Mesothelioma

Surgical procedures involved in the treatment and diagnosis of mesothelioma are divided into three main categories:

• Diagnostic surgery is used to confirm whether or not cancer is present and where it is located. This is typically non-invasive.
  
• Curative surgery is carried out with the intention of removing as much cancer as possible with hopes of curing the patient. Radiation therapy or chemotherapy is often administered following curative surgery.
  
• Palliative surgery involves the removal of cancerous tissue and is used to provide symptomatic relief, but does not offer a cure.

Though researchers continue to develop new ways to diagnose and treat mesothelioma, there are a number of techniques that have been on the scene for several decades. One such technique, thoracentesis, was developed in the late 19th century and is still used today.

Thoracentesis, the extraction of fluid from the lungs and the pleura (pleural effusion), can be used for two purposes. The first is as a diagnostic tool. In this procedure, a doctor uses a hollow needle, or cannula, to extract pleural fluid. This procedure helps to determine the causes behind the fluid buildup. The fluid is then examined for certain qualities that may indicate disease. Usually, however, thoracentesis is not sufficient to determine whether or not a person has mesothelioma. A biopsy is typically required as well.

Before performing the test, doctors will first take an x-ray of the chest, which reveals the extent of the problem and allows them to make the best insertion possible. The skin around the insertion will be disinfected and local anesthesia will be injected to numb the pain. The needle is then inserted. This may cause a feeling of pressure, but not pain (with the help of anesthesia). The procedure is often followed by an x-ray to verify the success of the thoracentesis and the amount of fluid removed.

After the fluid is collected from the lung's chest cavity, it is sent to a lab for analysis. There are a number of factors that doctors examine to determine whether mesothelioma is present. These include:

• Protein levels
  
• Glucose presence
  
• pH levels
  
• Cell count
  
• Cholesterol

Fluid in the pleural region can indicate a number of concerns other than mesothelioma. Although cancer is a common cause of excess fluid in the chest, the fluid may also indicate lung infection, connective tissue disease, congestive heart failure, cirrhosis, and a number of other conditions.

Thoracentesis may also be used for palliative reasons to treat the uncomfortable and often debilitating symptoms of pleural effusion. Removing the fluid lessens pressure on the chest and lungs, eases pain in those areas, and provides more space for the lungs to expand.

Thoracentesis is not without risk. Some of the complications that may occur include the following:

• Pneumothorax: This condition, better known as a collapsed lung, can occur if the doctor accidentally punctures the lung or disrupts an accumulation of air in the pleural cavity.
  
• Hemopneumothorax: Often causing the lung to collapse, hemopneumothorax takes place when damage occurs and blood begins filling the pleural space.
  
• Pulmonary edema: While removing a sample of the fluid in the lung area is supposed to help, it can sometimes cause even more fluid buildup in the pleural space or swelling. This condition is known as pulmonary edema and can lead to lung failure.

There are also a number of minor conditions that may develop as a result of the thoracentesis procedure. These include subcutaneous hematoma (slight bruising or bleeding), anxiety, and cough.

The surgical procedure known as pleurodesis is used to treat pleural effusion, the buildup of fluid in the chest cavity between the lungs and their lining, called the pleural space.

Technically, the process of pleurodesis is used to eliminate the pleural space so fluid cannot continue to collect. Doctors perform this procedure by draining the fluid and inserting a talc-like substance that causes inflammation and serves to seal the pleural space.

There are two methods doctors may use to produce this inflammation. Usually, inflammation achieved chemically, but cancer doctors also use a surgical procedure to irritate the tissue. When surgery is performed, it is common for some of the suspicious tissue to be removed as well.

In the chemical pleurodesis process, the chest is first drained using a tube. Doctors then introduce a chemical into the pleural space. There are a number of chemicals that may be used, but the most common are bleomycin, tetracycline, povidone iodine, and talc. These chemicals remain in the chest for a few hours until the tissue is thoroughly irritated. Doctors then connect a tube to a suction device, which causes the two layers of the pleura to come together and seals the space where fluid once collected. This process takes place during the course of a few days because it takes some time for the fluid to drain thoroughly. During this time, anesthesia and pain medications are administered, but most patients still describe this procedure as quite painful.

The second form of pleurodesis is surgical. This surgery is performed by using either a thoracotomy or thoracoscopy. In both cases, the pleura are irritated with a rough pad, causing inflammation. As in chemical pleurodesis, the layers are then brought together so they can fuse and future fluid retention can be eliminated.

After recovering from the surgery, patients should experience a marked difference in their ability to breathe, and pain and coughing should lessen as well.

Along with surgery and chemotherapy, radiation therapy is one of the most commonly recommended treatments for mesothelioma. Radiation has long been a standard treatment for many types of cancer and is often used in mesothelioma patients as a palliative measure (a form of therapy that helps reduce the pain of symptoms, but does not offer a cure for the disease).

What is Radiation Therapy?

Radiation therapy uses a form of radiation called "ionizing radiation" that is designed to kill and control the growth of cancer cells. Radiation therapy is used as a curative treatment as well as a palliative therapy to provide symptomatic relief.

Radiation therapy is often used in conjunction with other cancer treatments such as surgery and chemotherapy. For example, radiation therapy may be administered before surgery to shrink tumors, or in conjunction with chemotherapy to improve the success of both treatments.

There are three main types of radiation therapy: external beam radiotherapy, unsealed source radiation therapy, and brachytherapy.

Brachytherapy Treatments for Mesothelioma

Brachytherapy is a type of radiation therapy that involves the implantation of tiny radioactive rods in or near tumors. It is most commonly used to treat cervical, breast and prostate cancers, as well as cancers of the head and neck, but has also been used to treat mesothelioma.

An advantage of brachytherapy is that the radioactive rods placed inside tumors (often referred to as "seeds") emit radiation across short distances of approximately one centimeter. This treatment allows for the delivery of a strong and highly-concentrated dose of radiation directly to tumor cells, but causes very little damage to surrounding healthy cells and tissue. Because of this, healthy tissue is spared and side effects are less severe.

Brachytherapy seeds are very small (about the size of a grain of rice) and insertion of the seeds is carried out under general anesthetic. This means that patients must be evaluated to ensure they are fit enough to undergo surgery. Additional tests are done to determine the size and location of tumors so that seeds can be placed for maximum effect.

The seeds may be implanted using one of two methods. Intracavitary treatment involves inserting radioactive seeds housed in small containers into body cavities. In interstitial treatment containers are not used, and instead the seeds are placed directly into cancer tumors. For this procedure, the seeds are inserted through the use of a thin needle.

Brachytherapy Types

There are two main types of brachytherapy treatment for mesothelioma: temporary and permanent.

When a patient undergoes temporary brachytherapy treatment, radioactive seeds are placed inside tumors for a short period of time and are then removed. If the therapy is to be permanent, the seeds are never removed. However, over time the remaining seeds produce less radiation, until eventually radiation emission ceases. Depending on the type of radioactive material used in the treatment, radiation emission will most likely end within three to 12 months.

High Dose and Low Dose Brachytherapy

Brachytherapy treatments for mesothelioma are separated into two further types according to the strength of the dose that is administered and the duration of the treatment.

High dose brachytherapy is administered via a catheter, with the seeds being delivered into tumors one by one at regular intervals. This treatment takes place over the course of a single session that typically takes only a few minutes to complete, and is carried out as an out-patient procedure. Patients typically receive up to 12 separate treatments over the course of two or more weeks.

Low dose brachytherapy administers continuous low-dose radiation over several hours or even days, but the patient is given only one treatment rather than several. This is carried out as an in-patient procedure and requires at least one overnight hospital stay.

Pros and Cons of Brachytherapy

The immediate side effects of brachytherapy treatment for mesothelioma are pain, swelling and sometimes bruising at the treatment site. These symptoms are typically mild and last for just a few days. However, there are few other side effects, and the side effects of brachytherapy are much less severe than with other types of radiation therapy.

Brachytherapy is a non-invasive procedure because of the delivery method used to administer treatment. Patients can typically resume normal levels of activity within just a few days. People who receive this treatment also benefit from a reduced risk of developing post-operative infections and other complications that may result from more invasive surgical procedures.

Despite the lack of side effects for patients, there are some other concerns surrounding brachytherapy. The amount of radiation emitted by patients who receive brachytherapy is very low, but patients are still advised by their physicians to avoid contact with young children and pregnant women, who are typically more vulnerable to the effects of the radiation.

