Multidisciplinary treatment of pleural mesothelioma

Multidisciplinary treatment of malignant pleural mesothelioma

  by Giovanni Luca Ceresoli, Cesare Gridelli and Armando Santoro

Abstract

The incidence of malignant pleural mesothelioma (MPM) is increasing worldwide, and is predicted to peak in the next 10–20 years. Difficulties in MPM diagnosis and staging, especially of early disease, have thwarted the development of a universally accepted therapeutic approach. Single modality therapies (surgery, radiotherapy, chemotherapy) have generally failed to.......more on The Oncologist>>

Introduction

Malignant pleural mesothelioma (MPM) is an aggressive tumor, usually associated with a poor prognosis. The incidence of MPM is increasing throughout most of the world, and it is expected to rise in the next 10–20 years as a result of widespread exposure to asbestos in the past decades. The management of patients with MPM is controversial. Difficulties in diagnosing and staging, especially in early disease, have thwarted the development of a generally accepted stage-related approach. MPM is a heterogeneous disease often associated with different clinical courses; a number of prognostic factors have been described, and two major prognostic scoring systems have been.....more on The Oncologist>>

Staging

Correct clinical staging is mandatory in the approach to treat MPM. Early staging systems have reflected mainly the experiences of individual institutions on their respective patient populations; considerable discrepancies among the various systems have resulted in nonuniformity of reporting. At present, the recommended classification for clinical use is the International Mesothelioma Interest Group (IMIG) staging system, which is based mainly on surgical and pathological variables, and may not be completely applicable to cross-sectional imaging; moreover, the lymphatic drainage of the pleura is quite complex and is not fully reflected in the IMIG system, in which....more on The Oncologist>>

Chemotherapy

Most patients with MPM are potential candidates for chemotherapy at some point in their treatment. For many years a nihilistic attitude has existed about medical treatment of MPM. Most chemotherapy studies have used either single agents or combination regimens in the setting of small phase II trials; the rates of objective tumor regression have been generally <20%, with no significant impact on median survival. In a meta-analysis of early trials published between 1965 and 2001, cisplatin was found to be the most active single drug. Combination chemotherapy has been associated with higher response rates, but not with....more on The Oncologist>>

Source: The Oncologist - the official journal of the Society for Translational Oncology

Types of Mesothelioma

Mesothelioma Basic Terms

Let's first go back to basic terms associated with mesothelioma. Basically, every cancer, starts from the tumor mass in our bodies.A tumor is caused by body tissues that grow to form an abnormal mass. There are two basic types of tumors.

• Benign type is a non-cancerous type of tumor.
• Malignant is a cancerous type of tumor.

The terms tumor and cancer are sometimes used synonymously which can be misleading. A tumor does not necessarily mean a cancer. The term tumor simply refers to a mass. It is helpful to keep these distinctions clear when we are discussing a possible cancer diagnosis.
The term cancer refers to a new growth which will invade surrounding tissues, metastasize (spread to other organs) and may lead to the patient's death if untreated. The word cancer in Latine means crab. Like a cancer, a crab grabs onto something and will not let go.


Benign Mesothelioma is a tumor usually localized in the mesothelial layer around the lungs, heart, stomach or elsewhere in the abdomen and grows larger. However, it is not cancerous and rarely spreads to nearby tissues or other body areas. Benign mesothelioma symptoms are often similar to those of other types of mesothelioma. Treatment for benign mesothelioma tumor is usually surgery. The tumor responds very well to treatment. However, if left untreated, it can lead to a serious disease.

Malignant mesothelioma is a general term that means the mesothelioma is a cancerous type. All forms of cancer are malignant.


Based on cancerous cell types, mesothelioma is mainly classified into epithelioid, sacromatoid and mixed/biphasic.

• Epithelioid mesothelioma type is the most common form of mesothelioma cancer cells and accounts for about 50-70 percent of all people diagnosed with mesothelioma. It has the most positive prognosis (chance of recovery) among all other types, because it may grow slower and is more likely to respond to treatment. This form of mesothelioma targets the thin membrane surrounding the body's internal organs and surfaces.
• Sarcomatoid mesothelioma type is more aggressive and affects the body's secondary tissues - muscles, bones, fats and cartilage. It is found in about 7-20 percent of all mesothelioma cases and has a worse prognosis. It generally does not respond well to therapy.
• Mixed / biphasic mesothelioma type accounts for approximately 25-30 percent of all diagnosed mesothelioma cases and contains both sarcomatoid and epithelioid types. This mesothelioma type has an intermediate prognosis.

Mesothelioma Classification By Body Parts

Another classification of mesothelioma cancer is based on the areas /parts of the body affected by the disease . There are four main types of mesothelioma.

