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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 a 12-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.

Heather offers valuable insights into her successful treatment approach with Dr. David Sugarbaker. She has a unique perspective on life after surviving a mesothelioma diagnosis and enjoys sharing her story.

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:

Those who have been diagnosed with mesothelioma or other types of terminal cancer can find tremendous comfort in the support they get from family, friends and caregivers.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

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)

See the article here:

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma – What is Malignant Mesothelioma Cancer

Malignant mesothelioma is a rare, asbestos-related cancer that forms on the protective tissues covering the lungs, abdomen and heart. Symptoms include coughing, chest pain and shortness of breath. Treatments combining surgery, radiation and chemotherapy are improving survival and life expectancy.

Perceptions about malignant mesothelioma are changing.

Scientific research and increased awareness are leading to earlier diagnoses. Improved and developing mesothelioma treatments are allowing patients to live longer than ever.

As more thoracic surgeons and oncologists become familiar with malignant mesothelioma, patients will have more experienced doctors who can extend their life expectancy and increase their chances of surviving this disease.

Malignant mesothelioma is a cancer caused by asbestos exposure. It forms in the lining of the lungs, abdomen, heart or testicles. Around 2,500 new cases of malignant mesothelioma are diagnosed each year in the U.S.

A small portion of mesothelioma tumors are not cancerous. Known as benign mesothelioma, these tumors respond well to surgery and rarely recur.

To understand malignant mesothelioma, it is important to learn about its causes, symptoms, types, treatment and prognosis. Learning more about mesothelioma cancer will help you make wise decisions about treatment and help you choose the best path to extend your life expectancy.

Exposure to asbestos is still the overwhelming cause of mesothelioma. Asbestos is a naturally occurring mineral once highly regarded for its insulation and fire-retardant properties.

Approximately 75 percent of cases are men who were exposed to asbestos while serving in the military or working certain high-risk blue-collar jobs. Some of these jobs include construction, firefighting, shipbuilding and industrial work.

Secondary exposure also occurs when washing the clothes of someone in a high-risk occupation. Living near abandoned asbestos mines or areas where asbestos occurs naturally in the environment can lead to exposure.

LEARN ABOUT THE CAUSES OF MALIGNANT MESOTHELIOMA

Mesothelioma symptoms do not usually arise until tumors have grown and spread, and they begin to press against the chest wall or abdominal cavity.

If you have a history of asbestos exposure and experience these symptoms, you should consult a mesothelioma cancer specialist as soon as possible. Although symptoms appear during the late stage of the cancer, quick diagnosis may improve your prognosis and life expectancy.

Learn about Malignant Mesothelioma Symptoms

Select the diagnosis you or your loved one is facing and receive a free guide with the right information for you:

Veterans account for

30%

of all mesothelioma legal cases

Men over the age of 60 make up the majority of malignant mesothelioma cases. But, cases among women recently increased by 8 percent.

People who worked with asbestos products are at an increased risk of developing mesothelioma cancer. Those who served in the U.S. armed forces and worked at certain occupations, such as construction jobs, were more likely to use asbestos products.

The risk of developing mesothelioma increases with continued exposure to asbestos. Most people who get the cancer worked with asbestos products for years.

Asbestos use in the military was widespread from 1940 to 1980. Veterans from all branches of the U.S. armed forces were at risk of exposure. Navy veterans were especially at risk because this branch used more asbestos products than any other.

LEARN ABOUT VETERANS

More than 75 occupations have exposed workers to asbestos. Among the most at risk include auto mechanics, textile workers, steel mill workers, construction workers and firefighters.

LEARN ABOUT OCCUPATIONS

Before safety regulations were put in place, asbestos workers unknowingly brought asbestos fibers home on their hair, skin and clothing. This resulted in secondary asbestos exposure among residents of the home such as women and children.

LEARN ABOUT SECONDARY EXPOSURE

I remain optimistic that we can, in the next decade, put together the right combination of patients and treatments to effect a cure, which is our holy grail.

Dr. David SugarbakerDirector of Lung Institute at Baylor College of Medicine

Each type of malignant mesothelioma is classified by the location in the body where it develops. Prognosis, symptoms and treatment options vary by type.

The pleural and peritoneal types of mesothelioma are the most common. Pericardial accounts for just 1 percent of cases. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.

A patients prognosis, or survival outlook, is individualized to the patient based on how the disease is expected to affect their body and life span. Prognosis varies greatly from person to person. But, younger patients, women and people diagnosed with peritoneal mesothelioma typically have a better prognosis than older men diagnosed with the pleural type.

The two biggest factors that affect prognosis are the stage and cell type of the cancer. Other factors affecting life expectancy include age, gender, overall health and history of the patients asbestos exposure.

There are three types of mesothelioma cancer cells: Epithelioid, sarcomatoid and biphasic. Epithelioid is the most common and easier to treat than the other types.

Patients with early stages typically have a better prognosis than those with stage 3 or stage 4 because more treatment options are available the earlier the cancer is detected. Electing treatment at any stage can improve survival rates.

Stage

2-Year Survival Rate

5-Year Survival Rate

Stage 1A

46%

16%

Stage 1B

41%

13%

Stage 2

38%

10%

Stage 3A

30%

8%

Stage 3B

26%

5%

Stage 4

17%

Less than 1%

The stage of mesothelioma describes how far the cancer has spread (metastasized) locally, regionally and distantly from its point of origin. Doctors label the extent of pleural mesothelioma as stage 1, 2, 3 or 4.

During the early mesothelioma stages, tumors are localized. By the late stages, the cancer has spread to nearby locations or throughout the body.

The cancer is localized, surgery is most effective at this stage, and the survival rate is higher. Median life expectancy at stage 1 is 22.2 months.

LEARN ABOUT STAGE 1

Tumors have started to spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 20 months.

LEARN ABOUT STAGE 2

Cancer has progressed to a more advanced stage with spread into the regional lymph nodes. Surgery may still be an option. Median life expectancy at stage 3 is 17.9 months.

LEARN ABOUT STAGE 3

Cancer has spread extensively in the area where it developed. Chemotherapy and immunotherapy control symptoms and prolong survival. Median life expectancy at stage 4 is 14.9 months or less.

LEARN ABOUT STAGE 4

Mesothelioma is not just a death sentence anymore. There have been wonderful advancements in treating this disease in recent years.

Dr. Rodney LandreneauThoracic Surgeon

Finding a specialist is necessary to get an accurate diagnosis. Malignant mesothelioma experts know the right diagnostic tools to determine the exact stage you are in and will customize a treatment plan to extend your life expectancy.

Because this disease represents only 0.3 percent of all diagnosed cancers, most primary care doctors and many oncologists rarely treat or see mesothelioma cancer. Finding a mesothelioma specialty center with a staff that truly understands the intricacies of the cancer and the best ways to treat it is crucial to extending survival.

Mesothelioma specialists have diagnosed and treated this disease throughout their medical careers. They know the latest medical advancements specific to this unique disease and have the tools to improve prognosis.

More than 70 percent of mesothelioma patients undergo chemotherapy

The leading treatment options for mesothelioma cancer include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, which is an approach known as multimodal therapy. Numerous studies show this approach improves survival rates.

Palliative treatments that ease symptoms are quite common for patients of all stages. Emerging therapies in clinical trials, such as immunotherapy, show promise.

Additionally, many survivors credit less traditional alternative treatments for helping them live longer. Care in pursuit of these alternative approaches is recommended, because evidence to support claims of benefit may be lacking, and some practitioners may only be preying on fear and desperation to take advantage of patients.