In addition to chemotherapy and surgery, radiation therapy is one of the three most commonly used treatments for mesothelioma.

Radiation therapy makes use of a type of radiation called "ionizing radiation," which is used to kill existing cancer cells and control the growth of new cancer cells. Depending on the nature of the patient's condition and their type of asbestos cancer, radiation therapy may be used as a stand-alone treatment or may be used in conjunction with surgery or chemotherapy.

In addition, radiation may be used either as a curative treatment or as a palliative treatment. In the latter case, the purpose of radiation therapy is not to cure the patient, but simply to provide relief from pain and other symptoms of the cancer. This is often the case for mesothelioma patients that are prescribed radiation therapy.

There are three main types of radiation therapy: external beam radiotherapy, unsealed source radiation therapy, and brachytherapy. In most cases, only external beam radiotherapy and brachytherapy are used to treat mesothelioma. The type of radiation treatment a patient receives depends on several factors, including the type of mesothelioma, the stage of the disease, and whether other treatment options are also viable.

External Beam Radiotherapy

External beam radiotherapy is the most common type of radiation therapy for the treatment of cancer. During this procedure, the patient sits or lies down to expose the area that requires treatment, and an external source of radiation is directed at the treatment area.

Over the course of a series of treatments, mesothelioma tumors are bombarded with radiation to kill cancer cells and limit the growth and spread of these cells. However, in most cases involving mesothelioma, radiation therapy is not able to completely eradicate all tumor cells. As such, this type of therapy is usually given to provide the patient with some relief from pain and other symptoms associated with mesothelioma, such as shortness of breath and coughing.

Due to the nature of the treatment, it is common for healthy tissue near the treatment area to be affected by radiation. This damage causes side effects such as skin irritation, pain near the treatment site, digestive problems, and difficulty swallowing.

External beam radiotherapy is rarely effective as a stand-alone treatment for mesothelioma and is most often used in conjunction with chemotherapy or surgery.

Mesothelioma Brachytherapy

Brachytherapy, also known as sealed source radiation therapy, is a procedure that involves the implantation of tiny radioactive rods in or near tumors of mesothelioma and other types of cancer such as breast, cervical, and prostate cancer. This treatment method allows the delivery of a highly-concentrated and closely targeted dose of radiation to mesothelioma tumors that might be resistant to other types of radiation therapy.

This type of radiation therapy is beneficial because it causes little damage to healthy cells surrounding the affected area and is less invasive than traditional radiation.

Patients with mesothelioma may receive either temporary or permanent brachytherapy treatment. For temporary treatment, radioactive seeds are placed within tumors for a short time and are then removed. In the case of permanent treatment, the seeds are not removed, but are simply left within tumors and eventually cease the emission of radiation.

Unsealed Source Radiation Therapy

Treatment with unsealed source radiation involves the administration of soluble forms of radioactive substances. This type of treatment is administered either orally or via injection, but is only used to treat very specific types of cancer. For example, patients with thyroid cancer are often treated with a solution of radioactive iodine.

One major disadvantage of unsealed source radiation therapy is that people who receive this treatment are considered to be radioactive for the duration of the treatment and for several weeks after - this means they can actually pose a health risk to other people. Note that this is not a treatment that is used for patients with mesothelioma.

The term "remission" generally refers to a state of absence of any disease activity among patients with cancer. Doctors typically cite two types of remission, which includes complete remission and partial remission. Complete remission is the total absence of the disease without signs of cancer. Partial remission only indicates shrinkage of the tumor and lessening of the disease.

Mesothelioma Patients and Remission

For mesothelioma patients, remission is certainly less likely to occur. Most cases of mesothelioma are not detected until symptoms arise, which is when the cancer has already reached Stage III or IV of development. Nevertheless, some doctors have reported a handful of cases of both drug and therapy-induced remission. Researchers believe remission after treatment or therapy may be linked to changes in the immune system.

In particular, many long-term survivors of mesothelioma indicate they drastically changed their diet and added daily supplements to enhance their immune system. Many of these same survivors promote the efficacy of alternative treatments as part of their regimen and several have shunned conventional treatments such as chemotherapy, radiation, or surgery.

However, that does not mean conventional treatments should be discounted. There have been a number of cases where mesothelioma patients have experienced remission after chemotherapy. In one case, a 71-year-old Japanese woman with peritoneal mesothelioma went into remission after receiving intraperitoneal injections of the chemotherapy drug Cisplatin. She also received other chemotherapy medications that were administered in the traditional manner. The case, as reported by Yokohama City University School of Medicine, was judged to be quite rare and the disease did return less than a year later. Nevertheless, the woman enjoyed several additional disease-free months.

Today, with the advent of new medications, improved treatments, early detection methods and clinical trials, remissions are becoming more common. Additional money is now being spent on mesothelioma research and support groups nationwide are receiving more donations. Unfortunately, research still has a long way to go in conquering this aggressive disease.

Although the majority of those diagnosed with mesothelioma are told their survival rate is less than one year from the time of diagnosis, cases of patients living past their predicted survival date are continuing to surface. With each survivor story that comes to light, current mesothelioma sufferers are gaining a little more hope about their future.

Poor Outlook & Prognosis for Mesothelioma

In order to understand why most mesothelioma patients only survive for a short time, it is necessary to understand the nature of the disease. In most instances, mesothelioma is not detected until it has reached its later stages. This is because symptoms can take as long as 50 years to appear once a person has been exposed to asbestos. Without the presence of symptoms, those with mesothelioma usually do not even realize they have developed the disease.

However, with the development of new tests that aid in early diagnosis, such as the Mesomark blood test, doctors and scientists expect more mesothelioma patients to live longer, healthier lives. An early diagnosis can often open the door to more treatment options and a higher success rate in shrinking or removing tumors.

Patients and their loved ones may enjoy reading “Lean on Me – Cancer through a Carer’s Eyes,” a touching story by Lorraine Kember about her husband’s battle with mesothelioma. Reading about the emotions the Kember family experienced may provide insight into the road ahead for those recently diagnosed. To receive a complimentary copy of this book, click here.

Why Do Some Mesothelioma Patients Survive Longer?

There have been a number of patients that have survived far beyond the usual one year survival period and a handful that have even been cured, with no trace of the aggressive cancer several years after treatment (though recurrence is always possible). This has stumped many medical professionals as they experience difficulty in explaining why some mesothelioma patients survive and others do not.

Research seems to show one common thread – the immune system. Studies of those who have either survived or been cured of the disease reveal that most of these patients participated in some sort of therapy that enhanced their immune system. Some treatments included clinical trials in immunology while others involved alternative therapies dealing with the immune system.

A report released more than 20 years ago theorized that "the presence of asbestos fibers in exposed workers may have caused the eventual breakdown of the host's surveillance system and the onset of neoplasm [malignant mesothelioma]."

With this philosophy in mind, some researchers believe treatments that improve the immune system can stabilize and even cure the disease. Currently, this is the most prevalent theory in explaining why some patients continue to live a healthy life while mesothelioma is in remission and why others have apparently defeated the disease.

About Mesothelioma Survivors

A number of mesothelioma survivors have posted their stories on the Internet and have spoken to patients and their families with the hope of providing a brighter outlook for their future. These same survivors have also presented their cases to doctors and researchers.

The most outspoken of these individuals is Paul Kraus, an Australian mesothelioma survivor. Kraus was diagnosed with peritoneal mesothelioma in 1997, a form of the disease that is tougher to treat than the more common pleural variety. Kraus worked in a factory 35 years earlier where he was exposed him to blue (crocidolite) asbestos.

Upon his diagnosis, Kraus decided he would do everything possible to fight the cancer. He altered his diet (he's now a vegetarian), added many vitamins and supplements to his daily routine, began "juicing," and tried a treatment known as ozone therapy. Kraus explains, "They took blood out of a vein, used an ozone machine to add ozone (a molecule composed of three oxygen atoms) to the blood and reintroduced it into my body through a drip. The rationale for that was that cancer does not like an oxygenated environment."

The research in putting the protocol together took a lot of time, but in the long-run, Kraus believes the combination of all these treatments stabilized his mesothelioma. Today, tests show he still has the disease and his body is a bit weaker than it was, but he has no pain and his doctors tell him he could continue living for many more years.

