MESOTHELIOMA TREATMENT

Mesothelioma Diagnosis

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It is often difficult to diagnose mesothelioma because the symptoms of the disease are similar to those of several other conditions. To reach the diagnosis of mesothelioma, a physician must carefully assess several clinical and radiological findings as well as a confirming tissue biopsy.

It will usually take several days or longer to receive the results of diagnostic tests and biopsies to make a pleural mesothelioma diagnosis, peritoneal mesothelioma diagnosis or pericardial mesothelioma diagnosis. Though it is of course difficult to wait, patients should know that their doctors are using the best tools available to reach an accurate diagnosis and that their physicians will explain the diagnosis as soon as possible. A proper diagnosis is essential for determining the best mesothelioma treatment available.

Physical Examination and History

The first step in the diagnostic process is for the doctor to get a history from the patient and to conduct a thorough physical examination. Based on the examination and the patient’s symptoms, the doctor will choose the next appropriate step.

Radiological Tests

Radiological tests like chest x-rays, CT scans or PET scans play a major role in the diagnosis of mesothelioma. These tests are also valuable in determining how far the disease has spread. However, a confirmed diagnosis of mesothelioma will also require a biopsy.

Biopsy

Although preliminary tests can provide helpful information in narrowing down a diagnosis, a final accurate diagnosis of mesothelioma requires a biopsy. A biopsy is a procedure to remove tissue from the body to allow a pathologist to examine the suspected cancer under a microscope. Even though a biopsy is the most effective way to achieve an accurate diagnosis of mesothelioma, malignant mesothelioma cells may appear to be some other type of cancer. To prevent any mistake, a pathologist will conduct special laboratory tests on the body-tissue obtained during the biopsy and may even use an electron microscope to confirm a diagnosis of mesothelioma.

Blood Test (Mesomark)

A new blood test called Mesomark may offer the possibility of earlier diagnosis and perhaps more successful treatment for mesothelioma patients. Development of this test has been an exciting recent development in the diagnosis of mesothelioma.

Staging and Other Prognostic Factors

If a diagnosis of mesothelioma is confirmed, the doctor will proceed to determine the extent of the disease – called the “stage” of the illness. Staging may require further tests to discover whether the mesothelioma has spread to other parts of the body. By determining the stage of the illness, a physician can better plot out a course of treatment.

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Staging and Other Prognostic Factors

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After a diagnosis of mesothelioma is confirmed, the patient’s doctor may order additional tests to determine the extent, or “stage” of the cancer. Staging of mesothelioma is based in part on imaging studies such as chest x-rays, CT scans and MRI scans. Mesothelioma is described as localized if the cancer cells are located only on the membrane surface where the cancer originated. It is classified as advanced if the cancer has spread beyond its original site to other parts of the body, commonly the lymph nodes, chest wall, lung tissue or abdominal organs.

The treatment and outlook for patients with mesothelioma depends largely on the stage of their cancer. Unfortunately, mesothelioma often is not diagnosed until the cancer is in the late stages of development. As a result, the prognosis for the majority of patients with mesothelioma is poor. After the disease has progressed to Stage III or IV, treatment options are more limited and less effective.

Pleural mesothelioma is the only form of the disease to which a stage is assigned. Formal stages aren’t used for other types of mesothelioma because these types are rare and are not as well studied. There are four main TNM stages of pleural mesothelioma: Stage I pleural mesothelioma is localized, meaning it is limited to one portion of the lining of the chest. Stage II mesothelioma may have spread beyond the lining of the chest to the diaphragm or to a lung. Stage III mesothelioma may have spread to other structures within the chest and may involve nearby lymph nodes. Stage IV mesothelioma is an advanced cancer that has spread, or metastasized, to distant areas. Mesothelioma most commonly metastasizes to the brain, lymph nodes in the chest and areas of the lung that are away from the tumor.

Along with the TNM stage of the patient’s mesothelioma, there are additional prognostic factors that determine the mesothelioma survival rate.

Physical Examination & Medical History

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The physician will start by obtaining the patient’s medical history, symptoms, and risk factors—particularly any history of asbestos exposure. Many times, a patient who was exposed only briefly to asbestos many years ago will think it unnecessary to mention. Yet even brief exposure to asbestos can cause mesothelioma, so the patient should discuss any history that involved exposure to asbestos. This includes having had a family member who worked with asbestos as well as having lived or worked near a facility where asbestos-containing ore was mined or milled or asbestos-containing products were manufactured.

A physical exam will also be performed to give the physician information that suggests the presence of mesothelioma or other health problems. For example, a patient with pleural mesothelioma (mesothelioma of the chest) often has fluid in the chest cavity, called a pleural effusion. In cases of peritoneal mesothelioma, patients may experience fluid in the abdominal cavity (ascites). For pericardial mesothelioma (mesothelioma of the lining of the heart), fluid in the pericardium is common. All these conditions might be discovered during a physical exam.

A complete physical examination will also include a lung function test. Such testing is used to diagnose a variety of lung diseases and to measure the severity of any lung problem.

Blood Test (Mesomark)

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Mesothelioma is so difficult to treat in part because it is usually not detected until the disease has progressed to the late stages. If the disease could be detected earlier, mesothelioma patients would see an improved prognosis. Some researchers see a breakthrough in mesothelioma detection in the form of a blood test known as Mesomark. In the Mesomark test, blood is drawn from the patient and sent to a laboratory to measure the amount of a particular biomarker, called SMRP. Certain elevated levels of SMRP indicate the presence of mesothelioma. The test’s makers suggest that early detection of the biomarker in a patient’s blood can lead to an early diagnosis, resulting in more treatment options and a better prognosis for the patient.

In addition to detecting the presence of mesothelioma in patients who have not yet been diagnosed with the disease, the Mesomark blood test may also be helpful for monitoring the success of treatments in patients who have already been diagnosed with mesothelioma. The blood tests might be used to help determine the future course of treatment in such patients.

The results of a study released by researchers at New York University in February 2007 suggest that the test may be effective. Dr. Harvey Pass of the Department of Cardiothoracic Surgery at NYU’s School of Medicine stated in a press release: “Our findings not only show that SMRP is indeed a valid biomarker for mesothelioma, but also justify further research as a prospective screening test.” Dr. Pass indicated that the test might assist researchers on their “way towards improving survival rates and the quality of life for patients diagnosed with this aggressive and often fatal disease.”

Mesomark was first released in Australia in March 2005 and in Europe a few months later. The Food and Drug Administration approved the blood test for humanitarian use only in the U.S. in January 2007. The test was developed by Fujirebio Diagnostics Inc. of Malvern, Pennsylvania.

Radiological Tests

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Many mesothelioma patients will be referred to a radiologist during the diagnostic process and again during treatment. Radiologists are specially trained to diagnose patients through the use of medical imaging scans. In the past, radiology was generally limited to the use of x-ray machines, and chest x-rays may still provide helpful information. But now radiologists also use other medical imaging tests, including CT scans, MRIs, PET scans, and ultrasound, in addition to traditional x-rays. To study the heart, physicians may also use an echocardiogram. Each of these diagnostic tools employs a different type of technology to render one- or two-dimensional images of the inside of the human body. These images, or scans, pinpoint the location of bones, organs, and solid masses, or tumors.

The radiologist begins by consulting with the patient’s other physicians, reviewing the patient’s medical history, and consulting with the patient to discuss options before ordering diagnostic imaging tests. Generally, the radiologist does not personally perform the imaging scans. This is done by radiology technicians, who set up the machines and scans according to the radiologist’s instructions. After the tests are complete and the images have been generated, then the radiologist will read and interpret the images to reach a diagnosis and determine the stage of development.

Once a diagnosis is made, the radiologist and other doctors on the medical team will chart a course of treatment. The results of the scans provide the physicians with vital information about the size of the tumor, its exact location, and whether the tumor has spread to other organs. All this information is critical in deciding upon the best treatment.

These types of medical imaging tests may even be repeated during the treatment process. The radiologist may order scans periodically during a patient’s treatment with chemotherapy or radiotherapy to determine whether any tumors have shrunk or disappeared. Scans may also be performed at intervals after surgery, to allow the radiologist to see whether any tumors have reappeared following surgical removal.

Within the specialty of radiology, there are even further specialties. Some radiologists focus on diagnostic radiology of the chest, which would involve the diagnosis of pleural mesothelioma. A gastrointestinal radiologist would be more likely to work on a case of peritoneal mesothelioma, where the tumor occurs in the abdominal cavity. Radiologists also specialize according to the type of diagnostic machine they use. Some radiologists concentrate on the use of Computed Tomography (CT scans), while others specialize in Magnetic Resonance Imaging (MRIs).

The added levels of specialization make it likely that one mesothelioma patient will be referred to two or three different radiologists during the diagnosis and treatment process. One specialist might participate at the diagnostic phase before a diagnosis of mesothelioma is confirmed. During treatment, another radiologist might be called in to administer radiation, given that doctor’s specialty in medical imaging that concerns one particular part of the body.

Usually, the radiologist will clearly explain the procedures involved and will inform the patient about the results of the medical imaging tests. Where any part of the process is unclear, however, the patient should be sure to ask the radiologist for more information.

Biopsy

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In addition to the physical examination and radiographic tests, a biopsy is necessary for the confirmation of a diagnosis of mesothelioma. For a biopsy, a surgeon or a medical oncologist (a physician who specializes in diagnosing and treating cancer) obtains a sample of tissue from the body for examination under a microscope by a pathologist. A biopsy is performed in different ways, depending on the location of the tissue to be removed. Sometimes, a patient will undergo more than one biopsy procedure.

Sometimes a sample may be taken of the fluid that builds up around the mass in a procedure called a thoracentesis.

Tissue samples can be obtained through a needle biopsy, in which cells are extracted through a long needle; a tissue biopsy, using a very small incision; or a more open surgical biopsy, which experts now think may provide the most reliable means of diagnosing mesothelioma.

Other biopsy procedures may be used after diagnosis to determine how far the cancer has spread.

After a biopsy is performed, the tissue obtained is sent to experts for an evaluation to determine if mesothelioma is present. If fluid is removed during a thoracentesis or thorascopy, the fluid is sent to a Cytology lab for analysis. A tissue biopsy will be sent to a surgical pathology lab for analysis. The same is true when an entire tumor, pleura or lung is surgically removed. After analysis is completed, small pieces of any remaining tissue are preserved in paraffin wax for future use. Regardless of where the biopsy material is sent, the patient’s physician will receive a written report of the results. The doctor may receive an oral report from the lab prior to the written results.

Analysis of the biopsy material will be conducted by a pathologist, a doctor who specializes in identifying and determining the cause of diseases. A pathologist is trained to analyze abnormal cell growth, which can reveal the presence of mesothelioma, and other diseases.

Ordinarily, the pathologist will remove a razor thin layer of tissue from the sample, set the tissue on a microscope slide, add dye to the slide to make the cells more visible, and then seal the slide so it can be viewed under a microscope. It is often difficult to diagnose mesothelioma just by looking at the cells in the fluid taken from around the lungs, abdomen, or heart, or even from the tissue obtained in a small needle biopsy. Under the microscope, mesothelioma can have the appearance of several other types of cancer. Pleural mesothelioma, for example, may look like some types of lung cancer and peritoneal mesothelioma may seem to be a cancer of the ovaries. For this reason, special laboratory tests are often performed on the biopsy tissue to help distinguish mesothelioma from another type of cancer.

These tests often use special techniques to locate certain types of chemicals (called “markers”) contained in mesothelioma tumors. One method, immunohistochemistry, looks for certain proteins on the surface of the cells. This test can be used to tell the difference between mesothelioma and lung cancer, which can appear to begin in the lining of the chest cavity. DNA Microarray analysis is a newer test. This method actually analyzes genes in the tumor. Mesothelioma has different gene patterns than other types of cancers.

The electron microscope is also used to analyze biopsy samples and help diagnose mesothelioma. This microscope can magnify samples more than one hundred times greater than the traditional light microscope that is generally used in cancer diagnosis. The more powerful microscope enables doctors to see the small parts of the cancer cells that make mesothelioma different from other types of cancer.

A biopsy is not only useful for the pathologist who diagnoses a patient’s mesothelioma; a biopsy also allows the patient’s oncologist to analyze the possible spread of cancer cells to other parts of the body. When a complete tumor is removed from the body, the pathologist carefully examines the edges, or “margins,” of tissue outside the tumor to see if cancer is present. A finding of “negative margins” means the cancer has probably not spread; the appearance of “positive margins” suggests that the surgeon did not completely remove the cancer. Mesothelioma spreads quickly, so oncologists commonly order additional tests, including biopsies and x-rays on parts of the body that are commonly affected, such as the lymph nodes. The mediastinoscopy is one such test.

Thoracentesis

Some mesothelioma patients develop fluid in their lungs. This is called a pleural effusion. Often, a doctor will take a sample of this fluid with a needle injected into the chest and test the fluid for cancer cells. The procedure might also be performed for draining fluid from the lungs to help relieve pain. Although the procedure is safe and quick, its sensitivity is unfortunately less than 50 percent, and a negative test is generally not sufficient to rule out mesothelioma.

Needle Biopsy

A patient suspected of having mesothelioma will often be given a needle biopsy at the start. For this procedure, the doctor uses a long, thin needle to take samples of cells from the chest, or from the abdomen or pericardial region for examination under a microscope. This test can be uncomfortable but may take only a few minutes. Small pieces of the tissue are taken and then sent to a laboratory for analysis.

The doctor might also use an x-ray, CT scan or fluoroscopy to guide the needle as it is inserted into the tumor. Fluoroscopy is a diagnostic procedure in which x-rays are passed through the body and then projected onto a screen, providing a continuous image of the body’s internal structures.

Tissue Biopsy

Alternate biopsy procedures involve a small incision through which a surgeon can operate a tiny telescope and other fine instruments to obtain a tissue sample. Fluid can also be collected during such procedures. These procedures, called thoracoscopy and laparoscopy/peritoneoscopy, are done in the hospital under general anesthesia.

Thoracoscopy

A thoracoscopy permits a surgeon to look inside the patient’s chest. The procedure is sometimes called a VATS (video-assisted thoracic surgery) pleural biopsy. The surgeon makes one or two small incisions between the ribs and inserts a tube with a tiny video camera into the chest cavity. The doctor uses special forceps to remove the tissue sample as the tumor is viewed on a monitor screen connected to the telescope (the thoracoscope). The surgeon take special care to make the incisions in a place on the chest where they can be incised given that cancer cells can contaminate any incision.

Laparoscopy/Peritoneoscopy

A laparoscopy is similar to a thoracoscopy, in that it allows the surgeon to view and obtain a biopsy of a peritoneal tumor. The laparoscopy may also be referred to as a peritoneoscopy. In a laparoscopy, a video camera placed on a flexible tube is injected into the abdominal cavity through small cuts to the front of the abdomen. The biopsy specimen is sent to the pathology laboratory for examination and interpretation by the pathologist. If the procedure fails to yield enough tissue for the pathologist’s study, however, more extensive diagnostic surgery may be necessary.

Surgical Biopsy

Recently, mesothelioma doctors have determined that the open lung biopsy is the most reliable in making an accurate diagnosis. The procedure is a form of surgery and is done in the hospital under general anesthesia. The types of surgical biopsy are called thoracotomy and laparotomy.

Thoracotomy

A thoracotomy is a type of surgery to open the chest between the ribs to allow a surgeon to check for signs of disease. Sometimes, the surgeon will remove just a sample of tissue for testing. Other times, a larger portion of tumor is removed or, possibly, the entire tumor. The tissue will be forwarded to a pathologist for review and the patient’s physician will receive the report at a later time. A chest tube may be left in place for a few days after surgery to prevent the lung from collapsing.

Laparotomy

A laparotomy is surgery to open the abdomen to permit a physician to inspect for signs of peritoneal mesothelioma and to remove a sample of tissue for testing. As with a thoracotomy, the tissue sample is sent to a pathologist for analysis and the patient’s doctor is given the results at a later date.

Other Biopsy Procedures

Some biopsies are performed not just to confirm the diagnosis of mesothelioma, but also to discover the extent to which a mesothelioma tumor may have spread in the body. These biopsies include the mediastinoscopy and the bronchoscopy. This information is important for staging the cancer—that is, determining how advanced the cancer is. This information in turn assists the physician and the patient in choosing appropriate treatment options.

Mediastinoscopy

A mediastinoscopy is done to learn whether an existing tumor has spread to the mediastinal nodes (the lymph nodes in the center of the chest). A mediastinoscopy involves inserting a lighted tube (mediastinoscope) under the chest bone at the level of the neck and moving the scope down into the chest. This allows the surgeon to view the lymph nodes in this area and to take samples to check for malignant mesothelioma. The mediastinoscopy is performed under general anesthesia with the patient completely asleep.

The lymph nodes are described as bean-sized collections of cells that help the body fight infections and cancers through the immune system. Lymph nodes exist everywhere in the body and act to filter out infection and tumor cells. Cancers in the lung commonly spread to the lymph nodes, but for mesothelioma, this is less common. Tests on sample lymph nodes taken during a mediastinoscopy, then, may help distinguish lung cancer from mesothelioma. In addition, the tests may reveal whether a cancer is still localized or has begun to spread. This determination is important because disease treatment will vary according to the status of the lymph nodes.

Bronchoscopy

If it is suspected that a patient has pleural mesothelioma, the doctor may also perform a bronchoscopy. In this procedure, a flexible lighted tube is inserted through the patient’s mouth, down the trachea, and into the bronchi to determine whether any other masses are present in the airway. Small samples of tissue that appears abnormal may be removed for analysis by a pathologist.

Surgery

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In some cases, surgery may be recommended to alleviate symptoms or slow the progression of mesothelioma. Surgery may be performed in tandem with other treatments such as chemotherapy and radiation, also known as “multi-modal therapy.”

As scientists develop tests to diagnose mesothelioma at an earlier stage, surgery could play a role in curing the disease in the future. Doctors specializing in mesothelioma are working toward the goal of using surgery to remove the cancer and the necessary surrounding tissue in an effort to stabilize the disease.

Whether a surgery is recommended for a particular patient will depend on factors unique to each person, including the type and location of the cancer, the “stage” of the cancer and the patient’s overall health.

Even among the subgroup of patients for whom surgery is an appropriate option, there are a variety of surgical procedures that may be considered—some to control the buildup of fluid that can cause such discomfort and others to remove the tumor mass and slow progression of the disease.

For a patient with pleural mesothelioma, which affects the membrane surrounding the lungs, a surgeon may be called up to perform a thoracentesis, pleurodesis or pleurectomy/decortication to relieve or control discomfort and plural effusion, the buildup of fluid around the lungs that can cause pain and shortness of breath. Other surgeries, such as a pneumonectomy or an extrapleural pneumonectomy, remove more extensive tissue in an attempt to slow tumor progression.

For a patient dealing with peritoneal mesothelioma, which attacks the membrane lining the abdomen, the surgeon may relieve a peritoneal effusion, the buildup of fluid in the abdomen, through a paracentesis. The lining of the abdomen, called the peritoneum, may be removed by a peritonectomy. In a cytoreductive surgery, surgeon will open the abdomen and remove every visible sign of cancer.

Finally, for patients dealing with the most rare form of mesothelioma that involves the membrane surrounding the heart (pericardial mesothelioma), a surgeon might perform a pericardiocentesis to drain the buildup of fluid around the heart, or the more aggressive extrapleural pneumonectomy may be used in some cases to remove the tumor and surrounding tissues.

Types of surgery for mesothelioma treatment:

Thoracentesis

This procedure involves the draining of fluid that may build up (called a “pleural effusion”) in the chest between the lung and the pleura. A tube is placed in the chest in order to drain out the fluid. Thoracentesis is a palliative treatment, meaning that its purpose is to help relieve discomfort.

Pleurodesis

Pleurodesis is a surgical procedure to help control pleural effusion, which is the buildup of fluid between the lungs and the lung lining. Pleurodesis closes the space between the lung and the lung lining, reducing the chance for fluid to accumulate.

There are two approaches to performing a pleurodesis. In the first, a tube that is inserted into the chest drains the excess fluid. After this fluid is drained, a schlerosing agent (a substance that causes tissue to scar or harden), such as sterile talc powder, is injected through the chest tube and into the pleural space. The schlerosing agent is allowed to distribute itself through the pleural space, with the patient being asked to move about in order to facilitate the distribution. Once the agent is distributed, suction is applied to the tube in the chest. Similar to collapsing a plastic bag, the suction brings the two pleural surfaces together, allowing them to “scar” together.

The second method of pleurodesis uses thoracoscopy, whereby a small incision, or a series of small incisions, are made in the skin. A thoracoscope is passed through the incision in order to get a better look at the pleura. The schlerosing agent is then applied to the area.

Pleurectomy/decortication

Pleurectomy/decortication involves removing the pleura, where most of the tumor is located. This procedure may help control pleural effusions (fluid buildup) and help to decrease the pain caused by the tumor. It is a palliative treatment, meaning that its goal is to help to lessen the discomfort caused by mesothelioma.

