Mesothelioma is a cancer of mesothelial cells that cover the outside of most of our internal body organs. It forms a lining which is sometimes known as the mesothelium.

Mesothelioma cancer can develop in the tissues covering the lungs or abdomen.

The tissues covering the lungs are known as the pleura, of which there are two. Sometimes called pleural membranes, the gap between them is called the pleural space. The pleura are fibrous sheets and they help to protect the lungs, producing a lubricating fluid that fills the gap between the two pleura. This helps the lungs to move smoothly in the chest when we breathe.

Mesothelioma is most commonly diagnosed in the pleura and is known as pleural mesothelioma. As it is so close, pleural mesothelioma can also affect the sheet of tissue covering the heart - the pericardium. Doctors refer to the pericardium as the lining, even though it is on the outside of the heart. It helps to protect and allow the heart to move smoothly within the sac that surrounds it. Basically, it does much the same job for the heart as the pleura do for the lungs.

The tissue lining the abdomen is known as the peritoneum, and helps to protect the abdomen. It also produces a lubricating fluid to help the organs to move smoothly inside the abdomen as we move around.

Mesothelioma of the tissues lining the abdominal cavity os referred to as peritoneal mesothelioma, and is much less common than pleural mesothelioma.

It is not usual for mesothelioma to spread to other parts of the body. It does not usually cause troublesome symptoms if it does.

There is also a form of non cancerous (benign) mesothelioma which can develop within the lining of the lungs, or in the lining of the reproductive organs. This can occur in either men or women but these non cancerous tumours are very rare.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pleural Mesothelioma:

The most common form of mesothelioma is pleural mesothelioma. This is where the cancer affects the lungs and the protective lining and cavity of the lungs. The symptoms of pleural mesothelioma result from pleural effusion, which is a build up of fluid between the lung lining and the chest cavity. Sufferers of pleural mesothelioma may experience some or all of the following symptoms: difficulty in breathing, difficulty in swallowing, shortness of breath, persistent coughing, weight loss, fever, coughing up of blood, and rasping.

Peritoneal Mesothelioma:

A rarer form of mesothelioma is peritoneal mesothelioma. This is where the cancer affects the stomach and abdomen. The cancer can start in the abdominal area and spread to other parts of the body, but the tumours that press against the wall of the abdomen can cause some or all of the following symptoms: abdominal pain, abdominal swelling, nausea, loss of appetite, vomiting, breathing problems, chest pain, bowel obstruction, anaemia, fever, and blood clotting abnormalities.

Pericardial Mesothelioma:

The last and the rarest of the mesothelioma types is pericardial mesothelioma. This is where the cancer affects the heart and the cavity that surrounds the heart. The tumours affecting pericardial mesothelioma patients can cause some or all of these symptoms: chest pain, shortness of breath, trouble breathing, persistent coughing, and palpitations.

There are also cases of other asbestos related diseases such as asbestosis and respiratory problems that have stemmed from exposure to this potentially fatal material. Anyone that has worked with asbestos should see their doctor if they have any onset of this type of problem or if they are concerned and have doubts.

As you can see, the symptoms for all three types of mesothelioma are non-specific, which means that they could be the result of a number of more common diseases that are associated with the same symptoms. Many of the symptoms are the same as those displayed by viral pneumonia patients, and the disease if often mistaken for something else.

If your doctor is unaware that you have been exposed to asbestos, he or she is unlikely to assume that you may have mesothelioma and will instead test for a number of other more common diseases that are associated with your symptoms. People who have worked with asbestos or who have close contact with someone that works with asbestos should therefore always be vigilant in looking out for any of these symptoms and seeking medical advice if any or all of the symptoms manifest. They should also make their doctor aware that they have worked with asbestos so that no further time is wasted in testing for other types of disease. Much of the delay in diagnosing mesothelioma comes from lack of information and awareness on both the part of the doctor and the patient.

However, it is up to the patient, who is aware of the asbestos exposure, to increase the chances of a speedy diagnosis by making the doctor aware of the circumstances and keeping an eye out of any tell tale signs that mesothelioma may be present.

Mesothelioma Symptoms

It often is difficult to diagnose malignant mesothelioma. Because it is an uncommon form of cancer, many doctors, particularly those who are not cancer specialists, are not familiar with mesothelioma.

Many of the symptoms of mesothelioma are not very different from those associated with other health problems. Also, in its early stages some patients experience no symptoms at all.

Pleural Mesothelioma Symptoms

Some of the symptoms of pleural mesothelioma (mesothelioma cancer of the lung lining) include:

- pain in the lower back or the side of the chest
- chest pain under the rib cage
- unusual lumps of tissue under the skin on the chest
- shortness of breath
- a dry persistent cough
- difficulty swallowing food
- fever and sweating
- fatigue
- abdominal swelling
- abdominal pain
- unexplained weight loss
- a change in the bowel habits, such as more frequent diarrhea or constipation
- lumps of tissue in the abdomen

These symptoms are also common to many minor ailments and, therefore, may not cause a doctor to suspect mesothelioma.

