Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.
Bernie Banton was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian federal election.
Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits.[22] (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.[citation needed])
United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.[23] His mesothelioma has been attributed to his younger years spent working on building sites in London.[24][25]
Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation died of mesothelioma in 1994.
Scottish Labour MP John William MacDougall died of mesothelioma on August 13, 2008, after fighting the disease for two years.[26]
Canberra journalist and news presenter, Peter Leonard also succumbed to the condition on 23 September 2008.
Terrence McCann Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006 at his home in Dana Point, California.
David Nicholls an actor from Armley, Leeds, West Yorkshire, England, passed away on June 23, 2008 of the condition mesothelioma.
Wednesday, January 27, 2010
Treatments
Treatment of malignant mesothelioma using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved on average 74.6 percent successful in extending the patient's life span by five years or more [commonly known as remission][this percentage may increase or decrease depending on date of discovery / stage of malignant development] (Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself which has proved only be 16.3 percent likely to extend a patient's life span by five years or more [commonly known as remission]. 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.
Surgery
Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) 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.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[18] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
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 very toxic.
Chemotherapy
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.[19] 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 combination pemetrexed group in patients who 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.
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.[20]
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.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (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.
[edit] Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[21] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs 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.
Surgery
Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) 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.
Radiation
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[18] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
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 very toxic.
Chemotherapy
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.[19] 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 combination pemetrexed group in patients who 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.
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.[20]
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.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (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.
[edit] Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[21] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs 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.
Alternative and Complementary Therapies
There are no proven effective alternative therapies for mesothelioma. Because the prognosis is often poor, many patients may be interested in trying other avenues of treatment. Patients should first consult with their physicians prior to trying any of these methods. There are many well-studied complementary treatments that may increase a patient's comfort and sense of well-being. These may include meditation to aid in relaxation, massage to decrease pain, and guided imagery to help prevent nausea.
Clinical Staging, Treatments, and Prognosis
The treatment and outlook for those with mesothelioma depends a great deal on the stage of their cancer. Because the most frequently occurring type of mesothelioma is pleural, and it is also the one most studied, it is the only type for which a staging system exists. The following stages are based on a system known as the Butchart system, which divides mesothelioma into four stages:
Stage I: Mesothelioma is found within the right or the left pleura and may also involve the lung, the pericardium, or the diaphragm on the same side.
Stage II: In this stage, mesothelioma has spread to the chest wall or involves the esophagus, the heart, or the pleura on both sides. The lymph nodes in the chest may be involved as well.
Stage III: Mesothelioma has gone through the diaphragm and into the lining of the abdominal cavity. Additional lymph nodes besides those in the chest may be involved.
Stage IV: There is evidence that mesothelioma has spread through the bloodstream to distant organs or tissues.
Another system of staging mesothelioma is based on a TNM system (T=tumor, N=spread to lymph nodes, and M=metastasis). There are minor differences between this and the Butchart system. It is more detailed and precise, but the original Butchart system is still the one most often used to describe pleural mesotheliomas.
There are treatments available for all patients with malignant mesothelioma. The three kinds of treatment used are surgery, radiation therapy, and chemotherapy.
Surgery is a common treatment for mesothelioma. It is not an option unless the cancer is limited to one place and unless the person can withstand the surgery. During surgery, the physician may remove a portion of the lining of the chest (pleurectomy) or abdomen (peritonectomy) and some of the tissue surrounding it. Depending on the extent the disease has spread, a lung may also require removal (extrapleural pneumonectomy). Occasionally, a portion of the diaphragm is taken out as well. If treatment is not possible, other less invasive measures can be used to relieve the patient's symptoms. For example, a needle placed into the chest cavity (thoracentesis) can remove excess fluid in the chest. If recurrence of fluid causes symptoms, a nonsurgical or surgical method can be used to scar the lining of lung cavity and cause it to adhere to the lung. The procedure obliterates the pleural space and thus prevents the fluid from reaccumulating. (This procedure is called sclerosis or sclerotherapy.) These methods are called palliative, for they are not meant to cure the cancer but to improve symptoms.
Radiation therapy uses high-energy x rays to kill cancer cells and cause tumor shrinkage. It is rarely used as the primary treatment for pleural mesothelioma in those patients for whom surgery is not an option. It may also be used as an adjunct to surgery or as a method of alleviating various symptoms like trouble with swallowing, pain, and shortness of breath.
Chemotherapy involves the use of drugs to kill cancer cells. The most commonly used drugs are doxorubicin, cisplatin, and methotrexate. The medicines are delivered into a vein or taken by mouth. In the treatment of mesothelioma, they may also be injected directly into the chest or abdominal cavity. Chemotherapy may be given as the main treatment or may be an addition to surgery, depending on the type and stage of the cancer.
