Mesothelioma Vaccine

Cancer vaccines of any sort generally fall under the broader category of immunotherapy. Vaccines are best described as medicines that are designed to boost the body's natural immune system and protect it against bacteria or viruses that can cause disease. Most individuals are familiar with the vaccines that are administered to babies or young children. They are given to stop the development of certain diseases like whooping cough and tetanus. Cancer vaccines can do that, too; however, there are others that are also designed to keep an existing cancer from spreading. Two mesothelioma prevention cancer vaccines are now available in the U.S. but treatment vaccines are still in the developmental stages and many are currently being tested in clinical trials.
According to the National Cancer Institute, a mesothelioma vaccine - or one that is used for the treatment of any other type of cancer - must achieve two goals. It has to stimulate certain immune responses and direct them against the target, i.e. the cancer cells; and it must be powerful enough to overcome the barriers that cancer cells use to protect themselves from attack. As scientists discover how cancer cells can escape recognition by the body's immune system, they can better develop treatment vaccines that will meet these goals.

In March 2010, a group of Dutch doctors and researchers announced that they had developed the first vaccine for mesothelioma and reported their findings in the American Journal of Respiratory and Critical Care Medicine. The Dutch vaccine employs the use of tumor lysate-pulsed dendritic cells to stimulate the immune system, causing the body to produce mesothelioma-specific antibodies.

Treatment with this vaccine on clinical trial participants was achieved via a series of three vaccinations administered intradermally and intravenously over a two week period after mesothelioma chemotherapy. Results showed a positive effect in 80 percent of the individuals who participated. Side effects included a skin rash and flu-like symptoms for approximately 48 hours after the vaccines were given.

The results of the study indicated that the sooner the malignant mesothelioma patient receives the vaccine, the greater the chance of eliminating their disease. It's a very positive step in the right direction for mesothelioma cancer victims worldwide.

Sources

National Cancer Institute
http://www.cancer.gov/cancertopics/factsheet/Therapy/cancer-vaccines
Birmingham Science News Examiner
http://www.examiner.com

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Mesothelioma And Women

Traditionally, malignant mesothelioma is a form of asbestos cancer that affects men much more often then women. This is not because women are less genetically pre-disposed to the disease but merely because, historically, men more often worked at asbestos jobsites that put them in contact with dangerous asbestos. That said, however, mesothelioma disease has indeed been diagnosed in women, though on-the-job exposure is often not the reason for the development of the disease.

Some studies have also demonstrated that women who develop mesothelioma are much more likely to acquire peritoneal mesothelioma, the abdominal form of the disease, with the mesothelioma risk factors increasing five-fold with increasing exposure. This is noted in a study published in the journal, Chest. The reasons why are not clear but studies continue in hopes of discovering the answer to this question.

Reasons for Mesothelioma in Women

Because many women were part of the work force during World War II, some of them were regularly exposed to asbestos in shipyards, factories, and other places where they contributed to the war effort, and some of these women developed mesothelioma. These cases were indeed a result of direct exposure to asbestos.

Many of the women who are diagnosed with mesothelioma, however, have been deemed victims of second-hand asbestos exposure. This means they had no direct exposure to the toxic mineral but were perhaps subject to exposure by an indirect means. Generally, this occurred most often during the years when men worked in chemical plants, oil refineries, power plants, steel mills and factories that made widespread use of asbestos. The men - often husbands or fathers of the women who would later develop mesothelioma - would bring asbestos dust home on their clothes and the fibers would be inhaled by others living in the home. Often, these victims were the women who would wash their clothes. As a matter of fact, a 1997 study conducted by Durham (VA) and Duke University Medical Centers was able to identify a history of asbestos exposure in about 75 percent of the women who participated in their study; more than half of those 75 percent had suffered exposure due to household contact with asbestos workers.

In some cases, though rarely in the United States, women are exposed to naturally-occurring asbestos. This is asbestos that is found in the ground and is usually of the very toxic amphibole variety. This accounts for a high rate of mesothelioma cancer in countries like Turkey and its surrounding areas, where asbestos is abundant.

Sources

Malignant mesothelioma in women. Anat Pathol. 1997;2:147-63.

http://www.ncbi.nlm.nih.gov/pubmed/9575374

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Child Mesothelioma

Because it has a lengthy latency period and is primarily associated with industrial exposure, mesothelioma is a form of asbestos cancer that is usually suffered by older men; average age at the time of diagnosis is sixty-five.
Malignant mesothelioma is extremely rare in children, but has been known to occur. A study carried out and published in the late 1980s examined eighty children who had been diagnosed with mesothelioma; however, only five percent of these subjects had a known history of asbestos exposure. Of the eighty children studied, four had been knowingly exposed to asbestos, while one had received radiation treatments and another had suffered from prenatal exposure to a drug known as isoniazid, which is used in the treatment of tuberculosis.
It was later determined that only ten of the children actually had mesothelioma cancer; others had been diagnosed with other forms of cancer. Six were boys, and eight had the pleural variety. Two of the children were mesothelioma survivors until the age of nineteen.