-Pleural Effusion
-Fluid in the lungs

One of the most common and specific symptoms of pleural mesothelioma is the accumulation of fluid between the lungs and chest cavity. This generally causes shortness of breath, and requires a doctor to drain the fluid, called fine-needle aspiration, to make breathing easier and relieve chest pain. This symptom is more unique to mesothelioma, making it more likely that you may have the disease.

Peritoneal Mesothelioma Symptoms

Some of the symptoms of peritoneal mesothelioma (mesothelioma cancer of the lining that surrounds the stomach or abdomin) include:

Symptoms include:
- stomach pain
- nausea and vomiting
- weight loss
- abdominal pain and swelling due to a buildup of fluid in the abdomen.

Other symptoms of peritoneal mesothelioma may include:

- bowel obstruction
- blood clotting abnormalities
- anemia
- fever.

Pericardial Mesothelioma

Some of the symptoms of pericardial mesothelioma (mesothelioma cancer of the lining that surrounds the stomach or heart) include:

- dyspnea
- cough
- chest pain
- orthopnea (discomfort with breathing while lying flat)

Other symptoms of pericardial mesothelioma may include:

- upper abdominal distention or pressure
- hiccups due to pressure on the diaphragm
- pleuritic pain due to stretching of the pericardium
- increased distention of jugular veins with inspiration
- rapid diastolic descent of the venous pulse
- decrease of more than 10 mm Hg in the diastolic pressure on inspiration

Signs and symptoms of mesothelioma cancer that has spread to other parts of the body include:

• Pain in the area where cancer has spread
• Difficulty swallowing
• Swelling in the neck and face

Like pleural mesothelioma, these symptoms are also common to many minor ailments and, therefore, may not cause a doctor to suspect mesothelioma.

Effect

Nausea and/or vomiting is probably one of the chemotherapy side effects mesothelioma patients dread most, and although many patients get by quite well with some of the newer drugs, many do still experience these unpleasant side effects.

As chemotherapy drugs are administered and enter the body, several chemicals in the brain, including one called substance P, are released and can trigger nausea and vomiting. Some patients may experience these side effects within the first few hours after receiving chemotherapy (acute nausea and vomiting), while in others, it may be several days (delayed nausea and vomiting). Nausea or vomiting that is triggered simply because a patient expects to feel sick, is called anticipatory nausea and vomiting.

Before beginning chemotherapy, it is important to discuss the drugs you will be taking, and any potential side effects with your health care team. If nausea and vomiting is a common side effect, don't automatically assume it will affect you personally, but feel free to discuss what measures can be taken if it does occur. Anti-nausea medications have been in use for many years, and your doctor will decide what medications might be best for you based on the drugs you will be receiving and how much nausea or vomiting is generally associated with those drugs.

If your chemotherapy will be delivered in a clinic or hospital, anti-nausea medications are usually given intravenously at that time, but you may also be given medication to take home. Be sure you completely understand how these medications are to be taken before you leave your chemotherapy session B some are designed to be taken for several days whether you feel ill or not, while others are meant to be taken only if you experience symptoms.

Anti-nausea medications are generally divided into the following categories:

• Corticosteroids have been widely used for many years, and are very effective in controlling delayed nausea and vomiting. They are available in a number of different forms, and are often combined with other anti-nausea drugs for maximum benefit. Examples: Decadron©, Hexadrol©.
• Dopamine antagonists have also been used for many years and have proven helpful in controlling nausea and vomiting associated with many types of chemotherapy. This family of drugs, for the most part, has now been replaced by another family of drugs called serotonin antagonists. Example: Compazine©.
• Serotonin antagonists are often used to combat nausea and vomiting due to the administration of some of the more powerful chemotherapy drugs where these side effects are traditionally more severe. They work by preventing the natural substance, serotonin, from sending a signal to the brain that causes vomiting. Drugs in this family may be given intravenously at the time of chemotherapy, and can help prevent or ease both acute and delayed vomiting. Examples: Aloxi©, Zofran©, Kytril©, Arizemet©.
• Benzodiazepines are drugs that do not prevent nausea and vomiting, but are helpful in relieving the anxiety involved for those who expect to become ill. Examples: Ativan©, Valium©.
• Aprepitant, marketed under the brand name Emend©, belongs to a class of drugs called substance P antagonists. This drug blocks the action of substance P, which triggers nausea and vomiting reflexes. Since this drug works differently than corticosteroids and serotonin antagonists, it may be added in situations where chemotherapy is likely to cause acute or delayed vomiting.

