Mesothelioma – Mayo Clinic

Malignant mesothelioma (me-zoe-thee-lee-O-muh) is a type of cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).

Mesothelioma is an aggressive and deadly form of cancer. Mesothelioma treatments are available, but for many people with mesothelioma, a cure is not possible.

Doctors divide mesothelioma into different types based on what part of the mesothelium is affected. Mesothelioma most often affects the tissue that surrounds the lungs (pleura). This type is called pleural mesothelioma. Other, rarer types of mesothelioma affect tissue in the abdomen (peritoneal mesothelioma), around the heart and around the testicles.

Mesothelioma doesn’t include a form of noncancerous (benign) tumor that occurs in the chest and is sometimes called benign mesothelioma or solitary fibrous tumor.


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Mesothelioma – Mayo Clinic

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma is a rare, aggressive form of cancer that develops in the lining of the lungs, abdomen, or heart. Caused by asbestos, mesothelioma has no known cure and has a very poor prognosis.

According to a 2017 report by the Centers for Disease Control, 2,400 2,800 people are diagnosed with mesothelioma in the United States each year. People who have worked with or been exposed to asbestos have the highest risk of developing mesothelioma. After being exposed to asbestos, mesothelioma symptoms can take 20 50 years to appear.

The life expectancy for mesothelioma patients is poor, as there is no cure for the disease. The stage of the disease, cell type, and location of the tumor(s) are the most important factors for a patients survival. Factors such as the patients overall health, age, and whether the cancer has spread also impact prognosis.

Heather Von St. James is an 11-year pleural mesothelioma survivor who has become a spokeswoman for mesothelioma awareness and a proponent of banning asbestos. She also works with newly diagnosed mesothelioma patients as a mentor and advocate, helping them understand their treatment and legal options.

Mesothelioma is most commonly classified by the location in the body where it develops. Specifically, the cancer forms in the lining of certain organs or spaces within the body, known as the mesothelium. Mesothelioma typically develops in one of three specific areas.

The most common type, pleural mesothelioma is caused by the inhalation of asbestos fibers.

Inhaled or swallowed asbestos fibers can become trapped in the lining of the abdomen (the peritoneum).

In rare cases, asbestos fibers can get lodged in the pericardium, the lining around the heart cavity.

Mesothelioma symptoms can take 20 50 years to appear after the first exposure to asbestos. The signs of mesothelioma often look like those of other diseases, which can lead to misdiagnosis. When someone exhibits mesothelioma symptoms, doctors perform a variety of tests to rule out other diseases. It normally takes weeks or months for doctors to arrive at an accurate mesothelioma diagnosis.

Upon diagnosis, the doctor will categorize the disease into one of four stages. While there are several staging systems, the TNM System which stands for tumor, lymph nodes, and metastasis is the most commonly used.

The mesothelioma tumor is located in only one area and has not spread to other parts of the body.

A large tumor may have progressed to nearby areas and/or the lymph nodes, but has not gone on any further.

Tumors have typically spread beyond the local area to several nearby locations and the lymph nodes.

The tumors have spread into multiple areas and throughout the lymphatic system, invading other organs throughout the body.

Typically, Stage 1 and Stage 2 mesothelioma can be treated effectively with surgery and other forms of therapy. However, Stage 3 and Stage 4 mesothelioma are often treated palliatively.

Treatment for mesothelioma is similar to other types of cancer. The most common treatments are surgery, chemotherapy, and radiation. Newer treatments are being studied as part of clinical trials and may be available for some patients who do not respond to conventional therapies.

In some cases, treatment can improve a patient’s prognosis, extending his/her life significantly. Treatment can also be used palliatively to reduce pain and discomfort caused by the symptoms of mesothelioma.

Finding a mesothelioma doctor and creating a custom treatment plan based on your diagnosis is the most important decision you can make to improve prognosis. Browse our catalog of top mesothelioma doctors around the country.

Mesothelioma clinics and cancer centers offer patients a way to get the most comprehensive care, using the latest technology and techniques available. Locate the best mesothelioma clinics near you.

The costs of treating mesothelioma are significant. If you were exposed to asbestos on the job, in your home, or elsewhere, you have the right to recover these expenses from those responsible for the exposure.

Financial assistance is available to help offset the high cost of mesothelioma treatment. The primary ways mesothelioma patients and their families can receive compensation are:

JM Mazurek; G Syamlal; JM Wood; SA Hendricks, A Weston. U.S. Centers for Disease Control. Malignant Mesothelioma Mortality United States, 19992015. March 3, 2017:66(8);214218. DOI: 10.15585/mmwr.mm6608a3

National Cancer Institute Malignant Mesothelioma (Source)

Wagner, J.C., Sleggs, C.A., and Marchand, Paul. Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province. Department of Thoracic Surgery: University of The Witswatersrand. Johannesburg, South Africa. 1960.

Grondin, Sean C., Sugarbaker, David J. Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma Chest December 1999 116:suppl 3 450S-454S;

Rusch, Valerie W. Indications for pneumoctomy. Extrapleural pneumonectomy

Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT (2002). “Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases”. Ultrastruct Pathol 26(2): 5565.

Brigham and Womens Hospital International Mesothelioma Program (Source)

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Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma – Wikipedia

Mesothelioma Synonyms Malignant mesothelioma CT scan showing a left sided mesothelioma with an enlarged mediastinal lymph node Specialty Oncology Symptoms Shortness of breath, swollen abdomen, chest wall pain, cough, feeling tired, weight loss[1] Complications Fluid around the lung[1] Usual onset Gradual onset[2] Causes ~ 40 years after exposure to asbestos[3] Risk factors Genetics, infection with simian virus 40[3] Diagnostic method Medical imaging, examining fluid produced by the cancer, tissue biopsy[2] Prevention Decreased asbestos exposure[4] Treatment Surgery, radiation therapy, chemotherapy, pleurodesis[5] Prognosis Five year survival ~8% (US)[6] Frequency 60,800 (affected during 2015)[7] Deaths 32,400 (2015)[8]

Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium).[9] The most common area affected is the lining of the lungs and chest wall.[1][3] Less commonly the lining of the abdomen and rarely the sac surrounding the heart,[10] or the sac surrounding the testis may be affected.[1][11] Signs and symptoms of mesothelioma may include shortness of breath due to fluid around the lung, a swollen abdomen, chest wall pain, cough, feeling tired, and weight loss.[1] These symptoms typically come on slowly.[2]

Greater than 80% of mesothelioma cases are caused by exposure to asbestos. The greater the exposure the greater the risk.[3] As of 2013 about 125 million people have been exposed to asbestos at work.[12] High rates of disease occur in people who mine asbestos, produce products from asbestos, work with asbestos products, live with asbestos workers, or work in buildings containing asbestos. Asbestos exposure and the onset of cancer are generally separated by about 40 years.[3] Washing the clothing of someone who worked with asbestos also increases the risk.[12] Other risk factors include genetics and infection with the simian virus 40.[3] The diagnosis may be suspected based on chest X-ray and CT scan findings, and is confirmed by either examining fluid produced by the cancer or by a tissue biopsy of the cancer.[2]

Prevention centers around reducing exposure to asbestos.[4] Treatment often includes surgery, radiation therapy, and chemotherapy. A procedure known as pleurodesis, which involves using substances such as talc to scar together the pleura, may be used to prevent more fluid from building up around the lungs.[5] Chemotherapy often includes the medications cisplatin and pemetrexed.[2] The percentage of people that survive five years following diagnosis is on average 8% in the United States.[6]

In 2015 about 60,800 people had mesothelioma and 32,000 died from the disease.[7][8] Rates of mesothelioma vary in different areas of the world. Rates are higher in Australia, the United Kingdom, and lower in Japan.[3] It occurs in about 3,000 people per year in the United States.[13] It occurs more often in males than females. Rates of disease have increased since the 1950s. Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old. The disease was rare before the commercial use of asbestos.[3]

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.[14]

Mesothelioma that affects the pleura can cause these signs and symptoms:[14]

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.

The most common symptoms of peritoneal mesothelioma are abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other features may include weight loss, fever, night sweats, poor appetite, vomiting, constipation, and umbilical hernia.[15] 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.[citation needed] These symptoms may be caused by mesothelioma or by other, less serious conditions.

