Kinds of Mesothelioma

Mesothelioma is a rare kind of cancer that attacks the body after exposure to asbestos. Once used commonly in the manufacturing of materials for homes, ships, and other structures, today, asbestos is highly regulated by the EPA. However, the cases of mesothelioma continue to rise. Mesothelioma also takes a long time to develop (typically 15-40 years), so patients today could have been exposed prior to the 1980s when asbestos was not highly regulated.
There are three kinds of mesothelioma, each attacking a different organ. The most common is called pleural mesothelioma. Pleural mesothelioma is cancer of the pleura, which is the lining of the lungs. Other kinds of mesothelioma affect the linings of the heart and abdomen. With all three types of mesothelioma, if the cancer goes untreated, it can easily spread to the surrounding organs or to other parts of the body via the blood stream. Please see “Pericardial Mesothelioma” and “Peritoneal Mesothelioma” for information about these cancers…..
About ¾ of all mesothelioma cases are pleural mesothelioma. The average survival rate once diagnosed, according to one study, is less than a year.
When around airborne asbestos, it is easy to breath in small asbestos fibers. You may notice that your throat feels scratchy, but in most cases, you won’t notice any immediate reactions from breathing in asbestos fibers. Fibers fill the air whenever asbestos-contaminated products are disturbed (the same applies to naturally occurring asbestos). Asbestos fibers are microscopic, jagged particles. When you breathe them in, they travel into the lungs and can get stuck in the soft tissue lining – the pleural.
The lung actually has two parts to the pleura. The visceral pleura is the outside of the lungs themselves. This part of the lung is very soft, delicate tissue that protects the lung from abnormal particles. The parietal pleura is, essentially, a sack around the lung, lining the chest wall and diaphragm. This creates a pleural space. The lungs use this space to expand when you breathe.
When the jagged asbestos fibers enter the lung, they can get stuck in the pleura. The body tries to fix this problem, but the result is scar tissue that builds up in the pleural space, making it difficult to breathe since the lungs cannot expand properly. This environment with foreign objects and scar tissue creates the perfect environment for abnormal cell growth. The cells mutate, causing cancer, and these cancerous cells begin to grow quickly into tumors, further preventing you from breathing correctly.
Pleural mesothelioma builds up very slowly , as the scar tissue in the lungs is, at first, unnoticeable. Symptoms of pleural mesothelioma include shortness of breath, coughing, difficulty swallowing, fever, weight loss, and chest pain. That said, because these symptoms progress so slowly, more than 30 years or more in some cases, a patient might not notice them at all. In other words, the symptoms feel normal. Many patients do not catch mesothelioma until a late stage of development.
If diagnosed with pleural mesothelioma, there are a number of treatment options to try. If the cancer is contained in the pleura, one of the best options might be the removal of the cancerous area. Surgery isn’t the best option for everyone, however. You can also try radiation, chemotherapy, intraoperative photodynamic therapy, immunotherapy, and gene therapy. Only you and your doctor can decide on the best course of action for your body. For information about treatment, please see “Mesothelioma Treatment Options.”
You are at risk for developing pleural mesothelioma if you worked in an industry using this substance prior to 1980. Some of the main products manufactured with mesothelioma include the following: insulation, roofing, gaskets, piping, floor tiles, plaster, joint compound, shipbuilding products, and textiles. You’re also at risk if a family member worked in these industries, as asbestos readily sticks to clothing and hair (meaning it can be transferred home easily). In addition, you could be at risk if you live in a home built prior to 1980. You should have your home tested for asbestos to make sure that it is safe. Smokers are especially at risk, as smoking cigarettes weakens the lungs and complicates the chance of developing mesothelioma.
Another risk factor is level of exposure. If you’ve experienced exposure to asbestos for many years, you are more likely to develop mesothelioma and other asbestos-related health problems. The best way to protect yourself is to remove the asbestos from your environment. Exposure to asbestos does not automatically mean that you’ll contract mesothelioma, but the longer your exposure, the more likely you are to develop this condition.
Unfortunately, for many people, asbestos exposure occurred unknowingly at the workplace. Larger corporations conspired to keep the dangers of asbestos a secret and, as a result, many people were put at risk without consent. If you’ve developed pleural mesothelioma after exposure to asbestos that was not your fault, contact a lawyer today to learn about your rights. Please see “Legal Issues and Mesothelioma” for more information.