In another study, the cases and death certificates of 42,597 children who had died of childhood cancer in the U.S. during the 1960s were examined and reviewed. Of these, only 31 had been diagnosed with mesothelioma disease, and less than half of those could be confirmed by hospital records. Unfortunately, there was no history of asbestos exposure in any of the thirteen confirmed mesothelioma cases.
This does not mean that asbestos played no part in the children's disease; secondary exposure and genetic predisposition all play a large part in mesothelioma, and fetal exposure is not unknown. Childhood mesothelioma however remains the rarest form of this disease.

Sources

Cooper SP, et. al. "Epidemiologic Aspects of Childhood Mesothelioma." Pathology and Immunopathology Research Vol. 8:276-286 (1989)
Fraire AE, et. al. "Mesothelioma of Childhood." Cancer, Volume 62 Issue 4, Pages 838-847 (June 2006)
Grundy, Gordon W., et. al. "Malignant Mesothelioma in Childhood. Report of 13 Cases." Cancer, Volume 30 Issue 5, Pages 1216-1218 (June 2006)

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Adult Mesothelioma

Although mesothelioma can strike at any age, the majority of cases are found in men aged sixty-five and older. Although the gender factor is not entirely clear, age at diagnosis is due to the lengthy mesothelioma latency period. In most cases, it can be as much as sixty years between initial exposure to asbestos and the appearance of mesothelioma symptoms leading to a mesothelioma diagnosis. In the case of pleural mesothelioma, symptoms can also be indicative of many other disorders that range from something as innocuous as the common chest cold to emphysema or tuberculosis; moreover, the malignancy does not normally form lumps like most tumors, but rather spreads in a sheet-like fashion. These factors make diagnosis difficult.

Another factor has to do with the amount and intensity of asbestos exposure. The greater the intensity of the exposure, the higher the chances of contracting mesothelioma. This is one reason that most victims are men in their sixties and older. However, there are documented cases involving mesothelioma and women. In one case, a woman who was a first responder on 11 September 2001 and contracted fatal mesothelioma, dying within five years because of the high concentration of asbestos fibers that day.

Those who have a family history of cancer are also more likely to contract mesothelioma. Studies have shown that DNA can attach itself to asbestos fibers; this interaction results in the cellular mutations that cause cells to become malignant.

The only sure mesothelioma cure is mesothelioma prevention and regular health monitoring and screening; diagnosed in its earliest stage (when it is still localized and has not yet spread), mesothelioma treatment can be successful.

Sources

Roggli VL, Pratt PC and Brody AR. "Asbestos Fiber Type in Malignant Mesothelioma: an Analytical Scanning Electron Microscopic Study of 94 Cases." American Journal of Industrial Medicine. 1994 Apr Vol. 25(4). pp. 609-10
WrongDiagnosis. "Mesothelioma, Adult Malignant."
http://www.wrongdiagnosis.com

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Mesothelioma Prevention

Mesothelioma is an extremely aggressive and deadly form of cancer that is almost exclusively caused by exposure to asbestos fibers. Although mesothelioma disease is relatively rare, it is one of the most painful and difficult to treat; the best cure for mesothelioma is prevention. Ultimately, this means avoiding asbestos exposure. Although the chances of contracting mesothelioma are proportional to the amount and intensity of the exposure, the disease has been known to develop in people whose exposure has been minimal - but who have a genetic predisposition to cancer.

The U.S. Occupational Safety and Health Administration (OSHA) has enacted a number of regulations to protect workers on the job at asbestos jobsites, where most asbestos exposure takes place. Under current laws, the maximum permissible level of exposure is 01. fibers per cubic centimeter for an eight-hour work day and one fiber per cubic centimeter during any thirty minute period. In addition, employers are obligated to monitor and regulate the work environment and provide employees with protective gear and safety training.

The Environmental Protection Agency (EPA) has also issued recommendations on how people can protect themselves against non-occupational asbestos exposure:

1. Regular inspection and monitoring of asbestos products or materials in and around the home; asbestos was part of many common building materials.
2. Having asbestos abatement carried out by trained, licensed professionals with proper safety equipment only.
3. Avoiding sweeping, vacuuming, sanding, scraping or otherwise disturbing any surfaces that may be made from asbestos or contain asbestos materials.
4. Avoiding the use of tobacco; studies have demonstrated a link beween smoking and mesothelioma showing that smokers face up to a 9000% greater chance of contracting asbestos cancer
5. Getting regular checkups, particularly if there is a known history of asbestos exposure (i.e. having worked in an industrial occupation).