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

Pericardial mesothelioma is not well characterized, but observed cases have included cardiac symptoms, specifically constrictive pericarditis, heart failure, pulmonary embolism, and cardiac tamponade. They have also included nonspecific symptoms, including substernal chest pain, orthopnea (shortness of breath when lying flat), and cough. These symptoms are caused by the tumor encasing or infiltrating the heart.[10]

In severe cases of the disease, the following signs and symptoms may be present:[citation needed]

If a mesothelioma forms metastases, these most commonly involve the liver, adrenal gland, kidney, or other lung.[16]

Working with asbestos is the most common risk factor for mesothelioma.[17] In the United States, asbestos is considered the major cause of malignant mesothelioma[18] and has been considered “indisputably”[19] associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a signal or sentinel tumor.[20][21][22][23] A history of asbestos exposure exists in most 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 of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite or talc.[11][24] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[24] This has been confirmed in animal studies,[25][26] but studies in humans are inconclusive.[25][27][28] Pericardial mesothelioma may not be associated with asbestos exposure.[10]

Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. 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 naval personnel (e.g., Navy, Marine Corps, and Coast Guard), 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 official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and “permissible exposure limits” required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma.[29] Likewise, the British Government’s Health and Safety Executive (HSE) states formally that any threshold for exposure to asbestos 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 assumes that no such “safe” threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.[30] There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.[31] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[19] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[19] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 13 months of exposure.[32][33] People who work with asbestos wear personal protective equipment to lower their risk of exposure.[citation needed]

Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 3040 years.[19] In a review of occupationally related mesothelioma cases, the median latency was 32 years.[34] Based upon the data from Peto et al., the risk of mesothelioma appears to increase to the third or fourth power from first exposure.[31]

The incidence of mesothelioma has been found to be higher in populations living near naturally occurring asbestos. People can be exposed to naturally occurring asbestos in areas where mining or road construction is occurring, or when the asbestos-containing rock is naturally weathered. Another common route of exposure is through asbestos-containing soil, which is used to whitewash, plaster, and roof houses in Greece.[12] In central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villagesTuzky, Karain, and Sarhdr. Initially, this was attributed to erionite. Environmental exposure to asbestos has caused mesothelioma in places other than Turkey, including Corsica, Greece, Cyprus, China, and California.[12][35][36] In the northern Greek mountain town of Metsovo, this exposure had resulted in mesothelioma incidence around 300 times more than expected in asbestos-free populations, and was associated with very frequent pleural calcification known as “Metsovo Lung”.[37][38]

The documented presence of asbestos fibers 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 fibers.[citation needed]

Exposure to talc is also a risk factor for mesothelioma; exposure can affect those who live near talc mines, work in talc mines, or work in talc mills.[24]

Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.[39]

Commercial asbestos mining at Wittenoom, Western Australia, took place from 1937 to 1966. The first case of mesothelioma in the town occurred in 1960. The second case was in 1969, and new cases began to appear more frequently thereafter. The lag time between initial exposure to asbestos and the development of mesothelioma varied from 12 years 9 months up to 58 years.[40] A cohort study of miners employed at the mine reported that 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.[citation needed]

Occupational exposure to asbestos in the United States mainly occurs when people are maintaining buildings that already have asbestos. Approximately 1.3 million US workers are exposed to asbestos annually; in 2002, an estimated 44,000 miners were potentially exposed to asbestos.[24]

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][41][42] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers via washing a worker’s clothes or coming into contact with asbestos-contaminated work clothing.[12][24] 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.[citation needed]

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 were banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.[citation needed]

In a recent research carried on white American population in 2012, it was found that people with a germline mutation in their BAP1 gene are at higher risk of developing mesothelioma and uveal melanoma.[43]

Erionite is a zeolite mineral with similar properties to asbestos and is known to cause mesothelioma.[11] Detailed epidemiological investigation has shown that erionite causes mesothelioma mostly in families with a genetic predisposition.[12][35][36] Erionite is found in deposits in the Western United States, where it is used in gravel for road surfacing, and in Turkey, where it is used to construct homes. In Turkey, the United States, and Mexico, erionite has been associated with mesothelioma and has thus been designated a “known human carcinogen” by the US National Toxicology Program.[36]

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 fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber 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 fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.[citation needed]

Pleural contamination with asbestos or other mineral fibers 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).[19] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. 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.[44]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers 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 localized lesions of accumulated asbestos fibers 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 tumor.[citation needed]

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 fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to a malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers 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.[citation needed]

Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber 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.[citation needed]

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:[citation needed]

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:

Several genes are commonly mutated in mesothelioma, and may be prognostic factors. These include epidermal growth factor receptor (EGFR) and C-Met, receptor tyrosine kinases which are overexpressed in many mesotheliomas. Some association has been found with EGFR and epithelioid histology but no clear association has been found between EGFR overexpression and overall survival. Expression of AXL receptor tyrosine kinase is a negative prognostic factor. Expression of PDGFRB is a positive prognostic factor.[46] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[47]

As an environmentally triggered malignancy, mesothelioma tumors have been found to be polyclonal in origin, by performing a X-inactivation based assay on epitheloid and biphasic tumors obtained from female patients.[48] These results suggest that an environmental factor, most likely asbestos exposure, may damage and transform a group of cells in the tissue, resulting in a population of tumor cells that are, albeit only slightly, genetically different.[citation needed]

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic (chromosome-breaking) 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.[citation needed]

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- (TGF-) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.[citation needed]

Diagnosis of mesothelioma can be suspected with imaging but is confirmed with biopsy. It must be clinically and histologically differentiated from other pleural and pulmonary malignancies, including reactive pleural disease, primary lung carcinoma, pleural metastases of other cancers, and other primary pleural cancers.[11] Primary pericardial mesothelioma is often diagnosed after it has metastasized to lymph nodes or the lungs.[10]

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.[14] 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 cytopathology if this fluid is aspirated with a syringe.[10] For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for 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).[citation needed] However, with primary pericardial mesothelioma, pericardial fluid may not contain malignant cells and a tissue biopsy is more useful in diagnosis.[10] Using conventional cytology diagnosis of malignant mesothelioma is difficult, but immunohistochemistry has greatly enhanced the accuracy of cytology.[citation needed]

Generally, a biopsy is needed to confirm a diagnosis of malignant 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. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, an open surgical procedure may be necessary.[citation needed]

Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics, such as breast or lung cancer that has metastasized to the pleura. There are numerous tests and panels available, but no single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant. The positive markers indicate that mesothelioma is present; if other markers are positive it may indicate another type of cancer, such as breast or lung adenocarcinoma. Calretinin is a particularly important marker in distinguishing mesothelioma from metastatic breast or lung cancer.[11]

There are three main histological subtypes of malignant mesothelioma: epithelioid, sarcomatous, and biphasic. Epithelioid and biphasic mesothelioma make up approximately 75-95% of mesotheliomas and have been well characterized histologically, whereas sarcomatous mesothelioma has not been studied extensively. Most mesotheliomas express high levels of cytokeratin 5 regardless of subtype.[11]

Epithelioid mesothelioma is characterized by high levels of calretinin.[11]

Sarcomatous mesothelioma does not express high levels of calretinin.[11]

Other morphological subtypes have been described:

Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.[49]TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged IaIV (one-A to four) based on the TNM status.[49][50]

Mesothelioma can be prevented in most cases by preventing exposure to asbestos. The US National Institute for Occupational Safety and Health maintains a recommended exposure limit of 0.1 asbestos fiber per cubic centimeter.[24]

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.[51] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[52]

Mesothelioma is generally resistant to radiation and chemotherapy treatment. Long-term survival and cures are exceedingly rare.[11] Treatment of malignant mesothelioma at earlier stages has a better prognosis. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors 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. The histological subtype and the patient’s age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology.[53]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[54] However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008), or with one of the latter. 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.[citation needed] In localized pericardial mesothelioma, pericardectomy can be curative; when the tumor has metastasized, pericardectomy is a palliative care option. The entire tumor is not often able to be removed.[10]

For patients with localized disease, and who can tolerate a radical surgery, radiation can be given post-operatively as a consolidative treatment. The entire hemithorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations. It can also induce severe side-effects, including fatal pneumonitis.[55] As part of a curative approach to mesothelioma, radiotherapy is commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.[citation needed]

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 beyond human tolerance.[citation needed] Radiotherapy is of some use in pericardial mesothelioma.[10]

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive “curative” surgery.[56] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.[citation needed] Cisplatin and pemetrexed together give patients a median survival of 12.1 months.[11]

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[57]

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.[citation needed]

In pericardial mesothelioma, chemotherapy – typically adriamycin and/or cisplatin – is primarily used to shrink the tumor and is not curative.[10]

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Gurin (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.[citation needed]

This technique is used in conjunction with surgery,[58] including in patients with malignant pleural mesothelioma.[59] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained. High concentrations of selected drugs are then administered 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.[citation needed]

All of the standard approaches to treating solid tumorsradiation, chemotherapy, and surgeryhave been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (314 years) among patients with favorable prognostic factors.[60] However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years).[54] Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation namely depends on the size of the patient’s tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.[61] Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.[62] Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral (same side) diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.[63]

Mesothelioma often has a poor prognosis. Typical survival despite surgery is between 12 and 21 months depending on the stage of disease at diagnosis with about 7.5% of people surviving for 5 years.[64]

Women, young people, people with low-stage cancers, and people with epithelioid cancers have better prognoses.[11] Negative prognostic factors include sarcomatoid or biphasic histology, high platelet counts (above 400,000), age over 50 years, white blood cell counts above 15.5, low glucose levels in the pleural fluid, low albumin levels, and high fibrinogen levels. Several markers are under investigation as prognostic factors, including nuclear grade, and serum c-reactive protein. Long-term survival is rare.[46]

Pericardial mesothelioma has a 10-month median survival time.[10]

In peritoneal mesothelioma, high expression of WT-1 protein indicates a worse prognosis.[11]

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year.[65] 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.[66] Worldwide incidence is estimated at 1-6 per 1,000,000.[11] Incidence of mesothelioma lags behind that of asbestosis due to the longer time it takes to develop; due to the cessation of asbestos use in developed countries, mesothelioma incidence is expected to decrease.[24] Incidence is expected to continue increasing in developing countries due to continuing use of asbestos.[11] 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.[citation needed] Less than 5% of mesotheliomas are pericardial. The prevalence of pericardial mesothelioma is less than 0.002%; it is more common in men than women. It typically occurs in a person’s 50s-70s.[10][67]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[68] Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. 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.[citation needed] More than 80% of mesotheliomas are caused by asbestos exposure.[11]

The incidence of peritoneal mesothelioma is 0.53.0 per million per year in men, and 0.22.0 per million per year in women.[69]

Mesothelioma accounts for less than 1% of all cancers diagnosed in the UK, (around 2,600 people were diagnosed with the disease in 2011), and it is the seventeenth most common cause of cancer death (around 2,400 people died in 2012).[70]

The connection between asbestos exposure and mesothelioma was discovered in the 1970s. In the United States, asbestos manufacture stopped in 2002. Asbestos exposure thus shifted from workers in asbestos textile mills, friction product manufacturing, cement pipe fabrication, and insulation manufacture and installation to maintenance workers in asbestos-containing buildings.[24]

Mesothelioma, though rare, has had a number of notable patients:

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould, a well-regarded paleontologist, was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote “The Median Isn’t the Message”,[77] in which he argued that statistics such as median survival are useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to cancer not linked to his mesothelioma.