Pneumonectomy

A pneumonectomy is the removal of all or part of the lung. Your surgeon will make an incision in the side of the chest. When the lung is revealed, the surgeon visually assesses the tumor and decides how much tissue should be removed.

Extrapleural Pneumonectomy

This extensive surgery usually involves the removal of the pleura, pericardium, diaphragm and the whole lung on the side of the cancerous tumor. Your surgeon may decide to remove some of the surrounding tissues as well.

Paracentesis

Peritoneal mesothelioma can cause fluid to build up in the abdomen in a process called peritoneal effusion. This excess fluid is drained through a needle and tube inserted into the abdomen. Paracentesis (sometimes called an “ascitic tap”) can help take the pressure off the internal organs, and also helps reduce the risk of infection that may be caused by the fluid buildup. This is a “palliative” procedure, meaning that the goal of paracentesis is to help to relieve the discomfort associated with peritoneal mesothelioma.

Peritonectomy

A “peritonectomy” involves removing the peritoneum, the lining of the abdomen where the mesothelioma first develops. This form of surgery is most often used when the cancer is detected in the very early stages of the disease. Your surgeon might recommend that a peritonectomy be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy where the chemotherapy drugs are administered directly into the abdomen during and/or after surgery.

Cytoreductive surgery

During cytoreductive or “debulking” surgery, the surgeon opens the abdominal cavity (a procedure known as a “laparotomy”) to look for all signs of cancer and attempt to remove as much of the tumor as possible. This surgery can be quite long in duration because of the amount of detail the surgeon must use to search for and remove signs of cancer in the abdominal area. Your surgeon might recommend that this surgery be performed in tandem with “intraperitoneal hypothermic perfusion,” a form of heated chemotherapy administered into the abdominal cavity.

Pericardiocentesis

This is the process for drawing fluid out of the affected area to help to relieve the discomfort associated with pericardial mesothelioma. For this procedure, a needle is inserted into the pericardium (the sac around the heart) to drain the fluid and relieve circulatory problems. The draining of this fluid can be associated with complications, however.

Radiation

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Radiation therapy is an intense X-ray treatment to damage or kill cancer cells. Although not a cure for mesothelioma, radiation therapy nonetheless may be used at different stages of the disease to slow its growth. Radiation is often the main treatment for patients in weak health who are not candidates for surgery. When radiotherapy is used following surgical removal of the tumor, it is called adjuvant therapy. This type of therapy—surgery followed by radiation—has been demonstrated to reduce the local recurrence of the tumor and to improve the survival rate of patients with early-stage disease. Adjuvant therapy is also an essential part of the treatment of patients who undergo an extrapleural pneumonectomy.

Radiation therapy is important not just to control the growth of the tumor. Radiotherapy is also used to relieve the symptoms of mesothelioma by reducing pain, improving breathing, and easing the other physical problems caused by the cancer.

The kind of radiation treatment used for each patient will depend on several factors, including the size of the tumor and how close it is to vital organs, the stage of the disease, and whether other treatment options may also be used.

There are two primary types of radiation therapy used for mesothelioma patients: traditional external beam radiotherapy and brachytherapy. In addition, mesothelioma doctors are now employing a new form of radiotherapy, intensity-modulated radiation therapy (IMRT).

Adjuvant therapy

Adjuvant therapy is additional treatment to reduce the risk or cancer recurrence or increase the time before cancer recurs. Through the use of chemotherapy, radiation or other adjuvant therapies after a primary treatment like surgery, cancer specialists attempt to kill cancer cells that were left behind in the body but are too small to be seen. Adjuvant therapies, like all cancer treatments, also pose side effects that must be weighed in deciding whether to proceed with a possible treatment.

External Beam Radiation

External beam radiation therapy (EBRT) is routed to the site of the tumor with the use of linear accelerators. These machines generate high-energy external radiation beams that reach through the tissues into the areas where the tumor is found. To deliver the radiation precisely, doctors use computed tomography (CT) scans and PET scans to focus on the areas where the tumor is likely to reappear. Careful radiation planning allows the radiologist to direct a higher dose of radiation at the tumor tissue and to minimize the amount of normal tissue that will be exposed to this high dose of radiation.

Brachytherapy

Brachytherapy uses radioactive substances rather than radiation beams to deliver radiation treatments. The word “brachy” comes from the Greek, and means “short range.” This type of radiation therapy is different from external beam radiation, which is administered over a long range.

Because the radioactive substances used in brachytherapy will only work in the short range, they must be placed in or very near the target area of the body. This means that brachytherapy can be used for mesothelioma patients only by surgically implanting the radioactive substances. This therapy is generally performed during the same operation in which the tumor is removed, and is sometimes referred to as “Intraoperative Radiation Therapy” (IORT). For brachytherapy, the thoracic surgeon and radiation oncologist measure the areas of the chest cavity from which the mesothelioma and surrounding tissue cannot be fully removed. Then, a customized implant is created by weaving radioactive seeds into an absorbable mesh, known as a radioactive iodine seed implant. This flexible mesh is stitched into the body during surgery. The radiation from the implant is released over a three-month period, with a small amount of radioactivity still present for about a year. It is critical during this therapy not to increase a patient’s time in surgery too long, or complications may develop as a result of this delay. Doctors are still evaluating the overall benefits and risks of this procedure.

Intensity-modulated radiation therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is a new breakthrough in radiation oncology. The therapy allows for treatment of areas of the body that previously could not be treated with conventional radiation. IMRT for mesothelioma is delivered by a team of physicians, including a radiation oncologist, physicist and radiation therapist. The preliminary results for this new therapy suggest that the rate of local recurrence is significantly reduced for mesothelioma patients undergoing this treatment.

Chemotherapy

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Chemotherapy uses certain chemical agents or drugs that are specifically destructive to malignant tissues and cells. Doctors may recommend single agent chemotherapy or a combination chemotherapy treatment. The single agent chemotherapy treatment involves the use of just one type of chemical or drug. The combination chemotherapy method involves the use of more than one chemical or drug. While it is not a cure for mesothelioma, chemotherapy treatment may help to prevent the spread of the disease or slow its growth. Chemotherapy may also shrink tumors before surgery is performed (called neoadjuvant therapy), destroy tumor cells still remaining after surgery (called adjuvant therapy), and relieve symptoms, such as pain (called palliative therapy).

Generally, chemotherapy drugs are delivered by injection into a vein. Depending on the type and location of the cancer and the drug used, however, the chemotherapy drugs may be delivered by mouth, into the muscle or skin or by placing the drugs directly into a body cavity (called intracavitary chemotherapy).

Chemotherapy drugs usually cause fatigue or exhaustion. Patients also may experience nausea, vomiting and hair loss. Specific side effects will vary, based on the drug, its dosage, and the length of treatment. Other chemotherapy-related drugs and therapies may minimize the side effects or will be prescribed for use following chemotherapy.

Innovative Mesothelioma Therapies

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Traditional cancer treatment regimens such as radiation and chemotherapy are widely used for mesothelioma patients, but they do not offer a cure for the disease. Increasingly, patients have turned to unconventional forms of therapy in the hope that the answer lies with gene therapy, immunotherapy or photodynamic therapy. All of these treatment options should be discussed with the patient’s physician prior to setting out on a course of alternative treatment.

Gene Therapy

Gene therapy is a method for correcting defective genes that cause disease development. The therapy can work in several ways. Scientists can correct defective genes by removing, inserting, replacing, or altering genes in order to treat or prevent a disease.

To treat a disease such as mesothelioma, a carrier called a ‘vector’ would be used to deliver the therapeutic gene. Generally, viruses are used because they already have the capacity to invade a cell. Also, viruses are very good at targeting specific cells. In gene therapy, viral vectors are changed so they do not create a new virus in the cell, but just drop off a new gene.

Many scientists are searching for ‘suicide genes’ that would attack cancer cells, while leaving normal cells untouched. Gene therapy is a fairly new treatment approach, still very much in the experimental stages, and cannot be administered without the patient’s participation in a clinical trial.

Immunotherapy

Immunotherapy is also known as biological therapy, biotherapy, or biological response modifier (BRM) therapy. It is a treatment designed to stimulate the body’s own natural immune defenses to stop the spread of cancer. Scientists have determined that the immune system can recognize and eliminate cancer cells under some circumstances. The problem with mesothelioma is that the body does not recognize the cancer cells as abnormal.

Immunotherapy uses BRMs to boost the body’s natural ability to fight disease. Interferons, interleukins, tumor necrosis factors, monoclonal antibodies and cancer vaccines are all BRMs. Some occur naturally in the body, and others are generated synthetically in the lab. BRMs seem to change the body’s relationship with mesothelioma cells, so the body recognizes them as abnormal. As a result, the body’s ‘immune response’ kicks in to attack the mesothelioma cells and prevent the cancer from growing. Immunotherapy also seeks to block the process by which mesothelioma alters a normal cell into a cancer cell. Scientists hope that BRMs can stop the migration of mesothelioma to other parts of the body, and prevent its further growth.

Preliminary studies have demonstrated considerable shrinkage of tumors at very early stages of mesothelioma. But more research is required to determine whether immunotherapy will be effective as a mesothelioma treatment. In Phase I and Phase II clinical trials of a combined immunotherapeutic and chemotherapeutic approach for mesothelioma patients, the results failed to show any meaningful effect on survival or relapse rate.

Photodynamic Therapy

Photodynamic therapy (PDT) uses a drug that is activated by light and applies laser light to it. The two work together to target and destroy cancer cells while keeping damage to surrounding healthy tissue at a minimum. The therapy begins with the patient’s injection with a non-toxic photosensitizer drug. The drug invades all cells of the body, but in about two days, normal cells excrete the drug. Then the patient is exposed to laser light, which will activate the drug remaining in the cancer cells and destroy them. Timing is critical, because the tumor cells must be exposed to the laser light after the drug is excreted by the normal cells, but before the drug is expelled by the mesothelioma cells.

It is unclear what role photodynamic therapy may play in the treatment of mesothelioma. Since the laser light cannot be absorbed at any great depth in the body, treatment via PDT can only be used on superficial areas of the body. Still, the treatment may be ideal for the treatment of mesothelioma after surgical removal of the tumor. Some doctors have applied PDT intraoperatively after surgery, but the number of patients treated in clinical trials is small, making it difficult to draw definitive conclusions. Most reports concerning PDT are Phase I and II studies and the only phase III study was conducted with an earlier generation photosensitizer. That study reported no advantage in using PDT in combination with surgery and immunochemotherapy. At present, all that is known is that PDT can be performed safely with newer generation photosensitizers and that results are encouraging for mesothelioma patients with stages I and II disease.

Medical FAQs

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What is Mesothelioma?

Mesothelioma is a form of cancer caused by exposure to asbestos. Mesothelioma is not lung cancer. Instead, it is a specific kind of cancer that affects the lining around the lungs, heart or abdomen. Each year, between 2,500 and 3,000 men and women in the U.S. are diagnosed with mesothelioma. Asbestos is the primary cause of mesothelioma. It is an aggressive cancer that can be difficult to treat. Often, the cancer does not appear for 15 to 40 or more years after a person has been exposed to asbestos. Exposure to even relatively small amounts of asbestos can cause mesothelioma. Fortunately, researchers and doctors continue to make new advancements and discoveries regarding mesothelioma. For more information about treatment options for mesothelioma, visit mesothelioma treatments.

What is Asbestos?

Asbestos is a naturally occurring substance, mined from rock and made up of tiny fibers, that has been used extensively in thousands of building and insulation products. Asbestos releases microscopic fibers that people either breathe in or swallow. Asbestos fibers are so small the eye cannot see them. Asbestos has no smell or taste, and it is inhaled or swallowed without immediate or noticeable effect.

What are the types of malignant mesothelioma?

Mesothelioma can affect the lining of the lungs (pleural mesothelioma), heart (pericardial mesothelioma) and abdomen (peritoneal mesothelioma). The chest cavity, abdominal cavity and the cavity around the heart are all lined by a layer of specialized cells called mesothelial cells. The tissue formed by these cells is called mesothelium. Pleural mesothelioma is the most common form of the disease. Peritoneal mesothelioma is the next most common form, and pericardial mesothelioma is the most rare.Click here for the information about treatment options for pleural, peritoneal, and pericardial mesothelioma.

Who gets mesothelioma and why?

The primary known cause of mesothelioma is asbestos exposure. Throughout the 20th century, especially prior to the mid-1970s, asbestos was found in thousands of products, especially insulation and construction materials.

Here is a list of some products that at one time contained asbestos:

Pipe Covering/Pipe Insulation
Insulating cement
Insulating block
Refractory cement
Floor and ceiling tile
Fireproofing
Insulation
Firebrick
Gaskets
Joint compounds
Brake pads and linings
Clutches
Electraical wires
Boilers
Furnaces
Turbines
Wallboard/Millboard
Asbestos cloth, blankets, felt or paper
Asbestos packing
Asbestos rope
Shingles
Roofing materials
Plastic cement
Drilling additives

Here is a list of some trades that at one time were commonly exposed to asbestos on the job:

Insulators
Pipfitters
Plumbers
Boiler room tenders
Boilermakers
Steel workers
Shipyard workers
Electricians
Carpenters
Drywall finishers
Painters
Plasterers
Iron workers
Crane operators
Floor coverers
Masons
Brickmasons and blockmasons
Laborers
Construction workers
Pot tenders
Welders
Sheet metal workers
Railroad workers
Brake mechanics
Refinery workers
Power plant workers
Paper mill workers
Navy men

Particularly from the 1940s to the mid-1970s, many workers throughout the U.S. were exposed to asbestos at their jobs. In some cases, a member of the worker’s family may have been exposed to asbestos carried home on the worker’s clothes and developed mesothelioma many years later.

What are the symptoms of malignant mesothelioma?

The symptoms of mesothelioma may include: shortness of breath, pain in the chest or back, or pain or swelling in the abdomen. Other symptoms may include difficulty swallowing, cough, fever, sweating, fatigue and weight loss.The symptoms of pleural mesothelioma may also include hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, paralysis and sensory loss. Those with peritoneal mesothelioma may experience pain in the abdomen, weight loss, nausea, vomiting, hernia, fluid in the abdominal cavity or a mass in the abdomen.

How is mesothelioma diagnosed?

Diagnosis is the process of determining the kind of disease that is present. An accurate diagnosis is important because it helps to determine the type of treatment that you will undergo. Doctors may use a number of procedures to aid in the diagnosis of mesothelioma. The most common of those procedures are listed here. Whether one or a combination of these tests are conducted in a given patient’s case will depend on factors unique to the patient. Some tests might first be conducted to determine whether a biopsy should be performed. A biopsy is usually necessary to confirm a diagnosis.

CT scan
This type of X-ray provides a very detailed picture of the size and location of the cancer. The images taken are compiled by a computer to create a more complete image of the disease. The procedure is also called a computerized axial tomography (CAT) scan.
PET scan
A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.
Thoracoscopy
The diagnosis of pleural malignant mesothelioma may involve your doctor looking inside the chest cavity with an instrument called a thoracoscope. For this procedure, an incision is made through the chest wall and the thoracoscope is put into the chest between two ribs. This procedure is usually done in the hospital. Before the procedure, the patient is given a local anesthetic.
Bronchoscopy
A bronchoscopy involves an examination of the lungs and air passages. The doctor places a lighted tube down the patient’s throat and trachea into the lungs. This procedure is called a bronchoscopy, and the instrument used is called a bronchoscope.
Thoracentesis
Some patients develop fluid in their lungs. This is called a pleural effusion. A sample of this fluid can be taken out with a needle injected into the chest and tested for cancer cells. This procedure for draining fluid from the lungs may also be performed in an attempt to relieve pain.
Mediastinoscopy
This is a test which examines the mediastinum. This area is in the center of your chest, between your lungs, and contains the heart, blood vessels and lymph nodes. You’ll need a general anesthetic for this test and therefore will probably spend at least one night in the hospital.
Needle Biopsy
For this procedure, the doctor will use a thin needle to take samples of cells for examination under microscope. This test can be uncomfortable but may take only a few minutes. The doctor may use an X-ray, CT scan or fluoroscopy to guide the needle as it is inserted into the tumor.
Fluoroscopy
Fluoroscopy is a diagnostic procedure in which X-rays are passed through the body and then projected onto a screen, providing a continuous image of the body’s internal structures. Small pieces of the tissue are taken and then sent to a laboratory for analysis.
Wedge Biopsy
For this procedure, an incision is made through the skin, and a wedge of tissue or tumor is obtained and sent to a laboratory for analysis. The patient is under general anesthesia for this procedure. A wedge biopsy is often used when other biopsy methods have been unable to confirm a diagnosis.
Cytology and Pathology
Pathology is the study of a disease, which looks at specific cells and types of a disease process to determine the cause. Pathology tests are performed on samples of body fluid or tissue to determine the cell type (cytology) of a specific disease. The process of looking at these samples may include using microscopes, electron microscopes and special cell-staining techniques that identify specific types of cancer cells. Certain types of dyes or coloring are added to the patient’s biopsy samples. Depending on how the tissue responds to the dye, the doctor can make or confirm a diagnosis. In making the diagnosis, the more information the doctor has about the tumor, the better he or she can recommend appropriate treatment. Knowing the type of disease helps to make the treatment more specific.

What are the stages of malignant mesothelioma?

Malignant mesothelioma moves through four stages, each one more advanced than the next. Your doctor will probably determine at what stage the cancer is, a process called staging, because each stage requires a different variation of treatment.
Stage I: The cancerous growth is found in the lining of the lungs, heart or abdomen.
Stage II: The mesothelioma has moved to this stage when it goes from the lining into the lymph nodes.
Stage III: The cancer has spread into the chest wall, center of the chest, heart, diaphragm or stomach.
Stage IV: The most advanced stage is when the mesothelioma has spread into organs that are not part of the lung, heart or abdominal systems, such as the liver, pancreas or colon.

What kinds of treatment options or therapies are available for mesothelioma?

Research continues daily across the country in an effort to find a cure and effective treatments for mesothelioma. The most common treatments are surgery, radiation and chemotherapy. Some new therapies are starting to emerge, and research on new treatment options is ongoing. For detailed information about treatment options for mesothelioma, visit mesothelioma treatment.

Where can I get more medical information about mesothelioma?

In addition to your medical care providers, there are many good sources of information available with medical information about mesothelioma. Here are some links to other Web sites that may help you find more medical information.American Lung Association

Programs and strategies for dealing with lung disease.Centerwatch/Clinical Trials Listing Service
Information on clinical trials in the U.S.Clinical Trials
Public current information about clinical research studies.Mayo Clinic
Reliable information for a healthier life from Mayo ClinicMedscape
Late-breaking medical news.

National Cancer Institute
Cancer.gov, the National Cancer Institute’s Web site provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

Oncolink
Created by the Abramson Cancer Center of the University of Pennsylvania. Provides information on various forms of cancer.

How do I find a doctor or hospital that can help?

Because mesothelioma is a relatively rare form of cancer, not all doctors have experience with mesothelioma. Some doctors and medical centers have extensive experience with treating mesothelioma patients. Some cancer centers have experience with all types of cancer. Be sure to choose a doctor you feel comfortable with, and remember, you can always seek a second opinion.Click here for a list of doctors and hospitals specializing in mesothelioma.

Where can mesothelioma patients, their families and friends turn for help to cope with mesothelioma?

Coping with mesothelioma, like other types of cancer, can be especially difficult. There are few support groups specifically for mesothelioma, and these are often informal groups of people who live in the same area or who meet each other in doctors’ offices and hospital waiting rooms. There are bigger and more organized support groups for cancer sufferers in general. Choose whatever group you feel the most comfortable with.Click here for more information on support resources.

Types and Symptoms of Mesothelioma

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Mesothelioma is a form of cancer that develops in the lining around the lungs (the “pleura”), abdomen (the “peritoneum”) or heart (the “pericardium”). In contrast, lung cancer refers to a malignancy of the lung itself. And, unlike lung cancer, which may have other causes as well as asbestos exposure, mesothelioma is virtually always the result of exposure to asbestos. It generally does not appear until decades after the asbestos exposure.

Diagnosis of mesothelioma can be very difficult because its symptoms may not appear for decades after exposure to asbestos. Unfortunately, this lengthy time delay not only prevents diagnosis, but also complicates treatment efforts, given that mesothelioma is usually detected in the late stages, after serious side effects begin to present themselves.

The common symptoms of mesothelioma vary according to the cancer’s location. Because of the similarity of the diseases, however, many of the symptoms are overlapping. Most mesothelioma patients experience shortness of breath and generalized fatigue, but more acute pain will likely be more apparent in the chest for pleural and pericardial mesothelioma patients and in the abdominal region for peritoneal patients.

