Mesothelioma means cancer of the mesothelium (-oma is a medical term for tumor or cancer). The mesothelium is the sac that lines and protects vital organs such as the heart, the lungs, and the abdominal cavity (stomach). This disease causes the cells of the lining to become abnormal and malignant. About two thirds of all mesothelioma cases develop in the pleural mesothelium or lung lining. The remaining cases, about one third, develop in the abdomen. Rarely, mesothelioma occurs in other mesothelial tissue, such as around the heart or in the reproductive organs.
Without treatment, most patients will die from mesothelioma within 4 to 12 months from the time of diagnosis. Patients generally die as a result of respiratory failure or pneumonia. Small bowel obstruction, resulting from direct extension of tumor through the diaphragm, develops in about one-third of patients. About 10% die of cardiac complications when the tumor invades the pericardium and heart. Three subtypes of mesothelioma have been identified according to microscopic appearance; these are epithelial, sarcomatoid, and mixed types. A number of studies have demonstrated that the epithelial variant is associated with the best prognosis. Other favorable prognostic variables include younger age, good performance status, early stage disease, and lack of chest pain at diagnosis.
Saturday, August 22, 2009
Types of mesothelioma
- Malignant Pleural Mesothelioma
- Pleural Mesothelioma Symptoms
- Malignant Mesothelioma
- Benign Mesothelioma
- Peritoneal Mesothelioma
- Pericardial Mesothelioma
Malignant Pleural Mesothelioma:
Malignant Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. It is the most common type of mesothelioma and traditional treatments include surgery, chemotherapy and combined approaches utilizing multiple types of therapy (multimodality). Malignant pleural mesothelioma (MPM) affects over 3,000 people a year in the US, and considering the 30- to 40-year latency period between exposure and expression of the disease, there will be an estimated 300,000 cases before the year 2030. Epidemiological studies predict that approximately 250,000 Europeans will develop mesothelioma in the next few decades.
Pleural Mesothelioma Symptoms:
In the early stages of the disease, symptoms are subtle. In the asymptomatic patient, a small buildup of fluid between the lining of the lung and the chest cavity, called a pleural effusion, may be present. Cough and shortness of breath are the most frequent early complaints. Fatigue, weakness and weight loss typically occur later. Pain is also common later in the disease as the tumor invades the chest wall and/or mediastinum (the area in the chest behind the breast bone and in between the two lungs where the heart, major blood vessels, lymph glands, and nerve tissue exist). This type of the disease starts in the chest cavity and can then spread to other parts of the body. Pleural mesothelioma sufferers may also begin to display severe breathing difficulty, weight loss and fever as well as trouble swallowing and even swelling of the face and neck. Some patients may also develop a rasping voice and start coughing up blood. However, there are patients that may not have any significant symptoms at all.
Malignant Mesothelioma:
Tumors of the mesothelium can be benign (noncancerous) or malignant (cancerous). A malignant tumor of the mesothelium is called a malignant mesothelioma. Because most mesothelial tumors are cancerous, malignant mesothelioma is often simply called mesothelioma
Benign Mesothelioma:
A type of tumor that used to be called benign fibrous mesothelioma can form in the pleura surrounding the lungs. The tumor actually starts from tissue under the mesothelium, called the submesothelium. The new name of this tumor is solitary fibrous tumor of the pleura. This disease is usually not cancerous, but cancerous forms can occur. These tumors do not invade adjacent tissues, and the lack of invasion into adjacent tissues is the key microscopic feature that distinguishes these tumors from those labeled malignant. These
tumors are not associated with asbestos exposure and are found with equal frequency in men and women. A similar disease starting in the peritoneum is called solitary fibrous tumor of peritoneum. Complete surgical resection is the treatment of choice.
Peritoneal Mesothelioma:
Malignant peritoneal mesothelioma is a cancer of the cells lining the abdominal cavity. Peritoneal mesothelioma represents about one fifth to one third of all forms of mesothelioma and is a rapidly fatal malignancy with a median survival of less than 1 year. A small percentage of patients have a history of asbestos exposure, sometimes called chrysotile peritoneal mesothelioma, but a search for other cancer-causing agents continues. Traditional treatments include surgery, chemotherapy and combined approaches utilizing multiple types of therapy (multimodality).
