Mesothelioma

Mesothelioma Animation

2011-09-22T21:21:00.000-07:00

This is an illustrated Demostration on how mesothelioma cancer

Mesothelioma Doctors List

2011-09-20T22:08:00.001-07:00

This is a list of doctors who reportedly treat mesothelioma patients. Their appearance on this website is not a recommendation. You should treat these doctors as you would any unknown physician and ask many questions about their experience with other mesothelioma patients.

Arizona
	Linda Garland, M.D. Arizona Cancer Center - Hematology/Oncology Tucson, Arizona Tel. 520-694-CURE (2873) Dr. Garland is an oncologist and the Director of the Arizona Cancer Center Clinical Lung Program where one of her specialties includes Mesothelioma. For more information, click here.
	Helen J. Ross, M.D. Mayo Clinic, Hematology/Oncology Scottsdale, Arizona Tel. 1-800-446-2279 Dr. Ross is a Thoracic Oncologist and Associate Professor of Medicine at the Mayo Clinic. For more information, click here.
California
	Robert B. Cameron, M.D. UCLA Medical Center Los Angeles, California Tel. 310-794-7333 Dr. Cameron is the Director of Thoracic Oncology at UCLA Medical Center. He is board-certified in general surgery and cardiothoracic surgery. His research interests include lung cancer, esophageal cancer and mesothelioma. For more information, click here.
	David Jablons, M.D. UCSF Comprehensive Cancer Center San Francisco, California Tel. 1-800-888-8664 or 415-885-7777 Dr. Jablons is the Professor and Chief of the Section of General Thoracic Surgery at UCSF. He is Board Certified in General Surgery and Thoracic Surgery. For more information, click here.
	Theirry Jahan, M.D. UCSF Comprehensive Cancer Center San Francisco, California Tel. 415-567-5581 Dr. Jahan is an associate clinical professor of medicine at UCSF. He specializes in the treatment of lung cancer, mesothelioma, sarcomas and endocrine tumors and the use of multiple treatments. For more information, click here.
Connecticut
	Graeme L. Hammond, M.D., F.A.C.S. Yale University School of Medicine, Department of Surgery New Haven, Connecticut Tel. 203-785-2704 Dr. Hammond is a professor with the Department of Surgery at the Yale University School of Medicine in New Haven, Connecticut. He is board-certified in surgery and thoracic surgery. For more information, click here.
Florida
	Lary A. Robinson, M.D. H. Lee Moffitt Cancer Center & Research Institute at The University of South Florida Tampa, Florida Tel. 813-745-8412 Dr. Robinson is the Director of the Division of Cardiovascular and Thoracic Surgery at the H. Lee Moffitt Cancer Center. For more information, click here.
Massachusetts
	Raphael Bueno, M.D. Brigham and Women's Hospital, Division of Thoracic Surgery Boston, Massachusetts Tel. 617-732-6824 Dr. Bueno is the Associate Chief of the Division of Thoracic Surgery for Brigham and Women's Hospital. He is board certified in Surgery, Surgical Critical Care and Thoracic Surgery. His clinical interests include tracheal surgery, lung cancer and mesothelioma. For more information, click here.
	David J. Sugarbaker, M.D. Brigham and Women's Hospital, Division of Thoracic Surgery Boston, Massachusetts Tel. 617-732-6824 Dr. Sugarbaker is Chief of the Division of Thoracic Surgery at Brigham and Women's Hospital. Malignant pleural mesothelioma has been a central focus of Dr. Sugarbaker's clinical and laboratory research. For more information, click here.
	Scott J. Swanson, M.D. Brigham and Women's Hospital/Dana Farber Cancer Institute Boston, Massachusetts Tel. 617-732-6824 Dr. Swanson is board certified in Surgery and Thoracic Oncology and Thoracic Surgery. For more information, click here.
Nebraska
	Dr. Brian Loggie Creighton University School of Medicine Omaha, Nebraska Tel. 402-280-3273 Dr. Loggie is a Professor of Surgery, Chief of the Division of Surgical Oncology, and Director of the Cancer Biology Program at Creighton University School of Medicine. His special interest include: Peritoneal carcinomatosis and malignant ascites, and peritoneal mesothelioma. For more information, click here.
New York
	Manjit Bains, M.D., F.A.C.S Memorial Sloan Kettering Cancer Center New York, New York Tel. 212-639-7450 Dr. Bains is board certified in Surgery and Thoracic Surgery and has clinical expertise in mesothelioma. For more information,click here.
	Lee M. Krug, M.D. Memorial Sloan Kettering Cancer Center New York, New York Tel. 212-639-8420 Dr. Krug is a medical oncologist who specializes in the treatment of thoracic cancers. He is board-certified in internal medicine and medical oncology. His research is focused primarily on small cell lung cancer and mesothelioma. For more information, click here.
	Valerie Rusch, M.D., F.A.C.S Memorial Sloan Kettering Cancer Center New York, New York Phone: 212-639-5873 Dr. Rusch is a surgeon who treats patients with cancers of the lung, esophagus, mediastinum, and chest wall, including those with mesothelioma. She is board certified in surgery and thoracic surgery. For more information, click here.
	Harvey I. Pass, M.D. New York University Medical Center New York, New York Tel. 212-731-5414 Dr. Harvey Pass is the Director of the New York University Medical Center Division of Thoracic Surgery and is Chief of Thoracic Oncology. He is one of the world's leading authorities on mesothelioma. For more information, click here.
	Robert N. Taub, M.D. NewYork-Presbyterian/Columbia New York, New York Tel. 212-659-6815 Dr. Taub is Board Certified in Hematology, Allergy and Immunology, Internal Medicine and Oncology. Dr. Taub is involved in developing combined chemotherapeutic and surgical techniques to combat mesothelioma. For more information, click here.
North Carolina
	David H. Harpole, Jr., M.D. Duke University Health System Durham, North Carolina Tel. 919-668-8413 Dr. Harpole is Vice Chair of Faculty Affairs and a member of the Division of Cardiovascular and Thoracic Surgery in the Department of Surgery of the Duke University Health System. His clinical interests include thoracic oncology, and mesothelioma. For more information, click here.
Pennsylvania
	Daniel Sterman, M.D. University of Pennsylvania Medical Center Philadelphia, PA 19104-4283 Tel. 215-614-0984 Dr. Sterman is Associate Professor of Medicine, Associate Professor of Medicine in Surgery, Director of Interventional Pulmonology, and Clinical Director, Thoracic Oncology Gene Therapy Program at the University of Pennsylvania Medical Center. He is involved in various studies involving mesothelioma. For more information, click here.
Texas
	W. Roy Smythe, M.D. Texas A&M University Health Sciences Center Temple, Texas Tel. 254-724-2595 Dr. Smythe is involved in the surgical diagnosis and treatment of mesothelioma patients at the Texas A&M University Health Sciences Center. For more information, click here.
Washington, D.C.
	Paul H. Sugarbaker, M.D. Washington Cancer Institute Washington DC Tel. 202-877-3627 Dr. Sugarbaker is the Director of the Program in Peritoneal Surface Malignancy at the Washington Cancer Institute. His clinical interests include mesothelioma. For more information,click here.
Washington State
	Eric Vallieres, M.D. Swedish Medical Center Seattle, Washington Tel. 206-215-6800 Dr. Vallieres is a thoracic surgeon with the Swedish Medical Center. He is board-certified in general surgery and thoracic surgery. His areas of interest and expertise include mesothelioma and pleural diseases. For more information, click here.

