Quick Jump-to Guide:
- What is Mesothelioma?
- Cell Types
- Signs & Symptoms
- Other Asbestos Diseases
- Free Mesothelioma Book
What is Mesothelioma?
Mesothelioma is a rare form of cancer, known as the asbestos caused cancer, that develops from cells of the mesothelium, the lining that covers many of the internal organs of the body.
The main purpose of the mesothelium is to produce a lubricating fluid between tissues and organs. This fluid provides a slippery and protective surface to allow movement.
For example, it allows the lungs to expand and contract smoothly inside the body each time you take a breath. When the cells of the mesothelium turn cancerous they become mesothelioma.
That’s where the name for mesothelioma comes from.
Mesothelioma is a rare disease and there are only approximately 2,000 cases diagnosed in the United States every year. There are many more cases diagnosed throughout the world, especially in Australia and the U.K. where large amounts of asbestos was used.
United States Mesothelioma Statistics
- 3,000 cases diagnosed every year
- 80% diagnosed are men
- 12 months median survival time
- 125 million have been exposed
Mesothelioma In Other Countries
Number of mesothelioma cases per year in other countries:
Types of Mesothelioma
There are 4 types of mesothelioma: Pleural, peritoneal, pericardial and testicular. Pleural mesothelioma affects the outer lining of the lungs and chest wall and represents about 75% of all cases. Peritoneal mesothelioma affects the abdomen and represents about 23%. Incidences of mesothelioma in the lining of the testis and the heart represent about 1% each.
When then pleural lining around the lungs and chest wall are involved in this cancer it is called pleural mesothelioma. There are actually two layers of tissue that comprise the pleural lining. The outer layer, the parietal pleura, lines the entire inside of the chest cavity. The inner layer is called the visceral pleura and it covers the lungs.
Mesothelioma usually affects both layers of the pleura. Often it forms in one layer of the pleura and invades the other layer. The cancer may form many small tumors throughout this tissue.
When the peritoneum, the protective membrane that surrounds the abdomen is involved in this cancer it is called peritoneal mesothelioma. Just like pleural mesothelioma, there are two layers of tissues involved with the peritoneum, the parietal layer covers the abdominal cavity, while the visceral layer surrounds the stomach, liver and other organs.
The cancer often forms many small tumors throughout the tissue. One doctor has described it as if someone took a pepper shaker and scattered the pepper over the tissue.
Mesothelioma Cell Types
In addition to the different locations of mesothelioma within the body, there are also different cell types. These types are all considered mesothelioma, but they can affect the patient’s prognosis.
The three mesothelioma cell types are: epithelioid, sarcomatoid and biphasic.
Epithelioid mesothelioma cells are the most common type of mesothelioma cell and has the best prognosis of the three cell types. Notice the dark purple, elongated egg shaped cells amongst the healthy pink colored tissue.
Sarcomatoid mesothelioma cells are the rarest of the three cell types and tends to be more aggressive than epitheloid cells. Notice the dark purple nodules amongst the healthy light purple colored tissue.
Biphasic mesothelioma cells are mixtures of both cell types (epithelioid and sacromatoid) and usually has a prognosis that reflects the dominant cell type.
Symptoms of Pleural Mesothelioma
- Shortness of breath due to pleural effusion (accumulation of fluid between the lung and the chest wall)
- Chest pain
- Weight loss
Symptoms of Peritoneal Mesothelioma
- Abdominal pain and/or swelling
- Diarrhea or constipation
- Night sweats and/or fever
- Weight loss
- Nausea or vomiting
What Causes Mesothelioma?
Mesothelioma is caused by exposure to asbestos and it is therefore considered the asbestos caused cancer.
Asbestos has been in use since ancient times, but after the Industrial Revolution its use became widespread and was used all over the world in thousands of industrial and consumer products even after many companies knew that it was dangerous. Construction materials, automotive parts and household products such as hair dryers and oven mitts contained asbestos in the past.
Today, asbestos has been outlawed in most places around the world, however, asbestos has not been outlawed in the United States and is still found in millions of homes and public buildings, such as schools, offices and parking garages.
What is Asbestos?
Asbestos is actually a naturally occurring mineral found throughout the world. It was called the “magic mineral” because it is resistant to heat and corrosion. Also, it is a fiber so it can be woven into other materials.
Asbestos is composed of millions of sharp microscopic fibers. These fibers are so small that the body has difficulty filtering them out. This means that if you around airborne asbestos you may inhale it or ingest it. This is known as asbestos exposure.
How Does Asbestos Cause Mesothelioma?
The actual process as to how asbestos causes mesothelioma is still being investigated. Most scientists believe that when the small sharp fibers are ingested or inhaled they cause cell damage which can cause chronic inflammation.
