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Friday, May 1, 2009

What is Mesothelioma?

Mesothelioma is a cancer of the mesothelium. The mesothelium is a thin membrane that lines the chest and abdomen and surrounds the organs in these areas. The lining around the lungs is called the pleura and in the abdomen it is known as the peritoneum.

About 2000 people in the UK are diagnosed with mesothelioma each year.

Mesothelioma of the lining of the lungs, known as pleural mesothelioma, is much more common than mesothelioma in the peritoneum. For every one person with peritoneal mesothelioma, there will be about 12 people who have pleural mesothelioma.


Pleural mesothelioma

The pleura has two layers: the inner (visceral) layer, which is next to the lung; and the outer (parietal) layer, which lines the chest wall. The two layers of the pleura are usually in contact and slide over each other as we breathe. The membranes produce fluid, which allows them to slide over each other easily.

When mesothelioma develops in the pleura (pleural mesothelioma), the delicate membranes thicken and may press inwards on the lung. Fluid may also collect between the two layers of the pleura: this is known as a pleural effusion.


Structure of the lungs and pleura
Structure of the lungs and pleura


Peritoneal mesothelioma

The lining of the abdomen is known as the peritoneum. It also has two layers: the inner (visceral) layer, which is next to the abdominal organs, and the outer (parietal) layer, which lines the abdominal wall.

If the mesothelioma is in the peritoneum it is called peritoneal mesothelioma and causes thickening of the membranes surrounding the abdominal organs and a collection of fluid in the abdomen. The collection of fluid is called ascites and causes swelling of the abdomen.


Side view of the abdomen. The peritoneum is shown as the thick line surrounding the abdominal organs.
Side view of the abdomen. The peritoneum is shown as the thick line surrounding the abdominal organs.

Surgery for mesothelioma

In the uncommon situation where the cancer is only in one area of the pleura (localised), surgery can be used to treat mesothelioma. It may involve removing part, or all, of the pleura and the lung tissue close to it. This is known as pleurectomy. Sometimes the pleura, diaphragm, and the whole lung on the affected side are removed as well as the tumour. This operation is known as extra-pleural pneumonectomy.

At present it is not clear whether surgery can give better control of symptoms or can help people to live for longer than just using active symptom control. A research trial is currently looking at whether extra-pleural pneumonectomy can give a better quality and length of life for people with localised pleural mesothelioma. This trial is called the MARS trial. You may be invited to take part if your doctor thinks that surgery could possibly be helpful for you.

It is not usually possible to surgically remove abdominal (peritoneal) mesothelioma. If surgery is possible, it is carried out by surgeons with specialist expertise in treating mesothelioma. However, the operation is not likely to cure the mesothelioma.

It is important that you discuss any operation fully with your doctor beforehand so that you understand what it involves. Remember, no operation or procedure will be done without your consent.

Surgery may sometimes be combined with radiotherapy or chemotherapy.



After your operation

It can take many weeks to recover fully from a lung operation, although some people recover more quickly than others. There are things you can do to help speed up your recovery. After your operation, you will be encouraged to start moving about as soon as possible. Even if you have to stay in bed, the nurses will encourage you to do regular leg movements to help to prevent blood clots developing in your legs. A physiotherapist will visit you on the ward to help you with breathing exercises.



Drips and drains

A drip (intravenous infusion) will be used to give you fluids for a couple of days, until you are able to eat and drink normally again. You will also have drainage tubes in your wound. These are usually removed about 2–7 days after your operation depending on your recovery. X-rays will be taken regularly to make sure your lung is working properly.



Pain

It is normal to have some pain or discomfort after your operation. This can usually be controlled using painkilling drugs. Let your doctor or one of the nurses know if you have any pain so they can treat it as soon as possible. Mild discomfort or pain in your chest can last for several weeks and you will be given some painkilling tablets to take home with you.



Going home

You can usually go home after about seven days after a pleurectomy. If you have an extra-pleural pneumonectomy it will probably be about 14 days before you are ready to go home. If you think you might have problems when you go home – for example, if you live alone or have several flights of stairs to climb – let one of the nurses or the hospital social worker know when you are admitted to the ward, so that help can be arranged.