Kraus stresses the fact that he is not the only mesothelioma survivor. He has cited the case of a man diagnosed 14 years ago at age 58 (no name given) who had a chest wall resection after diagnosis and has had no symptoms or recurrence since. His doctors believe there was "moderate host inflammatory response" and that spontaneous regression may be an immune-mediated phenomenon" - in other words, his immune system played a role in his survival. (Pilling, J.E., et al., Prolonged Survival Due to Spontaneous Regression and Surgical Excision of Malignant Mesothelioma, Ann Thorac Surg, 2007; 83: 314-5.)

Another survivor, Rhio O'Connor - who recently published a book about his fight with mesothelioma - has lived with the disease for seven years. He opted against surgery, chemotherapy and radiation. Instead, with the help of several medical physicians, he developed a regimen that included 100 supplements per day, changed his diet drastically, and now practices what he calls "mind-body medicine" (such as non-stress techniques like meditation). In his book, he recommends a variety of alternatives to traditional medicines and treatments.

While mesothelioma cancer has been around for quite some time, doctors and research scientists have only just begun to receive the necessary funds to improve treatment options for the disease. In comparison with other cancers, mesothelioma is considered to be rare and research dollars have historically been sparse when it comes to allocating money for the study of asbestos-related disease.

Mesothelioma Breakthrough

Successful clinical trials and other research procedures have presented many new treatments for those suffering from mesothelioma. Some of the most recent successful trials and tests include:

Alimta - This chemotherapy medication has shown great promise in treating mesothelioma patients during clinical trials. Currently, it is now the only FDA-approved medication designated specifically for the treatment of asbestos-caused cancer and is most successful when combined with an older chemotherapy platinum agent known as Cisplatin.

Intensity Modulated Radiation Therapy - Scientists tested this form of radiation therapy to determine whether or not they could succeed in sparing more healthy tissue around the affected area. This treatment is more precise and allows higher doses to be aimed at the cancerous organ while protecting normal adjacent tissue. This unique form of radiation therapy has also allowed doctors to treat tumors that are tangled with vital organs.

Gene Therapy - Clinical trials often involve less conventional therapies that are considered to be cutting-edge. Gene therapy uses laboratory-modified viruses to prompt the body to activate its immune system and destroy cancer cells. Numerous clinical trials for gene therapy continue.

Bio markers - After extensive periods of research, Fujirebio Diagnostics was able to devise a simple blood test to check for bio markers that might indicate the development of mesothelioma in its earliest stages.

Mesothelioma Clinical Trials

Research for mesothelioma generally begins in a laboratory and initial tests typically involve lab mice. If early experiments are deemed successful and all parameters of the research meet federally-imposed guidelines for use on humans, the treatment is deemed safe for trial.

Clinical trials are designed to test new medications, treatments and therapies on patients who have a particular disease. Most oncologists, especially those who specialize in the treatment of mesothelioma, will be well-versed on what clinical trials are available and can easily determine who qualifies for what trial. Patients considering participation in clinical trials should know some basic information before making their decision.

Many patients diagnosed with mesothelioma may be interested in current clinical trials and Asbestos.com offers an informative packet containing the most up-to-date information about studies and various treatment options. Patients and family members who wish to receive a complimentary comprehensive packet may fill out this form to receive their packet overnight.

Clinical trials may test new forms of traditional treatments such as chemotherapy or new ways to deliver radiation to the affected area of the body. In the past, new medications with fewer side effects have emerged triumphant from clinical trials and some mesothelioma patients have seen significant improvement in their quality of life.

Some clinical trials address other potential treatments outside the traditional, including immunotherapy, gene therapy and photodynamic therapy. Those who participate in these trials need to be willing to step out of the box and try something that might not be proven to help, but most agree that participating in clinical trials are worth a try.

Clinical Trial Phases

Other clinical trials for mesothelioma research may include new ways to detect the disease before it reaches Stage III or IV, which is typically when the disease is diagnosed. Such clinical trials can be carried out with individuals who do not have the disease but are at high risk for developing it. Regardless of the type of clinical trial, most are conducted in stages or phases and patients may be involved every step of the way. Different qualifications may apply and not everyone will qualify for each step of the trial.

Phase I – During this phase, researchers must determine basic information about any new medication that is being considered for mass distribution. Factors to be considered are dosage and method of administration.

Phase II – This step of the trial is generally more specific and focuses on a certain type of cancer or disease. During this stage, researchers are concerned with how the medication or therapy in question interacts with that specific disease. The safety of the medication is also called into question at this point in the clinical trial.

Phase III – This is a comparison stage. During Phase III, researchers will gather data on how a new medication or treatment compares to the current standard. For example, a new chemotherapy medication being considered for the treatment of mesothelioma will be measured against the currently-approved treatment that is most often used. This phase will determine if the new medication can make a difference in prognosis and if it is worthy of seeking FDA approval.

It is important to note that not all treatments being tested make it through all three phases of the trial. Nevertheless, others emerge triumphant and offer new and better treatment options for mesothelioma.

Funds for Research

With the incidence rate of mesothelioma increasing, people are now rallying politicians at the national level for help in obtaining funds for mesothelioma research. In some cities, such as Libby, Montana, special research facilities have been built to accommodate individuals who can study the disease and provide cutting-edge treatment options for patients.

In 2008, the U.S. Department of Defense allocated $50 million in funding for mesothelioma research, making it a "research priority" for the first time ever. The funds have been made available to research facilities throughout the country and researchers are eligible to receive between $625,000 and $2.5 million for their studies.

The money was provided by the Department of Defense because veterans have been significantly impacted by mesothelioma. This is largely due to the abundance of asbestos that was used by the U.S. armed forces throughout World War I and World War II. Shipyard workers, both military and civilian, have the highest incidence of mesothelioma of any profession.

A clinical trial is a process that all potential treatment options and medications go through before they are deemed safe or effective for the general population. Many patients with aggressive or treatment-resistant diseases look to clinical trials as a last hope for a cure. Many drugs and therapies that become the standard of care for a particular illness go through an extensive period of testing with clinical trials.

Stages of a Clinical Trial

There are three stages of clinical trials. Phase I trials enroll a limited number of people. They normally center around the correct dosage and relative safety of a particular drug. Phase II trials enroll more people and are used to determine if the new drug actually works against a particular illness. Phase III trials are the final phase before a drug is approved for treating a disease. During Phase III, the new drug is compared against the existing treatment. The goal during Phase III is to prove the new drug is a more effective treatment.

How to Find Out About Clinical Trials

There are a variety of resources on the Internet that list ongoing clinical trials for mesothelioma, which include the qualifications for each. Those interested in participating in a clinical trial should consult their doctor. Doctors have access to all upcoming and current clinical trials, and can also help determine if a patient qualifies for a particular trial.

Patients may also want to contact the large regional cancer centers in their area, which will have access to information on clinical trials being coordinated from their hospitals.

Qualifications for a Clinical Trial

There are a variety of factors to take into consideration when considering participation in a clinical trial. Clinical trials typically occur in large metropolitan hospitals. It is important to know how often participants will need to see the physicians coordinating the trials and how long each visit will take, as hotel and travel expenses can add up quickly.

Not everyone qualifies for a clinical trial - this varies depending upon the participant and the trail at hand. Some clinical trials require that a patient have undergone an unsuccessful traditional treatment, while other clinical trials want patients who have not undergone any treatment for their disease.

A final factor when considering a clinical trial is the loss of control over medical treatment. In some clinical trials, referred to as randomized studies, patients receive the traditional treatment while others receive the experimental treatment. The patient does not choose which treatment they receive, nor do they likely know what treatment is being administered. There is no guarantee that a participant will receive the experimental treatment.

Despite apparent risks, the benefits of clinical trials are numerous. Without clinical trials it would be nearly impossible to judge the effectiveness of new drugs. The health care that participants receive during a clinical trial is fantastic. Careful records must be kept and extensive testing must be done to gauge the effectiveness and safety of a new therapy.

Clinical trials for mesothelioma are a vital part of the search for a cure. Mesothelioma is an aggressive form of asbestos cancer with an extremely low survival rate. The patients currently involved in mesothelioma clinical trials will hopefully pave the way for a more effective treatment. Consulting with a physician about various available clinical trials should be considered at the initial diagnosis.

What to Expect at a Pre-Clinical Trial Screening

It is important to realize that not everyone who applies will be accepted into a clinical trial. The purpose of the clinical trial is to determine if a particular drug or treatment protocol is effective against a particular disease. In order to gain as much information as possible from a clinical trial, the trial coordinator will try to control the group of patients as much as possible. Some trials want patients who have not begun any treatment for their disease, others want patients who have a disease that is not responding to a current treatment.