Learn more about the specific symptoms associated with three kinds of asbestos-related malignant mesothelioma:

Pleural Mesothelioma, which affects the lining of the lungs;
Peritoneal Mesothelioma, which attacks the membrane surrounding the abdominal cavity; and
Pericardial Mesothelioma, which invades the membrane around the heart.
Cell Types of Mesothelioma

Many of the symptoms of mesothelioma mirror those of other more common physical conditions. In fact, this is another factor that contributes to the difficulty in diagnosing mesothelioma; its symptoms are often mistaken for the flu, bronchitis, pneumonia or heart disease. Still, patients with any of the symptoms discussed below and a history of asbestos exposure should see a physician. If symptoms persist, you should ask your doctor for a thorough evaluation.

Finally, this discussion is not intended as a tool for self-diagnosis, nor is it intended to be a substitute for consulting with a doctor who specializes in the diagnosis and treatment of mesothelioma. This information is designed to help you learn about mesothelioma. For more resources, the following websites, from which this discussion was drawn, may also prove helpful:

Pericardial Mesothelioma

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Pericardial mesothelioma is also known as mesothelioma of the pericardium or cancer of the sac that holds the heart. The incidence of pericardial mesothelioma makes up less than 5 percent of all mesothelioma cases. Because pericardial mesothelioma is so rare, not as much is known about its disease processes.

In pericardial mesothelioma, layers of the pericardium thicken as the cancer cells grow, which results in a build-up of fluid between membrane layers. This build-up of fluid eventually impairs cardiac function.

Pericardial mesothelioma symptoms may cause:

Chest pain
Shortness of breath
Generalized fatigue

Cell Types of Mesothelioma

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A patient’s doctor or medical records may refer to the “cell type” of the malignant mesothelioma. This refers to the type of tissue where the cancer first developed. For example, “epithelial” malignant mesothelioma refers to cancerous cells that develop in the “epithelium,” which is the membrane lining of the lung, heart, or abdomen. In contrast, “sarcomatous” malignant mesothelioma arises in connective tissue. “Biphasic” refers to malignant mesothelioma that arises in two different cell types. Other cell types of malignant mesothelioma are lymphohistiocytoid and desmoplastic.

Mesothelioma and Asbestos

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Mesothelioma is a rare form of cancer caused by exposure to asbestos. Asbestos is a naturally-occurring fiber that, when released into the air, can be inhaled or swallowed. Asbestos has no smell or taste, and asbestos fibers are so small that they are not visible to the naked eye. Asbestos fibers can “stick” in the lung, abdomen and other body tissues and over time, lead to the development of asbestos-related diseases like mesothelioma. There is a long latency period between asbestos exposure and the development of mesothelioma; in other words, decades may pass after a person’s first exposure to asbestos before he or she becomes ill. A person who has been diagnosed with asbestosis (a non-cancerous scarring of the lungs) is at an increased risk of developing mesothelioma in the future.

Millions of people in the U.S. have been exposed to asbestos, and it is estimated that approximately 3,000 people are diagnosed with mesothelioma each year. In these pages, you will read about asbestos, cancer support and the common ways for occupational and environmental asbestos exposure

Pleural Mesothelioma

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Pleural mesothelioma, also known as mesothelioma of the pleura, is a tumor of the lining surrounding the lungs. The pleura is a thin tissue around the lungs and the inside of the chest. In order to protect the lungs, the pleura produces a small amount of fluid which helps cushion the lungs, making the lungs move more smoothly during breathing. There are two types of pleural mesothelioma: benign and malignant. Benign pleural mesothelioma is a non-cancerous tumor that has not spread to other organs of the body. If the tumor is large, it may squeeze the lung itself and cause shortness of breath and pain. Thus, even benign mesothelioma can cause significant health problems and should be treated.

Malignant pleural mesothelioma is cancerous and can spread to other parts of the body. Early symptoms of the disease may be very general. For this reason, they are often ignored. Most patients with mesothelioma experience symptoms for only two to three months before the cancer is diagnosed. Only around one-fourth of mesothelioma patients notice symptoms for six months or more before their cancer is found.

Pleural mesothelioma symptoms include the following:

Shortness of breath
Painful breathing (pleurisy)
Coughing up blood
Dry (nonproductive) cough
Unusual lumps of tissue under the skin on the chest or abdomen
Unexplained weight loss
Pain under the rib cage, in the lower back, or at the side of the chest
Pain or swelling in the abdomen
Difficulty swallowing
Hoarseness
Fever
Sweating
Swelling of the face and arms
Generalized fatigue
Muscle weakness

Of course, symptoms of malignant pleural mesothelioma will vary depending on the patient and the progression of the disease. Some patients experience no symptoms at all. In the early stages of mesothelioma, symptoms are subtle. An asymptomatic patient may experience a pleural effusion, a small buildup of fluid between the outside lining of the lung and the chest cavity. Early on in the disease process, the most frequent symptoms are cough and shortness of breath.

The growing mass causes the pleura to expand, allowing fluid to enter. The build-up of fluid results in greater pain, sometimes severe, in the chest and nearby regions. More than 50 percent of patients with pleural mesothelioma experience pain in the lower back or at the side of the chest. Over time, most people suffer from fatigue, weakness and weight loss. As the disease progresses, some patients also develop severe breathing difficulties, fever, a rasping voice and begin to cough up blood.

Peritoneal Mesothelioma

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Peritoneal mesothelioma, also known as cancer of the peritoneum, is a cancer of the abdominal lining. The disease is not nearly as common as pleural mesothelioma; only 25 to 30 percent of mesothelioma cases originate in the peritoneum. Symptoms of peritoneal mesothelioma are caused when the peritoneal membrane thickens and fluid builds up between membrane layers. The thickening and excess fluid put pressure on the entire abdominal region and organs.

Peritoneal mesothelioma symptoms commonly include:

Abdominal pain
Abdominal swelling
A change in bowel habits, such as more frequent diarrhea or constipation
Lumps of tissue under the skin in the abdomen
Unexplained weight loss
Blood clotting abnormalities
Anemia
Fever
Nausea
Vomiting
Hernia

Mesothelioma and Lung Cancer

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Pleural mesothelioma and lung cancer are both serious illnesses, but they are not the same. Pleural mesothelioma – sometimes called “asbestos lung cancer” – is really not a form of lung cancer because it does not develop in the tissue of the lungs. Instead, it is a cancer of the lining that surrounds the lung (the “pleura”).

Mesothelioma is caused almost exclusively by asbestos exposure. It is considered a “signature disease” for asbestos exposure, which means that, if you have mesothelioma, it can be assumed that you had exposure to asbestos at some point in your life. Smoking does not cause mesothelioma.
Lung cancer can be caused by asbestos exposure; it can also be caused by smoking. In fact, someone who smokes and was exposed to asbestos has a much higher risk of getting lung cancer. See Asbestos and Smoking.

Asbestos and Smoking

Asbestos exposure and smoking have something in common: they are bad news for your body, especially your lungs, and they are even worse when they happen together. If you have an asbestos-related disease, quitting smoking can help slow the progression of your disease, make is easier for you to breath, improve blood flow, and decrease stress on your heart. But quitting smoking is also important to cut your risk of getting cancer in the future, whether you are sick today or not.

You probably know that we are all exposed to things that can cause cancer. What you may not know is that sometimes combinations of exposures are more dangerous than the sum of the individual exposures. For example, it is generally accepted that asbestos exposure can make someone 5 times more likely to get lung cancer. Smokers are approximately 10 times more likely to get lung cancer. But if you are a smoker and were also exposed to asbestos, your risk is not 15 times higher—it’s about 50 times higher! Instead of adding the increased risks created by asbestos and smoking, the risks are multiplied when they occur in the same person. This is called a synergistic effect.

There is nothing that can be done about the increased risk of cancer caused by asbestos exposure. The asbestos fibers stay inside the body even when you are no longer exposed to asbestos. But something can be done about the risk of cancer caused by smoking. According to the American Lung Association, if you quit smoking today, in ten years your increased risk of lung cancer attributable to smoking would be half that of a continuing smoker. Your risk of heart disease, stroke and several other cancers would also decrease substantially.

Anyone concerned about health should stop smoking, but if you have a history of asbestos exposure and certainly if you already have an asbestos-related disease, the danger of continuing to smoke is even greater for you—and so are the benefits of stopping.

Alternative Therapy

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Many types of therapy are available to mesothelioma patients that can be used in addition to traditional medical treatments. Many patients have found these alternative therapies to be an excellent way to manage pain, improve general health, and get relief from other disease symptoms. These treatments cannot cure the disease, but they can assist patients in living more comfortably by relieving pain and stress. Alternative treatments that have had value for some mesothelioma patients include acupuncture, aromatherapy, massage, meditation, dietary supplements, TENS therapy, yoga and pet therapy.

Acupuncture

Acupuncture is so widely accepted as an alternative therapy that many insurance companies provide coverage for it. Acupuncture is performed by inserting very fine needles into pressure points at specific locations on the skin. Acupuncture is routinely used to give relief from pain and inflammation and from anxiety or stress. You can find more information on acupuncture at The American Association of Acupuncture & Oriental Medicine.

Aromatherapy

Aromatherapy uses fragrance to boost physical and psychological well-being. Distilled and highly concentrated plant-based oils are blended and used by aromatherapists to give relief from pain and other symptoms of the disease. Aromatherapy is often combined with massage therapy, which allows patients to receive a massage with oils that have been mixed with small amounts of the fragrant plant-based oils. You can find out more about aromatherapy at the National Association for Holistic Aromatherapy and Precious Aromatherapy, Inc.

Massage

Massage therapy is known to promote blood and lymphatic flow, boost circulation, and aid in relieving muscle tension. In addition, massage stimulates the digestive and nervous systems, and can relieve chronic pain. Many patients report that massage also reduces anxiety and feelings of stress. Get more information about the benefits of massage therapy at HolisticOnline.com and Alternative Medicine Online.

Meditation

Meditation has long been used as a means to reduce anxiety, feelings of stress and depression. It is also believed that meditation can assist in managing pain and other symptoms of mesothelioma. Many cancer patients who supplement their traditional treatment with meditation find that the practice relieves pain, stress, and anxiety.

Supplements

Many patients feel that the use of supplements is beneficial to their overall health during treatment. Vitamins, minerals, herbs, and amino acids are all dietary supplements. The body requires vitamins, minerals, and amino acids to perform essential life functions, and supplements may provide necessary chemicals when such substances are missing from a patient’s diet. In fact, in one clinical trial of chemotherapy for treating mesothelioma patients, the participants’ average survival and time to cancer progression was improved by the vitamin supplementation of B12 and folic acid. In addition, many herbs can help to provide relief from symptoms of the disease.

Of course, when taking any kind of supplement, a patient should discuss the matter first with his or her physician. Supplements can affect the performance of certain prescription medications. Some supplements may even be dangerous when taken with certain medications. For more information on the use of dietary supplements, visit the National Center for Complementary and Alternative Medicine and About.com’s Common Herb Mistakes.

TENS Therapy

TENS therapy stands for Transcutaneous Electrical Nerve Stimulation. TENS therapy is somewhat similar in principle to acupuncture, in that it stimulates defined body locations. In contrast to acupuncture, which uses fine needles, TENS therapy uses electrodes that deliver very mild electrical shocks to the body location to be stimulated. Like acupuncture, TENS may provide relief from pain and inflammation and from anxiety or stress.

Unlike most other alternative therapies, TENS has been approved by the FDA. This means that, according to the FDA, the procedure is safe and that TENS therapy may be covered by insurance. You can find more information on TENS Therapy at Health Scout and BBC Health.

Yoga

Yoga began in India, where it is practiced more to promote spirituality than physical well-being. But in the U.S., yoga has been recognized as a form of exercise that is also psychologically calming. Simple yoga techniques can help improve a patient’s general health and state of mind.

Pet Therapy

Pet therapy is also referred to as animal-assisted therapy or animal-assisted activities. The goal of pet therapy is to improve a patient’s general health and well-being by allowing the patient to interact with animals. The soothing effects of simply stroking a dog or cat have long been known to improve a patient’s mood and lift the spirits. In addition, the interaction even offers some physical benefits, such as, for example, the temporary lowering of blood pressure. Get more information at The Delta Society.

Assessing Your Pain and Communicating with Your Doctor

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Here are some suggestions provided by www.cancer-pain.org to help you work effectively with your health care providers in assessing your pain:

Put it in writing. If possible, written notes about your pain (see Pain Diary, below) are valuable in giving accurate and comprehensive information.

Plan to ask questions. It’s important that you fully understand what your health care professional says to you about your pain. Ask questions until you are satisfied that you understand.

Have a notetaker. Sometimes it’s difficult to talk about your pain, ask questions and take notes on what’s being said to you all at the same time, especially if you are in pain. Bringing a friend or family member to take notes during the discussion about your pain can provide a valuable resource for you once the conversation has ended.

Make your views heard. Don’t hesitate to offer an opinion about what may be causing or contributing to your pain. No one knows your body as well as you, and your insights can be valuable to your health care providers.

These are points to consider as you prepare to discuss your pain and its management with your health care providers:

The location of all of your pains.

How the pain feels (use descriptive words such as dull, aching, throbbing, stabbing, piercing, pinching, sharp, aching, burning, tingling).

The intensity of your pain (when it is at its worst) and whether the intensity changes throughout the day and night.
When you have the pain (all the time or occasionally).

How quickly the pain comes on (suddenly or intermittently), how long it lasts (a few minutes or several hours), and how often it occurs.
What makes the pain worse? Describe conditions under which the pain becomes more intense, such as moving, walking, talking, coughing, laying down, eating, going to the bathroom, etc.

What eases the pain? Be ready to discuss anything that has helped you, including medication(s) you have been using, and the amounts you are taking.

Medications you are taking. Tell them about your pain medications, including any over-the-counter pain relievers, any alternative medications like herbs, and any medications you may be taking for other health conditions not related to cancer.

Side effects of your pain medications. Tell them what side effects you are experiencing, how the side effects are currently being treated, and if you are satisfied with this treatment.

Quality of life issues:
What impact does the pain have on your quality of life? Can you work, enjoy your family and friends, eat and sleep well? If not, describe how the pain is limiting your activities. Also, tell your health care provider(s) what you want from pain management in terms of quality of life.

To keep an accurate record of what you are experiencing, consider creating a simple pain diary. You can do this in a notebook, recording information such as the date, time of day, level of pain you are feeling, what you did to remedy or alleviate it (i.e., medications taken, use of ice or heat, and so forth), and the outcome of your efforts to control the pain (Did the medication work? For how long? Were there side effects?)

Many health care professionals also use various “pain assessment scales” to record patients’ levels of pain. You can use this system, as well, in conversation with your health care provider. Make sure you always use the SAME scale when describing your pain, for consistency and clarity. One of the simplest involves describing your pain level in terms of numbers: “0” means “no pain at all,” and “10” means “the worst possible amount of pain.” The higher the number, the greater the pain. If your health care provider uses a different assessment measuring approach, you may want to use that one. Ask for an explanation of how she or he records patient pain levels.

Palliative Treatment

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Palliative treatment, which is also called palliative care, is treatment designed to relieve the symptoms of disease and improve quality of life. It can address psychological, social and spiritual needs as well as physical symptoms. With regard to physical symptoms, it aims to treat the symptoms of disease but is not meant to cure the illness. In cases of advanced cancer, palliative treatment may sometimes extend life and help the patient live more comfortably, even if the cancer cannot be cured.

Palliative treatment goes well beyond painkillers and anti-nausea drugs. Chemotherapy, radiotherapy, hormone therapy, biological therapy and surgery can all be used as palliative treatments under the right circumstances. Often, the level of pain associated with mesothelioma is quite high. Thus, pain control is usually one of the first symptoms addressed by palliative care, and it is important for the patient to be able to help the doctor accurately assess the pain the patient is experiencing. This may include traditional pain management programs, involving several different pain medications. Palliative care can also focus on behavior modification, managing stress, meditation or massage therapy. Palliative surgery may be performed to reduce pain caused by the tumor or to prevent fluid from building up and causing discomfort. Radiation therapy is also useful in relieving pain caused by mesothelioma. Palliative care plays an important role in maximizing the quality of life for mesothelioma patients.

Pain Management

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Because many people are diagnosed with mesothelioma in the late stages of the disease, they are often already in pain and dealing with symptoms of the disease at the time of their diagnosis. Controlling pain is a critical part of dealing with mesothelioma.

Assessing Your Pain and Communicating with Your Doctor

The better you and your doctors can understand and control your pain, the better your quality of life will be and the better your response to treatment is likely to be as well. Pain management is a dynamic process. The level of pain you experience can change over time, as can your response to pain management therapies. Monitor yourself carefully to see if your pain is interfering with your enjoyment of time with family or of favorite hobbies. You may want to ask for help from your loved ones in monitoring changes in your response to pain. The more information you have collected about your pain and how it is affecting you, the easier it will be to communicate effectively with you doctor. And communicating with your doctor is vitally important to controlling pain associated with mesothelioma.

Palliative Treatment

Palliative treatment (also called palliative care) focuses on relieving the symptoms of the patient’s disease and improving the quality of the patient’s life. Palliative care does not attempt to cure the patient’s illness, but it can make the patient more comfortable. It can also address emotional, social and spiritual needs of the patient as well as physical needs like pain management.

Alternative Therapies

In addition to more traditional pain treatments, there are also a number of alternative therapy options to heighten the patient’s quality of life and manage the patient’s pain. These alternative therapies can be combined with traditional medical treatment options. Many patients benefit from alternative therapies such as massage, meditation, acupuncture, or TENS therapy. Such treatments are known to relieve pain and stress, both of which can accompany a debilitating disease like mesothelioma.