When you go home, it is important to exercise gently, to build up your strength and fitness. Walking and swimming are suitable for most people after surgery to the lung area. But it is a good idea to check with your doctor or physiotherapist which kind of exercise would be suitable for you.

Active symptom control as a treatment for mesothelioma

This means that if you have any symptoms, these are treated with appropriate medicines such as painkillers, or drugs to reduce breathlessness or improve appetite. Radiotherapy may be used to reduce symptoms if needed. Chemotherapy may also sometimes be used to shrink the mesothelioma and control symptoms.There are a number of ways to help symptoms caused by the mesothelioma. Pleural mesothelioma commonly causes breathlessness or difficulty with breathing. Breathlessness can sometimes be caused by a build-up of fluid around the lungs (pleural effusion). Your doctor may be able to drain this fluid under a local anaesthetic so that your breathing becomes easier. It may be necessary to have the fluid removed on a regular basis.Talcum powder (talc), or a particular chemical powder, may be put into the pleural space through a tube. This procedure is called pleurodesis and causes inflammation of the pleural membranes, which then stick together to prevent the fluid from building up again. This can be done using keyhole surgery and is then called video assisted thorascopic surgery (VATS).Fluid in the abdomen (ascites) can also be removed using a needle inserted under local anaesthetic.You may be given medicines to help your breathing and also to control pain. If at any time you feel that your medicines are not working, let your doctor know as soon as possible so that the dose can be altered or the medicines changed.If you have any symptoms that are not easily controlled, you can be quickly referred to a relevant specialist such as a pain relief service, physiotherapist or symptom control team. The aim of this type of treatment is to keep you as free as possible of symptoms and to give you the best possible quality of life.Other helpful remedies include relaxation techniques and physiotherapy, and your GP or a local cancer self-help group can give you more details about these. You may also find it helpful to look at our sections on controlling cancer pain, controlling the symptoms of cancer and complementary therapies.Your doctor will discuss the different approaches to treatment, and you may need time to consider the options. You can then talk it over with family or friends before you make any firm decisions. If you would rather talk to someone outside your situation, you may find it helpful to speak to one of the nurses in our cancer support service.

Treatment of mesothelioma

Once the doctors know the stage of the mesothelioma they will be able to plan the most appropriate treatment.

The treatment for mesothelioma depends on whether it is only in one place or has spread. Currently, there is no cure for mesothelioma, unless it can be removed by an operation. Unfortunately, when mesothelioma is diagnosed, it has usually already spread beyond the point where it could be removed surgically.

The usual treatment for mesothelioma in this situation is active symptom control.

Radiotherapy may be used as part of treatment to try to cure mesothelioma. Most often it is used to control symptoms. Chemotherapy can also be used to control symptoms and to slow the growth of mesothelioma.


Multidisciplinary team

If your tests show that you have mesothelioma, you will be looked after by a multidisciplinary team. This is a team of staff who specialise in treating mesothelioma and in giving information and support. It will normally include:

  • surgeons who are experienced in chest surgery
  • specialist nurses who give information and support
  • oncologists – doctors who have experience in mesothelioma treatment using chemotherapy and radiotherapy
  • symptom-control specialists
  • radiologists who help to analyse x-rays
  • pathologists who advise on the type and extent of the cancer.

Other staff will also be available to help you if necessary, such as:

  • physiotherapists
  • counsellors and psychologists
  • social workers
  • dietitians.

Together they will be able to advise you on the best course of action taking into account a number of factors. These include your age, general health, and how the mesothelioma is affecting you.

Occasionally your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might experience, so that you can decide what is the right treatment for you.

Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with the nurses in our cancer support service.

If you have any questions about your own treatment, don't be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.



Second opinion

Even though a number of cancer specialists work as a team to decide on the most suitable treatment, you may want to have another medical opinion. Most doctors will be willing to refer you to another specialist for a second opinion if you feel that it will be helpful. The second opinion may take some time to organise and may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will be helpful.

If you do go for a second opinion, it may be a good idea to take a friend or relative with you, and to have a list of questions so you can make sure your concerns are covered during the discussion.



Giving your consent

Before you have any treatment your doctor will explain its aims to you. You will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form, you should have been given full information about:

  • the type and extent of the treatment you are advised to have
  • the advantages and disadvantages of the treatment
  • any other treatments that may be available
  • any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some treatments are complex, so it is not unusual for people to need their treatment to be explained more than once.

