Mesothelioma

Treatment by Stage

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A cancer diagnosis is always shocking and scary, no matter the age of the person involved. When someone finds out that they have Mesothelioma, depression may set it, anger might be present, and the life of the cancer victim will most certainly change.

Receiving proper treatment, however, is the most important issue after diagnosis.
Mesothelioma is treated in a variety of ways, largely dependent on which stage of the disease is present in the afflicted individual. The patient’s age, general health, and the location of the cancer are also taken into consideration when determining the best course of action to be used to fight the disease.

In Stage I, sometimes referred to as “localized malignant Mesothelioma”, treatment might include the following:

* Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
* Surgery to remove the pleura and the tissue near it, done in order to relieve symptoms. This is not considered a curative surgery.
* Radiation to relieve symptoms when surgery is not indicated due to poor health.
* The use of a clinical trial; i.e. medications being tested by patient volunteers in order to find better cures for Mesothelioma.

For those suffering from Stage II or III Mesothelioma, treatment may include the procedures listed below. Cure is often not possible for those who’ve reached Stage II or III Mesothelioma.

* Thoracentesis or paracentesis – the draining of the fluid around the heart or abdomen, done in order to reduce symptoms and relieve pain.
* Radiation or chemotherapy used to reduce symptoms.
* Injection of chemotherapy or radioactive drugs directly into the pleural space. This will serve to kill some of the cancer cells and slow down fluid collection in this area.
* Clinical trials

The treatment of Stage IV advanced malignant Mesothelioma will most likely involve keeping the patient as comfortable as possible. By this time, the disease has spread greatly and a cure is not possible, according to the American Cancer Society.

* Chemotherapy or radiation, though the goals should be clearly explained to the patient and family. Such aggressive therapy, laden with side affects, may not be desirable given the impossibility of a cure at this time.
* Supportive care - often performed in a hospice-type program. Advanced Mesothelioma patients usually require more care than a spouse or loved one can reasonably handle.
* Pain medication
* Clinical trials

In treating Mesothelioma, locating a specialist who is willing to discuss and explain all treatment options is essential. Take time to measure the pros and cons of various treatments and be sure that the patient is comfortable with the choices made. The Mesothelioma sufferer, like any cancer patient, should have a say in his/her individual treatment program.

Facing treatment for Mesothelioma can be overwhelming. For more information about the disease, its stages, and options for treatment, take a moment to sign up for the free Mesothelioma Resource Kit available on this website.

Treatment Options

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Even though mesothelioma is incurable, treatment is available. Treatment can prolong your life and make you more comfortable. The traditional therapies used in cancer treatment are the mainstay of mesothelioma treatment. These treatments are used alone and in combination to reduce the damage mesothelioma causes to your body.

* Chemotherapy
* Radiation treatment
* Surgery

The type of treatment that is right for you depends on several factors. The best options for treatment can only be determined after a thorough evaluation by your medical team. An oncologist is a cancer specialist and will most likely lead the process. You may also see a radiologist, pulmonary therapists and an oncology-nursing specialist. To help you cope with discomfort and the emotions stirred up by a serious illness, a social worker can also be a part of your care team. Learn more about the finding a medical team that is experienced in caring for people with mesothelioma.

The size and location of your tumor and the stage of your cancer must first be determined. To determine the stage of your cancer, MRI and CT scans are used. These tests are excellent at helping your doctor visualize the size, location and extend of any lung tumors. Other specialized testing using radionuclides can help tell if the disease has spread, or metastasized outside of the chest and abdominal cavities.

Mesothelioma therapy is very individualized. They type of therapy that is best for you depends on:

* Location of the cancer
* Size of the cancer
* Degree of invasion into nearby structures
* Cancer staging
* How widespread the cancer is
* Patient’s age
* Other medical conditions

Your health status and age will also play a big part in figuring out the very best way to treat your cancer. People with other health problems may not be candidates for very strong forms of treatment.