Aside from conventional treatments, many mesothelioma cancer patients turn to clinical trials to potentially extend survival.

53

mesothelioma clinical trials active or recruiting patients worldwide since 2016

Participation in such trials can advance the knowledge of those treating malignant mesothelioma and therefore can also help other patients with this disease now and in the future. These experimental studies are small and controlled opportunities for scientists to test new drugs, therapies and different combinations of treatments.

Clinical trials often become an option for patients whose traditional treatments were unsuccessful or for those not eligible for surgery. Emerging treatments under investigation in clinical trials include immunotherapy, photodynamic therapy and cryotherapy.

For example, clinical trials are currently exploring the immunotherapy drugs Keytruda and Opdivo in mesothelioma patients. Early results are promising that these drugs will play a key role in the future of mesothelioma treatment.

LEARN MORE ABOUT CLINICAL TRIALS

The therapy has given me a new window. Its like getting my life back.

Mesothelioma survivor Walter Merth on participating in Keytruda clinical trial

Personal injury lawsuits have gotten a bad rap thanks to poor portrayal in TV shows and movies. The media tends to focus on frivolous lawsuits. But mesothelioma lawsuits are not frivolous. Anyone diagnosed with mesothelioma knows they did nothing wrong to deserve it.

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.

Malignant mesothelioma and other asbestos-related diseases are preventable, but the companies that mined, manufactured and sold asbestos products put profits before the health of their own employee and customers. Our legal system ensures these companies are held accountable for their negligence.

A good mesothelioma lawyer can guide you through the process. There is no hassle for the patient to endure. Most mesothelioma lawsuits settle out of court. This means you likely wont have to testify in front of a jury. Most patients can do their deposition from the comfort of their home.

Get help finding an attorney who knows the process and can get you and your family the compensation you deserve.

Working with an experienced mesothelioma lawyer will help you move smoothly through the legal process of filing a lawsuit or trust fund claim.

Mesothelioma lawsuits include personal injury claims and wrongful death claims. Most lawsuits are settled out of court before a trial takes place.

Asbestos trust funds are established by now defunct companies that filed for bankruptcy protection. To date, these funds contain more than $30 billion to compensate workers and their families.

The median value for mesothelioma claims, according to a 2010 report from the RAND Corporation, a nonprofit institution that conducts research and analysis on asbestos bankruptcy trusts.

Other types of financial assistance are available. They will help you cover immediate costs while you wait for compensation. Examples include travel, housing and treatment grants, VA claims, Medicare, Medicaid and Social Security disability.

Veterans exposed to asbestos during military service can file for asbestos-related claims through the U.S. Department of Veterans Affairs (VA).

Government programs, such as Medicare or Medicaid, can help older patients or those with limited finances. Workers compensation may be available to people exposed to asbestos on the job.

Dont let the notion of high costs of mesothelioma cancer treatments deter you from pursuing the best treatment options possible.

It takes a village to support someone with mesothelioma. Building a strong system of support will help you navigate this journey. Youre not alone. Were here to help.

We have a team of Patient Advocates who are available seven days a week to answer your questions and provide free resources. Consider joining our support group to get guidance and understanding from other people facing mesothelioma.

Without a shadow of a doubt, the Mesothelioma Center Facebook group is one of the best groups I have joined The support the group provides is amazing.

Read this article:

Mesothelioma – What is Malignant Mesothelioma Cancer

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 a 12-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.

Heather offers valuable insights into her successful treatment approach with Dr. David Sugarbaker. She has a unique perspective on life after surviving a mesothelioma diagnosis and enjoys sharing her story.

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:

Those who have been diagnosed with mesothelioma or other types of terminal cancer can find tremendous comfort in the support they get from family, friends and caregivers.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

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)

The rest is here:

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma – Wikipedia

Cancer associated with asbestos

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]

More than 80% of mesothelioma cases are caused by exposure to asbestos.[3] 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.[3] 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.[5] 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.[3] 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.[3] Rates of disease have increased since the 1950s.[3] Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old.[3] 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] However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

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][18][19] 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”.[20][21]

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.[22]

In the United States, asbestos is considered the major cause of malignant mesothelioma[23] and has been considered “indisputably”[24] 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.[25][26][27][28] A history of asbestos exposure exists in most cases.

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 risk of disease.[31] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[24] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[24] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The time from first exposure to onset of the disease, is between 25 and 70 years.[32] It is virtually never less than fifteen years and peaks at 3040 years.[24][33] 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.[34][35]

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.[36]

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.[37] 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.[22]

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][38][39] 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][22] 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.[40]

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][18][19] 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.[19]

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][22] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[22] This has been confirmed in animal studies,[41][42] but studies in humans are inconclusive.[41][43][44]

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).[24] 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.[45]

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.[47] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[48]

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.[49] 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.[50] 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.[50][51]

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.[22]

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.[52] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[53]

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.[54]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[55] 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.[56] 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.[57] 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.[58]

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,[59] including in patients with malignant pleural mesothelioma.[60] 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.[61] 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).[55] 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.[62] 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.[63] 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.[64]

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.[65]

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.[47]

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.[66] 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.[67] 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.[22] 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][68]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[69] 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.[70]

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).[71]

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.[22]

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”,[78] 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.[79] 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.[80] 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.[81] 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.[82]

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.[83] 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.[84] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[85] 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.[86]

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

There are two high-confidence miRNAs that can potentially serve as biomarkers of asbestos exposure and malignant mesothelioma. Validation studies are needed to assess their relevance.[87]

Mesothelioma at Curlie (based on DMOZ)

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Mesothelioma – Wikipedia

Mesothelioma – What is Malignant Mesothelioma Cancer

Malignant mesothelioma is a rare, asbestos-related cancer that forms on the protective tissues covering the lungs, abdomen and heart. Symptoms include coughing, chest pain and shortness of breath. Treatments combining surgery, radiation and chemotherapy are improving survival and life expectancy.

Key StatsMesothelioma Cancer

Perceptions about malignant mesothelioma are changing.

Scientific research and increased awareness are leading to earlier diagnoses. Improved and developing mesothelioma treatments are allowing patients to live longer than ever.

As more thoracic surgeons and oncologists become familiar with malignant mesothelioma, patients will have more experienced doctors who can extend their life expectancy and increase their chances of surviving this disease.

Malignant mesothelioma is a cancer caused by asbestos exposure. It forms in the lining of the lungs, abdomen, heart or testicles. Around 2,500 new cases of malignant mesothelioma are diagnosed each year in the U.S.

A small portion of mesothelioma tumors are not cancerous. Known as benign mesothelioma, these tumors respond well to surgery and rarely recur.

To understand malignant mesothelioma, it is important to learn about its causes, symptoms, types, treatment and prognosis. Learning more about mesothelioma cancer will help you make wise decisions about treatment and help you choose the best path to extend your life expectancy.

Exposure to asbestos is still the overwhelming cause of mesothelioma. Asbestos is a naturally occurring mineral once highly regarded for its insulation and fire-retardant properties.

Approximately 75 percent of cases are men who were exposed to asbestos while serving in the military or working certain high-risk blue-collar jobs. Some of these jobs include construction, firefighting, shipbuilding and industrial work.

Secondary exposure also occurs when washing the clothes of someone in a high-risk occupation. Living near abandoned asbestos mines or areas where asbestos occurs naturally in the environment can lead to exposure.