Patients often feel that hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can't make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.



Benefits and disadvantages of treatment

Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Although cancer treatments can cause side effects, these can usually be controlled with medicines.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. For the few people with early-stage mesothelioma, surgery and radiotherapy may be given with the aim of curing the cancer.

However, in most people with mesothelioma, the cancer is at a more advanced stage and any treatment given is with the aim of controlling it, which for some people may lead to an improvement in symptoms and a better quality of life. But, for some people in this situation the treatment will have no effect upon the cancer and they will get the side effects of the treatment without any of the benefit.

When a cure is not possible and the aim of treatment is to control the cancer for a period of time, it may be difficult to decide whether to go ahead with treatment. Making decisions in these circumstances is always hard, and you may need to discuss your treatment and symptom control in detail with your doctor.

Staging of mesothelioma

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the extent of the cancer helps the doctors to decide on the best treatment. There are several staging systems for pleural mesothelioma.

A commonly-used system is described below:

Localised malignant mesothelioma

Stage 1 The cancer cells are found in the pleura near the lung and heart or in the diaphragm or the lung.

Advanced malignant mesothelioma

Stage 2 The cancer has spread beyond the pleura to lymph nodes in the chest.

Stage 3 The cancer has spread into one or more of the chest wall, the centre of the chest, the heart, the diaphragm, the abdominal lining, and the nearby lymph nodes.

Stage 4 The cancer has spread to distant organs or tissues.

A staging system has not yet been established for peritoneal mesothelioma. But sometimes doctors may use the TNM staging system for this cancer. The initials T, N and M stand for 'tumour', 'nodes' and 'metastases'.

  • T describes the size of the tumour
  • N describes whether the cancer has spread to the lymph nodes
  • M describes whether the cancer has spread to another part of the body.

How mesothelioma is diagnosed

Most people begin by seeing their GP when they have symptoms. Your GP will examine you and may arrange for you to have some tests or x-rays. You may be referred to hospital for these tests and for specialist advice and treatment. At the hospital, the doctor will take your medical history and occupational history before doing a physical examination.


Chest x-ray

A chest x-ray will be taken to check for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs. However, there can be other causes of thickening of the pleura and peritoneum (and fluid around the lungs or in the abdomen) apart from mesothelioma.

The following tests may also be needed to diagnose mesothelioma, and your doctor may arrange for you to have one or more of them at the hospital.


CT scan

A CT scan (computerised tomography scan) takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

CT scans of the chest and of the abdomen will show the size and position of the mesothelioma and whether it has spread to other parts of the body.

You may be given a drink or injection of a dye that allows particular areas of your body to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine, or have asthma, you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

You will probably be able to go home as soon as the scan is over.


Having a CT scan
Having a CT scan

Pleural or peritoneal aspiration

If there is fluid in your chest or abdomen, the doctor can take a sample by using a local anaesthetic and passing a needle through the skin into the fluid. Some of the fluid is then drawn off into a syringe and can be analysed in the laboratory to look for mesothelioma cells.

Taking fluid from between the pleura is known as a pleural aspiration and taking fluid from the abdomen is known as drainage of ascites (or peritoneal aspiration).


Biopsy

If you need a biopsy, your doctor will take a sample of tissue from the thickened pleura or peritoneum. A local anaesthetic is used to numb the area and a special type of needle is passed through the skin into the tumour. The needle has a tip that can cut out a sample of the tumour. The doctor may use ultrasound or a CT scanner to position the needle accurately. An ultrasound uses sound waves to build up a picture of the organs in a part of the body. A small device is passed over the skin to show the doctor where the tumour is and guide the needle into the right place.

Sometimes the doctor will want to look at the area of the pleura or the peritoneum directly to get a sample of tissue from the right area. This is done by using a thin flexible tube with a light and camera at the end. The tube (endoscope) can be passed through the skin of the chest, where it is called thoracoscopy, or the abdomen, where it is called laparoscopy. The procedure is done under a general anaesthetic by a surgeon. You will usually be able to go home the same day.

