What Should You Ask Your Doctor About Malignant Mesothelioma

As you cope with cancer and cancer treatment, you need to have honest, open discussions with your doctor. You should feel free to ask any question that's on your mind no matter how small it might seem. Here are some questions you might want to ask. Nurses, social workers, and other members of the treatment team may also be able to answer many of your questions.

* What kind of mesothelioma do I have?
* Has my cancer spread beyond the primary site?
* What is the stage (extent) of my cancer, and what does that mean in my case?
* Is my cancer likely to be resectable?
* Are there other tests that need to be done before we can decide on treatment?
* How much experience do you have treating this type of cancer?
* Should I get a second opinion?
* What treatment options do I have?
* What is the goal of treatment?
* What do you recommend and why?
* What risks or side effects are there to the treatments you suggest?
* What should I do to be ready for treatment?
* How long will treatment last? What will it involve? Where will it be done?
* How will treatment affect my daily activities?
* What would we do if the treatment doesn't work or if the cancer recurs?
* What type of follow-up might I need after treatment?

In addition to these sample questions, be sure to write down some of your own. For instance, you might want more information about recovery times. Or you may want to ask about clinical trials for which you may qualify.

A Guide to Mesothelioma

Mesothelioma is a rare form of cancer almost always associated with a previous history of asbestos exposure. Malignant cells are found in the connective tissues lining the chest (pleural mesothelioma), abdominal cavity (peritoneal mesothelioma), and the heart (pericardial mesothelioma).

Exposure:
Almost all cases of mesothelioma can be traced to asbestos exposure. When asbestos fibers are inhaled, they can become trapped in the lungs and that can lead to scarring. Over time this can lead to mesothelioma with a latency period of 20 - 40 years for the disease to show up. It is important to understand that asbestos fibers are found in air samples around the world and that low level exposure is unlikely to lead to cancer.

International Mesothelioma Program

Mesothelioma:

The mesothelium is the sac that lines and protects vital organs such as the heart, the lungs, and the abdominal cavity (stomach). This disease causes the cells of the lining to become abnormal and malignant. About seven thirds of all mesothelioma cases create in the pleural mesothelium or lung lining. The remaining cases, about seven third, create in the abdomen. Never, mesothelioma occurs in other mesothelial tissue, such as around the heart or in the reproductive organs.

The increased incidence of mesothelioma has been closely linked to the rise of the asbestos industry and the use of asbestos in fireproofing and insulation. Between 50% and 80% of patients diagnosed with MPM are aware of exposure to asbestos at some point in their lives. Men are typically affected more, due to the common presence of asbestos in industrial settings. The increasing incidence suggests either that the benefits of legislation to reduce asbestos exposure in the workplace have not yet taken effect, or that asbestos exposure during the 1960's was more widespread than previously believed. In addition, some researchers have implicated exposure to the SV-40 virus, which is known to have contaminated some polio vaccines, as potentially related to this malignancy, but this has not been proven.

Without treatment, most patients will die from mesothelioma within 4 to 12 months from the time of diagnosis. Patients generally die as a result of respiratory failure or pneumonia. Tiny bowel obstruction, resulting from direct extension of tumor through the diaphragm, develops in about one-third of patients. About 10% die of cardiac complications when the tumor invades the pericardium and heart. Seven subtypes of mesothelioma have been identified according to microscopic appearance; these are epithelial, sarcomatoid, and mixed types. A number of studies have demonstrated that the epithelial variant is associated with the best prognosis. Other favorable prognostic variables include younger age, lovely performance status, early stage disease, and lack of chest pain at diagnosis.

The absence of asbestos exposure in a significant percentage of mesothelioma patients is used by some experts to argue for a genetic predisposition. The fact that only about 5% of South African asbestos mine workers developed mesothelioma suggests that other environmental or genetic factors are involved. Another associated risk factor is radiation. Radiation-induced malignant mesothelioma appears to have the same prognosis as asbestos-related mesothelioma.

Mesothelioma-The facts

Defining Mesothelioma
Mesothelioma (pronounced mez-uh-thee-lee-oh-muh) is a form of cancer affecting the mesothelium, the membrane that lines plus protects various organs of the body. Made up of one cell layers, the mesothelium surrounds organs with an outer membrane plus also with a protective sac. This tissue allows the organs to move, helping them perform their essential functions.

