Mesothelioma Caner

Mesothelioma is a rare form of cancer that attack the layers of mesothelial cells, which form the thin lining (mesothelium) of the lung, chest, abdomen, and heart organs. The role of the mesothelium is to protect these organs by producing a lubricating fluid. The mesothelium found in the chest cavity is called the pleura and the mesothelium in the abdominal cavity is referred to as the peritoneum. The mesothelium that surrounds the heart is known as the pericardium. Almost all cases of mesothelioma are linked to exposure to asbestos. Mesothelioma affects roughly 2,500-3,000 people in the United States per year. It can be difficult to diagnose mesothelioma because many of the mesothelioma symptoms are similar to those of a number of other conditions, including lung cancer, viral pneumonia, stomach cancer and heart disease. This disease is extremely threatening as it has a long latency period and can lie dormant for up to 50 years after exposure. There are three main types of malignant mesothelioma: pleural mesothelioma, peritoneal mesothelioma and pericardial mesothelioma. In addition, malignant mesotheliomas are divided into three main “cell types”.

* Note: The time between first exposure to a cancer-causing agent and clinical recognition of the disease is called the latency period.

Pleural Mesothelioma

Is the most common form of mesothelioma accounting for roughly 70% of all mesothelioma diagnoses. Pleural mesothelioma begins in the chest cavity and affects the lungs. The most common way for pleural mesothelioma to present itself is through pleural effusion. The initial symptoms that a patient will experience due to the pleural effusion are dyspnea (difficulty breathing), chest pain and/or persistent cough some patients show no symptoms at all. Less common symptoms include fever, night sweats and weight loss.

Peritoneal Mesothelioma

Is the second most common form of mesothelioma and begins in the peritoneum. Peritoneal mesothelioma is sometimes referred to as “abdominal mesothelioma”. Symptoms of peritoneal mesothelioma: may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

Pericardial Mesothelioma

Is the rarest form of mesothelioma and affects the heart. Pericardial mesothelioma is found in about 5% of all mesothelioma cases. Symptoms of pericardial mesothelioma: may include shortness of breath, irregular heartbeat, heart palpitations and chest pain.

Cell Types

Malignant mesotheliomas are divided into three main cell types: epithelioid, sarcomatoid or fibrous and mixed type or biphasic.

Treatment of Mesothelioma

While a variety of treatments are currently available. Only a doctor or, preferably a mesothelioma specialist will be able to determine appropriate treatment action for an individual patient. Mesothelioma Cancer Treatment programs are designed based on factors such as: A patient’s age, health condition, date of diagnosis, Types of Disease Mesothelioma ( Pleural mesothelioma ,  Peritoneal mesothelioma or pericardial mesothelioma) and stage to which the cancer has spread. Treatments may include, radiation therapy, chemotherapy, surgery, clinical trials, drug therapy or a combination thereof (called multimodal treatment).


Radiation therapy uses high energy x-rays to damage or kill cancer cells. Though it is not a cure for mesothelioma, radiation therapy may be used to delay the cancers growth. When used in combination with surgery, radiation therapy is referred to as adjuvant radiation and can be used to destroy small deposits of cancer that may have been missed in surgery.

External beam radiation uses radiation delivered from outside the body. During treatment, a machine similar to an x-ray machine directs intense beams of light from outside the body at the cancer. It is the most commonly used form of radiation used in the treatment of mesothelioma.

Brachytherapy involves placing sources of radiation inside the body. Radioactive sources are positioned in the patient’s abdomen or chest, either close to, or inside the tumor itself.

Chemotherapy uses drugs or chemical agents to treat cancer. A doctor or mesothelioma specialist may recommend a single drug, or a combination of drugs. Chemotherapy drugs are systemic, meaning that the drugs are designed to enter the bloodstream and then circulate throughout the patient’s body or ’system’ to destroy the cancer cells. The drugs may be injected by needle into a vein or muscle or swallowed in pill form. In treating mesothelioma specifically, these drugs may also be given directly into the chest cavity (intrapleurally), or into the abdominal cavity (intraperitoneally). While not a cure for mesothelioma, chemotherapy may help delay the progression of the cancer.

Surgery may be used in one of two ways: as a palliative treatment (to relieve pain and discomfort caused by the disease) or, as a curative treatment (to cure or slow the progression of mesothelioma). Surgery may be performed in conjunction with other radiation or chemotherapy treatments, this is known as “multi-modal therapy.” Whether surgery is indicated depends on many factors, including the patient’s medical history, the health of the patient and the location and stage (extent to which the cancer has spread) and cell type of the cancer.

