Friday, February 15, 2008
Malignant mesothelioma. Medical oncology: standards, new trends, trials--the French experience.
Mesothelioma: The Basics
The mesothelium is a protective sac that covers and protects most internal organs in the body. It is composed of two layers, one layer covers the organ and the second layer forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the lungs) to move easily. The area between the two layers is often called the pleural space. Mesothelial tissue is found lining the abdominal cavity organs, the lungs and the heart. What is mesothelioma?
Mesothelioma occurs when the mesothelial cells grow out of control. These cells also lose the ability to stop producing the lubricating fluid when there is enough. This results in organs being encased with a thick rind of tumor tissue and excess fluid build up, causing symptoms. These cells can grow and invade other organs, or spread to other areas of the body. When the cells spread to other areas of the body, it is called metastasis.
The majority of mesotheliomas are found in the lining of the lung. About ten percent of cases are found in the abdominal cavity lining, and even more rarely, mesothelioma is found in the lining of the heart.
Am I at risk for mesothelioma?
Mesothelioma is a rare cancer, with only 2,300 cases diagnosed in 2000, in the United States. It is eight times more common in men, which is due in most part to work-related exposure to asbestos. Risk also increases with age. The biggest risk factor for developing the disease is exposure to asbestos, accounting for 70 to 80 percent of all cases. Asbestos has been used in many products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. Particles can be released from these products, particularly during the manufacturing process, and inhaled. Prior to knowing the dangers, asbestos miners and other workers exposed to asbestos worked without wearing any protection. Since the 1970's, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure and requires protective equipment in the workplace. Family members of people who worked with asbestos were also exposed to the toxin when it was carried home on clothing and hair, putting them at increased risk for mesothelioma. It takes 20 to 40 years from the time of asbestos exposure until mesothelioma is detected. This exposure was usually over a period of time, but has been reported to be as little as one or two months of exposure. Smoking does not seem to increase the risk of developing the disease.
The incidence of mesothelioma in Western Europe is much higher, with 5,000 new cases in 2000. This is because maximal exposure to asbestos in Europe occurred around 1970, whereas the maximum exposure in the U.S. was from the 1930s to 60s. It is expected that rates in the U.S. should begin to decline, whereas rates in Europe are expected to plateau in 2018 before declining.
How can I prevent mesothelioma?
By decreasing exposure to asbestos, the risk of mesothelioma is decreased. Workers who are exposed to asbestos on the job should wear protective clothing and masks. These workers should change their clothing before leaving the work site to avoid carrying any particles home. OSHA has set standards regulating these procedures. What screening tests are available?
There is no good screening test for mesothelioma. Radiologic studies (x-ray, CT scan) are not sensitive enough to detect tumors before symptoms occur.
What are the signs of mesothelioma?
The symptoms of mesothelioma are caused by a build-up of tumor tissue surrounding the lung and fluid in the pleural space that prevents the lung from expanding fully. This causes pressure on the lung, leading to pain and shortness of breath. As the disease progresses, patients may lose weight and have a dry, hacking cough. In the abdomen, this fluid and tumor tissue causes abdominal swelling, pain and weight loss.
How is mesothelioma diagnosed and staged?
Patients who present with symptoms worrisome for mesothelioma may have a chest x-ray done, indicating a build-up of fluid in the lining of the lung. These patients would then undergo CT scan to further evaluate the cancer. In the case of abdominal mesothelioma, a CT scan obtained to visualize the anatomy in the abdomen.
Patients would then undergo a biopsy to have the diagnosis confirmed. In the lung, a thoracoscope is used to go through the chest wall, between the ribs to obtain a sample of the tissue. A peritoneoscope is used to enter the abdomen to obtain a tissue sample in abdominal mesothelioma.
Staging refers to determining the extent of the disease and this dictates the treatment. Physicians use the TNM system (also called tumor - node - metastasis system). This describes the size of the tumor (T), if the lymph nodes are involved (N), and if it has spread to other areas of the body (M). This is then interpreted to a stage between one and four. Patients with earlier stage tumors tend to live longer and respond better to available treatments.
What are the treatments for mesothelioma?
Treatment is dependent on the stage of the disease, the location of the tumor, the patient's age and state of health at the time. Younger, healthy patients, with early stage disease may be candidates for surgery that removes the mesothelial tissue around the tumor. This surgery is extensive and it is not well understood how much benefit it provides the patient.