LEARN ABOUT THE CAUSES OF MALIGNANT MESOTHELIOMA

Mesothelioma symptoms do not usually arise until tumors have grown and spread, and they begin to press against the chest wall or abdominal cavity.

If you have a history of asbestos exposure and experience these symptoms, you should consult a mesothelioma cancer specialist as soon as possible. Although symptoms appear during the late stage of the cancer, quick diagnosis may improve your prognosis and life expectancy.

Learn about Malignant Mesothelioma Symptoms

Select the diagnosis you or your loved one is facing and receive a free guide with the right information for you:

Veterans account for

30%

of all mesothelioma legal cases

Men over the age of 60 make up the majority of malignant mesothelioma cases. But, cases among women recently increased by 8 percent.

People who worked with asbestos products are at an increased risk of developing mesothelioma cancer. Those who served in the U.S. armed forces and worked at certain occupations, such as construction jobs, were more likely to use asbestos products.

The risk of developing mesothelioma increases with continued exposure to asbestos. Most people who get the cancer worked with asbestos products for years.

Asbestos use in the military was widespread from 1940 to 1980. Veterans from all branches of the U.S. armed forces were at risk of exposure. Navy veterans were especially at risk because this branch used more asbestos products than any other.

LEARN ABOUT VETERANS

More than 75 occupations have exposed workers to asbestos. Among the most at risk include auto mechanics, textile workers, steel mill workers, construction workers and firefighters.

LEARN ABOUT OCCUPATIONS

Before safety regulations were put in place, asbestos workers unknowingly brought asbestos fibers home on their hair, skin and clothing. This resulted in secondary asbestos exposure among residents of the home such as women and children.

LEARN ABOUT SECONDARY EXPOSURE

I remain optimistic that we can, in the next decade, put together the right combination of patients and treatments to effect a cure, which is our holy grail.

Dr. David SugarbakerDirector of Lung Institute at Baylor College of Medicine

Each type of malignant mesothelioma is classified by the location in the body where it develops. Prognosis, symptoms and treatment options vary by type.

The pleural and peritoneal types of mesothelioma are the most common. Pericardial accounts for just 1 percent of cases. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.

A patients prognosis, or survival outlook, is individualized to the patient based on how the disease is expected to affect their body and life span. Prognosis varies greatly from person to person. But, younger patients, women and people diagnosed with peritoneal mesothelioma typically have a better prognosis than older men diagnosed with the pleural type.

The two biggest factors that affect prognosis are the stage and cell type of the cancer. Other factors affecting life expectancy include age, gender, overall health and history of the patients asbestos exposure.

There are three types of mesothelioma cancer cells: Epithelioid, sarcomatoid and biphasic. Epithelioid is the most common and easier to treat than the other types.

Patients with early stages typically have a better prognosis than those with stage 3 or stage 4 because more treatment options are available the earlier the cancer is detected. Electing treatment at any stage can improve survival rates.

Stage

2-Year Survival Rate

5-Year Survival Rate

Stage 1A

46%

16%

Stage 1B

41%

13%

Stage 2

38%

10%

Stage 3A

30%

8%

Stage 3B

26%

5%

Stage 4

17%

Less than 1%

The stage of mesothelioma describes how far the cancer has spread (metastasized) locally, regionally and distantly from its point of origin. Doctors label the extent of pleural mesothelioma as stage 1, 2, 3 or 4.

During the early mesothelioma stages, tumors are localized. By the late stages, the cancer has spread to nearby locations or throughout the body.

The cancer is localized, surgery is most effective at this stage, and the survival rate is higher. Median life expectancy at stage 1 is 22.2 months.

LEARN ABOUT STAGE 1

Tumors have started to spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 20 months.

LEARN ABOUT STAGE 2

Cancer has progressed to a more advanced stage with spread into the regional lymph nodes. Surgery may still be an option. Median life expectancy at stage 3 is 17.9 months.

LEARN ABOUT STAGE 3

Cancer has spread extensively in the area where it developed. Chemotherapy and immunotherapy control symptoms and prolong survival. Median life expectancy at stage 4 is 14.9 months or less.

LEARN ABOUT STAGE 4

Mesothelioma is not just a death sentence anymore. There have been wonderful advancements in treating this disease in recent years.

Dr. Rodney LandreneauThoracic Surgeon

Finding a specialist is necessary to get an accurate diagnosis. Malignant mesothelioma experts know the right diagnostic tools to determine the exact stage you are in and will customize a treatment plan to extend your life expectancy.

Because this disease represents only 0.3 percent of all diagnosed cancers, most primary care doctors and many oncologists rarely treat or see mesothelioma cancer. Finding a mesothelioma specialty center with a staff that truly understands the intricacies of the cancer and the best ways to treat it is crucial to extending survival.

Mesothelioma specialists have diagnosed and treated this disease throughout their medical careers. They know the latest medical advancements specific to this unique disease and have the tools to improve prognosis.

More than 70 percent of mesothelioma patients undergo chemotherapy

The leading treatment options for mesothelioma cancer include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, which is an approach known as multimodal therapy. Numerous studies show this approach improves survival rates.

Palliative treatments that ease symptoms are quite common for patients of all stages. Emerging therapies in clinical trials, such as immunotherapy, show promise.

Additionally, many survivors credit less traditional alternative treatments for helping them live longer. Care in pursuit of these alternative approaches is recommended, because evidence to support claims of benefit may be lacking, and some practitioners may only be preying on fear and desperation to take advantage of patients.

Aside from conventional treatments, many mesothelioma cancer patients turn to clinical trials to potentially extend survival.

53

mesothelioma clinical trials active or recruiting patients worldwide since 2016

Participation in such trials can advance the knowledge of those treating malignant mesothelioma and therefore can also help other patients with this disease now and in the future. These experimental studies are small and controlled opportunities for scientists to test new drugs, therapies and different combinations of treatments.

Clinical trials often become an option for patients whose traditional treatments were unsuccessful or for those not eligible for surgery. Emerging treatments under investigation in clinical trials include immunotherapy, photodynamic therapy and cryotherapy.

For example, clinical trials are currently exploring the immunotherapy drugs Keytruda and Opdivo in mesothelioma patients. Early results are promising that these drugs will play a key role in the future of mesothelioma treatment.

LEARN MORE ABOUT CLINICAL TRIALS

The therapy has given me a new window. Its like getting my life back.

Mesothelioma survivor Walter Merth on participating in Keytruda clinical trial

Personal injury lawsuits have gotten a bad rap thanks to poor portrayal in TV shows and movies. The media tends to focus on frivolous lawsuits. But mesothelioma lawsuits are not frivolous. Anyone diagnosed with mesothelioma knows they did nothing wrong to deserve it.

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.

Malignant mesothelioma and other asbestos-related diseases are preventable, but the companies that mined, manufactured and sold asbestos products put profits before the health of their own employee and customers. Our legal system ensures these companies are held accountable for their negligence.

A good mesothelioma lawyer can guide you through the process. There is no hassle for the patient to endure. Most mesothelioma lawsuits settle out of court. This means you likely wont have to testify in front of a jury. Most patients can do their deposition from the comfort of their home.

Get help finding an attorney who knows the process and can get you and your family the compensation you deserve.

Working with an experienced mesothelioma lawyer will help you move smoothly through the legal process of filing a lawsuit or trust fund claim.

Mesothelioma lawsuits include personal injury claims and wrongful death claims. Most lawsuits are settled out of court before a trial takes place.

Asbestos trust funds are established by now defunct companies that filed for bankruptcy protection. To date, these funds contain more than $30 billion to compensate workers and their families.