Medical Glossary

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Abdomen: The central trunk section of the body below the chest area. The abdomen contains some of the body’s major organs, such as the stomach, liver, gallbladder, pancreas and intestines.
Adjuvant: An adjuvant treatment is given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or biological therapy.
Adjuvant radiation: Radiation that aids in removing or preventing a disease. For example, a person with mesothelioma may be treated primarily with chemotherapy, supplemented by adjuvant radiation.
Alimta: Alimta (generic name: pemetrexed) is a chemotherapy drug approved by the FDA for the treatment of patients with malignant pleural mesothelioma. Patients also typically receive cisplatin (a platinum agent), another widely used chemotherapy drug, in combination with Alimta.
Alternative medicine: Practices used instead of or in addition to standard treatments. The medical community generally does not recognize them as standard or conventional medical approaches. Alternative medicine may include dietary supplements, mega dose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation.
Anesthesia: (an-es-THEE-zha): Drugs or substances that cause loss of feeling or awareness. Local anesthetics cause loss of feeling in a part of the body. General anesthetics put the person to sleep.
Anesthetic: A drug that causes numbness or loss of feeling. A general anesthetic causes the patient to fall asleep, whereas a local anesthetic affects only a part of the body.
Asbestos: A naturally occurring substance, mined from rock and made up of tiny fibers, used extensively in thousands of building and insulation products. It is considered the primary cause of mesothelioma.
Asbestosis: A non-cancerous lung disease caused by inhaling asbestos fibers. The fibers tear the tissue of the wall, and the lung tissue scars, becoming stiff and preventing the lung from working as it is supposed to. Asbestosis is progressive (it gets worse over time).
Aspiration: The process of removing fluid or tissue, or both, from a specific area, typically by using a needle or tube.
Benign: Benign tumors (non-cancerous) that do not spread to tissues around them or to other parts of the body.
Biopsy: The process of surgically removing tissue from the body. Tissue from a biopsy is examined in a laboratory under a microscope in order to make a diagnosis.
Brachytherapy: Radiation therapy whereby radioactive materials are placed directly inside the chest or the abdomen at the site of the mesothelioma or another form of cancer.
Bronchoscope: A bronchoscope is a flexible, lighted tube that is inserted through the mouth into the lungs to examine air passages. The procedure itself is called a bronchoscopy.
Bronchoscopy (bron-KOS-ko-pee): A procedure in which a thin, lighted tube is inserted through the nose or mouth. This allows examination of the inside of the trachea and bronchi (air passages that lead to the lung), as well as the lung. Bronchoscopy may be used to detect cancer or to perform some treatment procedures.
Cancer: Referring to a disease where the cells divide in an uncontrolled manner.
Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body.
Chemotherapy (kee-mo-THER-a-pee): The use of drugs or chemical agents in the treatment or control of disease.
Clinical Trial: A research study that attempts to improve current treatments or finds information on new treatments for particular diseases.
Combination chemotherapy: Treatment using more than one anticancer drug.
Complementary medicine: Practices that are meant to enhance or complement standard medical treatment for a particular disease.
CT scan (CAT scan): A test that uses computers and x-rays to create images of the various parts of the body.
Decortication: Removal of part or the entire external surface of an organ.
Diaphragm: A muscular wall separating the abdomen from the cavity containing the lungs and heart.
Effusion: A collection of fluid in a body cavity, usually between two adjoining tissues. For example, a pleural effusion is the collection of fluid between two layers of the pleura (the sac lining around the lung).
External radiation: Radiation that is directed onto the skin over a cancerous region within the body.
Extrapleural pneumonectomy: The surgical removal of the pleura, diaphragm, pericardium and the whole lung on the side of the cancerous tumor. It is intended to remove all or most of the cancer and some surrounding tissues as well.
Fluoroscopy: A diagnostic procedure in which x-rays that have passed through the body are projected onto a screen, providing a continuous image of the body’s internal structures.
Gene therapy: Insertion of normal or genetically altered genes into cells, usually to replace defective genes.
General anesthetic: A drug that causes loss of feeling or pain. When a general anesthetic is used during a medical procedure, the patient is typically asleep.
Immunoaugmentive therapy (IAT): A developing treatment for mesothelioma that seeks to strengthen the body’s natural immune system by balancing four blood proteins.
Internal radiation therapy: Placing the radiation treatment source into or near the cancer. This procedure is also called brachytherapy or internal radiation.
Intraoperative photodynamic therapy: A developing treatment for mesothelioma. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. The drug helps the surgeon better identify and remove cancerous growths. A special light is shone on the area during the surgery, which increases the chance of the surgeon seeing, and therefore removing, more of the cancer.
Intrapericardial chemotherapy: Chemotherapy drugs injected directly into the pericardium, the lining of the heart.
Intraperitoneal chemotherapy: Treatment in which anticancer drugs are put directly into the abdominal cavity through a thin tube.
Intrapleural chemotherapy: Treatment in which anticancer drugs are put within the pleural cavity through a thin tube.
Laparoscope (laparoscopy): A laparoscope is a lighted tube that is inserted into the abdomen to examine the abdominal wall. The procedure is called a laparoscopy. (See also peritoneoscope/peritoneoscopy)
Laparoscopy: A procedure involving the insertion of a thin, lighted tube (called a laparoscope) through the abdominal wall to inspect the inside of the abdomen.
Local anesthetic: A drug or anesthetic that causes a temporary loss of pain or feeling in a part of the body. When a local anesthetic is used during a medical procedure, the patient usually remains awake.
Localized mesothelioma: Mesothelioma that has not spread to other organs of the body.
Lung: One of a pair of organs in the chest that supplies the body with oxygen and removes carbon dioxide from the body.
Lymph nodes: Small oval bodies contained throughout the body that contain lymph. Lymph nodes act as a first line of defense against infections and cancer.
Malignant: Cancerous and capable of spreading to other parts of the body.
Malignant mesothelioma: A type of cancer in tissue surrounding the lining of the lungs, abdomen or heart. Asbestos exposure is considered the primary cause of malignant mesothelioma.
Mediastinoscopy (MEE-dee-a-stin-AHS-ko-pee): A mediastinoscopy is a procedure in which a lighted tube is inserted into the chest to view the organs in the area between the lungs and nearby lymph nodes. The tube is inserted through an incision above the breastbone. This procedure is often performed to obtain a tissue sample from the lymph nodes on the right side of the chest.
Mediastinum: The mediastinum is the partition between the lungs, formed by the adjoining walls of the pleura, and between the lungs and the lymph nodes.
Mesothelial cells (mesothelium tissue): The general name for the specialized cells that comprise the membrane that lines the lungs, abdomen, heart, and other organs in the body. The layer of cells is called mesothelium tissue.
Mesothelioma: A benign (noncancerous) or malignant (cancerous) tumor affecting the lining of the lungs (pleura), abdomen (peritoneum) or heart (pericardium). Asbestos is the primary cause of mesothelioma.
Metastasis (meh-TAS-ta-sis): Metastasis is the spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-ta-seez).
Metastatic (MET-uh-STAT-ik): Having to do with metastisis, which is the spread of cancer from one part of the body to another.
Metastatic tumor: A malignant tumor that has spread from the place in which it started to other parts of the body.
MRI (magnetic resonance imaging): A sophisticated test that provides in-depth images of organs and structures in the body.
Oncologist (on-KOL-o-jist): An oncologist is a doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.
Oncology: The study of cancer. An oncologist is a physician who specializes in cancer treatment.
Palliative radiation: Radiation treatment aimed at relieving pain and symptoms of disease but not intended to cure the disease.
Paracentesis: The process of removing fluid from the abdomen.
Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope.
Pathology: The study of the essential nature of diseases and especially of the structural and functional changes produced by them. To diagnose a particular form of cancer, a pathologist examines a piece of the cancerous tissue under a microscope to determine the size and type of cancer cell.
Pericardial mesothelioma: Cancer of the sac lining that surrounds the heart.
Pericardiocentesis: The process of removing fluid from the sac around the heart.
Pericardium: The lining that surrounds the heart.
Peritoneal mesothelioma: Cancer of the lining that surrounds the abdominal cavity.
Peritoneoscope: A peritoneoscope is a lighted tube that is inserted into the abdomen to examine the abdominal wall. The procedure is called a peritoneoscopy. (See also laparoscope/laparoscopy)
Peritoneoscopy: Procedure to examine and treat abdominal and pelvic organs, using a small surgical viewing instrument (laparoscope) inserted into the abdomen.
Peritoneum: The lining that surrounds the abdominal cavity.
PET (Positonic Emission Topography): A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.
Pleura: The lining that surrounds the lungs and prevents the lungs from rubbing against the ribs.
Pleural cavity: The space between the lungs and the chest wall. The cavity is lined by the pleura.
Pleural effusion: The collection of fluid in the space between the pleura (the lining of the lungs) and the general space inside the chest, also known as the chest cavity.
Pleural mesothelioma: Pleural mesothelioma is a cancer of the lining that surrounds the lung.
Pleurectomy (decortation): A surgical procedure to remove the pleura, where the cancerous mesothelioma tumor has lodged, along the inner chest wall. It is used to control effusions and ease pain.
Pleurodesis: A procedure used to treat fluid buildup (effusion) within the pleural space or cavity. A medical procedure using chemicals or drugs to cause inflammation and adhesion between the layers of the pleura (the tissue that covers the lungs and lines the interior wall of the chest cavity). This prevents the buildup of fluid in the pleural cavity. It is used as a treatment for severe pleural effusion.
Pneumonectomy: The surgical removal of a lung.
Prognosis: The projected outcome of a disease; the life expectancy.
Protocol: A treatment plan.
Radiation therapy: Intensive x-ray treatment that damages or kills cancer cells.
Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer.
Recurrence: The reappearance of a disease after a period of remission.
Regression: The shrinkage of cancer growth.
Remission: The complete or partial disappearance of the signs and symptoms of disease.
Risk factor: Anything that increases a person’s chances of developing cancer, for example, asbestos exposure and mesothelioma.
Single agent chemotherapy: A single chemical or drug used to combat cancer.
Staging: The determination of the size and extent of cancer in the body.
Standard treatment: The tested and most widely used treatments for a particular disease.
Supportive care: Medical care that is meant to improve the patient’s quality of life as opposed to trying to cure the disease. It is also called symptom management or palliative care.
Surgery: An operation. A medical procedure to examine, remove or repair a diseased or potentially diseased portion of the body.
Symptom: An indication or sign of disease. Pain and fever are examples of symptoms.
Systemic disease: A disease that affects the entire body instead of just a specific organ.
Systemic therapy: Treatment that is given through the bloodstream. This method of treatment reaches all the parts of the body.
Thoracentesis: A procedure to remove fluids from the area between the two layers covering the lung (the pleura).
Thoracoscope: A thoracoscope is a lighted tube that is inserted directly into the chest, between the ribs, to examine the lungs and heart. The procedure is called a thoracoscopy.
Thoracoscopy: The use of a thin, lighted tube (called a thoracoscope) to examine the inside of the chest.
Thoracotomy: A surgical procedure that opens up the chest cavity.
Tumor: An abnormal overgrowth of cells. Tumors can be either benign or malignant.
X-ray: High-energy electromagnetic radiation used to diagnose and treat disease.

MESOTHELIOMA TREATMENT OPTIONS

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The treatment program for mesothelioma depends on many factors, including: the stage of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope and the patient’s age and desires.

TIME MATTERS

People diagnosed with this disease are often told the expected survival rate is only eight to twelve months. However, specialists in treating malignant mesothelioma at the leading cancer centers often have better statistics.

For instance, the five-year survival rate has approached 40% for selected patients of Dr. David Sugarbaker at Brigham and Women’s Center in Boston. To qualify for Dr. Sugarbaker’s treatment you must meet certain criteria. One of them is being in the early stages of the disease, so time is of the essence. To find out more about Dr. Sugarbaker and other physicians and cancer centers specializing in mesothelioma click on Finding Specialists.

Keeping track of your medical treatment is useful and a personal medical records file can help.

TRADITIONAL CARE

There are three traditional kinds of treatment for patients with malignant mesothelioma:

Surgery (taking out the cancer)
Chemotherapy (using drugs to fight the cancer)
Radiation Therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)

Often two or more of these are combined in the course of treatment. (NEW! Click here for the newest trial of trimodal lung-sparing treatment for pleural mesothelioma: The Columbia Protocol.)

MESOMARK BLOOD TEST

In January 2007, the Food and Drug Administration (FDA) approved the MESOMARK assay to help monitor response to treatment in epithelial and bi-phasic malignant mesothelioma patients. A specific protein, or biomarker, called Soluble Mesothelin-Related Peptide (SMRP), may be released into the blood by mesothelioma cancer cells. By measuring the amount of SMRP in a blood sample, doctors may be able to better monitor a patient's progress. Based on the limited amount of data currently available, use of this test may be beneficial, but effectiveness has not been determined at this time. The MESOMARK blood test has NOT yet been approved for the early diagnosis of mesothelioma.

This test has been approved as a Humanitarian Use Device (HUD), meaning that physicians must follow certain procedures to qualify their patients for testing. Once the physician is certified, informational brochures will be sent to be distributed to each applicable patient.

Those wishing to take part in

MESOMARK testing will be asked to provide one or more samples of blood. The blood samples will then be sent to a national reference laboratory for testing. In conjunction with other clinical and laboratory data obtained by your doctor, decisions regarding your treatment and care may be simplified. You may discontinue testing at any time.

The costs associated with the MESOMARK blood test may not be covered under health insurance, therefore, you may be required to pay all or part of the costs out of pocket. It is recommended that you check with your insurance carrier to determine whether coverage is available under your policy.

SURGERY

Diagnostic Procedures

As previously mentioned in the "Symptoms" section of this website, a diagnosis of mesothelioma from fluid is many times inconclusive. Given this fact, diagnostic surgery becomes a necessary next step in confirming and staging mesothelioma.

Thoracoscopy enables a physician to evaluate the pleural cavity and to conduct multiple tissue biopsies under direct vision. In up to 98% of cases, a definitive diagnosis can be obtained. Often, chemical pleurodesis aimed at relieving the accumulation of fluid in the intrapleural space, can be accomplished during the same procedure. It is also possible to gauge the extent of the tumor, and make a determination of surgical resectability. While less invasive than an open biopsy, it can only be performed on patients where tumor has not obliterated the pleural space.

VATS, or video-assisted thoracic surgery is an alternative to thoracoscopy, although because of its more invasive nature, concerns of tumor seeding increase. By utilizing small incisions, the physician can view the pleural space with the assistance of a camera, and obtain sufficient tissue samples for analysis by a pathologist. Extent of the tumor (i.e., pleural involvement, chest wall invasion) may also determined, and recommendation as to the type of debulking procedure necessary can be made at this time.

Mediastinoscopy is sometimes used as an aid in staging extent of disease when enlarged nodes are seen using imaging techniques.

Laproscopy is used in mesothelioma patients in cases where imaging techniques suggest possible invasion of the tumor through the diaphragm. This information can be important in evaluating a patient for potential pleurectomy or extrapleural pneumonectomy.

Palliative Procedures

Palliative surgical procedures are those which treat a symptom of mesothelioma, without aggressively treating the disease itself.

Chest Tube Drainage and Pleurodesis is considered the most common of palliative treatments. Fluid build-up, or pleural effusion, is most often the first symptom which will prompt mesothelioma patients to seek medical attention. Once this effusion has occurred, it is many times persistent, returning rapidly after initial thoracentesis (draining of the fluid). In order to eliminate this problem, the pleural space must be closed. This is accomplished by use of a talc slurry or other sclerosing agent which produces an adhesion.

Thoracoscopy and Pleurodesis is done in conjunction with VATS using a powdered form of talc versus talc slurry. Both this and chest tube drainage and pleurodesis will be only effective if there is no tumor encasing the lung which restricts its expansion.

Pleuroperitoneal Shunt plays a limited role in palliation for several reasons. It involves placement of a catheter run under the skin from the pleural to the peritoneal cavity. Obstruction of the catheter and possible seeding of the tumor into the abdominal cavity may be concerns.

Pleurectomy, used as a palliative procedure, may be performed where more extensive surgery is not an option. In these cases, it is understood that all visible or gross tumor will not be removed. It is considered the most effective means of controlling pleural effusion in cases where the lung's expansion is restricted by disease.

Potentially Curative Procedures

These procedures are performed with "curative intent". Their goal is removal of all gross disease, with the knowledge that microscopic disease will most likely remain. Adjuvant therapy (another form of treatment in addition to the primary therapy) is typically aimed at eliminating residual disease.

For Pleural Mesothelioma:

Pleurectomy/Decortication is usually performed on patients with early stage disease (Stage I and selected Stage II), and attempts to remove all gross tumor. If it is found that all tumor can not be removed without removing the lung, this may be done at the same time and is called pneumonectomy.
Extrapleural Pneumonectomy is considerably more radical than other surgical approaches, and should be carried out by surgeons with great expertise in evaluating patients and performing the procedure itself. (See Finding Specialists.) Because in the past surgery alone has failed to effect a cure, or even to help prolong life for any extended period of time, it is currently being combined with traditional chemotherapy and/or radiation, or other new approaches such as gene therapy, immunotherapy or photodynamic therapy.

General Patient Selection Criteria for Extrapleural Pneumonectomy

Extrapleural pneumonectomy is a serious operation, and doctors experienced in this procedure choose their patients carefully. It is up to each individual surgeon to advise the patient on its feasibility and to conduct whatever tests he/she feel are necessary to optimize the patient's chances for survival and recovery. Following is a general list of patient selection criteria. This list may not be all inclusive, and may vary according to the preference of the surgeon.

Karnofsky Performance Status score of >70. This score relates to what symptoms of disease the patient may be experiencing and how well they are able to conduct their daily activities. Some surgeons may require a higher performance status than others.
Adequate renal (kidney) and liver function tests; no significant kidney or liver disease.
Normal cardiac function per electrocardiogram and echocardiography.
Adequate pulmonary function to tolerate the surgery.
Disease limited to the ipsilateral hemithorax (the same side of the chest in which the mesothelioma is located) with no penetration of the diaphragm, extension to the heart or extensive involvement of the chest wall.
Age of the patient is taken into consideration, but may not be as important as their overall status.

Surgeries of this nature should always be done with a complete understanding of the possible benefits and risks involved. If you are considering surgery as a treatment option, speak openly with your doctor about your concerns, and be sure all of your questions are answered to your satisfaction.

For Peritoneal Mesothelioma:

Cytoreductive Surgery is aimed at removing all or nearly all of the gross or visible tumor in the peritoneal cavity. In order to treat any remaining cancer cells, Intra-Peritoneal Hyperthermic (heated) Chemotherapy (IPHC) is then delivered to the abdominal cavity. The type of chemotherapy drug used may vary according to the physician’s preference. Click here for more on treatment of peritoneal mesothelioma.

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CHEMOTHERAPY

Chemotherapy is defined as the treatment of cancer using chemical substances. When cancer occurs, abnormal cells continue to divide uncontrolled. Anticancer, or chemotherapy drugs, work to destroy cancer cells by preventing them from multiplying. Read more on types of chemotherapy medicines.

Purposes of Chemotherapy

Chemotherapy may be used to achieve different goals, depending on the stage of the cancer at the time of diagnosis and the age and health of the patient. Since chemotherapy for mesothelioma is not considered "curative", the goal is:

To control the cancer by stopping its spread or slowing its growth.
To shrink tumors prior to other treatments, such as surgery. This is called neoadjuvant chemotherapy.
To destroy microscopic disease which may remain after surgery. This is called adjuvant chemotherapy.
To relieve symptoms, such as pain. This is called palliative chemotherapy, and is given in cases when a drastic reduction in the tumor is not expected.

The most common use for chemotherapy in mesothelioma patients, is as an option for those who are not surgical candidates, however, various cancer centers are now conducting trials using the neoadjuvant approach. Alimta (pemetrexed) is a drug approved by the Food and Drug Administration (FDA) for use with Cisplatin in the treatment of patients with malignant pleural mesothelioma whose disease is either unresectable or who are not candidates for curative surgery. Alimta is the first drug approval specific to mesothelioma.

The Alimta/Cisplatin chemotherapy regimen is the first Food and Drug Administration (FDA) approved treatment specifically for malignant pleural mesothelioma. This is currently considered the most effective first-line treatment for mesothelioma patients who are not surgical candidates. A multi-targeted antifolate drug, Alimta works by blocking the enzymes necessary for DNA copying and cell division. During the clinical trial process, Alimta/Cisplatin improved median survival for pleural mesothelioma patients by approximately three months over treatment with Cisplatin as a single agent. Eli Lilly's information on treatment with Alimta.

As with any medical treatment, it is important to discuss the use of Alimta with your doctor. This conversation should include all pertinent information regarding effectiveness, administration and possible side effects of the drug combination. It is also important to begin vitamin supplementation of B12 by injection during the week prior to treatment (to be repeated every 9 weeks), and folic acid by mouth daily (to be continued until 21 days after the last cycle of Alimta). Additionally, you will be given an oral steroid medication to minimize the risk of skin rash or other possible side effects. Your doctor will have information on the correct dosages of each medication. Be sure to tell your doctor of any other medications you are taking (including non-prescription drugs) so he may be aware of any adverse interactions.

Alimta/Cisplatin is administered to patients on an outpatient basis every 21 days. This cycle of treatment involves a 10-minute IV infusion of Alimta followed by a 2 hour infusion of Cisplatin. How many cycles of treatment you receive will be dependent on your response rate to the drug (regression of the tumor or halt to progression of the disease) and the side effects you might experience.

Side effects of Alimta/Cisplatin are mild to moderate for most mesothelioma patients, i.e., nausea, vomiting and fatigue, and can usually be managed by your doctor. For some patients, however, side effects may be debilitating, and may require a decrease in dosage or removal from the program. All potential side effects should be mentioned to your doctor. Never assume any complaint is minor.

Administration of Chemotherapy

The most common way to administer chemotherapy is intravenously, or through a vein. A thin needle is inserted into a vein in the hand or in the lower arm. Intravenous administration of drugs allows for rapid entry into the blood stream. Drugs may also be delivered via catheters and/or ports.

Catheters are soft, thin, flexible tubes placed into a large vein in the body. They remain in place for as long as they are needed.
The catheter may sometimes be attached to a port, a small round plastic or metal disc placed under the skin on the chest. Ports also remain in place for as long as necessary.

Intraperitoneal chemotherapy may also be delivered through a catheter or a port. The catheter is inserted through the abdominal wall. Chemotherapy drugs can then be infused directly into the abdominal cavity. Ports may also be placed under the skin of the abdominal wall and the catheter tunneled between the skin and muscle into the peritoneum.

Side Effects of Chemotherapy

Cancer cells grow and divide more rapidly than normal cells, but some normal cells also multiply quickly, particularly those in the digestive tract, reproduction system, and hair follicles. It is the damage done to normal cells that causes side effects. The type of side effects you might experience and how severe they are, depend on the type of chemotherapy you are receiving, the dosage given and how your own body reacts. Before beginning any chemotherapy treatment, you will be asked to sign a consent form. Before signing the form, be sure your doctor informs you of all the facts regarding the treatment he/she will be administering, including information about the particular drug or combination of drugs to be used, the possible risks or side effects (including nausea and vomiting and peripheral neuropathy), the number of treatments you will receive and how often, and whether it will be given during a hospital stay or on an outpatient basis. More on vomiting and nausea from chemotherapy. More on peripheral neuropathy. More on anti-nausea treatment for chemotherapy patients.

Click here if you are interested in learning more about chemotherapy for mesothelioma and the types of questions you should ask your doctor.

Chemotherapy Schedules

How often you will receive chemotherapy will be determined by your doctor, taking into consideration factors such as the stage of your cancer, the types of drugs you receive, the anticipated toxicities of the drugs and the time necessary for your body to recover from these toxicities. The doctor may also consider whether the goal of the chemotherapy is to control the growth of the cancer, or to ease symptoms associated with the disease.

In general, chemotherapy treatment is administered in "cycles" — a "cycle" being defined as a period of treatment followed by a period of rest. This cycle allows the cancer cells to be attacked by the drugs, and then allows the body's normal cells time to recover. The combination of drugs used, the length of time to administer the drugs, how often they should be repeated and the number of cycles recommended have been analyzed throughly in clinical trials. For mesothelioma patients, the "standard" treatment is a combination of Alimta and cisplatin, administered IV, with a 10 minute infusion of Alimta followed by two hours of cisplatin, given in 21 day cycles. Modifications to this schedule may be made according to what your doctor feels is appropriate in your particular case.

