Mesothelioma

What is Mesothelioma?

noreply@blogger.com (duyduy) — Sun, 16 May 2010 06:05:00 +0000

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body’s internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

# What is the mesothelium?

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

# What is mesothelioma?

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

Mesothelioma is a form of cancer that is almost always caused by previous 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 chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products. Unlike lung cancer, there is no association between mesothelioma and smoking.

Integrative Medicine

noreply@blogger.com (duyduy) — Fri, 25 May 2007 14:42:00 +0000

Most people have heard the terms "complementary" and "alternative" medicine. Now, a new term has evolved "integrative" medicine, and over the past several years, major cancer facilities across the country have begun incorporating this approach into their patient care.

Integrative medicine combines the very best of mainstream conventional therapies such as cutting-edge surgery, chemotherapy and radiation with appropriate complementary therapies proven to have sound scientific evidence as to their safety and effectiveness. It is care that extends not only to the patient's body, but to their mind and spirit as well. Complementary medicine may help ease stress and may help patients cope with side effects such as nausea, pain and fatigue common to many standard treatments.

Complementary medicine falls into five general categories as classified by the National Center for Complementary and Alternative Medicine (a component of the National Institutes of Health):

* Alternative Medical Systems are those which have evolved over many years in different cultures and parts of the world. Some examples include homeopathic and naturopathic medicines in Western culture and Ayurveda and Chinese traditional medicine in non-Western cultures.

* Biologically Based Therapies focus on things found in nature such as food, herbs and vitamins, as well as dietary supplements, herbal products and "natural" but scientifically unproven products.

* Energy Therapies subscribe to the belief that the body has energy fields that can be used to attain wellness. Examples are Tai Chi, Reiki and therapeutic touch.

* Manipulative and Body-Based Therapies are based on the manipulation and/or movement of one or more parts of the body, such as in chiropractic manipulation or massage therapy.

* Mind-Body Therapies use the premise that the mind can affect the body's functions and improve symptoms. Some examples are biofeedback, hypnosis, imagery, meditation and yoga. Also included in this category are expressive therapies such as art, dance and music.

While many cancer centers now offer classes in the some of the techniques listed above, not every choice is right for every patient. If you are considering some type of complementary treatment, discuss these options completely and openly with your doctor. While some choices may be beneficial, care needs to be taken that nothing interferes with your standard treatment or is unsafe in your particular case. If your doctor approves, ask for a referral to a qualified practitioner who has the proper credentials and training. Ask what benefits you might expect from the therapy, and what, if any, the potential risks and side effects might be.

Gene therapies

noreply@blogger.com (duyduy) — Thu, 24 May 2007 16:58:00 +0000

Targeted Therapy: Gene therapies

Cancer results from either the over expression of the oncogenes or the tumor suppressor genes becoming ineffective. The tumor suppressor genes which keeps a check on the development of cancer can be either defective or missing which results in the development of cancer. Gene therapy can be used either to block the oncogenes or replace the missing or the defective tumor suppressor genes. Gene therapy can also be used to make the conventional chemotherapy and the radiotherapy more effective against the cancer cells. It can also be used to protect the normal cells so that the conventional therapies can be used at a higher dose to destroy the cancer cells. Gene therapies are divided in to three groups.

* Replacing defective or missing tumor suppressor gene
* Blocking oncogenes
* Modification of the genetic information

Replacing defective or missing tumor suppressor gene

The tumor suppressor genes control cell replication. When this gene is missing or defective, the cells multiply indefinitely, causing cancer. The therapy involving replacement of tumor suppressor genes is still in the experimental stage and involves injecting the genes directly in to the cancer tissue. So far, results have not been uniform in tests.

Blocking oncogenes

Oncogenes are genes associated with cancer development. When mutated or over-expressed they can result in a malignancy. Agents used to fight this development include:

--Antisense oligonucleotides – They are smaller synthetic pieces of DNA and RNA. They attach to complementary sites especially the messenger RNA in the tumor genes and prevent their expression. This controls the development and growth of tumors. But these agents are not very effective as they concentrate poorly in the cancer tissue.