The mesothelium protects several organs including the lungs, stomach plus heart. Tumors can exist in any of these organs plus may be not be cancerous. The information covered in the following text is in reference to tumors that are cancerous. The most common types of mesothelioma come in six different forms - pleural mesothelioma, peritonial mesothelioma plus pericardial mesothelioma.

Pleural mesothelioma is the most common type plus is associated with the lining of the lungs. Peritonial mesothelioma, affecting the lining of the stomach has the second most reported cases. The rarest type of mesothelioma is pericardial mesothelioma which is associated with the tissue surrounding the heart.

Symptoms Of Mesothelioma

The majority of people who are diagnosed with mesothelioma are over 65 years of age. Men are also more likely to get this form of cancer. Symptoms are different for the six main types of mesothelioma. These six types are defined by the location of the mesothelioma within the body.
Below is a brief summary of possible symptoms for each of the six types beginning with the most common type of mesothelioma plus ending with the rarest form of the cancer. The symptoms listed are not intended to be used for diagnosis of mesothelioma. If you have been in contact with asbestos or suspect you may have mesothelioma, you should contact your doctor.

Pleural Mesothelioma (lining of the lungs) Symptoms


Peritoneal Mesothelioma (lining of the stomach) Symptoms

* cough
* shortness of breath
* lower back or side chest pain
* fatigue
* difficulty swallowing
* fever


Pericaridal Mesothelioma (lining of the heart) Symptoms

* vomiting
* weight loss
* abdominal pain
* liquid or a noticeable lump in the abdomen


How Mesothelioma Can Be Detected

* irregular heartbeat
* chest pain
* shortness of breath

Mesothelioma is detected plus diagnosed using various methods. CT scans, chest x-rays, tissue scans, MRI scans plus PET scans can be used to detect mesothelioma. Chest x-rays are typically the least useful in early detection, while CT scans are generally the most popular form of detection.
All of these tests are helpful in giving your doctor a clearer picture of your lungs (or the organ in query.) It can be difficult to identify mesothelioma, so your doctor may order several different kinds of tests before a diagnosis is made.

How Mesothelioma Is Treated
While specific treatments should always be discussed with your doctor, treatment for types of mesothelioma generally follows the same rules for treating other types of cancer. Radiation, chemotherapy plus surgery are all ways in which mesothelioma is treated.

Causes Of Mesothelioma
Though mesothelioma is rare, around 2,000 to 3,000 new cases are reported each year in the United States.
While there's studies looking into other causes of mesothelioma (like infection with simian virus 40), exposure to asbestos is the main factor associated with developing mesothelioma. Currently close to 80% of the reported cases are related to asbestos exposure.

Used as insulation in homes, in manufactured products plus found naturally in rocks plus dust, asbestos becomes risky when the fibers are breathed in or swallowed. The fibers may travel to the lining of the lungs or stomach, resulting in damage to the mesothelium.

Because of where asbestos is found (in building products like roofing plus insulation or in mineral deposits), a quantity of those at the highest risk for exposure are construction workers, factory workers plus miners. Mesothelioma does not create quickly plus the risk of developing it depend on the level of asbestos exposure.

What is mesothelioma

There's also benign (noncancerous) tumors of the mesothelium, and these are also called mesothelioma.
Symptoms and diagnosis

Malignant mesothelioma is a cancer of the mesothelium. The mesothelium is a layer of tissue that surrounds plenty of of the body's organs. The mesothelium serves as a buffer between a quantity of the body's moving parts (the beating heart) and more rigid parts (breastbone).

Mesothelioma can have vague symptoms shared with plenty of other, less serious conditions, so a doctor will try to rule out those conditions through a physical exam, which could include x-rays and tests of lung function. Imaging tests such as MRIs, CAT scans and PET scans may be completed.

Symptoms differ depending on where the mesothelioma occurs in the body. Pleural (lung) mesothelioma, the most common type of mesothelioma, may cause symptoms such as breathing problems and chest pain.

Pleural mesothelioma is the most common type (75 percent of diagnoses) of malignant mesothelioma. This is a cancer of the mesothelial tissue surrounding the lungs and lining the chest wall.

