the sheet of tissue covering the heart - the pericardium. Doctors call the pericardium the lining, although it is on the outside of the heart. It protects the heart and allows it to move smoothly within the sac that surrounds it. So it does much the same job for the heart as the pleura do for the lungs.

Are new treatments for mesothelioma being studied?

2008-06-08T04:09:00.001-07:00

Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI’s cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI’s Cancer.gov Web site, located at http://www.cancer.gov/clinical_trials on the Internet, provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.

How is mesothelioma treated?

2008-06-08T04:07:00.000-07:00

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

* Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

* Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

* Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

What are the risk factors for mesothelioma and Who is at increased risk for developing mesothelioma?

2008-06-08T03:43:00.000-07:00

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

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

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the air passageways in the lung.

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

How common is mesothelioma?

2008-06-08T03:42:00.000-07:00

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

What is the mesothelium?

2008-06-08T03:40:00.000-07:00

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

Cause of Mesothelioma Cancer

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Cause of Mesothelioma Cancer
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).

The only known cause for mesothelioma in the United States is a history of exposure to asbestos.When the asbestos fibers are breathed in, they travel into the nooks and crannies of the pleura where they irritate and can cause physical damage to the mesothelial cells that may result in mesothelioma cancer. The fibers can also cause damage that can result in lung cancer and asbestosis (excessive scarring of tissue on the lungs). If swallowed, the fibers can reach the abdominal cavity where they can cause peritoneal mesothelioma.

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

2008-06-06T09:08:00.000-07:00

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.

Mesothelioma symptoms are not specific to the disease; that is, many mesothelioma symptoms are also symptoms of other medical problems.Most studies show that the symptoms of mesotheliomausually begin to appear 30 to 40 years after exposure to asbestos. Thus, many mesothelioma patients are unaware that the symptoms they are experiencing are related to something that happened much earlier in their lives. Even a short period of asbestos exposure (as little as a few months) can create the conditions for a disease that erupts much later in life.

Mesothelioma affects the lining of various cavities in the body. Over time, the growth of cancerous tumors causes these tissues to expand and gather fluid. The presence of excess fluid is typically what causes the symptoms to occur. Mesothelioma symptoms also depend on the location of the tumors.

Pleural Mesothelioma Symptoms

For pleural mesothelioma, or mesothelioma of the lining surrounding the lung, common symptoms include shortness of breath, chest pain and a persistent cough. Unfortunately, these symptoms are also very common for a number of other ailments, including pneumonia. The most common symptom is localized chest pain, but this may not occur until the disease is well advanced. A less common but still prevalent symptom of pleural mesothelioma is weight loss. Some patients show virtually no symptoms.

Peritoneal Mesothelioma Symptoms

Peritoneal mesothelioma is a cancer of the abdominal lining. Symptoms include swelling or a mass in the abdomen, weight loss and abdominal pain. Bowel obstruction and blood clots also have been known to occur and fever is sometimes present.

Pericardial Mesothelioma Symptoms

Pericardial mesothelioma affects the lining of the heart, or pericardium. Symptoms include chest pain, cough, irregular heart beat and irregular breathing patterns. Many of these symptoms manifest during physical exertion – even minimal exertion. Pericardial mesothelioma is the rarest type of mesothelioma.

The earlier cancer is detected – mesothelioma or otherwise – the more effective treatment aimed at halting its progression will be.

What is Mesothelioma

2008-06-05T03:53:00.000-07:00

What is Mesothelioma?