Pleural Mesothelioma Surgery Options

Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. The goal with pleurodesis is to close the space between the lung and the lung lining, reducing the potential for fluid accumulation. There are two approaches to performing pleurodesis. In the first, a tube that is inserted into the chest in order to drain excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as talc (see below), is injected through the chest tube and into the pleural space. The second method, called thoracentesis uses thoracoscopy, whereby a small incision is made in the chest and a thoracoscope, which is an instrument similar to a telescope and is connected to a video camera, is passed through the incision and inserted in the area of the tumor to get a better look at the pleura. The sclerosing agent is then applied

The Role of Talc
Pleurodesis is the most commonly used method for preventing pleural effusion in the future after the fluid has been drained. The typical form of pleurodesis is by blowing talc or a talc slurry into the lungs while the doctor is using an endoscope to view the inside of the lungs. After the slurry is inside, the patient needs to rotate into six different positions over the next hour and a half to make sure the slurry covers all parts of the inside of the lung. The talc then helps macrophages accumulate which in turn assists in coagulation and prevention of future pleural fluid accumulation.

Pleurectomy/decortication involves removing the affected pleura where the tumor is located, thus freeing the underlying lung and allowing it to fill the pleural cavity. The literal meaning of this term is the stripping away of a rind. This procedure is typically referred to as a “palliative treatment”, meaning that its goal is to help to ease the discomfort caused by the pleural effusion caused by mesothelioma.

Pneumonectomy
Is the removal of all or part of the lung and surrounding tissues.

Extrapleural pneumonectomy (EPP)
EPP is a procedure that may involve the removal of the lung, pleura or pericardium and/or surrounding tissue. This operation is intended to remove all or most of the cancer and some surrounding tissue as well that may have been affected. It is an extensive procedure that requires the patient to be in good health.

Peritoneal Mesothelioma Surgery Options
Paracentesis
Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Sometimes referred to as an “ascitic tap”, paracentesis helps relieve pressure from the other internal organs and reduces the risk of infection caused by the fluid buildup.

Peritonectomy is a surgery that involves the removal of the affected peritoneum (abdominal lining), housing the mesothelioma. This form of surgery is commonly utilized in cases where the cancer is detected early.

Laparotomy
In this procedure, a surgeon opens the abdominal cavity and removes as much of tumor as possible.

Surgery Options for Pericardial Mesothelioma
If pericardial tumors have not metasticized (spread) to the lungs, abdomen or lymph nodes, surgery may be used to successfully remove most or all of the cancerous tissue.

Pericardiocentesis
In this procedure, a needle is inserted into the pericardium (the membrane lining the heart) in order to drain the fluid out of the affected area. This helps to relieve circulatory problems and the discomfort associated with pericardial mesothelioma.

In a clinical trial, human volunteers are used to test experimental therapies and their effectiveness. These studies are conducted under controlled environments and usually have limited participation. If you are interested in participating in a clinical trial, talk to your doctor or mesothelioma specialist about whether a clinical trial may be an option. Clinical trials are broken down into three phases.

Phase I trials are the first step in testing the effectiveness and safety of a new drug. Doctors and researchers try to determine the best way to give a new treatment and the correct dosage for the treatment in order to determine a drug’s safety and potential side effects.

Phase II
The purpose of a phase II trial is to determine if the drug works.
At this stage, researchers select a relatively small group of patients to study the specific effects of the dosage (set by evaluating the results of phase I).

In Phase III testing , doctors and researchers compare the effectiveness of the new, experimental drug against existing standard (most accepted) therapies. The trials often involve large numbers of patients. Often, patients enrolled in the clinical trial will be randomly assigned to therapeutic group (either a “control” group or an experimental group) in an attempt to eliminate the possibility of human bias. Participants are closely monitored for signs of improvement or side effects. The testing may be terminated if side effects of the new treatment are too severe or if one therapeutic group quickly experiences much better results than others.

New & Experimental Tharapiess
Cancer specialists and researchers are always looking for new and better ways to effectively treat mesothelioma. Several treatments show promise in helping to treat and lessen the symptoms of mesothelioma.

Photodynamic Therapy or PDT uses laser light to kill cancer cells. The Food and Drug Administration (FDA) has approved its use for non-small cell lung cancer and cancer of the esophagus. However, photodynamic therapy is in the experimental stage as treatment for mesothelioma.

