Mesothelioma Information

 

The hard truth about this cancer and it's causes

Mesothelium

The mesothelium is a membrane that protects many internal organs in the body.  It creates a sac that totally encompasses the organ. The membrane is formed from two layers of cells with a fluid between the two. The mesothelium helps to prevent damage to the protected organs (such as the heart and the lungs) caused by friction from the organ’s natural rhythm adjacent to each other.  Visceral mesothelium covers the internal organs and Parietal mesothelium covers the body walls.  Mesothelium is classified as different names depending on the location in the body:

• Peritoneum:  Abdominal Cavity organs
• Pleura:  Lungs and Chest Cavity Wall lining
• Pericardium: Heart
• Tunica Vaginalis Testis:  Male Internal Reproductive organs
• Tunica Serosa Uteri:  Female Internal Reproductive organs

Malignant Mesothelioma

Malignant Mesothelioma (meh-zuh-thee-lee-OH-muh) is a cancerous disease that affects the mesothelium.  Malignant Mesothelioma is where malignant (cancerous) cells develop on the mesothelium.  Most cases of malignant mesothelioma begin in the pleura (lungs and chest cavity wall lining) or peritoneum (abdominal cavity organs).  Cancerous cells can spread from their original site to other tissues and organs.  Refer to Malignant Pleural Mesothelioma: A Comprehensive Review published by Cancer Control, 2006; H. Lee Moffitt Cancer Center and Research Institute, Inc.;  and Mesothelioma published by Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices for additional information regarding this devastating disease.

Healthy Lung vs. Mesothelioma Lung

There are two classifications of malignant mesothelioma:

• Localized (Stage I):  Cancer is present only on the original membrane surface. 
• Stage I:  Usually located on the chest wall.  It may also be found in the lining of the lung, the diaphragm, or the sac that covers the heart on the same side of the chest.  
• Advanced (Stage II, Stage III, and Stage IV):  Cancer has spread beyond the original membrane surface to other parts of the body.
• Stage II:  Cancer is also present in the lymph nodes on the same side of the chest.
• Stage III: Cancer has spread to the chest wall, the mediastinum, the heart, beyond the diaphragm, and/or the peritoneum.  Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.
• Stage IV:  Cancer has spread to distant organs or tissues.

About 2,000 new cases of mesothelioma are diagnosed in the United States each year.  Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.  The American College of Chest Physician’s published an article Age and Sex Differences in Malignant Mesothelioma After Residential Exposure to Blue Asbestos for additional information.

Major Cause

Asbestos Exposure:  One of the major risk factors for developing mesothelioma is working with and around asbestos.  Most mesothelioma cases are linked to a history of asbestos exposure.

Many employees are not aware of the exposure risks they are facing on a day to day basis when working with asbestos containing materials.  Some of the more common industrial products include cement, brake linings, roof shingles, flooring products, textiles, and insulation.  Asbestos dust particles can be released into the air, and unknowingly inhaled or swallowed.  An increased risk of developing Mesothelioma has been found among shipyard workers, mines and mills, manufacturing plants, and the construction industry.  To help prevent exposure to asbestos containing materials, the U.S. Occupational Safety and Health Administration (OSHA) set limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos must use protective equipment to lower their risk of exposure.
Although longer exposures to asbestos have been found to have the most increased risk for mesothelioma, short exposures have also been known to cause mesothelioma.  Family members of living with asbestos workers also have an increased risk of developing mesothelioma, as the result of exposure to dust on the clothing and hair of asbestos workers.

Symptoms

Symptoms of mesothelioma may occur within a short time after exposure to asbestos or as long as 50 years after exposure.  If you have any of the symptoms below and have an increased risk of mesothelioma from current or past exposure to asbestos, contact a qualified physician immediately for a professional diagnosis. 