This last part is especially important, as many mesothelioma symptoms are indicative of other diseases as well.

Sources

American Cancer Society. "What Are The Risk Factors For Mesothelioma?"
http://www.cancer.org
"Mesothelioma Prevention"
http://www.wrongdiagnosis.com/m/mesothelioma/prevent.htm#preventlist

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Mesothelioma Life Expectancy

Numerous issues determine a mesothelioma patient's life expectancy once a diagnosis has been made. The stage of the disease, location and variety as well as the course of treatment and the patient's age and overall health can all play a significant part in determining how long the patient will survive.

Traditionally, mesothelioma patients have the worst prognosis of all cancer patients. The primary reason for this is the fact that mesothelioma latency period is long (i.e. usually measured in decades), and the symptoms are common to numerous other diseases that run the gamut from minor to life-threatening. for these reasons, mesothelioma is not usually diagnosed until the disease has reached an advanced stage, by which time little can be done other than attempts to make the patient more comfortable during his/her final days.

Mesothelioma types and location also significant in this regard. Epithelial mesothelioma tends to move more slowly, whereas sarcomatoid mesothelioma is more aggressive. Additionally, pleural mesothelioma and the very rare pericardial mesothelioma varieties that affect the respiratory system and heart respectively, tend to have more immediate effects. Those with the abdominal peritoneal type are known to have a slightly better mesothelioma prognosis. In some cases, such as those of Australian Paul Kraus and American Rhio O'Connor, patients with peritoneal mesothelioma have been able to live with the disease for a decade or more. Younger people (under age 65) who are in better health overall also have better mesothelioma survival rates.

In general however, the prognosis for a mesothelioma patient is not good. The most serious problem lies in the fact that by the later mesothelioma stages of the disease, cancer has spread - in some cases, to distant parts of the body. The average life expectancy of a mesothelioma patient following mesothelioma diagnosis is between four weeks and fourteen months.

Sources

Curran, D. et al. "Prognostic factors in patients with pleural mesothelioma: the European Organization for Research and Treatment of Cancer experience." Journal of Clinical Oncology, 16, 145-52.
Scagliotti, G.V., et al. "State of the art in mesothelioma." Annals of Oncology, 16 Supplement, ii240-5

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Mesothelioma Survival Rate

A common query for those who have been diagnosed with mesothelioma is “How long can I live with this disease?” Indeed, many patients will turn to their doctor with this question as will their concerned friends and family members. As with most diseases, however, there is no one answer as to the life expectancy of a meso patient, but - in general - the mesothelioma survival rate is based on a number of different factors. Every case is a little bit different and though the survival rate for mesothelioma victims has traditionally been grim, more and more patients are living longer with the disease as scientists discover more and better ways to detect the disease and to treat it.

Survival rates for mesothelioma patients depend on numerous factors that may include any or all of the following:

• mesothelioma latency period - Mesothelioma is an unusual form of cancer in that it has a very long latency period. Essentially, this means that the disease often “hides” in the body for many years, often up to four or five decades. Hence, 40-50 years may have passed since initial exposure to asbestos first occurred. This extended latency period also means that the disease is not detected until symptoms arise. Often, by that time, the cancer has spread from the primary area to other parts of the body.
• stage of disease at the time of diagnosis - Those whose mesothelioma is discovered in Stage 1 or 2 have a much better chance of surviving the disease for an extended period of time because more treatment options will be available to them. Those with Stage 3 or 4 mesothelioma will have fewer treatment options. The worst mesothelioma prognosis is seen in these patients with advanced cancer that present or are symptomatic with distant metastases of the primary tumor, i.e., the cancer has spread from the primary area to other parts of the body. 
• operability of the tumor - Due to the aforementioned latency period, surgery to remove the primary mesothelioma tumor is often not an option. However, if the disease is discovered in an early stage, a surgical procedure to remove the tumor may be a possibility, especially when the patient is otherwise healthy.
• age of the patient - The younger the patient, the better the chance for survival. Studies have shown that age does indeed play a factor in survival rate and young patients certainly fair better. 
• Co-morbidity with other illnesses - Patients, especially older ones, who have many other medical issues are less likely to survive for any length of time with mesothelioma. This is especially true with older patients, who account for large numbers of mesothelioma victims. Heart disease, kidney problems, diabetes, hypertension, and a host of other illnesses or disorders can severely impact treatment options and, hence, shorten a patient’s life span.
• mesothelioma treatment plan - The length of time a mesothelioma victim survives may depend on the treatment(s) he receives. Most doctors will be as aggressive as possible, understanding that this is a tough cancer to treat. 
• area and type of the disease - Mesothelioma comes in various forms. About 75 percent of cases appear in the pleura, 15 to 20 percent in the peritoneum, and just 5 percent in the pericardium. Pleural mesothelioma is easier to treat and patients will generally have a longer mesothelioma survival rate than those whose disease is centered elsewhere. In addition, those with epithelial mesothelioma (most cases are of this type) have a better prognosis than those with other types of mesothelioma.

