Treatment of Mesothelioma by Stage

Stage I: Many patients with stage I pleural mesothelioma have their cancer removed by pleurectomy/decortication or extrapleural pneumonectomy, as described in the section How Is Mesothelioma Treated. Patients with peritoneal mesotheliomas in an early stage might also benefit from surgery. The value of adjuvant chemotherapy or radiation therapy (treatments given after surgery) for stage I mesothelioma is being studied. Radiation therapy may be used if your general health is too poor to tolerate a major operation. Some doctors have had success with putting cisplatin into the thoracic space after the surgery. This can also be used in the abdomen for peritoneal mesothelioma.

Stages II, III: Treatment options include palliative and supportive care providing relief of symptoms, such as thoracentesis (to remove fluid accumulation in the chest cavity) along with pleurodesis, paracentesis (removing fluid from the abdomen), operations to remove as much of the tumor as possible in some cases, and radiation therapy or chemotherapy aimed at easing symptoms. Cure is usually not possible for patients in these stages. Enrollment in clinical trials evaluating the newest treatment possibilities in large medical centers should be considered. Some patients can have long remissions after extensive surgery by experts.

Other approaches include putting chemotherapy or radioactive drugs directly into the pleural space or abdominal cavity. This can be done simply with the doctor placing a needle into the pleural space or abdomen after numbing the skin with local anesthetic. Although this only kills some of the cancer cells, it often helps slow down fluid collection.

Stage IV: Because stage IV mesothelioma has spread to distant organs, a cure is not possible. The goals of using any aggressive therapy such as chemotherapy and radiation therapy should be clear to you and your family. You might want to consider enrolling in a clinical trial in a large medical center. These studies evaluate the newest treatment possibilities.

Supportive care may be the best choice, perhaps in the setting of a good hospice program. Pain management is an important aspect of your care. It is important for you to know that drugs are available to effectively treat pain due to mesothelioma. You should not hesitate to request pain medicines or discuss pain control problems with your cancer care team.

Malignant Mesothelioma Surgery

Surgery

Surgery for pleural mesothelioma may be done for 1 of 2 reasons: to relieve pain and discomfort caused by the tumor (called palliation) or to cure.

Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to remove completely, or if you are too ill to tolerate a more extensive operation.

Curative surgery is offered if you are in otherwise good health and the tumor is thought to be localized and can be removed completely. Unfortunately, the cancer cells tend to spread into the chest wall, around the heart, over nerves, and the diaphragm. It is often difficult to detect this spread. Because of this, doctors are not clear on the exact role of surgery. It is not likely to cure you but may extend your life. Curative surgery is being done in some cancer centers and a few of the patients who have had the surgery are experiencing long remissions of their disease.

Depending on the stage of a mesothelioma, surgery may be used to remove the cancer and some of the surrounding tissue. Often, however, an operation is not appropriate and you may have only smaller procedures to relieve symptoms.

A thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity, may be done to make a patient more comfortable. Sometimes talc or drugs that cause scarring may be injected into the chest cavity to try to prevent the fluid from returning. This is called pleurodesis. These techniques are successful in controlling the fluid, at least temporarily, in as many as 90% of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help you breathe more easily, however, they do not cure the cancer.

In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, a needle inserted into the pericardium (sac around the heart) can drain pericardial fluid and help relieve circulatory problems. Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area. This concern should not prevent fluid removal, though.

Two surgical procedures may be offered if you have pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy.

Pleurectomy/decortication: Pleurectomy/decortication is usually a palliative procedure (relieves symptoms without curing the cancer) in cases where the entire tumor cannot be removed. This procedure removes the pleura, where the majority of the tumor is located. It can control the build up of fluid improve breathing and decrease pain caused by the cancer.

Extrapleural pneumonectomy: Extrapleural pneumonectomy is a far more extensive operation and is most often used in patients with localized mesothelioma of the epithelioid type, when the surgeon thinks a cure is possible. It is a difficult operation and is done only by surgeons in large specialized medical centers. You should talk with your doctor about an appropriate treatment center nearest to your home. The operation removes the pleura lining the chest wall, diaphragm, pericardium, and the whole lung on the side of the tumor. The diaphragm and the pericardium are then reconstructed with prosthetic material. You must be in overall good health with no other serious illnesses to tolerate the surgery. This operation attempts to remove all or most of the cancer and some surrounding tissues as well.