Your doctors may want to check for any signs of spread of the cancer to the nearby lymph glands in the centre of the chest. This central area, around the lower part of the windpipe, is called the mediastinum and the lymph glands which are found there are the mediastinal lymph nodes. This test is called a mediastinoscopy. The test is done under a general anaesthetic and will mean a short stay in hospital. A small cut is made through the skin at the base of the neck. A tube, like a small telescope, is passed into the chest through the hole created by the cut. The doctor can use this tube to examine the area. Samples can be taken for examination under a microscope.

Analysing the biopsy in the laboratory is the only way your doctors can make the diagnosis of mesothelioma. Sometimes, even after taking a biopsy, the doctors may not be sure of the diagnosis, because mesothelioma can be very difficult to distinguish from other illnesses. In this situation, the biopsy samples may be sent to other laboratories to confirm the diagnosis, some of your tests may need to be repeated or you may be referred to another hospital for a second opinion.


Waiting for your test results

It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. This waiting period is likely to be an anxious time for you and it may help to talk things over with a close friend or relative. You may want to ring our cancer support service to ask any questions you may have.

Symptoms of mesothelioma

Mesothelioma often starts as a lot of tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they are quite large. The main symptoms of pleural mesothelioma are breathlessness and chest pain. Some people find that their voice becomes hoarse and they have a cough that does not go away.

Peritoneal mesothelioma often causes swelling and pain in the abdomen.

General symptoms

Both types of mesothelioma can cause other general symptoms, such as loss of appetite, sweating (especially at night), weight loss and tiredness. As many of these symptoms can also be caused by other illnesses, your doctor will need to do a series of tests before a diagnosis can be made.

Causes of mesothelioma

Asbestos is the most common cause of mesothelioma. Up to nine out of ten cases of mesothelioma are caused by exposure to asbestos. Asbestos is a natural mineral, mined from rock found in many countries. It is made up of tiny fibres that are as strong as steel but can be woven like cotton and are highly resistant to heat and chemicals.

During the 1960s the first definite link between mesothelioma and asbestos was made. In the past asbestos was imported to the UK in large quantities. It was used in construction, ship-building and in household appliances. Asbestos was very widely used in insulation materials, such as amosite insulation board, and building materials, including asbestos cement.

When asbestos is disturbed or damaged, it releases tiny fibres that can be breathed into the lungs. Asbestos fibres are very fine and, when breathed in, they can make their way into the smallest airways of the lung, so they cannot be breathed or coughed out. Once the fibres are in the lungs, the body's defence mechanism tries to break them down and remove them, which leads to inflammation in the lung tissue.

The asbestos fibres can also penetrate through the lung tissue to settle in the pleura (the membrane around the lung). Over many years they can cause mesothelioma or other lung diseases to develop.

Asbestos fibres can also be swallowed, and some of the fibres can stick in the digestive system. They can then move into the membrane that lines the abdomen (the peritoneum), where they cause inflammation.

The people most likely to have been exposed to asbestos include:

  • construction workers
  • plumbers
  • electricians
  • boilermakers
  • shipbuilders
  • demolition workers
  • people who worked in other places where asbestos was present and
  • people who lived near to asbestos factories.

Family members of people who worked with asbestos and brought the dust home on their clothes have also sometimes developed mesothelioma.

There are three types of asbestos: blue, brown and white. Blue and brown asbestos are the types most commonly linked with mesothelioma. They are now very rarely used and cannot be imported into the UK. Originally, white asbestos was thought not to be dangerous but recent studies have now shown that it is also harmful.

In the 1980s, imports of blue and brown asbestos into the UK were stopped, and in 1999 the importation and use of all asbestos was banned. However, as mesothelioma develops so slowly, it is estimated that by 2015 approximately 3000 people will be diagnosed with mesothelioma each year. The number of people who develop mesothelioma will then start to reduce each year.

Mesothelioma does not usually develop until many years after exposure to asbestos. It can take any time from 10 to 60 years, although the average is about 30 to 40 years after exposure to asbestos.

Occasionally, mesothelioma develops in people who have never been exposed to asbestos. The other causes of the disease are not fully understood, but in rare cases the development of mesothelioma has been linked to exposure to radiation.

Research has not found any evidence that smoking increases a person's risk of developing mesothelioma. It is also thought that exposure to other building materials such as fibreglass does not increase the risk.

Mesothelioma is not contagious and cannot be passed on to other people. It is not caused by inherited faulty genes and so family members do not have an increased risk of developing it, unless they have been in contact with asbestos.