Mesothelioma Lung Cancer

Mesothelioma is a form of lung cancer that develops in the lining around the lungs, called the pleura, and can also develop in the lining of the abdomen and heart. Mesothelioma lung cancer is almost always caused by exposure to asbestos. Because mesothelioma can take up to 30 years to develop, many people who are infec ted by the disease do not discover the illness until it is too late for treatment.
Most people with mesothelioma lung cancer and other asbestos diseases are exposed to the chemical through their jobs. The Environmental Protection Agency (EPA) asserts that there is no known level of safe exposure to asbestos, and the following groups are thought have the highest exposure and the greatest risk of developing mesothelioma:

• Workers at a shipyard
• Janitors
• Plumbers
• Electricians
• Firefighters
• Telephone repair workers
• Mechanics
• Maintenance personnel
• Insulation installers
• Workers at an asbestos mine and mill
• Producers of asbestos products
• Workers in the heating and construction industries
• Trades people
• Friends and family of the above-lis ted workers and
• People who live or work near a facility that uses asbestos.

Symptoms of mesothelioma lung cancer include shortness of breath, trouble swallowing, swelling of the neck or face, and pain in the chest due to an accumulation of fluid in the pleura.
Treatment for mesothelioma lung cancer depends on the stage of the disease and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined:

Surgery

A doctor may surgically remove part of the lining of the chest or abdomen and some of the tissue surrounding it. A lung may also be removed in an operation called a pneumonectomy, and sometimes the muscle below the lungs that helps with breathing is removed.

Radiation therapy

Also called radiotherapy, radiation therapy involves the use of high-energy rays to kill cancer cells and shrink tumors. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV).

If you or a loved one has developed mesothelioma lung cancer, you are not alone. Experienced mesothelioma attorneys in your area are ready and available to assist you with your mesothelioma lawsuit claim. Contact a LawInfo Lead Counsel qualified mesothelioma attorney today for more information.

Introduction

Mesothelioma International is dedicated to the fight against mesothelioma – a worldwide health crisis with roots in humanity's use of asbestos. Although the use of asbestos has now been banned in the European Union, it is estimated that 250,000 workers in Western Europe alone will have died from mesothelioma by 2029. It is our hope that this website will be helpful to those throughout Europe who have been affected by this epidemic.
Mesothelioma is a rare and virulent form of cancer that affects the lining of the lung, lining of the abdominal cavity or lining around the heart. Mesothelioma is caused by exposure to asbestos, and occurs in those who have breathed in asbestos fiber, in many cases 20 to 50 or more years ago. Some were exposed on their jobs; others were exposed secondarily through family members who without their knowledge, brought fiber home on their work clothes or on their hair or skin.
Despite the serious nature of the disease, there is hope. Every year, doctors and scientists worldwide are developing new treatments and making new discoveries that help to improve the chance of survival and the patient’s quality of life. This website, Mesothelioma International, helps patients and their family members connect with the resources they need to be informed and make the best decisions on their potential treatment and care.
The first section of our website answers common questions about mesothelioma and its cause and discusses those at risk. In the next section, the most common symptoms are discussed, as well as the various testing procedures which may be used to come to a diagnosis. The treatment section discusses types of aggressive treatment such as surgery, chemotherapy, radiation and clinical trials being conducted by cancer facilities throughout the world, as well as the palliative care option for those who either can not or choose not to be treated. Every year, progress is being made.
It is Mesothelioma International’s goal to consolidate the most up to date, concise mesothelioma information available today, and our resource co-ordinators are always available to help you and your family find the answers for your particular questions.

Mesothelioma and Its Relationship to Asbestos Exposure

What is mesothelioma?