The number of treatment cycles, or the length of time between the beginning and end of chemotherapy may vary, however in general, 3 to 4 cycles of treatment are given before response is evaluated; 2 to 3 cycles are considered a minimum to assess for effectiveness. After response to the treatment has been determined, the following criteria will be used to decide whether chemotherapy should continue:

If there is shrinkage of the tumor, or the disease is kept stable, chemotherapy may be continued for as long as it can be tolerated and there is no disease progression.
If there is continued disease progression, chemotherapy will be stopped, and the patient will be given alternative options.

The goal of setting a chemotherapy schedule is to make treatment as effective, timely and trouble-free as possible, but while the drugs are working to kill cancer cells, they may also affect healthy cells causing side effects. One of the most common side effects, and one your doctor will monitor carefully, is a chemotherapy-induced low white blood cell count (neutropenia) which means your immune system is weakened, therefore leaving you more prone to infection. While this side effect is anticipated when someone is undergoing chemotherapy, it can cause delays in your treatment schedule, or changes in the dosage of the drugs you will receive. Click here for more on understanding your blood counts.

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Note to Patients:

Chemotherapy treatment should be a cooperative effort between you and your doctor. The interaction that takes place is important to your health. It will not only help you feel better, but will also address any potential problems with miscommunication.

It is necessary for your doctor to be aware of any side effects which may result from your chemotherapy treatment.
These may include:
- Fever of, or greater than 101 degrees
- Nausea or vomiting
- Diarrhea or constipation
- Fatigue
- Tingling or numbness in the fingers or toes
- Ringing in the ears
- Bruises or rashes
- Sores in the mouth or throat
Taking other medication of any kind can alter the effects of chemotherapy or cause undesirable interactions.
Be sure you report all over-the-counter and prescribed medicines to your doctor. Don’t take aspirin unless it has been approved by your doctor. Ask your pharmacist if aspirin is contained in any drugs you plan to purchase.
Take extra care with your daily health.
Try to maintain a stable weight by eating a healthy diet and drinking plenty of fluids. If your stomach is upset, ask your doctor for helpful hints or work with a nutritionist who can tailor a program to your needs. Brush your teeth after every meal, or if you can’t brush, rinse your mouth thoroughly with water.
Stay away from people who have colds or the flu. Chemotherapy can compromise your immune system and lower your resistance to germs. Make sure you keep appointments for blood work – these tests help your doctor monitor your health.

Be open about your feelings regarding your treatment.
It is normal to feel sad, angry or afraid, however, letting these emotions get out of control can be detrimental to your overall well-being. Seek out the help of family, friends, your doctor, a counselor or a support group.

RADIATION THERAPY

Radiation therapy, also called radiotherapy, treats cancer by using penetrating beams of high energy or streams of particles called radiation. In treating mesothelioma, radiation may be used aggressively in combination with surgery, or palliatively to control symptoms.

In an aggressive combined modality approach, radiation is used to attack microscopic or residual disease remaining in the chest cavity after extrapleural pnuemonectomy. An example of this is Intensity Modulated Radiation Therapy (IMRT), which uses x-rays of varying intensities in conjunction with computer generated images to deliver targeted radiation directly to cancer cells while reducing the amount of radiation to surrounding healthy tissue. More on Intensity Modulated Radiation Therapy (IMRT).

Used palliatively, radiation can help control metastases (spread) of the tumor along tracks left by invasive procedures such as thoracoscopy, needle biopsy and chest tube drainage, or to control disease symptoms, such as pain or shortness of breath.

An exciting new development in radiation oncology is tomotherapy. A brief description of steps in the helical tomotherapy process.

NEW MESOTHELIOMA TREATMENT APPROACHES

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New approaches to treat malignant mesothelioma are currently being tested. They often combine traditional treatments or include something entirely new. They include:

Angiogenesis and Anti-angiogenesis Drugs
Although progress has been made in the early detection of cancer, and in improved treatment options once cancer is diagnosed, there are still many cancers, including mesothelioma, which can not be cured and remain difficult to treat effectively. In recent years, researchers have learned a great deal about how cancer cells differ from normal cells and, in an effort to find drugs without the potentially severe side effects of chemotherapy, have now discovered drugs which target the tumor itself while sparing the body’s normal cells. One such group are the anti-angiogenesis drugs.

Learn more about anti-angiogenesis agents in the treatment of mesothelioma.
Immunotherapy, sometimes called biological therapy, uses the body's own immune system to protect itself against disease. Researchers have found that the immune system may be able to recognize the difference between healthy cells and cancer cells, and eliminate those that become cancerous. Immunotherapy is designed to repair, stimulate, or enhance the immune system's natural anticancer function.
Substances used in immunotherapy, called biological response modifiers (BRMs) alter the interaction between the body's immune defenses and cancer, thereby improving the body's ability to fight disease. Some BRMs, such as cytokines and antibodies, occur naturally in the body, however, it is now possible to make BRMs in the laboratory that can imitate or influence natural immune response agents. These BRMs may:
- Enhance the immune system to fight cancer cell growth.
- Eliminate, regulate, or suppress body responses that permit cancer growth.
- Make cancer cells more susceptible to destruction by the immune system.
- Alter cancer cell's growth patterns to behave like normal cells.
- Block or reverse the process that changes a normal cell into a cancer cell.
- Prevent a cancer cell from spreading to other sites.
Many BRMs are currently being used in cancer treatment, including interferons, interleukins, tumor necrosis factor, colony-stimulating factors, monoclonal antibodies, and cancer vaccines.

PALLIATIVE CARE

2009-05-25T14:25:00.001-07:00

Palliative care is a specialized form of care that alleviates pain and other symptoms. The goal of palliative medicine is not to prolong life or hasten death, but rather, to keep the patient as comfortable as possible, while offering support to the patient and their family. Palliative care contributes to the quality of life for patients with life-threatening illnesses, such as mesothelioma, at any phase of the disease.

For the patients who are undergoing life-prolonging therapies, palliative care includes symptom management and therapy aimed at restoring function. For the dying patient, it addresses the traditional roles of the hospice movement. During the course of a serious illness, patients and their families should realize that the goals of care can, and do, change, sometimes rapidly. An open line of communication is essential to optimize patient care.

Symptoms Managed through Palliative Care

Some of the common symptoms managed through palliative care include:

Pain
Shortness of breath
Fatigue
Dry Mouth
Loss of appetite
Gastrointestinal problems
Skin problems
Anxiety/Depression

Pain

Pain management is one of the most important aspects of palliative care. Because it is now considered a medical specialty, you may wish to consult a physician well versed in pain management if your physician seems unable or unwilling to provide adequate pain control.

Many people with cancer experience pain. Statistics show that 30 to 40 per cent of patients in active cancer therapy, and 70 to 90 percent of patients with advanced cancer report pain. In most cases, pain can be controlled through medications prescribed according to the World Health Organization's Analgesic Ladder, an approach using various levels of medication based on the severity of pain. This type of pain treatment, using drugs, is called pharmacological therapy. Medications may include innon-opioid pain relievers, opioid pain relievers, adjuvant medications (those whose primary purpose is not for pain, but for other conditions), and topical treatments such as a patch, gel, or cream. A study published the Annals of Oncology found a reluctance among cancer patients to take opioid medications due to a belief that such medications are offerred only at the end of life.

Non-pharmacological therapies, those that do not rely primarily on medication to achieve effect, include therapeutic exercise and cognitive behavioral techniques such as deep breathing, muscle relaxation, imagery, meditation, biofeedback therapy, and distraction. Complementary and/or alternative approaches include acupuncture and massage therapy. Integretive medicine refers to the combination of mainstream conventional treatment such as surgery, chemotherapy and radiation with complementary therapies proven to have sound scientific evidence as to their safety and effectiveness.

Shortness of Breath

Shortness of breath, or dyspnea, affects 20 to 80 percent of palliative care patients. Causes of this condition may include, lung disease, fluid in the lungs, infection, anemia, or emotional factors such as anxiety. While medications or oxygen may be used to treat shortness of breath, sometimes measures such as changing position, using relaxation techniques, or improving air circulation may help. More on anemia from chemotherapy treatment.

Fatigue

Cancer-related fatigue may be the result of the general progression of the disease, the effects of medication, or the after effects of treatments such as surgery, chemotherapy, or radiation therapy. The following symptoms are usually associated with fatigue:

Diminished energy level disproportionate to activity
Diminished activity associated with physical or intellectual performance
Diminished motivation; lack of interest in activities
Exhaustion, apathy, or lethargy
Generalized tiredness
Sleep abnormalities
Irritability, impatience, or changes in mood

The treatment of fatigue is based on first identifying, and then managing, the underlying cause of the fatigue. Once that is accomplished, interventions such as medication, exercise, stress management, and nutrition are used. More on fatigue in mesothelioma patients.

Dry Mouth

Dry mouth, or xerostoma, is another symptom addressed in palliative care. Causes may be dehydration, depression or anxiety, or may be a side effect of medications such as pain relievers, antidepressants, diuretics, or tranquilizers. Chemotherapy treatments or radiotherapy may also be a cause.

Relief of dry mouth can often be achieved by:

Drinking plenty of fluids
Sucking on ice chips or Vitamin C tablets
Chewing sugarless gum
Maintaining good oral hygiene
Providing humidified air

Loss of Appetite

Patients with life-threatening illnesses often lose their appetite, and subsequently, lose weight. If the condition becomes too severe, it is called cachexia. Doctors uniformly agree that nutrition plays a vital role in the patient's well being. Causes of weight loss include inadequate intake of nutrients because the patient can not or does not want to eat, poor absorption of the food that is eaten, and changes in the patient's metabolism.

Weight loss may be managed by:

Eating smaller, more frequent meals
Eating high calorie, high protein foods
Receiving nutritional counseling

There are also medications which may help depending on the patient's desired goal. Some of these medications stimulate appetite, but do not usually increase weight, some stimulate appetite and cause slight weight gain, and still others help prevent nausea and vomiting.

Gastrointestinal Problems

Gastrointestinal problems may be associated with the disease process itself, or as a side effect of treatments or medications the patient is receiving. These may include nausea, vomiting, constipation, and diarrhea.

As mentioned above, there are medications which can help with nausea and vomiting. Your doctor or a nutritionist may also be able to provide eating hints and/or special diets tailored to fit the patient's individual needs. More on diarreah in mesothelioma patients.

Skin Problems

There are a variety of skin problems which may accompany cancer, including dryness, itching, rash, sores, and ulcers. It is important to treat these conditions as quickly as possible in order to reduce discomfort and the risk of infection.

Dryness may be lessened by adding baby or mineral oil to warm bath water, and by applying moisturizers. It is also important to drink 8-10 glasses of water per day.
Itching and rash may be lessened by adding baking soda to cool bath water, or by applying a cool, moist cloth to itchy areas. Avoid harsh laundry detergents, and change sheets and towels daily.
Keep skin clean and dry and check skin daily for pressure sores or ulcers which may become infected.

Anxiety/Depression

Anxiety is a hallmark of a life-threatening illness. Feelings of fear, worry, or apprehension may lead to long-term generalized anxiety, or short, intense panic attacks. Causes may include difficulty in coming to terms with the illness, fear of isolation and separation, poorly controlled pain, or side effects of medication.

Treatments to control anxiety may include stress management techniques, counseling, support of family and friends, and control of pain or side effects from medication.

Depression, while less common, often affects family members as well as the patient themselves. Depression may be related to loss of the ability to function, changing family roles, limited social and financial support, pain, or other symptoms such as shortness of breath.

Control of the above symptoms is accomplished through antidepressant medication, support and counseling, pain management, and stress management.

FINDING A MESOTHELIOMA SPECIALIST

2009-05-25T14:24:00.002-07:00

The following physicians are specialists in the treatment of malignant mesothelioma. You will find links to their web sites, when available and to some of their published articles.They are listed in no particular order with no particular endorsement.

Mesothelioma is typically treated by an interdisciplinary team of doctors rather than by a single physician. You may run into professionals called oncologists, thoracic surgeons, and pulmonologists. Glossary of members of a thoracic oncology care team. More on choosing your mesothelioma doctor.

W. Roy Smythe, MD

Professor and Chairman/Department of Surgery, Texas A&M University System Health Sciences Center, Scott & White Hospital, Temple, TX
Phone: 254-724-2595

Dr. Smythe is currently accruing patients for a protocol involving extrapleural pneumonectomy and Intensity Modulated Radiation Therapy (IMRT). (Click here for an abstract of this trial).

Biography

David C. Rice, MD

Assistant Surgeon and Assistant Professor of Surgery; Director, Mesothelioma Program; Director, Minimally Invasive Surgery Program, Thoracic Surgery/The University of Texas M. D. Anderson Cancer Center, Houston, TX
Phone: (713) 794-1477

Dr. Rice is currently concluding enrollment on a Phase II trial of extrapleural pneumonectomy (EPP) followed by Intensity Modulated Radiation Therapy (IMRT). He is also anticipating the opening of a new trial of preoperative Alimta/Cisplatin, followed by EPP and IMRT.

Biography

David J. Sugarbaker, MD

Chief, Division of Thoracic Surgery/Brigham and Women's Hospital, Boston, MA Chief, Department of Surgical Services/Dana-Farber Cancer Institute, Boston, MA
Phone: (617) 732-6824

Dr. Sugarbaker believes in aggressive treatment of pleural mesothelioma. He is a proponent of tri-modal therapy; extrapleural pneumonectomy, chemotherapy and radiation.

Click here for an article by Dr. David J. Sugarbaker that appeared in the The Journal of Thoracic and Cardiovascular Surgery, January 1999 (12 pages in Adobe PDF format).

Biography

Lambros Zellos, MD, MPH

Attending Thoracic Surgeon; Clinical Co-Director of the International Mesothelioma Program/Brigham & Women's Hospital/Dana Farber Cancer Institute Harvard Medical School, Boston, MA
Phone: (617) 525-9657

Dr. Zellos is an Attending Thoracic Surgeon and the Clinical Co-Director of the International Mesothelioma Program. Dr. Zellos is a proponent of tailored multimodality therapy for each individual patient. Appropriate therapy may include surgery such as pleurectomy or extrapleural pneumonectomy with chemotherapy or radiation. Dr. Zellos has published several papers on multimodality therapy as well as methods to improve surgical techniques.

Valerie W. Rusch, FACS

Attending Thoracic Surgeon/Memorial-Sloan Kettering Cancer Center, New York, NY
Phone: (212) 639-5873

Dr. Rusch is known for the treatment of pleural mesothelioma. She has published several papers comparing pleural decortication to extrapleural pneumonectomy.

Biography

Raja M. Flores, MD

Attending Thoracic Surgeon/Memorial-Sloan Kettering Cancer Center, New York, NY
Phone: (212) 639-2806

Dr. Flores is currently the Principal Investigator on a clinical trial of neoadjuvant gemcitabine and cisplatin followed by extrapleural pneumonectomy and high dose radiation, as well as being involved in a trial of neoadjuvant Alimta/cisplatin, extrapleural pneumonectomy and high dose radiation. He has also compiled a 1,000 patient database to research areas of failure, and how to improve treatments for mesothelioma.

Biography

Paul H. Sugarbaker, MD, FACS, FRCS

Director, Surgical Oncology/Washington Cancer Institute, Washington, DC
Phone: (202) 877-3908

Dr. Sugarbaker is a specialist in the treatment of peritoneal mesothelioma using a combination of surgery, chemotherapy and radiation.

Brian W. Loggie, MD

Professor of Surgery, Creighton University Medical School; Chief, Division of Surgical Oncology; Director of Cancer Center/Creighton University Medical Center, Omaha, NE
Phone: (402) 280-4100

Dr. Loggie specializes in the treatment of peritoneal mesothelioma and peritoneal carcinomatosis. His protocol, based on eligibility, involves surgical debulking in combination with intraperitoneal heated chemotherapy.

Biography

David L. Bartlett, MD

Professor of Surgery, Chief, Division of Surgical Oncology/UPMC Cancer Pavilion, Pittsburgh, PA
Phone: (412) 692-2852

Dr. Bartlett has particular expertise in the management of advanced, complex abdominal malignancies. He also has a research interest in treating advanced carcinomas in the peritoneal cavity, including peritoneal mesothelioma.

Claire F. Verschraegen, MD

Director, Clinical Trial Office and Investigational Drug Program/Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM
Phone: (505) 272-4551

Dr. Verschraegen is currently conducting a front-line Alimta/gemcitabine trial for peritoneal mesothelioma patients. She also offers the following Phase I trials for patients who have already been treated with Alimta:

Phase I Study of Capecitabine with Cisplatin and Irinotecan in Patients with Advanced Malignancies
Phase I Study of Intravenous TZT-1027 and Gemcitabine, Administered on Day 1 and Day 8 of a Three Week Course in Patients with Advanced Solid Tumors
Phase I Study of Flavoperidol in Combination with Gemcitabine and Irinotecan in Patients with Metastatic Cancer

Biography

David P. Mason, MD

Staff Surgeon, Department of Thoracic and Cardiovascular Surgery/Cleveland Clinic Foundation, Cleveland, OH
Phone: (216) 444-4053

Dr. Mason is a proponent of aggressive multimodality therapy for malignant mesothelioma. This includes extrapleural pneumonectomy, chemotherapy and radiation with Intensity Modulated Radiation Therapy (IMRT). Cleveland Clinic Foundation has a multidisciplinary Thoracic Oncology team with extensive experience and clinical trials in the management of malignant mesothelioma.

Biography

David M. Jablons, MD

Assistant Professor of Surgery Chief, General Thoracic Surgery/UCSF Mt. Zion Medical Center, San Francisco, CA
Phone: (415) 885-3882

Dr. Jablons treats pleural mesothelioma with a radical pleurectomy/decortication and is researching other therapies.

Biography

Lary A. Robinson, MD

Director, Division of Cardiovascular and Thoracic Surgery Principal Thoracic Surgical Oncologist/H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
Phone: (813) 972-8412

Dr. Robinson is a member of the multidisciplinary thoracic oncology group at H. Lee Moffitt Cancer Center which evaluates and treats all stages of mesothelioma. He is also involved in clinical research programs for lung cancer and mesothelioma.

Biography

Craig W. Stevens, MD, PhD

Division Chief, Radiation Oncology/H. Lee Moffitt Cancer Center & Research Institute/Tampa, FL
Phone: (813) 972-8424

Biography

Robert N. Taub, MD

Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons/New York Presbyterian Hospital, New York, NY
Phone: (212) 305-4076

Dr. Robert Taub is a medical oncologist who directs the Connective Tissue Oncology Program at the Herbert Irving Comprehensive Cancer Center, where there are a number of ongoing multimodality studies of patients with pleural and peritoneal mesothelioma. The Center is based at the Columbia University College of Physicians and Surgeons. Click here for a press release announcing a new multimodality study.

Biography

Daniel Sterman, MD

Assistant Professor, Department of Medicine/University of Pennsylvania Medical Center, Philadelphia, PA
Phone: (215) 614-0984

Dr. Sterman is the co-author of several informative articles on treatment and clinical trials for pleural mesothelioma.

Biography

Eric Vallieres, MD

Associate Professor of Surgery, Section of General Thoracic Surgery/University of Washington Medical Center, Seattle, WA
Phone: (206) 598-4477

Dr. Vallieres uses a multidisciplinary approach to thoracic malignancies and related clinical trials. Please see Medical Journal & News Articles for an article Dr. Vallieres co-authored on Induction Chemotherapy, Extra Pleural Pneumonectomy And Adjuvant Fast Neutron Radiationtherapy For Pleural Mesothelioma (Dmm).

Biography

Stephen C. Yang, MD

Chief, Division of Thoracic Surgery/Associate Professor of Surgery and Oncology/Surgical Director, Lung Transplantation Program/Director, Thoracic Oncology Program/Johns Hopkins Medical Institutions, Baltimore, MD
Phone: (410) 614-3891

Biography

Mark J. Krasna, MD

Medical Director of the Cancer Institute at St. Joseph Medical Center/Towson, MD
Phone: (410) 427-2220

Dr. Krasna is the former Head of the Division of Thoracic Surgery, Professor of Surgery and Associate Director for Surgical Oncology in the Greenebaum Cancer Center at the University of Maryland Medical Center.

Dr. Krasna is a leader in the development of thoracic surgery. He is the author of the first textbook on thoracoscopic surgery and has instructed surgeons worldwide on his techniques.

Biography

David H. Harpole, Jr., MD

Associate Professor of Surgery, Thoracic Oncology Program/Assistant
Professor of Pathology, Duke University Medical Center, Durham, NC
Phone: (919) 668-8413

Biography

Harvey Pass, MD

Professor and Chief, Division of Thoracic Surgery and Thoracic Oncology, Department of Cardiothoracic Surgery/NYU School of Medicine and Comprehensive Cancer Center/New York, NY
Phone: (212) 263-7417

Gregory P. Kalemkerian, MD

Co-Director of Thoracic Oncology/University of Michigan Comprehensive Cancer Center/Ann Arbor, MI
Phone: (734) 936-5281

Dr. Kalemkerian directs the multidisciplinary thoracic oncology clinic at the University of Michigan Cancer Center, in addition to collaborating with the thoracic oncology team at Karmanos Cancer Institute, to develop novel clinical trials for mesothelioma patients.