A patient's general health will also be a consideration. While no one will argue that a patient with mesothelioma could be considered healthy, pre-screening coordinators will typically want to avoid patients with other pre-existing medical conditions as well as those taking medications for other illnesses. This is to give an accurate assessment as to the effectiveness of the treatment being tested. The more health conditions and medications that are introduced, the more likely the results of the trial will be skewed.

Decades ago, doctors were just starting to learn all the facts about mesothelioma. For many years, little was mentioned about the disease and those who developed it often stumped family doctors who just weren't sure why their patients had suddenly become so very ill. Today, much more is known about the disease, why it develops, and what to do to treat it.

Though this asbestos-caused cancer is rare in comparison to other types of cancer, as diagnosed cases continued to grow throughout the last 20-30 years, a number of specialists have taken up the cause and have become experts in the diagnosis and treatment of this aggressive disease.

These top mesothelioma doctors won't be the first medical professional that most patients see. Generally, a patient's family doctor is the first to suspect the disease and, after several imaging tests and a definitive diagnosis, he/she passes the meso patient on to an oncologist that may be located in the region where the patient lives. While most oncologists are familiar with mesothelioma, because of the rarity of the disease not all of them have had experience treating this type of cancer.

Because of that, some patients prefer to seek out the country's top mesothelioma experts in order to receive the highest quality of care possible. In most cases, these doctors are located in larger cities at some of the nation's best hospitals, often those associated with top-notch universities and research centers. These doctors have forged a reputation based on their knowledge and exemplary care. Often, many of them are equally as involved in research as they are in patient care, meaning that they are able to provide mesothelioma patients with the latest information on treatment, clinical trials, and other particulars of the disease.

A mesothelioma cure seemed almost unattainable not long ago, but this negative outlook is beginning to change. Doctors and cancer specialists are constantly working towards the development of a cure and instilling mesothelioma hope in patients. During this search to find a cure for mesothelioma, stories of survival continue to surface, renewing hope and determination.
Mesothelioma Treatments

While a cure does not currently exist, intensive treatment can often increase the duration of a patient's survival and alleviate some of the pain and suffering associated with mesothelioma. Patients will typically undergo a combination of treatments to combat mesothelioma. Surgery, chemotherapy and radiation therapy are the most widely used treatments, though alternative therapies such as massage and TENS (transcutaneous electrical nerve stimulation), are often administered to aid in pain relief.

A combination of treatments, such as surgery to remove as much of the cancer as possible, used in conjunction with chemotherapy to prevent cancerous cell division, is typically recommended. The stage, or maturity level, at which mesothelioma is diagnosed greatly affects a patient's prognosis and treatment options. The earlier the cancer is found and treated, the more likely a patient will positively respond to treatment.

Mesothelioma Clinical Trials

Many patients elect to participate in clinical trials as a way of building mesothelioma hope. Clinical trials are conducted to test up-and-coming treatments and medications before they are released and recommended to the public as a safe and effective way to treat an illness. The three stages of clinical trials test new drugs extensively, from the correct dosage required to the effectiveness of the drug. To participate in a clinical trial, a patient must first qualify for the study and meet specific qualifications.

Clinical trials are imperative in the search for a mesothelioma cure. As results and information are gathered from a study, the knowledge gained helps medical professionals come closer to the discovery of a cure. Each successful clinical trial renews mesothelioma hope for all patients around the world.

Dr. Sugarbaker

Dr. David Sugarbaker, MD has taken an active role in the pursuit of better treatment options for mesothelioma patients and a cure for the asbestos-related cancer. Dr. Sugarbaker has been instrumental in the discovery of groundbreaking treatment options and his multi-modal approach to treating the disease has increased survival rates for mesothelioma patients. Dr. Sugarbaker is best known for his innovative treatment approach which involves surgery coupled with radiation and chemotherapy treatments for patients both before and after surgery.

Extrapleural pneumonectomy (EPP), a ground-breaking surgical procedure performed by Dr. Sugarbaker, involves the removal of the lung and its coverings and the coverings of the heart and diaphragm. This surgery has resulted in disease-free and long-term survival and yielded the greatest amount of cytoreduction, or decrease in the number of cancerous cells.

Another procedure performed by Dr. Sugarbaker is intracavitary chemotherapy. Though currently under evaluation, the procedure has demonstrated encouraging results for mesothelioma patients. Intracavitary chemotherapy is completed while the patient is in surgery. Surgery to remove the tumor is completed and the chemotherapy is administered into the chest and abdominal cavity, contacting surfaces containing tumor cells and killing them. Healthy cells are preserved as a cytoprotective agent is utilized throughout the procedure.

Dr. Sugarbaker also founded the International Pleural Mesothelioma Program, which focuses on developing new treatment strategies and researching the causes of mesothelioma in effort to aid in the development of improved care for mesothelioma patients.

Progress made by Dr. Sugarbaker and other passionate medical professionals help strengthen mesothelioma hope and keeps the search for a cure alive. The research completed about mesothelioma and the constant studies conducted will only help scientists and doctors increase the survival rate of mesothelioma patients as they come closer to the discovery of a cure.

Mesothelioma Prognosis and Survival

Though many patients and their loved ones often get discouraged if the prognosis following a mesothelioma diagnosis comes back poor, it is important to remember that a number of patients have survived much longer than their initial prognosis suggested. Prognosis is generally poor because most patients do not exhibit symptoms of mesothelioma until 20 to 50 years after initial exposure to asbestos occurred, allowing the cancer to develop and mature in the body. The development of tests to aid in early diagnosis, such as the Mesomark blood test, will hopefully help mesothelioma patients receive treatment in the earlier stages of the cancer. Early diagnosis results in greater treatment options available to mesothelioma patients which can greatly improve a patient's prognosis.


Research reveals that mesothelioma patients who have survived for many years with the disease have commonly participated in some sort of therapy to enhance their immune system. Participation in clinical trials in immunology and other alternative therapies relating to the immune system have yielded positive results in some instances. Researchers theorize that mesothelioma likely results from immune suppression and mesothelioma survivors that participated in treatments to improve the immune system may have experienced positive results because of this participation.

Mesothelioma Hope

Many patients and their loved ones may enjoy reading "Lean on Me - Cancer through a Carer's Eyes," a touching story by Lorraine Kember about her husband's battle with mesothelioma. Reading about the emotions the Kember family experienced may help provide insight into the road ahead for those newly diagnosed. To receive a complimentary copy of this book, click here.

Mesothelioma Nutrition

Without a current cure for mesothelioma, patients battling the cancer often want to fight it in every way possible. Nutritious eating is a wonderful way to instill mesothelioma hope and equip the immune system with positive fuel. The food and nutrients that we put into our bodies greatly affect our ability to heal and fight disease. Eating a balanced diet consisting of whole grains, proteins, dairy, fruits and vegetables enables the body to function properly and adequately fight infection and illness. Eating nutritious food while actively fighting mesothelioma through treatment may not cure the cancer, but fighting the disease from every angle will give patients the best possible outlook.

Mesothelioma patients undergoing various treatments may have additional nutritional concerns. Nutrition during chemotherapy is extremely important as the drugs used during treatment kill cancer cells, but simultaneously affect healthy cells as well, leaving the body in a weakened state. Many patients may experience side effects from the treatment, including nausea and diarrhea. Mild flavored foods such as whole grain toast may settle the stomach and be easier to keep down during treatment. To combat constipation, patients should select foods with a large amount of fiber such as apples, oatmeal and broccoli. Ensuring adequate protein consumption is also important and many patients include egg whites, beans, milk and lean meats in their daily diet.

Patients undergoing radiation therapy may also experience side effects such as vomiting and loss of appetite. Since radiation can zap energy, it is important to eat nutritious foods with healthy calories to fuel the body properly. Limiting the amount of salt, alcohol and caffeine ingested during treatment is also very important. Speaking with a doctor or a nutritionist can help a patient receive guidance about proper nutrition and recommended foods to eat or avoid during radiation.

For many decades, doctors have been addressing the seriousness of particular cancers in terms of stages. Throughout the years, various staging systems have been developed to assist cancer doctors in determining diagnosis and the best form of treatment for the individual patient.