Pleural mesothelioma

This type of mesothelioma cancer is the most common since it affects the pleural region of the chest cavity. Pleural Mesothelioma cancer makes up nearly 75 percent of all Mesothelioma diagnosed cases. This disease usually strikes the pleural cavity located between the thin membranes surrounding the lungs, causes pressure on it and trouble breathing as fluid builds in the chest cavity and the pleural lining thickens. That diminishes the lungs' air capacity and normal contraction and expansion functions.

Peritoneal mesothelioma

Another, second most common type of mesothelioma cancer is the peritoneal mesothelioma cancer, accounts around 20 percent of all mesothelioma cases. This disease affects the peritoneum lining of the abdominal cavity, gastrointestinal tract, bowel, liver and spleen, causing a build up of fluid in the abdominal cavity as cancerous cells spread. The lining surrounding vital organs in the abdominal area cannot function normaly and patients who suffers from peritoneal Mesothelioma cancer can experience symptoms of pain or swelling in the abdomen, anemia, breathing difficulty, blood clotting, or restriction of properly bodily functions like digestion and bowel movements.

Pericardial mesothelioma

Pericardial mesothelioma is the rarest type of the three main mesothelioma cancers and affects the pericardium, the protective sac that covers the heart and the major arteries and veins. The pericardium normaly provides constant lubrication so that the heart can function properly. Pericardial mesothelioma is more rare than pleural or peritoneal mesothelioma forms, but it is in the same time more dangerous. Often this type of mesothelioma cancer is discovered too late for treatment, and even when detected early only few treatment methods exist. Symptoms include coughing, heart palpitations, shortness of breath, irregular heartbeat and chest pains .

Testicular mesothelioma

Testicular mesothelioma cancer, has been reported in less than 100 cases. Unfortunately, this means that there are no common symptoms reported across these cases. Discovering lumps on the testicles and the swelling of the scrotum often lead to a testicular mesothelioma diagnosis.

Early detection of Mesothelioma is very important

All types of mesothelioma are hard to detect during their early stages of the disease, so the earlier that mesothelioma is detected, the more treatment options are available. Early detection can provide quicker treatment and disease management, as well as the greatest chance at a better quality of life. All types of mesothelioma cancers are very difficult to diagnose, in a large part because they mimic the normal symptoms of other more common diseases. Surgery is typically performed to remove the cancerous mass. Patients may also undergo radiation and chemotherapy to reduce or eliminate the remaining cancer mass, although in many cases the mesothelioma is deeply entrenched in the tissue and cannot be completely removed.


There are some other forms of mesothelioma, which are very rare, such as Papillary mesothelioma. Deciduoid mesothelioma, cystic mesothelioma, etc.

We will present them in the next few articles.


If you have mesothelioma cancer or another asbestos disease, and if you are considering starting a mesothelioma lawsuit then you need attorney. Before making this decision, you may want to contact several attorneys or law firms to gather some comparative information. You can find mesothelioma attorneys by state in our attorneys directory or you can read some of profiles of experienced and proven mesothelioma attorneys.

What is mesothelioma

Mesothelioma (malignant mesothelioma) is an aggressive uncommon form of cancer that develops from transformed cells originating in the mesothelium*. Most cases of mesothelioma occur in the chest (pleural mesothelioma), rarely may occur in the abdomen (peritoneal mesothelioma) or other organs. It is usually caused by exposure to asbestos, especially blue asbestos. Exposure may only be brief and there may be a lag-time of 20 to 40 years. Your risk is greater if you were exposed to large amounts of it from an early age for a very long period of time. But some patients say they have no history of any heavy exposure to asbestos. On every 10 people diagnosed with mesothelioma, about 80% say they have been in previous exposure to asbestos.

While mesothelioma is most common in the lungs (~90%), it's important to differentiate between lung cancer and mesothelioma. They are two very different types of cancer and require different types of treatment.

Pleural mesothelioma is the only known pleural cancer and is caused by asbestos exposure in nearly all cases. Of patients with pleural malignant mesothelioma, about 77% have been exposed to asbestos in the past. Early diagnosis is difficult because the results from fluid analysis of the tumor effusion are not usually diagnostic.

Wide range of occupations, notably railway engineering, shipbuilding and asbestos product manufacture, are associated with an increased risk of mesothelioma.

When someone is exposed to asbestos particles in the air, that will increases the risk of developing malignant mesothelioma. Most of patients who develop malignant mesothelioma in the past work on jobs where they inhaled asbestos, or were exposed to asbestos fibers and dust in other ways. Also has been suggested that washing clothes of a family member who worked with asbestos dust or fibers increases their risk for developing malignant mesothelioma. Unlike lung cancer (1.37 million deaths worldwide), there seems to be no association between malignant mesothelioma and uses of tobacco, but smoking increases the risk of other asbestos-induced cancers. Some patients who were exposed to asbestos have collected damages for asbestos-related disease (including mesothelioma). Asbestos workers have up to a 10% lifetime risk of developing the disorder, with an average latency of 30 yr. Mesothelioma can spread locally, but also can metastasize to the hilar and mediastinal lymph nodes, pericardium, peritoneum, diaphragm, kidneys, adrenals, liver and, infrequently to the tunica vaginalis of the testis.