Some people who were exposed to asbestos have collected damages for an asbestos-related disease, including mesothelioma. Compensation via asbestos funds or class action lawsuits is an important issue in law practices regarding mesothelioma.[citation needed]

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.[78] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation.[79] In 2013, the “Furthering Asbestos Claim Transparency (FACT) Act of 2013” passed the US House of representatives and was sent to the US Senate, where it was referred to the Senate Judiciary Committee.[80] As the Senate did not vote on it before the end of the 113th Congress, it died in committee. It was revived in the 114th Congress, where it has not yet been brought before the House for a vote.[81]

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. In 1960, an article published by Wagner et al. was seminal in establishing mesothelioma as a disease arising from exposure to asbestos.[82] 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. Prior to the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.[83] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[84] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.[citation needed]

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.[citation needed]

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.[citation needed]

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.[citation needed]

In Leeds, England the Armley asbestos disaster involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company’s factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.[85]

The WT-1 protein is overexpressed in mesothelioma and is being researched as a potential target for drugs.[11]

Mesothelioma at DMOZ

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Mesothelioma – Wikipedia

German Surgeons Offer Innovative Chemotherapy Approach to Pleural Mesothelioma – Mesothelioma.net Blog (blog)

No matter what type of mesothelioma a person has been diagnosed with, the most common form of therapy that is offered is a multi-modality approach that combines radiation therapy, surgery, and chemotherapy. But physicians have found that different regions of the body are more amenable to different approaches, and that certain therapies have only limited use because of vulnerabilities of other nearby organs. It is for this reason that radiation therapy is used with moderation in the treatment of peritoneal mesothelioma and that chemotherapy is limited in pleural mesothelioma. But now a group of German scientists believes that they have found a strategy that allows patients with pleural mesothelioma to get greater benefits from chemotherapy. By shutting down the pathways to surrounding structures, they have been able to target chemotherapy to limited areas in the chest and provide patients with extended survival times.

German surgical oncologists believe that they have found a way to improve survival times in patients with pleural mesothelioma while limiting the deleterious impact of aggressive surgery and systemic chemotherapy. As described in the journalOncoTargets and Therapy by chief investigator Karl Reinhard Aiger, The aorta and inferior vena cava were blocked at the level of the diaphragm and the upper arms were blocked by pneumatic cuffs. In effectively limiting the area in which the toxic chemicals could flow, they then administered cisplatin and mitoxantrone for a period of 15 minutes, allowing it to circulate freely in the area where the mesothelioma tumor was located but preventing it from coming into contact with healthy tissue or circulating to the rest of the body. After the 15 minute period was complete, the chemotherapy solution was removed using a special filtration system and the blocking structures were removed from the other areas shortly thereafter. The approach is called isolated thoracic perfusion with chemofiltration, or ITP-F.

The results of this approach were highly encouraging. According to the report, ITP-F for patients with advanced pleural mesothelioma progressive after standard therapies is an effective and well tolerated treatment modality offering comparably long survival data at a good quality of life.

If you or someone you love has mesothelioma and need information on innovative treatment protocols, the compassionate Patient Advocates at Mesothelioma.net are here to help. Contact us today at1-800-692-8608to learn more.

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German Surgeons Offer Innovative Chemotherapy Approach to Pleural Mesothelioma – Mesothelioma.net Blog (blog)

Mesothelioma | Answers to Common Questions

Approximately 3,000 people are diagnosed with mesothelioma of all types in the United States every year. In most cases, these victims exposure took place on the job and the cause of the illness can be traced to an unsafe workplace.

For example, in the past, an overwhelming amount of job sites across the nation used asbestos-containing materials (ACMs) in buildings, equipment, products, machinery, insulation, electrical wiring, and more.

Workers were exposed to ACMs each time they went to work, inhaling tiny, odorless asbestos fibers. Once the fibers become lodged in the body, its literally impossible to expel all of. Over time, the workers began developing asbestos-related illnesses, such as mesothelioma, asbestosis, and asbestos-related lung cancer.

With changing regulations and mitigation, exposure to asbestos is on the decline, but people continue to be diagnosed. This is because the disease has what is known as a long latency period. This means that the amount of time that can pass between the time of exposure to asbestos and the time that symptoms begin to appear can be as long as fifty years.

It is an unfortunate reality, but medical science has made great strides in understanding how this deadly disease progresses and various ways to prolong and improve the lives of those who have been diagnosed with the condition. Currently, however, there is still no cure for asbestos illnesses.

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Mesothelioma | Answers to Common Questions

Mesothelioma Victims Center Now Urges Contractors or … – PR Newswire (press release)

NEW YORK, Aug. 24, 2017 /PRNewswire/ –The Mesothelioma Victims Center is one of the top resources in the nation for the best possible mesothelioma financial compensation for construction workers or skilled tradesmen such as a plumber, electrician, or welder who has been diagnosed with this rare cancer. The group is now expanding their initiative to include contractors or lead skilled tradesmen who have been diagnosed with mesothelioma.

If a construction worker, skilled tradesman, or contractor has been diagnosed with mesothelioma they are urged to contact the Mesothelioma Victims Center anytime at 800-714-0303 to ensure they are dealing directly with some of the nation’s most skilled mesothelioma attorneys. Typically, these journeyman-level mesothelioma attorneys will be more than happy to provide a free compensation analysis for the diagnosed person or their family members. http://MesotheliomaVictimsCenter.Com

The types of construction workers or construction contractors who have been diagnosed with mesothelioma the Mesothelioma Victims Center is offering to assist include:

The Mesothelioma Victims Center says, “We have had the honor to assist construction workers, skilled tradesmen, and contractors who have been diagnosed with mesothelioma and we cannot over emphasize how not hiring one of the nation’s journeyman-level attorneys can result in not receiving the very best possible financial compensation. Before you hire a lawyer to assist with a mesothelioma compensation claim please call us anytime at 800-714-0303.” http://MesotheliomaVictimsCenter.Com

For a state-by-state breakdown of licensing requirements for contractors please review the following website. http://www.homeadvisor.com/r/state-by-state-licensing-requirements/

The average age for a diagnosed victim of mesothelioma in the United States is 72 years old.Because of their age, frequently people with mesothelioma are initially misdiagnosed with pneumonia. This year between 2,500 and 3,000 US citizens will be diagnosed with mesothelioma. Mesothelioma is attributable to exposure to asbestos.

According to the CDC, the states indicated with the highest incidence of mesotheliomainclude Maine, Massachusetts, Connecticut, Maryland,New Jersey, Pennsylvania, Ohio, West Virginia, Virginia,Michigan, Illinois, Minnesota, Louisiana, Washington, and Oregon.

However, based on the calls the Mesothelioma Victims Center receives a construction worker, a skilled tradesman, or a contractor with confirmed mesothelioma could live in any state including New York, Florida, California, Texas,Illinois, Ohio, Iowa,Indiana, Missouri, North Carolina,Kentucky, Tennessee, Georgia,Alabama, Oklahoma, Arkansas, Kansas, Nebraska, North Dakota, Colorado, New Mexico, Utah, Nevada,Arizona, Idaho, or Alaska.

High-risk work groups for exposure to asbestos include US Navy Veterans, power plant workers,shipyard workers, oil refinery workers, steel mill workers,manufacturing/factoryworkers, pulp or paper mill workers, plumbers, electricians, auto mechanics, machinists, miners, construction workers, insulators, rail road worker, roofers, or firemen. As a rule, these types of workers were exposed to asbestos in the 1950’s, 1960’s, 1970’s, or 1980’s. US Navy Veterans make up about one-third of all US Citizens who are diagnosed with mesothelioma each year. http://MesotheliomaVictimsCenter.Com

For more information about mesothelioma please refer to the National Institutes of Health’s web site related to this rare form of cancer: https://www.cancer.gov/types/mesothelioma.

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Michael Thomas 800-714-0303 170623@email4pr.com

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Mesothelioma Victims Center Now Urges Contractors or … – PR Newswire (press release)

Mesothelioma Symptoms – Mayo Clinic

Signs and symptoms of mesothelioma vary depending on where the cancer occurs.

Pleural mesothelioma, which affects the tissue that surrounds the lungs, causes signs and symptoms that may include:

Peritoneal mesothelioma, which occurs in tissue in the abdomen, causes signs and symptoms that may include:

Signs and symptoms of other types of mesothelioma are unclear, since these forms of the disease are very rare.

Pericardial mesothelioma, which affects tissue that surrounds the heart, can cause signs and symptoms such as breathing difficulty and chest pains.

Mesothelioma of tunica vaginalis, which affects tissue surrounding the testicles, may be first detected as swelling or a mass on a testicle.

See your doctor if you have signs and symptoms that may indicate mesothelioma. Signs and symptoms of mesothelioma aren’t specific to this disease and, due to the rarity of mesothelioma, are more likely to be related to other conditions. If any persistent signs and symptoms seem unusual or bothersome, ask your doctor to evaluate them. Tell your doctor if you’ve been exposed to asbestos.