The median value for mesothelioma claims, according to a 2010 report from the RAND Corporation, a nonprofit institution that conducts research and analysis on asbestos bankruptcy trusts.

Other types of financial assistance are available. They will help you cover immediate costs while you wait for compensation. Examples include travel, housing and treatment grants, VA claims, Medicare, Medicaid and Social Security disability.

Veterans exposed to asbestos during military service can file for asbestos-related claims through the U.S. Department of Veterans Affairs (VA).

Government programs, such as Medicare or Medicaid, can help older patients or those with limited finances. Workers compensation may be available to people exposed to asbestos on the job.

Dont let the notion of high costs of mesothelioma cancer treatments deter you from pursuing the best treatment options possible.

It takes a village to support someone with mesothelioma. Building a strong system of support will help you navigate this journey. Youre not alone. Were here to help.

We have a team of Patient Advocates who are available seven days a week to answer your questions and provide free resources. Consider joining our support group to get guidance and understanding from other people facing mesothelioma.

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Mesothelioma – What is Malignant Mesothelioma Cancer

Mesothelioma | 2018 Statistics, Symptoms, Treatment Options

Treatments

Most often, mesothelioma is treated with a multimodal plan, or combination, of conventional cancer treatment methods including surgery and chemotherapy. Treatment will either focus on extending life expectancy or, at later stages, focus on palliative care to relieve symptoms. Research and clinical trials have found new hope for a potential cure with emerging treatments, like immunotherapy, to more effectively combat the disease and improve life expectancy.

After receiving a mesothelioma diagnosis, the most important step is finding a mesothelioma doctor who specializes in asbestos-related diseases. They will be the best person to determine the most effective treatment options for your individual case, and will also be aware of the latest treatment advancements or clinical trials available. Creating a custom treatment plan with a mesothelioma doctor is the most effective way to improve prognosis.

Learn More About Treating Mesothelioma

More:

Mesothelioma | 2018 Statistics, Symptoms, Treatment Options

Mesothelioma – What is 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.

Key StatsMesothelioma

Perceptions about malignant mesothelioma are changing.

Diagram of mesothelioma & other asbestos-related diseases as they form on the lungs

Incidence rates still hover around 3,000 new cases each year in the U.S., according to a 2017 report from the Centers for Disease Control and Prevention.

However, scientific research and increased awareness are leading to earlier diagnoses, while improved and developing mesothelioma treatments are allowing patients to live longer than ever.

As more thoracic surgeons and oncologists become familiar with mesothelioma, patients will have more experienced doctors who can extend their life expectancy and increase their chances of surviving this disease.

In order to understand mesothelioma and choose the best path to extend survival, you must first grasp some of the basic information about this type of cancer, including its causes, types and symptoms.

Exposure to asbestos, a naturally occurring mineral once highly regarded for its insulation and fire-retardant properties, is still the overwhelming cause of mesothelioma.

Approximately 75 percent of cases are men who were exposed to asbestos while serving in the military or working certain high-risk blue-collar jobs, including construction, firefighting, shipbuilding and industrial work.

Secondhand exposure also occurs when washing the clothes of someone in a high-risk occupation and living near abandoned asbestos mines or areas where asbestos occurs naturally in the environment.

Each type of mesothelioma is classified by the location in the body where it develops. Prognosis, symptoms and treatment options vary by type.

The pleural and peritoneal types of mesothelioma are the most common, while pericardial accounts for just 1 percent of cases. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.

Mesothelioma symptoms do not usually arise until tumors have grown and spread, and they begin to press against the chest wall or abdominal cavity.

If you have a history of asbestos exposure and experience these symptoms, you should consult a mesothelioma specialist as soon as possible. Although symptoms appear during the late stage of the cancer, early diagnosis may improve your prognosis, survival rate and life expectancy.

Select the diagnosis you or your loved one is facing and receive a free guide with the right information for you:

The main reason the majority of patients are diagnosed later in life is because mesothelioma can take anywhere from 20 to 50 years after asbestos exposure before symptoms appear.

Doctors use several methods to test for malignant mesothelioma, but only a biopsy can truly confirm a diagnosis. This usually comes after a series of other tests and scans once symptoms arise.

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

About 3,000 new cases are diagnosed annually

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

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

Because mesothelioma is rare, the cancer is often misdiagnosed as less serious conditions such as the flu or pneumonia.

Anyone who thinks or knows they were exposed to asbestos at some point in time should immediately notify their primary care doctor about their exposure history. This will ensure mesothelioma and other asbestos-related diseases are not ruled out as the cause of the symptoms.

I remain optimistic that we can, in the next decade, put together the right combination of patients and treatments to effect a cure, which is our holy grail.

Dr. David SugarbakerDirector of Lung Institute at Baylor College of Medicine

The stage of mesothelioma describes how far the cancer has spread locally, regionally, and distantly (metastasized) from its point of origin, and doctors label the extent of pleural mesothelioma as stage 1, 2, 3 or 4.

During the early mesothelioma stages, tumors are localized. By the late stages, the cancer has spread to nearby locations or throughout the body.

The cancer is localized, surgery is most effective at this stage, and the survival rate is higher. Median life expectancy at stage 1 is 21 months.

Tumors have started to spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 19 months.

Cancer has progressed to a more advanced stage with spread into the regional lymph nodes. Surgery may still be an option. Median life expectancy at stage 3 is 16 months.

The spread of cancer is extensive, and surgery is usually not effective for prolongation of life. It may still have some utility to control symptoms. Chemotherapy and radiation, and involvement in clinical trials of new and emerging treatments, such as immunotherapy, may reduce symptoms and possibly extend survival. Median life expectancy at stage 4 is 12 months or less.

More than 70 percent of mesothelioma patients undergo chemotherapy

The leading treatment options for mesothelioma include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, which is an approach known as multimodal therapy. Numerous studies show this approach improves survival rates.

Palliative treatments that ease symptoms are quite common for patients of all stages. Emerging therapies in clinical trials, such as immunotherapy, show promise. Additionally, many survivors credit less traditional alternative treatments for helping them live longer. Care in pursuit of these alternative approaches is recommended, as evidence to support claims of benefit may be lacking, and some practitioners may only be preying on fear and desperation to take advantage of patients.

Surgery can be used for diagnostic or aggressive and potentially curative purposes. It offers the best chance of long-term survival for pleural and peritoneal mesothelioma patients eligible for surgery.

Chemotherapy can alleviate symptoms, improve quality of life and extend survival, but it can carry unpleasant side effects.

With fewer side effects than chemotherapy, radiation can help shrink tumors and relieve pain. It can be performed at all stages.

A combination of two or more traditional treatments, including chemotherapy, surgery and radiation. Studies show multimodal therapy can improve survival.

Heated or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a multimodal treatment that involves heating chemotherapy drugs and delivering them to the abdomen after surgery.

Because this disease represents only 0.3 percent of all diagnosed cancers, most primary care doctors and many oncologists rarely treat or see mesothelioma. Finding a mesothelioma specialty center with a staff that truly understands the intricacies of the cancer and the best ways to treat it is crucial to extending survival.

Mesothelioma is not just a death sentence anymore. There have been wonderful advancements in treating this disease in recent years.

Dr. Rodney LandreneauThoracic Surgeon

Mesothelioma specialists have diagnosed and treated this disease throughout their medical careers. They know the latest medical advancements specific to this unique disease and have the tools to improve prognosis.

Dr. Jacques Fontaine, a world-renowned mesothelioma specialist, discusses mesothelioma exclusively with Asbestos.com.