MESOTHELIOMA

Mesothelioma is a form of cancer that affects the mesothelial cells lining the lung, chest cavity, abdominal cavity or heart cavity. These mesothelial cells also cover the outer surface of most internal organs forming a tissue called mesothelium that helps protect the organs. Although tumors of the mesothelium can be benign (noncancerous), most cases are malignant (cancerous). Virtually all cases of malignant mesothelioma are attributable to asbestos exposure and are both difficult to diagnose and poorly responsive to therapy. As this form of cancer can occur 20 to 60 years after the initial exposure, it is important to recognize the most common symptoms which include:

  • Anemia
  • Back pain
  • Chest pain
  • Cough
  • Enlarged abdomen
  • Fever
  • Hoarseness
  • Recurrent build-up of fluid in the lungs
  • Shortness of breath
  • Weight loss

MESOTHELIOMA RESOURCES

Asbestos Disease Awareness Organization

The Asbestos Disease Awareness Organization (ADAO) provides a unified voice for asbestos victims in working towards awareness, education, advocacy, prevention, support and a cure for asbestos-related diseases.

Asbestos: Think Again

The Environmental Working Group’s report offers statistics on the pervasiveness of mesothelioma and other asbestos related diseases, what industry knew about the dangers of exposure to asbestos, how millions of Americans might have been exposed, a list of contaminated places, and information that will help every American become educated to the continuing menace of asbestos and the plight of its victims.

International Pleural Mesothelioma Program

The International Mesothelioma Program (IMP) was founded by Program Director Dr. David Sugarbaker in 2002 at Harvard Medical School’s Brigham and Women’s Hospital in Boston, Massachusetts. Since its inception, Dr. Sugarbaker has led a multidisciplinary team focused on conducting complex clinical research and translating findings into cutting-edge mesothelioma treatments and potentially curative therapies.

Lung Cancer Alliance

The Lung Cancer Alliance is a national not-for-profit organization dedicated solely to helping people with lung cancer, and those who are at risk for the disease, improve the quality of their lives through advocacy, support and education.

Malignant Mesothelioma

The All About Malignant Mesothelioma website provides comprehensive, up-to-date information on mesothelioma. The website discusses the full scope of malignant mesothelioma issues, including background, history, risk factors, diagnosis and treatment.

National Cancer Institute: Malignant Mesothelioma

The National Cancer Institute of the U.S. National Institutes of Health provides up-to-date information on mesothelioma, information on clinical trials, resources for people dealing with mesothelioma, and information for researchers and health professionals.

WHAT IS ASBESTOS?

Asbestos is a flexible mineral fiber that was widely used in many industrial products and materials for its fireproof quality and resistance to electricity and chemical damage. In addition to being indestructible, asbestos fibers are difficult to see, smell or taste and cause diseases that take years to manifest. Consequently, many are unknowingly exposed to this hazardous mineral. Inhaling asbestos fibers is associated with numerous types of cancer including mesothelioma and other deadly asbestos-related diseases of the lung.

THE HARMFUL EFFECTS OF ASBESTOS

Asbestos, when inhaled, may cause cancer by physically rather than chemically irritating cells. When non-asbestos fibers are inhaled, most are cleared in the nose, throat, windpipe or large breathing tubes of the lungs because they stick to mucus inside the air passages and are coughed up or swallowed. Asbestos fibers, however, are less readily cleared, and may reach the ends of the small airways and penetrate into the lining of the lung and chest wall. These fibers may then directly injure cells of the lining eventually causing mesothelioma.

Asbestos can also damage cells of the lung and result in asbestosis (formation of scar tissue in the lung) and lung cancer. The risk of lung cancer among people exposed to asbestos is seven times greater than that of the general population. Abdominal cancer may result from coughing up and swallowing inhaled asbestos fibers. Cancers of the larynx, pancreas, esophagus, colon, and kidney have also been linked to asbestos exposure.

TYPES OF ASBESTOS

There are two main forms of asbestos - serpentine and amphiboles. The three most common forms of asbestos traditionally used in product manufacturing are chrysotile, amosite, and crocidolite.

Serpentine

Chrysotile asbestos is the only type of serpentine fiber and is the most widely used form of asbestos. Used predominantly in products manufactured in the United States, these fibers are curly and pliable and have been associated with malignant mesothelioma, lung cancer, and all other forms of asbestos disease.