Surgical treatment of peritoneal mesothelioma is often done either to help relieve symptoms or to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be done to remove a mesothelioma from the pericardium (the sac around the heart).

Surgery for mesothelioma of the tunica vaginalis testis, which occurs in the groin, is also not usually curative. Most of the time surgery is done because the tumor resembles a hernia. The surgeon attempts to treat a suspected hernia and only realizes the diagnosis after the surgery is begun. This kind of mesothelioma can’t be entirely removed.

Researches

basic research

The following projects emerged from years of interdisciplinary discussion and collaboration among researchers at the Brigham and Harvard Medical Area interested in mesothelioma. The strategic approach has been to build an integrated research effort among multiple disciplines each contributing to a different aspect of the program. All projects share access to patients, clinical samples, and a central database of patient and research data. Only patients who consent will be studied. Each project is ultimately designed to improve patient therapy and outcome.

The Epidemiology Project will collect patient history and exposure data to assess genetic susceptibility factors for development of malignant pleural mesothelioma (MPM). The basic science and preclinical projects (Growth Regulatory Lesions in Mesothelial Oncogenesis, Kinase Targets and Genomic-based Projects) will contribute to the biology of MPM development, discover and validate molecular markers or targets, and develop targeted therapies. The Clinical Management Project will attract patients, track outcome data, supply patient blood and tissue samples to the other projects, and assess new options for diagnostic tools, chemotherapy, surgery and post-treatment care. Synergistic progress is expected from the coordinated efforts of the proposed studies.

Abstracts of the Individual Projects

Epidemiology of Malignant Mesothelioma – Karl T. Kelsey, M.D.
e goal of this project is to conduct a comprehensive epidemiologic study of MPM to investigate the underlying disease etiology using both a case control and a case-series design. The case control study includes all incident cases of MPM identified through the Brigham and Women’s Hospital and the Dana-Farber Cancer Institute. This project will recruit the base population for the entire program. We will administer a detailed risk factor, demographic and clinical questionnaire to both cases and controls that will be used to identify exposures and traints that increase the risk of MPM.

Tumor profiling, including assessment of epigenetic silencing, will be used to further our understanding of the mechanism of action of asbestos, asbestiforma materials and other exposures that may contribute to this disease.

Thus, the objectives of the proposed study are to further the understanding of the extent and etiology of malignant mesothelioma.

Growth Regulatory Lesions in Mesothelial Oncogenesis – James G. Rheinwald, Ph.D.
Our long-term objective is to characterize the mechanisms responsible for malignant behavior of mesothelioma, with a focus on identifying genes responsible for specific stages of neoplastic progression and critical oncogenes that confer aggressive tumorigenic behavior. We know little about the mechanisms by which the mesothelial cell, the normal progenitor of mesothelioma, acquires the ability to spread laterally, dedifferentiate, invade, and colonize distant sites within the body cavities.

The aims of this project are based on two lines of our previous research. One has used cell culture to discover mechanisms of growth regulation, replicative lifespan limits, the differentiation/ dedifferentiation process of normal human mesothelial cells, and autocrine mitogen-independence of mesotheliomas. The other line of research has used microarray hybridization and molecular biologic methods to identify a set of abnormally expressed genes in mesothelioma, which have proved to be of prognostic value, and also represent a set of candidate oncogenes that may be critical to the malignant behavior of this cancer.

Kinase Targets in Mesothelioma - Jonathan A. Fletcher, M.D.
The aims of the proposed studies are to make therapeutic advances in mesothelioma by characterizing kinase activation mechanisms in mesothelioma patients and by evaluating clinical regimens designed to circumvent these mechanisms.

This project will identify and evaluate activated receptor tyrosine kinase proteins as novel therapeutic targets in mesothelioma. Oncogenic receptor tyrosine kinases play key roles in the pathogenesis of many types of cancer, and they have emerged recently as compelling therapeutic targets, particularly when activated by genomic mutations resulting in kinase sequence alterations or overexpression. These therapeutic developments have prompted the large-scale validation of small molecule, peptide, and immunological inhibitors of various receptor tyrosine kinase proteins with suspected roles in tumorigenesis. EGRF and MET have been implicated as potential receptor tyrosine kinase targets in mesothelioma, and our own preliminary proteomic and in vitro studies suggest that AXL can also be activated strongly in mesothelioma.