--Ribozymes – These are enzymes which are involved in cleaving the RNA and thus prevent the expression of genes. This is used mainly to cleave the RNA Bcr-Abl gene which is involved in chronic myelogenous leukemia. Again these agents have not proven effective as they concentrate poorly in the cancer tissue.

Modification of genetic information

Under this modality the genetic information of the cancer cells are modified to make them susceptible to conventional anti-cancer therapy and also to modify the genetic information of the normal cells so that they are protected against the effects of the conventional anti-cancer therapy.

This modality of treatment has three categories.

--Immunomodulatory gene therapy – Tumor cells are retrieved, irradiated and transduced with cytokines like interleukin 2. When reintroducted, the tumor cells synthesize immunoregulatory cytokines, causing tumor rejection.

--Suicide gene therapy – Specific viruses are used which infect only the cancer cells. This virus carries an enzyme with it. This enzyme converts the chemotherapeutic pro-drug in to active drug. So when then the conventional chemotherapy is given, it gets accumulated in the cancer cells where it gets activated and destroys the cancer cells.

--Chemoprotection – Cells from the bone marrow are taken and transduced with genes to confer drug resistance and introduced back in to the patient. When conventional chemotherapy is administered, the patient's body better withstands the effects. Chemoprotection is still in the experimental stages.

Anti angiogenesis Drugs

noreply@blogger.com (duyduy) — Tue, 22 May 2007 16:25:00 +0000

Angiogenesis and Anti-angiogenesis Drugs

Although progress has been made in the early detection of cancer, and in improved treatment options once cancer is diagnosed, there are still many cancers, including mesothelioma, which can not be cured and remain difficult to treat effectively. In recent years, researchers have learned a great deal about how cancer cells differ from normal cells and, in an effort to find drugs without the potentially severe side effects of chemotherapy, have now discovered drugs which target the tumor itself while sparing the body’s normal cells. One such group are the anti-angiogenesis drugs.
What is angiogenesis?

The term “angiogenesis” refers to the formation of new blood vessels. During the human growth process, the body needs new blood vessels to supply blood to all the cells of the body, however in someone with cancer, this identical process creates blood vessels that supply the tumor with the oxygen and nutrients it needs to grow, spread and establish new colonies of cancer cells.
Why do tumors require their own blood supply?

A tumor begins as a single cell that becomes “malignant” and then goes on to rapidly divide, forming multiple cancer cells. Early on, these cells use nearby blood vessels to supply nourishment, but as the tumor grows, some cells may be further from the blood supply. In order to continue tumor growth, new blood vessels must be formed.
What is anti-angiogenesis treatment?

Anti-angiogenesis is a targeted therapy using drugs or other substances to prevent tumors from creating new blood vessels, thus, stopping the growth of the tumor. Researchers are currently studying both natural and synthetic anti-angiogenesis inhibitors, and although many of these drugs are still available only in clinical trials, the first anti-angiogenesis drug, bevacizumab (Avastin), was approved by the Food and Drug Administration in February, 2004, for use in the treatment of metastatic colon cancer. A Phase II clinical trial of cisplatin, pemetrexed and bevacizumab for untreated mesothelioma and a Phase II trial of bevacizumab and erlotinib for previously treated mesothelioma are ongoing, and trials of other anti-angiogenesis agents are being tested in mesothelioma as well.
How do anti-angiogenesis drugs work?

Anti-angiogenesis drugs do not directly attack cancer cells, but target the blood supply necessary for survival and growth of the tumor. In this way, they may prevent new tumors from forming, and cause existing tumors to shrink.

One of the most important proteins in the growth of new blood vessels is called vascular endothelial growth factor or VEGF, which is secreted by some cancer cells. It appears that VEGF plays an important role in the growth of mesothelioma. VEGF attaches to a protein, or VEGF receptor, on the surface of nearby endothelial cells, and then signals the cell’s control centers to begin growth and formation of new blood vessels. Many of the anti-angiogensis drugs currently being tested attack this VEGF pathway, including bevacizumab (Avastin) which is a synthetic version of an immune system protein that binds to VEGF and prevents it from reaching the VEGF receptor. Other drugs, such as sorafenib (Nexavar) are small molecules that attach directly to the VEGF receptor and prevent it from being activated.
How is anti-angiogenesis treatment different from traditional chemotherapy?