Mesothelioma Survival Rate Statistics

Mesothelioma is a form a cancer with a notably poor prognosis; mesothelioma life expectancy following diagnosis ranges between eight and fourteen months. The primary reason is the lengthy mesothelioma latency period as well as the fact that early mesothelioma symptoms are indicative of numerous other respiratory diseases as well, often delaying a correct diagnosis. While Stage 1 or stage 2 mesothelioma is often potentially curable, Stage 3 and stage 4 mesothelioma is not; such patients are often relegated to palliative treatments to relieve symptoms and restore quality of life.

Mesothelioma prognosis is officially determined by a standard measure known as the relative five-year survival rate. This number indicates how many patients are still alive five years after being diagnosed with the disease. Currently, the relative five-year survival rate for meso is about 10 percent, a number that is significantly higher than it was a few decades ago. The one-year survival rate has also improved throughout the last 20 years or so and now sits at approximately 40 percent. Nevertheless, the overall mesothelioma survival rate remains poor.

However, there are exceptions to the rule and there are some individuals who have defied the normal mesothelioma survival rate. One man, Australian Paul Kraus, has been living with the disease since 1997, designing his own treatment program and shunning traditional medicine. Other meso victims who have been treated with standard therapies like chemo and radiation have also survived longer than the usual 10-11 months after diagnosis. For example, there are recorded cases of patients with a typical mesothelioma prognosis that beat the odds and survived with the disease for ten years and longer. In two cases (both elderly women), mesothelioma remission occurred for no apparent reason.

It has been difficult for doctors to determine why one patient can survive with mesothelioma for years and others succumb to the disease within a year of diagnosis. Some indicators point to the role of the immune system in fighting the disease; many survivors participated in some sort of treatment that served to enhance their body’s immune system.

Source
www.survivingmesothelioma.com

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Mesothelioma Survivors

Mesothelioma is a serious cancer that, although latent in the body for usually decades before symptoms become apparent, once mesothelioma symptoms are apparent and a diagnosis is reached, patients often face a short mesothelioma life expectancy. The good news is that there are some long-term survivors of mesothelioma, and their cases may help researchers to unlock the clues that will one day help to provide a mesothelioma cure for this life-threatening illness.

Paul Kraus and Other Survivors

One such individual is Paul Kraus, who is from Australia. Because asbestos is found in Australia, the country suffers from some of the highest rates of mesothelioma in the world. Mr. Kraus was exposed as a youth on a summer job he took in 1962. The cancer was latent until 1997, when he was diagnosed. However, through a series of alternative mesothelioma treatments, changes to diet, as well as meditation, Mr. Kraus has caused the cancer to not progress, and has lived with the disease to the current day of 2009. Mr. Kraus discovered that cancer cells do not thrive in an oxygen-rich environment, and thus he undergoes ozone therapy on a regular basis. Ozone is oxygen with one extra atom attached to the molecule. His diet includes nutrient-rich foods that help the body remove toxins and prevent the buildup of new ones. His positive outlook on living is also part of his care regimen that appears to be having excellent results in terms of controlling his cancer.
Other survivors of mesothelioma were described in Cancer Monthly's April 2007 issue. Three patients took part in treatments that ranged from mesothelioma surgery to minimal radiation, and these individuals lived for many years, up to fourteen years, after being diagnosed with mesothelioma.

Treatments that Survivors Have Used

What Paul Kraus and now oncology researchers have come to understand is that the body's immune system plays a part in mesothelioma survival rates. A Swiss study indicates that the when asbestos fibers are present in the lung tissue, the immune system, over the decades of time the disease is latent, eventually becomes fatigued trying to fight them off. Another immune system issue is cell identification. Because the body produces the cancer cells, pathogen-attacking white-blood cells do not fight the cancer cells because they do not see them as "foreign invaders." However, research is underway to figure out how to train the immune system to fight the cancer cells.

What is clear is that the earlier any type of cancer is detected and then treated, including mesothelioma, the better chance that it can be cured. Because of the typical mesothelioma latency period mesothelioma is often quite advanced by the time of diagnosis. A Japanese company has recently developed a blood test that can identify protein markers that are in high levels in the blood, as an early warning sign that mesothelioma cancer may be present, offering hope for earlier detection of this disease.