Joseph S. Friedberg, MD

Chief of Thoracic Surgery/University of Pennsylvania at Presbyterian, Philadelphia, PA
Phone: (215) 662-9195

Dr. Friedberg is currently the Principal Investigator on a trial of photodynamic therapy for pleural malignancies, and also on a trial combining Alimta/cisplatin, surgery and XRT.

Robert Cameron, MD

UCLA Medical Center, Los Angeles, CA
Phone: (310) 794-7333

Your Health Care Team

2009-05-25T14:24:00.001-07:00

A diagnosis of mesothelioma brings with it one of the most difficult challenges you or your loved one will ever face. One of the most important things to remember, however, is that there are resources to help with every aspect of care, and that you or your loved one is at the center of the health care team that will provide help in many different forms. Remember also that in addition to your doctor you can also get a second opinion from another physician.

You, the Patient

Your role as the most important member of the team is to be a good consumer by gathering information and asking questions. Following are some easy ways to make the most of your appointment times with other members of your medical team:

Once you know the day and time of your appointment, start a list of questions you want to ask that particular team member. These questions could be about mesothelioma itself, about test results or about treatments you are undergoing or considering. It is also a good idea to write down any symptoms you may be experiencing so that they can be addressed at this time. If there is something you don’t completely understand, ask to have it explained in simpler terms. Above all, don’t be embarrassed to ask questions or request clarifications.
If possible, take along another person who can take notes, ask additional questions or record your appointment for later review. Sometimes it can be helpful to return home and play back what was discussed.
Ask for written material or brochures that can help in making treatment or care decisions . These might include information on nutrition, pain management, support groups or hospice or home care.

Other than your doctors, who could include your primary care doctor, surgeons, medical oncologists, and/or radiation oncologists, you will probably have the most contact with your nursing staff and your social worker. These medical professionals can be your best source of practical assistance when trying to navigate the waters of a mesothelioma diagnosis.

Nurses

All specialized cancer treatment facilities have nurses who are familiar with implementing the cancer treatment plan initialized by your doctor, and are trained to administer medication, monitor side effects and conduct routine tests. Whether you are a hospital inpatient or outpatient, you can benefit greatly from developing a strong working relationship with your nursing staff.

You may also request home visits by a registered nurse, if necessary. If approved by your doctor, these visits may be covered under insurance. Be sure to check with your individual insurance provider for details.

Social Workers

Social workers are a good starting point for newly diagnosed patients who are overwhelmed by their diagnosis and the many things that have to be accomplished and decided.

Some types of social workers include:

Oncology social workers specialize in assisting those diagnosed with cancer. Most cancer treatment facilities have certified oncology social workers on staff.
Clinical social workers specialize in providing services aimed at family therapy and counseling, or counseling for those coping with a serious illness.
Hospital social workers can help find resources in your local area such as home care, transportation services or support groups, and can also help you understand your diagnosis, your treatments and other care options.

Psychiatrists and Psychologists

Because of the emotional issues surrounding a mesothelioma diagnosis, some patients or their family members may benefit from the help of someone trained to deal with depression, anxiety or inability to cope. Don’t be afraid to ask for this type of help for yourself or your loved one – good emotional health is essential to quality of life.

Psychiatrists are medical doctors who specialize in providing psychotherapy and other general psychological services to their patients. They are licensed to prescribe medications such as antidepressants and sleep aids. (Related: concerns about drug addition during cancer treatment.)
Psychologists can provide many of the same services as a psychiatrist such as counseling for depression, anxiety, etc., however, they are not medical doctors. Most have PhD’s in psychology and counseling.

Nutritionists and Dietitians

Nutrition is another area that can greatly affect quality of life. Many patients lose weight because of anxiety associated with the diagnostic process, subsequent treatments or the natural progression of mesothelioma. Working with a nutritionist or dietitian as soon after diagnosis as possible is one of the most important benefits you can obtain from your health care team. These professionals can help you be sure you receive enough calories, vitamins and protein to maintain a healthy weight, as well as tailoring a program for those with concurrent health problems such as diabetes or high cholesterol. They can also suggest ways to minimize the side effects of chemotherapy or other aggressive treatment.

Most local hospitals have registered dietitians on staff, or you can ask your doctor to recommend someone in your area. As with other health care needs, check to see whether these services are covered under your insurance. If they are not, there may be community-based services available in your area at no cost.

Hospice and Home Care

Hospice care is palliative in nature, and provides comfort care by helping to control a patient’s physical symptoms as well as offering emotional and spiritual support. Although in most cases, care is provided at home, there are also hospice facilities that provide full-time care in a hospital setting. You can discuss the benefits of hospice with your doctor, nurse or social worker.
Home care provides assistance in the home with daily activities such as bathing, meal preparation or household chores. These services are usually provided by a home health aide, and may or may not be under the supervision of a nurse. Ask your doctor, nurse or social worker for Home Health Care Agencies in your area.

COMPREHENSIVE CANCER CENTERS

2009-05-25T14:23:00.001-07:00

The National Cancer Institute (NCI) has designated 40 cancer centers throughout the United States as "Comprehensive" centers. These elite centers have been recognized for their focus on scientific excellence and have dedicated themselves to the prevention, treatment and cure of cancer, including malignant mesothelioma. Following is a list of Cancer Centers by state.

For veterans wishing to be treated at a Veterans Health Administration (VA) cancer care facility, click here for a listing by state.

Alabama

UAB Comprehensive Cancer Center
1802 6th Avenue, S.
Birmingham, AL 35294
Request an appointment: (800) UAB-0933 or (205) 975-8222

Arizona

Arizona Cancer Center
1515 N. Campbell Avenue
Tucson, AZ 85724
Request an appointment: (520) 626-2900

California

City of Hope National Medical Center
1500 E. Duarte Road
Duarte, CA 91010
Request an appointment: (866) 434-HOPE (4673)

University of California, San Diego (UCSD) Moores Cancer Center
3855 Health Sciences Drive
La Jolla, CA 92093
Request an appointment: (866) 773-2703 or (858) 822-6200

UCLA Jonsson Comprehensive Cancer Center
10833 Le Conte Avenue
Los Angeles, CA 90095
Request an appointment: (800) 825-2631

USC/Norris Comprehensive Cancer Center
1441 Eastlake Avenue
Los Angeles, CA 90033
Request an appointment: (800) USC-CARE

University of California, Irvine (UCI) Chao Family Comprehensive Cancer Center
101 The City Drive, S.
Orange, CA 92868
Request an appointment: (877) UCI-DOCS (824-3627)

University of California, San Francisco (UCSF) Comprehensive Cancer Center
1600 Divisadero Street
San Francisco, CA 94115
Request an appointment: (888) 689-8273 or (415) 885-7777

Stanford University Comprehensive Cancer Center
875 Blake Wilbur Drive
Stanford, CA 94305
Request an appointment: (650) 498-6000

Colorado

University of Colorado Cancer Center
1665 N. Ursula Street
Aurora, CO 80045
Request an appointment: (800) 473-2288 or (720) 848-0300

Connecticut

Yale Cancer Center
15 York Street
New Haven, CT 06510
Request an appointment: (203) 785-4191

District of Columbia

Lombardi Comprehensive Cancer Center at Georgetown University
3800 Reservoir Road, NW
Washington, DC 20007
Request an appointment: (202) 444-2223

Florida

H. Lee Moffitt Cancer Center & Research Institute
12902 Magnolia Drive
Tampa, FL 33612
Request an appointment: (888) 860-2778 or (813) 979-3980

Illinois

Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Galter Pavilion
675 N. St. Clair, 21st Floor
Chicago, IL 60611
Request an appointment: (866) LURIE-CC (587-4322)

Iowa

University of Iowa Holden Comprehensive Cancer Center
200 Hawkins Drive
Iowa City, IA 52242
Request an appointment: (319) 356-4200 8:00 am - 5:00 pm (M-F)
(800) 777-8442 or
(319) 384-8442 (After hours)

Maryland

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
401 N. Broadway
Baltimore, MD 21231
Request an appointment: (410) 955-5222

Massachusetts

Dana-Farber Cancer Institute
44 Binney Street
Boston, MA 02115
Request an appointment: (877) 332-4294

Michigan

University of Michigan Comprehensive Cancer Center
1500 E. Medical Center Drive
Ann Arbor, MI 48109
Request an appointment: (800) 865-1125

Barbara Ann Karmanos Cancer Institute
4100 John R
Detroit, MI 48201
Request an appointment: (800) KARMANOS (527-6266)

Minnesota

University of Minnesota Cancer Center
425 E. River Road
Minneapolis, MN 55455
Request an appointment: (888) CANCER MN (226-2376)
(Toll Free in IA, MN, ND, SD, WI)
(612) 624-2620 (Outside Area)

Mayo Clinic Cancer Center
200 First Street, SW
Rochester, MN 55905
Request an appointment: (507) 538-3270

Missouri

Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
660 S. Euclid Avenue
St. Louis, MO 63110
Request an appointment: (877) 251-6485 or (314) 747-3046

New Hampshire

Norris Cotton Cancer Center
One Medical Center Drive
Lebanon, NH 03756
Request an appointment: (603) 653-9000

New Jersey

Cancer Hospital of New Jersey at Robert Wood Johnson University Hospital
195 Little Albany Street
New Brunswick, NJ 08903
Request an appointment: (732) 828-3000

New York

Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263
Request an appointment: (800) ROSWELL (767-9355)

Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, NY 10021
Request an appointment: (800) 525-2225

Herbert Irving Comprehensive Cancer Center
161 Fort Washington Avenue
New York, NY 10032
Request an appointment: (877) NYP-WELL (697-9355)

North Carolina

University of North Carolina (UNC) Lineberger Comprehensive Cancer Center
450 West Drive
Chapel Hill, NC 27599
Request an appointment: (866) 828-0270

Duke Comprehensive Cancer Center
2424 Erwin Road
Durham, NC 27705
Request an appointment: (888) ASK-DUKE (275-3853)

Wake Forest University Comprehensive Cancer Center
Medical Center Boulevard
Winston-Salem, NC 27157
Request an appointment: (800) 446-2255 or (336) 716-2255

Ohio

Case Comprehensive Cancer Center, Ireland Cancer Center
11100 Euclid Avenue
Cleveland, OH 44106
Request an appointment: (800) 641-2422

Comprehensive Cancer Center - Arthur G. James Cancer Hospital & Richard J. Solove Research Institute
300 W. 10th Avenue
Columbus, OH 43210
Request an appointment: (800) 293-5066 or (614) 293-5066

Pennsylvania

Abramson Cancer Center of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
Request an appointment: (800) 789-PENN (7366)

Fox Chase Cancer Center
333 Cottman Avenue
Philadelphia, PA 19111
Request an appointment: (215) 728-2570

University of Pittsburgh Cancer Institute
5150 Centre Avenue
Pittsburgh, PA 15232
Request an appointment: (412) 647-2811

Tennessee

Vanderbilt-Ingram Cancer Center
691 Preston Building
Nashville, TN 37232
Request an appointment: (800) 811-8480

Texas

University of Texas M. D. Anderson Cancer Center
1515 Holcombe Boulevard
Houston, TX 77030
Request an appointment: (800) 392-1611 or (713) 792-6161

Vermont

Vermont Cancer Center at the University of Vermont
89 Beaumont Avenue
Burlington, VT 05405
Request an appointment: (802) 656-4414

Washington

Fred Hutchinson Cancer Research Center
1100 Fairview Avenue, N.
Seattle, WA 98109
Request an appointment: (800) 804-8824 or (206) 288-1024

Wisconsin

University of Wisconsin Comprehensive Cancer Center
600 Highland Avenue
Madison, WI 53792
Request an appointment: (800) 622-8922

NATIONAL CANCER INSTITUTE CANCER CENTERS

UC Davis Cancer Center
4501 X Street
Sacramento, CA 95817
Request an appointment: (800) 362-5566 or (916) 734-5900

University of Chicago Hospitals
5841 S. Maryland Avenue
Chicago, IL 60637
Request an appointment: (888) UCH-0200

NYU Cancer Institute
550 First Avenue
New York, NY 10016
Request an appointment: (888) 7-NYU-MED (769-8633)

The Cleveland Clinic, Taussig Cancer Center
9500 Euclid Avenue
Cleveland, OH 44195
Request an appointment: (866) 320-4573 or (216) 444-5501

National Institutes of Health (NIH) Clinical Center, Bethesda, MD
National Insitutes of Health
10 Center Dr.
Bethesda, MD 20892
Request an appointment: 301-496-2626

Thoughts on choosing a cancer treatment.

MESOTHELIOMA CLINICAL TRIALS

2009-05-25T14:22:00.002-07:00

NEW! The Mesothelioma Center at the New York-Presbyterian Hospital and Columbia University is recruiting patients for a new clinical trial on treatment of mesothelioma with targeted radiation an chemotherapy. This multimodality treatment is an innovative approach led by oncologist Dr. Robert Taub. Click here to learn more.

CLINICAL TRIAL BASICS

Clinical trials are studies of the safety and/or effectiveness of new drugs being tested on humans. For mesothelioma, trials are being conducted to find a better and more effective means of treatment. Anyone interested in participating in a clinical trial should discuss the particular trial thoroughly with their doctor before a making a decision on whether it is right for them.

All clinical trials carry potential benefits and risks, and it is important that you have a complete understanding of what you might expect. For instance, since clinical trials are often conducted at larger cancer centers, in many cases, travel may be necessary to receive treatment and routine tests. On the other hand, care is provided at top-notch facilities by physicians who are leaders in the field of cancer research. Another benefit would be having access to the new drug before it is widely available, however, the new drug may ultimately be proven not as effective as the “standard” of care.

Eligibility requirements for clinical trials are not the same; each study has specific guidelines to participate. Some trials allow participation after other treatments have failed, while others require that the patient have no prior treatment. Your doctor should be able to advise you which trial might be the best fit in your particular case.

Some treatment trials are “randomized”, meaning the new treatment is compared with a current standard of treatment. Depending on which arm of the protocol you are assigned, you may receive the new treatment or the standard. You should be informed in advance of this eventuality by the doctor conducting the trial. Placebos (pills that contain no active ingredient) are rarely used in cancer trials.

For more information on the terminology associated with clinical trials, visit our clinical trial glossary.

TRIAL PHASES

Though mesothelioma has no cure, there are clinical trials currently underway to test new drugs and procedures in the fight against the disease. All clinical trials or studies are divided into different phases:

Phase I trials usually enroll only a small number of people and test how new drugs or procedures should be administered. Click here for an in-depth description of Phase I trials.

Phase II trials give early information about whether or not a new drug or procedure works and also provide information about safety and benefit. Click here for an in-depth description of Phase II trials.

Phase III trials compare promising new drugs or procedures with the current standard treatment. Large numbers of people from across the nation usually participate in Phase III trials and receive either the new treatment or the standard treatment. Click here for an in-depth description of Phase III trials.

An explanation of the Clincial Trials process

Common questions and answers about Clincial Trials

ELIGIBILITY

In order to be sure the study results are accurate, trial participants in all phases must fit a certain profile. Eligibility for mesothelioma trials are often specific as to age, how long it has been since therapy, stage of disease, and other characteristics. To find out about the eligibility requirements and other information for the trials listed below, click on the clinical trial web site listed after each trial or call one of our MW Coordinators toll-free at 1-877-367-6376.

CLINICAL TRIALS AND MEDICARE

If you choose to enter a clinical trial and are on Medicare, it is important that you have a complete understanding of the trial itself, and what costs will or will not be covered under your Medicare policy.

Clinical trials for cancer are currently covered if:

The trial is funded by the National Cancer Institute (NCI), the NCI-Designated Cancer Centers, the NCI-Sponsored Clinical Trials Cooperative Groups or other Federal agencies that fund cancer research.
The goal of the trial is to diagnose or treat cancer (cancer prevention trials are not covered).

CURRENT CLINICAL TRIALS

The National Cancer Institute states that the purpose of most listed clinical trials is to test new cancer treatments or new methods of diagnosing, screening for or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in each clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol.

At present, the following trials are actively testing new drugs or treatments for mesothelioma. They are listed by title with a short description and have no particular order or endorsement.

Phase III Study of Suberoylanilide Hydroxamic Acid (SAHA) Versus Placebo in Advanced Malignant Pleural Mesothelioma
Click here for an abstract of this trial
NEW! Phase II Study of Everolimus in Patients With Unresectable Malignant Pleural Mesothelioma
Click here for an abstract of this trial
NEW! Phase II Study of Eloxatin® Plus Gemcitabine Chemotherapy for Mesothelioma
Click here for an abstract of this trial
Phase II Study Using Chemotherapy Followed by Intensity Modulated Radiation Therapy to the Pleura in Patients With Locally Advanced But Unresectable Malignant Pleural Mesothelioma
Click here for an abstract of this trial
A Randomized Phase II Study of a Lung-Sparing Combined Modality Protocol for the Treatment of Malignant Pleural Mesothelioma: The Columbia Protocol
Click here for an abstract of this trial: For health professionals | For patients
Click here for the complete protocol from Columbia University Medical Center (PDF file)

Click here to read the consent form for this trial (PDF file)

Contact our MW Coordinators toll-free at 1-877-367-6376 to find out if you are eligible.

Related Trial: Trimodal Lung-Sparing Treatment of Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Study Using Chemotherapy Followed by Intensity Modulated Radiation Therapy to the Pleura in Patients With Locally Advanced But Unresectable Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Study of CBP501 + Pemetrexed + Cisplatin in Patients With Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Study of Dasatinib in Patients With Previously Treated Malignant Mesothelioma
Click here for an abstract of this trial

Phase II Study of Pazopanib Hydrochloride in Patients With Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Randomized Study of Pemetrexed Disodium Combined With Either Gemcitabine or Carboplatin in Patients With Advanced Malignant Mesothelioma of the Pleura
Click here for an abstract of this trial

Phase II Study of AZD2171 in Patients With Unresectable Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Study of Cisplatin, Pemetrexed and Bevacizumab for Untreated Malignant Mesothelioma
Click here for an abstract of this trial

Phase II Study of Induction Combination Chemotherapy Comprising Methotrexate, Vinorelbine Ditartrate, and Cisplatin With or Without Surgery and Adjuvant Chemoradiotherapy in Patients With Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Study of PDX101 as Second-Line Therapy in Patients With Unresectable Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase II Study of Milataxel (TL139) Administered Orally for Malignant Mesothelioma
Click here for an abstract of this trial

Phase I/II Study of Carboplatin, Bevacizumab and Pemetrexed in the First-Line Treatment of Patients With Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase I Study of Extrapleural Pneumonectomy, IHOC Cisplatin and Gemcitabine With Amifostine and Sodium Thiosulfate Cytoprotection for Resectable Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase I Dose-Escalation Study of Azacitidine In Combination With Temozolomide
Click here for an abstract of this trial

Phase I Study of Safety and Tolerability of Intravenous CRS-207 in Adults With Selected Advanced Solid Tumors Who Have Failed or Who Are Not Candidates for Standard Treatment
Click here for an abstract of this trial

Phase I Study of SS1 (dsFv)-PE38 Immunotoxin in Combination With Pemetrexed Disodium and Cisplatin in Patients With Unresectable Maligant Epithelial Mesothelioma
Click here for an abstract of this trial

Phase I Study To Find the Best Dose of SU011248 When Given With Pemetrexed, Pemetrexed and Cisplatin Or Premetrexed and Carboplatin In Patients With Advanced Solid Tumors
Click here for an abstract of this trial

Phase I Pharmacokinetic, Safety, and Efficacy Effects of Oral LBH589 on Dextromethorphan in Patients With Advanced or Metastatic Non-Small Cell Lung Cancer or Malignant Pleural Mesothelioma
Click here for an abstract of this trial

Phase I Study of Erlotinib in Patients With Solid Tumors and Hepatic or Renal Dysfunction
Click here for an abstract of this trial

Phase I Study of BMS-690514 in Patients With Advanced or Metastatic Solid Tumors
Click here for an abstract of this trial

Phase I Study of Anti-Mesothelin Monoclonal Antibody MORAB-009 in Patinets With Recurrent Advanced Mesothelin-Expressing Tumors
Click here for an abstract of this trial

Phase I Study Using Sunitinib Plus Radiation Therapy for Cancer Patients
Click here for an abstract of this trial

Phase I Study of Oxaliplatin and Paclitaxel Plus Bevacizumab in Advanced Peritoneal Carcinomatosis
Click here for an abstract of this trial

Phase I Study of Cisplatin, Imatinib Mesylate, and Pemetrexed in Malignant Mesothelioma Patients
Click here for an abstract of this trial

Phase I Study of Gene Induction Mediated by Sequential Decitabine/Desipeptide Infusion in Subjects With Pulmonary and Pleural Malignancies
Click here for an abstract of this trial

Phase I Study of Flavopiridol in Patients With Metastatic or Unresectable Refractory Solid Tumors or Hematologic Malignancies
Click here for an abstract of this trial

Phase I Study of FR901228 (Depsipeptide) and Flavopiridol in Patients With Advanced Lung or Esophageal Cancer, Malignant Pleural Mesothelioma, or Lung or Pleural Metastases
Click here for an abstract of this trial

Phase I Study of Suberoylanilide Hydroxamic Acid in Advanced Solid Tumors
Click here for an abstract of this trial

Phase I Study of Gene Therapy for Pleural Malignancies
Click here for an abstract of this trial

Phase I Study of MORAb-009 in Subjects With Pancreatic Cancer, Mesothelioma, or Certain Types of Ovarian or Lung Cancer
Click here for an abstract of this trial

Phase I Pilot Study of Wilms Tumor-1 Analog Peptide Vaccine and Sargramostim (GM-CSF) in Patients With Acute Myeloid Leukemia, Myelodysplastic Syndromes, Non-Small Cell Lung Cancer, or Mesothelioma
Click here for an abstract of this trial

Diagnostic Trials
Study of the Use of Breathing Synchronized CT and PET Scans in Radiation Therapy Treatment Planning
Click here for an abstract of this trial

Multiple Biomarkers in Undiagnosed Pleural Effusion
Click here for an abstract of this trial

Study of the Etanidazole Derivative EF5 for the Detection of Hypoxia and Vascularity in Patients With Intraperitoneal or Pleural Malignancies Treated With Photodynamic Therapy
Click here for an abstract of this trial

Supportive Care Trials
Phase III Study of Fentanyl Sublingual Spray for Breakthrough Cancer Pain in Patients Who are Opiod Tolerant
Click here for an abstract of this trial

Biomarker/Laboratory Analysis Trials
Study of Early Detection of Mesothelioma Biomarkers in Patients With Asbestos and Vermiculite Exposure
Click here for an abstract of this trial

Multiple Biomarkers in Undiagnosed Pleural Effusion
Click here for an abstract of this trial

FURTHER INFORMATION - CLINICAL TRIALS

National Institutes of Health (NIH) Clinical Center, Bethesda, MD

The Informed Consent process for patients in clinical trials.