Immunotherapy
The immune system plays a central role in both protecting the body against disease caused by certain viruses and bacteria, and combating disease that has already developed. Immunotherapy treatment is based of boosting the body’s own immune system’s reaction to fight mesothelioma. Experimental treatments include the use of interferons or interleukins, that have hormone-like properties that activate the immune system.

Gene Therapy
Gene therapy is a technique for correcting or replacing defective or weakened genes responsible for the development of disease. While still in its infancy for the treatment of mesothelioma, gene therapy holds a lot of promise for future cancer patients.

Pericardial Mesothelioma

Refers to cancer of the thin sac that surrounds the heart and the great blood vessels (called the “pericardium”). Pericardial mesothelioma is the rarest form of mesothelioma, occurring less than 5% of mesothelioma cases.

Symptoms of pericardial mesothelioma are typically non-specific and can resemble symptoms of several other cardiac conditions. Symptoms may include shortness of breath, irregular heartbeat, heart palpitations and chest pain. Please keep in mind that these symptoms may be caused by mesothelioma or by other less serious conditions. Only a doctor or preferrably a mesothelioma specialist can make a definitive diagnosis.


Diagnosis of pericardial mesothelioma can be difficult as symptoms of the disease are is relatively non-specific. The process of diagnosis typically begins when doctor or, preferably a mesothelioma specialist reviews the patients medical history, including the possibility of exposure to asbestos. In order to confirm the diagnosis a tissue sample must be removed (called a biopsy) from the affected area. The biopsy involves removal of fluid (aspirate) or tissue (a biopsy) from the pericardial area, and testing of this tissue or fluid for the presence of cancer cells. This can be accomplished via a thoracoscopy or a mediastinoscopy. Chest x-rays, a CT scan or an MRI scan may also used to help diagnose pericardial mesothelioma.

Thoracoscopy
In this procedure, a small incision is made in the chest and a thoracoscope, which is an instrument similar to a telescope and is connected to a video camera, is inserted in the area of the tumor. A doctor can then view the tumor and/or take a tissue sample at this time.

Mediastinoscopy
In a mediastinoscopy, a small incision is made just above the sternum and a lighted tube is placed behind the breast bone. allowing the doctor to view the lymph nodes which can provide clues about the body’s immune system, a tissue sample may be removed at this time. Once removed, the tissue samples are then analyzed under a microscope.

X-Ray
X-ray machines use radiation to take a picture of the affected area. An x-ray may reveal several types of abnormalities including buildup of fluid in the pericardium . These abnormalities may indicate asbestos exposure and the development of mesothelioma.

CT Scan
Type of x-ray procedure that produces detailed cross-sectional images of the body. Unlike a traditional x-ray that takes a single picture, a CT scanner takes many pictures as it rotates around you. A computer then combines these images to create a cross-sectional “slice” of the body. A radiocontrast agent or “dye” may be injected into patient intravenously, which helps define the structures of the body and may help in determining the extent to which the cancer has spread.

MRI Scan
This scan uses radio waves, strong mangnets and a computer to produce a cross-sectional image of the body. The energy from the radio waves and magnets are absorbed and released by the different tissues in the body. In this procedure the patient may be injected with a radiocontrast agent prior to being positioned in the tunnel of the MRI machine.

PET Scan
This scan uses radioactive glucose (sugar) to determine the spread of cancer. Cancer tissue consumes glucose at a much faster rate than normal tissue. When radioactive glucose is injected intervenously into the patient the diseased tissue takes up higher levels of the radioactive material and when scanned, can provide insight into the stage and spread of the cancer.

Treatment
In most cases, by the time a positive pericardial diagnosis is made, the cancer has progressed to a stage where conventional treatments are largely ineffective. Palliative treatments, or treatments whose intention is to provide temporary relief from symptoms are most often employed as treatment for pericardial mesothelioma. However, in cases where the disease has been diagnosed early enough, several surgical procedures may be effective.

Peritoneal Mesothelioma

Peritoneal mesothelioma is a rare form of cancer caused by asbestos exposure. It refers to cancer of the serous membrane that forms the lining of the abdominal wall (called the “peritoneum”). Peritoneal mesothelioma may result from coughing up and swallowing inhaled asbestos fibers. Peritoneal mesothelioma is the second most common form of mesothelioma, accounting for approximately 10%-20% of mesothelioma diagnoses.



Symptoms of peritoneal mesothelioma may include swelling, pain due to accumulation of fluid in the abdominal cavity (called ascites), weight loss, and a mass in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia (a lowered red blood cell count), and fever. Keep in mind that these syptoms may be caused by mesothelioma or by other less serious conditions. Only a doctor or mesothelioma specialist can make a definitive diagnosis.