This inflammation can then set the stage for disease after many years or even decades. Some scientists believe that a person’s immune system may actually help prevent mesothelioma, even if that person is exposed to asbestos.
Since asbestos causes mesothelioma, how to people get exposed to asbestos? While asbestos was in thousands of products, workers in some professions had more exposure to this carcinogen than others.
Examples of occupations that exposed workers to asbestos includes: Navy veterans, construction trades such as electricians, mechanics, and plumbers, people working in power houses and power plants, firefighters, and refinery workers. Individuals in these professions often had a multitude of asbestos containing products on their various job sites.
Most asbestos containing products were removed voluntarily by the late 1970’s. However, because there is no comprehensive ban on asbestos in the U.S. and because of the long latency period, people are still being diagnosed with mesothelioma today.
History of Asbestos
The history of asbestos in the United States and other industrialized countries is a sad story of corporate greed. Companies that produced asbestos containing products saw their workers becoming sick with lung scarring, asbestosis, and cancer nearly 100 years ago.
Some companies even brought in researchers and scientists to better understand the health impact of asbestos. Once it was shown that their “magic mineral” was toxic to human beings, the industry faced a dilemma.
Should they protect workers, warn consumers, notify public health officials, and most importantly, phase out this dangerous mineral? Their answer was “no.”
Instead industry did just the opposite. They warned no one, kept their knowledge about asbestos secret and continued to use it – for decades! Only by the 1960’s did independent researchers like Dr. Irving Selikoff of Mt. Sinai School of Medicine
begin to connect asbestos exposure to disease.
By then hundreds of thousands of men, women, and children were already exposed to this deadly mineral. The EPA would ban asbestos in 1989. However, the asbestos industry would sue the EPA and win.
In 1991 the ban was lifted. Even today, there is no comprehensive asbestos ban in the United States. Sad but true.
(Asbestos Medical and Legal Aspects by Barry Castleman)
Secondary Exposure, and the “Deadly Hug”
People exposed directly to asbestos are called “primary exposed.” Sometimes the person who is primary exposed will transfer asbestos fibers from their clothes to the clothes of another person. The person who gets this transfer of asbestos exposure is said to have “secondary exposure.”
One example of secondary exposure is called the “deadly hug.” Sadly, the deadly hug happens when an adult comes home from work with asbestos on their clothes and hugs their son or daughter, unknowingly transferring the dangerous fibers to their child. There have been many cases of adults being diagnosed with mesothelioma whose only exposure to asbestos came from their time as a child.
Time from Asbestos Exposure to Disease
There is a long latency period for mesothelioma which is the time from asbestos exposure to diagnosis of the cancer. This period can range anywhere from 20 to 50 years. There are different theories as to why there is such a long latency period and why most people exposed to asbestos do not get mesothelioma.
One theory suggests that there may be other variables that play a role. For example, some doctors believe that the condition or “competency” of a person’s immune system could determine whether asbestos in their body leads to cancer.
Other possibilities include a person’s genes and diet.
When doctors suspect a patient has mesothelioma they will initiate a “work-up.” This work- up may include imaging scans, biopsies, pathology exams, blood tests and staging.
Various types of scans may be used to determine if there are signs of tumors or other abnormalities. These scans may include X-rays, CT scans, MRIs, or PET scans.
If scans reveal what doctors believe may be a cancer then a biopsy may be suggested. A biopsy is a procedure where doctors remove a small piece of the suspected tumor tissue from the patient’s body.
The biopsy material will then be given to a pathologist. A pathologist will use special stains and other tests to determine if there is cancer and identify exactly what type of cancer was removed from the patient.
Blood tests may sometimes be used to determine if mesothelioma is present in the body. While these tests are helpful they are not considered as important as the biopsy which is considered the “gold standard.”
If mesothelioma is diagnosed, doctors may stage the disease. Over the years a variety of staging systems have been used. The one used most frequently today groups the disease into localized (only in the mesothelium) or advanced (spread outside the mesothelium).
The prognosis of mesothelioma or any other cancer depends on a number of variables. Those variables include:
Type/stage of mesothelioma
- The type of mesothelioma (pleural or peritoneal) and stage of the cancer (localized or advanced) play a role on prognosis. Some clinical studies suggest that peritoneal mesothelioma may have a better prognosis than pleural mesothelioma, with the appropriate treatment. A positive prognostic factor is also associated with cancer that has not metastasized. Cancer that is local and has not spread is obviously better.
Size and location of tumor
- Mesothelioma that is limited to the mesothelium and has not spread to lymph nodes or metastasized to other areas of the body can also indicate better prognosis.
Whether the cancer is operable or not
- Of all the conventional treatments (chemo, radiation or surgery), surgery has the greatest impact on prognosis. If a surgery can be performed this can often extend life. Therefore, whether a patient has operable mesothelioma (which depends on the size and location) is another important prognostic factor.