Traditional chemotherapy drugs work by attacking cells in the body that divide rapidly. Unfortunately, some normal cells such as those in the mouth or the digestive system, also divide rapidly and can not be differentiated from malignant cells. This can lead to side effects including mouth sores, nausea and diarrhea. Anti-angiogenesis drugs do not target normal cells, so in many cases, side effects are milder. They can have their own side effects however, and because many drugs are still being evaluated in the clinical trial system, it is not yet known whether side effects will be similar for all drugs in this class. If enrolling in a clinical trial that involves anti-angiogenesis drugs, your doctor will explain what side effects may be encountered.
Are anti-angiogenesis drugs ever combined with other chemotherapy drugs?

There is some reason to believe that standard chemotherapy drugs and anti-angiogenesis drugs may work well in combination. In early clinical trials of bevacizumab (Avastin), it was determined that bevacizumab alone did not help cancer patients live longer. In subsequent studies, however, it was found that when combined with other chemotherapy drugs it was more effective.
Is continued research being done on anti-angiogenesis drugs?

In the clinical trial system, there are currently hundreds of anti-angiogenesis drugs being studied. Some of these drugs are being tested as single agents, while others are being used in combination with other treatments. Drugs that are in the early stages of trials often carry a letter and/or number designation, while those in later trials may be listed by name. There are several trials of anti-angiogenesis drugs now enrolling patients with malignant mesothelioma.

New Approaches

noreply@blogger.com (duyduy) — Tue, 22 May 2007 16:22:00 +0000

New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include:

* Angiogenesis and Anti-angiogenesis Drugs

Although progress has been made in the early detection of cancer, and in improved treatment options once cancer is diagnosed, there are still many cancers, including mesothelioma, which can not be cured and remain difficult to treat effectively. In recent years, researchers have learned a great deal about how cancer cells differ from normal cells and, in an effort to find drugs without the potentially severe side effects of chemotherapy, have now discovered drugs which target the tumor itself while sparing the body’s normal cells. One such group are the anti-angiogenesis drugs.

* Immunotherapy, sometimes called biological therapy, uses the body's own immune system to protect itself against disease. Researchers have found that the immune system may be able to recognize the difference between healthy cells and cancer cells, and eliminate those that become cancerous. Immunotherapy is designed to repair, stimulate, or enhance the immune system's natural anticancer function.

Substances used in immunotherapy, called biological response modifiers (BRMs) alter the interaction between the body's immune defenses and cancer, thereby improving the body's ability to fight disease. Some BRMs, such as cytokines and antibodies, occur naturally in the body, however, it is now possible to make BRMs in the laboratory that can imitate or influence natural immune response agents. These BRMs may:

* Enhance the immune system to fight cancer cell growth.
* Eliminate, regulate, or suppress body responses that permit cancer growth.
* Make cancer cells more susceptible to destruction by the immune system.
* Alter cancer cell's growth patterns to behave like normal cells.
* Block or reverse the process that changes a normal cell into a cancer cell.
* Prevent a cancer cell from spreading to other sites.

Many BRMs are currently being used in cancer treatment, including interferons, interleukins, tumor necrosis factor, colony-stimulating factors, monoclonal antibodies, and cancer vaccines.
More on immunotherapy for mesothelioma.

* Photodynamic therapy (PDT) is a type of cancer treatment based on the premise that single-celled organisms, if first treated with certain photosensitive drugs, will die when exposed to light at a particular frequency. PDT destroys cancerous cells by using this fixed frequency light to activate photosensitizing drugs which have accumulated in body tissues.

In PDT, a photosensitizing drug is administered intravenously. Within a specific time frame (usually a matter of days), the drug selectively concentrates in diseased cells, while rapidly being eliminated from normal cells. The treated cancer cells are then exposed to a laser light chosen for its ability to activate the photosensitizing agent. This laser light is delivered to the cancer site, (in the case of mesothelioma, the pleura), through a fiberoptic device that allows the laser light to be manipulated by the physician. As the agent in the treated cells absorbs the light, an active form of oxygen destroys the surrounding cancer cells. The light exposure must be carefully timed, so that it occurs when most of the photosensitizing drug has left the healthy cells, but is still present in cancerous ones.