Pericardial Mesothelioma:
Pericardial mesothelioma is the rarest form of mesothelioma, accounting for less than 1% of all cases. It is a cancer of the cells that line the heart called the pericardium.
Mesothelioma Treatment is Expensive
Mesothelioma is a highly aggressive cancer, resistant to most current cancer treatments. Because mesothelioma is a relatively rare cancer, the medical community often has difficulty diagnosing the disease and determining the best treatment. Patients are often referred to specialists for diagnosis and a treatment plan.
Treatment costs often include physician fees, hospital stays, tests, chemotherapy treatments, radiation therapy and medications. The cost for just one chemotherapy treatment alone can run $6,000 while the patient often has 4-6 cycles of chemotherapy. If non-traditional treatment methods are selected, such as photodynamic or gene therapy, costs can run even higher.
Mesothelioma treatment costs may be covered by the patient's health insurance, Medicare or Medicaid. However, many patients may not be eligible for Medicaid or Medicare, or they may not have sufficient health insurance. The medical costs can leave mesothelioma victims deep in debt. Special treatments and clinical trials may also not be covered. Belluck and Fox can help mesothelioma patients cover the costs of medical treatment by filing a lawsuit on their behalf. All of a patient's medical bills can be recovered in a mesothelioma lawsuit.
Treatment costs often include physician fees, hospital stays, tests, chemotherapy treatments, radiation therapy and medications. The cost for just one chemotherapy treatment alone can run $6,000 while the patient often has 4-6 cycles of chemotherapy. If non-traditional treatment methods are selected, such as photodynamic or gene therapy, costs can run even higher.
Mesothelioma treatment costs may be covered by the patient's health insurance, Medicare or Medicaid. However, many patients may not be eligible for Medicaid or Medicare, or they may not have sufficient health insurance. The medical costs can leave mesothelioma victims deep in debt. Special treatments and clinical trials may also not be covered. Belluck and Fox can help mesothelioma patients cover the costs of medical treatment by filing a lawsuit on their behalf. All of a patient's medical bills can be recovered in a mesothelioma lawsuit.
Mesothelioma Treatment
Mesothelioma treatment depends on several factors, including the stage of mesothelioma, the location of the tumor, and the age and overall health of the patient.
Surgery - Removal of Mesothelioma
Surgical removal of the tumor and surrounding tissue may be done depending on how far the mesothelioma has spread (the stage). The more advanced the stage, the less likely that surgery will be effective in treating mesothelioma.
Radiation - Radiotherapy
Radiation therapy uses high-energy x-rays to kill mesothelioma cancer cells and to shrink tumors. There are two types of radiation therapy.
Chemotherapy
Chemotherapy is the use of drugs to treat cancer. Chemotherapy can be administeredorally (by mouth) or by injection into the muscles. However, for mesothelioma, as with other cancers chemotherapy agents are usually injected into the veins (intravenously). Sometimes the chemotherapy agents can be put directly into the chest cavity (intrapleurally)in the case of pleural mesothelioma or the abdominal cavity (intraperitoneally), in the case of peritoneal meothelioma. The goal of mesothelioma chemotherapy is for the drug destroy the cancer cells while sparing normal cells as much as possiible.
New Mesothelioma Treatments
New mesothelioma treatments are being evaluated in mesothelioma clinical trials in hopes of a mesothelioma cure. Mesothelioma clinical trials are research studies that evaluate new mesothelioma treatments for safety and efficiency. There are no guarantees that a treatment offered through a mesothelioma clinical trial will work, and because the treatments are in the trial stage, there are some risks. However, a mesothelioma clinical trial is not undertaken unless the researchers believe the treatment may have some value.
Photodynamic Therapy
Photodynamic Therapy (PDT) involves administering photosensitive drugs into the mesothelial cells. Doctors then use a laser light to activate the photosensitive drugs in order to destroy the surrounding cancer cells.
