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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. Tentative evidence also raises concern about carbon-fibre nanotubes.[18][19]

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][20][21] 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”.[22][23]

The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.[citation needed]

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

In the United States, asbestos is considered the major cause of malignant mesothelioma[25] and has been considered “indisputably”[26] 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.[27][28][29][30] 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.[31] 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.[32] There appears to be a linear, dose-response relationship, with increasing dose producing increasing risk of disease.[33] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[26] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[26] 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.[34] It is virtually never less than fifteen years and peaks at 3040 years.[26][35] 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.[36][37]

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.[38]

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.[39] A cohort study of miners employed at the mine reported that 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.[citation needed]

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

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][40][41] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers via washing a worker’s clothes or coming into contact with asbestos-contaminated work clothing.[12][24] To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.[citation needed]

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK, use of chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos were banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.[citation needed]

In a recent research carried on white American population in 2012, it was found that people with a germline mutation in their BAP1 gene are at higher risk of developing mesothelioma and uveal melanoma.[42]

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][20][21] 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.[21]

In rare cases, mesothelioma has also been associated with irradiation of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite or talc.[11][24] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[24] This has been confirmed in animal studies,[43][44] but studies in humans are inconclusive.[43][45][46]

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).[26] 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.[47]

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.[49] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[50]

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.[51] 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.[52] 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.[52][53]

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

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[54] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[55]

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.[56]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[57] 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.[58] 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.[59] 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.[60]

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,[61] including in patients with malignant pleural mesothelioma.[62] 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.[63] 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).[57] 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.[64] 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.[65] 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.[66]

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.[67]

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.[49]

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.[68] 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.[69] Worldwide incidence is estimated at 1-6 per 1,000,000.[11] Incidence of mesothelioma lags behind that of asbestosis due to the longer time it takes to develop; due to the cessation of asbestos use in developed countries, mesothelioma incidence is expected to decrease.[24] Incidence is expected to continue increasing in developing countries due to continuing use of asbestos.[11] Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.[citation needed] Less than 5% of mesotheliomas are pericardial. The prevalence of pericardial mesothelioma is less than 0.002%; it is more common in men than women. It typically occurs in a person’s 50s-70s.[10][70]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[71] 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.[72]

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).[73]

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

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

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould, a well-regarded paleontologist, was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote “The Median Isn’t the Message”,[80] 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.[81] 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.[82]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.[83] 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.[84]

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.[85] 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. Before the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.[86] In 1962, McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[87] 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 demanded 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.[88]

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.[89]

Mesothelioma at Curlie (based on DMOZ)

Excerpt from:

Mesothelioma – Wikipedia

Malignant Mesothelioma | 2018 Statistics & Symptoms

Written By Tonya Nelson

Tonya Nelson is an experienced writer and editor, who has published on a wide variety of topics, particularly in the health field. Her bachelors degree in magazine journalism from the S.I. Newhouse School of Public Communications at Syracuse University sparked her curiosity for writing stories about environmental and medical issues. As the Managing Editor, Tonya oversees the content development process, ensuring every article and informational page published adheres to MAA Centers editorial guidelines.

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Malignant Mesothelioma | 2018 Statistics & Symptoms

Malignant Mesothelioma Cancer | Stages, Prognosis, Treatment

Malignant Mesothelioma Cancer | Stages, Prognosis, Treatment

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.

After receiving a mesothelioma diagnosis, there are a number of vital decisions that must be made. The Mesothelioma Cancer Alliance is dedicated to providing patients with the best resources available on current treatment, stories of survival and hope, and financial assistance.

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. Click here to connect with Heather.

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.

Doctors will use a number of different tests and techniques including blood tests, imaging and biopsies to diagnose the cancer and assign it a stage. The stage and other diagnostic details are used to determine your prognosis and to predict what your life expectancy may be.

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.

The Mesothelioma Cancer Alliance is also part of the larger community dedicated to promoting mesothelioma research and preventing new cases through a worldwide asbestos ban.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

We work with and donate to the following organizations whose missions complement our own: Asbestos Disease Awareness Organization, Mesothelioma Applied Research Foundation, National Foundation for Cancer Research, National Cancer Institute, American Society of Clinical Oncology and the Cancer Research Institute. The mesothelioma community gets together often at various events around the country.

According to the National Alliance for Caregiving, more than 44 million people in the United States are caring for a loved one with a disability or disease. This month honors those people for their contributions and helps find new ways to help caregivers provide the best care possible. For more information, please visit the organization’s site via the link below.

Lung cancer accounts for more than a quarter of all cancer deaths and is a leading killer among both men and women. International non-profit lung cancer organizations, including the International Association for the Study of Lung Cancer (IASLC), are working together to share survivor stories, support families and caregivers, and promote continued research and medical breakthroughs.

Editor in Chief, Mesothelioma Cancer Alliance

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)

Please fill in the form below to request our FREE Mesothelioma Treatment Guide. It will be sent to you within 24 hours.

Link:

Malignant Mesothelioma Cancer | Stages, Prognosis, Treatment

Mesothelioma | 2018 – Treatments, Symptoms, Causes, Prognosis

Are You a Veteran? Get VA Claims Help

Most veterans with mesothelioma are eligible for benefits through the Department of Veterans Affairs (VA).

Two financial benefits available to veterans are Disability Compensation for veterans primarily exposed in the military, while Pension is for non-service related mesothelioma cases. Family members and dependents can also receive financial assistance.

In addition, the VA has contracted with two world-renowned thoracic surgeons who provide specialized mesothelioma treatment to any veteran enrolled in the VA Health Care system.