Investigational drugs are those under evaluation in the clinical trial system, but not yet approved by the Food and Drug Administration to be legally marketed and sold. More on investigational drugs.

The process of developing new mesothelioma drugs.

The Department of Veterans Affairs and the National Cancer Institute have an agreement to increase access of eligible veterans to all phases of NCI-sponsored prevention, diagnostic and treatment clinical trial. Click here for more information.

The Community Clinical Oncology Program (CCOP) is a nationwide network that ensures that cancer patients have access to medical care in their own communities.

Keeping a Personal Medical Records File

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When you or a family member is going through the diagnostic process, or are being treated for mesothelioma, it is an undeniable fact that there will be a multitude of paperwork and reports involved. Although each individual medical professional or facility will keep its own record of your care, it is also important that you maintain an accurate, up to date medical history of your own.

It is likely that several different doctors, possibly at various locations, will be involved in your care, and each will generate a series of test results, treatment reports, scripts for medications, etc. By consolidating and organizing this information in one file, you will always have access to what you need if questions arise, or if a report is lost or inadvertently destroyed. It will also give you an opportunity to go over your records in your own time, and make note of any questions or concerns you might have. In this way, you will become a more active participant in your health care, and will feel more knowledgeable and in control of your situation. Keeping a personal medical file is also helpful in managing your health insurance claims, taxes and other legal matters.

Your personal medical record file should include the following:

Information on past medical history, including the dates and details of any previously diagnosed illnesses such as diabetes or heart disease.
Information on past physical examinations and screening tests.
Immunization records.
Contact information for all doctors, clinics and/or hospitals involved in your diagnosis, treatment or other care.
Dates of initial diagnosis and a schedule for subsequent treatments.
Copies of reports and diagnostic tests, including laboratory results, pathology reports and imaging tests (x-ray, CT, MRI, PET).
Treatment information including surgical reports, names and dosages of drugs used for chemotherapy and sites and dosages for radiation therapy.
Notes on treatment results including any complications or side effects experienced.
Information on supportive care such as pain management or nutritional support. All medications you are taking, including prescription and over the counter drugs, should be listed by name, dosage and how often they are taken.

If you have been diagnosed with mesothelioma, it is best to collect information for your file each time you have an appointment, test or procedure. At each doctor appointment, ask for any records being added to your file, and if you have a laboratory test or a procedure of any kind, request a copy of the test results or the procedure report. If you are hospitalized for any reason, request a complete copy of your hospitalization records when you are released. Keep copies of medical bills and insurance claims.

How you organize your file is a matter of personal preference. Some people prefer a filing cabinet, while others prefer a folder, binder or box; some prefer to scan documents into a computer file. Records can be divided according to date or by category such as appointments, tests or treatments. However you choose to compile your file, be sure it is stored in a safe place. You may wish to leave an additional copy with a relative or friend in case of emergency.

The Health Insurance Portability and Accountability Act of 2003 assures that all patients have access to their medical records, so if you did not start a medical file when you were first diagnosed or treated, you can still obtain the information you need. In this case, it may be necessary to request your records in writing, and you may need to complete an "Authorization to Release Medical Information". Unfortunately, requesting records after the fact can take time, and you may be charged copying fees.

Related: Managing your medications.

Managing Your Medications

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Before you were diagnosed with mesothelioma, you may have been taking a small number of medications, or perhaps, none at all. Now, it is possible you have been prescribed several different drugs, and you may be taking over-the-counter medications as well. With the added stress of disease or treatment-related symptoms, it can be easy to confuse medications or simply to inadvertently miss taking a dose. Following are some easy ways to help organize and manage your medications:

Compile a complete list of all drugs you are taking, including both their brand and generic names (i.e., Tylenol = acetaminophen), the dosage amount, times they are to be taken and any additional instructions (i.e., take with food, take before bedtime, etc.). This list should include both prescription and over-the-counter drugs, as well as any herbal supplements or vitamins you may be taking.
When a new medication is prescribed, find out the name of the drug, how and when it should be taken, whether there can be any interactions with other medications, foods or beverages, what side effects are possible and what to do if you miss a dose. Write down this information and include it on your list.
If possible, purchase all medications from the same pharmacy so that the records of what you purchased will be all in one place. Keep the patient information that is attached to prescriptions in case you need to refer to it later.
If you need help organizing dosage schedules or have questions about medications you are taking, talk to your doctor, physician's assistant, nurse or pharmacist.
Read and keep package inserts that come with your prescription medicine. This is not highly technical material or useless boilerplate wording. It is directly relevant to your experience with the medicine. More on package inserts.
Read the label on the drug container before you taking any medication. If you are confused or can't read the label, have someone else read it to be sure you are taking the right medication.
Do not skip scheduled doses. If you are taking medications for pain, they need to be taken as directed to be effective. If you have breakthrough pain between doses, follow your doctor's recommendations.
If you don't feel confident that you will remember to take your medication on schedule, set an alarm on your clock, watch, cell phone or computer.
Store medications in a safe place away from heat, light and humidity.

There are pill cases with compartments, organized by time of day, that may be helpful, and dose tracker devices such as 'Dose Dial' that will attach to any container, and can monitor the number of doses and/or the interval of doses.

Medications can play a significant role in how well you feel and can enhance, or in some cases, lessen your quality of life. Always follow directions when taking any medication, and if you have questions, concerns or are experiencing undesirable side effects you feel may be related to the drugs, speak frankly with a member of your health care team.

Managing Your Medical Expenses

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The volume of paperwork involved in managing insurance claim forms, co-pays, benefits statements, etc., can be overwhelming for a mesothelioma patient who is trying to concentrate on their health care, but by keeping organized, accurate records, you can eliminate unnecessary stress.

Perhaps the simplest way of keeping information to be referred to when filing an insurance claim, is to use a paper calendar to make note of all doctor's appointments, lab tests, procedures and treatments, as well as prescription drugs purchased. If this information is recorded on the day it occurs, you will have a complete chronological record when you need it. Other records you should organize in an expandable folder or binder include:

Bills from all health care providers.
Bills or receipts for prescription drugs.
Receipts from co-pays or other health care related costs.
Insurance claims filed.
Reimbursements received.

Keeping medical expenses entered on a basic computer spreadsheet is another option, or, there is specialized software available for those who prefer a better display of information and the ability to search for and sort information. One of these programs is the "Medical Expense Manager" offered by Quicken. This program will allow you to track and organize medical expenses, tax deductions, medical and prescription history for multiple individuals, insurance payments and deductibles and billing or claims disputes.

Another alternative is to hire someone to manage your claims for you, and if you feel you need professional help, there are health insurance claims assistance services available in many areas. These professionals can file and track claims, contact health care providers and insurance companies to resolve claim issues, review medical bills for accuracy and appeal rejected claims. Fees for services rendered can vary significantly according to provider.

For those with Medicare coverage, a health insurance assistance program is available in every state. Counselors can help Medicare recipients understand their benefits, and can make suggestions on establishing a record keeping system.

Asbestos Disease

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MESOTHELIOMA

Mesothelioma is a rare form of cancer almost exclusive to asbestos exposure. This is the most serious of the asbestos-related cancers, and may develop from exposures ranging from heavy, daily exposure to minimal exposure. While the latency period of from 20 to 50 years or more is a medical fact, it is often difficult for victims and their families to imagine that this can occur after so long a period of time.

Mesothelioma originates in the sac lining of the chest (pleura) or the abdomen (peritoneum). In the advanced stages of the disease, it is possible to have both pleural and peritoneal mesothelioma. Although mesothelioma is not curable, early detection is a factor in having a cho ice in treatment options. Mesothelioma specialists and world-class cancer centers, as well as new surgical approaches, chemotherapy drugs and ongoing clinical research all play an important part in helping extend life expectancy and in increasing quality of life.

Symptoms

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, symptoms of pleural mesothelioma may include shortness of breath, chest pain and/or persistent cough. A chest x-ray may show a build-up of fluid called pleural effusion. Less common symptoms are fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet. It is important to keep in mind that these symptoms may be caused by mesothelioma or by other less serious diseases. Only your doctor can make a definitive diagnosis, and while mesothelioma may be suspected by using imaging techniques such as x-rays or CT scans, in most cases it can only be confirmed through a tissue biopsy.

Treatment

Traditional approaches such as surgery, chemotherapy and radiation are most commonly used in the treatment of mesothelioma, however, multi-modality treatments which combine all three methods are now widely accepted. Other still experimental approaches include gene therapy, photodynamic therapy and immunotherapy. There are also a number of promising new drugs being evaluated in the clinical trial system.

LUNG CANCER

Asbestos is the most common industrial substance known to cause lung cancer. When asbestos fibers break apart, microscopic particles are released into the air. These fibers are easily inhaled and can lodge in the lungs, damaging cells and increasing the risk of cancer. The risk of asbestos-related lung cancer is substantially higher for those who were, or are now smokers, as opposed to those who have never smoked.

Symptoms

Symptoms of lung cancer include persistent cough, coughing up blood, chest pain, shortness of breath, wheezing, repeated pneumonia or bronchitis, fatigue, loss of appetite or weight loss.

Treatment

Options for the treatment of lung cancer depend on factors such as the size, location and type of the cancer, and the overall health of the patient. As with all cancers, early diagnosis may be the most important element in a successful treatment program.

ASBESTOSIS

Asbestosis is a form of diffuse pulmonary fibrosis caused exclusively by inhaling asbestos fiber. It is a chronic and irreversible lung condition characterized by scarring of the lower lobes of the lungs, leading to a decrease in healthy tissue. As a result, the lungs become stiff and do not allow for normal expansion and contraction.

Symptoms

Symptoms may include shortness of breath, coughing, tightness in the chest, chest pain, a crackling sound in the chest or clubbing of the fingers. Diagnosis of asbestosis is generally made through a chest x-ray, with the films interpreted by a Certified B-reader, or through a high resolution CT scan.

Treatment

Since asbestosis is a progressive disease, monitoring on a regular basis is essential following a diagnosis. If the disease worsens, inhalers or oxygen may be necessary to alleviate discomfort.

Early Detection

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It is strongly encouraged that anyone who has had past asbestos exposure be checked periodically for asbestos disease. Early detection is vital, since even lung cancers have a higher survival rate if caught early. Non-cancerous disease may be diagnosed through a normal front and side view x-ray (also called a PA and lateral), with the x-ray films read preferably by a radiologist called a Certified B-reader. This should be an adequate diagnostic test to determine if any scarring is present which would be consistent with asbestos exposure. Click here for a current listing of these radiologists. If anything suspicious appears on the x-ray films, the patient would be referred to a specialist for further evaluation. Cancerous disease, although it may be suspected through tests such as an x-ray or CT scan, can only be confirmed through a tissue biopsy. Be sure you understand the significance of your diagnosis.

Non-Cancerous

Pleural disease - often noted as a scarring of the lining of the lung, and sometimes expressed as "pleural thickening", "pleural plaque" or "pleural calcification".
Asbestosis - defined as a scarring of the lower lobes of the lungs bilaterally (on both sides); often referred to as "asbestos in the lung".

If you have been diagnosed with a non-cancerous disease, it is important that your doctor monitor your condition with regular x-rays and/or high resolution CT scans, and pulmonary function tests. It is also important to compare new and old radiographic films and review any other pertinent test results to check for progression of disease.

Note: Although these diseases are non-cancerous at the onset, they can be progressive, eventually leading to a need for inhalers or oxygen. They also constitute a significantly greater risk of future cancer in those who have a prior smoking history, or those who continue to smoke.

Cancerous

Lung cancer - diagnosed as non-small cell (which includes adenocarcinoma, squamous cell or large cell) and small cell (which includes oat cell, lymphocytic, intermediate or combined); lung cancer may be contributed to by asbestos exposure, although it is not normally the sole cause.
Mesothelioma - a rare form of cancer of the lining of the lung (pleural mesothelioma) or the lining of the abdominal cavity (peritoneal mesothelioma), or in rare cases, the lining of the heart (pericardial mesothelioma); exclusive to asbestos exposure.

If you have been diagnosed with lung cancer, it is important to make a treatment decision, and then follow your doctor's recommendations. Additional information on various types of lung cancer may be obtained through the National Cancer Institute at 1-800-4-CANCER.

Lung Cancer Deaths associated with Smoking and Asbestos Exposure
(Data from Hammond et al., 1979)

Group	Mortality Ratio
Non-Smoker without Asbestos Exposure	1*
Smoker without Asbestos Exposure	5
Smoker without Asbestos Exposure	11
Smoker with Asbestos Exposure	53

*Note: A mortality ratio of A1" would translate to 1 death from lung cancer per 9,000 individuals

Asbestos Exposure

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The government has designated asbestos as a carcinogen, and there is no safe threshold of exposure. The degree of risk is related to the length of exposure and how high the asbestos fiber concentration was in the air when the person was exposed. Exposure to asbestos is the major known cause of malignant mesothelioma.

Materials Containing Asbestos

Most insulation materials before the mid-1970s contained asbestos. Many other construction materials also contained asbestos. Some of the most common products were:

Insulation on pipes
Boiler insulation
Insulating cements, plasters and joint compounds that came in powder form and created a lot of dust before being completely mixed with water
Fireproofing spray insulation
Firebrick and gunnite used for internal insulation of furnaces, boilers and other vessels
Roof, floor and ceiling tiles
Transite siding
Brakes and clutches

Most Commonly Exposed Personnel

The following Navy personnel could have worked around asbestos:

Boilermen
Enginemen
Firemen
Machinist Mates
Shipfitters
Pipefitters
Electrician's Mates
Seabees (military construction)
Civilian shipyard workers

Shipboard Exposure

Fire and engine rooms aboard ship typically had the highest exposure because of the insulation and refractory products necessary in these high-heat areas, but no area was considered safe. Pipe coverings throughout the ship were covered with asbestos lagging, and literally ran inches over the bunks in the sleeping quarters. In addition, ships crews generally lived and worked aboard ships during routine maintenance operations and sometimes while their ships were overhauled in dry docks over months long periods.

Shipyard Exposure

During World War II, large quantities of asbestos used by shipyards as they built, overhauled and decommissioned warships, exposed thousands of shipyard workers to its insidious effects. Based on statistics, working in an American shipyard during the war years was almost as deadly as fighting in the war itself. The combat death rate was roughly 18 per thousand service members. For every thousand wartime shipyard employees, about 14 died of asbestos-related cancer, and unknown numbers died of asbestosis or related complications. See our section on asbestos exposure and the Seabees.

In 1984, a medical survey of shipyard workers at Norfolk Naval Shipyard in Portsmouth, VA, showed that 79 percent of these workers exhibited signs of lung abnormalities consistent with asbestos exposure, while x-rays given to 90 wives of workers revealed 8 to 9 percent showed similar abnormalities.

U. S. Government (Naval) Shipyards where ships were built and/or overhauled include:

Boston Naval Shipyard, Charlestown, MA
Charleston Naval Shipyard, Charleston, SC
Hunter's Point Naval Shipyard, San Francisco, CA
Long Beach Naval Shipyard, Long Beach, CA
Mare Island Naval Shipyard, Vallejo, CA
New York Naval Shipyard, Brooklyn, NY
Norfolk Naval Shipyard, Portsmouth, VA
Philadelphia Naval Shipyard, Philadelphia, PA
Portsmouth Naval Shipyard, Kittery, ME
Puget Sound Naval Shipyard, Bremerton, WA

Private Sector Shipyards where Navy ships, Liberty ships and Victory ships were also built include:

Alabama Dry Dock & Shipbuilding Company, Mobile, AL
American Bridge Company, Pittsburgh, PA
Associated Shipbuilders, Inc., Seattle, WA
Bath Iron Works Corporation, Bath, ME
Bethlehem Steel Company, Hingham, MA
Bethlehem Steel Company, Quincy, MA
Bethlehem Steel Company, San Francisco, CA
Bethlehem Steel Company, San Pedro, CA
Bethlehem Steel Company, Staten Island, NY
Bethlehem-Fairfield Shipyards, Inc., Baltimore, MD
Brown Shipbuilding Company, Houston, TX
California Shipbuilding Corporation, Los Angeles, CA
Chicago Bridge & Iron Company, Seneca, IL
Consolidated Steel Corporation, Orange, TX
Cramp Shipbuilding Company, Philadelphia, PA
Defoe Shipbuilding Company, Bay City, MI
Delta Shipbuilding Company, New Orleans, LA
Dravo Corporation, Pittsburgh, PA
Dravo Corporation, Wilmington, DE
Electric Boat Company, Groton, CT
Federal Shipbuilding & Dry Dock Company, Kearny, NJ
Federal Shipbuilding & Dry Dock Company, Port Newark, NJ
Gulf Shipbuilding Corporation, Chickasaw, AL
J. A. Jones Construction Company, Brunswick, GA
J. A. Jones Construction Company, Panama City, FL
Jeffersonville Boat & Machine Company, Jeffersonville, IN
Kaiser Company, Richmond, CA
Kaiser Company, Vancouver, WA
Lake Washington Shipyards, Houghton, WA
Manitowoc Shipbuilding Corporation, Manitowoc, WI
Marinship Corporation, Sausalito, CA
Missouri Valley Bridge & Iron Company, Evansville, IN
Moore Dry Dock Company, Oakland, CA
New England Shipbuilding Company, South Portland, ME
New York Shipbuilding Company, Camden, NJ
Newport News Shipbuilding & Dry Dock Company, Newport News, VA
North Carolina Shipbuilding Company, Wilmington, NC
Oregon Shipbuilding Company, Portland, OR
Permanente Metals Corporation, #1 Yard, Richmond, CA
Permanente Metals Corporation, #2 Yard, Richmond, CA
Southeastern Shipbuilding Corporation, Savannah, GA
St. John's River Shipbuilding Company, Jacksonville, FL
Sun Shipbuilding & Dry Dock Company, Chester, PA
Tampa Shipbuilding Company, Inc., Tampa, FL
Todd Houston Shipbuilding Corporation, Houston, TX
Todd Pacific Shipyards, Inc., Seattle, WA
Todd Pacific Shipyards, Inc., Tacoma, WA
Todd Shipyards, Inc., Los Angeles, CA
Western Pipe & Steel Company of California, San Pedro, CA
Willamette Iron & Steel Corporation, Portland, OR
Walsh-Kaiser

Veteran Service Officers

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Veteran Assistance for Mesothelioma and Other Asbestos-Related Disease

Each state has a network of Veteran Service Officers dedicated to assisting veterans and/or their dependents with filing claims relating to a diagnosis of mesothelioma or other asbestos-related illnesses. These officers are often located in the county in which the veteran resides, and are responsible for walking them through the process necessary to file for service-related disabilities. Up to 90% of the claims received by the Veterans Administration each year are submitted through a County Veteran Service Office.

If you or a loved one has been diagnosed with mesothelioma, lung cancer related to asbestos exposure, asbestosis or pleural disease, a Veteran Service Officer may be able to assist you.