The overall aim of this project is to discover oncogenic kinase targets (both receptor and non-receptor tyrosine kinases), and to determine whether such kinases serve as appropriate therapeutic targets for patients with mesothelioma. This project is highly translational in that the objective is to identify drug targets that are evaluable in the near-term in clinical trials.

Genomic-based Prognosis, diagnosis, and Development of Novel Therapeutic Strategies in Mesotheleioma - Raphael Bueno, M.D.
Malignant Pleural Mesothelioma (MPM) is a highly malignant neoplasm for which therapy is inadequate. We have studied gene expression in MPM with microarrays and developed diagnostic and predictive tests for patients undergoing surgery for this disease using the gene ration methods. We also discovered that the anti apoptotic gene IAP-1 mediates chemotherapy resistance in mesothelioma cell lines. In this project we plan to test our diagnostic and prognostic tests in tissue biopsies obtained from patients enrolled in the clinical projects of this program project. We hope to identify the best predictive and diagnostic test for each of the therapies and at the same time discover new targets for research.

We will also work on elucidating the mechanism by which IAP-1 mediates cisplatin resistance in MPM cell lines. We will determine if any additional anti apoptotic genes mediate such resistance and then construct cell line models to test inhibitors of involved pathways with the hope of identifying new targets for therapy. This approach will also be used for other potential targets discovered during our microarray analysis.

Lung Cancer Diagnosis

Diagnosis

Chest x-rays may not show a tumor but may show other clues that indicate a problem related to lung cancer. An x-ray may show spots or images suggestive of fluid accumulation, masses, enlarged lymph nodes or pneumonia.

A chest CT (Computerized Axial Tomography) is a more precise way of studying chest anatomy. Both chest CT and MRI (magnetic resonance imaging) scans use computers to produce highly detailed cross-sectional (slices) images of the body. They can show 3-dimensional images that help determine the size, shape, and location of a tumor. A CT scanner uses fine streams of X-rays taken from many angles to produce picture of anatomical details within a "slice" through the person. Magnetic Resonance Imaging (MRI) does much the same thing, but using magnetic and radiowave fields.

PET (Positron Emission Tomography) scanning is different from CT and MRI scanning. A CT or MRI scan shows only structural details of the tissue, whereas the PET scan provides a color-coded image of the tissue’s function.

Simple sugars, labeled with radioactive tracers, are injected into the body intravenously (or inhaled as a gas). All cells pick up the sugar, but since tumor cells are metabolically more active than normal cells, a larger concentration of the radioactive sugar will accumulate in them. The PET scanner picks up the radiation given off by the sugar as it journeys through the body and collects in the targeted tissue (the tissue ‘lights up’ called a ‘hot spot’). A computer reassembles the signals into actual images and shows in fine detail the metabolism of the sugar in the tumor cells. PET can tell you whether a tumor is benign or malignant, the extent of the disease, and if the tumor has spread or has recurred.

PET/CT is a new technique that fuses PET and CT technologies into a single device. The PET scan picks up the metabolic activity in the body, and the CT scan provides a detailed picture of the body’s structure. By taking the pictures simultaneously, the two images are overlaid so that the tumor "hot spot" on the PET scan corresponds directly to the physical mass on the CT scan, thus eliminating the visual side-by-side comparison. This new technology has the potential to substantially impact treatment plans for many patients.

A sputum (mucus coughed up from the lungs) sample can be used to look for the presence of cancerous cells. If there are cancer cells in the bronchi, some of these cells are likely to be shed and carried up the throat in the sputum.