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mesothelioma lawyers

2011-09-20T22:00:00.001-07:00

Deciding to pursue legal recourse and selecting an attorney to represent you in a mesothelioma or asbestos lawsuit are important decisions that should be made carefully. The facts of your situation and the law firm you select have a dramatic impact in the outcome of your case.

The Facts of Your Situation

Some mesothelioma patients know they worked around asbestos, but many do not know how they were exposed or how often. In fact, many people are not sure if they were ever near this carcinogen. Unfortunately, there have been thousands of products that contained asbestos - cigarette filters, hair dryers, brakes, basement and roof materials, pipes, boilers, insulation, and many other products found throughout the home and at work. If you were diagnosed with mesothelioma it is more than likely that you were exposed to asbestos multiple times in your life and that this happened decades before your diagnosis.

In general, the value of your case depends on how many asbestos containing products you were exposed to, the number of identifiable defendants that still exist (many have declared bankruptcy), your age and earning capacity. And the speed of your case can depend on a number of variables including the state where you worked and lived when you were exposed to asbestos.

The Law Firm You Choose

When you have been given the news about this terrible disease, you may not feel that you have the time to deal with the legal questions - Should I talk to a lawyer? Should I file a claim? However, you should not wait too long to learn about your legal rights for at least three reasons:

Statutes of Limitations - There are statute of limitations which means you only have a limited time to file your case after diagnosis. The statute of limitations time period is set by individual states and varies. The clock usually starts ticking on the day of diagnosis.
Financial Pressure - A mesothelioma diagnosis can bring financial stress, less income, more expenses, and treatments that are not covered by insurance. Knowing that money may be on the way from filing a claim can bring financial relief.
Lawyers Can be Excellent Resources - The more experienced mesothelioma lawyers and law firms can often be excellent sources of information about various doctors and treatment options available for this disease.

But, picking a lawyer is serious business and you should not use TV ads as the reason to hire an attorney. Actual credentials are what counts. For example, what type of accomplishments has the law firm achieved? How committed are they to mesothelioma/asbestos cases? Are these cases a substantial part of their practice or just a small piece? How many other cases like yours have they handled?

Also, make sure you understand the fees being charges. Contingency is the term that means that the lawyer gets paid only after they collect money for you. The amount of the contingency fee that your lawyer can charge varies and is usually between 33% and 40%. It is important to discuss fees openly, ask what services they cover, how they are calculated, and whether there will be any extra charges.

Finally, for something as important as a mesothelioma lawsuit, your attorney should not only be experienced, skilled, and dedicated, but also a trusted partner who understands that your health needs always take precedence. The best lawyers are those that are not only expert at what they do, but are also caring, supportive, thoughtful and compassionate.

Mesothelioma attorneys

2011-09-20T21:58:00.000-07:00

Since 1999, our mesothelioma law firm has recovered over $4 billion in verdicts and settlements for thousands of clients.* If you're looking for a mesothelioma attorney who understands your case and can help you get the compensation you deserve, learn more about the experience team at the Simmons Law Firm. Read about results attained by our asbestos attorneys by visiting theVerdicts and Settlements page.

Recent Results for Our Clients

A lifetime HVAC worker from North Carolina receives a $3.6 million settlement.
Shipyard worker and engineer from Nevada receives $2.9 million settlement.
Engineer from Missouri receives $3.9 million settlement.
Wisconsin man with lifetime navy asbestos exposure receives $2.9 million settlement.
Plastics factory worker from Iowa receives $2.5 million settlement.
Powerhouse worker from Illinois receives $2 million settlement.
St. Louis area man and his family received a $3.5 million settlement after he was diagnosed with mesothelioma, a deadly asbestos cancer. Read more.
A Montana man's family received a $4.9 million settlement after he was exposed to asbestos and contracted pleural mesothelioma, a deadly cancer that attacks the lining of the lungs. Read more.

As a leading mesothelioma law firm with a proven track record, every asbestos and mesothelioma lawyer at the Simmons Law Firm is committed to helping families affected by mesothelioma and asbestos-related diseases. We have been working with people diagnosed with mesothelioma for nearly a decade, and in that time our mesothelioma lawyers have represented thousands of individuals from all areas of the United States.