Following are listings of Veteran Service Offices/Officers by state, where this information is available. While accuracy has been insured to the best of our ability, the names of responsible parties, contact numbers or days or times of operation may change. In many offices, there may also be a number of Assistant Veteran Service Officers to assist you.

Alabama	Kentucky	North Dakota
Alaska	Louisiana	Ohio
Arkansas	Maine	Oklahoma
Arizona	Maryland	Oregon
California	Massachusetts	Pennsylvania
Colorado	Michigan	Rhode Island
Connecticut	Minnesota	South Carolina
Delaware	Mississippi	South Dakota
Florida	Missouri	Tennessee
Georgia	Montana	Texas
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MESOTHELIOMA COMMON QUESTIONS

2009-05-21T00:45:00.000-07:00

What is Mesothelioma?
The National Cancer Institute states that: "Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura), the lining of the abdominal cavity (the peritoneum) or the lining around the heart (the pericardium)."

What is peritoneal mesothelioma?
Peritoneal mesothelioma is a cancer of the lining of the abdominal cavity. This form of cancer makes up approximately one-fifth to one-third of the total number of mesothelioma cases diagnosed. More on peritoneal mesothelioma.

How do you get malignant mesothelioma?
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Others have been exposed to asbestos in a household environment, often without knowing it. More about the different ways in which people have been exposed to asbestos.

How much exposure does it take to get the disease?
An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later. Mesothelioma cause.

How long does it take after exposure for the disease to show up?
People exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.

What is the prognosis for malignant mesothelioma?
Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated. Click on Treatment Options to find out more about traditional and new approaches.

Is there any promising research or are there promising drugs for mesothelioma?
Research is being conducted at various cancer centers all over the United States as well as by pharmaceutical companies. To find more about these studies, click on Clinical Trials. To read abstracts of the latest journal articles on mesothelioma research and to access these articles, click on Medical Journal Articles; or Mesothelioma News for news articles. A recent study of Alimta showed patients living much longer with Alitma than other chemotherapy drugs.

Where can I find information on living with mesothelioma?
Mesothelioma Aid is a good website for resource for families dealing with mesothelioma. It includes advice and referrals to other resources for coping with cancer, caregiving, financial challenges, and support groups. Alternatively, contact us here at Mesothelioma Web for help finding resouces for living with this disease.

What kinds of other resources are available for people with malignant mesothelioma?
There are numerous cancer web sites, some specific to mesothelioma. Because they are often difficult to locate, we have listed some relevant medical sites under Leading Cancer Links. We are always on the lookout for more so check our site often.

MESOTHELIOMA'S CAUSE - ASBESTOS EXPOSURE

2009-05-21T00:44:00.002-07:00

At some point in our lives, nearly all of us have been exposed to asbestos in the air we breathe and the water we drink; from natural deposits in the earth, and from the deterioration of asbestos products around us. Most of us, however, do not become ill as a result of our exposure. More commonly, those who at some point are diagnosed with asbestos disease, have worked in jobs where more substantial exposure occurred over longer periods of time. Nevertheless, cases of mesothelioma have been documented as the result of lesser exposure, affecting family members of workers who came into contact with asbestos and brought it home on their clothing, skin or hair, or affecting those who lived in close proximity to asbestos manufacturing facilities. Symptoms of asbestos disease usually are not be apparent until decades after exposure.

Asbestos was used commercially in North America as early as the late 1800s, but its use increased dramatically during the World War II era when shipyards produced massive numbers of ships for the war effort. Since that time, asbestos-containing products were used by the construction and building trades, the automotive industry and the manufacturing industry. All told, more than 5,000 products contained asbestos.

For more than 50 years, products containing asbestos remained unregulated, and the manufacturers of those products continued to prosper, knowing full well that many of the millions of workers who came into contact with their products would ultimately suffer as the result of their actions. Finally, in the late 1970s, the Consumer Products Safety Commission banned the use of asbestos in wallboard patching compounds and artificial ash for gas fireplaces because the fiber could easily be released during use. In 1989, the Environmental Protection Agency banned all new use of asbestos, but uses established prior to that time were still allowed. Although awareness of the dangers of asbestos and public concern over the issue have led to a decline in domestic consumption over the years, a total ban on asbestos has not come to fruition. Asbestos is still imported, still used and still dangerous.

Although it is suggested that the number of mesothelioma cases in the U.S. has reached its peak and has begun to drop, a forecast released by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER), in April, 2003, projected the total number of American male mesothelioma cases from 2003-2054 to be approximately 71,000. This number, however, does not take into consideration events such as the World Trade Center disaster on September 11, 2001, when millions of New Yorkers were potentially exposed to air filled with carcinogenic asbestos particles. The incidence of mesothelioma cases by state and county are shown in these tables. When the latency period for asbestos disease is factored in, cases of mesothelioma will continue to be diagnosed for years to come. See our page on mesothelioma risk factors.

MESOTHELIOMA DIAGNOSIS

2009-05-21T00:43:00.001-07:00

How is mesothelioma diagnosed?

A diagnosis of mesothelioma is most often obtained with careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. (Learn about typical mesothelioma symptoms.) A review of the patient's medical history, including history of asbestos exposure is taken, followed by a complete physical examination, x-rays of the chest or abdomen, and lung function tests. A CT scan or MRI may also be done at this time. If any of these preliminary tests prove suspicious for mesothelioma; a biopsy is necessary to confirm this diagnosis.

Imaging Techniques and Their Value in Diagnosing and Assessing Mesothelioma

There are several imaging techniques which may prove useful when mesothelioma is suspected due to the presence of pleural effusion combined with a history of occupational or secondary asbestos exposure. While these imaging techniques can be valuable in assessing the possibility of the cancer, definitive diagnosis is still most often established through fluid diagnosis or tissue biopsy.

Some of the most commonly used imaging methods include:

• X-ray

A chest x-ray can reveal pleural effusion (fluid build-up) which is confined to either the right (60%) or left (40%) lung. On occasion, a mass may be seen. Signs of prior non-cancerous asbestos disease, such as pleural plaques or pleural calcification, or scarring due to asbestosis may also be noted.

• Computed Tomography (CT)

CT scans are also able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures, or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease (pleural disease), or differentiate between adenocarcinoma of the lung wh

ich may have spread to the pleura verses mesothelioma. CT scans may also be valuable in guiding fine needle aspiration of pleural masses for tissue diagnosis.

• Magnetic Resonance Imaging (MRI)

MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes (those lymph nodes which lie between the two lungs), as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy.

• Positron Emission Tomography (PET)

PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. While PET scans are more expensive than other types of imaging, and are not always covered under insurance, they are now considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma. Further explanation of PET scans.

• CT/PET

For patients who may be candidates for aggressive multimodality treatment (surgery, chemotherapy and radiation), accurate clinical staging is extremely important. Integrated CT/PET imaging provides a relatively new tool in this respect, and has become the imaging technique of choice for determining surgical eligibility. By combining the benefits of CT and PET (anatomic and metabolic information) into a single scan, this technology can more accurately determine the stage of the cancer, and can help identify the best treatment option for the patient. Read about a study of CT-PET imaging in preoperative evaluation of patients with malignant pleural mesothelioma.

A needle biopsy of the mass, or the removal and examination of the fluid surrounding the lung, may be used for diagnosis, however, because these samples are sometimes inadequate as far as determining cell type (epithelial, sarcomatous, or mixed) or because of the unreliability of fluid diagnosis, open pleural biopsy may be recommended. In a pleural biopsy procedure, a surgeon will make a small incision through the chest wall and insert a thin, lighted tube called a thoracoscope into the chest between two ribs. He will then remove a sample of tissue to be reviewed under a microscope by a pathologist. In a peritoneal biopsy, the doctor makes a small incision in the abdomen and inserts a peritoneoscope into the abdominal cavity.

Once mesothelioma is suspected through imaging tests, it is confirmed by pathological examination. Tissue is removed, put under the microscope, and a pathologist makes a definitive diagnosis, and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid build-up or pleural effusions, shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an x-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:

Video-Assisted Thoracoscopic Surgery (VATS)

Over the past decade, the use of video-assisted thoracic surgery (VATS) has become one of the most widely used tools in the diagnosis of mesothelioma. Biopsies of the pleural lining, nodules, masses and pleural fluid can now easily be obtained using this minimally invasive procedure, and other therapies such as pleurodesis (talc) for pleural effusions can be done concurrently.While the patient is under general anesthesia, several small incisions or “ports” are made through the chest wall. The surgeon then inserts a small camera, via a scope, into one incision, and other surgical instruments used to retrieve tissue samples into the other incisions. By looking at a video screen showing the camera images, the surgeon is able to complete whatever procedures are necessary

In many cases, this video-assisted technique is able to replace thoracotomy, which requires a much larger incision to gain access to the chest cavity, and because it is minimally invasive, the patient most often has less post-operative pain and a potentially shorter recovery period.

Thoracoscopy

For pleural mesothelioma the doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test is usually done in a hospital with a local anesthetic or painkiller.

If fluid has collected in your chest, your doctor may drain the fluid out of your body by putting a needle into your chest and use gentle suction to remove the fluid. This is called thoracentesis.

Peritoneoscopy

For peritoneal mesothelioma the doctor may also look inside the abdomen with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is usually done in the hospital under a local anesthetic.

If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.

Biopsy

If abnormal tissue is found, the doctor will need to cut out a small piece and have it looked at under a microscope. This is usually done during the thoracoscopy or peritoneoscopy, but can be done during surgery. More on needle biopsies.

Pathology and The Role of Pathologists in the Diagnostic Process

Pathology, or the scientific study of cells, tissue, or fluid taken from the body is an integral part of a mesothelioma diagnosis. Most hospitals have their own pathology labs staffed by board-certified pathologists and licensed technologists. The importance of pathological diagnosis can not be underestimated, since the course of treatment is dependent upon an accurate diagnosis.

To make a diagnosis, pathologists examine tissue under a microscope, and based on established criteria, make a determination of benign vs. malignant cells. (More on biopsy tissue processing.) Subsequently, the type of cancer is determined. Although most pathologists have a general expertise of various diseases, a small number acquire training in a subspecialty, such as mesothelioma. These are physicians who have received world-wide recognition as premier experts, and have achieved high acclaim for their research, published articles and abstracts, and teaching. For a list of expert pathologists in the field of mesothelioma diagnosis, please call the MW toll free at 1-877-367-6376 or fill in the form at the bottom of this page specifying your request.

Knowing the stage is a factor in helping the doctor form a treatment plan. Mesothelioma is considered localized if the cancer is confined to the pleura, or advanced if it has spread beyond the pleura to other parts of the body such as the lungs, chest wall, abdominal cavity, or lymph nodes.

Immunohistochemical Markers for Mesothelioma

A diagnosis of any specific type of cancer often means ruling out other cancers in the process. This is true in the case of mesothelioma, where the most common “differential diagnosis” is that of adenocarcinoma versus mesothelioma.

During the biopsy procedure, the surgeon removes tissue samples to be sent to the laboratory. In the lab, slides are produced and then viewed and analyzed by a pathologist. These tissue specimens arrive at the lab with a request form that details patient information and history along with a description of the site in the body from which the specimen was obtained. Each individual specimen is numbered for each patient.

The pathologist then does a “gross examination” which consists of describing the tissue, and then placing it in a plastic cassette. The cassettes are then placed in a fixative that preserves the tissue permanently. Once the tissue has been fixed, it is processed into a paraffin block that will allow the pathologist to slice off thin microscopic sections that will then be stained to determine the patient’s diagnosis.

Immunohistochemistry is defined as “a method of analyzing and identifying cell types based on the binding of antibodies to specific components of the cell”. It is this process that helps diagnose mesothelioma versus adenocarcinoma (or other types of cancer).

Early on, the “markers” which helped distinguish mesothelioma from adenocarcinoma were “negative markers”; those expressed in adenocarcinomas, but not in mesotheliomas. This made it more difficult to confirm a diagnosis, because pathologists were dealing with the absence of, rather than the presence of certain markers. Some of these markers, which are normally “positive” in an adenocarcinoma diagnosis and “negative” in a mesothelioma diagnosis, are carcinoembryonic antigen (CEA), CD 15 (LeuM1), epithelial glycoprotein (Bg8), tumor glycoprotein (BerEp4) and tumor glycoprotein (MOC-31).

In more recent years, “positive markers” expressed by mesotheliomas have come to the forefront. Some of the markers which are normally “positive” in mesotheliomas and “negative” in adenocarcincomas are calretinin, cytokeratin 5, HBME-1, mesothelin, N-cadherin, thrombomodulin, vimentin and Wilm’s tumor gene product (WT-1).

It is important to remember that while the above markers are commonly used to help diagnose the epithelial sub-type of mesothelioma, that they may also be expressed in other types of cancer, and may not necessarily apply to the bi-phasic or sarcomatoid sub-types of mesothelioma. Your doctor can always contact a more specialized lab if he/she feels your diagnosis is in any way inconclusive.

MESOTHELIOMA DIAGNOSIS QUESTIONS

2009-05-21T00:42:00.000-07:00

Doctor-Patient Communication

An open line of communication between a patient and his or her physician is vital when dealing with a serious disease such as mesothelioma. There will be many questions regarding treatment, whether palliative or aggressive, choices to deal with, and life issues to confront. Being informed and proactive in your care will give you a sense of empowerment.

Although most physicians have limited time to spend with each patient at appointments, it is important to address issues as they occur and resolve them to the satisfaction of all parties involved. Initially, this may mean going to your appointment with a list of symptoms or concerns, or questions regarding specific tests that are recommended. Once mesothelioma has been diagnosed, you may have questions regarding treatment options.

Most questions from patients stem from an initial diagnosis of mesothelioma and subsequent treatment options. Following are some frequently asked questions regarding these two important issues.

What Is My Diagnosis?

There are three types of mesothelioma. Pleural mesothelioma is a cancer of the lining of the lung (pleura), peritoneal mesothelioma is a cancer of the lining of the abdominal cavity (peritoneum), and pericardial mesothelioma is a cancer of the lining surrounding the heart (pericardium). Sub-types (or cell types) of mesothelioma are epithelioid (the most common, and considered the most amenable to treatment), sarcomatous (a much more aggressive form), and biphasic or mixed (a combination of both of the other cell types).

The structural appearance of cells under the microscope determine the cell or sub-type of mesothelioma. Epithelioid is the least aggressive; sarcomatoid, the most aggressive. The biphasic or mixed cell type shows structural elements of both of the other two. More on the histologic subtypes of mesothelioma.

Epithelioid mesothelioma tissue

Sarcomatoid mesothelioma tissue

Biphasic mesothelioma tissue

MESOTHELIOMA STAGES

Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use for pleural mesothelioma and each one measures somewhat different variables; peritoneal mesothelioma is not staged.

Staging is the term used to describe the extent of a patient's cancer, based on the primary tumor and its spread in the body. It can help the medical team plan treatment, estimate prognosis and identify clinical trials for which the patient may be eligible.

Staging is based on a knowledge of how the cancer develops, from the primary tumor, to the invasion of nearby organs and tissues, to distant spread or metastasis. Staging systems have evolved over time, and they continue to change as scientists learn more about cancer. Some staging systems cover many different types of cancer, while others focus on more specific cancers. The TNM (primary tumor, regional lymph nodes, distant metastasis) is the most common staging system for mesothelioma.

Some elements common to most staging systems are:

Location of the primary tumor.
Size and number of the tumors.
Lymph node involvement.
Cell type and tumor grade.
Metastasis.

Many cancer registries, such as the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER) use summary staging, a system used for all types of cancer. Summary staging groups cancer into five main categories:

In situ - cancer that is present only in the layer of cells in which it began.
Localized - cancer that is limited to the organ in which it began with no evidence of spread.
Regional - cancer that has spread from the primary site to nearby lymph nodes or organs.
Distant - cancer that has spread from the primary site to distant lymph nodes or organs.
Unknown - cases where not enough information exists to indicate stage.

Several types of testing may be used to help doctors determine stage, and to formulate a treatment plan.

Physical examinations. The doctor examines the body by looking, feeling and listening to anything out of the ordinary.
Imaging techniques. Procedures such as x-rays, CT scans, MRIs and PET scans may show the location, size of the tumor and whether the cancer has spread.
Laboratory tests. Studies of blood, urine, fluid and tissue can provide information about the cancer. Tumor markers, sometime elevated when cancer is present, may provide information.
Pathology reports. Results of the examination of tissue samples can include information about the size of the tumor(s), extension into adjacent structures, type of cells and grade of the tumor. Results of the examination of cells in fluid, such as that from a mesothelioma-related pleural effusion, may also provide information.
Surgical reports. Observations about the size and appearance of the tumor(s), lymph nodes and nearby organs.

Staging information should be provided to the patient by his doctor so that potential treatment plans can be discussed. Stage of the mesothelioma, as well as consideration of other factors such as age, health status and the patient's wishes may dictate different treatment options.

The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages. The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.

Butchart System – extent of primary tumor mass

Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.

TNM System -- variables of T (tumor), N (lymph nodes), M (metastasis)

Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
Stage III: Mesothelioma is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or directly extends into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

Brigham System: (variables of tumor resectability and nodal status)

Stage I: Resectable mesothelioma and no lymph node involvement
Stage II: Resectable mesothelioma but with lymph node involvement
Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
Stage IV: Distant metastatic disease

How Was This Diagnosis Determined, and How Accurate Were the Tests?

Although you probably took many different tests leading up to your diagnosis, a tissue biopsy is normally the final determining factor. Following are some tests your doctor may recommend, and what may or may not be concluded from these tests.

X-rays, CT scans, and MRIs - See the imaging section for more on these techniques. On conventional x-ray film, mesothelioma appears as a markedly thickened, nodular, irregular pleural-based mass which covers the pleural surface. The tumor often encompasses the involved lung, but is only rarely seen bilaterally. Chest wall, diaphragmatic, and mediastinal invasion may be seen in advanced cases. Moderate to large pleural effusion is often noted on the affected side. On CT scan, pleural thickening greater than 1 cm can be identified in over 90% of cases; thickening which extends into the interlobular fissure is seen in 85% of cases. Absence of pleural thickening does not preclude mesothelioma, and at times, the only CT finding is that of pleural effusion.
Cytology - Testing of the pleural fluid for malignant cells is considered to have limited value in diagnosing mesothelioma. Negative or inconclusive readings account for nearly 85% of all fluid tested. Even with a positive fluid report, many doctors prefer to perform a confirming tissue biopsy as long as it does not compromise the patient's health.
Needle Biopsy - In this test, done under local anesthetic, a large hollow needle is inserted through the skin and into the chest cavity. The needle is then rotated, and as it is taken out, tissue samples are collected. Because of the small sample size of the tissue, this type of biopsy is considered to be only 25-60% accurate in diagnosing mesothelioma. Because tumor seeding may occur along the needle tract in approximately 20% of patients, local radiation therapy may be used in conjunction with this test.
Open biopsy - This type of biopsy is considered to be the most accurate for mesothelioma diagnosis, and is the procedure of choice because it affords the pathologist a larger tissue sample.. It is done in a hospital under general anesthetic. As with a needle biopsy, local radiation may be used because of the possibility of tumor seeding.

Can I Be Treated by the Doctor Who Diagnosed My Mesothelioma?

If the doctor who diagnosed your mesothelioma is your primary physician, he will most likely refer you to a local oncologist for treatment. The oncologist may offer what he or she feels are the best treatment options, or, if their knowledge of this disease is limited, may suggest you seek out a doctor who specializes in mesothelioma. Most often these physicians are located at larger, teaching hospitals such as those listed in the Comprehensive Cancer Center Section. These facilities are ranked as state-of-the-art cancer centers, and are highly respected for their patient care and innovative cancer treatments. If your choice of treatment involves a radical surgical procedure or a clinical trial involving new, as yet unproven drugs, these facilities may be best for you. If your treatment involves an already-approved, standard form of chemotherapy, this can be carried out locally.

What Treatment Options Will I Be Offered?

Treatment options may vary according to the age and over-all health of the patient, and the extent of the disease. It is important to be informed of all available options for your particular case, so that you can make decision on the option you feel most comfortable with. Surgery, chemotherapy, and clinical trials, as well as new approaches such as photodynamic therapy, immunotherapy, and gene therapy may be offered. Speak openly with your doctor regarding suggested procedures. Questions may include:

Why is this procedure best for me?
What does the procedure entail?
What are the advantages/disadvantages of this treatment (i.e, will this procedure limit my eligibility for other treatments)?
What are the possible risks or adverse side effects?
What are the response, survival, and mortality rates associated with this procedure?

Is Palliative Treatment an Option?

In some circumstances, age, contributing health problems, or advanced disease may make aggressive treatment impossible. In these cases, palliative care (that which treats the symptoms, but not the disease itself) may be appropriate. If you opt for palliative care, it is doubly important to communicate fully with your doctor. Many symptoms of mesothelioma can be alleviated or substantially lessened if you are completely open with your doctor. Each time you have an appointment, tell your doctor how you feel, what discomfort you are experiencing, and your level of pain. A good doctor should be willing to address your questions and concerns.

Check our mesothelioma glossary.