A Bronchoscopy involves the use of a bronchoscope to directly view the airways into the lungs. A bronchoscope is a small tube that is inserted through the nose or mouth, down the throat, and into the bronchi (the small tubes that go into each lung). During the procedure, the surgeon may remove some tissue for analysis. Local anesthesia and mild sedation are generally used to make the patient comfortable during the procedure

A biopsy involves obtaining a small piece of tissue and examining it under a microscope. A biopsy is necessary to confirm a cancer diagnosis and to identify the specific type of cancer and its stage. To examine areas of the lungs that are not accessible during a bronchoscopy, physicians may perform a needle biopsy (called "fine needle aspiration" or FNA) to remove a small sample of tissue for analysis. Sometimes, surgical biopsies of the lung may be performed. If a surgical biopsy is needed, the surgeon will perform the surgery through an incision in the chest so that all or part of a tumor and/or lymph nodes can be removed.

Palliative therapies

Palliative care addresses physical, psychological, social and spiritual sources of distress for patients with advanced or life-threatening disease and their families. The goal of palliative care is to provide comfort and to maintain the highest possible quality of life for as long as life remains.

Those diagnosed with mesothelioma experience a variety of different symptoms. Often, the level of pain experienced with mesothelioma is very high. Pain control is usually one of the first symptoms addressed with mesothelioma palliative care. Palliation can include the traditional pain management programs, such as prescribing several different pain medications, but it also can focus on behaviour modification, stress management, meditation, or even massage therapy. Palliative surgery can be done to reduce pain caused by the tumor or to prevent fluid from accumulating. Studies have shown that radiation therapy is useful in relieving pain due to mesothelioma. Palliative care can be a sound choice to increase the remaining quality of life for patients who suffer from mesothelioma.

At the Brigham and Women’s Hospital, patients will have the opportunity to enrol in a quality of life protocol in which patients will undergo bi-weekly palliative care assessment and symptom management. Patients will be assessed and treated by skilled palliative care practitioners, teaming with the oncology team, anesthesia pain specialists and psychologists. The techniques and methods are available to make sure that every patient with mesothelioma can have adequate pain control at any stage of the disease.

Mesothelioma surgery

Treatment of mesothelioma depends on a number of factors, which include the stage of the cancer, the cancer’s location, how far it has spread, and the patient’s age and general health. Some surgical procedures treat the symptoms while others attempt to remove the diseased tumor.

Radiation therapy

Radiation therapy uses high-energy rays to damage or kill cells by preventing them from growing and dividing. It is delivered to the site of the tumor by machines called linear accelerators, which produce high-energy external radiation beams that penetrate the tissues deep into the areas where the cancer is located. This technique is called external beam radiation therapy (EBRT). Radiation therapy also can palliate the symptoms of mesothelioma by reducing pain, improving breathing, or relieving other side effects caused by the cancer.

Factors that can limit the application of this treatment include the volume of the tumor and how near it is to vital organs. Radiotherapy following surgical resection (adjuvant therapy) has been shown to reduce local cancer recurrence and improve the survival of patients with early-stage disease and is an essential part of the management of patients undergoing extrapleural pneumonectomy.

EBRT is delivered precisely by using computed tomography (CT) scan as well as PET scans to localize the areas at risk for tumor recurrence. Careful radiation planning allows for a higher dose of radiation to be directed at the tumor tissue and at the same time, decreasing the volume of normal tissue exposed to this high dose. Our faculty in radiation oncology has over 15 years of experience in treating mesothelioma patients with radiotherapy.

Intensity-modulated radiation therapy (IMRT) is a novel breakthrough in radiation oncology. It allows treatment of areas that were previously out of the reach of conventional radiation. IMRT for mesothelioma is available @ BWH one of the few sites in the country where this technique has been perfected. It requires a treatment team composed of radiation oncologist, physicists and radiation therapists to deliver. The state of the art machinery available here @ BWH represents the top-of the line in radiation delivery equipment. Preliminary data indicates significant improvements in local recurrences for mesothelioma patients undergoing this treatment.

New clinical trials investigating the optimum method for combining chemotherapy and radiation are underway at BWH/DFCI.

Traditional Treatments

There is no known cure for mesothelioma, current treatment strategies are limited, and there exists no universally accepted standard therapy. Since mesothelioma is an uncommon cancer, it is rarely seen in most medical centers. However, specialists in leading treatment centers who have experience in treating mesothelioma have produced some long-term survivors with patients living 10 years.