Our asbestos lawyers have seen firsthand the pain a mesothelioma diagnosis can cause and are passionate about helping victims and families affected by mesothelioma. At the Simmons Law Firm, each asbestos attorney focuses on providing clients with the personal attention they deserve. If you've been diagnosed with mesothelioma, an asbestos lawyer will come to you, no matter your location.

For more information on any Simmons Law Firm mesothelioma attorney, please visit the Attorneys page.

Mesothelioma cancer

2011-09-19T21:34:00.000-07:00

Mesothelioma is a rare type of cancer. Malignant (cancerous) cells develop in the mesothelium, the protective sac that covers most of the body’s internal organs. Mesothelioma generally starts in the outer membrane of the lungs (pleura), but can also occur in the lining of the abdominal cavity (peritoneum). Uncommonly, the heart or reproductive organs may be affected. Treatment depends on where the cancer is found and whether it has spread.

Currently there is no cure for mesothelioma unless it can be removed by surgery. Unfortunately, by the time mesothelioma is diagnosed, it has usually already spread beyond the point where it could be removed by an operation. In this case, treatment aims to prolong life and keep the person as comfortable as possible.

Mesothelioma is almost always caused by exposure to asbestos and can develop decades after the exposure.

The role of asbestos
Asbestos is the name of a group of minerals that was once widely used for its fire-resistant and insulating properties. Due to health risks, it is no longer mined, milled or manufactured in Australia. All uses of asbestos in new products are now banned in Australia and no asbestos products may be imported. Strict precautions also govern the removal and disposal of asbestos and asbestos-containing materials.

Mesothelioma is common in Australia
Australia has one of the highest rates of mesothelioma in the world. This is due to the high rate of asbestos use and mining over many years. In 2007 there were nearly 600 people diagnosed with mesothelioma in Australia. Of these new cases, 81 per cent were men.

In Victoria there are over 160 cases diagnosed each year. Experts believe the number of people diagnosed with asbestos-related diseases will not peak until 2020 with a possible 13,000 more new cases of mesothelioma in Australia each year.

How it spreads
Malignant (cancerous) cells develop in the mesothelium. This protective sac has different names, depending on its location in the body. Those most commonly affected by mesothelioma are:

Visceral pleura – the membrane that surrounds the lungs
Parietal pleura – the membrane that lines the chest wall
Peritoneum – the membrane that forms the lining of the abdominal and pelvic cavities.

Mesothelioma most often starts in the pleura. Normally, the two pleura touch and slide across each other while we breathe, lubricated by a slick of fluid. In cases of pleural mesothelioma, the pleura make more fluid than necessary, which presses on the lung (pleural effusion). Mesothelioma usually develops in only one lung. The tumour tends to grow across the lung until the entire organ is encased.

In about 10 per cent of mesothelioma cases, asbestos fibres that have been swallowed can move through the stomach wall and cause cancer cells to develop in the peritoneum (peritoneal mesothelioma).

Sometimes cancer cells migrate to lymph nodes and other areas of the body (such as the unaffected lung) via the lymphatic system. Uncommonly, the heart or reproductive organs may be affected.

Symptoms of mesothelioma – lungs
Symptoms of pleural mesothelioma include:

Breathlessness
Dry cough
Pain.

Symptoms of mesothelioma – peritoneum
Symptoms of peritoneal mesothelioma include:

Painful abdomen
Swollen abdomen
High temperature
Nausea and vomiting
Bowel problems
Urinary problems.

Symptoms in the later stages
Symptoms in the later stages of the disease include:

Sudden and unexplained weight loss
Spitting up sputum
Spitting up blood
Swallowing problems
Hoarseness.

High-risk groups
The primary risk factor for mesothelioma is asbestos exposure. The disease is rarely seen in young people. Since mesothelioma can take as long as 40 years to develop, the incidence tends to rise following middle age. High-risk groups include anyone who has worked with asbestos – in jobs such as asbestos mining, milling and manufacture or in the construction, power and shipbuilding industries – and their close family or household members, for example, those who washed their work clothes.

Smoking greatly increases the risk of lung cancer in a person who has been exposed to asbestos. Most asbestos-related lung cancers are attributable to the combined effects of asbestos and tobacco smoke.

Diagnosis
The symptoms of mesothelioma may be caused by this condition or may be due to other, less serious conditions. It is important to see a doctor about any symptoms. Only a doctor can make a diagnosis.

Diagnosis of mesothelioma may include:

Medical history, including history of asbestos exposure
Physical examination
Blood tests
Chest x-rays
CT scans
Drainage and laboratory analysis of the pleural fluid
Tissue sample (biopsy) to help differentiate mesothelioma from another condition known as ‘benign asbestos related pleural disease’.

Treatment
Treatment depends on the type of mesothelioma, the stage (extent) of disease and the person’s preference. Options may include:

Pleurectomy – surgery to remove the affected tissue. The affected lung may also be removed in whole (pneumonectomy) or in part (lobectomy). Usually only small tumours are treated with surgery. A person’s life span may be prolonged for a few months or years.
Phototherapy – a procedure sometimes used during pleurectomy. Stray cancer cells within the chest are highlighted with special dye and killed by laser.
Thoracentesis – a procedure that removes fluid from the pleural cavity through a needle inserted between the ribs.
Pleurodesis – a special powder is inserted between the pleural layers to cause inflammation and stop production of excess fluid. This is performed using a slender instrument (endoscope) inserted into the chest.
Paracentesis – a procedure in which a thin needle or tube is put into the abdomen to remove fluid from the peritoneal cavity (the space within the abdomen that contains the intestines, the stomach and the liver).
Peritoneal surgery – surgery to remove tumours in the abdominal cavity. Bowel symptoms can often improve following this procedure.
Chemotherapy – the use of cancer-killing drugs that can shrink the cancer and ease symptoms. Chemotherapy is often recommended if the cancer has returned following other treatment or if other treatments are inappropriate.
Radiotherapy – x-ray treatment to kill cancer cells. Only small areas can be treated or else the healthy cells of the lungs, heart and liver may be damaged. Radiotherapy is often used to ease pain and breathlessness.