The major side effect of PDT is skin sensitivity. Patients undergoing this type of therapy are usually advised to avoid direct and even indirect sunlight for at least six weeks. Other side effects may include nausea, vomiting, a metallic taste in the mouth, and eye sensitivity to light. These symptoms may sometimes come as a result of the injection of the photosensitizing agent.

* Gene therapy is an approach to treating potentially fatal or disabling diseases by modifying the expression of an individual's genes toward a therapeutic goal. The premise of gene therapy is based on correcting disease at the DNA level and compensating for the abnormal genes.

Replacement gene therapy replaces a mutated or missing gene, most often a tumor suppressor gene, with a normal copy of that gene which serves to keep cell growth and division under control. The p53 gene, the most common gene mutated in cancer has become a prime target for gene replacement, and has met with some success in inhibiting cell growth, inhibiting angiogenesis (the development of a tumor's blood supply), and inducing apoptosis (cell death).

Knockout gene therapy targets the products of oncogenes (a gene that can induce tumor formation) in an effort to render them inactive and reduce cell growth.

With constantly expanding knowledge of the genes associated with cancer, their functions, and the delivery systems used in administering these genes, gene therapy has a promising future.

# Complementary and alternative medicine covers a wide range of healing philosophies that conventional medicine does not commonly accept or make available to its patients. Some of these practices include the use of acupuncture, herbs, homeopathy, therapeutic massage, and Far Eastern medicine to treat health conditions.

These therapies may be used alone as an alternative to conventional medicine, or in addition to conventional medicine, in which case they are referred to as complementary. Many are considered holistic, meaning their focus is to treat the whole patient - physically, mentally, emotionally, and spiritually. These treatments are not widely taught as a part of the medical curriculum, are not generally used in hospitals, and, for the most part, are not covered under insurance policies.

Many cancer patients try various complementary and/or alternative medicine techniques during the course of their treatment, and although they may not work for everyone, some patients benefit by managing their symptoms or side effects. One important caveat, is to discuss any complementary or alternative treatments you may be considering with your doctor to be sure nothing interferes with your conventional care. For instance, dietary supplements such as herbs or vitamins may be "natural", but not necessarily "safe". They may lessen the effectiveness of certain anticancer drugs, or when taken with other drugs or in large doses, may actually cause harm. Since supplements of this nature are not governed by the FDA (Food and Drug Administration), and a prescription is not necessary to purchase, it is up to the consumer to make informed and conscientious decisions regarding their use.

Your personal physician may be able to advise you about the use of complementary and alternative treatments and therapies, and how they relate to mesothelioma.
The combinaton of complementary and conventional therapies is sometimes referred to as integrative medicine.

Tomotherapy

noreply@blogger.com (duyduy) — Mon, 21 May 2007 15:10:00 +0000

The field of radiation oncology changes rapidly as new and better methods of treatment are found. Many of these changes are the result of enhanced computer applications and their integration into diagnostic imaging and dose delivery equipment. The newest concept in this regard is called helical tomotherapy, which allows the radiation oncologist to deliver radiation therapy to the patient with surgical precision. This translates into more effective treatment of the tumor while sparing healthy tissue and significantly reducing side effects.

Basically a combination of spiral CT scanning and Intensity Modulated Radiation Therapy (IMRT), this state-of-the-art technology is now being used at a growing number of facilities nationwide. Following is a brief description of steps in the helical tomotherapy process.

* 3-D imaging is generally performed with standard CT imaging equipment.

* The radiation oncologist uses special software to establish the contours for each target volume and identifies organs or structures at risk. The doctor then decides what dose the target area(s) should receive as well as what dose(s) will be acceptable to the organs or structures at risk.

* The 3-D data and the contours of the target volume and organs or structures at risk are transferred to the tomotherapy treatment planning computer which performs delivery optimization calculations including leaf positions for the gantry angles and couch positions for the patient.

* Computer planning data is transferred to the tomotherapy unit for delivery implementation.