Aside from conventional treatments, many mesothelioma patients turn to clinical trials to potentially extend survival. Participation in such trials can advance the knowledge of those treating mesothelioma and therefore can also help other patients with this disease now and in the future. These experimental studies are small and controlled opportunities for scientists to test new drugs, therapies and different combinations of treatments.

Clinical trials often become an option for patients whose traditional treatments were unsuccessful or for those not eligible for surgery.

The therapy has given me a new window. Its like getting my life back.

Mesothelioma survivor Walter Merth on participating in Keytruda clinical trial

Immunotherapy is a promising cancer treatment only available to mesothelioma patients through clinical trials. Checkpoint inhibitors, such as pembrolizumab (Keytruda) and avelumab (Bavencio), have shown encouraging results in multicenter trials testing the drugs in combination with surgery and chemotherapy regimens. In May 2017, the U.S. Food and Drug Administration approved pembrolizumab as a first-line treatment of metastatic non-small cell lung cancer, making approval for mesothelioma a possibility in the near future.

53

mesothelioma clinical trials active or recruiting patients worldwide since 2016

Photodynamic therapy uses light energy to kill cancer cells. A 2016 clinical trial at the Penn Medicine Abramson Cancer Center nearly doubled survival for pleural mesothelioma patients who received intraoperative photodynamic therapy (PDT) and chemotherapy following a P/D procedure.

The process of killing tumor cells by exposing them to extreme cold known as cryotherapy is a viable treatment option for mesothelioma patients in the few places that offer the procedure. Unlike many treatments, cryotherapy causes few side effects. In May 2015, the Mayo Clinic in Rochester, Minnesota, opened the only ongoing cryotherapy clinical trial for mesothelioma in the U.S.

Our Patient Advocates are available to answer your questions about mesothelioma and help you understand your options.

A patients prognosis, or survival outlook, is individualized to the patient based on how the disease is expected to affect their body and life span. Prognosis varies greatly from person to person, but younger patients, women and people diagnosed with peritoneal mesothelioma typically have a better prognosis than older men diagnosed with the pleural type.

The two biggest factors that determine a mesothelioma prognosis are the stage and cell type of the cancer. Other factors affecting prognosis include age, gender, overall health and history of the patients asbestos exposure.

Patients with early stages typically have a better prognosis than those with stage 3 or stage 4 because more treatment options are available the earlier the cancer is detected.

There are three types of mesothelioma cancer cells: Epithelioid, sarcomatoid and biphasic. Epithelioid is the most common and easier to treat than the other types.

Because asbestos use in the military was widespread 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.

Veterans account for

30%

of all mesothelioma cases

Job duties known for high rates of harmful exposures include pipefitting, mechanical work, equipment maintenance and shipyard work.

Veterans diagnosed with mesothelioma or other asbestos-related diseases have the option to pursue benefits from the U.S. Department of Veterans Affairs (VA), including VA health care and VA Disability Compensation.

While this is often the only way for veterans to receive compensation from the government, veterans exposed to asbestos before or after military service and their family members may be eligible to file a lawsuit or to make a claim against asbestos bankruptcy trust.

Our VA-Accredited Claims Agents can help veterans diagnosed with mesothelioma understand and file VA benefits claims.

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.

Mesothelioma and other asbestos-related diseases are 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.

The median value for mesothelioma claims, according to the latest report from the RAND Corporation, a nonprofit institution that conducts research and analysis on asbestos bankruptcy trusts.

Mesothelioma lawsuits include personal injury claims and wrongful death claims. Most lawsuits are settled out of court before a trial takes place.

Asbestos trust funds are established by now defunct companies that filed for bankruptcy protection. To date, these funds contain more than $30 billion to compensate workers and their families.

Veterans exposed to asbestos during military service can file for asbestos-related claims through the U.S. Department of Veterans Affairs (VA).

Government programs, such as Medicare or Medicaid, can help older patients or those with limited finances, while workers compensation may be available to people exposed to asbestos on the job.

Dont let the notion of high costs of mesothelioma treatments deter you from pursuing the best treatment options possible. In addition to legal options, travel and housing grants may be available as well as access to social security disability benefits.

See the original post here:

Mesothelioma – What is Malignant Mesothelioma Cancer

Mesothelioma – Wikipedia

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]

More than 80% of mesothelioma cases are caused by exposure to asbestos.[3] 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.[3] 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.[5] 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.[3] 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.[3] Rates of disease have increased since the 1950s.[3] Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old.[3] The disease was rare before the commercial use of asbestos.[3]

Contents

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] However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

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][18][19] 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”.[20][21]

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.[22]

In the United States, asbestos is considered the major cause of malignant mesothelioma[23] and has been considered “indisputably”[24] 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.[25][26][27][28] A history of asbestos exposure exists in most cases.

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 risk of disease.[31] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[24] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[24] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The time from first exposure to onset of the disease, is between 25 and 70 years.[32] It is virtually never less than fifteen years and peaks at 3040 years.[24][33] 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.[34][35]

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.[36]

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.[37] 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.[22]

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][38][39] 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][22] 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.[40]

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][18][19] 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.[19]

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][22] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[22] This has been confirmed in animal studies,[41][42] but studies in humans are inconclusive.[41][43][44]

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).[24] 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.[45]

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.[47] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[48]

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.[49] 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.[50] 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.[50][51]

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.[52] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[53]

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.[54]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[55] 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.[56] 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.[57] 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.[58]

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,[59] including in patients with malignant pleural mesothelioma.[60] 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.[61] 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).[55] 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.[62] 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.[63] 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.[64]

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.[65]

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.[47]

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.[66] 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.[67] 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.[22] 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][68]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[69] 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.[70]

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).[71]

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.[22]

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”,[78] 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.[79] 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.[80] 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.[81] 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.[82]

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.[83] 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.[84] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[85] 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.[86]

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

There are two high-confidence miRNAs that can potentially serve as biomarkers of asbestos exposure and malignant mesothelioma. Validation studies are needed to assess their relevance.[87]

Link:

Mesothelioma – Wikipedia

Mesothelioma – Symptoms and causes – Mayo Clinic

Overview

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.

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.

In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control. It isn’t clear what causes the initial genetic mutations that lead to mesothelioma, though researchers have identified factors that may increase the risk. It’s likely that cancers form because of an interaction between many factors, such as inherited conditions, your environment, your health conditions and your lifestyle choices.

Asbestos is a mineral that’s found naturally in the environment. Asbestos fibers are strong and resistant to heat, making them useful in a wide variety of applications, such as in insulation, brakes, shingles, flooring and many other products.

When asbestos is broken up, such as during the mining process or when removing asbestos insulation, dust may be created. If the dust is inhaled or swallowed, the asbestos fibers will settle in the lungs or in the stomach, where they can cause irritation that may lead to mesothelioma. Exactly how this happens isn’t understood. It can take 20 to 40 years or more for mesothelioma to develop after asbestos exposure.

Most people with years of asbestos exposure never develop mesothelioma. And yet, others with very brief exposure develop the disease. This indicates that other factors may be involved in determining whether someone gets mesothelioma or doesn’t. For instance, you could inherit a predisposition to cancer or some other condition could increase your risk.

Factors that may increase the risk of mesothelioma include:

As pleural mesothelioma spreads in the chest, it puts pressure on the structures in that area. This can cause complications, such as:

Reducing your exposure to asbestos may lower your risk of mesothelioma.