Where to get help

Your doctor
Asbestos Diseases Foundation of Australia Tel. (02) 9637 8759
Asbestos Diseases Society of Australia Tel. 1800 646 690
Cancer Council Helpline Tel. 13 11 20
Multilingual Cancer Information Line, Victoria Tel. (03) 9209 0169
Peter MacCallum Cancer Centre Tel. (03) 9656 1111
WorkSafe Victoria Tel (03) 9641 1444 or 1800 136 089 (toll free) - for general enquiries
WorkSafe Victoria Emergency Response Line Tel. 13 23 60 - to report serious workplace emergencies, seven days, 24 hours
Environment Protection Authority Victoria Tel. (03) 9695 2722
Department of Health, Environmental Health Unit Tel. 1300 761 874
Asbestos Victims Association South Australia Tel. (08) 8212 6008 or 1800 665 395 (SA country only)
Asbestos Diseases Society of Victoria – Information, Support and Counselling Service Tel. (03) 9329 9584 or 1300 659 226

Things to remember

Mesothelioma is a rare type of cancer that can develop decades after exposure to asbestos.
Mesothelioma usually targets the outer membrane of the lungs (pleura) but can also occur in the membrane lining of the abdominal cavity (peritoneum). Uncommonly, the heart or reproductive organs may be affected.
Unless surgical removal is an option there is no cure – treatment aims to prolong life and keep the person as comfortable as possible.

Mesothelioma Alternative medicine

2011-09-18T23:01:00.001-07:00

No alternative medicine treatments have proved helpful in treating mesothelioma. But complementary and alternative mesothelioma treatments may help control signs and symptoms. Discuss options with your doctor.

Mesothelioma can cause pressure within your chest that can make you feel as if you're always short of breath. Breathlessness can be distressing. Your doctor may recommend using supplemental oxygen or taking medications to make you more comfortable, but often these aren't enough. Combining your doctor's recommended treatments with complementary and alternative approaches may help you feel better.

Alternative treatments that have shown some promise in helping people cope with breathlessness include:

Acupuncture. Acupuncture uses thin needles inserted at precise points into your skin.
Breath training. A nurse or physical therapist can teach you breathing techniques to use when you feel breathless. Sometimes you may feel breathless and begin to panic. Implementing these techniques may help you feel more in control of your breathing.
Relaxation exercises. Slowly tensing and relaxing different muscle groups may help you feel more at ease and breathe easier. Your doctor may refer you to a therapist who can teach you relaxation exercises so that you can do them on your own.
Sitting near a fan. Directing a fan to your face may help ease the sensation of breathlessness.
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Mesothelioma Treatments and drugs

2011-09-18T22:58:00.001-07:00

What treatment you undergo for mesothelioma depends on your health and certain aspects of your cancer, such as its stage and location. Unfortunately, mesothelioma often is an aggressive disease and for most people a cure isn't possible. Mesothelioma is usually diagnosed at an advanced stage — when it isn't possible to remove the cancer through an operation. Instead, your doctor may work to control your cancer to make you more comfortable.

Discuss treatment goals with your doctor. Some people want to do everything they can to treat their cancer, even if that means enduring side effects for a small chance of an improvement. Others prefer treatments that make them comfortable so that they can live their remaining time as symptom-free as possible.

Surgery
Surgeons work to remove mesothelioma in instances where it is diagnosed at an early stage. Sometimes it isn't possible to remove all of the cancer. In those cases, surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in your body. Surgical options may include:

Surgery to decrease fluid buildup. Pleural mesothelioma may cause fluid to build up in your chest, causing difficulty breathing. Surgeons insert a tube or catheter into your chest to drain the fluid. Doctors may also inject medicine into your chest to prevent fluid from returning (pleurodesis).
Surgery to remove the tissue around the lungs or abdomen. Surgeons may remove the tissue lining the ribs and the lungs (pleurectomy) or the tissue lining the abdominal cavity (peritonectomy) in order to relieve signs and symptoms of mesothelioma.
Surgery to remove as much of the cancer as possible (debulking). If all of the cancer can't be removed, surgeons may attempt to remove as much as possible.
Surgery to remove a lung and the surrounding tissue. Removing the affected lung and the tissue that surrounds it may relieve signs and symptoms of pleural mesothelioma. If you'll be receiving radiation therapy to the chest after surgery, this procedure also allows doctors to use higher doses, since they won't need to worry about protecting your lung from damaging radiation.
Chemotherapy
Chemotherapy uses chemicals to kill cancer cells. Systemic chemotherapy travels throughout the body and may shrink or slow the growth of a pleural mesothelioma that can't be removed using surgery. Chemotherapy may also be used before surgery (neoadjuvant chemotherapy) to make an operation easier or after surgery (adjuvant chemotherapy) to reduce the chance that cancer will return.

Chemotherapy drugs may also be heated and administered directly into the abdominal cavity (intraperitoneal chemotherapy), in the case of peritoneal mesothelioma, or into the chest cavity (intrapleural chemotherapy), in the case of pleural mesothelioma. Using this strategy, chemotherapy drugs can reach the mesothelioma directly without injuring healthy cells in other parts of the body. This allows doctors to administer higher doses of chemotherapy drugs.

Radiation therapy
Radiation therapy focuses high-energy beams, such as X-rays, to a specific spot or spots on your body. Radiation may reduce signs and symptoms in people with pleural mesothelioma. Radiation therapy is sometimes used after biopsy or surgery to prevent mesothelioma from spreading to the surgical incision.

Combination therapy
Surgery, chemotherapy and radiation therapy may be used in various combinations to treat both pleural mesothelioma and peritoneal mesothelioma.