Traditional radiation therapy has not shown a benefit, and can cause damage to the healthy lung tissue in the process of treating the cancer. Research is investigating ways of giving radiation directly to the tumor, using implants or UV light therapy. Chemotherapy has often been used to treat patients with mesothelioma, but until recently trials did not find any one medication to be superior to others. These medications have had responses in 10 to 20 percent of patients, but combining more than one medication has not increased these rates. Recently, a new medication called pemetrexed (Alimta) was given in combination with cisplatin with positive results. Patients received either cisplatin alone or cisplatin in combination with pemetrexed. Patients who received the combination of drugs had increased response rates, survived longer, and had fewer side effects. This regimen is now considered standard of care for mesothelioma not treatable with surgery. Researchers are conducting studies that administer the chemotherapy directly into the pleural space. So far, the results of these studies have been disappointing.
Because the current therapies have limited effectiveness, researchers are studying new ways to treat mesothelioma. Some of the treatments being investigated include interleukin 2 (a biologic therapy), lovastatin (a cholesterol-lowering drug), immunotherapy, gene therapy (a method that attempts to correct the abnormal gene that causes the cancer to grow out of control), and Photodynamic Therapy (PDT-a treatment that uses a laser to activate a photosensitizing drug during the surgical removal of the cancer). Patients should talk with their physicians about current clinical trials for mesothelioma.
One problem that patients may encounter is the recurring build-up of fluid in the pleural space. This fluid can be removed with a chest tube (a tube that is put into the chest wall and left in for a period of time to allow drainage) or a procedure called thoracentesis (a small needle is put through the chest wall, into the pleural space, the fluid is drained, and the needle removed). In the abdomen, the procedure to remove fluid is called paracentesis. In this procedure, a needle is inserted through the abdomen into the fluid filled space, and the fluid is drained.
If this is a chronic problem, patients may have a catheter placed in the chest semi-permanently, allowing them to drain the fluid themselves at home as they need to. Removal of the fluid alleviates the difficulty breathing and chest pain caused by the build-up.
Follow-up testing?
The physician will follow the patient with physical examinations, chest x-rays, and CT scans.
References
DeVita, V., Hellman, S., & Rosenberg, S. Cancer: Principles and Practice of Oncology, Seventh Edition (2004). Lippincott, Williams & Wilkins, Philadelphia, Pennsylvania.
Light, R. Pleural Diseases, Fourth Edition (2001). Lippincott, Williams & Wilkins, Philadelphia, Pennsylvania.
Vogelzang, N et al., Phase III Study of Pemetrexed in Combination With Cisplatin Versus Cisplatin Alone in Patients With Malignant Pleural Mesothelioma, Journal of Clinical Oncology, 21: 2636-2644 (2003)
National Cancer Institute. Mesothelioma: Questions & Answers
The Mesothelioma Applied Research Foundation : This nonprofit organization’s website is a great resource for patients, families & healthcare professionals.
Wednesday, December 19, 2007
Treatment - Surgery
In some cases, surgery may be indicated to alleviate symptoms or slow the progression of mesothelioma. Surgery may be performed in tandem with other treatments such as chemotherapy and radiation, also known as “multi-modal therapy.”
Whether a surgery is recommended in your case will depend on factors unique to your situation, including the type and location of the cancer, the “stage” of the cancer, and your overall health. Of course, whether your doctor recommends surgery in your case will depend on factors individual to your case.
Pleural Mesothelioma Surgeries
Thoracentesis
This procedure involves the draining of fluid that may build up (called a “pleural effusion”) in the chest between the lung and the pleura. A tube is placed in the chest in order to drain out the fluid. Thoracentesis is a “palliative” treatment, meaning that its purpose is to help relieve discomfort.
Pleurodesis
Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. Pleurodesis closes the space between the lung and the lung lining, reducing the chance for fluid to accumulate.
There are two approaches to performing a pleurodesis. In the first, a tube that is inserted into the chest drains the excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as sterile talc powder, is injected through the chest tube and into the pleural space. The schlerosing agent is allowed to distribute itself through the pleural space, with the patient being asked to move about in order to facilitate the distribution. Once the agent is distributed, suction is applied to the tube in the chest. Similar to collapsing a plastic bag, the suction brings the two pleural surfaces together, allowing them to “scar” together.
The second method of pleurodesis uses thoracoscopy, whereby a small incision, or a series of small incisions, are made in the skin. A thoracoscope is passed through the incision in order to get a better look at the pleura. The schlerosing agent is then applied to the area.
Pleurectomy/Decortication
Pleurectomy/decortication involves removing the pleura, where most of the tumor is located. This procedure may help control pleural effusions (fluid build-up) and help to decrease the pain caused by the tumor. It is a palliative treatment, meaning that its goal is to help to lessen the discomfort caused by mesothelioma.