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Mesothelioma | 2018 – Treatments, Symptoms, Causes, Prognosis

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. Tentative evidence also raises concern about carbon-fibre nanotubes.[18][19]

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][20][21] 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”.[22][23]

The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.[citation needed]

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

In the United States, asbestos is considered the major cause of malignant mesothelioma[25] and has been considered “indisputably”[26] 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.[27][28][29][30] 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.[31] 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.[32] There appears to be a linear, dose-response relationship, with increasing dose producing increasing risk of disease.[33] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[26] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[26] 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.[34] It is virtually never less than fifteen years and peaks at 3040 years.[26][35] 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.[36][37]

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.[38]

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.[39] A cohort study of miners employed at the mine reported that 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.[citation needed]

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

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][40][41] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers via washing a worker’s clothes or coming into contact with asbestos-contaminated work clothing.[12][24] To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.[citation needed]

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK, use of chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos were banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.[citation needed]

In a recent research carried on white American population in 2012, it was found that people with a germline mutation in their BAP1 gene are at higher risk of developing mesothelioma and uveal melanoma.[42]

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][20][21] 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.[21]

In rare cases, mesothelioma has also been associated with irradiation of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite or talc.[11][24] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[24] This has been confirmed in animal studies,[43][44] but studies in humans are inconclusive.[43][45][46]

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).[26] 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.[47]

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.[49] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[50]

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.[51] 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.[52] 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.[52][53]

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

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[54] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[55]

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.[56]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[57] 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.[58] 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.[59] 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.[60]

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,[61] including in patients with malignant pleural mesothelioma.[62] 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.[63] 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).[57] 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.[64] 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.[65] 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.[66]

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.[67]

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.[49]

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.[68] 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.[69] Worldwide incidence is estimated at 1-6 per 1,000,000.[11] Incidence of mesothelioma lags behind that of asbestosis due to the longer time it takes to develop; due to the cessation of asbestos use in developed countries, mesothelioma incidence is expected to decrease.[24] Incidence is expected to continue increasing in developing countries due to continuing use of asbestos.[11] Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.[citation needed] Less than 5% of mesotheliomas are pericardial. The prevalence of pericardial mesothelioma is less than 0.002%; it is more common in men than women. It typically occurs in a person’s 50s-70s.[10][70]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[71] 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.[72]

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).[73]

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

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

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould, a well-regarded paleontologist, was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote “The Median Isn’t the Message”,[80] 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.[81] 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.[82]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.[83] 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.[84]

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.[85] 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. Before the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.[86] In 1962, McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[87] 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 demanded 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.[88]

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.[89]

Mesothelioma at Curlie (based on DMOZ)

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Mesothelioma – Wikipedia

Pleural Mesothelioma | Symptoms, Stages, Prognosis & More

Patients experiencing any of these symptoms should talk to their doctor about any possible exposures to asbestos in the past. Even if it happened years ago, no amount of exposure is considered safe, and it can help your doctor test for mesothelioma or other asbestos-related diseases.

With these nonspecific symptoms and the long latency period associated with all forms of mesothelioma, some patients have to wait weeks or even months before receiving a proper pleural mesothelioma diagnosis. Though a diagnosis will generally begin with a variety of imaging tests like CT scans and x-rays to determine the presence of cancer, a biopsy is currently the only method to confirm pleural mesothelioma.

The biopsy will consist of taking samples of pleural tissue for testing. The doctor may also perform a thoracentesis, or a pleural tap, which is a slightly invasive procedure that removes fluid from the pleura for analysis. A pathologist will determine if the cells are malignant, and if pleural mesothelioma is confirmed they will also be able to decipher the cell type.

Unlike the other forms of mesothelioma, pleural mesothelioma has several staging systems that oncologists rely on to determine the progression of the disease. The most widely used and accepted, however, is the TNM Staging System, which stands for Tumor, Nodule, and Metastasis. Doctors will use the system to score an area for each category, which will collectively make up the stage.

Refers to disease which is confined to the primary site, or site of origin. The lymph nodes are free of disease and there are no metastases present. Most often, treatment for stage I mesothelioma consists of surgical resection, or removal, of the disease.

Refers to disease which is confined to one site. While the lymph nodes are still free of disease and there are no metastases present, the tumor extends into the deeper pleural surfaces on the same side as the tumor as well as at least one of the following: the diaphragm or the lung.

Refers to disease which either has spread to lymph nodes on the same side as the tumor; or, a tumor which is extensive and involves the deeper pleural surfaces as well as at least one of the following: chest wall, thoracic fascia, sac around the heart, or mediastinal fat. The tumor is still considered resectable by surgery. There is no metastasis present.

Refers to disease in which one of the following occurs: the tumor is too extensive for surgery, there is distant lymph node involvement on the opposite side from the tumor, or there is distant metastasis present.

Doctors may also use the Brigham staging system, which focuses on a tumors ability to be surgically removed, or the Butchart system, which focuses on the extent of the primary tumor and in general is viewed as more limiting. Regardless of the staging system used, the stage of pleural mesothelioma has a large impact in determining what treatments a patient is eligible for and their prognosis. A stage 1 patient, for instance, will have more treatment options like curative surgery, compared to a stage 4 patient whose malignant mesothelioma has likely spread to other parts of the body or the tumors are too extensive for removal.

Learn More About Mesothelioma Stages

Like the other types of mesothelioma, pleural mesothelioma patients also face a poor prognosis. Though it is the most common and most researched, doctors still face difficulties in diagnosing and treating the disease. Advancements in treatment and ongoing clinical trials have provided hope in finding new, effective treatments like immunotherapy, which has already shown promise in extending survival for some patients. On average, pleural mesothelioma patients have a life expectancy of about one year, though a number of factors can influence an individuals prognosis like stage, cell type, and the patients age.

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Pleural Mesothelioma | Symptoms, Stages, Prognosis & More

Mesothelioma Symptoms, Causes & Prognosis

What Is Mesothelioma?