Pleural Mesothelioma

• Shortness of Breath
• Chest Pain

PeritoneumMesothelioma

• Weight Loss
• Abdominal Pain
• Abdominal Swelling
• Bowel Obstruction
• Abnormal Blood Clotting
• Anemia
• Fever

Symptoms of the cancer having spread beyond the mesothelium to other parts of the body:

• Pain and/or Trouble Swallowing
• Neck and Face Swelling

Diagnosis

It is often difficult to diagnose mesothelioma due to the common symptoms shared with other conditions.  However, a qualified physician will take the necessary steps in determining the patient’s condition.

Diagnosis may vary from physician to physician, but below is typical for a proper diagnosis:

• Complete Review of Patient’s Medical History:  To determine the patient’s past illnesses and treatments and any known history of asbestos exposure. 
• Complete Physical Examination:  To determine the patient’s general health and any signs of disease or other illness. 

• Complete blood count (CBC): To determine the number of red blood cells, white blood cells, and platelets; and the amount of hemoglobin in the red blood cells.
• Chest x-ray: To determine if abnormalities are present within the chest cavity. See
• CT scan (CAT scan): To determine if abnormalities are present within the chest and abdomen.
• MRI (magnetic resonance imaging): To determine if abnormalities are present within the chest and abdomen.
• Sedimentation Rate:  To determine the rate at which red blood cells settle at the bottom of a test tube.

• Biopsies/Surgical Procedures:  Biopsies and other surgical procedures should be ordered to confirm a diagnosis of mesothelioma.  They are also ordered to determine if the cancer has spread to other parts of the body.  This is important in determining the stage of cancer for necessary treatment.  Common types are listed below.  Your physician will determine which to order based on the location of the abnormal area. 
• Fine-Needle Aspiration Biopsy: Also called a needle biopsy may be done to remove part of a lump, abnormal tissue, or fluid.
• Lung biopsy:  A lung biopsy is done by inserting a needle through the chest wall and into the abnormal lung tissue to remove a piece of tissue to check for signs of cancer.
• Thoracoscopy: An incision between two ribs for insertion of a thoracoscope into the chest.
• Thoracotomy: An incision between two ribs to check inside the chest for signs of disease.
• Peritoneoscopy: An incision in the abdominal wall for insertion of a peritoneoscope into the abdomen.
• Laparotomy: An incision in the wall of the abdomen to check the inside of the abdomen for signs of disease.
• Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs.
• Cytologic Exam: Fluid is taken from around the lungs or abdomen to check the cells in the fluid.

Treatment

There are many different treatment options that you and your physician may decide is right for you.  They should be determined on an individual basis, based on the location and stage of the cancer; and the patient’s age and general health.  The following are treatments that may be considered.
Treatment of Localized Malignant Mesothelioma (Chest - Stage I) may include the following:
Mesothelioma in One Area Only:  Surgery to remove the cancerous part of the mesothelium and surrounding area.
Mesothelioma in More Than One Area:

• Pleurectomy and Decortication (Refer to the American College of Chest Physician’s publication Surgical Treatment of Mesothelioma: Pleurectomy for additional information on this procedure.)
• Extrapleural Pneumonectomy (Refer to the American College of Chest Physician’s publication Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma)
• Radiation Therapy
• Anti-Cancer Drugs – Clinical Trial (directly in the chest after surgery to remove the tumor)
• Combinations of Surgery, Radiation Therapy, and Chemotherapy – Clinical Trial

Treatment of Advanced Malignant Mesothelioma (Stage II, Stage III, and Stage IV) may include the following:

• Surgery (to drain fluid that has collected in the chest)
• Pleurodesis (to stop additional fluid from collecting in the chest)
• Pleurectomy and Decortication
• Radiation Therapy
• Chemotherapy (with Anticancer Drug)
• Combination Chemotherapy - Clinical Trial
• Combinations of Surgery, Radiation and Chemotherapy - Clinical Trial
• Chemotherapy – Clinical Trial (directly in the chest or abdominal cavity to reduce tumors and prevent fluid build-up.)