Gene Therapy
Gene therapy is used to correct disease at the DNA level by compensating for abnormal genes. Several types of gene therapy are currently being studied for the treatment of mesothelioma. Although this treatment has proved successful in animal studies, the results in human studies have been disappointing.
Immunotherapy
Immunotherapy seeks to improve the immune system’s natural ability to fight cancer. Studies have shown that the immune system distinguishes healthy cells from cancer cells in order to eliminate the cancerous cells.
Multimodality Therapy
This type of therapy simply means the use of any combination of surgery, radiation therapy, or chemotherapy to treat mesothelioma. The most common form combines surgery with intercavitary radiation or chemotherapy, both before and after, to remove and eliminate mesothelioma.
Alternative Treatment
Given the relatively unsuccessful results of conventional medicine in treating mesothelioma and that there is still no mesothelioma cure, a number of persons have turned to alternative mesothelioma treatments. These have included holistic forms of treatment, such as acupuncture, homeopathy, herbs, and other forms of Eastern medicine to treat mesothelioma.
Stage IV Mesothelioma Treatment
Patients with stage IV malignant pleural mesothelioma have cancer that is considered inoperable and has spread to the opposite side of the chest or to distant sites. Patients with recurrent or refractory malignant pleural mesothelioma have cancer that has failed primary treatment or recurred after an initial response.
- Surgery - Removal of Mesothelioma
- Radiation - Radiotherapy
- Chemotherapy
- New Mesothelioma Treatments
- Photodynamic Therapy
- Gene Therapy
- Immunotherapy
- Multimodality Therapy
- Stage IV Mesothelioma Treatmen
Surgery - Removal of Mesothelioma
Surgical removal of the tumor and surrounding tissue may be done depending on how far the mesothelioma has spread (the stage). The more advanced the stage, the less likely that surgery will be effective in treating mesothelioma.
Radiation - Radiotherapy
Radiation therapy uses high-energy x-rays to kill mesothelioma cancer cells and to shrink tumors. There are two types of radiation therapy.
Chemotherapy
Chemotherapy is the use of drugs to treat cancer. Chemotherapy can be administeredorally (by mouth) or by injection into the muscles. However, for mesothelioma, as with other cancers chemotherapy agents are usually injected into the veins (intravenously). Sometimes the chemotherapy agents can be put directly into the chest cavity (intrapleurally)in the case of pleural mesothelioma or the abdominal cavity (intraperitoneally), in the case of peritoneal meothelioma. The goal of mesothelioma chemotherapy is for the drug destroy the cancer cells while sparing normal cells as much as possiible.
New Mesothelioma Treatments
New mesothelioma treatments are being evaluated in mesothelioma clinical trials in hopes of a mesothelioma cure. Mesothelioma clinical trials are research studies that evaluate new mesothelioma treatments for safety and efficiency. There are no guarantees that a treatment offered through a mesothelioma clinical trial will work, and because the treatments are in the trial stage, there are some risks. However, a mesothelioma clinical trial is not undertaken unless the researchers believe the treatment may have some value.
Photodynamic Therapy
Photodynamic Therapy (PDT) involves administering photosensitive drugs into the mesothelial cells. Doctors then use a laser light to activate the photosensitive drugs in order to destroy the surrounding cancer cells.
Gene Therapy
Gene therapy is used to correct disease at the DNA level by compensating for abnormal genes. Several types of gene therapy are currently being studied for the treatment of mesothelioma. Although this treatment has proved successful in animal studies, the results in human studies have been disappointing.
Immunotherapy
Immunotherapy seeks to improve the immune system’s natural ability to fight cancer. Studies have shown that the immune system distinguishes healthy cells from cancer cells in order to eliminate the cancerous cells.
Multimodality Therapy
This type of therapy simply means the use of any combination of surgery, radiation therapy, or chemotherapy to treat mesothelioma. The most common form combines surgery with intercavitary radiation or chemotherapy, both before and after, to remove and eliminate mesothelioma.