A new treatment option may be found in mesothelin. When combined with recombinant "immunotoxins," the mesothelin is sent back to the mesothelium to combat the cancer cells there, forcing them to die.
As Paul Kraus and other long-time mesothelioma survivors understand, meditation, a positive mental outlook, and stress reduction all seem to play a part in these survivors' longevity. Common in Eastern medical traditions but a fairly new idea in the West, the mind-body connection, along with alternative treatments and appropriate nutrition all play a role in keeping malignant mesothelioma under control.

Sources

Hassan, R. "Mesothelin Targeted Cancer Immunotherapy." European Journal of Cancer, August 2007.
Kraus, Paul. Surviving Mesothelioma and Other Cancers: A Patient's Guide. (Raleigh: Cancer Monthly, 2005)
Mitchell, Steve. "Clearing the Air Over Asbestos." ScienceNOW Daily News, 10 April 2008.
Staff. "Mesothelioma and the Immune System." Cancer Monthly, April 2007.

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Mesothelioma Cure

Although currently there are no cures for the asbestos cancer known as mesothelioma, research is moving in a hopeful direction toward finding a cure. Treatments to better manage the disease and live longer are available at this time, and offer a range of options for mesothelioma patients and hope for a greater mesothelioma life expectancy.

Understanding Mesothelioma

Mesothelioma is a type of cancer that affects the mesothelium, which is a lining that surrounds the heart, lung, and abdominal cavity. The major cause of malignant mesothelioma is exposure to asbestos, and in particular the blue ‘crocidolite' and brown ‘amosite' types of asbestos. The asbestos particles, once they have been breathed in, act like tiny needles that work their way into the lung tissue and out into the outer layer surrounding the lungs, the mesothelium. Although how it happens it not presently understood by medical researchers, the presence of asbestos in this area causes cells to mutate, and the cancer to form. Changes to the immune system due to the presence of the asbestos particles may play a role in the formation of the cancer, but more research is needed to fully understand its cause.

The mesothelioma latency period is quite long before mesothelioma symptoms become apparent. What this has meant in the past is that once the cancer is discovered, it is often in latter stages of development, making it harder to treat the cancer. Surgery, mesothelioma chemotherapy and radiation treatments were given to help relieve pain, but recovery levels were not high.

The Road to a Cure

Japanese researchers working to change that have developed a new blood test. Earlier detection is possible with the Mesomark test, which looks for protein markers that are often tied to cancers. This test may make it possible to stop this disease with surgical procedures in the early stages, and offers hope for a higher success rate.

An early-stage vaccine was recently developed by researchers at the Erasmus Medical Center in the Netherlands that has thus far show fairly promising results. The experimental vaccine utilizes dendritic cell immunotherapy, in which the body’s immune system, is trained to target and destroy malignant mesothelioma cells. The vaccine is comprised of a sample of the patient’s own dendritic immune cells that have been introduced to proteins taken from the mesothelioma tumor. Once reintroduced into the body, these cells have a defense mechanism built in to attack the tumor.

While the trials are in their early stages, the hope is that soon, those who may be at risk for mesothelioma (i.e. those exposed to asbestos), may be able to prevent tumor development altogether, or defend and eliminate developing tumors in their early stages. Thus far, the vaccine has been used only in patients diagnosed with malignant pleural mesothelioma.

Mesothelioma doctors and researchers have also examined the steps a long-time mesothelioma cancer survivor, Paul Kraus, has taken to live with this disease for going on 14 years. Although the treatments he partakes in are considered to be outside traditional clinical oncology, they have worked effectively for him to keep the cancer in check. In addition to oxygen treatments, he also eats a nutrient-rich vegetarian diet, many vitamin supplements, and prays and meditates. He has ozone, which is a form of oxygen, injected into his blood, to form an environment where the cancer cells do not thrive. Because oxygen can cause damage to healthy cells, he counters this effect with anti-oxidants in the foods he eats. Anti-oxidants are also supposed to keep cancers at bay.

Curative Surgical Approaches to Mesothelioma

Dr. David Sugarbaker is widely considered the country’s leading mesothelioma expert, and is currently engaged in the most progressive clinical therapies for malignant pleural mesothelioma. His most aggressive therapy involves the use of surgical resection in the form of an extrapleural pneumonectomy in conjunction intra-operative, intrapleural chemotherapy, with adjuvant radiation therapy. Extrapleural pneumonectomy involves total pneumonectomy (removal of entire affected lung), the removal of the pericardium, the entire pleura, and the diaphragm. Following resection of these internal structures, the pericardium and diaphragm are reconstructed with prosthetic material. While the tumor mass and lung are resected, Cisplatin or other prescribed chemotherapy is applied directly to the surface of the internal organs in the hope to eliminate all remaining tumor cells. Radiation therapy is then administered following the patient’s recovery from surgery.
In patients considered ideal candidates for EPP with adjuvant chemotherapy and radiotherapy, five-year survival rates have thus far been encouraging. Dr. Sugarbaker continues to advocate the use of GEMzar® (Gemcitabine) in many patients who have encountered adverse reactions to Cisplatin. Because the surgery and tri-modal approach utilized by Dr. Sugarbaker is extensive, many patients have utilized physical therapy, and other palliation therapies following treatment to regain mobility and for symptomatic pain relief.
There are also new mesothelioma treatment options that, while currently considered experimental, may provide an effective cure after further testing and research are conducted. Dr. Stephen Cantrell, as reported in Medical News Today, has combined a protein used by the immune system called interferon with cholesterol-lowering medication in a regimen called "Neo-Plas. It is thought that killer cells are activated by the interferon, and thus may help by going after the cancer cells. Early results are hopeful that this may provide a potential cure for mesothelioma and higher numbers of mesothelioma survivors.