Treatment Includes
Cancer treatment focuses on destroying the malignant cells while preserving the healthy ones. This can be achieved by chemical or physical means that wipe out the tumor cells. These treatment modalities can be used alone, or in combination to have the strongest effect on the disease. When an additional therapy is added to the main treatment for cancer it is called adjuvant therapy.

Chemotherapy uses very toxic drugs to kill the tumor cells, but healthy cells can be affected too. Newer chemotherapy drugs have fewer side effects, and combinations of powerful drugs can also help reduce toxic effects. Response to some of the most effective chemotherapy regimens has been less than hoped for. The FDA recently approved a combination of cisplatin and pemetrexed for patients with mesothelioma because it showed a significantly stronger effect on the disease than a single drug.

Radiation therapy employs strong doses of radiation to destroy the cancer cells. Radiation therapy is frequently used to shrink tumors before surgery, or to help patients feel less discomfort. While advances in technology allow the radiation to be very tightly focused, cells surrounding the treatment area do suffer significant damage.

Tumors can also be removed surgically. In early stage disease, surgery can provide significant improvement and slow the progression of the disease. If the cancer has spread beyond the chest cavity, surgery is much less effective in slowing down the disease, although it can be used in advanced cases to help patients breathe more easily and feel more comfortable.

During treatment, the progress of the disease will be monitored periodically. Using blood tests, x-rays and in some cases, MRI or CT scans, the size and extent of tumor can be followed. Depending on the response to treatment, the regimen can be stopped or adjusted. Side effects can also have an impact on the treatment regimen. Fortunately there are many medications that can help patients withstand the toxic effects of these treatments.

Because mesothelioma is a very aggressive cancer that is difficult to detect and tends to spread, traditional treatments are less effective than they are in other forms of cancer. Some patients are not candidates for surgery or radiotherapy, especially in widespread or advanced disease. For these patients, chemotherapy may be the only treatment option.

Investigational treatments

Newer treatments are being researched which provide a great deal of hope for patients who do not respond to some of the established therapies in use today. Clinical trials provide information about improved treatments and give hope for better outcomes. Clinical trials are currently going on across the United States and worldwide.

Photodynamic therapy employs a light sensitive drug that is administered into your pleural fluid. Exposure to a specific type of light activates the drug and causes a chemical reaction, which produces oxygen free radicals. The free radicals are very toxic to the tumor cells and cause necrosis, or tumor cell death.

Another promising treatment is immunotherapy. Preliminary studies in early stage mesothelioma have shown encouraging results. Patients administered a form of interferon experienced complete response to therapy.

Complementary and Alternative Therapies can help patients feel better and participate in their treatment longer.

Your medical team

It’s important to have supportive medical team as well an experienced one. One resource for finding an expert in mesothelioma is your primary care doctor, who may be able to recommend. For more information about mesothelioma, including cancer centers that specialize in mesothelioma, complete the contact information.

Mesothelioma Stages

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Doctors employ the use of “stages” in both cancer diagnoses and monitoring to determine the progress of an individuals’ disease. Staging takes a close look at cancers, like Mesothelioma, and determines to what extent it has developed and/or spread. Most importantly, staging helps determine the course of treatment.

Currently, though there are three types of Mesothelioma – pleural, peritoneal, and pericardial – staging has thus far been established for the most frequently occurring form of this cancer - pleural - and not for the others. The three systems that stage this disease are the Butchart, TNM, and Brigham systems.

Butchart is the oldest system and is still the most commonly used. Its four stages are based on the extent of primary tumor mass.

* Stage I: Mesothelioma is present in the right or left pleura (the thin, transparent membrane which covers the lungs and lines the inside of the chest walls) and may also involve the diaphragm (the muscle separating the chest from the abdomen) on the same side.
* Stage II: Mesothelioma invades the chest wall or involves the esophagus (food passage connecting the throat to the stomach, 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 now be affected as well.
* Stage IV: There is evidence of metastasis (the spreading of the Mesothelioma) through the bloodstream to other organs.

The TNM System looks at three components: the tumor (T), the lymph nodes (N), and the spreading of the disease, otherwise known as metastasis (M). It is also divided into four stages.

* Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium (the fluid filled sac that surrounds the heart), 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 has now invaded the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side. It may or may not have 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 metastasis is included in this stage.

The most recent system to be devised is the Brigham System. It stages the disease according to the ability to surgically remove the tumor (resectability) and the involvement of the lymph nodes. It, too, is divided into four stages.

* Stage I: Mesothelioma is resectable and no lymph node involvement.
* Stage II: Mesothelioma is resectable but with lymph node involvement.
* Stage III: Presence of unresectable Mesothelioma extending into the chest wall, heart, or through the diaphragm or peritoneum; with or without extra-thoracic lymph node involvement.
* Stage IV: Distant metastatic disease (widespread cancer throughout the body).

Diagnosis is achieved in a number of ways, especially because other diseases may possess similar symptoms to those presented by Mesothelioma. A wide variety of imaging techniques may be used in diagnosis, such as CT scans, MRI, and conventional x-rays. Some doctors also choose to test the pleural fluid for malignant cells.

Biopsy, however, is by far the most accurate way to diagnose Mesothelioma. Needle biopsies, done under local anesthetic, may be used but provide only small tissue samples. That means the accuracy rate might be less than desirable. The preferred course of action in suspected Mesothelioma is an “open” biopsy, which provides a larger tissue sample. This type of biopsy is performed in a hospital setting under general anesthesia.

Do you suspect that you or someone close to you may be suffering from Mesothelioma or do you worry about a spouse or loved ones’ previous exposure to asbestos? Learn the facts about asbestos and the diseases it causes by ordering our free Mesothelioma Resource Kit.

Mesothelioma Symptoms

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Mesothelioma develops many years after exposure to asbestos. Sometimes, it may be 30 to 40 years before symptoms occur. Unfortunately, in the early stages of the disease, symptoms may be vague or not noticeable. Thus, if you have been exposed to asbestos in the past, even for a very brief time, it’s important to have regular check-ups to detect any lung abnormalities, even if you don’t have symptoms.

Benign lung disease, such as asbestosis is common in people who have been exposed to asbestos. The symptoms can be very similar, and only a complete medical exam can provide an accurate diagnosis.

Early detection of mesothelioma allows doctor to use more effective and more powerful treatments. For this reason, you should watch carefully for any of the symptoms of mesothelioma.

Symptoms of Mesothelioma may include:

* Coughing
* Shortness of breath or difficulty breathing
* Difficulty Sleeping
* Weight Loss
* Pain in chest and abdomen
* Fluid in the chest

Usually, difficulty breathing and a lingering cough bring patients into the doctor for evaluation. This occurs because tumors of the mesothelium make if hard for the lungs to expand smoothly. Large tumors, or tumors that spread to the chest wall can cause chest pain. When fluid builds up in the pleura, breathing can be even more difficult while lying down, making it hard to sleep. The spread of cancerous cells takes a toll on your body, causing weakness, extreme fatigue. Changes in your body’s ability to absorb nutrients as a result of invasion into the abdomen can cause weight loss. 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.

Depending on the type of mesothelioma, slightly different symptoms can occur. Peritoneal disease has an effect on the intestines, liver and other structures in the abdominal cavity. As fluid builds up, the abdomen can become very expanded. Because the liver plays a big part in manufacturing the substances needed to control bleeding, there is often a change in your ability to make blood clots. Weight loss occurs for several reasons, and is more dramatic in this form of the disease.
The pleural form of mesothelioma can also cause damage to the upper airway. Swallowing can become difficult, and voice changes can occur if the larynx is affected.

Specific symptoms of Peritoneal mesothelioma:

* Weight loss
* Abdominal pain
* Buildup of fluid in the abdomen
* Bowel obstruction
* Abnormal blood clotting
* Abdominal mass
* Fever

Specific symptoms of Pleural Mesothelioma:

* Pain in the lower back
* Pain in the side of chest
* A persistent cough
* Shortness of breath
* Husky voice
* Difficulty swallowing
* Fever

Regardless of the location, malignant mesotheliomas occur in three forms. The epithelioid type is the most common, accounting for 50-70% of all mesotheliomas. Between 20-35% of mesotheliomas are sarcomatoid. The remaining 7-20% of tumors are classified as mixed/biphasic. Epithelioid mesothelioma has the best outlook for survival.