Amphiboles

Amphiboles are thin, rod-like asbestos fibers. Of the five main types of amphiboles asbestos, amosite and crocidolite are the most carcinogenic (cancer-causing).

PAIN MANAGEMENT

Mesothelioma patients often suffer from a great deal of pain as a result of their illness. Tumors can press on nerves, organs or bones causing pain ranging from mild to severe. There can also be pain associated with the mesothelioma treatment itself - whether treatment is from surgery, chemotherapy or radiation. Psychological pain associated with the knowledge that you have cancer or the belief that the demands of cancer are burdensome to family and friends can be difficult, as well. The three most common types of pain are chronic, acute and breakthrough. Chronic pain can be varying in degree from mild to severe and persists over a long time. Acute pain is short in duration, quite sudden and severe. Someone who experiences pain when his or her chronic pain is normally controlled by medication is said to have "breakthrough" pain. Many patients are unaware of the numerous resources available that can help them feel better - some of them at no cost. There is no benefit to enduring this pain as it can cause problems sleeping, problems with activity and movement, make a patient less likely to eat, increase depression, and interfere with how a patient interacts with family and friends. Untreated, pain can diminish a patient’s quality of life.
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TREATMENT FACTORS AND OPTIONS

Unfortunately, the overall prognosis for patients with malignant mesothelioma remains poor. Often, by the time symptoms appear and a diagnosis is made, the disease is advanced. The average length of survival is around one to two years from diagnosis, and only about 7% of those diagnosed survive for five years or more. Research scientists and doctors, however, are pursuing several promising improvements in treatment. Treatment decisions are based on the location of the cancer, the stage of the disease, and the patient’s age and general health. The three types of standard treatments used are surgery (removing the cancer), radiation therapy (using targeted high-dose x-rays or other high-energy rays to kill cancer cells) and chemotherapy (using drugs to destroy the cancer). In order to achieve optimal results, these treatments may be combined.

The chance of recovery for a person with mesothelioma depends on several factors, including:

  • Age of the patient
  • Appearance of the cells under a microscope
  • Location of the cancer
  • Response to treatment
  • Size of the cancer
  • Spread of the cancer throughout the body

MEDICAL TREATMENTS FOR MESOTHELIOMA

Malignant mesothelioma is a rare form of cancer which occurs in the lining of the lung (the pleura) or in the abdomen (the peritoneum). In very rare cases, mesothelioma can occur in other areas of the body as well. Although science is not certain as to the exact way asbestos causes mesothelioma, it is thought that the asbestos fibers puncture the lungs and become lodged in the pleura, and the irritation creates the change in the cells which causes the mesothelioma. Knowledge of available mesothelioma treatment options can be an essential weapon in the fight against the progression of this deadly disease.

TYPES OF MESOTHELIOMA

Pleural mesothelioma spreads within the chest cavity, sometimes involving the lung. Metastases can occur in any organ, including the brain, and the onset is typically very slow with the most common presenting symptom being persistent pain localized in the chest. Sometimes the pain is accompanied by severe difficulty breathing, coughing, weight loss and fever.

Peritoneal mesothelioma involves the abdominal cavity and infiltrates the liver, spleen or bowel. As with pleural mesothelioma, pain is the most common complaint. In addition, patients may also experience nausea, vomiting, swelling of the feet, fever, difficulty in moving their bowels and fluid accumulation in the abdominal cavity resulting in an enlarged abdomen.

Cystic mesothelioma is a rare form of benign mesothelioma involving a thin membrane of mesothelial cells that envelopes many of the organs in the abdomen. This type has been diagnosed primarily in young women, and most patients must undergo surgery.

MESOTHELIOMA AND ASBESTOS-RELATED DISEASES

Asbestos exposure is strongly associated with several potentially fatal diseases and illnesses, the most serious of which is malignant mesothelioma. Asbestos fibers are smaller than other airborne particles and cause serious long-term consequences by penetrating the lung and infiltrating organ tissues. Asbestos-related diseases generally develop many years, even decades, after initial exposure.