Alternative Treatment
Given the relatively unsuccessful results of conventional medicine in treating mesothelioma and that there is still no mesothelioma cure, a number of persons have turned to alternative mesothelioma treatments. These have included holistic forms of treatment, such as acupuncture, homeopathy, herbs, and other forms of Eastern medicine to treat mesothelioma.
Stage IV Mesothelioma Treatment
Patients with stage IV malignant pleural mesothelioma have cancer that is considered inoperable and has spread to the opposite side of the chest or to distant sites. Patients with recurrent or refractory malignant pleural mesothelioma have cancer that has failed primary treatment or recurred after an initial response.
Stages of Mesothelioma
As with other cancerous diseases, the progression of mesothelioma is typically broken into stages, with the treatment options based on the stage of the disease.
Stages of Mesothelioma
The staging commonly used for mesothelioma is the Brigham staging system, and it can be described as follows:
Stage 1 occurs when the tumor lies completely within the capsule of the
pleura, without swollen lymph nodes (adenopathy).
Stage 2 has the characteristics of Stage 1, except that the tumor has spread and there is presence of adenopathy. The boundaries of the tumor still allow for a resection (removal of the tumor) without cutting into other organs.
Stage 3 includes extension of the disease into the chest wall or into the heart, through the diaphragm or peritoneum, or outside the pleura to involve the lymph nodes.
Stage 4 occurs when the cancer has formed in distant organs through metastases.
Stages of Mesothelioma
The staging commonly used for mesothelioma is the Brigham staging system, and it can be described as follows:
Stage 1 occurs when the tumor lies completely within the capsule of the
pleura, without swollen lymph nodes (adenopathy).
Stage 2 has the characteristics of Stage 1, except that the tumor has spread and there is presence of adenopathy. The boundaries of the tumor still allow for a resection (removal of the tumor) without cutting into other organs.
Stage 3 includes extension of the disease into the chest wall or into the heart, through the diaphragm or peritoneum, or outside the pleura to involve the lymph nodes.
Stage 4 occurs when the cancer has formed in distant organs through metastases.
Mesothelioma Symptoms
Many of the symptoms of mesothelioma are not very different from those associated with other health problems. Also, in its early stages some patients experience no symptoms at all.
symptoms of pleural mesothelioma
(mesothelioma cancer of the lung lining) include:
* pain in the lower back or the side of the chest (over half of patients experience this)
* chest pain under the rib cage
* shortness of breath
* a dry persistent cough, which may bring up blood
* difficulty swallowing (food or liquids)
* hoarseness
* swelling of the face and arms
* fever and sweating
* fatigue
* abdominal swelling
* abdominal pain
* unexplained weight loss
However, a pleural effusion, one of the most common and specific symptoms of pleural mesothelioma, is the accumulation of fluid between the lungs and chest cavity. This generally causes shortness of breath, and requires a doctor to drain the fluid, to make breathing easier and relieve chest pain. This symptom is more unique to mesothelioma, making it more likely that you may have the disease.
SYMPTOMS OF peritoneal mesothelioma
(mesothelioma cancer of the lining that surrounds the abdomen) include:
- abdominal pain
- nausea and vomiting
- weight loss
- abdominal pain and swelling due to a buildup of fluid in the abdomen.
- an abdominal mass
Other symptoms of peritoneal mesothelioma may include:
- bowel obstruction
- blood clotting abnormalities
- anemia
- fever.