Members of the Brigham and Women's Hospital Thoracic Surgery Division have extensive experience in treating patients with mesothelioma. Options for therapy include surgery, chemotherapy and combined approaches, utilizing multiple types of therapy (multimodality). It is important that patients with mesothelioma are treated at centers with expertise in MPM to maximize expertise and allow innovative treatment combinations to be implemented with the greatest chance of success.

Pain management

Pain from mesothelioma is one of the major challenges facing patients and their doctors, and it can have a significant impact on their quality of life. Cancer pain is a chronic, progressive pain that increases in severity over time. Many mesothelioma patients have pain that is unresponsive to conventional medical management.

Symptoms of early stage disease may be experienced by a nagging discomfort or mild pain in the chest area or in the back. As the disease progresses, it destroys soft tissue and nearby nerves, and the patient experiences the most discomfort. Eventually, as the tumor spreads, it grows into the chest, the chest muscles and ribs, causing tissue destruction and severe pain. Surgery, radiation and chemotherapy are aimed at stopping the spread of the disease and thus easing the pain; however, these treatments are not pain-free.

The Brigham and Women’s Hospital Pain Management team is a multidisciplinary team whose goal is to bring maximum physical comfort and quality of life to all patients. Treatment is tailored to the needs of the individual patient. The goal is to provide the greatest amount of pain relief with the fewest number of side effects and with the greatest ease of administration.

Today, pain management specialists are providing more relief than ever before, thanks to superior pain management techniques. Some of these techniques include implanting devices, which deliver pain-fighting drugs directly to the central nervous system. Patients no longer responsive to the strongest oral or intravenous pain medications may have a special pain-killing mixture delivered intraspinally (inside of the dural membrane of the spinal cord, but still within the spinal canal). This intrathecal implant reduces the need for in-hospital pain care, allowing the pain to be controlled at home

At the Brigham and Women’s Hospital, eligible patients will have the opportunity to participate in a protocol studying the effectiveness of a three-drug intrathecal (administered into the spine) therapy in the management of pain due mesothelioma.

Tests for mesothelioma

This page tells you about tests you may have that can diagnose mesothelioma. You can scroll down the page to read all the information here.

At the GP

Usually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. Your doctor will listen to your chest, to see if there are any signs of fluid collecting.

After your examination, your doctor may need to refer you to hospital for tests and X-rays. You may be referred directly to a specialist. Or your GP may send you to hospital for some tests first.

At the hospital

If you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests to check your general health. Then your tests will be arranged in the out patients department.

If your doctor suspects you may have mesothelioma, you may have quite a few tests. This is because it can be difficult to diagnose. Many of the usual tests used to diagnose lung disease prove negative when used to diagnose mesothelioma.

X-ray

You will almost certainly be asked to have a chest X-ray or abdominal X-ray. A chest X-ray can show up fluid collecting around the lung. An abdominal X-ray may show up a swelling or fluid in the abdomen (tummy).

CT scan
This is a computerised scan using X-rays. You may be asked to have a CT scan of your chest or abdomen. A CT scan can show abnormal swellings in body organs or lymph nodes. You may be given an injection of dye called ‘contrast’ before the scan. This helps to make the scan clearer to read.


Thoracoscopy
This is a small operation usually carried out by a specialist surgeon. It is done under a general anaesthetic. A small cut (incision) is made in your chest wall and a thoracoscope (a telescope like instrument with a video camera attached) is inserted through the hole.

Fluid drainage

Many people with pleual mesothelioma have fluid around their lungs (a pleural effusion). People with peritoneal mesothelioma may have fluid in their abdominal cavity (peritoneal effusion). The diagram shows a pleural effusion.



Fluid build up happens because cancer cells are irritating the pleura or peritoneum. Fluid in the plura can make it difficult to breathe. Fluid in the abdomen can make the abdomen feel swollen and tight and uncomfortable. If mesothelioma is the cause of the fluid build up, the fluid may contain cancer cells. To drain the fluid off, a needle is put into the chest or abdominal cavity and the fluid drained through a tube into a bag. A sample of the fluid will be sent to a laboratory for testing to see if contains cancer cells. Your doctor may call this 'thoracocentesis' or pleural aspiration if you are having fluid removed from your chest. If you are having fluid removed from your tummy (abdomen), you may hear your doctor call it an abdoparacentesis or peritoneal aspiration.