Sources

Kraus, Paul. Surviving Mesothelioma and Other Cancers: A Patient's Guide. (Raleigh: Cancer Monthly, 2005)
McCabe, Edward. O2xygen Therapies: A New Way Of Approaching Disease. (Energy Publications, 1988).
Staff. "Boysenberries Seen to Impede Asbestos-Induced Mesothelioma". Environmental Health News, 8 February 2007.
Staff. "New Cancer Treatment Stops Aggressive Sarcomas." Medical News Today, 28 February 2008.

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Mesothelioma Remission

Mesothelioma is a cancer of the mesothelium, or lining, which surrounds the abdominal cavity, the lungs and the heart. Because of its commonly long mesothelioma latency period before diagnosis, the cancer is often far developed by the time a mesothelioma diagnosis occurs, and thus does not often go into remission. Remission is when the mesothelioma symptoms disappear in full or in part. However, there have been some encouraging recent cases of patients who consider themselves mesothelioma survivors because they have been able to manage the disease and live with it for several years. They have achieved this through alternative mesothelioma treatment therapies as well as major adjustments to their diets. Although mesothelioma chemotherapy and radiation treatments are still used in advanced cases of mesothelioma, new diagnostic methods offer hope that physicians may soon be able to diagnose this cancer earlier, and may thus be able to apply treatment much sooner to eliminate it.

Detection of Cancer

Malignant cancer cells are present in conjunction with protein markers. Patients who have been exposed to asbestos in the past also show higher levels of osteopontin protein, as reported in a New England Journal of Medicine 2005 article, a promising new bit of understanding about this form of cancer. Japanese researchers have also developed a new tool to detect mesothelioma in the earliest stages, when surgery could provide a superior mesothelioma treatment. This diagnostic tool is the Mesomark®.

Traditional Treatments

Chemotherapy and mesothelioma radiation are typical treatments used for many types of cancer, including mesothelioma. However, the Japan Journal of Clinical Oncology reported in 1998 that a 71-year old woman with peritoneal mesothelioma was given cisplatin and tegafur-uracil, two common chemotherapy drugs. This caused the patient to go into complete remission.

Adjuvant radiation therapy, which is a therapy applied after mesothelioma surgery, helps to reduce the recurrence of cancer, according to a study held at Sloan-Kettering. The type of radiation therapy often used is known as EBRT, or External beam radiation therapy.

Alternative Treatments

Paul Kraus, a patient who has stopped the progression of his mesothelioma for fourteen years as of 2009, has done so through oxygen therapy, as well as diet and meditation. The oxygen therapy is based on evidence showing that cancer cells grow in a low-oxygen environment, so by increasing the oxygen it has helped to slow the disease.

Dr. William Coley developed a different treatment in the late 19th and early 20th centuries. He injected strep throat bacteria into a patient with cancer, and this caused the patient's own immune system to kick in, with the result that the cancer cells went into remission.

In the 1980s, Dr. Demetrio Sodi-Pallares, a Mexican electrocardiologist, determined that by changing the diet and using a magnetic pulsating mattress of a patient with pleural mesothelioma, that the patient's effusions eventually disappeared. Unfortunately, the doctor's work has not been paid much attention in the United States.

Remission with No Outside Treatment

Although unusual, there has been a case reported of spontaneous remission of mesothelioma cancer in Australia. The 61-year old woman, a patient of Dr. Roger K. Allen of the Wesley Medical Centre, went into a rapid remission. The physician suggests that what caused the remission was the patient's own immune system as well as "cell-mediated immunity." Further study may lead to immunotherapy as a method of treatment leading to the remission of this type of cancer.