Mesothelial cells are a layer of specialized cells that line the body cavities, including the pleura (lining of the lung), peritoneum (lining of the abdominal cavity), and pericardium (lining of the heart). The tissue formed by these cells is called mesothelium.

The mesothelium contains both an outer and an inner layer. The inner layer surrounds the organs themselves, while the outer layer lines the body cavities in which the organs covered by mesothelial cells reside. The mesothelial cells themselves produce and secrete a small amount of lubricating fluid between the two layers that permits the organs to move smoothly against adjacent organs and structures.

Like other cells of the body, mesothelial cells can also grow abnormally, leading to the development of tumors. The tumors of the mesothelial cells can be benign (noncancerous) or malignant (cancerous). A malignant tumor of the mesothelium is called a malignant mesothelioma. Because most mesothelial tumors are cancerous, malignant mesothelioma is often simply referred to as mesothelioma. This article focuses on mesothelioma of the lining of the lungs (pleural mesothelioma), which is the most common form of all mesotheliomas.

Mesothelioma is an uncommon disease. The disease is more common in men of Caucasian and Hispanic ethnicity, and less common among Asian and African American men. The disease shows a male predominance, which is like due to occupational exposure.

The main risk factor for developing pleural mesothelioma is exposure to asbestos. Asbestos is a mineral that occurs naturally as strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed.

Prior to the 1970s, enormous amounts of asbestos were used in commercial construction and shipbuilding. After the health risks of asbestos became known, production of asbestos slowed drastically in the 1970s. Governmental restrictions were placed on its use, and alternative materials became available. Despite these changes, asbestos continues to be used.

Occupations that deal with asbestos and typically associated with the onset of mesothelioma later in life include asbestos production, insulation work, heating trades, shipyard work, and construction.

The period between asbestos exposure and the development of mesothelioma is generally 35-40 years. Usually, people who develop mesothelioma have been exposed to asbestos for a prolonged period of time; however, some people with only brief exposures have also developed mesothelioma. On the other hand, not all workers who are heavily exposed develop mesothelioma.

Mesothelioma can also occur in family members and other people living with asbestos workers. It may be a result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers.

In some people with mesothelioma, no specific asbestos exposure can be found. Frequently, such people have worked in a job where the exposure was not recognized or typically associated with asbestos exposure. Mesothelioma without asbestos exposure does occur.

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Mesothelioma Symptoms, Causes & Prognosis

Mesothelioma: Symptoms, Causes, Treatments, and Coping

Mesothelioma is a somewhat rare cancer, with only about 2,000 new cases diagnosed in the United States each yearbut its incidence is increasing worldwide. Sadly, most cases of this disease are related to on-the-job exposure to asbestosand could be prevented through awareness and protective measures at work. That said, in many cases, mesothelioma does not develop until decades after asbestos exposure occurs, and many people that are diagnosed today were exposed to asbestos years ago.

Mesothelioma is a cancerous (malignant)tumor that begins in the mesothelium. The mesothelium is a membrane that lines and protects the lungs, the heart, and the abdominal cavity. There are three main types of mesothelioma:

Most cases of mesothelioma are because of exposure to asbestos on the job. Other causes include:

Most people with pleural mesothelioma note shortness of breath and chest pain (especially under the ribs), but other symptoms can include:

Diagnosing mesothelioma can be difficult since there are many conditions that cause similar symptoms. Your physician will first take a careful history, especially questioning you about your employment history, and then perform a physical exam. Imaging studies are often doneand may include x-rays of your chest and abdomen, CT scans, MRI scans,or PET scans.

If your doctor suspects mesothelioma, she will need to schedule a biopsy. Depending upon the location of your tumor, she may recommend a thoracoscopyor video-assisted thoracoscopy (VAT), a procedure where a tissue sample is taken from the pleura, or a peritoneoscopy, a similar procedure to obtain tissue from the abdomen. If the biopsy reveals mesothelioma, further studies are then done to determine the stage of the cancer (how advanced it is).

Mesothelioma is divided into 2 primary stages:

Depending on the size and location of your tumor, and if it has spread, treatment options may include:

On top of the heartbreak, a diagnosis of cancer brings, many people with mesothelioma lack the emotional and psychosocial support that those with other forms of cancer find readily available. In addition, medico-legal battles related to asbestos exposure on-the-job can be emotionally draining. Participating in a support group, either through your cancer center, community, or online, can help you wade through the maze of treatment options, and find camaraderie in others who are living with mesothelioma.

The most important thing you can do to prevent mesothelioma is to use appropriate precautions if you are exposed to asbestos at work. OSHA has asbestos safety standards for individuals who may be exposed on the job. If you work with asbestos, it is important to follow these guidelines to minimize your families exposure as well. Asbestos insulation in homes is usually not a problemunless it is damaged or disturbed by remodeling projects. If you may have asbestos insulation (homes built prior to 1950) make sure to hire a contractor certified in asbestos management before you begin any home improvement projects.

Some people who have been exposed to asbestos may want to consider CT screening for lung cancer. At this time, recommendations for screening include only those people aged 55 to 74 with a 30 pack-year history of smoking. Yet studies show that some people who have been exposed to asbestos may be at an even higher risk of developing lung cancer than heavy smokers. If you’ve been exposed to asbestos make sure to talk to your doctor about lung cancer screening.

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Mesothelioma: Symptoms, Causes, Treatments, and Coping

Mesothelioma: Integrative Treatment Program | CTCA

Mesothelioma is treated in three main ways: with surgery, chemotherapy and/or radiation therapy. Patients with stage I, II or III pleural mesothelioma are typically treated with a combination of all three therapies. If microscopic disease remains after surgery, your oncologist may recommend radiation therapy to destroy leftover cancer cells. Radiation treatments may also be used to alleviate chest pain, shortness of breath or swallowing difficulties. For patients with inoperable, stage IV disease, chemotherapy is typically recommended.