Malignant mesothelioma is a rare form of cancer that begins in the mesothelium, the membrane that covers and protects most of the body’s internal organs. The mesothelium is made up of two layers, one which surrounds the organ itself, and the other which forms a sac lining around it. A small amount of fluid is normally produced between these two layers, lubricating the movement of the protected organs. When the normal cells of the mesothelium become out of control and spread rapidly, mesothelioma occurs. The most common form of mesothelioma is “pleural” mesothelioma. This occurs in the lining of the lung. Other forms are “peritoneal” mesothelioma, affecting the lining of the abdominal cavity, and “pericardial” mesothelioma, affecting the lining of the heart.

What causes mesothelioma?

Mesothelioma is almost always caused by exposure to asbestos fiber. Many people were exposed in the military; others through their occupation; and still others, secondarily, through contact with exposed workers. Because of the latency of the cancer, it may not appear for 20 to 50 or more years after exposure.

Who is at risk for developing mesothelioma?

Those who have worked directly with asbestos or asbestos products carry the greatest risk of developing mesothelioma, however, mesothelioma has been reported in some individuals with minimal exposure.
Trades at high risk for developing mesothelioma include:

• Metal plate workers (including shipbuilding)
• Vehicle body builders (including rail vehicles)
• Plumbers
• Gas fitters
• Carpenters
• Electricians
• Construction workers
• Plasterers
• Builders
• Handymen
• Steel erectors
• Painters
• Sheet metal workers
• Welders

What types of products typically contained asbestos?

The following products commonly contained varying degrees of asbestos. This list is not all inclusive, and is meant only as general information.

• Molded or preformed lagging used in thermal insulation of pipes and boilers
• Sprayed asbestos used as fire protection in ducts, firebreaks, panels, partitions, soffit boards, ceiling panels and around structural steel work
• Insulating boards used for fire protection, thermal insulation, partitioning and ducts
• Asbestos packing used in firebreaks in ceiling voids
• Millboard, paper and paper products used for insulation of electrical equipment; asbestos paper may also be used as a fireproof facing on wood fiberboard
• Asbestos cement products in both flat and corrugated sheets used as roofing or wall cladding; cement products were also used in gutters, rainwater pipes and water tanks
• Textured coatings (such as Artex)
• Bitumen roofing material
• Vinyl or thermoplastic floor tile

Mesothelioma Symptoms and Diagnosis

Symptoms

Early symptoms of mesothelioma are non-specific in nature, and may lead to a delay in diagnosis. In general, shortness of breath, chest pain and persistent cough are common symptoms of pleural mesothelioma, but in some cases, may not be severe enough to force the patient to seek medical help. Some patients complain of pain in the shoulder blade or lower back. These symptoms most often occur 2-3 months prior to a confirmed diagnosis. In peritoneal mesothelioma, abdominal pain and swelling, nausea or vomiting, bowel obstruction and weight loss are the most common symptoms. Importantly, these symptoms are not unique to mesothelioma, and may be symptoms of other conditions as well. Evaluation by a qualified physician is always suggested.
As mesothelioma progresses, pleural effusion (fluid build up between the two pleural layers) occurs in 95% of patients, and it is this symptom which ultimately leads to patients visiting their GP. During this visit, a chest x-ray is taken which may confirm the effusion. A thickening of the pleura may also be noted at this time. If the GP suspects cancer is a possibility, referral may be made to a hospital consultant who specializes in lung cancer and mesothelioma.
When your GP recommends a referral, you should be given the following information:

• Where you are being referred.
• When the appointment will be scheduled.
• Who you will see.
• What testing you can expect.
• When the results of the testing will be available.

The National Institute for Health and Clinical Excellence has developed the following general referral guidelines for suspected cancer, effective June, 2005. These guidelines may not apply to every individual, and you should always discuss the details of your specific case with your health care team, so you can play a proactive role in your treatment and care.
An assessment of urgency will be made by your GP, and will be based on the following criteria:

• Immediate referral: The patient needs to be seen within a few hours.
• Urgent referral: The patient will be seen within two weeks.
• Non-urgent: All other referrals.