There are three popular staging systems used to examine the extent of pleural mesothelioma. Since other forms of mesothelioma are even less common than the occurrence of pleural mesothelioma, there currently are no formal staging systems for other forms of this aggressive cancer (although they can be applied if desired). Each of the three different staging systems measure various factors of malignant mesothelioma, including the extent of the tumor (primary mass), the metastasis (spreading), and the involvement of the lymph nodes.

The knowledge of what particular stage a patient is in after they are diagnosed with mesothelioma greatly affects what treatment options are recommended by doctors. We offer a personalized comprehensive packet that details the various stages of mesothelioma and available treatment options and we can cater this information to meet a patient’s specific situation.

Butchart System - Mesothelioma Staging Systems

The Butchart System is the oldest staging system for malignant mesothelioma and is the one most commonly used by doctors and specialists to diagnose and treat malignant mesothelioma. The Butchart System is based on the tumor size (mass) and divides malignant mesothelioma into four stages:

• Stage 1 - Malignant mesothelioma has affected the right or left side of the chest cavity (pleural lining) and may be seen in the diaphragm.
  


• Stage 2 - Malignant mesothelioma has been found in the pleura on both sides of the body and may have also moved into the heart, stomach, or esophagus on both sides. Lymph nodes may be affected.
  


• Stage 3 - Malignant mesothelioma has reached the abdominal cavity (peritoneum). Lymph nodes past the chest may be affected.
  


• Stage 4 - Malignant mesothelioma has reached other organs and has entered the blood stream.

• Stage 1 - Malignant mesothelioma is present in the left or right chest cavity (pleura) and may have metastasized to the lung, the sac around the heart (pericardium) or the diaphragm on the same side. Lymph nodes at stage 1 are not involved.
  
• Stage 2 - Malignant mesothelioma has reached from one side of the chest cavity to a lymph node near the lung area on the same side as the cancer. The cancer has metastasized to the diaphragm, pericardium (sac around the heart), or the lung on the same side as the primary tumor.
  
• Stage 3 - Malignant mesothelioma has penetrated the chest lining, heart, esophagus, muscle, ribs and vital organs within the chest cavity on the same side as the cancer. Lymph nodes may or may not be involved during this stage.
  
• Stage 4 - Malignant mesothelioma has metastasized to the pleural area and the lymph nodes on the opposite side of where the cancerous tumor is located. It may also have reached the chest cavities or lungs on both sides, or may have spread to the abdomen.

• Stage 1 - Malignant mesothelioma tumor is still resectable (able to be removed surgically) and the lymph nodes are not affected.
  
• Stage 2 - Malignant mesothelioma tumor is still resectable, but the lymph nodes are now affected.
  
• Stage 3 - Malignant mesothelioma tumor is not resectable and the malignant mesothelioma has penetrated the heart, chest wall, abdominal cavity or diaphragm. Lymph nodes may or may not be affected.
  
• Stage 4 - Malignant mesothelioma tumor is not resectable and has completely metastasized (spread throughout the body).

• Chest x-ray
  
• CT scan of the chest and/or abdomen
  
• MRI scan of the chest and/or abdomen
  
• PET scan of the chest and/or abdomen

Research scientists and doctors have struggled to improve the life expectancy for mesothelioma patients for decades. While there is no definitive cure for mesothelioma, patients may elect to undergo intensive treatment that may help prolong their life expectancy or improve the patient’s overall quality of life.

What Affects a Mesothelioma Patient's Life Expectancy?

Mesothelioma is a rare cancer caused by asbestos exposure. The life expectancy of a mesothelioma patient is affected by numerous factors including:

• Latency Period – Unlike other cancers with symptoms that surface quickly, asbestos fibers that cause mesothelioma over time can lay dormant in the body for up to 50 years. This long period of latency often results in a late diagnosis. In many cases, the diagnosis is made when it has already reached late stages of development, making mesothelioma treatment difficult and sometimes ineffective. Mesothelioma patients diagnosed in later stages will typically receive palliative treatments rather than curative, which serve to make the patient more comfortable and increase their quality of life rather than cure the disease.
  
• Age of Diagnosis – Most reports indicate that the average age of a mesothelioma patient is 60. In fact, more than 75 percent of mesothelioma cases diagnosed in the United States occur in men age 55 or older. However, some researchers believe the average age is dropping due to the influx of cases from secondary exposure. When an older person develops mesothelioma cancer, treatment can be compromised due to the presence of other health-related problems. These might include heart disease, additional lung ailments, and high blood pressure. Advanced age and the presence of other diseases can significantly affect a patient's life span.
  
• Types of Mesothelioma – There are three major types of mesothelioma an individual can develop. The most common form is pleural mesothelioma, which affects the lining of the lungs. Other forms of the disease include peritoneal and pericardial mesothelioma, which affect the lining of the abdomen and heart. Since pleural mesothelioma affects the most mesothelioma patients, more knowledge and research about this form of the cancer is present to utilize when detailing a treatment plan, often times making a plueral life expectancy much longer.
  
• Smoking – Smoking can greatly decrease the life span of an individual who has been diagnosed with mesothelioma. Anyone diagnosed with mesothelioma should quit smoking immediately.

Approximately 2,000 to 3,000 new cases of mesothelioma are diagnosed in the United States each year. Once a patient is diagnosed, a doctor will likely discuss their prognosis, or probable course and outcome of the cancer's influence on the body.

The best way to avoid a poor prognosis is through early detection.

What Factors Affect Prognosis?

Mesothelioma is not generally diagnosed until the latest stages of development because of the amount of time it takes for patients to display symptoms associated with the disease. In addition to this, the symptoms of mesothelioma are very general and often resemble less serious conditions, which can make the cancer difficult to diagnose. As a result, the prognosis for the majority of patients is poor, but many doctors can recommend treatment options such as surgery, chemotherapy and radiation to help combat the disease.

Doctors typically address the cancer in terms of stages, ranging from stage one to stage four. Unfortunately, once mesothelioma cancer has reached stage three or four, treatment options not only become more limited but less effective as well. When a patient is diagnosed with stage four mesothelioma, their health condition often rules out the possibility of surgery. Treating mesothelioma becomes more difficult the later a diagnosis occurs.

In addition to the stage of the cancer and the age of the patient, other factors that affect prognosis include:

• The type of mesothelioma – pleural, peritoneal, pericardial or testicular
  


• The size of the tumor
  


• The location of the tumor and whether it can be
  


• surgically removed
  


• The extent of other symptoms, including fluid in the
  


• lungs or abdomen
  


• Whether or not the patient is a smoker

Malignant mesothelioma is typically diagnosed in individuals over 55 years old, though there are certainly exceptions. Some patients already have multiple medical problems caused by advancing age, making treatment even more difficult and increasing the mortality rate among mesothelioma patients.

Mesothelioma Survival Rates

Many studies have been conducted in regards to survival rates among mesothelioma patients. When discussing survival rates for this or any type of cancer, references to the "five-year relative survival rate" are often stated. This number refers to the percentage of patients who live at least five years after their cancer is diagnosed.

According to statistics published by the American Cancer Society, the five-year relative survival rate for patients with mesothelioma is approximately 10 percent. That number has improved in the last five years, up from 9 percent reported at the end of 2002. In addition, recent studies show that the one-year survival rate is now about 40 percent, a number that has also increased in the past five years. Throughout the 1990s, it was rare for a patient to survive more than a year after diagnosis.

Though numerous factors affect a patient’s prognosis such as age, overall health, and the type of mesothelioma the patient is battling, the average length of survival reported throughout the last five years has been 10 to 11 months after diagnosis.

Exciting stories about mesothelioma survivors continue to surface, providing hope to mesothelioma patients and their loved ones.

The term latency period is used to describe the period of time between exposure to a potential disease-causing agent and the time the disease becomes apparent. According to most experts, in the case of mesothelioma the latency period ranges from 20 to 50 years after initial exposure to asbestos occurred, though there have been instances when the time period was shorter or longer.

Due to the long latency period associated with the cancer, those exposed to asbestos during the 1950s, '60s and '70s are beginning to demonstrate mesothelioma symptoms today, decades after they were exposed to asbestos.

Living During the Latency Period

While no one should spend their days dwelling on the fact that they could someday develop an asbestos-related disease, there are some things that can be done to aid in early diagnosis if mesothelioma is indeed present.

The most notable development in the last few years is the mesothelioma blood test known as Mesomark. Approved by the FDA in 2007, this simple test measures a particular cancer biomarker and can catch mesothelioma in the early stages of development. The blood test is not available everywhere but if you wish to undergo testing, asking your doctor where you may take advantage of the test may aid in early detection.