Mesothelioma is more common in males than in females, probably because many cases have been caused by exposure to asbestos at work. It occurs most between the ages of 60 and 79 years (average age at diagnosis is 62 years of age )

Annually it's diagnosed on approximately 2,000 to 3,000 individuals in the US** comprising around .3 percent of all cancer diagnoses , most of whom die within 2 years of the diagnosis (summary by Bott et al., 2011). Unfortunately, long-term survival is uncommon.

The most common body location for the development of mesothelioma is the pleura (the outer lining of the lungs and internal chest wall), but it can also arise in the peritoneum (the lining of the abdominal cavity), and the pericardium (heart sac), or the tunica vaginalis (a sac that surrounds the testis).

Mesothelioma exists in four stages. Depending on the stage of the disease, there are various treatments available to help patients or at the very least relieve pain and improve their comfort and quality of life.

Tumor predisposition syndrome may contribute to the development of malignant mesothelioma upon asbestos exposure and is caused by germline mutation in the BAP1 gene on chromosome 3p21.

Class action lawsuits or compensation via asbestos funds is an important issue in law practices regarding malignant mesothelioma. Finding the right mesothelioma attorney and filing a lawsuit is a serious thing for you and your family, and that will increase your chances of winning a settlement in a court of law.

*Mesothelium is a protective membrane, made up of two thin layers that forms the lining of several body cavities: peritoneum (abdominal cavity including the mesentery), the pleura (thoracic cavity), and pericardium (the sac that surrounds the heart). Also, mesothelial tissue surrounds the male internal reproductive organs and covers the internal reproductive organs of women. Mesothelium that covers the body walls is called the parietal mesothelium, while the layer that covers the internal organs is called visceral mesothelium. When cancer develops in the mesothelium it's between these layers. Mesothelioma is very difficult to diagnose in its early stages, because of the narrow space in the mesothelium.

**In the UK around 2,400 people are diagnosed with mesothelioma each year.

A Place to Find Accredited Asbestos Removal Companies

Asbestos Portal - The Online Resource

Find Asbestos Surveyors and Removal Companies Easily!

Asbestos Portal (asbestosportal.co.uk) is a specialist asbestos directory and resource

Today I’d like to give a quick shout out to http://www.asbestosportal.co.uk who are developing a specialist online resource dedicated to asbestos information. This website lists a host of asbestos removal companies. The beauty about it is that people can easily browse through a host of recommended and trusted UKAS accredited trade specialists whose companies are fully qualified to safely remove asbestos from houses throughout the UK.

Up until the early 1970s asbestos was used extensively across the United Kingdom and the world as a fire retardant building and insulating material for homes and factories. Many council homes aging 20 years may still contain asbestos materials.
To date, it has been extremely difficult to estimate the actual percentage of affected UK homes in statistical reports.

To gain control over the situation certain responsibilities have been placed on Social landlords. Social landlords are required by law to keep an asbestos register on file for all properties that they own.
This register has to comply with the regulations and should indicate whether or not a building has been surveyed, whether any asbestos has been detected by asbestos surveyors and also whether or not this material has been removed, damaged or sealed in place.

If, through renovation and refurbishment, you disturb certain asbestos types the dust emitted and inhaled can have devastating consequences on your future health and livelihood.

If you are suspicious of any asbestos in your building then simply visit this list of asbestos companies to find your nearest asbestos removal specialist.

Promoting the Awareness of CANCERactive - www.canceractive.com

A Independent Cancer Support Network & Resource

Seek Support From CANCERactive - www.canceractive.com

CANCERactive is an independent charity that aims to help people increase their personal odds of beating cancer.





CANCERactive believes in empowering people – to understand the possible causes, and to build effective integrated therapy programmes, using well-researched, Complementary and Alternative therapies not merely Orthodox ones – the best of the best.

On the www.canceractive.com Web Site you will find ‘Everything you need to know to help you beat cancer’: over 2000 pages of information, all written in a user-friendly way.

It’s a magazine on the internet. CancerActive don’t limit their attentions to merely Orthodox therapies like Chemotherapy, Radiotherapy and Surgery, they include fully-evidenced and effective Complementary and Alternative Therapies too. CANCERactive include all the latest information from around the world on everything from Nutritional Supplements that improve the effectiveness of Chemo and Radiotherapy to new treatments that are genuinely working for people in other countries.