* A CT scan is taken just prior to treatment to verify the anatomical targets and patient position. This affords the opportunity to make any necessary adjustments and ensure correct dose delivery.

* After verification of the above, the dose is delivered to the patient. The radiation is produced by a linear accelerator (linac) which travels in circles around the gantry ring. The linac moves in unison with a multileaf collimator (MLC). The leaves of the collimator move in and out rapidly to modulate the radiation beam leaving the accelerator. Concurrently, the patient couch is being guided slowly through the center of the gantry ring. Each time the accelerator circles, the radiation beam is directed at a slightly different plane.

* While treatment is in progress, the amount of actual radiation to the patient is measured so that dose delivery can be verified and compared to the planned dose. If necessary, adjustments can be made for subsequent treatments.

Radiation Therapy

noreply@blogger.com (duyduy) — Mon, 21 May 2007 14:56:00 +0000

Radiation therapy, also called radiotherapy, treats cancer by using penetrating beams of high energy or streams of particles called radiation. In treating mesothelioma, radiation may be used aggressively in combination with surgery, or palliatively to control symptoms.

In an aggressive combined modality approach, radiation is used to attack microscopic or residual disease remaining in the chest cavity after extrapleural pnuemonectomy. An example of this is Intensity Modulated Radiation Therapy (IMRT), which uses x-rays of varying intensities in conjunction with computer generated images to deliver targeted radiation directly to cancer cells while reducing the amount of radiation to surrounding healthy tissue.

Used palliatively, radiation can help control metastases (spread) of the tumor along tracks left by invasive procedures such as thoracoscopy, needle biopsy and chest tube drainage, or to control disease symptoms, such as pain or shortness of breath.

An exciting new development in radiation oncology is Tomotherapy.

Chemotherapy

noreply@blogger.com (duyduy) — Sun, 20 May 2007 13:05:00 +0000

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:

* To control the cancer by stopping its spread or slowing its growth.
* To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
* To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
* To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.

The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a new drug recently approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.

* Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.
* The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.

Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.

Side Effects of Chemotherapy

Cancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects, the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis.

Note to Patients:

Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.

1. It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
These may include:
* Fever of, or greater than 101 degrees
* Nausea or vomiting
* Diarrhea or constipation
* Fatigue
* Tingling or numbness in the fingers or toes
* Ringing in the ears
* Bruises or rashes
* Sores in the mouth or throat

2. Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.

3. Take extra care with your daily health.
Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.

Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.

4. Be open about your feelings regarding your treatment.
It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.

Surgery

noreply@blogger.com (duyduy) — Sat, 19 May 2007 13:10:00 +0000

Diagnostic Procedures

As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Palliative Procedures

Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.

Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.

Potentially Curative Procedures

These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.

For Pleural Mesothelioma:

* Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.

* Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.

For Peritoneal Mesothelioma:

* Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma.

Traditional Care

noreply@blogger.com (duyduy) — Sat, 19 May 2007 13:02:00 +0000

There are three traditional kinds of treatment for patients with malignant mesothelioma:

* Surgery (taking out the cancer)
* Chemotherapy (using drugs to fight the cancer)
* Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

Often two or more of these are combined in the course of treatment.

Time Matters

noreply@blogger.com (duyduy) — Sat, 19 May 2007 12:57:00 +0000

The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope and the patient’s age and desires.

Time Matters

People diagnosed with this disease are often told the expected survival rate is only eight to twelve months. However, specialists in treating malignant mesothelioma at the leading cancer centers often have better statistics.

Mesothelioma Stages

noreply@blogger.com (duyduy) — Fri, 18 May 2007 14:31:00 +0000

Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use for pleural mesothelioma and each one measures somewhat different variables; peritoneal mesothelioma is not staged.

The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages. The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.

Butchart System – extent of primary tumor mass

* Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
* Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
* Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
* Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.