ASBESTOS EXPOSURE

Outside of occupational and industrial exposure, asbestos is most commonly found in older homes, furnace and pipe insulation materials, asbestos shingles, millboard, textured paints and other coating materials, and floor tiles. Elevated concentrations of airborne asbestos can occur after asbestos-containing materials are disturbed by cutting, sanding or other remodeling activities. Improper attempts to remove these materials can release asbestos into the air. When inhaled, these fibers are strongly associated with numerous types of cancer and illness, including mesothelioma.

Monday, March 30, 2009

Mesothelioma

Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart,[1] the pericardium (a sac that surrounds the heart) or tunica vaginalis. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing mesothelioma.[2] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases risk of other asbestos induced cancer.[3] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law). The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Signs and symptoms

Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

  • chest wall pain
  • pleural effusion, or fluid surrounding the lung
  • shortness of breath
  • fatigue or anemia
  • wheezing, hoarseness, or cough
  • blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

  • abdominal pain
  • ascites, or an abnormal buildup of fluid in the abdomen
  • a mass in the abdomen
  • problems with bowel function
  • weight loss

In severe cases of the disease, the following signs and symptoms may be present:

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

Diagnosis

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).

If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.

If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Typical immunohistochemistry results
Positive Negative
EMA (epithelial membrane antigen) in a membranous distribution CEA (carcinoembryonic antigen)
WT1 (Wilms' tumour 1) B72.3
Calretinin MOC-3 1
Mesothelin-1 CD15
Cytokeratin 5/6 Ber-EP4
HBME-1 (human mesothelial cell 1) TTF-1 (thyroid transcription factor-1)

Screening

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[4] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.

Staging

Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as early (stages I or II) if localized to a single organ surface, usually the lining of the lungs or kidney. Advanced classification is defined (stages III or IV) if it has spread beyond the original membrane surface to other parts of the body.

Pathophysiology

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.

Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).[6] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.[7]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

  • Inactivation of tumor suppressor genes
  • Activation of oncogenes
  • Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
  • Activation of DNA repair enzymes, which may be prone to error
  • Activation of telomerase
  • Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.

Epidemiology

Incidence

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year.[8] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[9] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.

Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[10] Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.

Risk factors

Working with asbestos is the major risk factor for mesothelioma.[11] A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.

Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.

Exposure

Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related mesothelioma.

Occupational

Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.

The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.

Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.

Paraoccupational secondary exposure

Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

Asbestos in buildings

Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.

Environmental exposures

Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in Cappadocia, Turkey, an unprecedented mesothelioma epidemic caused 50% of all deaths in three small villages. Initially, this was attributed to erionite, however, recently, it has been shown that erionite causes mesothelioma mostly in families with a genetic predisposition.

Treatment

Treatment of malignant mesothelioma using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved on average 74.6 percent successful in extending the patients life span by five years or more [commonly known as remission][this percentage may increases or decrease depending on date of discovery / stage of malignant development] (Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself which has proved only be 16.3 percent likely to extend a patients life span by five years or more [commonly known as remission]. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Surgery

Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[14] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.[15] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[16]

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.

Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[17] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

Notable people who died from mesothelioma

Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.

Bernie Banton was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian Federal Election.

Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits.[18] (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.[citation needed])

United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.

After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.

Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.[19] His mesothelioma has been attributed to his younger years spent working on building sites in London.[20][21]

Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation died of mesothelioma in 1994.

Scottish Labour MP John William MacDougall died of mesothelioma on August 13, 2008, after fighting the disease for two years.[22]

Canberra journalist and news presenter, Peter Leonard also succumbed to the condition on 23 September 2008.

Terrence McCann Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006 at his home in Dana Point, California.

Notable people who have lived for some time with mesothelioma

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the Message"[23] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another twenty years eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma.

Author Paul Kraus was diagnosed with mesothelioma in June 1997 following an umbilical hernia operation. His prognosis was "a few months." He continues to survive using a variety of integrative and complementary modalities and has written a book about his experience.

Legal issues

The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). Today, you may see a commercial stating something like, "Mesothelioma is a rare type of cancer caused by asbestos particles. Asbestos particles can be found in lumberyards, shipyards or any of the heating or automotive industries." The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.[24] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, Congress has failed to enact significant asbestos reforms.

Legal History

The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al. first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos.[26] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[27] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.

In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.

Despite proof that the dust associated with asbestos mining and milling causes asbestos related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.

By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.