Sources

Allen, Roger K. "Apparent Spontaneous Complete Regression of a Multifocal Malignant Mesothelioma of the Pleura." The Medical Journal of Australia, 2007.
Ito, H, et. al. "A Case Of Malignant Peritoneal Mesothelioma Showed Complete Remission With Chemotherapy." Japan Journal of Clinical Oncology, 28 Feb 1998.
Kraus, Paul. Surviving Mesothelioma and Other Cancers: A Patient's Guide. (Raleigh: Cancer Monthly, 2005)
Lüderitz, Berndt, and Augustin Castellanos, eds. "History: Demetrio Sodi-Pallares (1913-2003). Journal of Interventional Cardiac Electrophysiology, 2004.
Pain, Stephanie. "Dr. Coley's Famous Fever." New Scientist, 2 November 2002.
Rusch, VW, et. al. "A Phase II Trial Of Surgical Resection and Adjuvant High-Dose Hemithoracic Radiation For Malignant Pleural Mesothelioma." Journal of Thoracic and Cardiovascular Surgery, 2001.

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Mesothelioma Latency Period

Malignant mesothelioma often has a long period of latency, in fact the longest of the asbestos-related diseases, before a mesothelioma diagnosis occurs in people. Diagnosis happens by mesothelioma doctors when the disease becomes apparent, but latency refers to the length of time it takes from being exposed to asbestos until the time when the disease becomes apparent in a clinical examination. Latency can be as short as 10 years or as long as 50, but the average length of latency for malignant mesothelioma is 35 to 40 years between exposure and diagnosis.

Because the latency period for mesothelioma can vary from patient to patient, so too does the age of onset of the disease vary. However, most adult mesothelioma cases are diagnosed in patients between the ages of 40 and into their 60s. Child mesothelioma, while rare, does occur in 2 to 5 percent of malignant mesothelioma diagnoses.

A shorter latency period may occur if a patient has had a higher exposure to asbestos. Many of the people who have a short latency period were exposed to asbestos on the job; this is especially true of people with occupations in shipyards as well as the asbestos and insulation industries.

The typical long latency period of this disease is a contributing factor to a poor mesothelioma prognosis. Most cancers respond much better if they are caught early in their development. Because mesothelioma remains under the surface for typically many years, it is often quite advanced once a diagnosis is made.

Forms of Mesothelioma


The different types of mesothelioma cancer are named based on the parts of the body in which the disease occurs. The three primary mesotheliomas are:

• Peritoneal mesothelioma
• Pleural mesothelioma
• Pericardial mesothelioma

Peritoneal mesothelioma is found in the abdomen, while Pleural mesothelioma occurs in the lungs. Pericardial mesothelioma happens in the area of the heart. Where the cancer occurs may also play a part in the latency period; a study showed that 28 years was the average latency period for peritoneal mesothelioma with an average asbestos exposure duration of 5 years, and 35 years latency period with 11 years exposure duration for pleural mesothelioma, but exposure duration could vary widely.

Asbestos Exposure

Exposure to asbestos while on the job appears to be the major cause of mesothelioma. Asbestos was widely used in the United States in the 1960s, and thus the disease tends to become most apparent 30 to 40 years after this, so perhaps the peak of diagnoses in the U.S. will have been between 2000 and 2004. Because laws on exposure to harmful elements while on the job were put into place, it is expected that these statistics will not be on the rise. Australia and Europe may see a peak in 2010 to 2019, and it remains to be seen what will occur in third world countries without the benefit of strong occupational hazard laws in place.

The Future


These statistics may be in flux, however, for several reasons. They include:

• better health care and better food, people are living longer after retirement
• better occupational exposure regulations, workers are no longer exposed to high levels of asbestos
• better occupational exposure regulations, workers are no longer exposed to high levels of asbestos
• Fewer cases of bronchogenic cancer, which may be fatal in workers exposed to asbestos, before the mesothelioma has made a physical impact

Due to these factors, we may see more cases of new-onset mesothelioma.
Secondary or limited exposure to asbestos is a contributing factor to the difficulty encountered when trying to figure out exactly when asbestos exposure occurred. However, one of the consequences of the World Trade Center disaster may help researchers to better understand this disease. Because rescue, cleanup, recovery and volunteer personnel were exposed to asbestos along with other airborne contaminants, long-term studies of these people are under way, which may assist researchers in gaining more knowledge about this serious disease.

Sources

Neumann V, Gunther, S., Muller, K.M., Fischer, J. Malignant Mesothelioma - German Mesothelioma Register 1987-1999. International Archives Of Occupational And Environmental Health. 2001 August. Vol. 74 (6), pp. 383-95.
Varan, A. et al. Malignant Mesothelioma in an Adolescent Boy. Pediatrics International. 1999 Dec. Vol 41 (6), pp. 693-695.
Chahinian, A.P., Pajak, T.F., Holland, J.F. Norton, L., Ambinder, R.M., and Mandel, E.M. Diffuse Malignant Mesothelioma: Prospective Evaluation of 69 Patients. Annals of Internal Medicine. 1982 June. Vol 96 (6 Pt 1), pp. 746-55.
Robinson, B.W., Lake, R.A. Advances in Malignant Mesothelioma. The New England Journal of Medicine. 2005 Oct. Vol 353 (15), pp 1591-603.
Ohar, J., Sterling, D., Bleecker, E., Donohue, J. Changing Patterns in Asbestos-Induced Lung Disease. Chest. 2004 Feb. Vol 125 (2) , pp 744-53.
Landrigan, P.J. et al. Health and Environmental Consequences of the World Trade Center Disaster. Environmental Health Perspectives. 2004 May. Vol 112 (6), pp 731-9.