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Mesothelioma Symptoms – Mayo Clinic

Nearly One-Third of Mesothelioma Patients Remain Untreated – Asbestos.com

A new report from the National Cancer Institute (NCI) shows between 20 and 30 percent of malignant mesothelioma patients do not receive any cancer treatment.

The study, Patterns of care and survival among patients with malignant mesothelioma in the United States, published August 10 in the journal Lung Cancer, aimed to describe the patterns of care and subsequent survival among mesothelioma patients in the U.S. while adjusting for patient demographics and pre-existing health conditions.

Using the NCIs Surveillance, Epidemiology, and End Results (SEER) data, researchers discovered significant differences in treatment patterns and overall survival between pleural mesothelioma patients and nonpleural patients.

Mesothelioma patients diagnosed with the pleural type and older than 70 were less likely to receive therapy compared to peritoneal mesothelioma patients and those diagnosed at younger ages.

Key findings included:

These findings indicate the need for efforts to ensure equitable application of currently available therapies to all patients, lead author Lindsey Enewold wrote in the study.

For many years, the combination of surgery, chemotherapy and radiation therapy has been the standard of care for mesothelioma.

This latest study gave new insight into the number of patients who undergo surgery, chemotherapy or radiation.

Systemic therapies which includes chemotherapy and immunotherapy was the most widely performed treatment for all types of mesothelioma, with around 62 percent of patients receiving some form of drug to treat cancer cells.

More pleural mesothelioma patients (18.4 percent) received radiation therapy than nonpleural patients (4.9 percent). This is likely because radiation therapy is limited for those with peritoneal mesothelioma, the second-most-common disease type, because it affects the lining of the abdominal cavity where radiation is commonly restricted.

However, peritoneal mesothelioma patients are more likely to undergo surgery. Only 27.1 percent of pleural patients underwent surgery, while 51.8 percent of nonpleural patients had at least one procedure.

A combination of cytoreduction surgery and heated chemotherapy has become the standard treatment option for peritoneal mesothelioma. Studies show half of patients who receive the procedure survive at least five years after diagnosis.

Heated chemotherapy isnt as viable of an option for pleural patients, but some mesothelioma specialists have found success with intraoperative heated chemotherapy, which adds a chemotherapy solution to the thoracic cavity directly following surgery. The solution is then circulated throughout the cavity for up to an hour before it is drained.

Enewold and her team noted that new treatments for mesothelioma are being developed, but currently available therapies remain underutilized.

Emerging therapies, such as immunotherapy, continue to be a popular topic in the mesothelioma community.

Immunotherapy drugs including pembrolizumab (Keytruda) and nivolumab (Opdivo) still dont have approval from the U.S. Food and Drug Administration (FDA) for the treatment of mesothelioma, but recent FDA approvals for non-small cell lung cancer are a step in the right direction for making immunotherapy a first-line treatment option for the asbestos-related cancer.

The drugs, which belong to a class known as checkpoint inhibitors, can be used in combination with other treatments or on their own for patients who may be ineligible for surgery or when chemotherapy is no longer effective.

Keytruda and Opdivo are available to mesothelioma patients through clinical trials and from doctors and oncologists who prescribe the drugs as an off-label use.

However, the NCI report shows clinical trial participation is very low for mesothelioma patients. According to the study, around 5 percent of pleural patients participated in a trial, while less than 2 percent of peritoneal patients enrolled.

Multivariate analysis from the study showed that systemic therapy improved overall survival regardless of treatment regimen or whether surgery was used. This demonstrates the need for more patients to enroll in clinical trials and the potential impact immunotherapy and other emerging therapies can have on treating mesothelioma and other aggressive cancers.

Receipt of either surgery or systemic therapy and particularly the combination of these two modalities was associated with better all-cause survival, Enewold wrote.

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Mesothelioma | Statistics, Warning Signs, Treatment Options

In most cases, by the time mesothelioma is caught, it has spread to other parts of the body from where it originated, making it hard to remove all the cancerous tissue by surgery. For that reason, standard mesothelioma treatment uses a multimodal approach, combining surgery, chemotherapy, and possibly radiation. Each of these methods has its benefits and drawbacks, but together they can treat the disease with some effectiveness.

In cases where there is little hope for a complete cure, conventional treatments may also be used to help relieve symptoms.

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Mesothelioma | Statistics, Warning Signs, Treatment Options

Mesothelioma – Overview of Malignant Mesothelioma Cancer

Malignant mesothelioma is a rare, asbestos-related cancer that forms on the thin protective tissues that cover the lungs and abdomen. A combined approach to treatment is helping people improve their survival and ease symptoms.

Or watch our video on mesothelioma

Dr. Jacques Fontaine, world-renowned mesothelioma specialist, sits down and talks about mesothelioma exclusively with Asbestos.com.

Did you know that doctors diagnose an estimated 3,000 cases of mesothelioma annually in the U.S.? The majority of those are traced to job-related exposures to asbestos. Most people have the pleural type of mesothelioma disease, which forms on the lining of the lungs, but the cancer can also form around the lining of the abdomen or heart.

Although asbestos use in this country has dropped in recent decades, a steady number of people are still getting mesothelioma. That’s because this cancer can take anywhere from 20 to 50 years after asbestos exposure before symptoms appear, and an oncologist can make a definitive diagnosis.

While there’s no cure for mesothelioma and the outlook is generally poor, researchers have made significant progress in understanding the cancer and developing new treatment options and alternative therapies.

Mesothelioma typically develops after people are exposed to asbestos in the workplace in industrial settings, shipyards, auto repair shops, old houses, schools and public buildings. While it usually takes long-term exposure to put someone at risk, short-term and one-time exposures are also known to cause mesothelioma cancer.

Fast Fact: 70-80 percent of people with mesothelioma were exposed to asbestos at work.

Statistics show that asbestos-related health complications arise when work duties or other activities disturb asbestos-containing materials and release fibers into the air. When we inhale or swallow these microscopic fibers, our bodies struggle to get rid of them. Over decades, the trapped fibers trigger biological changes that can cause inflammation, scarring and genetic damage that sometimes leads to cancer. The lengthy gap between asbestos exposure and diagnosis is called the latency period.

Asbestos fibers most often become trapped in the lining of the lungs, called the pleura. They also can collect in the lining of the abdominal cavity (peritoneum) or heart (pericardium). Once fibers cause biological damage, the stage is set for the decades-long latency period for the development of malignant mesothelioma disease.

Although several factors help determine your mesothelioma prognosis, or survival outlook, it is most affected by the stage of your cancer. Your doctors will perform tests to determine your cancer stage, typically represented by a Roman numeral (I-IV) or 1-4 that describes the seriousness of your diagnosis. Your cancer stage helps doctors determine the treatment options likely to work best for you.

There are three main types of mesothelioma. The most common type of the disease is pleural mesothelioma, it represents about 75 percent of all diagnoses. Peritoneal is the second-most common type, and it accounts for 10 to 20 percent of diagnoses. Approximately 1 percent of cases are of the pericardial variety. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.

Mesothelioma symptoms can be so mild that few people notice or recognize them, and many don’t experience any of them until later stages of the cancer. Fatigue and slight pain around the tumor may surface in early mesothelioma stages. Late-stage symptoms are more noticeable and commonly motivate people to visit the doctor.

These late-onset signs can include shortness of breath, chronic pain near the tumor, weight loss, fluid buildup or bowel obstruction. Effective therapies can relieve symptoms, and some treatments, such as talc pleurodesis, can even prevent symptom recurrence.

Doctors use several methods to test for malignant mesothelioma. Some exams, such as imaging scans and biopsies, provide more information than others but a combination of these helps doctors confirm an accurate mesothelioma diagnosis.

Most people initially undergo a basic chest X-ray to check for any abnormalities. If an abnormal growth is detected, doctors will recommend a more detailed imaging scan such as a PET scan, CT scan or MRI.

If cancer is suspected, doctors will recommend taking a sample of tissue, also knowns as a biopsy. Doctors use this tissue sample to definitively confirm the presence of mesothelioma cells.

Blood tests are also available, but they do not confirm the presence of mesothelioma. Research and development is underway to determine if blood tests can aid in early diagnosis for at-risk former asbestos workers.

There are at least five staging systems doctors use to stage pleural mesothelioma. The most widely used is the IMIG staging system. There are currently no universal staging systems for the cancer’s other types.

Despite the often poor prognosis associated with malignant mesothelioma, there are a number of encouraging stories of success accounts of people who live to celebrate special days with spouses, kids and grandkids. Each mesothelioma survivor has a unique tale to tell.

“We needed the right information so that we could be prepared, so we could understand what we would be going through, what we needed to do.”

“We’re very fortunate to know the Veterans Department and the whole team at Asbestos.com. We were in dire straits, and they gave us hope.”

“So much support made me realize I wasn’t alone in this fight. This is a path you don’t want to try and walk alone. You have to let others into your life.”

“I can’t do everything I once could, but I’m still out there getting around. I was fortunate in the care I received. And I don’t mind sharing my good fortune.”

“When you are diagnosed, don’t listen to the doom and gloom. Fight with all your might. Don’t worry if you feel selfish, as you are important.”

“I don’t dwell on this disease. I try to forget what I have. It just taps me on the shoulder and lets me know when I climb stairs, or walk too fast and get out of breath.”

The leading treatment options for mesothelioma include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, an approach known as multimodal therapy. Clinical trials show this approach has improved survival rates.

Palliative treatments that ease symptoms are quite common for patients of all stages, and experimental therapies like immunotherapy show progress for the future. Additionally, many survivors tout less-traditional alternative treatments for helping them to live longer.