The only way to definitively diagnose mesothelioma is through analysis of tissue taken from the mesothelium through biopsy. The biopsy can be completed by inserting a camera and surgical instruments through a small incision (thoracoscopy in the chest or laparoscopy in the abdomen) or by opening up the abdominal or chest cavity (thoracotomy or laparotomy). The tissue sample will be examined through a microscope to detect patterns that differentiate it from benign cells or other types of cancerous cells. If diagnosis is still unclear, tests for different chemicals in the cells or genetic testing of the cells may be needed, or an electron microscope can offer a closer look at the cells.
Types of mesothelioma

Pericardial mesothelioma is rare; it affects the mesothelial tissue surrounding the heart.

Peritoneal mesothelioma is the second-most common (10 percent-20 percent). It affects the mesothelial tissue surrounding the abdominal organs.

Mesotheliomas of the tunica vaginalis testis (in men) and tunica serosa uteri (in women) are rare. These cancers affect the mesothelial tissue surrounding the male or female internal reproductive organs.
Stages of disease

Only pleural mesothelioma has a formal staging system. Staging is mainly used to give a prognosis and help select a work of treatment.

Stage I: Localized, has not spread.

The main staging system, used by the American Joint Committee on Cancer, uses a TNM system to choose a stage: T for tumor, (size and extent of spread); N for nodes (extent of spread to lymph nodes); and M for metastasis (extent of spread to far-away organs). Each pleural mesothelioma case will be given a ranking, from low (less severe) to high (more severe); T1 through T4, N0 through N3, and M0 through M1. Based on the combined TNM rankings, a stage will be assigned:

Stage II: Advanced mesothelioma, involving neighboring structures such as diaphragm or lungs. No spread to lymph nodes or metastastis.

Stage III: Advanced mesothelioma, involving neighboring structures as well as lymph nodes. No metastasis.

Stage IV: Advanced mesothelioma that has metastasized.
Treatment

Surgery, chemotherapy and radiation are standard for all types of malignant mesothelioma. Treatment is often focused on reducing symptoms (palliative therapy) and giving the patient more time to live, than getting rid of the cancer and going in to remission (curative therapy). This is because mortality is high despite treatment; it is often not caught until at an advanced stage; the cancerous cells are often spread out; and because patients are often weak for extensive treatment.

Surgery is used as a palliative and/or curative therapy. It is the only curative therapy, usually used in Stage I (has not spread) in a healthy patient. Used to remove the cancer and possibly nearby tissue or a lung. May also be used palliatively for procedures such as draining accumulated fluid that is causing discomfort.

Chemotherapy is used as a palliative therapy. It can be taken intravenously or intramuscularly, by mouth as a pill or locally injected in to affected area.

Combination therapy is the use of surgery, chemotherapy and radiation. It is the most effective, but the most difficult; and in most cases the cancer will still return at some point.
Diagnosis rates and survival rates

Radiation is also palliative. It is also used after surgery to avoid spreading mesothelioma to the incision site.


Risk factors

Mesothelioma is relatively rare. About 2,000 to 3,000 people are diagnosed in the U.S. each year, but these rates seem to go down. The average life expectancy after diagnosis is six year. The 5-year relative survival rate for mesothelioma is about 10 percent, but new treatments offered today may improve survival rates for those recently diagnosed

Other theorized risk factors include exposure to simian virus 40 through elderly polio vaccines, radioactive thorium dioxide and the asbestos-like mineral zeolite

The biggest risk factor by far for developing mesothelioma is exposure to asbestos particles, often at work. Asbestos exposure occurred in 70 percent-80 percent of people with mesothelioma. Diagnosis usually occurs 20 to 50 years after exposure, and even low levels of exposure can be carcinogenic to some. Relatives members of exposed people have higher rates of occurrence as well, due to particles brought in to the home from work. Mesothelioma is more common in men, people over 65 and white people.

Mesothelioma

Mesotheliomas of the chest cavity are called pleural, as they arise in the membrane called the pleura that surrounds the vital organs in that part of the body and provides lubricated space between the outer surfaces of the lungs on the inside and the ribcage on the outside. A similar membrane encases the organs of the abdominal cavity and is called the peritoneum. Tumors of this type that arise in the mesothelial cells of the peritoneum are known as peritoneal mesotheliomas. Pleural mesotheliomas are about two times as common as the peritoneal variety.