Besides being sure you completely understand your prescribed anti-nausea medications and how they should be taken, following are several other hints you might find helpful if you have issues with nausea and vomiting:

• Ask your doctor whether any other medications you are taking could be contributing to your stomach upsets.
• Be sure your intake of fluids is adequate to prevent dehydration. Dehydration can be a serious condition if neglected, and can cause a variety of symptoms as well as possible organ damage.
• Eat and drink slowly. Sometimes eating smaller meals throughout the day is more tolerable.
• Avoid foods that are sweet, fried or fatty, as well as those with strong odors.
• Eat foods cold or at room temperature.
• Consult a registered dietician who can assist you with an eating plan that can help you meet your nutritional needs and maintain fluid intake. Dieticians will also be able to take into account any other health conditions you might be dealing with.

Nausea and vomiting may also be caused by conditions unrelated to your chemotherapy. It is important to call your doctor:

• If you continue to experience nausea and/or vomiting even after taking your prescribed anti-nausea medication.
• If you experience undesirable side effects from your anti-nausea medication itself.
• If you have nausea or vomiting that interferes with your ability to eat or drink.
• If you vomit 4 to 5 times in a 24-hour period.
• If you feel bloated.
• If you have pain or swelling in your stomach before vomiting.

Mesothelioma patients who are taking chemotherapy should work together with their health care team to prevent or lessen any side effects they experience as a result of their treatments. Keeping side effects under control is an essential part of maintaining the best quality of life possible, and avoiding any delays in your treatment schedule.

Nausea and/or vomiting is probably one of the chemotherapy side effects mesothelioma patients dread most, and although many patients get by quite well with some of the newer drugs, many do still experience these unpleasant side effects.

As chemotherapy drugs are administered and enter the body, several chemicals in the brain, including one called substance P, are released and can trigger nausea and vomiting. Some patients may experience these side effects within the first few hours after receiving chemotherapy (acute nausea and vomiting), while in others, it may be several days (delayed nausea and vomiting). Nausea or vomiting that is triggered simply because a patient expects to feel sick, is called anticipatory nausea and vomiting.

Before beginning chemotherapy, it is important to discuss the drugs you will be taking, and any potential side effects with your health care team. If nausea and vomiting is a common side effect, don't automatically assume it will affect you personally, but feel free to discuss what measures can be taken if it does occur. Anti-nausea medications have been in use for many years, and your doctor will decide what medications might be best for you based on the drugs you will be receiving and how much nausea or vomiting is generally associated with those drugs.

If your chemotherapy will be delivered in a clinic or hospital, anti-nausea medications are usually given intravenously at that time, but you may also be given medication to take home. Be sure you completely understand how these medications are to be taken before you leave your chemotherapy session B some are designed to be taken for several days whether you feel ill or not, while others are meant to be taken only if you experience symptoms.

Anti-nausea medications are generally divided into the following categories:

• Corticosteroids have been widely used for many years, and are very effective in controlling delayed nausea and vomiting. They are available in a number of different forms, and are often combined with other anti-nausea drugs for maximum benefit. Examples: Decadron©, Hexadrol©.
• Dopamine antagonists have also been used for many years and have proven helpful in controlling nausea and vomiting associated with many types of chemotherapy. This family of drugs, for the most part, has now been replaced by another family of drugs called serotonin antagonists. Example: Compazine©.
• Serotonin antagonists are often used to combat nausea and vomiting due to the administration of some of the more powerful chemotherapy drugs where these side effects are traditionally more severe. They work by preventing the natural substance, serotonin, from sending a signal to the brain that causes vomiting. Drugs in this family may be given intravenously at the time of chemotherapy, and can help prevent or ease both acute and delayed vomiting. Examples: Aloxi©, Zofran©, Kytril©, Arizemet©.
• Benzodiazepines are drugs that do not prevent nausea and vomiting, but are helpful in relieving the anxiety involved for those who expect to become ill. Examples: Ativan©, Valium©.
• Aprepitant, marketed under the brand name Emend©, belongs to a class of drugs called substance P antagonists. This drug blocks the action of substance P, which triggers nausea and vomiting reflexes. Since this drug works differently than corticosteroids and serotonin antagonists, it may be added in situations where chemotherapy is likely to cause acute or delayed vomiting.

Besides being sure you completely understand your prescribed anti-nausea medications and how they should be taken, following are several other hints you might find helpful if you have issues with nausea and vomiting:

• Ask your doctor whether any other medications you are taking could be contributing to your stomach upsets.
• Be sure your intake of fluids is adequate to prevent dehydration. Dehydration can be a serious condition if neglected, and can cause a variety of symptoms as well as possible organ damage.
• Eat and drink slowly. Sometimes eating smaller meals throughout the day is more tolerable.
• Avoid foods that are sweet, fried or fatty, as well as those with strong odors.
• Eat foods cold or at room temperature.
• Consult a registered dietician who can assist you with an eating plan that can help you meet your nutritional needs and maintain fluid intake. Dieticians will also be able to take into account any other health conditions you might be dealing with.