Those exposed to asbestos run the risk of developing asbestosis or mesothelioma and may wish to schedule yearly chest X-rays to check for any suspicious signs of disease. If a doctor determines there may be a concern after the X-ray, further imaging tests such as CT scans or MRIs may be recommended. A biopsy may also be requested to test for the presence of cancerous cells.

Varying Latency Periods

A number of studies have been conducted on the specifics of the length of latency periods among those exposed to asbestos.

In the case of mesothelioma, evidence has indicated that high exposure for short periods of time might be more damaging than low exposure for many years. For example, Deborah Reeve, a New York City paramedic and first responder at the site of the World Trade Center attacks in 2001, passed away from mesothelioma in 2006, just five years after her exposure to asbestos from the events on September 11. Deborah had symptoms of the disease as early as 2003 and was diagnosed with mesothelioma in 2004.

Numerous studies on asbestosis agree that more than 90 percent of individuals who were exposed to asbestos for 40 years or more will develop the disease. For those who worked with the toxic mineral for 20-30 years, the rate is about 75 percent. Those who experienced 10-19 years of exposure have an incidence level of about 10 to 15 percent. These numbers may also vary according to the level of asbestos someone is exposed to on a daily basis.

For example, shipbuilders of the mid-20th century were nearly always surrounded by asbestos as were many construction workers. Those groups have tended to develop asbestosis sooner than those who worked in other industries where the levels may not have been as high.

Patients concerned about the latency period associated with mesothelioma and the possibility of developing the cancer may be interested to read more about mesothelioma symptoms.

When a patient learns of a mesothelioma diagnosis, confusion is often one of the first emotions experienced. What exactly is mesothelioma? Is it a disease? A virus? Mesothelioma is actually a rare type of cancer. When people refer to mesothelioma disease, they are actually referring to mesothelioma cancer. Mesothelioma develops in the mesothelium, the membrane that surrounds several body cavities. The mesothelium is comprised of mesothelial cells, which become abnormal and divide uncontrollably if mesothelioma is present.

Four different types of mesothelioma exist. Pleural mesothelioma is the most common form of the cancer and develops in the lining of the lungs, known as the pleura. Peritoneal mesothelioma affects the lining of the abdomen, known as the peritoneum. Pericardial mesothelioma is very rare, as approximately 200 cases have been reported internationally. Pericardial mesothelioma develops in the pericardium, the membrane that surrounds the heart and protects the organ. Testicular mesothelioma is the rarest form of mesothelioma and develops in the lining surrounding the testicles, known as the tunica vaginalis.

Approximately 2,000 to 3,000 people are diagnosed with mesothelioma annually in the United States. Many patients are not diagnosed with the cancer until it has reached later developmental stages since it may take 20 to 50 years for a patient to demonstrate symptoms of mesothelioma. The cancer is caused almost exclusively by asbestos exposure and it often takes decades for a patient to express mesothelioma symptoms from the time initial asbestos exposure occurred.

Mesothelioma Symptoms

Diagnosis can be difficult because symptoms often resemble more common illnesses and are non-specific. Patients are often unaware of the severity of their condition until they are diagnosed with mesothelioma. A patient with peritoneal mesothelioma may express symptoms such as a persistent dry or raspy cough, difficulty breathing and swallowing, night sweats and fever, among others. Pericardial mesothelioma patients may complain of swelling or pain in the abdomen, fatigue, nausea, night sweats or the appearance of lumps under the skin on the abdomen. A patient with pericardial mesothelioma may experience heart palpitations or irregular heartbeat, chest pain, difficult breathing, fever and fatigue. Testicular mesothelioma symptoms have been confined to the appearance of testicular lumps.

Mesothelioma Diagnosis

Once a patient demonstrates unusual symptoms and visits a doctor, a medical review and physical examination often follow. Typically, further testing will be needed and an x-ray will likely be requested to pinpoint the location of the cancer and determine whether or not it has spread to other areas of the body. Additional imaging tests such as a CT scan, PET scan or MRI are often recommended for a more detailed image of the cancer. A fluid and tissue test, known as a biopsy is then typically conducted to collect a sample of fluid or tissue to test for the presence of cancerous cells. A pathologist generally examines the sample to determine whether or not mesothelioma is present.

Mesothelioma Treatment

After diagnosis, patients and their loved ones are often anxious to do everything possible to fight mesothelioma. This may involve several different treatment options. The most common treatments mesothelioma patients utilize include surgery, chemotherapy and radiation. Though a cure for mesothelioma does not currently exist, many patients undergo several treatments for relief from symptoms to improve the quality of life. Patients may also experience relief through experimental options and treatments available through clinical trials and alternative therapies.

The biggest and almost exclusively known risk factor for mesothelioma is exposure to asbestos. Those who have inhaled or ingested the toxic mineral are prime candidates for developing the disease. Even indirect exposure (known as secondary exposure) has been linked to cause mesothelioma in many instances.

Risks from Direct Exposure

Anyone who has encountered asbestos is at risk for developing mesothelioma. Asbestos and asbestos-containing products were commonly used in a wide variety of industries throughout most of the twentieth century. Some workers in those industries encountered the dangerous mineral on a daily basis, unknowingly exposing themselves to a substance that would eventually wreak havoc on their lungs.

Workers who may have encountered asbestos on the job include:

• Shipyard workers
  
• Insulators
  
• Construction workers
  
• Electricians
  
• Plumbers
  
• Pipefitters
  
• Steamfitters
  
• Welders
  
• Railroad employees
  
• Power plant employees
  
• Chemical plant employees
  
• Boilermakers
  
• Auto mechanics
  
• 9/11 first responders/emergency personnel

The dangers of asbestos exposure were known long before any efforts were made to protect workers. Thousands of American workers were exposed to asbestos during the 20th century, and were often unaware of the hazards of exposure.

Companies that produced asbestos-containing products or used these products on a daily basis are liable for their negligence in failing to protect their workers. If you or a loved one has developed mesothelioma or another asbestos-related disease as a result of asbestos exposure, you may wish to speak with an attorney to seek compensation to help cover medical expenses, lost income and pain and suffering.

There are several types of treatment available for patients with mesothelioma, some recommended more frequently than others. The most commonly used treatments are surgery, chemotherapy, and radiation therapy. In addition, some experimental treatments are becoming more widely used, or are showing some encouraging results in clinical trials. These treatments include photodynamic therapy, gene therapy, and immunotherapy, among others.

Mesothelioma Cure

Though a cure for mesothelioma does not currently exist, many patients elect to undergo treatment to combat the cancer. Patients may also wish to participate in clinical trials conducted to test up-and-coming treatments and medications before they are released and recommended for public use. Clinical trials are extremely important in the search for a mesothelioma cure. Knowledge gained from study results greatly help medical professionals come closer to the discovery of a cure for mesothelioma.

Certain doctors such as Dr. David Sugarbaker have actively pursued better treatment options for mesothelioma patients and have been instrumental in the quest for a cure. Utilizing a multi-modal approach, Dr. Sugarbaker has made great strides in mesothelioma treatment and has increased survival rates for mesothelioma patients.

Learning that a cure does not exist can be discouraging to mesothelioma patients and their loved ones, but stories of survivors continue to surface, instilling hope in those affected by the cancer.

Mesothelioma Surgery

Surgical treatments for mesothelioma include three main types - diagnostic surgery, curative surgery, and palliative surgery. Some types of surgery fall into more than one category.

For example, thoracentesis may be used as a diagnostic procedure, and as a palliative treatment to provide symptomatic relief. Only curative surgery can potentially remove all cancer from a patient with mesothelioma.

However, for curative surgery to be effective, it is particularly important that mesothelioma be diagnosed as early as possible. Unfortunately, mesothelioma is not usually diagnosed until it reaches Stage III or IV, when surgery is not an option.

Mesothelioma Chemotherapy

Most forms of chemotherapy involve the intravenous administration of drugs such as Alimta and Cisplatin. Chemotherapeutic drugs are targeted to kill cells that are rapidly dividing by interfering with processes that occur during cell division.

However, while cancer cells themselves divide rapidly, so do some types of healthy cells, causing some of the unpleasant side effects that are often associated with this form of treatment. Though older chemotherapy medications seemed to do little to fight mesothelioma, newer chemotherapy drugs are showing much promise.

A relatively new form of chemotherapy called heated chemotherapy is an option for patients with peritoneal mesothelioma.