Pneumonectomy
A pneumonectomy is the removal of all or part of the lung. Your surgeon will make an incision in the side of the chest. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.
Extrapleural pneumonectomy
This extensive surgery usually involves the removal of the pleura, pericardium, diaphragm, and the whole lung on the side of the cancerous tumor. Your surgeon may decide to remove some of the surrounding tissues, as well.
Peritoneal Mesothelioma Surgeries
Paracentesis
Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Paracentesis (sometimes called an “ascitic tap”) can help take the pressure off the internal organs, and also helps reduce the risk of infection that may be caused by the fluid buildup. This is a “palliative” procedure, meaning that the goal of paracentesis is to help to relieve the discomfort associated with peritoneal mesothelioma.
Peritonectomy
A “peritonectomy” involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease. Your surgeon might recommend that a peritonectomy be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy where the chemotherapy drugs are administered directly into the abdomen during and/or after surgery.
Cytoreductive (or “debulking”) surgery
During cytoreductive or debulking surgery, the surgeon opens the abdominal cavity (a procedure known as a “laparotomy”) to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be quite long in duration because of the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area. Your surgeon might recommend that this surgery be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy administered into the abdominal cavity.
Pericardial Mesothelioma Surgeries
Pericardiocentesis
This is the process for drawing fluid out of the affected area to help to relieve the discomfort associated with pericardial mesothelioma. For this procedure, a needle is inserted into the pericardium (the sac around the heart) to drain the fluid and relieve circulatory problems. The draining of this fluid can be associated with complications, however.
Extrapleural pneumonectomy
An aggressive surgery also used in appropriate situations to treat pleural mesothelioma, an extrapleural pneumonectomy involves removal of the pleura, diaphragm, pericardium, and the entire lung on the side of the tumor.
Coping With Cancer
The first step in making your life “normal” again is to realize that you will most likely cope with your mesothelioma in the same manner you have handled other aspects of your life. The person you have always been, whether laid back or in control, is the person you will continue to be. You will learn to substitute new roles for lost ones, and will continue to adapt to the changes life will bring your way.
In this section, three areas in which you will use your coping skills will be discussed. These include:
Emotional Coping
When you are facing a serious illness, your emotions can play an important role in how you feel about life, and these emotions can extend to your family and friends as well. You can minimize the impact by understanding that your feelings are normal, and then by moving ahead and becoming proactive in your treatment and care.
Physical Coping
Many people think of coping as only an emotional process, but dealing with treatment regimens and their potential side effects, as well as quality of life concerns must also be addressed. While you can’t control the fact that you have been diagnosed with mesothelioma, you can learn to minimize its effects on your health and wellness.Financial Coping
Serious illnesses like mesothelioma can deplete your life savings quickly. Most cancer treatments such as surgery, chemotherapy and radiation can be costly, and because of the rarity of mesothelioma, you may feel you want to travel to a specialist for a second opinion or for treatments not available in your local area. By being aware of the financial resources available, including compensation from the asbestos industry, you can help ease the stress on yourself and your family and, therefore, maintain control over your life.
Mesothelioma Legal Advice
Mesothelioma was recognized as a legitimate cause of death by the US government in 1989 and consequently commercial use of asbestos was banned. It was done after numerous researches unquestionably proved that mesothelioma is a deadly cancer caused by asbestos exposure. For people who are suffering from mesothelioma, the good news is that now they can get compensated for all their medical expenses and treatment. But, it is not as easy as it sounds. You cannot fight the legal battle on your own for you will require a professional, experienced and a reputable mesothelioma lawyer to help you fight your case and get you fair compensation from the responsible source of asbestos exposure.
In case you decide to not go for a full fledged legal battle your lawyer can also assist you in getting an out of court settlement from the liable asbestos source. To file a case against the offender, you need to have a number of evidences with you which will make your lawsuit strong. This evidence may be your employment record with a company, your medical reports proving mesothelioma as well as witnesses who can testify for you.
Mesothelioma patients or their family members can file a claim against the negligent employers who did not ensure protective workplace safety measures against an asbestos filled environment. The compensation thus obtained can help the patient with the treatment and medical bills and it can help make up for some of the anguish and distress which the patients and their families suffer. Check out the articles in our mesothelioma legal advice for sound lawful advice before you file your mesothelioma compensation case.
Tuesday, December 11, 2007
Is Mesothelioma a sleeping dragon?
Of the six types of asbestos, only four are used commercially. These are chrysotile, crocidolite, amosite and anthrophyllite. Of these, crysotile or white asbestos accounts for 99% used in USA. In it natural state or well contained and maintained in products, asbestos do not pose a real hazard. It is when asbestos is broken down and fibres are released that there is concern.