A new treatment being studied for early stages of mesothelioma confined to the chest is called intraoperative photodynamic therapy. This treatment uses special drugs that make cancer cells more sensitive to killing by a laser light. The drugs are given several days before surgery. During surgery, the special light is used to shine on the pleura.
By the time symptoms show up and mesothelioma is diagnosed, the disease is often advanced. The average survival period after diagnosis is about one year. If the cancer is found before it has spread and it is treated aggressively, about half of the patients will live two years, and approximately 20% will survive five years.
Stage I: Mesothelioma is found within the right or the left pleura and may also involve the lung, the pericardium, or the diaphragm on the same side.
Stage II: In this stage, mesothelioma has spread to the chest wall or involves the esophagus, the heart, or the pleura on both sides. The lymph nodes in the chest may be involved as well.
Stage III: Mesothelioma has gone through the diaphragm and into the lining of the abdominal cavity. Additional lymph nodes besides those in the chest may be involved.
Stage IV: There is evidence that mesothelioma has spread through the bloodstream to distant organs or tissues.
Another system of staging mesothelioma is based on a TNM system (T=tumor, N=spread to lymph nodes, and M=metastasis). There are minor differences between this and the Butchart system. It is more detailed and precise, but the original Butchart system is still the one most often used to describe pleural mesotheliomas.
There are treatments available for all patients with malignant mesothelioma. The three kinds of treatment used are surgery, radiation therapy, and chemotherapy.
Surgery is a common treatment for mesothelioma. It is not an option unless the cancer is limited to one place and unless the person can withstand the surgery. During surgery, the physician may remove a portion of the lining of the chest (pleurectomy) or abdomen (peritonectomy) and some of the tissue surrounding it. Depending on the extent the disease has spread, a lung may also require removal (extrapleural pneumonectomy). Occasionally, a portion of the diaphragm is taken out as well. If treatment is not possible, other less invasive measures can be used to relieve the patient's symptoms. For example, a needle placed into the chest cavity (thoracentesis) can remove excess fluid in the chest. If recurrence of fluid causes symptoms, a nonsurgical or surgical method can be used to scar the lining of lung cavity and cause it to adhere to the lung. The procedure obliterates the pleural space and thus prevents the fluid from reaccumulating. (This procedure is called sclerosis or sclerotherapy.) These methods are called palliative, for they are not meant to cure the cancer but to improve symptoms.
Radiation therapy uses high-energy x rays to kill cancer cells and cause tumor shrinkage. It is rarely used as the primary treatment for pleural mesothelioma in those patients for whom surgery is not an option. It may also be used as an adjunct to surgery or as a method of alleviating various symptoms like trouble with swallowing, pain, and shortness of breath.
Chemotherapy involves the use of drugs to kill cancer cells. The most commonly used drugs are doxorubicin, cisplatin, and methotrexate. The medicines are delivered into a vein or taken by mouth. In the treatment of mesothelioma, they may also be injected directly into the chest or abdominal cavity. Chemotherapy may be given as the main treatment or may be an addition to surgery, depending on the type and stage of the cancer.
A new treatment being studied for early stages of mesothelioma confined to the chest is called intraoperative photodynamic therapy. This treatment uses special drugs that make cancer cells more sensitive to killing by a laser light. The drugs are given several days before surgery. During surgery, the special light is used to shine on the pleura.
By the time symptoms show up and mesothelioma is diagnosed, the disease is often advanced. The average survival period after diagnosis is about one year. If the cancer is found before it has spread and it is treated aggressively, about half of the patients will live two years, and approximately 20% will survive five years.
Treatment Team
A person with symptoms of mesothelioma will most likely seek help from a primary physician initially. During the diagnostic phase, various technicians will perform the imaging studies. A specially trained physician—a thoracic surgeon or, rarely, a pulmonologist—performs other diagnostic tests like pleural biopsy and thoracoscopy. A pathologist will view the tissue samples and make the tissue diagnosis. Following diagnosis, the patient will be offered some form of treatment, which may entail surgery, radiation therapy, chemotherapy, or a combination of these. The patient may receive care from a thoracic surgeon, an anesthesiologist, medical and radiation oncologists, and specially trained nurses who administer chemotherapy
Diagnosis
A doctor should be seen if a person experiences shortness of breath, chest pain, or pain or swelling in the abdomen. If these symptoms are present, the doctor may order an x ray of the abdomen or chest. The doctor will do a complete physical examination and take a thorough medical history. Then, one or more of the following methods may be used to ascertain whether mesothelioma is present.