This treatment is carried out following surgery, and involves the perfusion of heated chemotherapeutic medications into the peritoneum.

Mesothelioma Radiation

Radiation therapy, or "ionizing radiation", is used to kill cancer cells and to limit the spread of cancer. For patients with mesothelioma, radiation therapy is most often used in conjunction with surgery.

However, in some cases radiation may be used as a stand-alone treatment to relieve pain and other symptoms associated with mesothelioma. In either case, it is rare for radiation therapy to provide more than short-term symptomatic relief.

Mesothelioma patients may receive one of two types of radiation therapies, depending on whether or not they are suitable candidates for either procedure.

External beam radiation therapy is the traditional type of radiation therapy, where tumors are bombarded with beams of radiation to kill cancer cells. Brachytherapy is a newer type of radiation treatment. It involves tiny radioactive rods which are implanted within a tumor to provide a strong, concentrated dose of radiation to tumors while doing very little damage to surrounding healthy tissue.

Photodynamic Therapy

Photodynamic therapy is a highly specialized and specific form of treatment that is most often used to treat skin cancers, some types of lung cancer, and pleural mesothelioma.

However, this treatment is usually unsuitable for patients with metastasized cancer; it is most effective in patients who have localized disease.

This type of therapy involves the use of light energy to kill cancer cells. In photodynamic therapy treatment, the patient is given an intravenous solution of a medication that makes cancer cells highly sensitive to a particular kind of light.

One to three days after this treatment, the patient is exposed to the light, and cancer cells that have absorbed the medication are killed.

Gene Therapy

Gene therapy involves using genetic material to specifically target cancer cells and make them more vulnerable to chemotherapy treatment.

The main type of gene therapy being developed for use in mesothelioma patients is called "suicide gene therapy," because it forces cancer cells to produce substances that cause their death.

When undergoing this type of gene therapy, the patient is treated with a non-infectious virus that has been altered with genetic material that makes them produce a particular protein.

Following this procedure, the patient is then treated with a chemotherapeutic medication that is specially formulated to be toxic only to cancer cells. This type of therapy has produced some promising results for mesothelioma patients, but it is still only available through clinical trials.

Immunotherapy is a type of treatment in which the patient's own immune system is 'tricked' into killing cancer cells. A healthy, normally-functioning immune system does not kill cancer cells, because even though these are diseased cells, the immune system is unable to recognize them as being harmful.

There are two main types of immunotherapy: active and passive. In active immunotherapy, mesothelioma cancer cells are removed from a patient and then treated in a laboratory to turn them into a vaccine. Following this laboratory treatment, the patient is injected with the vaccine and if the treatment is successful, the patient's immune system recognizes the vaccine as a harmful substance, thus recognizing the cancer as being harmful as well.

Passive immunotherapy is somewhat different in that it does not attempt to activate the patient's immune system. Instead, it uses substances such as cytokines (molecules that direct and regulate the immune system) and other agents to help boost the patient's immune response to their cancer.

Mesothelioma patients are typically diagnosed within three to six months of their first visit to a doctor with complaints about breathing problems or chest and abdominal pain. The first step involved in a diagnosis of mesothelioma is providing a full and accurate medical history to your doctor, including details about current and past health concerns, as well as the types of symptoms you are currently experiencing.

It is important to mention any possible exposure to asbestos. Without revealing this fact, your doctor may not consider asbestos-related diseases in his or her examination. Next, patients will undergo a physical examination where a doctor will examine causes for any types of symptoms being displayed. In most cases, the doctor's next step will be to recommend further testing.

Mesothelioma Diagnostic Tests

If your doctor suspects an asbestos-related disease such as mesothelioma, the next step in the diagnostic process includes testing to confirm the presence of mesothelioma, determine the location, size and type of cancer involved, and determine whether the asbestos cancer has spread to other parts of the body. This will often involve imaging tests such as:

• Chest X-ray: This is the most commonly used imaging test for the diagnosis of mesothelioma. Almost all diagnoses will involve an X-ray, but a more sophisticated test may follow.
  
• CT Scan: This is an X-ray-like procedure in which several X-ray pictures are taken and combined with a computer to produce a detailed image of body tissues. If you undergo a CT scan, you may be given an intravenous injection of dye that helps produce more detailed images.
  
• PET Scan: A glucose solution is administered through intravenous injection and a scanner is used to spot deposits of cancer cells. Malignant cells take up and use sugars more quickly than normal cells, so they can be easily distinguished using this procedure.
  
• MRI Scan: A combination of radio waves and a strong magnetic field is used to create detailed three-dimensional images that can be carefully examined by a radiologist.

• Fine Needle Aspiration: Mesothelioma cancers cause fluid to build up in affected locations, such as in the pleural membrane. During a fine needle aspiration, a doctor will remove a fluid sample using a very long, thin and hollow needle.
  
• Thoracoscopy: Thoracoscopy is used in cases where pleural or pericardial mesothelioma is suspected. During this procedure, a very small incision is made in the chest wall and a sample of tissue is removed.
  
• Bronchoscopy and Laparoscopy: These procedures are similar to the thoracoscopy, but are performed on different parts of the body. The bronchoscopy is used to view the trachea and airway, while the laparoscopy is used to remove samples of peritoneal tissue.
  
• Mediastinoscopy: This procedure is used to view lymph nodes in the chest and neck, to determine if cancer has spread from its point of origin.

A patient with mesothelioma often demonstrates symptoms 15 to 50 years after initial exposure to asbestos. The cancer may take decades to develop in the body and symptoms do not arise until after the cancer is present. Many patients are unaware of the severity of their condition since mesothelioma symptoms typically resemble symptoms of less serious illnesses.

If you have a history of asbestos exposure, the leading cause of mesothelioma, it is best to seek immediate medical advice. Informing your doctor of previous asbestos exposure can alert them to the possibility of an asbestos-related disease such as mesothelioma.

Early Symptoms of Mesothelioma

Unfortunately, there are practically no early symptoms of mesothelioma, which is why the disease is commonly diagnosed at a late stage of development. In the interest of early detection, those who were exposed to asbestos but have not yet exhibited symptoms should undergo regular chest X-rays or pulmonary function tests to monitor any adverse affects of asbestos inhalation.

When a doctor informs a patient of a mesothelioma diagnosis, patients and their loved ones are often very confused since the cancer is relatively unknown. Asbestos.com provides a complimentary packet with comprehensive information about mesothelioma symptoms and next-step guidance following a diagnosis.

Pleural Mesothelioma Symptoms

Pleural mesothelioma is the most common form of the cancer, comprising approximately two-thirds of all mesothelioma cases.

Known symptoms of pleural mesothelioma include:

• Persistent dry or raspy cough (typically non-productive, meaning there is little or no phlegm)
  
• Coughing up blood (hemoptysis)
  
• Difficulty in swallowing (dysphagia)
  
• Night sweats or fever
  
• Unexplained weight loss of 10 percent or more
  
• Fatigue
  
• Persistent pain in the chest or rib area, or painful breathing
  
• Shortness of breath (dyspnea) that occurs even when at rest
  
• The appearance of lumps under the skin on the chest

Symptoms of pleural mesothelioma occur as a result of thickening of the pleural membrane, caused by the rapid production of cancerous cells which can lead to the buildup of fluid between membrane layers. Tissue thickening and fluid buildup place pressure on the lungs, leading to reduced respiratory function.

Peritoneal Mesothelioma Symptoms

Peritoneal mesothelioma accounts for approximately 25 to 30 percent of mesothelioma diagnoses and symptoms may include:

• Night sweats or fever
  
• Unexplained weight loss
  
• Swelling or pain in the abdomen
  
• Anemia
  
• Fatigue
  
• Diarrhea or constipation (in general, any change in bowel habits or regularity)
  
• Nausea or vomiting
  
• The appearance of lumps under the skin on the abdomen

Symptoms are caused by the thickening of the peritoneal membrane and the resulting build-up of fluid between membrane layers. These changes in membrane composition put pressure on the abdominal region and organs, causing a patient to demonstrate symptoms of the cancer.

Pericardial Mesothelioma Symptoms

Pericardial mesothelioma accounts for less than 5 percent of all mesothelioma. Symptoms are caused by thickening of the pericardial membrane and fluid buildup. Known symptoms include:

• Heart palpitations or irregular heartbeat
  
• Chest pain
  
• Difficulty breathing, even when resting (dyspnea)
  
• Fever or night sweats
  
• Generalized fatigue

Pericardial mesothelioma is so rare that the recognized body of symptoms is not as well-developed as with more common types of mesothelioma. It is a particularly difficult type of mesothelioma to diagnose, and this correlates to a poor prognosis among pericardial mesothelioma patients.