Curative surgery is available for people with early stage mesothelioma, while palliative surgery is best for easing the symptoms of those diagnosed at a later stage.

Chemotherapy is a standard treatment to kill cancer cells, shrink tumors, prevent recurrence and relieve symptoms.

Radiation therapy is used alone or in combination with chemotherapy or surgery to kill cancer cells, manage tumors and prevent cancer from spreading along the path of a biopsy incision.

Mesothelioma specialists encompass a number of specialties, including surgery, medical and radiation oncology, radiology, pathology and palliative care. All can be part of a patients treatment plan. Working with an experienced mesothelioma doctor can make all the difference.

Get Help Finding a Specialist

The best mesotheliomatreatment centers attract people from across the country. Renowned for their cutting-edge technology and groundbreaking research, these centers can connect you with a multidisciplinary team of physicians with years of experience in treating asbestos-related diseases.

Get Help Finding a Cancer Center

Funding for mesothelioma research falls far short of that for other cancers, but new drugs and treatment options emerge from important clinical trials. These experimental studies are small and controlled opportunities for scientists to develop effective drugs like cisplatin and carboplatin.

Get Help Finding a Clinical Trial

Treatment is expensive, and insurance companies may not cover the cost of diagnostic tests or experimental therapies. People without medical insurance will face an even harder battle. If you or a loved one is diagnosed, consider taking steps to protect your finances.

Lawyer and in-house legal expert Joe Lahav knows the ins and outs of all the financial aid options available to you, including mesothelioma trust funds and grants to cover travel, treatment, housing and other expenses. Let him review your information and determine if you qualify for free financial assistance.

Many people with mesothelioma seek legal help to recoup medical expenses and secure a financial future for their families. Mesothelioma and other asbestos-related diseases are entirely preventable, but the companies that mined, manufactured and sold asbestos products put profits before the health of customers and their own employees. Our legal system ensures these companies are held accountable for their negligence.

Fast Fact: A 2011 report from the Government Accountability Office reported that $36.8 billion remained in asbestos trusts. This money was set aside to help compensate victims of asbestos exposure and their families.

People who were injured by asbestos can seek legal help through an established asbestos trust fund or by filing a lawsuit against the companies responsible for their asbestos exposure. Trust fund benefits, winning legal claims or out of court settlements can help you and your family cover treatment, lost wages and other expenses.

Manufacturers that used asbestos could have prevented their workers and others from getting exposed to the deadly mineral. Filing an asbestos lawsuit can ensure they are held financially responsible for their negligence.

The outcome of an asbestos-related lawsuit can vary because each case comes with its own set of facts, but juries have returned with verdicts of $337 million (for Alfred Todak), $30.3 million (for Susan Buttitta) and $22 million (for Eugene McCarthy and Walter Koczur).

Most asbestos-related lawsuits are settled out of court. A paper trail of occupational exposure can lead defendants to settle out of court to avoid lawsuit expenses as soon as possible. Mesothelioma settlements can range from moderate to large sums.

Because asbestos use in the military was so rampant from 1940 to 1980, veterans from all branches of the U.S. armed forces who served during those years are now at high risk of developing mesothelioma and other asbestos-related conditions. Job duties known for high rates of harmful exposures include pipefitting, mechanical work, equipment maintenance and shipyard work.

If you or a loved one was injured by asbestos exposure in the military, U.S. Army Capt. Aaron Munz can help you navigate the VA claims process and get the benefits you deserve. Munz, who joined The Mesothelioma Center as Veterans Department Director in 2015, is a decorated veteran who served nine years in combat and earned the Bronze Star Medal for Valor in 2004 during Operation Iraqi Freedom. He understands the challenges veterans face when diagnosed with mesothelioma, and can answer any questions about the disease and the complicated filing process for VA claims.

Every cancer diagnosis comes with a wide range of physical and emotional challenges, and it’s not just patients who are affected. Sometimes family members and loved ones need support too. We can get you free support resources to help you move forward, whether you’re a new caregiver or a concerned spouse or family member.

Request a comprehensive mesothelioma guide to gain a deeper understanding of the cancer and how you can help your loved one in this difficult time. We provide free must-read books that answer frequently asked questions about the asbestos-related cancer, too.

Visit our Facebook page for the latest in survivor stories, treatment news and inspirational images. While you’re there, connect with other members of the mesothelioma community who understand exactly what you’re going through.

Order a free wristband today to support your loved one. By wearing a mesothelioma wristband you can help bring awareness to this deadly cancer and also bring to light the dangers of asbestos exposure. Order today and have them shipped overnight.

Learn how to help your loved one cope with mesothelioma by participating in our monthly support group. You can participate online or over the phone to watch a presentation by our licensed mental health counselor, Dana Nolan, and share your experiences with other survivors and caregivers.

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Mesothelioma – Overview of Malignant Mesothelioma Cancer

New Report Reveals Disparities in Mesothelioma Treatment – Surviving Mesothelioma

A new study of mesothelioma treatment and survival in the US contains some disturbing facts about treatment trends.

Among them is the fact that people over 70 are much less likely to get any treatment for malignant mesothelioma, a rare but but fast-growing malignancy that can be quickly fatal. In fact, nearly a third of mesothelioma patients receive no therapy at all.

The study was based on 2011 data from the National Cancer Institutes Surveillance, Epidemiology and End REsults (SEER) database. It included 389 patients with pleural mesothelioma and 53 patients with non-pleural mesothelioma.

The researchers used statistical models to identify the factors associated with receiving mesothelioma treatment and to calculate mortality rates.

One of the most striking findings was that 29.3% of the pleural mesothelioma patients and 21.5% of the non-pleural patients received no therapy at all. Among the patients with pleural mesothelioma the most common variety which starts on the pleural membrane around the lungs older patients were less likely to receive therapy.

Mesothelioma is a highly aggressive cancer. Without treatment, it is typically fatal in just a few months. Including the data on both treated and untreated pleural mesothelioma patients, the researchers found that median survival was just 9 months.

The news was somewhat better for patients with non-pleural mesothelioma. The median survival for this group was 18 months.

As with previous studies, the new report suggests that there is no single treatment that works best for mesothelioma but, rather, that the most powerful way to attack the asbestos cancer is from multiple angles.

Receipt of either surgery or systemic therapy and particularly the combination of these two modalities was associated with better all-cause survival, reports researcher Lindsey Enewold in the new October issue of the journal Lung Cancer.

Among the pleural mesothelioma patients, being younger and in a lower socioeconomic bracket was associated with better overall survival. Having other health problems (comorbidities) did not appear to be linked to whether or not a patient received treatment or even their survival.

The researchers conclude that there are clear inequities in the way mesothelioma treatment is delivered in the US and that more should be done to ensure that all patients who need mesothelioma care can receive it.


Enewold, Lindsey, et al, Patterns of care and survival among patients with malignant mesothelioma in the United States, October 2017, Lung Cancer, pp. 102-108

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New Report Reveals Disparities in Mesothelioma Treatment – Surviving Mesothelioma

New UK Research Points to Value of Immune Cells in Predicting Mesothelioma Outcomes, According to Surviving … – Benzinga

Scientists say testing for immune system markers could even help direct mesothelioma treatment.

Raleigh, NC (PRWEB) August 24, 2017

Doctors with Southampton University in the UK have developed a system of immune system tests that they say show the relationship between immune cells and mesothelioma survival. Surviving Mesothelioma has the full story. Click here to read it now.

Researchers used 302 tissue samples from patients with advanced malignant mesothelioma to determine that patients appear to have better treatment outcomes when they test high for certain kinds of immune system cells and low for others.

“Our data demonstrate for the first time, in predominately advanced disease, the association of key markers of adaptive and innate immunity with survival and the differential effect of histology [subtype],” writes Serena Chee, a member of the medical faculty at the University of Southampton.

According to the study published in the British Journal of Cancer, mesothelioma patients with the epithelioid subtype had better outcomes when their tumor samples tested high for a certain type of T-cell (CD4+) and B-cell (CD20+) and low in another type of T-cell (FOXP3+), macrophages, and neutrophils.

“Determining mesothelioma prognosis and making informed decisions about treatment are significant challenges for doctors and patients,” says Alex Strauss, Managing Editor for Surviving Mesothelioma. “This study suggests that immune system testing could be a relatively simple way to improve both prognosis and treatment outcomes.”

For a more indepth look at the possible association between immune system cell counts and mesothelioma survival, see Using Immune Cells to Predict Mesothelioma Outcomes, now available on the Surviving Mesothelioma website.

Chee, SJ, “Evaluating the effect of immune cells on the outcomes of patients with mesothelioma”, August 17, 2017, British Journal of Cancer, Epub ahead of print, http://www.nature.com/bjc/journal/vaop/ncurrent/full/bjc2017269a.html?WT.feed_name=subjects_immunology&foxtrotcallback=true

For more than a decade, Surviving Mesothelioma has brought readers the most important and ground-breaking news on the causes, diagnosis and treatment of mesothelioma. All Surviving Mesothelioma news is gathered and reported directly from the peer-reviewed medical literature. Written for patients and their loved ones, Surviving Mesothelioma news helps families make more informed decisions.

For the original version on PRWeb visit: http://www.prweb.com/releases/2017/08/prweb14627320.htm

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New UK Research Points to Value of Immune Cells in Predicting Mesothelioma Outcomes, According to Surviving … – Benzinga

Using Immune Cells to Predict Mesothelioma Outcomes – Surviving Mesothelioma

Immune system cells may be some of the best predictors of mesothelioma outcomes, according to a group of British scientists.