Tumor cell type
- As discussed above, tumor cell type (epithelioid, sacromatoid and biphasic) plays a role in prognosis. The epitheloid cell type generally has the better prognosis.
Patient’s overall health
- A patient’s overall health also is important when discussing prognosis. The healthier a patient is can often determine what treatments are available and how well their body can withstand toxic therapies like chemo and radiation or recover from invasive surgery.
Doctor’s experience with the disease
- Patients often assume that all doctors are equally skilled with this rare disease. That is not true. For example, when it comes to surgery, multiple studies have shown that surgeons who have the most experience with mesothelioma often have better outcomes.
- Obviously the type and effectiveness (efficacy) of the treatment chosen plays a role on prognosis. Today, there are a variety of treatments and approaches available to mesothelioma patients.
The treatments for mesothelioma can be divided into three paths: Conventional Therapies, Clinical Trials, and Alternative Modalities.
Conventional Therapies include chemotherapy, radiation therapy and surgery. The standard chemo drugs used are Alimta (pemetrexed) and cisplatin (or carboplatin). They are often prescribed for the various types of mesothelioma regardless of location. Both chemo and radiation therapy are known as cytotoxic or cell killing therapies. They work indiscriminately, killing both healthy and cancer cells. This is the reason that they can have severe side effects.
Surgery for Pleural Mesothelioma
Of all the conventional treatments available, surgery is generally considered the most effective. Â For pleural mesothelioma, there are various types of surgical procedures including lung sparring surgery (also called pleurectomy/decorticiaton or PD) and extrapleural pneumonectomy (also called EPP).
Pleurectomy / Decortications (PD)
Pleurectomy/decortication surgery is a two-part surgery that removes the lining surrounding one lung (pleurectomy), then removes any visible cancer seen growing inside the chest cavity (decortication). The advantage of P/D or lung sparring surgery is exactly what the name implies a lung is not removed.
Extrapleural Pneumonectomy (EPP)
An extrapleural pneumonectomy (EPP) is a much more invasive surgery than PD. An EPP involves removing a lung, the diaphragm, portions of the chest lining and heart lining, and nearby lymph nodes.
Numerous studies have been performed comparing the prognosis with a pleurectomy/decortications surgery versus an extrapleural pneumonectomy. While there is no consensus on the subject, the latest reports suggest that PD may be a better choice for many patients because survival is generally equivalent to EPP and PD is less invasive and therefore easier to tolerate.
There are also other surgical procedures used to treat pleural effusion. Pleural effusion is the buildup of excess fluid in the pleural space between the visceral and parietal linings of the lungs. Examples of these procedures include pleurodesis and thoracentesis.
Surgery for Peritoneal Mesothelioma
The standard of care in many hospitals is to treat peritoneal mesothelioma with surgery and HIPEC. HIPEC stands for hyperthermic intraperitoneal perioperative chemotherapy which basically means flushing the surgical area with heated chemotherapy during the surgical procedure. The obvious advantage of this approach is that it enables doctors to put the chemo in exactly the place it needs to be.
Clinical Trials are treatments that are still being tested. These treatments may include chemotherapy or other more innovative approaches based on immune therapy, gene therapy or other biological approaches. One example of new treatments being tried in mesothelioma involve the use of monoclonal antibodies. Monoclonal antibodies are essentially an immune system therapy that tries to use antibodies to target cancer cells. The National Cancer Institute indexes clinical trials offered throughout the country.
Alternative Modalities include a large number of approaches such as intravenous vitamin therapy, herbs and Traditional Chinese Medicine, cannabis oil, dietary approaches, and mind-body medicine. It is important to note that while none of these modalities are FDA approved, there are a number of long-term mesothelioma survivors who have used them, including Paul Kraus.
Compensation for Mesothelioma Victims
Because asbestos causes mesothelioma and asbestos was put deliberately into products by manufacturers even after they knew it could cause disease, today there is compensation available to most mesothelioma victims. Examples of compensation may include workman’s compensation, VA benefits, bankruptcy trust funds, and lawsuits.
The most significant compensation can come from trust funds and lawsuits. The amount of compensation generally depends on four factors:
- How the mesothelioma patient was exposed to asbestos?
- Did those companies declare bankruptcy or are they still in business?
- Where (in what state) did the asbestos exposure take place?
- Which mesothelioma lawyers or law firm is hired?
Other Asbestos Related Diseases
Mesothelioma is not the only disease caused by asbestos. Asbestosis which is essentially scarred lung tissue, pleural plaques and some lung cancers can also be caused by asbestos. There may also be compensation available to victims of these diseases as well. Treatments vary by condition.
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