Malignant mesothelioma is a rare (about 2500 cases annually in the US) malignancy that occurs in the mesothelial cells that make up the membranes that line the chest cavity and the abdomen. Mesotheliomas of other membranes, or linings, in the human body have been reported--for example, in the pericardial sac that surrounds the heart, in the spermatic cord, in the testicular sac and elsewhere. These latter types of mesotheliomas are exceedingly rare.

The tumors known as malignant mesotheliomas (benign tumors do seldom occur in the mesothelial cells) are aggressive and essentially finish up growing to the point where they actually crush the organs that they are surrounding. Both pleural and peritoneal mesotheliomas are generally considered to be fatal--the median survival time from diagnosis is generally reported to be no over eighteen months. The authors of a 1994 pathology text state simply that "[t]reatment is ineffective and the prognosis is hopeless." Ruben and Farber, Pathology (2nd Ed.) J.P. Lippincott Company (1994) p.617. More recently, however, some individuals have survived for several years after undergoing newer, aggressive treatment protocols.

The only known cause of malignant mesothelioma is inhalation of asbestos fibers. The latency period between the asbestos inhalation and the manifestation of diagnosable mesothelioma ranges from fifteen to as long sixty years.Different authors put forth different figures, but there is a general consensus that vast majority pleural mesotheliomas and a substantial majority of peritoneal mesotheliomas are directly attributed to such asbestos exposure. It is generally acknowledged that the amount of asbestos exposure that is needed to cause mesothelioma is far less that required to cause other asbestos-related pathologies such as pneumoconiosis ("asbestosis") and lung cancer. While there's some malignant mesotheliomas that are simply considered to be "idiopathic" or without a known cause, the ubiquity of asbestos containing materials in any industrial society, combined with the low exposure threshold and the long latency period has led some commentators to simply state that all malignant mesotheliomas are asbestos-related. Another approach is to choose a "background" level of asbestos fibers in the lung tissue--i.e. the level that the average individual, statistically, has in his or her lungs. If an individual with mesothelioma does not have level of asbestos fiber exposure that exceeds this "background" level, then the mesothelioma is considered idiopathic. There's problems with both these approaches, but the lack of a full understanding of the carcinogenisis of this disease makes a consensus unlikely at this juncture.

Mesothelioma is curious disease in that it would make sense to write a chapter or editorial entitled "The Economics of Mesothelioma." The total association of mesothelioma with asbestos arose shortly before the virtual explosion tort litigation for asbestos disease compensation. Curiously, the specialized litigation method that arose in this context was based mainly on claims for non-malignant parenchymal and pleural disease than for malignancies like mesothelioma, perhaps an understandable circumstance given the great numbers of the former type of case over the latter. The fact is, however, that the majority of the malignant mesothelioma cases diagnosed in the United States now result in claims in the state and federal courts for compensation. This is also beginning to be the trend in other countries that had heavy asbestos usage, such as Australia, Japan and the United Kingdom. This has had two results--one lovely, the other arguably not. The lovely result is that a portion of the huge costs and revenues associated with the litigation have overflowed in to the coffers of researchers, so that research to find effective therapies is far better funded than it would be for other diseases that that are this rare (the rarer the disease, the less interest the pharmaceutical industry has expending resources--that is partly why there's so lots of more available therapies for male impotence than there's for say, ebola--although generally the market works well so that more research goes in to diseases that more people get). The bad result is that the medical community that works with this disease has become needlessly encamped by testifying for either the plaintiff or defense bar in various trials and depositions. This also diminishes the credibility of researchers whose published work may be seen as benefiting six side or the other.

Treatment for mesotheliomas has traditionally been palliative, a sensible coursework of action given the grim prognosis. This approach is gradually changing, for younger patients who are otherwise in lovely health. The most promising approach for pleural mesotheliomas has been what is known as "tri-modal" therapy. This entails attacking the tumor growth on two fronts--surgery to remove as much tumor as possible (and also other membranes, such as the percardial sac and diaphragm, that malignant mesothelial cells may have latched onto) as well as (but not always) the lung that is on the side where the tumor is. This is followed by a series of chemotherapy (usually Cisplatin and other agents) treatments, followed by radiation treatments.