If your symptoms suggest you may have mesothelioma, you doctor will order a number of tests. Imaging studies like X-rays, CT scans and MRI show any abnormalities within the lungs. A complete blood count and levels of specific proteins can help make the diagnosis. However, the diagnosis of mesothelioma cannot be made by blood work and imaging studies in every case. Other more common diseases such as benign asbestos-related pleural disease and metastatic adenocarcinoma can have very similar appearances on imaging studies. Biopsy, and the use of special staining are often necessary for the accurate diagnosis of mesothelioma.

Promising studies on the early detection of mesothelioma may soon provided more accurate methods for diagnosis. If you have these warning signs you should consultant a qualified medical professional immediately. Only a doctor can make a diagnosis.

Mesothelioma Risk Factors

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In as many as 75-85% of mesothelioma cases, there is a history of exposure to asbestos. The material was used extensively in numerous industries from the early 1900’s through the 1960’s. Through the World War II era, over 8 million workers were exposed to asbestos. Evidence that serious health problems were related to asbestos began to mount, and in 1999, a conclusive link between asbestos exposure and mesothelioma was made.

Because it can take as long as 50 years for mesothelioma to develop, anyone who has been exposed should be evaluated by a physician experienced in this form of cancer. Even if you are not ill, you should learn about your legal rights in case mesothelioma is found in the future.

Asbestos is a broad term which refers to a collection of minerals know as asbestiform. It is a small mineral comprised of tiny fibers. Asbestos fibers exist in two forms; they can be either amphibole or serpentine (chrysotile). Several studies suggest that the amphibole form of asbestos is more dangerous than the chrysotile form, especially in mesothelioma.

These small particles float in the air, in an exposed environment and they may be inhaled or swallowed. Asbestos fibers breathed into the lungs cannot be expelled; they become embedded in the thin lining of the lungs, the mesothelium. Over the period of many years, cells in the mesothelium can become cancerous. In most cases of mesothelioma, it takes decades for the disease to cause symptoms.

Although a serious hazard to your health, asbestos is an excellent insulating material. It is used in many products that need to withstand high heat such as home insulation and construction, brake pads, electrical equipment, hot water piping, boilers, ship engines, and welding supplies. People who have worked in these industries should be screened regularly for the development of lung disease.

When the asbestos is contained within finished products such as walls and tiles, it does not appear to pose a health as long as it is not damaged or disturbed. However, damage or inadvertent destruction can release dangerous fibers into the air. When asbestos fibers are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease.

While smoking has not been found to cause mesothelioma, smoking has been linked to an increased incidence in mesothelioma in asbestos exposed workers. Therefore, if you have had occupational e exposure to asbestos, smoking could raise the risk of developing mesothelioma.

Asbestos exposure

The most common way in which people are exposed to asbestos is through their work. There are a number of jobs in which exposure to asbestos may have occurred. Asbestos has been extensively used in industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation as well as shipbuilding and other forms of construction. The risk of developing Mesothelioma increases according to the length and level of exposure to asbestos.

The number of workers exposed to asbestos far exceeds the number of documented cases. The reasons why some people who are exposed to asbestos do not develop the disease are not well understood.

The risk of developing asbestos-related diseases varies with the type of industry in which the exposure occurred and with the extent of the exposure. According to the Environmental Protection Agency (EPA) there is no safe level of exposure to asbestos fibers. The Occupational Safety and Health Administration (OSHA), however, has set a Permissible Exposure Limit (PEL) of 0.1 fibers per cubic centimeter (f/cc) for an 8 hour time weighted average. The safest course of action is to limit exposure and always wear protective gear when dealing with any type of suspected asbestos.