Clinical trials
Clinical trials are studies of new mesothelioma treatment methods. People with mesothelioma may opt for a clinical trial for a chance to try new types of treatment. However, a cure isn't guaranteed. Carefully consider your treatment options and talk to your doctor about what clinical trials are open to you. Your participation in a clinical trial may help doctors better understand how to treat mesothelioma in the future.

Clinical trials are currently investigating a number of targeted drugs. Targeted drug therapy uses drugs to attack specific abnormalities within cancer cells. Targets being studied in mesothelioma include a substance that cancer cells make to attract new blood vessels that bring oxygen and nutrients to the cancer. Researchers hope drugs that target these areas can help kill mesothelioma cells.

Treatment for other types of mesothelioma
Pericardial mesothelioma and mesothelioma of tunica vaginalis are very rare. Early-stage cancer may be removed through surgery. Doctors have yet to determine the best way to treat later stage cancers, though. Your doctor may recommend other treatments to improve your quality of life.

Mesothelioma Defination

2011-09-18T22:57:00.000-07:00

Malignant mesothelioma (me-zoe-thee-lee-OH-muh) is a rare cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).

Doctors divide mesothelioma into different types based on what part of the mesothelium is affected. Mesothelioma most often affects the tissue that surrounds the lungs (pleura). This type is called pleural malignant mesothelioma. Other, rarer types of mesothelioma affect tissue in the abdomen, around the heart and around the testicles.

Mesothelioma is an aggressive and deadly form of cancer. Mesothelioma treatments are available, but for many people with mesothelioma, a cure is not possible. Instead, treatment for mesothelioma is often focused on keeping you as comfortable as possible.

Pericardial Mesothelioma Symptoms

2011-09-12T00:56:00.003-07:00

The pericardium is the lining that surrounds the heart. Mesothelioma affecting this area of the body is known as pericardial mesothelioma and symptoms include:

Heart palpitations
Chest pain
Shortness of breath
Persistent coughing

The early signs of mesothelioma are often similar to pneumonia with symptoms including chest pain, coughing, shortness of breath and a buildup of fluid (shown by a chest x-ray). The most commonly affected lung is the right, approximately 60% of the time, while symptoms in both lungs are rare at 5% of the time. Mesothelioma symptoms are not limited to the above.

Peritoneal Mesothelioma Symptoms

2011-09-12T00:56:00.001-07:00

Mesothelioma affecting the abdominal cavity lining is known as peritoneal mesothelioma. Symptoms of peritoneal mesothelioma include:

Stomach pain
Weight loss
Nausea
Vomiting
Swollen belly
Bowel obstruction
Anemia
Fever
Blood clotting abnormalities

The early signs of mesothelioma are often similar to pneumonia with symptoms including chest pain, coughing, shortness of breath and a buildup of fluid (shown by a chest x-ray). The most commonly affected lung is the right, occurring approximately 60% of the time, while symptoms in both lungs are rare, occurring 5% of the time. Mesothelioma symptoms are not limited to the above list.

Pleural Mesothelioma Symptoms

2011-09-12T00:55:00.001-07:00

Pleural mesothelioma affects the lining of the chest. Symptoms of pleural mesothelioma may include:

Shortness of breath
Difficulty swallowing
Coughing
Sweating
Fever
Weight loss
Fatigue
Swelling in the upper body, especially the face and arms
Lower back pain
Pain in the side of the chest
Muscle weakness

The early signs of mesothelioma are often similar to pneumonia with symptoms including coughing, shortness of breath, chest pain, and a buildup of fluid. The right lung is the most commonly affected, occurring around 60%, while symptoms in both lungs are rare at 5% of the time. Mesothelioma symptoms are not limited to the above

Clinical Signs of Mesothelioma

2011-09-12T00:54:00.001-07:00

Mesothelioma is a rare type of cancer that affects the mesothelium, a membrane that covers many of the body’s internal organs, such as the heart and lungs. There are very few causes for mesothelioma, including exposure to asbestos, exposure to mineral called Zeolite, and exposure to thorium dioxide (which was formerly used in performing certain types of x-rays).

By far, the most common cause of mesothelioma is exposure to asbestos, a term which refers to a group of six naturally occurring minerals. Asbestos was widely used in industrial and construction processes, and in the production of many common households products, from the late 1800’s through the late twentieth century. Its use in the United States was largely banned by the Environmental Protection Agency in 1989.

Asbestos is dangerous because its fibers can become embedded in tissue and, many years later, lead to asbestosis or cancer. Mesothelioma can develop anywhere from fifteen to fifty years after the initial asbestos exposure occurs. Those who were exposed to asbestos or feel that they are at risk for developing mesothelioma should closely monitor their health for any signs or symptoms of mesothelioma, or other respiratory conditions that can result from exposure.

Mesothelioma occurs in several parts of the body:

pleural mesothelioma, which affects the lining of the chest wall;
peritoneal mesothelioma, which affects the lining of the abdomen;
pericardial mesothelioma, which affects the sac surrounding the heart;
testicular mesothelioma, which affects the tissue surrounding the testes in males.

It is helpful to understand the different parts of the body that can be affected by mesothelioma in order to better understand the disease’s symptoms.

Unfortunately, the earliest symptoms of mesothelioma are often ignored because they feel like common or minor health issues. In fact, it is common for an individual to experience symptoms for up to three months before seeking treatment and being diagnosed with mesothelioma.

Pleural mesothelioma is the most common form of the disease. Lower back pain and/or discomfort in the side of the chest, are very common early symptoms of this type of mesothelioma. Some people may experience cough, sweating, fever, exhaustion, weight loss and difficulty swallowing. People may also cough up blood and experience swelling of the face and arms, hoarseness, and weakness.

Symptoms of peritoneal mesothelioma are pain or discomfort in the abdomen (stomach/belly), vomiting, nausea and weight loss. Fluid may build up in the abdomen, or a mass may be detected.