Additional clinical trials may be available from NCI's PDQ Cancer Clinical Trials Registry for patients with advanced malignant mesothelioma.
Treatment of Recurrent Malignant Mesothelioma:  may include the following:

• Biologic Therapy – Clinical Trial
• Chemotherapy – Clinical Trial
• Surgery – Clinical Trial

New Diagnostic Tool May Aid in Mesothelioma Detection

New tool in the radiography approach will assist in earlier detection of asbestos-related diseases.click here

New Treatment (from the National Cancer Institute):  The National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.  People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI’s cancer information database, to identify and provide detailed information about specific ongoing clinical trials.   
Some clinical trials, medical publications, and their findings are summarized below.  
The Journal of Clinical Oncology by the American Society of Clinical Oncology published A Phase II Trial of Pleurectomy/Decortication followed by Intrapleural and Systemic Chemotherapy
for Malignant Pleural Mesothelioma.  This study investigated the feasibility of a novel approach to the treatment of malignant pleural mesothelioma by combining surgical resection with immediate postoperative intrapleural hemotherapy and subsequent systemic chemotherapy.

The Journal of Thoracic and Cardiovascular Surgery published General Thoracic Surgery: Prevention, Early Detection, And Management Of Complications After 328 Consecutive Extrapleural Pneumonectomies.  Extrapleural pneumonectomy for therapy of mesothelioma has been associated with
significant perioperative mortality and morbidity. Postoperative complications of this procedure require a
unique management approach. We developed treatment algorithms for most of the common
complications of extrapleural pneumonectomy resulting in reduced mortality and hospital stay.
Complications after extrapleural pneumonectomy were further analyzed to elucidate means of prevention, early detection, and treatment.

The Nature Clinical Practice Oncology published Advances In the Systemic Therapy of Malignant Pleural Mesothelioma.  Summarizes the evidence supporting the clinical activity of chemotherapy, discusses the use of end points for its assessment and examines the influence of clinical and biochemical prognostic factors on the natural history of malignant pleural mesothelioma. Early-phase clinical trials of second-line and novel agents are emerging from an increased understanding of mesothelioma cell biology. Coupled with high-quality translational research, such developments have real potential to improve the outlook of patients at a time of increasing incidence.

Presented at STS: Radical Decortication/Pleurectomy Best Surgical Approach for N2 Malignant Mesothelioma by Ed Susman FORT LAUDERDALE, FL - February 1, 2008.  Patients who underwent the more extensive treatment of radical decortication/pleurectomy in attempt to cure stage 3 pure epithelial mesothelioma appear to have significantly better outcomes than patients who had less extensive operations, according to a study presented at the Society of Thoracic Surgeons 44th Annual
Meeting (STS).

Annals of Surgical Oncology published Extrpleural Pneumonectomy Is The Preferred Surgical Management in the Multimodality Therapy of Pleural Mesothelioma:  Con Argument, by Robert B Cameron, MD. 

Malignant peritoneal mesothelioma: Treatment with Maximal Cytoreductive Surgery Plus Intraperitoneal Chemotherapy was published to report survival results in patients with diffuse malignant peritoneal mesothelioma (MPM) treated with maximal cytoreductive surgery followed by immediate intraperitoneal chemotherapy, and to compare them with the median survival of 12-24 months obtained with the standard treatment based on systemic chemotherapy.

Science Direct published an article Induction Chemotherapy, Extrapleural Pneumonectomy (EPP) and Adjuvant Hemi-Thoracic Radiation in Malignant Pleural Mesothelioma (MPM):  Feasibility and Results.  Trimodality therapy seems to be the best treatment for malignant pleural mesothelioma
(MPM). A large experience served to evaluate the efficacy of surgery followed by adjuvant
chemo-radiotherapy.  Trimodality therapy results have led us to test induction chemotherapy followed
by EPP and adjuvant radiotherapy in stages I—III of MPM. The aim of this study was to evaluate the feasibility of this protocol and to estimate survival

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