Mesothelioma from the (Greek meso+ thelioma, tumor of
middle lining tissue) is an uncommon cancer, originating from the cells which
form the membrane lining the abdominal cavity (peritoneal membrane or
peritoneum) which houses the intestines, or the chest (pleural membrane or
pleura) cavity housing the heart and lungs, in which the cells making up those
tissues begin to grow out of control.
Mesotheliomas most often are seen in older patients, more often men that have a history of occupational exposure to asbestos, although other causes such as
radiation and certain viruses have occasionally been implicated. In a proportion
of cases, no asbestos exposure can be identified.
Mesotheliomas involving the lung and pleura characteristically present as
progressive shortness of breath due to the thickening of the lining membrane of
the lung with gradual contraction of the breathing space; often, fluid
accumulates in the lung spaces as well, further interfering with breathing,
Mesotheliomas involving the abdominal cavity present with digestive symptoms,
and abdominal swelling due to thickening of the lining membranes of the gut, and accumulation of large amounts of fluid in the abdomen.

How serious is it ?

Mesotheliomas are serious and potentially life-threatening. Survival of patients with mesothelioma is usually short if effective treatment is not found, especially those with tumors that can be shown to be growing aggressively. Because mesotheliomas have usually spread throughout the pleural or peritoneal cavity before the diagnosis is made, complete surgical removal is only rarely possible. Moreover, mesotheliomas are not as sensitive to radiation therapy or chemotherapy as are many other tumors.

How are mesotheliomas diagnosed?

In all cases, the diagnosis of mesothelioma must first be unquestionably established by biopsy of affected or suspicious tissues, and by definitive microscopic examination by a trained pathologist. Biopsy almost always requires an invasive procedure such as thoracoscopy and pleural biopsy, or laparotomy or laparoscopy, The removed tissues may be treated with special biological or chemical stains which are used to help the pathologist establish a firm diagnosis. The pathologist usually also comments upon the rate of growth and biological virulence of the tumor

Second, the tumor must be staged if possible by X-ray, CAT scan, MRI or other
types of scans to clarify its location within the body, and to estimate the
likelihood of effective curative or palliative therapy. Staging of mesothelioma
by x-ray measurements, however, is difficult and often unreliable.

How are mesotheliomas treated?

A treatment plan is devised depending upon the mesothelioma type, aggressiveness, primary location, and degree of local (rarely, distant) spread. The treatment of pleural mesothelioma is difficult. Treatment with surgery, radiation therapy or chemotherapy used alone or in combination may be proposed, depending upon the potential benefits and risks of each modality. Surgery is rarely used alone, but sometimes suffices when only a small pleural patch of mesothelioma is detected, thus allowing visually complete removal of the tumor. More often, mesotheliomas of the left or right pleural cavity cannot be completely removed without taking the entire lung (pneumonectomy) on the same side as well. In such cases, radiation therapy and/or chemotherapy is given postoperatively to help eradicate any residual mesothelioma that may have escaped the surgeon.

The treatment of peritoneal mesotheliomas is even more problematic; until
recently no consistent treatment was available. At our institution, peritoneal
mesotheliomas have been managed in the experimental setting with combined
modality treatment consisting of extensive (usually not complete) debulking
surgery, followed by intraperitoneal and systemic chemotherapy followed in turn
by whole abdominal radiation therapy.

Because mesotheliomas now represent less than one percent of cancers and and are infrequently seen in the practice of most community oncologists, finding the
correct treatment can be very difficult. Proper management of mesotheliomas
often requires evaluation at larger tertiary hospitals or Comprehensive Cancer
Centers by specialists in medical, surgical and radiation oncology with
experience in all aspects of the clinical care of mesothelioma patients,
including the newest experimental treatments.

Mesothelioma wiki

2008-06-05T03:32:00.000-07:00

Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and 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

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.

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

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

* chest wall pain

* pleural effusion, or fluid surrounding the lung

* shortness of breath

* fatigue or anemia

* wheezing, hoarseness, or cough

* blood in the sputum (fluid) coughed up (hemoptysis)

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

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

* abdominal pain

* ascites, or an abnormal buildup of fluid in the abdomen

* a mass in the abdomen

* problems with bowel function

* weight loss

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

* blood clots in the veins, which may cause thrombophlebitis

* disseminated intravascular coagulation, a disorder causing severe bleeding in
many body organs

* jaundice, or yellowing of the eyes and skin

* low blood sugar level

* pleural effusion

* pulmonary emboli, or blood clots in the arteries of the lungs

* severe ascites

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

Diagnosis

CT scan of a patient with mesothelioma, coronal section (the section follows the
plane the divides the body in a front and a back half). The mesothelioma is
indicated by yellow arrows, the central pleural effusion (fluid collection) is
marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left
lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney,
(8) right kidney, (9) liver.