The less common forms of mesothelioma – pericardial mesothelioma and tunica vaginalis mesothelioma – are harder to detect. In fact, tunica vaginalis mesothelioma is often misdiagnosed as a hernia, and not detected as cancer until the corrective surgical procedure is performed.

It is strongly recommended that individuals seek medical attention as soon as symptoms are detected. Once an individual sees a doctor, a series of tests will be performed to determine the cause of the symptoms. The first step in this process is conducting a thorough medical history to identify risks and to document all symptoms. People will be asked questions about their work history and their family’s medical history.

Those who have mesothelioma often develop fluid in the affected area. In the lungs, such fluid build up is called pleural effusion. In the abdomen, it is called ascites, and in the pericardium, it is called pericardial effusion. A physician will be able to diagnose fluid buildup when an exam is conducted, or through the use of diagnostic imaging. If there is fluid buildup, a sample of this fluid may be taken to test it for the presence of cancerous cells, and then to determine the type of cancer cells. This procedure is called an aspiration.

Imaging, such as an x-ray, Computed tomography (CT) scan, Positron emission tomography (PET) scan, or magnetic resonance imaging (MRI) scan, is often performed during the diagnostic process. These imaging techniques allow physicians to determine the size and location of the cancer, and if and where it has spread, or metastasized. If a tumor is detected through imaging, tissue samples may also be taken using a procedure called a thoracoscopy, a bronchoscopy, or a mediastinoscopy.

Chest x-rays can help physicians detect the effects of asbestos exposure, but this is not considered a way to detect mesothelioma. Research is currently being conducted about a blood test that assesses the amount of osteopontin in the blood. Osteopontin is a protein that occurs in higher levels in people whose lungs have been damaged by asbestos. Once a person develops mesothelioma, levels of this protein are even higher.

When a diagnosis of mesothelioma occurs, the next step is for a physician to “stage” the disease to classify the type/s of the body that are affected and how advanced the cancer is. There are several staging systems that are used, including the Butchart System, the TNM System and the Brigham System.

Next, the patient will work with his/her physician to determine the type of treatment that will be pursued. The most common forms of treatment are: chemotherapy, surgery, radiation, experimental therapies such as immunotherapy, or some combination of the above. Some individuals also choose to pursue holistic therapies related to changes in diet and breathing and movement techniques. Factors such as age, weight, general health and a patient’s wishes will determine the course of treatment.

Depending on the type of disease and whether or not it has spread beyond the primary site, treatments may be used to slow the progress or growth of the disease and/or to alleviate symptoms such as shortness of breath. Treatments are not considered curative (that is, they do not get rid of the cancer permanently), but they may extend an individual’s lifespan, and some individuals have lived with mesothelioma for many years.

Patient advocacy groups, such as the American Cancer Society, recommend that individuals and their families, or support systems, take time to learn more about the disease and the range of treatment options before deciding on a treatment path.

Early Symptoms of Mesothelioma

2011-09-12T00:53:00.001-07:00

Early Symptoms of Mesothelioma

In many mesothelioma cases, beginning symptoms are so minor that many do not believe there is enough reason to seek medical attention. In some instances, no early symptoms exist at all. Mesothelioma usually remains undiagnosed or missed for approximately two to three months and can even remain undiagnosed up to six months. The importance of seeking prompt medical attention for any of the symptoms associated with mesothelioma cannot be stressed enough. If you fail to receive a diagnosis and appropriate treatment, the cancer has a chance to develop and spread to other parts of the body.

Mesothelioma can develop after recent exposure to asbestos or up to 40 years after the exposure. If you have been exposed to asbestos, which causes mesothelioma, consult a doctor and seek regular medical screenings. Even a brief exposure can cause mesothelioma . A physician can perform a regular check up and lung screening to catch early stages of the disease. The earlier you catch mesothelioma, the less time it has to spread and the more likely you are to survive.

The first symptoms of mesothelioma are shortness of breath or breathlessness which may be accompanied by a heavy or uncomfortable feeling in the chest. Approximately 90% of mesothelioma patients will originally only have these two symptoms . Though these symptoms are vague and subtle, seek proper medical attention if you are experiencing them.

Pleural effusion causes the breathlessness and uncomfortable feeling in the chest. Pleural Effusion occurs when fluid accumulates within the lungs, making it difficult to bring oxygen into the body. If you have been exposed to asbestos and are experiencing these symptoms, see your doctor immediately.

The cancer most commonly develops in the chest cavity or lungs, referred to as pleural mesothelioma . It also commonly develop in the abdomen, called peritoneal mesothelioma. Depending on where the cancer has developed, symptoms may differ. Overlapping symptoms can be found in the majority of cases, regardless original tumor's location. Mesothelioma can also develop around the heart, though this is rare.

Symptoms of pleural mesothelioma include side and frontal chest pain, shortness of breath, back pain, fatigue, trouble swallowing, fever, a cough that does not go away and unexplained weight loss. Additional symptoms include facial and arm swelling, coughing up of blood, muscle weakness, a hoarseness in the voice and nausea.

Symptoms of peritoneal mesothelioma include swelling of the feet, abdominal pain and swelling, nausea, unexplained weight loss, bowel obstruction, vomiting, lower back pain, shortness of breath and anemia. The abdominal mass can also affect the liver, which controls bleeding, which is why blood-clotting abnormalities may occur. Extreme fatigue and muscle weakness have also been reported.

Although these symptoms may develop in early stages of the disease, many symptoms do not appear until later stages. In addition, you may also only experience a few of the symptoms, rather than all the ones mentioned above. See your doctor if you have developed any of these symptoms or if you have been exposed to asbestos.

Asbestosis is a benign condition that is very common among those experiencing asbestos exposure. Many believe they cannot develop mesothelioma without having asbestosis first. However, the cancer can develop without any prior benign disease or symptoms, making this theory a myth. Asbestosis has similar symptoms to mesothelioma, making it difficult to determine which disease you have without appropriate medical screening and diagnosis.