Diagnosis
It can be difficult to diagnose mesothelioma because many of the mesothelioma symptoms are similar to those of a number of other conditions, including stomach cancer and other types of cancers. If mesothelioma is suspected, a doctor will typically do a physical examination and ask the patient for a complete a medical history which will include the possibility of prior exposure to asbestos. At this point, the most effective way to make a positive peritoneal mesothelioma diagnosis is for a mesothelioma specialist to examine tissue from the abdominal cavity via a laparoscopy or mediantinoscopy. There are several additional tests that can be used to assist in confirming the diagnosis of peritoneal mesothelioma including x-ray, CT scan, MRI scan or PET scan.

Laparoscopy
In this procedure, a small incision is made in the front of the abdomen and a flexible tube which is connected to a video camera, is inserted in the area of the tumor. A doctor can then view the tumor and/or take a tissue (called a biopsy) or remove fluid at this time.

Mediastinoscopy
In a mediastinoscopy, a small incision is made just above the sternum and a lighted tube is placed behind the breast bone, allowing the doctor to view the lymph nodes which can provide clues about the body’s immune system. A tissue sample may be removed at this time for later analysis under a microscope.

X-Ray
X-ray machines use radiation to take a picture of the affected area. An x-ray may reveal several types of abnormalities including buildup of fluid in the abdominal cavity. These abnormalities may indicate asbestos exposure and the development of mesothelioma.

CT Scan
Type of x-ray procedure that produces detailed cross-sectional images of the body. Unlike a traditional x-ray that takes a single picture, a CT scanner takes many pictures as it rotates around you. A computer then combines these images to create a cross-sectional “slice” of the body. A radiocontrast agent or “dye” may be injected into patient intravenously, which helps define the structures of the body and may help in determining the extent to which the cancer has spread.

Magnetic Resonance Imaging - RI Scan
This scan uses radio waves, strong mangnets and a computer to produce a cross-sectional image of the body. The energy from the radio waves and magnets are absorbed and released by the different tissues in the body. In this procedure the patient may be injected with a radiocontrast agent prior to being positioned in the tunnel of the MRI machine.

Positron Emission Tomography Scan
This scan uses radioactive glucose (sugar) to determine the spread of cancer. Cancer tissue consumes glucose at a much faster rate than normal tissue. When radioactive glucose is injected intervenously into the patient the diseased tissue takes up higher levels of the radioactive material and when scanned, can provide insight into the stage and spread of the cancer.

Treatment
Treatment options may include chemotherapy, surgery, radiation, participation in a clinical trial or a combination of several therapies.

Pleural mesothelioma

A rare form of cancer caused by asbestos exposure. Pleural mesothelioma refers to cancer of the outer lining of the lung and chest cavity (called the “pleura”). It is the most common form of mesothelioma and accounts for approximately 70% of all mesothelioma diagnoses.

Pleural mesothelioma Symptoms
The most common symptoms of pleural mesothelioma are difficulty in breathing and pain in the lower back or chest, which are typically caused by pleural effusion (see below Fig 1)
. Other less common symptoms include weight loss, fever, fatigue, trouble swallowing, night sweats, cough, and a general feeling of not being well. Occasionally, a patient may not have symptoms at diagnosis.
Please keep in mind that these symptoms may be caused by mesothelioma or by other less serious conditions. Only a doctor, or preferably a mesothelioma specialist can make a definitive diagnosis.

FIG 1
Pleural effusion, is an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these pleural membranes are comprised of mesothelial cells which, under normal circumstances, produces fluid that acts as a lubricant between the lung and the chest wall. Normally, any excess fluid is absorbed back into the system via the lymph vessels and blood. However, when too much builds up and cannot be drained, the result is an effusion. Pleural effusion is broken down into two categories, transudates and exudates. A transudate is a clear fluid that builds up not because the pleura itself is diseased, but rather because of an imbalance between fluid production and removal. An exudate, which is often times a cloudy fluid, results from disease of the pleura and is common to mesothelioma. In order to discover whether the fluid of the effusion is transudate or exudate, a fluid sample must be taken and analyzed.

Diagnosis
It can be difficult to diagnose mesothelioma because many of the mesothelioma symptoms are similar to those of a number of other conditions, including lung cancer and other types of cancers.