Testicular Mesothelioma Symptoms

Testicular mesothelioma is an extremely rare form of cancer, as less than 100 cases of testicular mesothelioma have been recorded in the last 60 years. With so few cases recorded, very little is known about the symptoms of this disease. The only known symptom of testicular mesothelioma is the appearance of testicular lumps, and the lumps may or may not be painful.

Mesothelioma is caused by long-term, repeated exposure to asbestos fibers. The disease is generally found in four different forms: pleural, peritoneal, pericardial, and testicular. In each case, the cancer develops in mesothelial cells, which form the membranous linings that surround and protect organs. The different names for each type of mesothelioma refer to the point of origin of the cancer.

Mesothelial membranes are made up of two different layers, called the parietal and visceral layers. Parietal layers are outer layers, and these typically cover large areas such as the chest cavity (in the case of pleural and pericardial membranes) and the abdominal cavity (as in the case of peritoneal membranes). Visceral layers are those that cover organs such as the lungs and heart. Mesothelioma develops in these membranes when asbestos fibers become trapped in the spaces between mesothelial cells.

Mesothelioma is a particularly aggressive type of asbestos cancer, and is highly resistant to treatment, resulting in very high mortality rates and poor prognosis for people diagnosed with the disease. In general, pleural mesothelioma responds more positively to treatment, particularly if the disease is diagnosed early. However, all forms of mesothelioma are difficult to diagnose, and unfortunately, it is common for the disease to be diagnosed too late for treatment to be effective.

Pleural Mesothelioma

Pleural mesothelioma develops in the mesothelial lining of the lungs, which is known as the pleura. About 75 percent of all mesothelioma cases are pleural.

Symptoms of pleural mesothelioma include difficulty swallowing, a persistent dry cough, persistent chest pain, or pain when breathing, and difficulty breathing even when resting. These mesothelioma symptoms result from pressure on the lungs and respiratory system, caused by thickening of the pleural membrane and fluid build-up between membrane layers. As the cancer advances, lumps may develop under the skin of the chest.

Diagnosis of pleural mesothelioma involves imaging tests such as chest x-rays, MRIs, and CT scans, and may also include biopsies that remove tissue and fluid to test for the presence of cancer cells. These tests also help determine the stage of the cancer and the options available for treatment. Generally, patients in stage one and two mesothelioma are good candidates for surgery, whereas patients in stages three and four have more limited treatment options, and may only be able to receive palliative treatments.

Peritoneal Mesothelioma

Peritoneal mesothelioma develops in the peritoneal lining of the abdominal cavity. This is a relatively rare form of mesothelioma; approximately 10 to 20 percent of all mesothelioma cases are peritoneal in nature.

Symptoms of peritoneal mesothelioma include pain or swelling of the abdomen, changes in bowel habits (such as constipation or diarrhea), unexplained weight loss, and nausea or vomiting. These symptoms are caused by thickening of peritoneal membranes and fluid build-up, which puts pressure on internal organs and prevents normal function of some organs. As the cancer advances, people with peritoneal mesothelioma may notice lumps developing under the skin of the abdomen.

Diagnosis of peritoneal mesothelioma involves imaging tests such as CT scans and MRIs, as well as biopsies of fluid and tissue to detect the presence of mesothelioma cells. There is currently no recognized staging process for peritoneal mesothelioma.

Peritoneal mesothelioma is problematic in terms of treatment, because the cancer can spread quickly throughout the peritoneum and often metastasizes more quickly than other types of mesothelioma. In some cases surgery is possible, but this is typically a palliative treatment option.

Pericardial Mesothelioma

Pericardial mesothelioma develops in the membrane that surrounds the heart, also known as the pericardium. This is a very rare form of mesothelioma, occurring in only 1 to 5 percent of cases. This form of mesothelioma is also very difficult to treat.

Symptoms of pericardial mesothelioma include irregular heartbeat or palpitations, chest pain, and difficulty breathing. These are caused by the pressure put on the heart by the build-up of fluid in the spaces between pericardial membrane layers.

It is very rare for pericardial mesothelioma to be diagnosed early enough for any form of treatment to be effective, and pericardial mesothelioma patients typically have an extremely poor prognosis. In very rare cases, the cancer may be diagnosed early enough for surgery to have a positive effect; however, the proximity of this cancer to the heart makes such surgery a high-risk mesothelioma treatment option.

Testicular Mesothelioma

Testicular mesothelioma is the rarest of all mesothelioma cancers, as less than one hundred cases have been recorded. This type of mesothelioma develops in the lining that surrounds the testicles, known as the tunica vaginalis.

Due to the extreme rarity of testicular mesothelioma, very little has been noted about its symptoms and the treatment options available. Often, the disease is not diagnosed until patients notice the appearance of testicular lumps. In some cases, surgery for an unrelated condition such as a hernia leads to the detection of testicular mesothelioma.

If the primary tumor has developed in the testicles, treatment involves removal of part or the entire affected testicle, followed by chemotherapy or radiation therapy. In many cases the testicular tumor is secondary, and the primary cancer is located in the peritoneum. In these cases, treatment follows established patterns for peritoneal mesothelioma in addition to removal of testicular tumors.

Mesothelioma is a highly aggressive cancer that is difficult to both diagnose and treat. Between 2,000 and 3,000 cases of malignant mesothelioma are diagnosed each year in America, and these figures are projected to increase throughout the next decade.

A significant amount of research has been conducted on potential mesothelioma causes (also known as mesothelioma etiology) and scientific discoveries continue to help medical professionals further understand how this cancer develops.

Causes of Mesothelioma Cancer

An overwhelming body of scientific and medical evidence has proven that the primary cause of malignant mesothelioma is exposure to asbestos. The exact method by which asbestos causes mesothelioma is still being researched, but medical professionals have a number of theories:

• Asbestos causes irritation and inflammation of mesothelial cells, which results in irreversible scarring, cellular damage, and eventually cancer.
  
• Asbestos fibers enter cells and disrupt the function of cellular structures that are essential for normal cell division, causing cellular changes that lead to cancer.
  
• Asbestos causes the production of free radicals. These molecules damage DNA, and cause cells to mutate and become cancerous.
  
• The presence of asbestos causes cells to produce oncoproteins. These molecules cause mesothelial cells to ignore normal cellular division restraints, and s can lead to the development of cancer.

The element that ties each theory together is the fact that asbestos results in cellular damage. This causes cells to lose control over normal cell cycles and results in uncontrollable division. Healthy cells follow cycles of cell division that ensure tissues do not grow and duplicate beyond normal conditions - in cancerous cells, these restraints are lost.

In cases of mesothelioma, the result of the cellular damage is that membranes in the affected location begin to thicken, and fluid builds up in the spaces between membrane layers. As cancer cells continue to divide and pile on top of one another, tumors begin to form. The uncontrolled division of cancer cells results in the impaired function of the body's organs and systems (primarily due to factors such as internal pressure caused by the growth of tumors, and the reduction of essential nutrients for organs), resulting in a number of symptoms.

Additional Risk Factors

Other risk factors that may cause malignant mesothelioma include:

• Radiation: Some mesothelioma patients with no traceable history of asbestos exposure do share a history of radiation exposure. Around 45 cases of mesothelioma following radiation therapy have been reported and discussed in medical literature.
  
• Nonasbestos Mineral Fibers: A few nonasbestos mineral fibers have been linked to malignant mesothelioma, such as erionite and taconite.
  
• Simian Virus 40: Originating in the rhesus monkey and contaminating millions of polio vaccines administered in the 1950s and ’60s, simian virus 40 has been linked to malignant mesothelioma and several other malignancies.

Additional risk factors that are not as well-researched in medical literature include chronic inflammation, chest injuries, genetics and organic chemicals.

It should be noted that cancer doctors and research scientists know that smoking does not cause mesothelioma, but it can aggravate other asbestos-related conditions (such as asbestosis) and compromises the body’s ability to fight the biological effects of asbestos fibers. Additionally, asbestos exposure and smoking has a synergistic affect that can increase a person's risk of developing lung cancer by as much as 84 times or more. For this reason, those who have been exposed to asbestos are highly advised not to smoke.