Imaging tests. These tests may include x rays, computed tomography (CT scans), or magnetic resonance imaging (MRI) to allow the doctor to visualize the area in question. These studies will help determine the location, size, and extent of the cancer.
Pleural biopsy. Diagnosing mesothelioma requires an adequate biopsy specimen. However, because mesothelioma usually arises from the lower part of the diaphragmatic and/or parietal pleura, obtaining enough tissue may be difficult. A simple, or closed, pleural biopsy involves the insertion of a needle into the chest cavity to obtain tissue from the pleural membrane for analysis. This technique is minimally invasive and normally requires only local anesthesia. This technique, however, may not provide adequate material for the necessary stains of the tissue to make a diagnosis of mesothelioma. Moreover, since the biopsy is not done under direct vision, the sample may not be exactly in the area of the tumor. If the diagnosis cannot be made with this relatively noninvasive technique, an adequate tissue sample usually can be obtained via an open pleural biopsy. In this approach, a surgeon makes an incision on the patient's side and goes into the pleural space. This method allows maximum exploration of the pleural membranes as well. However, the technique requires general anesthesia.
Thoracoscopy. A thoracoscopy, which is a relatively new technique, allows the doctor to look directly into the chest (pleural) cavity at the tumor and during the same operation to also take a tissue sample for laboratory analysis. The thoracoscopy is performed by making a small incision into the chest and using a tiny video camera to inspect the region. The doctor can then use forceps to obtain a tissue biopsy. A laparoscopy, a similar operation, is used to obtain a biopsy of a peritoneal tumor.
Bronchoscopy. A bronchoscopy, which examines the airways, or a mediastinoscopy, which looks at the lymph nodes in the chest, allows the doctor to look at the area using a lighted tube. Samples may be taken with a needle and sent to the lab to find out if cancer cells are present. However, bronchoscopy and mediastinoscopy are not that effective for diagnosing mesothelioma, as the disease is seldom found within the airways or the lymph nodes.
Surgery. This lets the doctor obtain a larger tumor sample or, on occasion, the entire tumor.
Diagnosing mesothelioma is often difficult, even with tissue biopsies. Microscopically, mesothelioma is often difficult to distinguish from several other forms of cancer. For this reason, certain laboratory tests are performed to help correctly diagnose mesothelioma. Some of these tests involve using antibodies to distinguish lung cancer from mesothelioma. Sometimes the tissue samples must be viewed under an electron microscope in order to get the correct diagnosis.
Imaging tests. These tests may include x rays, computed tomography (CT scans), or magnetic resonance imaging (MRI) to allow the doctor to visualize the area in question. These studies will help determine the location, size, and extent of the cancer.
Pleural biopsy. Diagnosing mesothelioma requires an adequate biopsy specimen. However, because mesothelioma usually arises from the lower part of the diaphragmatic and/or parietal pleura, obtaining enough tissue may be difficult. A simple, or closed, pleural biopsy involves the insertion of a needle into the chest cavity to obtain tissue from the pleural membrane for analysis. This technique is minimally invasive and normally requires only local anesthesia. This technique, however, may not provide adequate material for the necessary stains of the tissue to make a diagnosis of mesothelioma. Moreover, since the biopsy is not done under direct vision, the sample may not be exactly in the area of the tumor. If the diagnosis cannot be made with this relatively noninvasive technique, an adequate tissue sample usually can be obtained via an open pleural biopsy. In this approach, a surgeon makes an incision on the patient's side and goes into the pleural space. This method allows maximum exploration of the pleural membranes as well. However, the technique requires general anesthesia.
Thoracoscopy. A thoracoscopy, which is a relatively new technique, allows the doctor to look directly into the chest (pleural) cavity at the tumor and during the same operation to also take a tissue sample for laboratory analysis. The thoracoscopy is performed by making a small incision into the chest and using a tiny video camera to inspect the region. The doctor can then use forceps to obtain a tissue biopsy. A laparoscopy, a similar operation, is used to obtain a biopsy of a peritoneal tumor.
Bronchoscopy. A bronchoscopy, which examines the airways, or a mediastinoscopy, which looks at the lymph nodes in the chest, allows the doctor to look at the area using a lighted tube. Samples may be taken with a needle and sent to the lab to find out if cancer cells are present. However, bronchoscopy and mediastinoscopy are not that effective for diagnosing mesothelioma, as the disease is seldom found within the airways or the lymph nodes.
Surgery. This lets the doctor obtain a larger tumor sample or, on occasion, the entire tumor.