A new article in the British Journal of Cancer has found a close association between outcomes in people with different subtypes of malignant mesothelioma and the levels of different types of immune system cells in their bodies.

To create the experiment, researchers with the University of Southampton in the UK devised a series of tests based on 302 tissue samples from people with advanced malignant mesothelioma.

The samples were examined for markers of adaptive immune response including T-cells and B-cells as well as markers of innate immunity including neutrophils, natural killer cells and macrophages.

These cells all play slightly different roles in responding to perceived threats in the body, including malignant mesothelioma and other cancers.

According to the study, mesothelioma patients with the epithelioid subtype had better outcomes when their tumor samples tested high for a certain type of T-cell (CD4+) and B-cell (CD20+) and low in another type of T-cell (FOXP3+), macrophages, and neutrophils.

High CD4+ and CD20+ counts and a low neutrophil count were also helpful in predicting prognosis in the same group.

Only FOXP3+ counts were found to be independently associated with mesothelioma survival in both the epithelioid subgroup and in people with non-epithelioid mesothelioma.

Our data demonstrate for the first time, in predominately advanced disease, the association of key markers of adaptive and innate immunity with survival and the differential effect of histology [subtype], writes Serena Chee, part of the medical faculty at the University of Southampton.

The next step is for researchers to learn how to best apply this information in individual cases of malignant mesothelioma.

Malignant mesothelioma, which usually occurs in the pleural form on the membrane around the lungs, or the peritoneal form on the membrane around the abdomen, is extremely rare and difficult to treat. Among the biggest challenges is determining exactly which combination of therapies is likely to produce the best outcome for each mesothelioma patient.

Immunotherapies, cancer drugs designed to alter the immune system, are emerging as one of the most hopeful methods of treating and perhaps even curing malignant mesothelioma and other cancers. A number of immunotherapy drug trials for mesothelioma are currently ongoing.

The University of Southampton researchers say they hope that a better understanding of the Immunological drivers behind different mesothelioma subtypes will help clinicians in determining mesothelioma prognosis and planning treatment.


Chee, SJ, Evaluating the effect of immune cells on the outcomes of patients with mesothelioma, August 17, 2017, British Journal of Cancer, Epub ahead of print


Using Immune Cells to Predict Mesothelioma Outcomes – Surviving Mesothelioma

10-Year Study Confirms Longer Mesothelioma Survival with Trimodal Therapy – Surviving Mesothelioma

Surgical Intervention Improves Peritoneal Mesothelioma Survival

Trimodality therapy including surgery, chemotherapy, and radiation appears to give carefully-selected patients the best odds of surviving mesothelioma.

In a new article in the Journal of Clinical Oncology, researchers from MD Anderson Cancer Center detail the results of their analysis of mesothelioma survival using the National Cancer Database.

The research team started with a pool of 20,561 pleural mesothelioma cases diagnosed between 2004 and 2014.

They then focused on 6,645 patients who were matched for their similar characteristics. Of these, 850 underwent mesothelioma surgery, 988 had surgery with chemotherapy, and 274 underwent trimodality therapy.

When the researchers compared the outcomes of mesothelioma patients with similar characteristics to each other, they found that cancer-directed surgery (surgery performed specifically to remove all or part of a tumor), chemotherapy, and radiation therapy were independently associated with improved survival.

Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based and multimodality therapies, writes lead author and thoracic surgeon David B. Nelson, MD.

Malignant mesothelioma is a rare and aggressive malignancy that rarely responds to a single cancer therapy. The study data showed that the most positive treatment outcomes were seen in patients who had a very specific combination of therapies: cancer-directed surgery, chemotherapy, and radiation.

But pleural mesothelioma surgery is not without risk. Just over six percent of the subjects included in this study died within a month of their procedure and 15.5 percent did not survive beyond three months.

The best news to come from the new study centers on people with the most common subtype of pleural mesothelioma called epithelioid. For these patients, trimodality therapy including surgery extended their survival by nearly nine months from 14.5 to 23.4 months.

The researchers conclude that surgery-based multimodality therapy has the power to improve the odds of surviving mesothelioma, especially when patients are carefully selected.

About 2,500 people are diagnosed with mesothelioma each year in the US. For most of them, the disease was the result of on-the-job exposure to the toxin, asbestos.


Nelson, DB, et al, Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma: Propensity Score Matching Analysis, August 17, 2017, Journal of Clinical Oncology, Epub ahead of print

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10-Year Study Confirms Longer Mesothelioma Survival with Trimodal Therapy – Surviving Mesothelioma

Results From Opdivo Trial May Help Mesothelioma Oncologists Identify Which Patients Will Benefit From Drug – MesotheliomaHelp.org (blog)

In April, MesotheliomaHelp reported on the findings of a phase I clinical trial showing that the five-year survival rate for some lung cancer patients treated with Opdivo (nivolumab), an immunotherapy treatment, was much higher than historical data. Now, researchers report that results from a phase III clinical trial may help oncologists determine those lung cancer patients, and possibly, mesothelioma patients, who will benefit from the immuno-oncology drug.

Opdivo, developed by Bristol-Myers Squibb, works by blocking the PD-L1 protein and activating the immune system, leading it to attack and kill cancer cells. According to a June 21 press release from The Ohio State University Comprehensive Cancer Center, a team of researchers led by David Carbone, MD, PhD, of The Ohio State University Comprehensive Cancer Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, found that although the trial did not improve progression-free survival when compared with chemotherapy in the overall population, those patients with a high expression of PD-L1 did benefit.

The good news is that we discovered that a subset of patients who had both high tumor mutation burden and high PDL-1 positive status did experience a significant benefit from immunotherapy, says Carbone.

Specifically, the researchers report that patients who had both high tumor mutation burden and high PDL-1 positive status realized a 75 percent response rate compared to just 16 percent response rate with low mutation burden and low PDL-1. However, the response rates for chemotherapy treatment in these same subsets were nearly the same leading the researchers to conclude that the PDL-1 markers were selective for immunotherapy.

Mesothelioma, a rare, asbestos-related cancer of the lining of the lungs, abdomen or heart, is highly aggressive and is resistant to many cancer treatments. The prognosis for mesothelioma patients is usually grim: the average survival time varies from 4 18 months after diagnosis. For the close to 3,000 Americans diagnosed with the disease each year, personalized care may bring a breakthrough treatment not previously considered by their physician.

The benefits of personalized care for mesothelioma patients have been proven where researchers have identified genetic biomarkers that reflect the aggressiveness of mesothelioma as well as markers that can assess the effectiveness of a particular treatment.

Opdivo is currently in a phase III clinical trial in the UK for mesothelioma patients. Known as The CheckpOiNt Blockade For Inhibition of Relapsed Mesothelioma, or CONIFRM, the trial has a goal of exploiting the potential of immunotherapy.

Keytruda, which gained popularity after saving former President Jimmy Carters life after sending his melanoma into remission, is also a PD-L1 inhibitor. Both immunotherapy drugs have shown in studies to be effective in fighting pleural mesothelioma. Keytruda is, perhaps, more well known due to eight-year mesothelioma survivor Mavis Nye of England, who went into remission after a two-year clinical trial of the drug.

This study is an important step toward understanding the impact of tumor mutation burden and PDL-1 in immunotherapy response. This data shows we should evaluate these two factors independently to most accurately define who will benefit from immunotherapy, says Carbone.

See the full results of the study in the June 22 issue of the New England Journal of Medicine.

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Results From Opdivo Trial May Help Mesothelioma Oncologists Identify Which Patients Will Benefit From Drug – MesotheliomaHelp.org (blog)

Osteoporosis Drug May Help Treat Advanced Mesothelioma, Too … – Surviving Mesothelioma

A drug normally used to treat and prevent osteoporosis may be useful in the treatment ofadvanced malignant mesothelioma, too.

The drug, called zoledronic acid, is a member of the drug class bisphosphonates and is also used to prevent skeletal fractures in patients with certain kinds of cancer.

In a new study published in the journal Lung Cancer, University of Alabama researchers found that more than a third of mesothelioma patients treated with zoledronic acid saw some benefit from it and none of them experienced any serious side effects.

Malignant mesothelioma is a fast-growing cancer of internal membranes caused by exposure to asbestos. Conventional cancer therapies do not typically work well for mesothelioma and researchers are continually looking for new and better options.

The new pilot study of zoledronic acid involved eight men with advanced malignant pleural mesothelioma. The median age of the study subjects was 62 and three quarters of them had epithelioid mesothelioma, the most common subtype.

The patients had either failed to respond to previous mesothelioma treatments or had been judged too unhealthy to undergo systemic chemotherapy.

The research team used several factors to measurehow well the zoledronic acid worked for these patients, including the patients levels of vascular endothelial growth factor (VEGF) and the mesothelioma biomarkers mesothelin and osteopontin.

While zoledronic acid did not have a major impact on mesothelioma survival, 37.5 percent of patients did benefitfrom the treatment. The patients who responded either saw a reduction in the size of their mesothelioma tumors or experienced a temporary cessation of tumor growth.

It took a median of2 months for those mesothelioma tumors to start growing again after treatment with zoledronic acid, but the longest progression-free survival was 21 months. Median overall survival on the treatment was 7 months. Patients who experienced a drop in VEGF levels were the ones who weremost likely to benefit from zoledronic acid.

Equally significant was the fact that there were no treatment-related toxicities associated with zoledronic acid treatment. In contrast, standard chemotherapy treatment for mesothelioma can produce serious side effects and may even be too caustic for the most fragile patients. Zoledronic acid may offer a viable alternative.

