Mesothelioma is an uncommon form of cancer, usually associated with previous exposure to asbestos, which affects the pleura, a sac which surrounds the lungs, the peritoneum, the lining of the abdominal cavity, or the pericardium, a sac that surrounds the heart. In this disease, 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, or have been exposed to asbestos dust and fiber 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.
Symptoms of Mesothelioma.
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. 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. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
Diagnosis of Mesothelioma.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
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by Enrique Anton, MD, PhD
To the Editor:
Pistolesi et al (October 2004)1 state that “diagnosis and management of malignant pleural mesothelioma (MPM) are major challenges that often frustrate both patient and clinician.” I would like to make the following comments.
Generally, malignant mesothelioma equates with a diffuse malignant mesothelioma, a rare and fatal tumor related frequently to asbestos exposure, which could arise from the surface of all serosas. The most frequent location is the pleura (> 90%), followed by the peritoneum (6 to 10%).2 Although the majority of cases are unicavitary, sometimes simultaneous involvement of the pleura and peritoneum can occur.3
Unilateral pleural effusion, an early manifestation of MPM, is the most frequent radiographic finding in MPM,1 and may be present in up to 95% of patients during clinical evolution.4 However, physicians should remember that the absence of pleural effusion is rare but possible,3 and pleural thickening and/or calcification could be the only finding.4
Pleural effusion is usually insufficient for diagnosing mesothelioma based on cytologic analysis alone.1 However, when peritoneal involvement occurs and ascites are present, cytology could be a useful tool, helping in the diagnosis of mesothelioma.3
Currently, the outcome of MPM is unavoidably fatal; although the “median” survival is approximately 9 to 12 months,1 occasionally an individual patient with mesothelioma could have a very poor outcome.3 Prognostic score systems have been developed in recent years1 with the aim of being able to help in clinical trials. However, these systems applied to an individual patient could sometimes not be very reliable. If the five prognostic factors of the European Organization for Research and Treatment of Cancer5 were applied to the patient referred above,3 the patient would be classified in the good prognostic group (only two poor prognostic factors). In fact, he only lived 1 month after diagnosis.
In our daily clinical practice, physicians have to attend not to a “series” of patients with “mean” features but individual patients sometimes significantly different from classical descriptions. In addition to useful information provided in updates and reviews, we have to take into account other less-frequent features usually absent in these reports but with obvious usefulness for diagnosis and management of our real patients.
References
A conference call is a telephone call in which the calling party wishes to have more than one called party listen in to the audio portion of the call. The conference calls may be designed to allow the called party to participate during the call, or the call may be set up so that the called party merely listens into the call and cannot speak. It is often referred to as an ATC (Audio Tele-Conference).
Conference calls can be designed so that the calling party calls the other participants and adds them to the call. In most cases, the participants are able call into the conference call themselves, by dialing into a special telephone number that connects to a "conference bridge" (a specialized type of equipment that links telephone lines).
Usually, most companies use a specialized service provider who maintains the conference bridge, or who provides the phone numbers and PIN codes that participants dial to access the meeting or conference call.
Three-way calling is available (usually at an extra charge) for most customers on their home or office phone line. To three way call, the first person one wishes to talk to is dialed. Then the Hook flash button is pressed and the other person's phone number is dialed. While it is ringing, flash is pressed again. This will put the three people together. This option allows callers to add a second outgoing call to an already connected call.
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| There are several mesothelioma treatment options including chemotherapy, radiation, and surgery. |
Most of these treatments are not used in isolation. In many cases, treatment may consist of a combination of therapies. For example, surgery to remove as much of the cancer as possible may be followed by radiotherapy or chemotherapy to remove residual cancer cells. This is one of the most common treatment options for mesothelioma among those who are candidates for surgery.
A number of alternative therapies can also be combined with traditional treatment options. Many patients choose to add alternative therapies such as massage, acupuncture, or TENS therapy to their conventional treatment approach in an effort to enhance or compliment the treatment process. A variety of alternative therapies, including aromatherapy, meditation, or yoga, are often added to a treatment regimen to provide pain relief and foster relaxation.
Aside from standard and alternative therapies, many forms of support are available to mesothelioma patients. By filling out the form on the right, those affected by mesothelioma can receive a free copy of the cancer support book "Lean On Me," by Lorraine Kember. Kember served as a caregiver to her husband as he fought mesothelioma, and the supportive book offers valuable insight on how to cope with a mesothelioma diagnosis.
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There are certain occupations that increase one's risk of asbestos exposure. Shipyard workers who served between World War II and the Korean War were very likely exposed to asbestos. The material was ideal for use in shipbuilding because of its ability to resist corrosion and high temperatures. It has been used as insulation for boilers, incinerators, hot water pipes and steam pipes. The asbestos dust tended to build up around these areas and other inadequately ventilated parts of the ship, which led to human exposure aboard vessels. For more information on where asbestos could be found on ships, please fill out the form on the right to receive an informative packet.
Not only the shipbuilders, but the crews of those ships and the longshoreman (those who load the ships) were heavily exposed to asbestos as well. In fact, before the 1980s, many longshoremen probably even loaded bundles of asbestos onto ships. Before that time, the health risk associated with asbestos was not known by these workers and no special precautions were taken to prevent inhalation. Because of this, many shipyard workers run an increased risk of developing mesothelioma or other asbestos-related illnesses.
A study conducted at the Mt. Sinai School of Medicine found that 86 percent of shipyard workers with 20 or more years of experience developed asbestos-related lung disease or lung cancer. If you have ever worked in a shipyard or on an old ship and feel you may have been exposed to asbestos, it is important that you discuss it with your physician. As with any type of cancer, mesothelioma is most easily treated when it is caught as early as possible. Once you have taken care of your health, you should contact a lawyer about seeking compensation for your exposure.
The encompassing resources at Asbestos.com offer exceptional referrals for some of the most experienced asbestos and mesothelioma attorneys in the nation. Please direct all email inquiries to assistance@asbestos.com . For more information about veterans' rights or how to file an asbestos-related VA claim, please call 1-800-ASBESTOS (1-800-272-3786) or fill out the form on the right to receive a comprehensive information packet on all issues surrounding asbestos exposure and resulting diseases.
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