TNM System - variables of T (tumor), N (lymph nodes), M (metastasis)

* Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
* Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
* Stage III: Mesothelioma is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
* Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

Brigham System (variables of tumor resectability and nodal status)

* Stage I: Resectable mesothelioma and no lymph node involvement
* Stage II: Resectable mesothelioma but with lymph node involvement
* Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
* Stage IV: Distant metastatic disease

Mesothelioma Cause

noreply@blogger.com (duyduy) — Thu, 17 May 2007 15:50:00 +0000

At some point in our lives, nearly all of us have been exposed to asbestos in the air we breathe and the water we drink; from natural deposits in the earth, and from the deterioration of asbestos products around us. Most of us, however, do not become ill as a result of our exposure. More commonly, those who at some point are diagnosed with asbestos disease, have worked in jobs where more substantial exposure occurred over longer periods of time. Nevertheless, cases of mesothelioma have been documented as the result of lesser exposure, affecting family members of workers who came into contact with asbestos and brought it home on their clothing, skin or hair, or affecting those who lived in close proximity to asbestos manufacturing facilities. Symptoms of asbestos disease usually are not be apparent until decades after exposure.

Asbestos was used commercially in North America as early as the late 1800s, but its use increased dramatically during the World War II era when shipyards produced massive numbers of ships for the war effort. Since that time, asbestos-containing products were used by the construction and building trades, the automotive industry and the manufacturing industry. All told, more than 5,000 products contained asbestos.

For more than 50 years, products containing asbestos remained unregulated, and the manufacturers of those products continued to prosper, knowing full well that many of the millions of workers who came into contact with their products would ultimately suffer as the result of their actions. Finally, in the late 1970s, the Consumer Products Safety Commission banned the use of asbestos in wallboard patching compounds and artificial ash for gas fireplaces because the fiber could easily be released during use. In 1989, the Environmental Protection Agency banned all new use of asbestos, but uses established prior to that time were still allowed. Although awareness of the dangers of asbestos and public concern over the issue have led to a decline in domestic consumption over the years, a total ban on asbestos has not come to fruition. Asbestos is still imported, still used and still dangerous.

Although it is suggested that the number of mesothelioma cases in the U.S. has reached its peak and has begun to drop, a forecast released by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER), in April, 2003, projected the total number of American male mesothelioma cases from 2003-2054 to be approximately 71,000. This number, however, does not take into consideration events such as the World Trade Center disaster on September 11, 2001, when millions of New Yorkers were potentially exposed to air filled with carcinogenic asbestos particles. When the latency period for asbestos disease is factored in, cases of mesothelioma will continue to be diagnosed for years to come.

Diagnosis

noreply@blogger.com (duyduy) — Thu, 17 May 2007 05:29:00 +0000

How is mesothelioma diagnosed?

A diagnosis of mesothelioma is most often obtained with careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. A review of the patient's medical history, including history of asbestos exposure is taken, followed by a complete physical examination, x-rays of the chest or abdomen, and lung function tests. A CT scan or MRI may also be done at this time. If any of these preliminary tests prove suspicious for mesothelioma; a biopsy is necessary to confirm this diagnosis.

Imaging Techniques and Their Value in Diagnosing and Assessing Mesothelioma

There are several imaging techniques which may prove useful when mesothelioma is suspected due to the presence of pleural effusion combined with a history of occupational or secondary asbestos exposure. While these imaging techniques can be valuable in assessing the possibility of the cancer, definitive diagnosis is still most often established through fluid diagnosis or tissue biopsy.

Some of the most commonly used imaging methods include:

• X-ray

A chest x-ray can reveal pleural effusion (fluid build-up) which is confined to either the right (60%) or left (40%) lung. On occasion, a mass may be seen. Signs of prior non-cancerous asbestos disease, such as pleural plaques or pleural calcification, or scarring due to asbestosis may also be noted.

• Computed Tomography (CT)

CT scans are also able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures, or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease (pleural disease), or differentiate between adenocarcinoma of the lung which may have spread to the pleura verses mesothelioma. CT scans may also be valuable in guiding fine needle aspiration of pleural masses for tissue diagnosis.

• Magnetic Resonance Imaging (MRI)

MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes (those lymph nodes which lie between the two lungs), as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy.

• Positron Emission Tomography (PET)

PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. While PET scans are more expensive than other types of imaging, and are not always covered under insurance, they are now considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma.