Pericardial Mesothelioma
Some of the symptoms of pericardial mesothelioma (mesothelioma cancer of the lining that surrounds the heart) include:
- dyspnea, including significantly difficult breathing at night in bed
- cough
- chest pain
- orthopnea (discomfort with breathing while lying flat)
- wheezing
- weight loss
- swelling of legs and feet
Signs and symptoms of mesothelioma cancer that has spread to other parts of the body include:
* Pain in the area where cancer has spread
* Difficulty swallowing
* Swelling in the neck and face
Like pleural mesothelioma, these symptoms are also common to many minor ailments and, therefore, may not cause a doctor to suspect mesothelioma.
symptoms of pleural mesothelioma
(mesothelioma cancer of the lung lining) include:
* pain in the lower back or the side of the chest (over half of patients experience this)
* chest pain under the rib cage
* shortness of breath
* a dry persistent cough, which may bring up blood
* difficulty swallowing (food or liquids)
* hoarseness
* swelling of the face and arms
* fever and sweating
* fatigue
* abdominal swelling
* abdominal pain
* unexplained weight loss
However, a pleural effusion, one of the most common and specific symptoms of pleural mesothelioma, is the accumulation of fluid between the lungs and chest cavity. This generally causes shortness of breath, and requires a doctor to drain the fluid, to make breathing easier and relieve chest pain. This symptom is more unique to mesothelioma, making it more likely that you may have the disease.
SYMPTOMS OF peritoneal mesothelioma
(mesothelioma cancer of the lining that surrounds the abdomen) include:
- abdominal pain
- nausea and vomiting
- weight loss
- abdominal pain and swelling due to a buildup of fluid in the abdomen.
- an abdominal mass
Other symptoms of peritoneal mesothelioma may include:
- bowel obstruction
- blood clotting abnormalities
- anemia
- fever.
Pericardial Mesothelioma
Some of the symptoms of pericardial mesothelioma (mesothelioma cancer of the lining that surrounds the heart) include:
- dyspnea, including significantly difficult breathing at night in bed
- cough
- chest pain
- orthopnea (discomfort with breathing while lying flat)
- wheezing
- weight loss
- swelling of legs and feet
Signs and symptoms of mesothelioma cancer that has spread to other parts of the body include:
* Pain in the area where cancer has spread
* Difficulty swallowing
* Swelling in the neck and face
Like pleural mesothelioma, these symptoms are also common to many minor ailments and, therefore, may not cause a doctor to suspect mesothelioma.
Thursday, August 20, 2009
MESOTHELIOMA TREATMENT
Following are a few methods of treating mesothelioma :
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. 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.
Conventional Therapies :
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 patients 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
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.
RADIATIONS
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..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.
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.
- CHEMOTHERAPY
- THERAPIES
- SURGERY
- RADIATIONS
- IMMUNOTHERAPY
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. 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.
Conventional Therapies :
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 patients 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
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.
RADIATIONS
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..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.
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.
MESOTHELIOMA DIAGONOSIS
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma.
A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
Mesothelioma Symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos.
The symptoms of mesothelioma include :
Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever.
If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
Mesothelioma that affects the pleura can cause these signs and symptoms:
* Chest wall pain
* Pleural effusion, or fluid surrounding the lung
* Shortness of breath
* Fatigue or anemia
* Wheezing, hoarseness, or cough
* Blood in the sputum (fluid) coughed up
In severe cases of the disease, the following signs and symptoms may be present:
* Blood clots in the veins, which may cause thrombophlebitis
* Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* Jaundice, or yellowing of the eyes and skin
* Low blood sugar level
* Pleural effusion
* Pulmonary emboli, or blood clots in the arteries of the lungs
* Severe ascites
The symptoms of mesothelioma include :
Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever.
If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
Mesothelioma that affects the pleura can cause these signs and symptoms:
* Chest wall pain
* Pleural effusion, or fluid surrounding the lung
* Shortness of breath
* Fatigue or anemia
* Wheezing, hoarseness, or cough
* Blood in the sputum (fluid) coughed up
In severe cases of the disease, the following signs and symptoms may be present:
* Blood clots in the veins, which may cause thrombophlebitis
* Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
* Jaundice, or yellowing of the eyes and skin
* Low blood sugar level
* Pleural effusion
* Pulmonary emboli, or blood clots in the arteries of the lungs
* Severe ascites
MESOTHELIOMA
Mesothelioma is a form of cancer that is almost always caused by exposure to Asbestos.
In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart, the pericardium (a sac that surrounds the heart) or tunica vaginalis.
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma.
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