Zoledronic acid shows modest clinical activity without significant toxicity in patients with advanced malignant pleural mesothelioma, concludes lead author, oncologist Muhammad Omer Jamil, MD.

Zoledronic acid is on the World Health Organizations List of Essential Medicines, drugs that are considered the safest and most effective for health systems to have on hand.


Jamil, MO, et al, A pilot study of zoledronic acid in the treatment of patients with advanced malignant pleural mesothelioma, June 12, 2017, Lung Cancer, pp. 39-44

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Osteoporosis Drug May Help Treat Advanced Mesothelioma, Too … – Surviving Mesothelioma

Father’s Participation in Mesothelioma Clinical Trial Driven by Desire to Bring Cure to Others – MesotheliomaHelp.org (blog)

When my father was diagnosed with pleural mesothelioma, it was a devastating blow to my entire family. That is to say the least. However, throughout his illness, Dad always said that if something could come from his experience that would help someone else, it would be worth it. This is partly the reason that he decided to take part in a clinical trial.

I remember approaching this man whom I adored, and telling him that he would have the opportunity to qualify as a participant. I was so excited at the prospect of him being a part of something so wonderful, but also for another option to help him beat this disease. Despite the travel that was required, Dad agreed to do it. He told me that, once again, maybe even if this trial didnt help him, it would help someone else someday.

Ultimately, mesothelioma took my father from me, but his part in finding a cure for this cancer continues. Through his participation in a clinical trial, he is still helping people, people that he didnt even know. His prayer was for mesothelioma to be eradicated forever; and he did everything he could to help to make this a reality.

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Father’s Participation in Mesothelioma Clinical Trial Driven by Desire to Bring Cure to Others – MesotheliomaHelp.org (blog)

Mesothelioma Cancer: Symptoms, Causes, Treatment and …

The fibers become lodged in the lining of the lungs, abdomen or heart and can lay dormant for decades before symptoms start to show. Mesothelioma can accurately be described as a deadly and aggressive form of cancer.

Mesothelioma is a rare type of cancer primarily caused by inhaling or swallowing certain carcinogens at home or on the job. With 3,000 cases diagnosed each year, mesothelioma affects men and women of all ages. The long latency period means you could be exposed to carcinogenic fibers as a teenager and be unaware you have mesothelioma until much later in life.

At Mesowatch, we will meet at your convenience to help you document your claim, initiate the process, file lawsuits and go after the parties potentially liable for negligently exposing you to the hazardous carcinogens that caused the mesothelioma to develop. In addition, we help you get started on filing trust fund claims so you recover the compensation youre entitled to receive for your mesothelioma diagnosis and asbestos exposure injuries. If you or a loved one have been diagnosed with mesothelioma, or have symptoms related to mesothelioma, contact Mesowatch today.

Mesothelioma is a rare type of cancer primarily caused by inhaling or swallowing asbestos fibers. Mesothelioma develops from the fibers building up inside the thin membrane lining of vital organs, causing inflammation and scarring. The membrane layer that carcinogenic fibers accumulate inside of is known as the mesothelium.

The mesothelium membrane around your lungs, abdomen, heart and testicles provides a lubricating fluid that allows the organs to expand, contract and move against each other with ease. Over time, the chronic inflammation from the asbestos fibers inside the internal organ tissues forms into cancerous mesothelial cells. The cellular damage to DNA from carcinogens can alter how cell growth functions and cause a tumor to develop.

Mesothelioma tumors can contain up to three different cellular variations that will affect the cancer patients prognosis and treatment options. Determining the cell type, epithelioid, sarcomatoid, or biphasic, is one of the primary steps in confirming a diagnose. Often times, the cell type is determined by collecting a tissue sample for a biopsy.

Epithelioid cells account for three out of four of all mesothelioma diagnoses. The cells have an elongated, uniform shade and are often associated with lung cancer. These cell types typically have the best response to treatment.

Sarcomatoid cells account for approximately 10 percent of all mesothelioma cases. These spindle-shaped cells typically grow, in a haphazard arrangement, from supportive structures like bones and muscles. Sarcomatoid cell types are often the most difficult to diagnoses and their prognosis is often the most fatal.

Biphasic cells account for around 40 percent of all mesothelioma cases. Biphasic cells are made from a mixture of sarcomatoid and epithelial cell types, but the two often stay differentiated. The prognosis for biphasic is often better than sarcomatoid cells, but worse than epithelioid cells.

The leading cause of pleural mesothelioma, the most common form, is inhaling the asbestos fibers used to construct many of the buildings we live and sleep in. The microscopic fibers are inhaled, penetrating the lung until they are caught in the protective lining of the pleura. The fibers could remain lodged in lung tissue undetected for 10 to 50 years before any mesothelioma symptoms start to show.

Direct exposure from the local environment, like working with products containing asbestos or inside a workspace where airborne asbestos can be inhaled or swallowed, is the most common way people develop this disease. Secondary exposure, like family members being exposed to an asbestos workers clothing and equipment, or other compounding factors, like family history, is also relevant to whether or not mesothelioma develops. If the asbestos fibers are swallowed, mesothelioma in the testes or abdomen is more likely. However, not everyone exposed to asbestos will develop mesothelioma in the future.

Asbestos Timeline

The latency for mesothelioma typically lasts from 10 to 50 years from the date of exposure. This means that the scarring and inflammation of the mesothelium can go on for decades before any symptoms are detected by the victim. The average latency period for patients with malignant mesothelioma is 35 to 40 years.

The latency period for Mesothelioma begins once the microscopic fibers have begun to biologically damage the body. The widespread use of asbestos has declined recently, but the number of mesothelioma patients continues to steadily increase due to the extremely long latency period. For anyone with a history of extensive exposure to asbestos, the latency period may be shorter.

If you are diagnosed at a younger age, you have a better chance of surviving longer. The long latency period makes providing an accurate prognosis difficult for many physicians. Many times, mesothelioma has already developed into the advanced stages by the time its actually detected. The five-year survival rate for people diagnosed with mesothelioma ranges between 5 and 10 percent.

For people diagnosed with stage I, the median survival rate is 21 months. If youve received a diagnosis of stage II of mesothelioma, the median survival rate is 19 months. Generally speaking, patients with mesothelioma cancer too far spread to remove have a lower survival rate than those who can still be operated on. For later stages of a mesothelioma diagnosis, the median survival rate is 12 to 16 months, respectively.

Mesothelioma affects people of all ages exposed to asbestos and other carcinogens, including children and senior citizens. However, children only account for up to 4 percent of all mesothelioma cases.The average age of patients diagnosed with pleural mesothelioma is 69, and most patients are at least 40-years-old. Overall, males seem to be more affected by mesothelioma than females.

According to the CDC, there were nearly 2,600 deaths attributed to malignant mesothelioma during 2015. Most cases involved patients between 75 and 84, who were most likely exposed before 1980 when asbestos was still widely used in hundreds of consumer products and construction materials. However, nearly 700 of the cases involved patients ages 24 to 44, who born after most asbestos-related materials and products were banned by the EPA.

Historically, the rate of mesothelioma has also been higher for people who identify as white or Hispanic, than those identifying as Asian American or African American. People with a family history of mesothelioma may also be at greater risk. However, up to 80 percent of all mesothelioma cases are attributed to asbestos exposure that occurred on the job. Some of the common places to be exposed to asbestos include:

Anyone employed in industries involving asbestos exposure, along with their family members, may face a high risk of developing mesothelioma later in life. This is largely due to the fact that thousands of companies were involved in the chain of exposure that led to asbestos being used in over 3,000 different types of products. Workers handling the asbestos materials during this time period were unwittingly suffered an unhealthy amount of asbestos exposure. This is the main reason why most mesothelioma patients today are around 70 years old now.

The main types of mesothelioma are pleural, peritoneal and pericardial and testicular mesothelioma. The pericardial and testicular varieties are extremely rare and only account for approximately 1 percent of all mesothelioma cases.

Pleural mesothelioma is the most prominent variety and accounts for around 75 percent of all cases. With this type of mesothelioma, the carcinogenic fibers and disease are found in the pleura lining of the lungs. A number of clinical studies are currently underway to help develop better treatment options available and improve survival rates.

Peritoneal mesothelioma accounts for up to 20 percent of all diagnosed cases. With this type of mesothelioma, the scarring and inflammation from inhaling or swallowing asbestos fibers are forming cancerous mutations in the perineum that lines the abdominal cavity. Peritoneal mesothelioma is best treated with a combination of heated chemotherapy and surgery.

Pericardial mesothelioma is one the rarest varieties a patient can receive a diagnosis for. With pericardial mesothelioma, the protective tissue that sustains the scarring and inflammation serves as the lining of the heart. This is especially hard to treat due to the sensitivity of the area that needs to be treated.

Testicular mesothelioma accounts for less than 2 percent of all mesothelioma cases. Many physicians believe the mesothelioma forms in the lining of the testes as a result of ingesting asbestos. This variety typically responds better to treatment than pleural mesothelioma.

Mesothelioma symptoms can be difficult to diagnose because they are easily mistaken as being related or caused by another condition. Anyone with symptoms and an employment history related to a high-risk occupation should not hesitate to see a physician to receive a physical assessment for any illnesses related to asbestos exposure. Its better to try and catch mesothelioma symptoms early, rather than suffer the consequences of discovering them too late. Some of the most common mesothelioma symptoms to be aware of include:

If you or a loved one are suspicious of potential mesothelioma symptoms, contact a medical professional right away.