Diagnosing mesothelioma is often difficult, even with tissue biopsies. Microscopically, mesothelioma is often difficult to distinguish from several other forms of cancer. For this reason, certain laboratory tests are performed to help correctly diagnose mesothelioma. Some of these tests involve using antibodies to distinguish lung cancer from mesothelioma. Sometimes the tissue samples must be viewed under an electron microscope in order to get the correct diagnosis.
Causes and Symptoms
The primary risk factor for developing mesothelioma is asbestos exposure. In the past, asbestos was used as a very effective type of insulation. The use of this material, however, has been declining since the link between asbestos and mesothelioma has become known. It is thought that when the fibers of asbestos are inhaled, some of them reach the ends of the small airways and penetrate into the pleural lining. There the fibers may directly harm mesothelial cells and eventually cause mesothelioma. If the fibers are swallowed, they can reach the abdominal cavity, where they can contribute to the formation of peritoneal mesothelioma.
Exposure to certain types of radiation as well as to a chemical related to asbestos known as zeolite has also been related to incidences of mesothelioma.
The early symptoms of mesothelioma are often ignored, because they may be caused by a variety of ailments. These symptoms include:
pain in the lower back or at the side of the chest
shortness of breath
difficulty swallowing
cough
fever
fatigue
abdominal pain, weight loss, and nausea and vomiting (symptoms of peritoneal mesothelioma)
Exposure to certain types of radiation as well as to a chemical related to asbestos known as zeolite has also been related to incidences of mesothelioma.
The early symptoms of mesothelioma are often ignored, because they may be caused by a variety of ailments. These symptoms include:
pain in the lower back or at the side of the chest
shortness of breath
difficulty swallowing
cough
fever
fatigue
abdominal pain, weight loss, and nausea and vomiting (symptoms of peritoneal mesothelioma)
Demographics
Mesothelioma is a fairly rare form of cancer. According to the American Cancer Society, there are an estimated 2,000 to 3,000 new cases per year of the disease in the United States, but this figure seems to be rising. This rising figure is related to the widespread use of asbestos from the 1940s to the end of the 1970s. European researchers studying the disease expect deaths from mesothelioma to peak around the year 2020 and then drop off, because asbestos use has been cut back greatly since the early 1980s.
The average age of a person with mesothelioma is 50 to 70 years old. It affects men three to five times more often than women and is less common in African-Americans than in Caucasian Americans.
The average age of a person with mesothelioma is 50 to 70 years old. It affects men three to five times more often than women and is less common in African-Americans than in Caucasian Americans.
Description
In the chest and abdominal cavities, as well as in the cavity around the heart (pericardial sac), there is a layer of specialized cells called mesothelial cells. These cells also surround the outer surface of most internal organs. These cells form tissue called mesothelium.
The mesothelium performs a protective function for the internal organs by producing a lubricating fluid that permits the organs to move around. For example, this fluid makes it easier for the lungs to move inside the chest while a person breathes. The mesothelium of the abdomen is known as the peritoneum, and the mesothelium of the chest is called the pleura. The pericardium refers to the mesothelium of the pericardial cavity.
There are three primary types of malignant mesotheliomas:
Epithelioid. About 50% to 70% of mesotheliomas are of this type and have the best outlook for survival.
Sarcomatoid. Approximately 7% to 20% of cases are of this type.
Mixed/biphasic. From 20% to 35% of mesothelioma cases fall into this category.
Approximately three-fourths of all mesotheliomas begin in the chest cavity and are known as pleural mesotheliomas. Peritoneal mesotheliomas begin in the abdomen, and make up around 10% to 20% of all cases. Mesotheliomas arising in the cavity around the heart are quite rare.
The mesothelium performs a protective function for the internal organs by producing a lubricating fluid that permits the organs to move around. For example, this fluid makes it easier for the lungs to move inside the chest while a person breathes. The mesothelium of the abdomen is known as the peritoneum, and the mesothelium of the chest is called the pleura. The pericardium refers to the mesothelium of the pericardial cavity.
There are three primary types of malignant mesotheliomas:
Epithelioid. About 50% to 70% of mesotheliomas are of this type and have the best outlook for survival.
Sarcomatoid. Approximately 7% to 20% of cases are of this type.
Mixed/biphasic. From 20% to 35% of mesothelioma cases fall into this category.
Approximately three-fourths of all mesotheliomas begin in the chest cavity and are known as pleural mesotheliomas. Peritoneal mesotheliomas begin in the abdomen, and make up around 10% to 20% of all cases. Mesotheliomas arising in the cavity around the heart are quite rare.
Definition
Mesothelioma is a rare form of cancer. In mesothelioma, malignant cells are found in the sac lining of the chest (the pleura) or the abdomen (the peritoneum). The majority of people with mesothelioma have a history of jobs that exposed them to asbestos, an insulation material.
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