Once urgency is determined, your GP will send all information pertaining to your case to your specialist for evaluation.

Diagnosis

A diagnosis of mesothelioma is most often obtained with a careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. Following are some of the tests your specialist may recommend and their value in diagnosing and assessing mesothelioma.

• Computed Tomography (CT)

CT scans are able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease, or differentiate between adenocarcinoma of the lung versus mesothelioma. CT scans may also be of value in guiding fine needle aspiration of pleural masses for tissue diagnosis. This scan usually takes 10-30 minutes, but may vary according to the patient.

• Magnetic Resonance Imaging (MRI)

MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes which lie between the two lungs, as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy. An MRI scan usually takes 20-40 minutes, but may vary according to the patient.

• Positron Emission Tomography (PET)

PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. PETs are considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma. Because PET scans are relatively new and may not be available in all locations, it may be necessary to travel to a specialized center to have one.

• Fluid Analysis

Testing of the pleural fluid for malignant cells is considered to have limited value in diagnosing mesothelioma. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists. Unfortunately, negative or inconclusive readings account for nearly 85% of all fluid tested. Even in the event of a positive fluid report, doctors may opt to perform a confirming tissue biopsy as long as it is not detrimental to the patient’s health.

• Tissue Analysis (Biopsy)

In most cases, it is ultimately a needle biopsy of the pleura, or an open surgical biopsy, that yields a confirmed diagnosis of mesothelioma. In a pleural biopsy procedure, the surgeon will make a small incision through the chest wall and insert a thin, lighted tube called a thorascope into the chest between two ribs. He will then remove a sample of tissue to be reviewed under a microscope by a pathologist. In a peritoneal biopsy, the surgeon makes a small incision in the abdomen and inserts a peritoneoscope into the abdominal cavity.

Stages of Mesothelioma

Knowing the stage of your mesothelioma will be a factor in helping your doctor formulate a treatment plan. The most definitive and most widely used system is the TNM International Staging System for Diffuse Malignant Pleural Mesothelioma, also called the International Mesothelioma Interest Group System. This system takes into consideration Primary Tumor (T), Lymph Nodes (N) and Metastases (M). There is no established staging system for peritoneal mesothelioma. Peritoneal patients may be staged according to the general TNM system for cancer, or on the bulk of the tumor present (i.e., minimally bulky, moderately bulky, etc.). Because the TNM system is very in depth, and difficult for interpretation by lay persons, following is a simplified version. Stage I is the earliest stage; Stage IV the most advanced.

Stage I

Mesothelioma involves the right or left pleura and may also have spread to the lung, pericardium or diaphragm on the same side. Lymph nodes are not involved.

Stage II

Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium or diaphragm on the same side.

Stage III

Mesothelioma has invaded the chest wall, muscle, ribs, heart, esophagus or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.

Stage IV

Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side or directly extends into organs in the abdominal cavity or neck. Any distant metastases in included in this stage.

Mesothelioma Treatment

Which treatment option will be best for you as an individual, depends on many factors including your age, overall health status, stage of the cancer, cell type (which determines the aggressiveness of the cancer) and most importantly, your personal wishes. To assist you in evaluating these options, you will have a “multidisciplinary team” (MDT) of doctors, who will discuss your case and provide you with their suggested treatment strategy. These team members may include a cardiothoracic surgeon, a medical oncologist, a radiation oncologist, a pain management specialist, and a palliative care specialist. Nurses and other health care workers may also be involved in your care.
Conventional treatment for mesothelioma offers several options, and you should discuss each option thoroughly with your MDT before making a treatment decision. Be sure you are informed as to the risk factors, prognosis with treatment, potential side effects and quality of life each option affords.