Mesothelioma : Asbestos Cancer

Mesothelioma Asbestos Cancer Information

Mesothelioma FYI is a resource for those seeking detailed information on mesothelioma, asbestosis, and asbestos exposure leading to asbestos cancer and disease. Mesothelioma FYI provides medical and legal information to mesothelioma, asbestosis, and asbestos exposure victims and their loved ones. This mesothelioma information resource is sponsored by the following leading mesothelioma and asbestos attorneys dedicated to defending the rights of those victimized by employers and manufacturers that have led to asbestos exposure.

Mesothelioma Information

Mesothelioma is a rare form of cancer that is caused by asbestos exposure. Mesothelioma is not a form of lung cancer. It actually develops in the mesothelium; a thin, double-layered protective sheath that surrounds vital organs and body cavities. The mesothelium that protects the chest and lungs is called the pleura and the mesothelium that surrounds the abdomen is called the peritoneum. This protective tissue holds vital organs in position and provides lubrication that allows internal organs to smoothly move during breathing and movements. Mesothelioma is the most serious of all asbestos-related diseases. Mesothelioma asbestos cancer can be very difficult to diagnose and can take anywhere from 25 to sometimes 50 years to develop. Prognosis for mesothelioma is poor and is worse than other forms of asbestos cancer. Mesothelioma typically affects the pleural mesothelium but in some cases, patients develop peritoneal mesothelioma in the abdomen.
Since the only known cause for mesothelioma is asbestos, there is a chance that an asbestos company can be held responsible for your asbestos exposure and resulting mesothelioma or asbestos disease. Retaining a qualified mesothelioma attorney may help you receive the compensation you and your family deserve.

Asbestos

Asbestos is a mineral substance that occurs naturally in our environment. Asbestos has a long history of useful applications, as it is one of few minerals that have a fibrous structure that can be woven into fabric, rope, and added into other products to add strength and flexibility. Asbestos is highly heat and chemical resistant. This is why asbestos is used in so many insulation applications. Asbestos fibers can be broken down to microscopic size. Exposure to these tiny asbestos fibers can cause to asbestos cancer, asbestosis and mesothelioma.

Mesothelioma Treatment Information

Mesothelioma is an incurable disease. However, if mesothelioma cancer is diagnosed early the patient's quality and length of life may be greatly increased. There are several mesothelioma cancer treatments that deal.

Mesothelioma Information - Please Note:

Many surviving patients claim that the most powerful treatment against mesothelioma cancer, or any terminal condition, is a good attitude and appreciation of life. Medical research has proven the benefits of a positive attitude against disease; patients with positive outlooks show increased immune activity, more energy, and are more independent than those who remain isolated and in depression.
There are three common methods of treatment for malignant mesothelioma cancer:

Surgery - Invasive techniques remove the cancerous tissues from the body
Radiation treatments- External or internal devices used to shrink reduce mesothelioma cancer in the patient
Chemotherapy - a mesothelioma treatment in which a series of pills or injections cause the cancer to discontinue reproducing.

In addition to the above mesothelioma treatments, there are additional mesothelioma cancer clinical trials being conducted to help patients with the disease. If you or a loved one is suffering from mesothelioma, there is hope. Also, You may be able to hold accountable those responsible for your suffering by seeking the advice of a qualified mesothelioma lawyer.

Mesothelioma Symptoms

Mesothelioma is a very serious malignant tumor that affects the torso of the human body. There is a very strong link between mesothelioma and exposure to asbestos particles (by breathing or swallowing). There are three common forms of mesothelioma:

Pleural Mesothelioma is the most common form of Mesothelioma. It starts in the chest cavity (after breathing the particles) before spreading to other areas.

Peritoneal Mesothelioma starts in the abdomen (after swallowing the particles) and accounts for about 10-20% of Mesothelioma patients.