Asbestos fibres are very thin and sharp. The fibre is 2,000 times thinner than a human hair. It measures under 0.3 microns or one millionth of a millimetre in diameter and five microns in length. It is not visible with the naked eye or through a microscope.
When released, the fibres remain in the atmosphere for a long time and can be carried great distances. When the fibres are inhaled, they stick to the lung tissue and are not expelled by breathing out or coughing. Some remain in the lungs, others gravitate into the pleural lining.
Asbestos exposure can lead to disease and develops over a long period of time. Asbestos related diseases are asbestosis, pleural plaques and lung cancers. The lung cancer can be either cancer of the lung itself or mesothelioma, a cancer of the lung lining. These cancers can take between 20 and 50 years to develop.
A recent article in a UK Newspaper highlighted the case of a Hospital Consultant who developed mesothelioma. He cannot recall any exposure to asbestos. It may well be that he was inadvertently exposed to asbestos without his knowledge i.e. such as living in the vicinity of a factory that leaked asbestos into the atmosphere.
Professor Peto has shown that new cases of mesothelioma will continue to increase in the early part of the twenty first century. He also said, "Every single person in the UK has asbestos in their lungs. It is the level of exposure that is important."
We also know that people who has a history of asbestos exposure has a greater risk of lung cancer if they smoked. In a survey in 1992, 2602 individuals with lung cancer were interviewed. One in eight was exposed to asbestos and of these a third still smoked. A US study suggested that non-smokers exposed to asbestos have a five times greater risk of lung cancer. If they smoked, then the risk increased by a factor of 11. Smoking and asbestos exposure increases the risk of developing lung cancer to 52 times that of the general population.
At present no one knows how many lung cancers are due to asbestos exposure because of the long latency period and that cigarette smoking remains the major cause. Mesothelioma, however, is caused by asbestos exposure and this has been the basis of numerous high value legal claims.
As for the future, in the USA and Europe, asbestos related diseases will gradually increase to a peak. Of concern, however, are areas of conflict. In the Middle East, when a building was bombed, or when numerous buildings were bombed during the invasion of Iraq, do we have any idea how much asbestos was released into the atmosphere?
We are, however, certain that during the 9/11 disaster, asbestos fibres were released. When the Twin Tower collapsed, there were 400 tons of asbestos in the structure. The toxic cloud that hung over Manhattan, contained high level of asbestos. It is estimated that over 100,000 people suffered asbestos exposure. The greatest exposure was amongst first responders. Deborah Reeve was the first to die from asbestos related disease after 9/11. She was a first responder and paramedic. She died in March 2005 from mesothelioma. This concerned experts because mesothelioma takes a very long time to develop. They concluded that her exposure must have been excessive.
A study result showed that 70% of recovery and rescue workers who were active during and after the World Trade Centre collapse had some form of respiratory problem. A six year follow up study showed that sufferers with respiratory problems continue to have the same ailments.
"In the six years since the attacks," Nadler said, "We have accumulated a mountain of evidence that thousands of those exposed are suffering from chronic respiratory disease and, increasingly, a variety of rare cancers."
Hopefully, as experts predict, within the next few years asbestos related diseases will peak and the annual new cases will drop. If not, could it be a sleeping dragon about to wake up?
Article Source: ArticlesMaker.com
About the Author: Dr. Phil Hariram is a retired General Practitioner. He has treated various medical conditions. His website on asbestos and mesothelioma is intended to help anyone who is looking for comprehensive information on the asbestos related diseases. Visit his website: http://www.themesothelioma-info.com and learn about this very serious condition.
Symptoms of Mesothelioma
Mesothelioma has a poor prognosis, especially since by the time the doctor has determined a patient has mesothelioma, the cancer has progressed greatly. The symptoms of mesothelioma are common with other types of health conditions. Unless the doctor is aware that someone was exposed to asbestos, he or she will not necessarily be looking for mesothelioma. Being exposed to asbestos is the only known manner of contracting this cancer.
Symptoms of mesothelioma will vary based on the type of mesothelioma, the progression of the cancer, the location of the tumor, the health status of the patient, and so on. A person can experience symptoms such as back aches and muscles aches. Their breathing can be interrupted or the patient can experience shortness of breath in general. Other symptoms could be a bad cough that persists for a prolonged period, chest pain, weight loss, or general fatigue. Again, unless the doctor is aware there has been exposure to asbestos, these symptoms can be a result of numerous health conditions, which may not lead to a clear diagnosis.