Most people with mesothelioma were exposed to the asbestos fibers at work. Workers who may encounter asbestos fibers include:

Ask your employer whether you have a risk of asbestos exposure on the job.

Follow all safety precautions in your workplace, such as wearing protective equipment. You may also be required to shower and change out of your work clothes before taking a lunch break or going home. Talk to your doctor about other precautions you can take to protect yourself from asbestos exposure.

Older homes and buildings may contain asbestos. In many cases, it’s more dangerous to remove the asbestos than it is to leave it intact. Breaking up asbestos may cause fibers to become airborne, where they can be inhaled. Consult experts trained to detect asbestos in your home. These experts may test the air in your home to determine whether the asbestos is a risk to your health. Don’t attempt to remove asbestos from your home hire a qualified expert. The Environmental Protection Agency offers advice on its website for dealing with asbestos in the home.

Dec. 22, 2017

Excerpt from:

Mesothelioma – Symptoms and causes – 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 a 12-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.

Heather offers valuable insights into her successful treatment approach with Dr. David Sugarbaker. She has a unique perspective on life after surviving a mesothelioma diagnosis and enjoys sharing her story.

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:

Those who have been diagnosed with mesothelioma or other types of terminal cancer can find tremendous comfort in the support they get from family, friends and caregivers.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

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)

See the original post:

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma – Wikipedia

Cancer associated with asbestos

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]

More than 80% of mesothelioma cases are caused by exposure to asbestos.[3] 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.[3] 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.[5] 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.[3] 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.[3] Rates of disease have increased since the 1950s.[3] Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old.[3] 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] However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

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][18][19] 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”.[20][21]

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.[22]

In the United States, asbestos is considered the major cause of malignant mesothelioma[23] and has been considered “indisputably”[24] 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.[25][26][27][28] A history of asbestos exposure exists in most cases.

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 risk of disease.[31] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[24] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[24] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The time from first exposure to onset of the disease, is between 25 and 70 years.[32] It is virtually never less than fifteen years and peaks at 3040 years.[24][33] 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.[34][35]

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.[36]

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.[37] 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.[22]

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][38][39] 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][22] 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.[40]

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][18][19] 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.[19]

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][22] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[22] This has been confirmed in animal studies,[41][42] but studies in humans are inconclusive.[41][43][44]

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).[24] 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.[45]

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.[47] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[48]

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.[49] 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.[50] 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.[50][51]

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.[22]

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.[52] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[53]

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.[54]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[55] 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.[56] 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.[57] 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.[58]

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,[59] including in patients with malignant pleural mesothelioma.[60] 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.[61] 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).[55] 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.[62] 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.[63] 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.[64]

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.[65]

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.[47]

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.[66] 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.[67] 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.[22] 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][68]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[69] 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.[70]

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).[71]

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.[22]

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”,[78] 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.[79] 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.[80] 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.[81] 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.[82]

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.[83] 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.[84] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[85] 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.[86]

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

There are two high-confidence miRNAs that can potentially serve as biomarkers of asbestos exposure and malignant mesothelioma. Validation studies are needed to assess their relevance.[87]

Mesothelioma at Curlie (based on DMOZ)

Read more from the original source:

Mesothelioma – Wikipedia

Mesothelioma – What is 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.

Key StatsMesothelioma

Perceptions about malignant mesothelioma are changing.

Diagram of mesothelioma & other asbestos-related diseases as they form on the lungs

Incidence rates still hover around 3,000 new cases each year in the U.S., according to a 2017 report from the Centers for Disease Control and Prevention.

However, scientific research and increased awareness are leading to earlier diagnoses, while improved and developing mesothelioma treatments are allowing patients to live longer than ever.

As more thoracic surgeons and oncologists become familiar with mesothelioma, patients will have more experienced doctors who can extend their life expectancy and increase their chances of surviving this disease.

In order to understand mesothelioma and choose the best path to extend survival, you must first grasp some of the basic information about this type of cancer, including its causes, types and symptoms.

Exposure to asbestos, a naturally occurring mineral once highly regarded for its insulation and fire-retardant properties, is still the overwhelming cause of mesothelioma.

Approximately 75 percent of cases are men who were exposed to asbestos while serving in the military or working certain high-risk blue-collar jobs, including construction, firefighting, shipbuilding and industrial work.

Secondhand exposure also occurs when washing the clothes of someone in a high-risk occupation and living near abandoned asbestos mines or areas where asbestos occurs naturally in the environment.

Each type of mesothelioma is classified by the location in the body where it develops. Prognosis, symptoms and treatment options vary by type.

The pleural and peritoneal types of mesothelioma are the most common, while pericardial accounts for just 1 percent of cases. Another rare type known as testicular mesothelioma represents less than 1 percent of all mesotheliomas.

Mesothelioma symptoms do not usually arise until tumors have grown and spread, and they begin to press against the chest wall or abdominal cavity.

If you have a history of asbestos exposure and experience these symptoms, you should consult a mesothelioma specialist as soon as possible. Although symptoms appear during the late stage of the cancer, early diagnosis may improve your prognosis, survival rate and life expectancy.

Select the diagnosis you or your loved one is facing and receive a free guide with the right information for you:

The main reason the majority of patients are diagnosed later in life is because mesothelioma can take anywhere from 20 to 50 years after asbestos exposure before symptoms appear.

Doctors use several methods to test for malignant mesothelioma, but only a biopsy can truly confirm a diagnosis. This usually comes after a series of other tests and scans once symptoms arise.

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

About 3,000 new cases are diagnosed annually

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

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

Because mesothelioma is rare, the cancer is often misdiagnosed as less serious conditions such as the flu or pneumonia.

Anyone who thinks or knows they were exposed to asbestos at some point in time should immediately notify their primary care doctor about their exposure history. This will ensure mesothelioma and other asbestos-related diseases are not ruled out as the cause of the symptoms.

I remain optimistic that we can, in the next decade, put together the right combination of patients and treatments to effect a cure, which is our holy grail.

Dr. David SugarbakerDirector of Lung Institute at Baylor College of Medicine

The stage of mesothelioma describes how far the cancer has spread locally, regionally, and distantly (metastasized) from its point of origin, and doctors label the extent of pleural mesothelioma as stage 1, 2, 3 or 4.

During the early mesothelioma stages, tumors are localized. By the late stages, the cancer has spread to nearby locations or throughout the body.

The cancer is localized, surgery is most effective at this stage, and the survival rate is higher. Median life expectancy at stage 1 is 21 months.

Tumors have started to spread from the original location into adjacent structures. Surgery is still an option. Median life expectancy at stage 2 is 19 months.

Cancer has progressed to a more advanced stage with spread into the regional lymph nodes. Surgery may still be an option. Median life expectancy at stage 3 is 16 months.

The spread of cancer is extensive, and surgery is usually not effective for prolongation of life. It may still have some utility to control symptoms. Chemotherapy and radiation, and involvement in clinical trials of new and emerging treatments, such as immunotherapy, may reduce symptoms and possibly extend survival. Median life expectancy at stage 4 is 12 months or less.

More than 70 percent of mesothelioma patients undergo chemotherapy

The leading treatment options for mesothelioma include surgery, chemotherapy and radiation therapy. Many specialists prefer to combine two or more of these treatments, which is an approach known as multimodal therapy. Numerous studies show this approach improves survival rates.

Palliative treatments that ease symptoms are quite common for patients of all stages. Emerging therapies in clinical trials, such as immunotherapy, show promise. Additionally, many survivors credit less traditional alternative treatments for helping them live longer. Care in pursuit of these alternative approaches is recommended, as evidence to support claims of benefit may be lacking, and some practitioners may only be preying on fear and desperation to take advantage of patients.