Surgery

There are two surgical approaches to mesothelioma, pleurectomy/ decortication (P/D) and extrapleural pneumonectomy (EPP). These are extremely specialized surgeries, and may not be offered at all facilities. Not all thoracic surgeons have expertise in these types of surgeries. The ultimate goal of these procedures is the removal of all gross disease, with the knowledge that residual microscopic disease will most likely remain. Adjuvant therapy, in which additional forms of treatment are used along with the primary therapy, is typically aimed at the elimination of this residual disease. The most common forms of adjuvant therapy are chemotherapy and/or radiotherapy.
Pleurectomy/decortication is considered the less radical of the two approaches since it involves only the removal of the pleura (lining of the lung) without resecting the underlying lung. In some cases, the pericardium and diaphragm may be removed, dependent on the extent of the tumor. Advantages of this procedure are a generally quicker recovery time, and usefulness for patients who may not be able to tolerate the more radical EPP. Disadvantages include an increased risk for recurrence of the disease because of inability to remove all cancerous tumor, and inability to use high dose adjuvant radiation because of potential damage to the underlying lung.
Extrapleural pneumonectomy is a more radical procedure involving the removal of the lung, the pleura (lining of the lung), the pericardium surrounding the heart and part of the diaphragm. During surgery the pericardium and the diaphragm are reconstructed with a Gortex like material. Patients may be eligible for this surgery only if they meet certain staging criteria and demonstrate adequate pulmonary and cardiac function to be able to tolerate the procedure.

Chemotherapy

Chemotherapy involves the use of anti-cancer drugs which work by preventing cancer cells from multiplying. In most cases, combinations of drugs are used in order to increase effectiveness. Chemotherapy may be used aggressively to shrink the tumor, or palliatively to relieve symptoms such as shortness of breath or pain. Administration of chemotherapy may be via injection into a vein or muscle, as an oral medication or may sometimes be administered directly into the pleural or peritoneal cavity. Some of the most commonly used drugs include:

• Pemetrexed (Alimta)
• Cisplatin (Platinol)
• Carboplatin (Paraplatin)
• Gemcitabine (Gemzar)
• Doxorubicin (Adriamycin)
• Mitomycin
• Raltitrexed (Tomudex)
• Vinorelbine (Navelbine)

New drugs are constantly being investigated by pharmaceutical companies, so you should always feel free to ask your doctor about the newest and most promising drugs. One such drug, Alimta (pemetrexed) was approved in Europe in September, 2005.

Radiotherapy

Radiotherapy involves the use of high energy x-rays to kill cancer cells and shrink tumors. It may be used aggressively in conjunction with surgery to help eliminate microscopic seeding which can cause recurrence of disease, or palliatively to treat pain caused by tumors pressing on nerve endings or on another organ. Radiotherapy has also proven effective in preventing tumor seeding at the sites of biopsy or chest tube drainage.

Clinical Trials

The purpose of clinical trials is to involve patients in finding new and better treatments for their illnesses. Different clinical trials have different goals which may include the testing of new drugs, comparing various ways to treat an illness or the testing of various techniques for cancer prevention. Clinical trials are divided into three phases. Following are short summaries of what each trial phase seeks to accomplish.
Phase I trials are the earliest phase of the clinical trial system. At this point, drugs have only been tested in the laboratory, but have had an effect on destroying cancer cells. These trials enroll only a limited number of participants, and are only available at limited cancer facilities. The goal of Phase I trials is to find the maximum tolerated dosage of the drug without causing serious side effects, which side effects are most common and whether the drug continues to have anti-cancer activity when administered to humans. If the drug is proven to have an effect on cancer at a safe dosage, the drug will then be tested in Phase II trials.
Phase II trials continue to test the safety of drugs or procedures, but also begin to look more closely at their effectiveness for particular types of cancer. These trials accrue somewhat larger numbers of participants, and may be located at more facilities. These trials may be “randomized”, meaning that different groups of participants are chosen by a computer, rather than by a doctor.
Phase III trials compare promising new drugs or procedures with the current standard of treatment. Large numbers of participants from widespread areas are accrued for these trials, and receive either the new treatment or the standard treatment. One of the primary goals of Phase III trials is to determine whether cancer is reduced or slowed by the drugs, how long patients remain stable without progression of disease and how treatment with the drug affects the patient’s quality of life.