CT scan of a patient with mesothelioma, coronal section (the section follows the
plane the divides the body in a front and a back half). The mesothelioma is
indicated by yellow arrows, the central pleural effusion (fluid collection) is
marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left
lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney,
(8) right kidney, (9) liver.

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

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

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

Typical immunohistochemistry results Positive Negative

EMA (epithelial membrane antigen) in a membranous distribution CEA (carcinoembryonic
antigen)

WT1 (Wilms' tumour 1) B72.3

Calretinin MOC-3 1

Mesothelin-1 CD15

Cytokeratin 5/6 Ber-EP4

HBME-1 (human mesothelial cell 1) TTF-1 (thyroid transcription factor-1)

Screening

There is no universally agreed protocol for screening people who have been
exposed to asbestos. Screening tests might diagnose mesothelioma earlier than
conventional methods thus improving the survival prospects for patients. The
serum osteopontin level might be useful in screening asbestos-exposed people for
mesothelioma. The level of soluble mesothelin-related protein is elevated in the
serum of about 75% of patients at diagnosis and it has been suggested that it
may be useful for screening.[2] Doctors have begun testing the Mesomark assay
which measures levels of soluble mesothelin-related proteins (SMRPs) released by
diseased mesothelioma cells.[3]

Staging

Mesothelioma is described as localized if the cancer is found only on the
membrane surface where it originated. It is classified as advanced if it has
spread beyond the original membrane surface to other parts of the body, such as
the lymph nodes, lungs, chest wall, or abdominal organs.

Pathophysiology

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

Pleural contamination with asbestos or other mineral fibres has been shown to
cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are
more potent carcinogens than "feathery fibers" (chrysotile or white asbestos
fibers).[4] However, there is now evidence that smaller particles may be more
dangerous than the larger fibers.[1][2] They remain suspended in the air where
they can be inhaled, and may penetrate more easily and deeper into the lungs.
"We probably will find out a lot more about the health aspects of asbestos from
[the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of
pulmonary and critical-care medicine at North Shore-Long Island Jewish Health
System. Dr. Fein has treated several patients for "World Trade Center syndrome"
or respiratory ailments from brief exposures of only a day or two near the
collapsed buildings.[3]

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

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

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

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

* Neurofibromatosis type 2 at 22q12

* P16INK4A

* P14ARF

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

* Inactivation of tumor suppressor genes

* Activation of oncogenes

* Activation of proto-oncogenes due to incorporation of foreign DNA containing a
promoter region

* Activation of DNA repair enzymes, which may be prone to error

* Activation of telomerase

* Prevention of apoptosis

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

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

Epidemiology

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. 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.[5] 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.

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.[6]

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-dispostioned
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.

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.

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.

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.

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[7].

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.

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. It is not
possible to remove the entire mesothelium without killing the patient.

Radiation

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Wikibooks has a book on the topic of

Radiation Oncology/Lung/Mesothelioma

For 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.[8] 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.

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.

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.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was
developed by Paul Sugarbaker at the Washington Cancer Institute.[8] 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.

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 because of its use as an insulating material in car racing suits.[9]
(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.[10] His mesothelioma has been attributed to his younger years spent
working on building sites in London.[11][12]

Bob Miner, one of the founders of Software Development Labs, the forerunner of
Oracle Corporation died of mesothelioma in 1994.

Notable people that 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"[13] 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.

Legal issues

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.[citation needed] The amounts
and method of allocating compensation have been the source of many court cases,
and government attempts at resolution of existing and future cases.

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.[14] 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.[15] 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.