Surgery can be used for diagnostic or aggressive and potentially curative purposes. It offers the best chance of long-term survival for pleural and peritoneal mesothelioma patients eligible for surgery.

Chemotherapy can alleviate symptoms, improve quality of life and extend survival, but it can carry unpleasant side effects.

With fewer side effects than chemotherapy, radiation can help shrink tumors and relieve pain. It can be performed at all stages.

A combination of two or more traditional treatments, including chemotherapy, surgery and radiation. Studies show multimodal therapy can improve survival.

Heated or Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a multimodal treatment that involves heating chemotherapy drugs and delivering them to the abdomen after surgery.

Because this disease represents only 0.3 percent of all diagnosed cancers, most primary care doctors and many oncologists rarely treat or see mesothelioma. Finding a mesothelioma specialty center with a staff that truly understands the intricacies of the cancer and the best ways to treat it is crucial to extending survival.

Mesothelioma is not just a death sentence anymore. There have been wonderful advancements in treating this disease in recent years.

Dr. Rodney LandreneauThoracic Surgeon

Mesothelioma specialists have diagnosed and treated this disease throughout their medical careers. They know the latest medical advancements specific to this unique disease and have the tools to improve prognosis.

Dr. Jacques Fontaine, a world-renowned mesothelioma specialist, discusses mesothelioma exclusively with Asbestos.com.

Aside from conventional treatments, many mesothelioma patients turn to clinical trials to potentially extend survival. Participation in such trials can advance the knowledge of those treating mesothelioma and therefore can also help other patients with this disease now and in the future. These experimental studies are small and controlled opportunities for scientists to test new drugs, therapies and different combinations of treatments.

Clinical trials often become an option for patients whose traditional treatments were unsuccessful or for those not eligible for surgery.

The therapy has given me a new window. Its like getting my life back.

Mesothelioma survivor Walter Merth on participating in Keytruda clinical trial

Immunotherapy is a promising cancer treatment only available to mesothelioma patients through clinical trials. Checkpoint inhibitors, such as pembrolizumab (Keytruda) and avelumab (Bavencio), have shown encouraging results in multicenter trials testing the drugs in combination with surgery and chemotherapy regimens. In May 2017, the U.S. Food and Drug Administration approved pembrolizumab as a first-line treatment of metastatic non-small cell lung cancer, making approval for mesothelioma a possibility in the near future.

53

mesothelioma clinical trials active or recruiting patients worldwide since 2016

Photodynamic therapy uses light energy to kill cancer cells. A 2016 clinical trial at the Penn Medicine Abramson Cancer Center nearly doubled survival for pleural mesothelioma patients who received intraoperative photodynamic therapy (PDT) and chemotherapy following a P/D procedure.

The process of killing tumor cells by exposing them to extreme cold known as cryotherapy is a viable treatment option for mesothelioma patients in the few places that offer the procedure. Unlike many treatments, cryotherapy causes few side effects. In May 2015, the Mayo Clinic in Rochester, Minnesota, opened the only ongoing cryotherapy clinical trial for mesothelioma in the U.S.

Our Patient Advocates are available to answer your questions about mesothelioma and help you understand your options.

A patients prognosis, or survival outlook, is individualized to the patient based on how the disease is expected to affect their body and life span. Prognosis varies greatly from person to person, but younger patients, women and people diagnosed with peritoneal mesothelioma typically have a better prognosis than older men diagnosed with the pleural type.

The two biggest factors that determine a mesothelioma prognosis are the stage and cell type of the cancer. Other factors affecting prognosis include age, gender, overall health and history of the patients asbestos exposure.

Patients with early stages typically have a better prognosis than those with stage 3 or stage 4 because more treatment options are available the earlier the cancer is detected.

There are three types of mesothelioma cancer cells: Epithelioid, sarcomatoid and biphasic. Epithelioid is the most common and easier to treat than the other types.

Because asbestos use in the military was widespread 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.

Veterans account for

30%

of all mesothelioma cases

Job duties known for high rates of harmful exposures include pipefitting, mechanical work, equipment maintenance and shipyard work.

Veterans diagnosed with mesothelioma or other asbestos-related diseases have the option to pursue benefits from the U.S. Department of Veterans Affairs (VA), including VA health care and VA Disability Compensation.

While this is often the only way for veterans to receive compensation from the government, veterans exposed to asbestos before or after military service and their family members may be eligible to file a lawsuit or to make a claim against asbestos bankruptcy trust.

Our VA-Accredited Claims Agents can help veterans diagnosed with mesothelioma understand and file VA benefits claims.

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.

Mesothelioma and other asbestos-related diseases are 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.

The median value for mesothelioma claims, according to the latest report from the RAND Corporation, a nonprofit institution that conducts research and analysis on asbestos bankruptcy trusts.

Mesothelioma lawsuits include personal injury claims and wrongful death claims. Most lawsuits are settled out of court before a trial takes place.

Asbestos trust funds are established by now defunct companies that filed for bankruptcy protection. To date, these funds contain more than $30 billion to compensate workers and their families.

Veterans exposed to asbestos during military service can file for asbestos-related claims through the U.S. Department of Veterans Affairs (VA).

Government programs, such as Medicare or Medicaid, can help older patients or those with limited finances, while workers compensation may be available to people exposed to asbestos on the job.

Dont let the notion of high costs of mesothelioma treatments deter you from pursuing the best treatment options possible. In addition to legal options, travel and housing grants may be available as well as access to social security disability benefits.

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Mesothelioma – What is Malignant Mesothelioma Cancer

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 a 12-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.

Heather offers valuable insights into her successful treatment approach with Dr. David Sugarbaker. She has a unique perspective on life after surviving a mesothelioma diagnosis and enjoys sharing her story.

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:

Those who have been diagnosed with mesothelioma or other types of terminal cancer can find tremendous comfort in the support they get from family, friends and caregivers.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

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 | 2018 Statistics, Symptoms, Treatment Options

Treatments

Most often, mesothelioma is treated with a multimodal plan, or combination, of conventional cancer treatment methods including surgery and chemotherapy. Treatment will either focus on extending life expectancy or, at later stages, focus on palliative care to relieve symptoms. Research and clinical trials have found new hope for a potential cure with emerging treatments, like immunotherapy, to more effectively combat the disease and improve life expectancy.

After receiving a mesothelioma diagnosis, the most important step is finding a mesothelioma doctor who specializes in asbestos-related diseases. They will be the best person to determine the most effective treatment options for your individual case, and will also be aware of the latest treatment advancements or clinical trials available. Creating a custom treatment plan with a mesothelioma doctor is the most effective way to improve prognosis.

Learn More About Treating Mesothelioma

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Mesothelioma | 2018 Statistics, Symptoms, Treatment Options

Mesothelioma – Wikipedia

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]

More than 80% of mesothelioma cases are caused by exposure to asbestos.[3] 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.[3] 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.[5] 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.[3] 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.[3] Rates of disease have increased since the 1950s.[3] Diagnosis typically occurs after the age of 65 and most deaths occur around 70 years old.[3] The disease was rare before the commercial use of asbestos.[3]

Contents

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] However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

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][18][19] 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”.[20][21]

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.[22]

In the United States, asbestos is considered the major cause of malignant mesothelioma[23] and has been considered “indisputably”[24] 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.[25][26][27][28] A history of asbestos exposure exists in most cases.