Learn more about mesothelioma treatment options

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Mesothelioma: Integrative Treatment Program | CTCA

Mesothelioma – What is Malignant Mesothelioma Cancer

The American Cancer Society records about 3,000 new cases of mesothelioma each year in the U.S.

Its a disease that mostly affects people who worked with asbestos and products containing asbestos.

While there are treatments that control tumor growth, researchers have not found a definitive cure for the cancer.

Mesothelioma is a rare cancer caused by exposure to asbestos.

The cancer develops when a person ingests asbestos, and it causes changes to a persons DNA.

Our genes, which are made of DNA, control how cells grow, multiply and die. Changes in our genes may cause cells to divide out of control and may lead to cancer.

Tumors also can be benign (noncancerous). But when tumors are cancerous, doctors call the disease malignant mesothelioma. It is often shortened to mesothelioma.

Common mesothelioma symptoms include:

These mesothelioma symptoms usually do not show until tumors have grown and spread. Mesothelioma latency is 20-50 years. Thats how long it takes from initial exposure to accurate diagnosis. For that reason, many people with mesothelioma are in their 60s or 70s.

You should talk to a mesothelioma specialist soon if you have a history of asbestos exposure and experience these symptoms. An early diagnosis may improve your prognosis and life expectancy.

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

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 are most at risk. This branch used the largest quantity of asbestos products.

More than 75 occupations have exposed workers to asbestos. Auto mechanics, textile workers, steel mill workers, construction workers and firefighters are among the most at risk.

Asbestos workers unknowingly carried asbestos fibers on their body and clothing. This resulted in secondary asbestos exposure among residents such as women and children.

Oncologists name each type of mesothelioma by the location in the body where it develops.

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

Prognosis, symptoms and treatment options vary by type.

Younger patients and women have a better mesothelioma prognosis than older men. People diagnosed with peritoneal mesothelioma also have a higher chance of survival.

Patients eligible to undergo multimodal therapy, which is a combination of two or more standard-of-care treatments, have a better life expectancy and improved prognosis.

A patients mesothelioma cell type also plays a significant role in prognosis and life expectancy.

The three types of cells include:

The cancer is localized. Surgery is most effective at this stage. Survival rate is higher. Median life expectancy at stage 1 is 22.2 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 20 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 17.9 months.

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.

Mesothelioma is a rare cancer. It represents only 0.3 percent of all cancer diagnoses. Most doctors and oncologists have never encountered it.

A 2009 study published in the Journal of General Internal Medicine states that cancer care requires the technical knowledge and skills of specialty physicians such as medical oncologists, surgeons and radiation oncologists.

These are factors that impact a mesothelioma patients survival. Thats why finding a mesothelioma specialist is so important.

Finding a mesothelioma specialty center with experienced mesothelioma doctors is crucial to survival.

Lung Institute at Baylor College of Medicine

UCLA Jonsson Comprehensive Cancer Center

H. Lee Moffitt Cancer Center

We can help you or a loved one find a mesothelioma doctor who specializes in chemotherapy.

Mesothelioma treatment helps patients live longer lives. But not every patient is eligible for each type of mesothelioma treatment.

The most common treatments for mesothelioma include:

More than 70 percent of mesothelioma patients undergo chemotherapy

Clinical trials offer mesothelioma patients access to experimental therapies. They also provide scientific and medical information for researches to develop new treatments. Patients in clinical trials also receive excellent medical care.

Herbal medicines, mind-body therapies, holistic healing and other complementary therapies may benefit patients.

Thank you for the doctor referral info. We met with the doctor and came away with what seemed like a weight lifted.

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We can help you or a loved one get a diagnosis or a second opinion from a mesothelioma specialist.

Many companies that produced, distributed or used asbestos products knew it was deadly. But they neglected to warn their employees. Filing a lawsuit can help mesothelioma patients cover lost wages, medical expenses and other costs.

$180,000 is 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.

A person with mesothelioma can file a personal injury lawsuit. Mesothelioma lawyers file these against companies responsible for their clients asbestos exposure. Families can file wrongful death claims when a loved one dies of mesothelioma.

Qualified mesothelioma attorneys can help you decide when to file a lawsuit. They can also guide you through the process. Time is of the essence because statute of limitations may expire. A mesothelioma lawyer will review your case so you receive the highest compensation.

Learn How to Hire a Qualified Mesothelioma Lawyer

Support is available for mesothelioma patients, survivors and loved ones in many forms.

The Mesothelioma Centers monthly online support group meets every second Wednesday. Licensed mental health counselor Dana Nolan runs the support group. Patients and survivors can share their experiences with others on a similar cancer journey.

Last Modified October 4, 2018

Registered Nurse and Patient Advocate

Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

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Mesothelioma – What is Malignant Mesothelioma Cancer

Malignant Mesothelioma | 2018 Statistics & Symptoms

Written By Tonya Nelson

Tonya Nelson is an experienced writer and editor, who has published on a wide variety of topics, particularly in the health field. Her bachelors degree in magazine journalism from the S.I. Newhouse School of Public Communications at Syracuse University sparked her curiosity for writing stories about environmental and medical issues. As the Managing Editor, Tonya oversees the content development process, ensuring every article and informational page published adheres to MAA Centers editorial guidelines.

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Malignant Mesothelioma | 2018 Statistics & Symptoms

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 Cancer | Prognosis, Treatment and Survival

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.

After receiving a mesothelioma diagnosis, there are a number of vital decisions that must be made. The Mesothelioma Cancer Alliance is dedicated to providing patients with the best resources available on current treatment, stories of survival and hope, and financial assistance.

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. Click here to connect with Heather.

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.