• Nausea and vomiting may also be caused by conditions unrelated to your chemotherapy. It is important to call your doctor:

  • If you continue to experience nausea and/or vomiting even after taking your prescribed anti-nausea medication.
  • If you experience undesirable side effects from your anti-nausea medication itself.
  • If you have nausea or vomiting that interferes with your ability to eat or drink.
  • If you vomit 4 to 5 times in a 24-hour period.
  • If you feel bloated.
  • If you have pain or swelling in your stomach before vomiting.

  Mesothelioma patients who are taking chemotherapy should work together with their health care team to prevent or lessen any side effects they experience as a result of their treatments. Keeping side effects under control is an essential part of maintaining the best quality of life possible, and avoiding any delays in your treatment schedule.

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.

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.

1. 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
2. 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.
3. 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.

4. 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.

If you or someone you know has an asbestos-related disease, you owe it to yourself to make sure that your rights are protected. Your rights vary depending on many factors such as your residence, where you were exposed to asbestos, and the location of the responsible asbestos companies. Each state has its own laws and governs the law differently. Each state also has its own deadlines for allowing victims of asbestos disease to file lawsuits, called statutes of limitation and statutes of repose.

The effects of asbestos 20, 30 and even 40 or more years later have been devastating. Workers exposed to asbestos could potentially contract Mesothelioma, a terminal cancer or another condition called asbestosis.

Under the law, if you have an asbestos-related disease, you are entitled to fair compensation from the companies that are responsible for the asbestos products that caused your disease.

Mesothelioma Legal Rights - Mesothelioma Help Center

Eligibility

If you are a victim of Mesothelioma or Asbestosis, your eligibility will depend on several factors:
a) Statute of Limitations
b) Identify Your Exposure
c) Responsible Parties

Wrongful Death Suit

The law also says that if you are a close family member of a person who died of an asbestos-related disease, you may also have the right to seek compensation for your loss. This right is called a "wrongful death" suit. The laws of different states vary as to which family members have the legal right to recover for the wrongful death of a family member. We can help decide which state is best for your case, depending upon your individual situation.

Statute of Limitations

While you have the right to sue if you have, or a family member has, an asbestos-related disease, there is a time frame during which you must file your case. This statute of limitations varies from state to state, but if you wait too long, you will be barred from taking legal action. If you are interested in filing a case, it is important that you seek legal advice as soon as possible.

Mesothelioma Lawyer

Did you know?

It is estimated that 27.5 million Americans were exposed to asbestos between 1940 and 1979. Welcome to the leading source on

Connecting you with Mesothelioma lawyers nationwide!

This site is dedicated to providing important information on asbestos & mesothelioma cancers. We help mesothelioma patients and families make educated decisions about how to proceed with filing asbestos and mesothelioma claims. Those dealing with asbestos cancers face a number of challenges, including the tremendous costs of treatment. If you were unknowingly exposed to harmful levels of asbestos, you have legal rights and there is compensation help available for you.

MESOTHELIOMA LAWYER - EXPERIENCE
Law firms that we work with concentrate only on asbestos mesothelioma cases. We have experience placing people with experienced asbestos lawyers for five years. We will actually walk you the process of connecting you with an experienced asbestos lawyer in your state.

We help asbestos and asbestos patients and their families get in touch with legal and medical professionals. We help keep the public aware of new discoveries in treatments for Mesothelioma and Asbestos cancers. We also maintain a current online Mesothelioma Dictionary of Legal & Medical Terms and we keep you up to date on current legal settlements for asbestos cases.

MESOTHELIOMA LAWYER -CHOICES
Deciding which law firm to represent you and your case is very important. Choosing the right lawyer will also be important to your settlement. You are entitled to an experienced mesothelioma lawyer who has a track record of success in asbestos lawsuits

MESOTHELIOMA LAWYER - LOSS OF A LOVED ONE
If you or a loved one has been diagnosed with an asbestos cancer, or a family member has died as a result, you may be entitled to recover compensation from the companies that made these asbestos products.

MESOTHELIOMA LAWYER – FILING A LAWSUIT
It is not uncommon for there to be 10-20 parties that are named in an asbestos lawsuit that are located across the United States. For example, a worker in California may have been exposed to asbestos from asbestos products shipped from Libby, Montana or from an iron ore plant in St. Paul Minnesota. This is why it is very important to obtain an experienced mesothelioma lawyer that knows all of the companies in each state who have responsibility for your asbestos exposure.