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 risk of disease.[31] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[24] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[24] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The time from first exposure to onset of the disease, is between 25 and 70 years.[32] It is virtually never less than fifteen years and peaks at 3040 years.[24][33] 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.[34][35]

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.[36]

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.[37] 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.[22]

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][38][39] 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][22] 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.[40]

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][18][19] 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.[19]

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][22] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[22] This has been confirmed in animal studies,[41][42] but studies in humans are inconclusive.[41][43][44]

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).[24] 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.[45]

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.[47] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[48]

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.[49] 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.[50] 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.[50][51]

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.[52] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[53]

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.[54]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[55] 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.[56] 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.[57] 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.[58]

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,[59] including in patients with malignant pleural mesothelioma.[60] 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.[61] 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).[55] 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.[62] 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.[63] 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.[64]

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.[65]

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.[47]

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.[66] 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.[67] 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.[22] 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][68]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[69] 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.[70]

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).[71]

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.[22]

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”,[78] 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.[79] 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.[80] 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.[81] 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.[82]

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.[83] 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.[84] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[85] 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.[86]

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

There are two high-confidence miRNAs that can potentially serve as biomarkers of asbestos exposure and malignant mesothelioma. Validation studies are needed to assess their relevance.[87]

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Mesothelioma – Wikipedia

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 a 12-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.

Heather offers valuable insights into her successful treatment approach with Dr. David Sugarbaker. She has a unique perspective on life after surviving a mesothelioma diagnosis and enjoys sharing her story.

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:

Those who have been diagnosed with mesothelioma or other types of terminal cancer can find tremendous comfort in the support they get from family, friends and caregivers.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

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)

Link:

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma – Symptoms and causes – Mayo Clinic

Overview

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.

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.

In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control. It isn’t clear what causes the initial genetic mutations that lead to mesothelioma, though researchers have identified factors that may increase the risk. It’s likely that cancers form because of an interaction between many factors, such as inherited conditions, your environment, your health conditions and your lifestyle choices.

Asbestos is a mineral that’s found naturally in the environment. Asbestos fibers are strong and resistant to heat, making them useful in a wide variety of applications, such as in insulation, brakes, shingles, flooring and many other products.

When asbestos is broken up, such as during the mining process or when removing asbestos insulation, dust may be created. If the dust is inhaled or swallowed, the asbestos fibers will settle in the lungs or in the stomach, where they can cause irritation that may lead to mesothelioma. Exactly how this happens isn’t understood. It can take 20 to 40 years or more for mesothelioma to develop after asbestos exposure.

Most people with years of asbestos exposure never develop mesothelioma. And yet, others with very brief exposure develop the disease. This indicates that other factors may be involved in determining whether someone gets mesothelioma or doesn’t. For instance, you could inherit a predisposition to cancer or some other condition could increase your risk.

Factors that may increase the risk of mesothelioma include:

As pleural mesothelioma spreads in the chest, it puts pressure on the structures in that area. This can cause complications, such as:

Reducing your exposure to asbestos may lower your risk of mesothelioma.

Most people with mesothelioma were exposed to the asbestos fibers at work. Workers who may encounter asbestos fibers include:

Ask your employer whether you have a risk of asbestos exposure on the job.

Follow all safety precautions in your workplace, such as wearing protective equipment. You may also be required to shower and change out of your work clothes before taking a lunch break or going home. Talk to your doctor about other precautions you can take to protect yourself from asbestos exposure.

Older homes and buildings may contain asbestos. In many cases, it’s more dangerous to remove the asbestos than it is to leave it intact. Breaking up asbestos may cause fibers to become airborne, where they can be inhaled. Consult experts trained to detect asbestos in your home. These experts may test the air in your home to determine whether the asbestos is a risk to your health. Don’t attempt to remove asbestos from your home hire a qualified expert. The Environmental Protection Agency offers advice on its website for dealing with asbestos in the home.

Dec. 22, 2017

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Mesothelioma – Symptoms and causes – Mayo Clinic

Mesothelioma | 2018 Statistics, Symptoms, Treatment Options

Treatments

Most often, mesothelioma is treated with a multimodal plan, or combination, of conventional cancer treatment methods including surgery and chemotherapy. Treatment will either focus on extending life expectancy or, at later stages, focus on palliative care to relieve symptoms. Research and clinical trials have found new hope for a potential cure with emerging treatments, like immunotherapy, to more effectively combat the disease and improve life expectancy.

After receiving a mesothelioma diagnosis, the most important step is finding a mesothelioma doctor who specializes in asbestos-related diseases. They will be the best person to determine the most effective treatment options for your individual case, and will also be aware of the latest treatment advancements or clinical trials available. Creating a custom treatment plan with a mesothelioma doctor is the most effective way to improve prognosis.

Learn More About Treating Mesothelioma

Continue reading here:

Mesothelioma | 2018 Statistics, Symptoms, Treatment Options

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 a 12-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.

Heather offers valuable insights into her successful treatment approach with Dr. David Sugarbaker. She has a unique perspective on life after surviving a mesothelioma diagnosis and enjoys sharing her story.

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:

Those who have been diagnosed with mesothelioma or other types of terminal cancer can find tremendous comfort in the support they get from family, friends and caregivers.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

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)

Read more here:

Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma – Symptoms and causes – Mayo Clinic

Overview

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.

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.

In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control. It isn’t clear what causes the initial genetic mutations that lead to mesothelioma, though researchers have identified factors that may increase the risk. It’s likely that cancers form because of an interaction between many factors, such as inherited conditions, your environment, your health conditions and your lifestyle choices.

Asbestos is a mineral that’s found naturally in the environment. Asbestos fibers are strong and resistant to heat, making them useful in a wide variety of applications, such as in insulation, brakes, shingles, flooring and many other products.

When asbestos is broken up, such as during the mining process or when removing asbestos insulation, dust may be created. If the dust is inhaled or swallowed, the asbestos fibers will settle in the lungs or in the stomach, where they can cause irritation that may lead to mesothelioma. Exactly how this happens isn’t understood. It can take 20 to 40 years or more for mesothelioma to develop after asbestos exposure.

Most people with years of asbestos exposure never develop mesothelioma. And yet, others with very brief exposure develop the disease. This indicates that other factors may be involved in determining whether someone gets mesothelioma or doesn’t. For instance, you could inherit a predisposition to cancer or some other condition could increase your risk.

Factors that may increase the risk of mesothelioma include:

As pleural mesothelioma spreads in the chest, it puts pressure on the structures in that area. This can cause complications, such as:

Reducing your exposure to asbestos may lower your risk of mesothelioma.

Most people with mesothelioma were exposed to the asbestos fibers at work. Workers who may encounter asbestos fibers include:

Ask your employer whether you have a risk of asbestos exposure on the job.

Follow all safety precautions in your workplace, such as wearing protective equipment. You may also be required to shower and change out of your work clothes before taking a lunch break or going home. Talk to your doctor about other precautions you can take to protect yourself from asbestos exposure.

Older homes and buildings may contain asbestos. In many cases, it’s more dangerous to remove the asbestos than it is to leave it intact. Breaking up asbestos may cause fibers to become airborne, where they can be inhaled. Consult experts trained to detect asbestos in your home. These experts may test the air in your home to determine whether the asbestos is a risk to your health. Don’t attempt to remove asbestos from your home hire a qualified expert. The Environmental Protection Agency offers advice on its website for dealing with asbestos in the home.

Dec. 22, 2017

Original post:

Mesothelioma – Symptoms and causes – Mayo Clinic


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