Pericardial Mesothelioma is the rarest form of Mesothelioma. It starts in the cavity that surrounds the heart.Mesothelioma is so difficult to diagnose early because the symptoms are often mistaken for those of other, less serious ailments. To make matters worse, it often takes many years for the symptoms to show up after the asbestos exposure takes place.Here is a list of the most common Mesothelioma symptoms:

Difficulty breathing (shortness of breath)
A cough that won't go away
A change in your normal coughing pattern
Frequent hoarseness or raspy voice
Significant weight loss that cannot be explained
Difficulty swallowing
Pain in the chest or abdomen
Coughing up blood

If you experience one or more of these symptoms of Mesothelioma for more than a short period of time, you should consult your physician right away. Mesothelioma, by its very nature, is very difficult to diagnose early (many people simply ignore the symptoms at first).This is why you need to pay attention to your body and monitor your health for the symptoms, especially if you're in one of these high-risk occupations:

Brake Mechanics
Steel Workers
Insulators
Boilermakers
Shipfitters
Maintenance Workers
Pipe Fitters

Any other occupation where exposure to asbestos is possible or likely Once Mesothelioma is diagnosed, the chances of recovery vary according to several factors, including the size and location of the tumor, how much it has spread, and the age of the patient.In general, the earlier that Mesothelioma is diagnosed, the better the chances of survival. So if you experience any of the common Mesothelioma symptoms, see your doctor right away.

Who is at Risk for Mesothelioma?

Mesothelioma, the deadly disease which has topped news headlines for the last decade, is contracted through exposure to airborne fibers of asbestos. Sadly, the under-regulation of asbestos usage in years past, and arguably still today, exposed millions to airborne fibers and as a result thousands contracted the disease.

It can be safely said that almost everyone in the world has been exposed to asbestos in varying degrees. Because of the unique nature of the disease, even those who have suffered only minimal exposure are at risk of contracting the disease. In effect, virtually everyone has some risk of contracting Mesothelioma.

But this sort of statement perhaps oversteps the bounds of rationality. While it is certainly true that individuals who have been exposed to small amounts of asbestos for relatively short periods of time have contracted the disease, this is a rarity rather than a regularity. In fact, the vast majority of Mesothelioma cases involve individuals who were exposed to airborne asbestos fibers for intense and extended periods of time.

The industries most in danger of prolonged exposure and thus of contraction are shipbuilding trades, asbestos mining and milling, textile manufacturing, insulation work in construction, and brake repair personnel. There are, however, some other minor factors which can affect the likelihood of contracting the disease. Among these is radiation exposure. There have been causes in which individuals who were exposed to radiation have subsequently displayed signs of and ultimately contracted mesothelioma. However, empirical studies to attempt to verify this correlation have not proven out this claim very strongly.

Another more certain cause of the disease was the taking of the Polio vaccine between 1955 and 1963. Some batches of this vaccine were contaminated with Simian Virus 40 which has been detected in a host of rare cancers including Mesothelioma.

Those involved in construction or who lived in homes in the Cappadocian region of Turkey are also particularly at risk. In this region, homebuilders used Erionite, which is a type of zeolite silica stone. Exposure to the fibrous strands of this building material have led to an annual death rate of roughly 1% of the population which dies of mesothelioma each year in Turkey.

One of the most influential factors affecting Mesothelioma contraction is genetics. Some individuals who have been exposed to long periods and high quantities of asbestos have not contracted the disease. As a result, doctors have concluded that genetics play a major role in determining whether or not patients contract the disease. Unfortunately, the gene variability which offers some resistance to the disease also means that some are particularly vulnerable to asbestos exposure.

Mesothelioma- the Financial Costs to Society

Mesothelioma- the Financial Costs to Society

Much has been written about asbestos related diseases such as Mesothelioma over the last couple of years. The focus has been on three main areas:

a) The unfortunate victims of mesothelioma such as former employees of asbestos mining companies who caught these diseases whilst in the course of their employment. We have seen the heart rendering images on TV of these people, all of them in their retirement years, gasping for air and suffering enormously.

b) Whether the asbestos mining companies knew that asbestos mining was a danger to human life.

c) The Multibillion dollar class actions filed by the victims against their former employers seeking compensation.

Two issues that have not been addressed are the financial costs to society of asbestos related diseases such as Mesothelioma cancer and who pays for these costs. Secondly, should asbestos mining companies be paying compensation not only to the sufferers of mesothelioma and other diseases but also to Society also?