Hidden asbestos risks

The risk of developing mesothelioma is not just confined to the person directly exposed but may extend to family members and friends of those directly exposed. Even someone who has not been directly exposed or has been exposed at very low levels is at risk may develop the disease.

An increasing incidence of mesothelioma in spouses and children whose only to asbestos was from the dust laden work clothes of a family member is being reported. People who were in contact with workers in asbestos related injuries should also be vigilant for symptoms and be screened for lung disorders regularly.
Risk Factors Include:

* Automotive Mechanics
* Boilermakers
* Bricklayers
* Building Inspectors
* Carpenters
* Cement Finishers
* Drywallers
* Engineers
* Electricians
* Floor Coverings
* Welders
* Furnace Workers
* Glazers
* Grinders

*
* Hod carriers
* Insulators
* Iron Workers
* Labourers
* Longshoremen
* Machinists
* Maintenance workers
* Mechanics
* U.S. Navy veterans
* Merchant marines
* Metal Lathers
* Millwrights
* Operating Engineers
* Painters

* Pipefitters
* Plasterers
* Power Plant Workers
* Plumbers
* Railroad Workers
* Roofers
* Sand blasters
* Sawyers
* Sheet metal workers
* Shipyard Workers
* Steam fitters
* Tile setters
* Welders

What is Mesothelioma

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Mesothelioma is a serious and rare form of lung cancer. It is most frequently seen in men between the ages of 50 to 70. Women are affected far less frequently. In the US, between 2000 and 3000 cases are diagnosed each year. Estimates suggest that the incidence of mesothelioma for every 100,000 in the US is about 1.8 and 0.9 internationally. This form of cancer affects people of every race equally. The number of people who have been diagnosed with mesothelioma has increased significantly in the past 30 years. Although many advances in treatment have been made, there is no cure for this type of cancer.

In mesothelioma, the cells of the mesothelium become cancerous and grow out of control. The mesothelium is a protective, two-layered membrane that covers the internal organs of the body including the lungs, heart and abdominal organs. Between these layers, the cells produce fluid, which allows easy movement of the heart and lungs within the chest cavity. The layer that covers the lungs is called the pleura, and the layer that covers the heart is called the pericardium. The peritoneum lines the abdominal cavity. Mesothelium also lines the male and female reproductive organs. Mesothelioma can affect any of these cells, but is usually seen in the pleural or peritoneal mesothelium. The most common form of mesothelioma is pleural.

The primary risk factor for developing mesothelioma is exposure to asbestos. Between 70-80% of people diagnosed with mesothelioma have been exposed to asbestos, usually in the workplace. Although it is possible to develop mesothelioma without any exposure to asbestos, it is very rare. While one person for every million people in the US will be diagnosed with mesothelioma, about 7-13 men who have been exposed to asbestos will be diagnosed with the disease. Symptoms frequently take 20 years to develop, but can take as long as 50 years to occur.

When cancerous cells invade the mesothelium, it becomes increasingly difficult to breathe. In the pleural form of mesothelioma, tumors growing in the mesothelium cause pleural effusions, which prevent the smooth movement of the lungs and other organs in the chest. Peritoneal mesothelioma invades the abdominal cavity and can cause loss of appetite weight loss, nausea and vomiting. Most patients seek medical care after having symptoms only 4-6 months.

Mesothelioma is a very aggressive form of cancer. Because it takes so long for symptoms to appear it can spread to the other organs in the chest, the chest wall and into the lymph nodes. The cancerous cells spread, or metastasize from the mesothelium into other parts of the body and damage internal tissues and organs. Treatment is more effective when the disease is detected early.

Treatment is aimed at reducing the size of tumors, and relieving symptoms. Chemotherapy, radiation treatment and surgery are some of the traditional treatment strategies used to help patients live longer, with fewer symptoms. New advances in photodynamic therapy and immunotherapy give hope for prolonging the lives of patients with mesothelioma. On average, however, the life expectancy after being diagnosed with mesothelioma is less than one year.