Doctors will use a number of different tests and techniques including blood tests, imaging and biopsies to diagnose the cancer and assign it a stage. The stage and other diagnostic details are used to determine your prognosis and to predict what your life expectancy may be.

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.

The Mesothelioma Cancer Alliance is also part of the larger community dedicated to promoting mesothelioma research and preventing new cases through a worldwide asbestos ban.

FREE Mesothelioma Awareness Wristbands and Treatment Guide.

We work with and donate to the following organizations whose missions complement our own: Asbestos Disease Awareness Organization, Mesothelioma Applied Research Foundation, National Foundation for Cancer Research, National Cancer Institute, American Society of Clinical Oncology and the Cancer Research Institute. The mesothelioma community gets together often at various events around the country.

Remember the Fallen, Honor the Brave, Fight for the Cure! The 7th annual 5K Walk for Mesothelioma will be held at the Paramount Ranch in Agoura Hills, and funds raised will go toward mesothelioma research at the PMCs Punch Worthington Lab at UCLA and the Pacific Mesothelioma Center. The event begins with a walk, followed by a catered lunch, vendors, an opportunity drawing, and more.

American Public Health Association’s APHA’s Annual Meeting and Expo is the largest annual gathering of public health professionals. More than 12,000 people attend, and thousands of new abstracts are presented each year, making APHA 2018 the most influential meeting in public health. For more information, please visit the APHA’s conference site via the link below.

Editor in Chief, Mesothelioma Cancer Alliance

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)

Please fill in the form below to request our FREE Mesothelioma Treatment Guide. It will be sent to you within 24 hours.

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Mesothelioma Cancer | Prognosis, Treatment and Survival

Mesothelioma | 2018 – Treatments, Symptoms, Causes, Prognosis

Selecting a mesothelioma specialist is one of the most important decisions a patient can make. Specialists are doctors who are experienced and knowledgeable about treating a specific disease.

A specialist can:

General oncologists do not have much experience in treating mesothelioma because only 2,000 to 3,000 cases are diagnosed in the U.S. each year.

Treatment prescribed by a specialist can significantly extend a patient’s life. Not every specialist treats every type of mesothelioma. Depending on the stage, type, location, severity and more, certain specialists are a better fit than others.

Read this article:

Mesothelioma | 2018 – Treatments, Symptoms, Causes, Prognosis

Malignant MesotheliomaPatient Version – National Cancer …

Malignant mesothelioma is a cancer of the thin tissue (mesothelium) that lines the lung, chest wall, and abdomen. The major risk factor for mesothelioma is asbestos exposure. Explore the links on this page to learn more about malignant mesothelioma treatment and clinical trials.

For more information, view Malignant Mesothelioma Symptoms, Tests, Prognosis, and Stages.

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Malignant MesotheliomaPatient Version – National 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. Tentative evidence also raises concern about carbon-fibre nanotubes.[18][19]

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][20][21] 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”.[22][23]

The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.[citation needed]

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

In the United States, asbestos is considered the major cause of malignant mesothelioma[25] and has been considered “indisputably”[26] 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.[27][28][29][30] 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.[31] 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.[32] There appears to be a linear, dose-response relationship, with increasing dose producing increasing risk of disease.[33] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[26] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[26] 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.[34] It is virtually never less than fifteen years and peaks at 3040 years.[26][35] 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.[36][37]

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.[38]

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.[39] A cohort study of miners employed at the mine reported that 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.[citation needed]

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

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases.[11][40][41] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers via washing a worker’s clothes or coming into contact with asbestos-contaminated work clothing.[12][24] To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.[citation needed]

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK, use of chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos were banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.[citation needed]

In a recent research carried on white American population in 2012, it was found that people with a germline mutation in their BAP1 gene are at higher risk of developing mesothelioma and uveal melanoma.[42]

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][20][21] 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.[21]

In rare cases, mesothelioma has also been associated with irradiation of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite or talc.[11][24] Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[24] This has been confirmed in animal studies,[43][44] but studies in humans are inconclusive.[43][45][46]

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).[26] 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.[47]

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.[49] In general, mesothelioma is characterized by loss of function in tumor suppressor genes, rather than by an overexpression or gain of function in oncogenes.[50]

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.[51] 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.[52] 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.[52][53]

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.[54] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by mesothelioma cells.[55]

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.[56]

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[57] 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.[58] 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.[59] 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.[60]

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,[61] including in patients with malignant pleural mesothelioma.[62] 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.[63] 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).[57] 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.[64] 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.[65] 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.[66]

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.[67]

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.[49]

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.[68] 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.[69] Worldwide incidence is estimated at 1-6 per 1,000,000.[11] Incidence of mesothelioma lags behind that of asbestosis due to the longer time it takes to develop; due to the cessation of asbestos use in developed countries, mesothelioma incidence is expected to decrease.[24] Incidence is expected to continue increasing in developing countries due to continuing use of asbestos.[11] Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.[citation needed] Less than 5% of mesotheliomas are pericardial. The prevalence of pericardial mesothelioma is less than 0.002%; it is more common in men than women. It typically occurs in a person’s 50s-70s.[10][70]

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[71] 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.[72]

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).[73]

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

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

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould, a well-regarded paleontologist, was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote “The Median Isn’t the Message”,[80] 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.[81] 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.[82]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.[83] 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.[84]

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.[85] 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.[86] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[87] 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.[88]

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.[89]

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Mesothelioma – Wikipedia

Mesothelioma.net | Resources for Mesothelioma Victims & Families

While this thank you is long overdue, it is still deeply, deeply heartfelt. My family will be forever grateful to you for your care, compassion, encouragement and for making it possible for us to gather with family and seek help without any worry about work responsibilities. You have such an exemplary and kind heart and we cannot thank you enough for all you did (and continue to do so) to help us get through this difficult time.