Once a tumor has been found, additional tests will be conducted to find out which type of mesothelioma you have. Treatment and prognosis vary with the different mesothelioma types, as well as the location. The three main types of mesothelioma are Mixed/Biphasic, Epithelioid and Sarcomatoid. Epithelioid, which is the most common, has the best long-term survival rate.

Symptoms of Mesothelioma

2011-09-12T00:52:00.001-07:00

Mesothelioma Symptoms

Mesothelioma symptoms may not appear until 30 to 50 years after asbestos exposure. Common symptoms of pleural mesothelioma include chest pain (caused by fluid accumulation in the pleura) and shortness of breath. Peritoneal mesothelioma symptoms may include weight loss, abdominal pain and swelling caused by fluid buildup in the abdomen. Additional peritoneal mesothelioma symptoms include blood clotting abnormalities, bowel obstruction, fever and anemia. If the cancer spreads beyond the mesothelium, symptoms may include difficulty swallowing, pain, or swelling of the face or neck.

These symptoms may be caused by mesothelioma or by less serious medical conditions. It is imperative to visit a physician concerning any of these symptoms.

Pleural Effusion Symptoms

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A pleural effusion occurs when fluid accumulates between the layers of the membrane that line the chest cavity and lungs.

The human body produces small amounts of pleural fluid to lubricate the surfaces of the pleura, which is the thin membrane that surrounds the lungs and lines the chest cavity. An abnormal collection of this fluid is called a pleural effusion.

Two different types of effusions can develop in humans. Transudative pleural effusions can be caused by abnormal lung pressure or congestive heart failure. Often caused by lung disease, exudative effusions occur when the pleura becomes inflamed. Examples of lung disease include pneumonia, lung cancer, tuberculosis, asbestosis, drug reactions and sarcoidosis.

Common symptoms of a pleural effusion include:

Shortness of breath
Cough
Chest pain (often a sharp pain that is worse with deep breaths or coughs)
Rapid breathing
Hiccups

However, in some cases, there may be no symptoms.

During a physical exam, a physician will listen to your breathing with a stethoscope and may tap on your chest to listen for dullness. Chest x-rays, ultrasounds of the chest, pleural fluid analysis, thoracentesis or a thoracic CT may help to confirm a diagnosis.

The type and cause of pleural effusion is usually determined by thoracentesis, where a fluid sample is taken from between the ribs with a needle.

Understanding the Symptoms of Mesothelioma

2011-09-12T00:51:00.000-07:00

what is Purchase structured Settlements

2011-09-12T00:46:00.000-07:00

You should know the basics of buying or selling a structured settlement before entering the contract.A structured settlement is a contract between two parties where one party receives financial payments from other parties in part or installment according to the terms and conditions of settlement. The most common form of structured settlement occurs when an insurance company agrees to pay large sums of money to an individual as a personal injury claim in part or as a regular installments as agreed between both parties.Structured settlements can also be agreed between the two companies in which a financial dispute resolved and the company agreed to pay a certain amount spread over a given period to another company pursuant to the settlement.Sell Structured SettlementIf you are receiving a structured settlement with another party, you will receive a total settlement amount in part or periodic installments according to the provisions of the settlement during a period of time.However, if you want to get a lump sum immediately rather than accept the money in small installments, you have the right to sell your structured settlement market. The proper way to create a structured settlement sale is to file a petition in court and asked for permission to sell the settlement.It is advisable to consult with an attorney who specializes in the transaction that can tell you about the pros and cons of such sales. Once you receive the green light from legal authorities, you can negotiate your sales with a variety of structured settlement buyers in the market.Finding Buyers for Structured SettlementsThere are a number of professional company engaged in the business buying structured settlements. Some financial institutions are also interested in the opportunity. This is a financial investment that provides a good return rate. Buyers bought out all the cash settlement for price discounts

Mesothelioma

2011-09-09T14:32:00.001-07:00

Mesothelioma

, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium. It is usually caused by exposure to asbestos.^[1]
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 pericardium (a sac that surrounds the heart),^[2] or the tunica vaginalis (a sac that surrounds the testis).

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos, 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.^[3] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers.^[4] Those who have been exposed to asbestos have collected damages for asbestos-related disease, including mesothelioma. Compensation via asbestos funds or lawsuits is an important issue in law practices regarding mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wallpain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with abiopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Contents

[hide]

· 1 Signs and symptoms

· 2 Cause

o 2.1 Environmental exposures

o 2.2 Occupational

o 2.3 Paraoccupational secondary exposure

o 2.4 Asbestos in buildings

· 3 Diagnosis

o 3.1 Staging

· 4 Screening

· 5 Pathophysiology

· 6 Treatment

o 6.1 Surgery

o 6.2 Radiation

o 6.3 Chemotherapy

o 6.4 Immunotherapy

o 6.5 Heated Intraoperative Intraperitoneal Chemotherapy

o 6.6 Multimodality Therapy

· 7 Epidemiology

· 8 Society and culture

o 8.1 Notable cases

o 8.2 Notable people who have lived for some time with mesothelioma

o 8.3 Legal issues

· 9 See also

· 10 References

o 10.1 Sources

o 10.2 Notes

· 11 External links

[edit]Signs and symptoms

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) 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 ofPeritoneal 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.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

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 (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

§ Abdominal pain

§ Ascites, or an abnormal buildup of fluid in the abdomen

§ A mass in the abdomen

§ Problems with bowel function

§ Weight loss

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

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

[edit]Cause

Working with asbestos is the major risk factor for mesothelioma.^[5] In the United States, asbestos is the major cause of malignant mesothelioma and has been considered "indisputably"^[6] associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor.^{[7][8][9][10]} A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.^[11]

Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and "permissible exposure limits" required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, they are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma.^[12] Likewise, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such "safe" threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.^[13] There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.^[14] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.^[6] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.^[6] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure.^[15][16] People who work with asbestos wear personal protective equipment to lower their risk of exposure.

Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years.^[6] In a review of occupationally related mesothelioma cases, the median latency was 32 years.^[17] Based upon the data from Peto et al., the risk of mesothelioma appears to increase to the third or fourth power from first exposure.^[14]

[edit]Environmental exposures

Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages — Tuzköy, Karain and Sarıhıdır. Initially, this was attributed to erionite, a zeolite mineral with similar properties to asbestos. Recently, however, detailed epidemiological investigation showed that erionite causes mesothelioma mostly in families with a genetic predisposition.^[18][19] The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.

[edit]Occupational

Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.

Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.

[edit]Paraoccupational secondary exposure

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.^[20][21] This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

[edit]Asbestos in buildings

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.

[edit]Diagnosis

CXR demonstrating a mesothelioma

CT scan of a patient with mesothelioma,coronal section (the section follows the plane that divides the body in a front and a back half). The mesothelioma is indicated by yellow arrows, the central pleural effusion(fluid collection) is marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney, (8) right kidney, (9) liver.

Micrograph of a pleural fluid cytopathology specimen showing mesothelioma.

Micrographs showing mesothelioma in a core biopsy.

Image of Metastatic mesothelioma

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 (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done bythoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial^{[disambiguation needed]} 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). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists.

Generally, a biopsy is needed to confirm a diagnosis of malignant 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. Alternatively, the chest surgeon might directly open the chest (thoracotomy). 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.

Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics. There are numerous tests and panels available. No single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant.

Typical immunohistochemistry results
Positive	Negative
EMA (epithelial membrane antigen) in a membranous distribution	CEA (carcinoembryonic antigen)
WT1 (Wilms' tumour 1)	B72.3
Calretinin	MOC-3 1
Mesothelin-1	CD15
Cytokeratin 5/6	Ber-EP4
HBME-1 (human mesothelial cell 1)	TTF-1 (thyroid transcription factor-1)

There are three histological types of malignant mesothelioma: (1) Epithelioid; (2) Sarcomatoid; and (3) Biphasic (Mixed). Epithelioid comprises about 50-60% of malignant mesothelioma cases and generally holds a better prognosis than the Sarcomatoid or Biphasic subtypes.^[22]

[edit]Staging

Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.^[23] TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged Ia–IV (one-A to four) based on the TNM status.^[23][24]

[edit]Screening

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.^[25] Doctors have begun testing the Mesomark assaywhich measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.^[26]

[edit]Pathophysiology

Diffuse pleural mesothelioma with extensive involvement of the pericardium.

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of thevisceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.

Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos,amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).^[6] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.^[27]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact withchromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality ismonosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

§ Neurofibromatosis type 2 at 22q12

§ P16^INK4A

§ P14^ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

§ Inactivation of tumor suppressor genes

§ Activation of oncogenes

§ Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region

§ Activation of DNA repair enzymes, which may be prone to error

§ Activation of telomerase

§ Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.

[edit]Treatment

The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments.^[28] Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. 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. The histological subtype and the patient's age and health status also help predict prognosis. The epithelioid histology responds better to treatment and has a survival advantage over sarcomatoid histology.^[29]

[edit]Surgery

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.^[28] However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). 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.

[edit]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. 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.

[edit]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.^[30] 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 group of patients treated with cisplatin in the combination with pemetrexed and who also 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; bothquality 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.^[31]

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.

[edit]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.^[32] 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.

This technique is also used in patients with malignant pleural mesothelioma.^[33]

[edit]Multimodality Therapy

All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors.^[34] However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years).^[28] Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.^[35] Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.^[36] Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.^[37]

[edit]Epidemiology

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year.^[38] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.^[39] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.^[40] Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.

[edit]Society and culture

[edit]Notable cases

Mesothelioma, though rare, has had a number of notable patients.

§ Malcolm McLaren, former manager of New York Dolls and Sex Pistols, died on 8 April 2010.

§ Billy Vaughn, American bandleader, died in 1991.

§ Hamilton Jordan, Chief of Staff for U.S. President Jimmy Carter and lifelong cancer activist, died in 2008.

§ Richard J. Herrnstein, psychologist and co-author of The Bell Curve, died in 1994.

§ 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, American architect, died in 1997.

§ Bernie Banton, an Australian workers' rights activist, 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 48 hours to live. Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007Australian federal election.

§ Actor 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 subsequently sought alternative treatments at 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 automobile racing suits (McQueen was an avid racing driver and fan).^[41]

§ United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder award is given yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.

§ Rock and roll musician and songwriter Warren Zevon, after a long period of untreated illness and pain, was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments that 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.^[42]Hennessy's mesothelioma has been attributed to his younger years spent working on building sites in London.^[43][44]

§ 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.^[45]

§ Australian journalist and news presenter Peter Leonard of Canberra succumbed to the condition on September 23, 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.

§ Merlin Olsen, Pro Football Hall of Famer and television actor, died on March 10, 2010, from mesothelioma that had been diagnosed in 2009.

[edit]Notable people who have lived for some time with mesothelioma

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote "The Median Isn't the Message"^[46] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma. Author Paul Kraus was diagnosed with peritoneal mesothelioma in July 1997. He was given a prognosis of less than a year to live and used a variety of complementary modalities. He continued to outlive his prognosis and wrote a book about his experience "Surviving Mesothelioma and Other Cancers: A Patient's Guide"^[47] in which he presented his philosophy about healing and the decision making that led him to use integrative medicine.

[edit]Legal issues

Main article: Asbestos and the law

The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.^[48] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation.^[49]

History

The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. In 1960, an article published by Wagner et al. was seminal in establishing mesothelioma as a disease arising from exposure to asbestos.^[50] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. Prior to the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.^[51] In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.^[52] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.

In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.

Despite proof that the dust associated with asbestos mining and milling causes asbestos-related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western AustralianGovernment decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.

By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.

In Leeds, England the Armley asbestos disaster involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company's factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.^[

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