Mesothelioma is often difficult for physicians to diagnose, and they use a combination of methods to confirm their findings:

Biopsy: A number of different nonsurgical and surgical biopsy procedures may be required to confirm the diagnosis and outline the appropriate treatment options.

Imaging and Scanning: MRIs, X-rays, CT scans and PET scans are typically involved in the first steps of the diagnostic process. In order to properly diagnosis and treat the condition, physicians use these tools to learn how far the mesothelioma has developed and where the tumor is located.

Blood Tests and Biomarkers: In order to confirm the diagnosis or a physicians suspicions, blood tests like CA125, Fibulen-3 or Mesomark can be used to measure biomarkers and confirm if the patient has mesothelioma.

Aside from the long latency period, mesothelioma has a high rate of misdiagnosis because the symptoms often resemble common conditions like pneumonia, cold and flu. If you think you have the symptoms and asbestos exposure in your past, contact Mesowatch today and well direct you to a reputable mesothelioma cancer treatment facility to receive specialized care from the proper specialists.

Mesothelioma has no known cure, but there are treatment options to help alleviate the symptoms and improve survival rates. In addition, cancer specialists have been looking for alternative therapies and innovative options for treatment. The options for treatment are dictated by the stage the patients mesothelioma is in. Patients receiving later stage diagnoses have limited options. If you think you were exposed to asbestos in the past, see a physician regularly to catch the disease in the early stages of development.

Treating the mesothelioma is difficult, and doctors are still studying the effectiveness of radiation therapy, chemotherapy, and surgery. People diagnosed with stage IV mesothelioma or early on in stage IV may qualify for chemical pleurodesis, a treatment that helps prevent the symptoms from recurring.Other therapies include photodynamic therapy, targeted drugs, gene therapies and immunotherapies and virus therapies.

Surgery: Procedures to remove the tumors, but patients must qualify based on a number of factors. Approximately 20 percent of pleural mesothelioma patients have the surgery.

Chemotherapy: Administered through oral or IV-based medications that target cells to help limit cancer cell growth. Prognosis and survival rate improves for some patients.

Radiation: Conventional therapy for cancer cells used to shrink and kill tumors. The effectiveness and precision of the therapy are improved by using intensity-modulated radiotherapy, IMRT.

You or a loved one may be entitled to financial compensation if youve been diagnosed with mesothelioma. Mesowatch is here to assist mesothelioma patients and asbestos exposure victims obtain justice for their injuries.

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Mesothelioma Cancer: Symptoms, Causes, Treatment and …

Recent Increase in Therapeutic Clinical Trials for Mesothelioma – Mesothelioma.com

Jillian Duff covers pressing news for the Mesothelioma Cancer Alliance. Bio

June 29, 2017

Houston, TX – Within the past year, there has been a significant increase in the number of therapeutic clinical trials for mesothelioma cancer. Many of these trials have focused on developing or improving immunotherapy treatments that enhance the bodys natural cancer-fighting capabilities through the immune system.

For example, several immunotherapy basket trials focusing on PD-1/PD-L1 inhibitors have produced response rates between 9% and 28%, with disease control rates resulted anywhere from 50% to 77% in mesothelioma patients. These trials have also shown checkpoint inhibitors to be more active in PD-L1 IHC positive patients.

Clinical trials test new mesothelioma treatments, as well as new ways to use existing treatments. For patients who do not respond well to conventional therapies, these trials offer the best opportunity for long-term survival. The use of experimental drugs begins with in-depth studies that can significantly improve life expectancy and quality of life.

Some recent successes with immunotherapy drugs include Keytruda (pembrolizumab) and Avastin (bevacizumab), but other experimental treatments like gene therapy, photodynamic therapy, and multimodality therapy are also being studied.

Most clinical trial expenses are covered by the sponsoring entity. This might include a government agency, hospital, university hospital, or a pharmaceutical company. They are typically conducted at a cancer clinic or a specialized area of a hospital that treats cancer patients. Patients may still need to pay for transportation, trips to the doctor, and various tests.

Before a treatment receives approval from the Food and Drug Administration (FDA), it must undergo at least three separate phases of clinical trials, with a possible fourth phase following approval. These phases occur after a treatment has been tested in laboratory and animal studies. The trials intend to show a drug is both effective and safe for human use.

Researchers like Dr. Anne Tsao agree we still need to explore the biology and develop combination therapies. Dr. Tsao is the director of the mesothelioma program at the M.D. Anderson Cancer Center at the University of Texas in Houston, one of the nations foremost authorities on malignant mesothelioma.

Other clinical trials are testing immunotherapy in combination with surgery as a more effective way to treat mesothelioma. The Baylor College of Medicine Mesothelioma Treatment Center began running the trial this year. Up until now, either immunotherapy has always been administered as a standalone treatment or, more often, after surgery takes place.

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Recent Increase in Therapeutic Clinical Trials for Mesothelioma – Mesothelioma.com

Mesothelioma Survivors Unite to Celebrate Remission – Asbestos.com (blog)

Every year, peritoneal mesothelioma survivor Trina West-Clark takes a trip to the casino to have a few cocktails with friends and celebrate another year of living cancer-free.

To celebrate 16 years of mesothelioma remission, she will travel to Canada and meet fellow peritoneal mesothelioma survivor Raeleen Minchuk and Cheryl Ewoldt, who lost her husband, Barry, to the aggressive cancer.

Weve never met before, but we decided to meet up there and celebrate together, West-Clark told Asbestos.com. Im so excited to do that.

West-Clark and Minchuk were diagnosed on the same day, but 13 years apart. Minchuk found solace in West-Clarks survivor story and plans to commemorate her own three-year survival mark with her inspiration.

They are still ironing out details of the trip, but West-Clark hopes to plan it around their shared cancer anniversary on September 11.

Were throwing around dates, but Im trying to talk Raeleen into doing the 9th to the 12th so I can be with her on the 11th, she said.

Its been more than a year since West-Clarks last CT scan. She periodically experiences some pain and stomach issues but says life is good.

I cant believe its been 16 years. I honestly cant, she said. Im just loving life. No complaints whatsoever.

And as fun as having cocktails with friends at a casino can be, West-Clark knows her 16th anniversary will be special because it will be spent with others affected by peritoneal mesothelioma a rare cancer diagnosed in approximately 500 people in the U.S. each year.

They are the only people that can actually relate to where you have been, she said. Its pretty emotional Im not going to lie because [Minchuk] looks up to me so much. Its very emotional to know that Im finally going to meet her.

West-Clark admitted it will be tough meeting Ewoldt, the third member of the trip.

Peritoneal mesothelioma took the life of Ewoldts husband at age 55. Cheryl was his caregiver until he entered hospice care.

I have the upmost respect for any caregiver, West-Clark said. My caregiver saved my life.

West-Clarks caregiver was Victor Elia. They dated for 18 years and have two children together.

He is the one that actually pushed me through it all, she said. When I was standing in the shower and started losing all my hair, he was the one that picked it up off the shower floor and said, Its okay. He told me I was sexy, and I told him Youre crazy. You have to have a caregiver thats actually going to push you to survive in a situation such as that. Otherwise, youre just going to lie there and die.

Trina West-Clark with former caregiver Victor Elia.

Recently, West-Clark has seen several friends lose their battle with mesothelioma. Too often, survivors give up hope.

The role of a caregiver can be overwhelming, but its essential to a patients quality of life. Caregivers with a personal connection to patients can be even more overwhelming, but, like Elia, these people can make an invaluable difference in a mesothelioma survivors cancer journey.

I thank him every single time I talk to him and see him, West-Clark said. I actually think he had a lot to do with all of it.

Those around West-Clark tell her she is the strongest person theyve ever met. No matter what happens, she finds a way to bring up others.

You will work your way through what you have to deal with and get that next person where you are. Thats what they say to me that I am so strong, she said. What I say to that is that Im as strong as cement, but some days, that cement is about to crumble.

However, she always seems to find a way to push through and put the needs of others ahead of her own.

My son tells me theres a purpose that was left for me that has allowed me to survive as long as I have, and that purpose is to be the caregiver and take care of everyone else, she said.

She saved a friend who suffered a heart attack in front of her and cared for him during his recovery. She later nursed another friend back to health after he underwent open-heart surgery.

In December, West-Clark found out her sister needed a heart transplant. She dropped everything and went to Florida to care for her.

West-Clark recently looked after two grandkids as her daughter recovered from surgery.

Trina West-Clark enjoys spending time with her three grandchildren.

Taking care of loved ones helps keep her mind off her own struggles. She still thinks of herself as a cancer survivor and occasionally fears a recurrence, but not as much as she used to.

In the first five years, youre so fearful, she said. After that, you have to stay positive. You have to tell yourself that youre not going to go backwards after the good Lord let you go this far. I want to go forward. Life is good.

Its a message she hopes instills in Minchuk, who is still in the early stages of fearing the unknown.

West-Clark lives by the philosophy of body in motion. She still tours the country in her fiances 18-wheeler during the winter months.

Summers are spent in Gladwin, Michigan, on Secord Lake. She bought a new pontoon boat and spends as much time on the water with family and friends.

Trina West-Clark (back, left) with family and friends aboard her pontoon boat.

She recently celebrated her third grandchild her sons first child. West-Clarks daughter lives nearby and serves as her support system when she needs a helping hand or a listening ear.

When shes not helping others, West-Clark is likely on the lake, building jigsaw puzzles or landscaping her yard.

Life has become all about my grandkids, she said. Traveling and family is my thing. I dont dwell on [the cancer], I just live every moment.

More here:

Mesothelioma Survivors Unite to Celebrate Remission – Asbestos.com (blog)