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Mesothelioma.net | Resources for Mesothelioma Victims & Families

Mesothelioma Causes, Symptoms, Treatment & Prognosis

Mesothelioma facts

What is mesothelioma?

Mesothelioma is a rare form of cancer (malignancy) that most frequently arises from the cells lining the sacs of the chest (the pleura) or the abdomen (the peritoneum). Pleural mesothelioma is the most common form, often becoming apparent with symptoms in the chest area such as chest pain, cough, and/or shortness of breath. Shortness of breath often occurs due to a large pleural effusion (fluid in the thoracic cavity). Peritoneal mesothelioma is much less common. This can affect the organs in the abdomen, and its symptoms are related to this area of the body, that is, abdominal swelling, nausea, vomiting, and bowel obstruction. The rarest form of mesothelioma is pericardial mesothelioma, which involves the sac surrounding the heart.

There are two major cell types of mesothelioma, epithelial and sarcomatoid. Sometimes both of these cell types can be present, also referred to as biphasic. The sarcomatoid type is rarer and occurs in only about 15% of cases; it portends a poorer prognosis. In very rare cases, mesothelioma can originate from benign, non-malignant cells. Surgery cures this so-called benign mesothelioma.

There are many causes of chest pain. A serious form of chest pain is angina, which is a symptom of heart disease and results from inadequate oxygen supply to the heart muscle. Angina can be caused by coronary artery disease or spasm of the coronary arteries. Chest pain can also be due to a heart attack (coronary occlusion), aortic aneurysm dissection, myocarditis, esophageal spasm, esophagitis, rib injury or disease, anxiety, and other important diseases. Do not try to ignore chest pain and “work (or play) through it.” Chest pain is a warning to seek medical attention.

What are mesothelioma symptoms?

Most people present with complaints of shortness of breath. They also can have complaints of chest pain and cough. Patients may also be asymptomatic, with the disease discovered by physical exam or an abnormal chest X-ray.

As the disease progresses, shortness of breath increases, and weight loss, decreased appetite, and night sweats can develop. Local invasion by the tumor can result in changing of voice, loss of function of the diaphragm, and symptoms specific to the area and involvement of adjacent structures.

What causes mesothelioma?

Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Usually, this involves men over 40 years of age. Others have been exposed to asbestos in a household environment, often without knowing it. The number of new cases of mesothelioma has been relatively stable since 1983, the same time that the U.S. Occupational Safety and Health Administration (OSHA) instituted restrictions on asbestos. In Europe, the number of new cases of mesothelioma continues to rise.

How much asbestos exposure does it take to get mesothelioma?

An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later and in some cases, as much as 70 years later.

How long does it take after asbestos exposure for mesothelioma to show up?

People exposed in the 1940s, ’50s, ’60s, and ’70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.

How do health care professionals diagnose mesothelioma?

Pathological examination from a biopsy diagnoses mesothelioma. A health care professional removes tissue. Then a pathologist places it under a microscope and makes a definitive diagnosis and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid buildup around the lungs (pleural effusions), shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an X-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:

What is the prognosis for mesothelioma?

Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated. Unfortunately, oftentimes health care professionals find mesothelioma at a stage in which a cure is unobtainable. Many will succumb to the disease within one year of diagnosis.

Treatment options are determined by the stage of mesothelioma (the extent to which the tumor has spread in the body). There are three staging systems currently in use, and each one measures somewhat different variables.

The oldest staging system and the one most often used is the Butchart system, based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages.

The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis.

TNM system: variables of T (tumor), N (lymph nodes), and M (metastasis)

The Brigham system is the latest system and stages mesothelioma according to resectability (the ability to remove the tumor surgically) and lymph node involvement.

What is the treatment for mesothelioma?

There are three traditional kinds of treatment for patients with malignant mesothelioma. Often physicians combine two or more of these in the course of treatment:

Surgery: There are several types of surgery used in treating mesothelioma.

Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are (internal radiation therapy).

If fluid has collected in the chest or abdomen, your doctor may drain the fluid out of your body by putting in a needle into the chest or abdomen and using gentle suction to remove the fluid. If a doctor removes fluid from the chest, this is called thoracentesis. If a physician removes fluid from the abdomen, this is called paracentesis. Your doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.

Health care professionals administer adjuvant radiation in a manner to avoid exposure of the opposite lung to radiation and its potential side effects.

Chemotherapy is the use of drugs to kill cancer cells. Health care professionals administer chemotherapy by pill, or it may be put into the body by a needle in the vein or muscle. Often, a platinum-based chemotherapy (cisplatin or carboplatin) drug is given along with a second agent, pemetrexed. The side effects can be quite toxic, therefore they are used in people who are physically well enough to tolerate these side effects.

Chemotherapeutic agents can be administered either systemically (through the bloodstream) or intrapleurally (in the pleural cavity). When it is administered intrapleurally, the treatment is localized at the site of the tumor. These drugs are generally very toxic and you should discuss their use very carefully with your physician.

Is there any promising research or are there promising drugs for mesothelioma?

Medical researchers are testing new approaches to treat malignant mesothelioma. They often combine traditional treatments or include something entirely new. They include:

Research is being conducted at various cancer centers all over the United States.

A recent study involving L-NDDP produced two cases of remission in mesothelioma patients. Another study found that a drug known as lovastatin might hold promise for mesothelioma patients.

To learn more about mesothelioma clinical studies and journal medical journal articles, visit the Mesothelioma Web (http://www.mesotheliomaweb.org).

What other kinds of information is available for people with mesothelioma?

There are numerous cancer web sites, some specific to mesothelioma. Because they are often difficult to locate, we have listed some relevant medical web sites that have information about mesothelioma.