CANCERactive's covers extensive a variety of topics and concerns from details on drug side effects to diet therapies that have clinical trials supporting them. CANCERactive frequently discusses the benefits of supplements from herbs to vitamins that can play a proven anti-cancer role, and full coverage of complementary therapies from acupuncture to meditation, from massage to hands-on-healing.

CANCERactive also have overviews on a great many specific and fast emerging cancer treatments like the use of pancreatic enzymes, metabolic typing, energy therapies, Photo-Dynamic Therapy and Ultrasound (HIFU) and on different cancers from Breast to Prostate. CANCERactive add over 50 pages on a monthly basis.

Only recently, the information provided by CANCERactive on certain breast cancers has been described as ‘amazing’ and a recommended resource according to chat users on the two leading US Cancer sites, to quote: ‘with information I didn’t know you could get anywhere’.

CANCERactive take a ‘Precautionary stance’ on cancer prevention, bringing you the latest information on all the factors that have been shown to increase the risks of cancer. This will enable you to cut them out of your life as much as possible, again increasing your personal odds of beating the disease.

Not surprisingly CANCERactive are already the major source of valuable information for Integrated therapies and Cancer Prevention in the UK.

According to the spokespersons at CANCERactive - "the feedback from patients is simply excellent", just as it is for our quarterly magazine icon which goes now into over 400 Hospitals,, Iibraries and cancer centres providing the very latest information, for free, right into the patients’ hands and the hands of others that need to know. CANCERactive aim to be the ‘Patient’s Champion’.

CANCERactive's information on ALL the therapies comes with the backing of research and scientific evidence. CANCERactive give you the Whole Truth - Information you can trust - because CANCERactive have no vested interests, no hidden benefactors, our Trustees and Directors take no financial rewards or incentives. CANCERactive aim to help – Visit: CANCERactive. Intelligent Information. Independent Voice.

Another Ban Asbestos Video Found on Utube in 2009

Interesting Video Relating To The Ban Asbestos Campaign:

View: Asian Ban Asbestos Video,English

What Statistic of Mesothelioma Information Is Web Spam?

...A rant about web spam and Mesothelioma information

Re.Journalists promoting Mesothelioma sites...

Can you believe this? Correct me if I'm wrong please!

I found this following statistic on a EZine article that states that amost 80% of all mesothelioma victims have been exposed to asbestos in their daily lives.

Source: http://bit.ly/eXyObB

I found this statistic outstanding, unbelievable and unfound. Now I am by no means an expert (I simply write this to help promote Mesothelioma fundraisers and other certain channels of Mesothelioma support) but isn’t asbestos (as scientists and medical professionals researched thus far:) the only significant cause of Mesothelioma lung cancer?
Surely that figure should be 100%???? Or 99.99999% for any element of doubt that - one in however many people may have got it by divine intervention!? Hey - Mary fell pregnant remember - the lord giveth and taketh! Could that random made up statistic be more fruitful? It allows a miniscule benefit of the doubt. It is no surprise that only 99% of statistics are made up! (An old one I know)

Does the article writer not take into account those thousands of people living in India? Those who are working in mines? Producing asbestos sheets in a factory production line? Those who have no choice? Would these civilians out number those veterans who served in world war II and various other wars since? I’m not discounting anybody in particular here. Any person suffering from Mesothelioma lung cancer deserves all the support necessary to improve their quality of life. This is not a dig pointing out who is the most unfortunate. It is a dig at people who write articles on a subject that they know nothing about (myself included) who provide false information on the net! And I’ll tell you why I have this huge beef – it is not related to Mesothelioma, but is related to mortality…and the cursed web – my father was in a coma after a heart operation went wrong and he was considered to have an anoxic brain injury of which the French doctor said in broken English “it is the reptilian side of the brain that is operating” – basically they told me that he was a vegetable and was not locked in as the blood flow to the brain was seriously reduced / cut off (they don’t know) for 16 mins! I later managed to get various reactions and basic signals, 98% paralytic forms of communication out of him before his demise. Now it pains me to think that if his recent wife had got the right kind of treatment for him soon then some quality of life could remain.
I get angry at people writing articles out of FICTION to increase companies or professionals online web presence – as in the article link above – which I have no followed and have only posted as an example. This is simply because when these circumstances hit me – I went online to find help out there and the only information I found were ropey blogs with dodgy English, copied content or no authority on the subject (All this said - one search did provide a really good establishment based in the South of England that offered specialist care to act as a stimulus for anoxic injuries). But to wade through so much rubbish - I find it despicable – and frustrating that these people lay down such falsities just so that they can get a “link” or attract advertising from affiliates or companies with a relevant topic base.
Can they not see what effect they are having on people in the world by polluting the web with such…spam?
I hereby state that – it is my mission to only provide information on this blog that is either opinionated, a proven statistic or fact or of significant benefit to the cause represent on Mesothlioma Hindsight.