There are two costs to society that can be identified. The first is the cost to the public health system. The second cost is the loss of tax revenue by governments due to Asbestos mining companies claiming a tax deduction for the compensation payments that are made to the victims.

In illustration of the costs to the public health system, the Asbestos Diseases Foundation of Australia has stated that by 2020 there will be 13000 cases of mesothelioma and 40000 asbestos related lung cancer diseases, totaling 53000 people and this is only in Australia! This means that 53000 people will need to have constant medical attention for the next 15 years or so. The question therefore, who pays for the cost? The answer of course is the current taxpayer and the next generation of taxpayers.

In relation to tax revenue, governments are essentially missing out on tax revenue as the asbestos companies are claiming the compensation payment as a tax deduction. For illustrative purposes, assume that an asbestos mining company pays out $100m per year over five years to the victims. Also assume that the corporate tax rate is 30 per cent. Therefore over five years, a respective government is losing $150m in revenue. Essentially it means that the asbestos mining companies are sharing the costs with the taxpayer. They pay 70 per cent of the compensation payment and the taxpayer pays the remaining balance. Most people would view this as totally inequitable.

It can be seen that the Asbestos companies are only paying a part of the costs and not the full cost.

To rectify this, there are two possible solutions.

a) Respective Governments should also join class actions with Mesothelioma sufferers against the asbestos mining companies seeking compensation for medical and future medical costs. This would not be unprecedented as various State Governments of the United States sought compensation against the Tobacco Companies to pay for the medical costs of its citizens who needed medical attention because of the ill effects of smoking.

b) Governments deny a tax deduction for Mesothelioma compensation payments made by the asbestos mining companies.

Until either part a or part b happens, it is the taxpayer who will be unfairly burdened with the additional financial costs of Asbestos related diseases such as Mesothelioma.

10 Keys to Choosing a Mesothelioma Attorney

10 Keys to Choosing a Mesothelioma Attorney

Hiring a lawyer can be an intimidating process, especially if you've never hired one before. Mesothelioma and other asbestos-related cases are complex and require experienced, top notch attorneys. How do you know which lawyer will bring the attention and skill to your case that it deserves? We've compiled the following list to help you with your decision:

1. Trust your instincts. Do you feel comfortable talking with the prospective attorney? Does he or she listen and ask questions? If you feel that you are not being taken seriously, go elsewhere.

2. Check the attorney’s professional credentials. Carefully review the firm’s website and brochures, and check the attorney’s profile and rating at www.martindale-hubbell.com. If you’re still unsure, ask for references.

3. Make sure the firm is customer-oriented. Do you have direct access to the attorney who is actually responsible for your case? Does he or she return your phone calls promptly? Remember you are the customer and have the right to expect good service.

4. Ask if your case will be handled individually. Some firms will accept your case, only to bundle it with a large group of similar cases. This practice tends to diminish the value of stronger cases in order to help weaker ones.

5. Find an attorney with experience in mesothelioma litigation. Does your attorney have direct experience in mesothelioma litigation? Look nationally for a firm with a solid track record in this area.

6. Make sure your attorney has trial experience. Many attorneys have limited trial experience. Although most cases settle out of court, a lawyer with a strong trial record puts you in a better bargaining position during the negotiating process.

7. Find a skilled negotiator. Does your attorney have training in negotiation? What is his or her settlement value track record? Even though most lawyers spend a much greater percentage of their time negotiating than trying cases, very few attorneys have training or expertise in this area.

8. Ask the firm who their strategic partners are. Under certain circumstances law firms join forces to share their research, expertise and other resources in order to build the best possible case for you.

9. Make sure the firm works on a contingency fee basis. With this type of arrangement the law firm incurs all the financial risk. You don’t pay any out-of-pocket costs until the firm recovers compensation for you; fees are a percentage of the recovery.

10. Check to see if the lawyer is AARP-approved. If not, go to the AARP Legal Services Network to find an attorney. Besides being extensively screened by AARP to become approved, AARP attorneys offer AARP members a 20% discount on their standard legal fees.

Although selecting a qualified mesothelioma attorney is not easy, don't get discouraged. There are great lawyers out there who are genuinely interested in helping others. Your case deserves no less. For more information visit www.mesotheliomaadvice.org/legal/mesothelioma-attorney.asp.