American Institute for Cancer Research(http://www.aicr.org)

American Thoracic Society(http://www.thoracic.org/)

Canadian Cancer Society(http://www.bc.cancer.ca)

Mesothelioma Web(http://www.mesotheliomaweb.org)

Medically Reviewed on 7/5/2018

References

Mujoomdar, A.A., and D.J. Sugarbaker. “Hyperthermic Chemoperfusion for the Treatment of Malignant Pleural Mesothelioma.” Semin Thorac Cardiovasc Surg 20.4 Winter 2008: 298-304.

Ried, Michael, et al. “Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience.” Eur J Cardio-thoracic Surgery 43.4 April 2013: 801-807.

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Mesothelioma Causes, Symptoms, Treatment & Prognosis

What is Mesothelioma Cancer? | Mesothelioma Book

Mesothelioma is a cancer found in the lining surrounding the lungs, the stomach, the heart or the testicles. This cancer takes its name from the name that is given to this lining – the mesothelium. The pleura is the name for the mesothelial tissue surrounding the lungs and lining the chest cavity. If the cancer is in this lining, it is called “pleural mesothelioma.” Pleural mesothelioma is the most common type of mesothelioma.

The peritoneum is the lining that covers most of the organs in the abdominal cavity, while the pericardium is the lining that covers and protects the heart. If the cancer is in either of these areas, it is called “peritoneal mesothelioma” or “pericardial mesothelioma.”

Like other forms of cancer, mesothelioma occurs when cells become abnormal and divide or grow out of control. When someone has mesothelioma, the lubricating fluid in the lining may be over-produced. This excess fluid encases the organs with a thick layer of tumor tissue, described as a rind type of layer, that puts pressure on the organs. People with pleural mesothelioma often complain of shortness of breath and a buildup of fluid in the chest area. In advanced cases of mesothelioma, cells metastasize, or grow and invade other organs and spread to other areas of the body.

The only agreed upon cause of mesothelioma is exposure to asbestos.

It often takes 10 to 60 years after exposure to asbestos before the symptoms of mesothelioma develop.

This period of time is referred to as a latency period. Because of the latency period, the disease commonly affects men and women that are at least 50 years of age and that worked with asbestos between 10 and 60 years ago.

However, there are many known cases of people developing mesothelioma at an earlier age. Often these are the sons and daughters whose parents were exposed to asbestos and who unwittingly brought the invisible dust home on their clothes or who did home remodeling projects and used products, such as joint compound, that contained asbestos. In some cases the child was around the parent as the parent changed the brakes – lined with asbestos – in the family car. This is called secondary exposure to asbestos.

Many people working 10 to 60 years ago were not required to use any type of protection in the workplace while they were exposed to asbestos even though the companies that manufactured the products containing asbestos had full knowledge that it was dangerous and that exposure to it would harm the health of many of the workers.

As with other cancers, a speedy diagnosis is important to effective treatment of mesothelioma. If you believe that you may have mesothelioma and that you worked with asbestos in the past, you should inform your doctor of this fact.

If you wish to learn more about mesothelioma, CLICK HERE to receive a free book written by medical professionals who have treated mesothelioma.

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What is Mesothelioma Cancer? | Mesothelioma Book

Mesothelioma Cancer Alliance | Information for Patients and …

Malignant mesothelioma is a rare type of cancer that occurs in the thin layer of cells lining the body’s internal organs, known as the mesothelium.

There are three recognized types of mesothelioma. Pleural mesothelioma is the most common form of the disease, accounting for roughly 70% of cases, and occurs in the lining of the lung known as the pleura. Peritoneal mesothelioma occurs in the lining of the abdominal cavity, known as the peritoneum and pericardial mesothelioma originates in the pericardium, which lines the heart.

An individual may be at risk to develop mesothelioma if he or she was exposed to asbestos in the workplace or at home. Mesothelioma is caused by exposure to asbestos and the inhalation of asbestos particles. In most cases, mesothelioma symptoms will not appear in an individual exposed to asbestos until many years after the exposure has occurred.

Those with a past asbestos exposure history experiencing symptoms should consult a physician with experience in accurately diagnosing mesothelioma. The earlier mesothelioma is diagnosed, the more likely it is to be caught at an early stage. At earlier stages of mesothelioma progression, more treatment options are available and oftentimes a better prognosis is given.

Additional mesothelioma information and statistics can be found in this section. Read stories of hope from mesothelioma surviviors as well.

In 2006, at the age of 36, Heather Von St. James gave birth to her daughter, Lily Rose. Just three months later, she was diagnosed with mesotheliomastartling news for someone so young. Heather had been exposed to asbestos second-hand as a child when her father would return home from work with his clothing covered in asbestos dust. Heather often wore his coat, and in the process she unwittingly breathed in the fibers. With strong faith, support from a host of family and friends, and a vibrant sense of humor, Heather emerged from a multi-month course of treatment healthy and cancer-free.

Mavis describes herself as an ordinary woman who married a shipwright. For 48 years, she washed her husbands clothes when he came home from work, never knowing that the dust on his jacket was full of deadly asbestos. In June 2009, Mavis was diagnosed with mesothelioma and given only three months to live. Chemotherapy worked to extend her life for another year beyond that, but eventually the tumors started growing again. However, she was given a new lease on life through an immunotherapy trial, which has kept her cancer free much longer than expected.

Paul Cowley

Paul Cowley and his wife Claire could hardly believe it when they got the news that he had pleural mesothelioma. He was only 34, much younger than most people diagnosed with this rare and deadly form of cancer. Being so young, Paul was able to attempt an aggressive multimodal treatment regimen that included multiple avenues of attack against the cancer. Paul has beaten the odds by surviving beyond five years a feat that only 9% of mesothelioma patients accomplish.