If mesothelioma is suspected, a doctor will typically do a physical examination and ask the patient for a complete a medical history which will include the possibility of prior exposure to asbestos. At this point, the most effective way to make a positive pleural mesothelioma diagnosis is for a mesothelioma specialist to examine tissue from the lung or tumor via a thoracoscopy, a mediastinoscopy or a bronchoscopy. There are several additional tests that can be used to assist in confirming the diagnosis of pleural mesothelioma, including a chest x-ray, CT scan, MRI scan, PET scan and examining the pleural fluid.

Thoracoscopy
In this procedure, a small incision is made in the chest and a thoracoscope, which is an instrument similar to a telescope and is connected to a video camera, is inserted in the area of the tumor. A doctor can then view the tumor and/or take a tissue (called a biopsy) at this time.

Mediastinoscopy
In a mediastinoscopy, a small incision is made just above the sternum and a lighted tube is placed behind the breast bone. allowing the doctor to view the lymph nodes which can provide clues about the body’s immune system, a tissue sample may be removed at this time. Once removed, the tissue samples are then analyzed under a microscope.

Bronchoscopy
In this procedure, a lighted tube is inserted through the mouth , down the throat and into the bronchi. Abnormal masses or irregular tissue can then be removed (called a biopsy) for testing.

Chest X-Ray
X-ray machines use radiation to take a picture of the lungs or affected area. An x-ray may reveal several types of abnormalities including buildup of fluid in the pleural space, irregular thickening of the pleura and pleural calcifications (mineral deposits). These abnormalities may indicate asbestos exposure and the development of mesothelioma.

Computed Tomography Scan Or CT Scan
Type of x-ray procedure that produces detailed cross-sectional images of the body. Unlike a traditional x-ray that takes a single picture, a CT scanner takes a series of pictures as it rotates around you. A computer then combines these images to create a cross-sectional “slice” of the body. A radiocontrast agent or “dye” may be injected into patient intravenously, which helps define the structures of the body and may help in determining the extent to which the cancer has spread.

Magnetic Resonance Imaging Or MRI
This scan uses radio waves, strong mangnets and a computer to produce a cross-sectional image of the body. The energy from the radio waves and magnets are absorbed and released by the different tissues in the body. In this procedure the patient may be injected with a radiocontrast agent prior to being positioned in the tunnel of the MRI machine.

Positron Emission Tomography  Scan
This scan uses radioactive glucose (sugar) to determine the spread of cancer. Cancer tissue consumes glucose at a much faster rate than normal tissue. When radioactive glucose is injected intervenously into the patient the diseased tissue takes up higher levels of the radioactive material and when scanned, can provide insight into the stage and spread of the cancer.

Types of Disease Mesothelioma

Virtually all cases of mesothelioma are linked with asbestos exposure. It is a rare cancer of the thoracic and abdominal cavities and surrounding internal organs. The symptoms of mesothelioma are: shortness of breath, pain in the lower back or side of the chest, coughing and weight loss. Mesothelioma is the most insidious of the asbestos-related diseases in that it can affect people who have experienced low or intermittent levels of asbestos exposure.

Asbestos Lung Cancer : Lung Cancer is the most common type of cancer linked to asbestos exposure. It is found in people who have sustained prolonged exposure to asbestos. Lung cancer, asbestos related or otherwise, develops in the tissue that surrounds the lung, often obstructing and invading air passages. The length of time between exposure to asbestos and the occurrence of lung cancer is usually 20 to 30 years and in some cases longer. Smokers exposed to asbestos multiply the effect, which increases the susceptibility to lung cancer significantly.

Asbestosis : A serious, chronic, non-cancerous fibrous hardening and scarring of the lungs. The scarring can cause lung impairment and heart disease. The symptoms of asbestosis are: shortness of breath, coughing and a dry crackling sound while inhaling. In advanced stages asbestosis may cause cardiac failure. Asbestosis is a slowly progressive disease with a latency period of 15 to 30 years or more and can lead to serious respiratory problems.

Pleural Thickening : is a non-cancerous scarring of the lining of the lung. Pleural thickening, if widespread, impairs lung function, restricting breathing capacity.

We have successfully handled compensation claims on behalf of clients with all of the above diseases. Please contact us today to see if we are able to do the same for you.


Pleural Plaques : Are small localised areas of fibrosis found within the pleura of the lung caused by asbestos exposure. It has been argued by medical experts that they do not cause significant symptoms (if any) and do not impair lung function. They are seen as merely evidence that someone has been exposed to asbestos in the past.

For this reason, defendant insurers have successfully argued through the courts that claims for pleural plaques should not attract an award of compensation. This decision has been upheld and therefore despite pleural plaques being a condition for which compensation could be claimed for over 20 years, this is no longer the case.