• CT/PET

For patients who may be candidates for aggressive multimodality treatment (surgery, chemotherapy and radiation), accurate clinical staging is extremely important. Integrated CT/PET imaging provides a relatively new tool in this respect, and has become the imaging technique of choice for determining surgical eligibility. By combining the benefits of CT and PET (anatomic and metabolic information) into a single scan, this technology can more accurately determine the stage of the cancer, and can help identify the best treatment option for the patient.

A needle biopsy of the mass, or the removal and examination of the fluid surrounding the lung, may be used for diagnosis, however, because these samples are sometimes inadequate as far as determining cell type (epithelial, sarcomatous, or mixed) or because of the unreliability of fluid diagnosis, open pleural biopsy may be recommended. In a pleural biopsy procedure, a surgeon will make a small incision through the chest wall and insert a thin, lighted tube called a thoracoscope into the chest between two ribs. He will then remove a sample of tissue to be reviewed under a microscope by a pathologist. In a peritoneal biopsy, the doctor makes a small incision in the abdomen and inserts a peritoneoscope into the abdominal cavity.

Once mesothelioma is suspected through imaging tests, it is confirmed by pathological examination. Tissue is removed, put under the microscope, and a pathologist makes a definitive diagnosis, and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid build-up or pleural effusions, shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an x-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:

* Video-Assisted Thoracoscopic Surgery (VATS)

Over the past decade, the use of video-assisted thoracic surgery (VATS) has become one of the most widely used tools in the diagnosis of mesothelioma. Biopsies of the pleural lining, nodules, masses and pleural fluid can now easily be obtained using this minimally invasive procedure, and other therapies such as pleurodesis (talc) for pleural effusions can be done concurrently.While the patient is under general anesthesia, several small incisions or “ports” are made through the chest wall. The surgeon then inserts a small camera, via a scope, into one incision, and other surgical instruments used to retrieve tissue samples into the other incisions. By looking at a video screen showing the camera images, the surgeon is able to complete whatever procedures are necessary

In many cases, this video-assisted technique is able to replace thoracotomy, which requires a much larger incision to gain access to the chest cavity, and because it is minimally invasive, the patient most often has less post-operative pain and a potentially shorter recovery period.

* Thoracoscopy

For pleural mesothelioma the doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test is usually done in a hospital with a local anesthetic or painkiller.

If fluid has collected in your chest, your doctor may drain the fluid out of your body by putting a needle into your chest and use gentle suction to remove the fluid. This is called thoracentesis.

* Peritoneoscopy

For peritoneal mesothelioma the doctor may also look inside the abdomen with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is usually done in the hospital under a local anesthetic.

If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.

* Biopsy

If abnormal tissue is found, the doctor will need to cut out a small piece and have it looked at under a microscope. This is usually done during the thoracoscopy or peritoneoscopy, but can be done during surgery.

Pathology and The Role of Pathologists in the Diagnostic Process

Pathology, or the scientific study of cells, tissue, or fluid taken from the body is an integral part of a mesothelioma diagnosis. Most hospitals have their own pathology labs staffed by board-certified pathologists and licensed technologists. The importance of pathological diagnosis can not be underestimated, since the course of treatment is dependent upon an accurate diagnosis.

To make a diagnosis, pathologists examine tissue under a microscope, and based on established criteria, make a determination of benign vs. malignant cells. Subsequently, the type of cancer is determined. Although most pathologists have a general expertise of various diseases, a small number acquire training in a subspecialty, such as mesothelioma. These are physicians who have received world-wide recognition as premier experts, and have achieved high acclaim for their research, published articles and abstracts, and teaching.

Knowing the stage is a factor in helping the doctor form a treatment plan. Mesothelioma is considered localized if the cancer is confined to the pleura, or advanced if it has spread beyond the pleura to other parts of the body such as the lungs, chest wall, abdominal cavity, or lymph nodes.

Signs and symptoms

noreply@blogger.com (duyduy) — Wed, 16 May 2007 09:56:00 +0000

Mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. 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.

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

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.

Increased risk

noreply@blogger.com (duyduy) — Wed, 16 May 2007 09:47:00 +0000

Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. 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 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 U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. 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 fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

Risk Factor

noreply@blogger.com (duyduy) — Wed, 16 May 2007 07:56:00 +0000

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the air passageways in the lung.