Paul Kraus

Paul Kraus has lived with peritoneal mesothelioma for nearly two decades. Born into a Nazi labor camp in Austria, he escaped as an infant with his mother and brother and soon emigrated with his family to Australia. Asbestos is prevalent in Australia, and as a result, the country suffers from some of the highest rates of mesothelioma in the world. Mr. Kraus was exposed as a youth on a summer job he took in 1962. The cancer was latent until 1997 at which time he was diagnosed and given just weeks to live.

Stephen Jay Gould

One of the most popular scientific authors of recent times, evolutionary biologist Stephen Jay Gould, authored more than 20 books on a variety of scientific subjects, and published hundreds of essays in Natural History magazine. Gould lived for twenty years after being diagnosed with mesothelioma in 1982. After his diagnosis, he wrote an essay, The Median Isnt the Message, about his reaction to the news and to the realization that half of all mesothelioma patients died within eight months of diagnosis. His essay has been cited as a source of comfort and hope by many cancer victims.

Once an individual has been diagnosed by a qualified mesothelioma doctor, the next step is to discuss mesothelioma treatment options and to develop a treatment plan. Recent scientific research has produced significant breakthroughs with regard to treatment protocols for mesothelioma patients and more options are now available for managing mesothelioma and supporting improved quality of life.

Newly diagnosed mesothelioma patients often have many questions for their doctors about the treatment options that would be most effective for them. Conventional treatment options for mesothelioma include surgery, radiation and chemotherapy. Recently, chemotherapy drugs including Alimta and Cisplatin have showed promising results in some patients.

Mesothelioma clinical trials as well as experimental treatments are other options that certain mesothelioma patients may be eligible to participate in. Our site features a comprehensive mesothelioma cancer treatment section that includes important information for patients and families. We’ve included resources on top mesothelioma experts such as Dr. Raphael Bueno, as well as a comprehensive list of cancer centers where mesothelioma treatment takes place.

Beyond the conventional treatments for mesothelioma, certain alternative therapies may provide assistance to mesothelioma patients. Financial assistance is available to help offset mesothelioma treatment costs. We continually update this section of our site as new mesothelioma treatment information becomes available.

Asbestos exposure is the primary cause of mesothelioma cancer. Inhaled or ingested asbestos fibers may cause an inflammation of internal tissue and disrupt organ function which leads to the development of mesothelioma. Asbestos products were used extensively in the 20th century throughout the United States, in a wide variety of applications.

Asbestos companies continued to produce these products even after they were known to be hazardous to workers. These products were responsible for asbestos exposure sustained by the individuals who manufactured them as well as those who used them. Renovation and construction both at home and in schools also poses high risk areas for exposure. People also may have been exposed to asbestos-contaminated talc in baby powder

Many workers were put at risk at commercial and industrial locations including refineries, power plants, steel mills, auto production facilities and large construction sites. Some of the occupations of workers at risk include electricians, plumbers, boilermakers, carpenters, mechanics, machinists and more. Additionally, if you lived with someone who was regularly exposed to asbestos and washed their clothes, you could be at risk for second hand asbestos exposure.

Although rare, mesothelioma affects veterans from all branches of service: Army, Navy, Air Force, Marines and Coast Guard. As mesothelioma has a long latency period and can remain dormant for several decades, veterans who served our country from 1930 through 1980 are just now being diagnosed with the disease.

Navy veterans who worked in navy shipyards and or served on our nation’s aircraft carriers, battleships, destroyers, submarines and warship from WWII through the Vietnam War were exposed to high concentrations of deadly asbestos and are at a high risk for developing asbestos-related cancer. Boiler rooms, engine rooms, sleeping quarters, and other areas of naval vessels were the most common areas where asbestos was present.

Some prominent shipyards where asbestos was prevalent include Brooklyn Navy Yard, Norfolk Navy Shipyard, Long Beach Naval Shipyard and Hunters Point Naval Shipyard. Financial assistance and help with VA Benefits is available to veterans diagnosed with mesothelioma.

Asbestos manufacturers and distributors made a concerted effort to hide the dangers of asbestos from the public, while at the same time profiting heavily from the sale and manufacture of harmful asbestos products. Those suffering from Mesothelioma can seek compensation from the manufacturers of asbestos and asbestos-containing products by hiring a competent mesothelioma lawyer.

When deciding whether or not you should pursue your legal rights, you should think about the following three things. First, asbestos manufacturers had knowledge of the dangers of asbestos and knowingly put hardworking men and women at risk. Second, treatment for mesothelioma can be very expensive. Third, by exercising your legal rights, you can protect your loved ones in the future.

Ask a question and Jennifer will respond to you promptly.

Once you make the decision to pursue your rights, a competent asbestos attorney will maximize recovery from both viable and bankrupt asbestos defendants. Over 65 asbestos trusts have been established holding billions of dollars combined across them. These asbestos trust funds have been set aside to help compensate those workers who have been diagnosed with mesothelioma cancer or other asbestos-related diseases.

The legal process to compensate mesothelioma victims is not overly burdensome and should be strongly considered to help offset treatment costs and to provide financial security for loved ones.

Each year on September 26, we stop to observe Mesothelioma Awareness Day, a national event building support for the mesothelioma community, patients who are battling the rare cancer, and all of the…

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Every once in a while, you get an email that makes you yell out loud. I received one of those emails a few weeks ago, and I literally screamed when I read it.

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Newark, NJ – October 03, 2018

The Department of Justice is objecting to Duro Dynes appointment for its asbestos trust fund, citing several conflicts of interest.

Washington, DC – August 17, 2018

Despite an ongoing asbestos evaluation, the EPA recently suggested it might approve new uses of asbestos in manufacturing. Learn more at Mesothelioma.com.

Editor in Chief, Mesothelioma Cancer Alliance

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Mesothelioma Cancer Alliance | Information for Patients and …


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