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Mesothelioma Disease

Mesothelioma is a rare form of cancer that attacks the cells of the mesothelium, a thin membrane that lines the thoracic and abdominal cavities as well as the heart sac. It has been determined that the cause of mesothelioma is almost always exposure to asbestos. This disease is one of the most aggressive forms of cancer and there is no known mesothelioma cure. Unfortunately, most patients die within just a few years of a mesothelioma diagnosis.

History


Mesothelioma cancer was first described and recognized as a pathologic entity in the 1870s by E. Wagner, who found two cases during a study of some 3,000 autopsies. However, this form of cancer was not recognized as a separate form of lung cancer until almost 100 years later. In 1960, a report by Wagner et al finally established asbestos as a definitive cause of the disease, citing a study of 30 cases of mesothelioma in South Africa, including those who were exposed on their jobs as miners and others with simply passing exposure. By just a few years later, the British Journal of Industrial Medicine confirmed that miners as well as those who lived near asbestos mines but didn’t work in mining were both developing the disease. Many similar reports followed.

Asbestos and Mesothelioma

As studies continued to point to asbestos as one of the primary mesothelioma causes, it became more and more evident that this mineral was wreaking havoc with the lungs of those who were consistently exposed to it. A close look at asbestos, its types, and its uses would soon prove necessary in the study of mesothelioma disease.
Asbestos comes in a variety of shapes and sizes. Some types of asbestos are more lethal than others. As a matter of fact, the types of asbestos that belong to the amphibole group are the most toxic. These include amosite, tremolite, crocidolite, actinolite, and anthophyllite asbestos. The fibers that make up these amphibole varieties are long, thin, and sharp. Once inhaled, they are difficult to expel and become imbedded in the chest area where they cause scarring and can eventually result in the development of cancerous tumors and mesothelioma disease.

The serpentine form of asbestos - known as chrysotile - has been proven to be less likely to cause cancer but is hazardous nonetheless. Experts advise that any kind of asbestos exposure is unsafe and there have indeed been cases when chrysotile fibers were found in the lungs of those with mesothelioma disease.

Risk Factors

Asbestos has been mined for centuries, but the mineral, long considered a prime insulating material, enjoyed increased use after the Industrial Revolution. In particular, peak usage of this hazardous mineral occurred from the 1930s through the 1970s, and asbestos use was especially popular during World War II, particularly in the shipbuilding industry.

A total of about 90% of all patients who develop mesothelioma disease are believed to have been exposed to asbestos in the workplace. Navy vets and shipyard workers account for about one-third of these cases, putting them in the highest risk group for developing this aggressive cancer. Furthermore, in 1978, a study found that the disease affects 6% of workers who have been employed in high-risk occupations at asbestos jobsites for 15 years or longer, confirming that length of exposure may also have something to do with who gets asbestos and who does not.

Recent events have also shown that exposure to a large amount of asbestos for a short amount of time may also result in development of this disease. For example, emergency responders who worked at the World Trade Center disaster were diagnosed with pleural mesothelioma or peritoneal mesothelioma within just a few short years of being exposed to the material in the days surrounding 9/11. The first Sept. 11-related victim of the disease died in 2005, just four years after the tragedy occurred.

Individuals may also suffer secondhand exposure to asbestos. In 1990, for example, researchers discovered that half the mesothelioma patients under the age of 40 were exposed to asbestos in childhood. Many grew up in the shadow of an asbestos plant or mine, some lived near a natural source, and others had family members who worked with asbestos and inadvertently brought fibers into the home on their clothes, skin, or in their hair.

Today, the average mesothelioma patient is a white male, 65 years of age or older.  However, this statistic has more to do with employment than with specific mesothelioma risk factors. In addition, researchers have studied the impact of certain genetic factors on the development of mesothelioma and note that those with a family history of cancer have a greater chance of developing mesothelioma. This may explain why some individuals with only minimal exposure develop the disease.

Treatment


Regardless of how and why an individual develops mesothelioma disease, doctors acknowledge that it is one of the most difficult cancers to treat. The disease has a long latency period, remaining essentially silent for up to five decades. Because it is usually not diagnosed until it has reached advanced mesothelioma stages, most standard treatments for cancer are not very effective in slowing the disease, adding only a few months to the patient’s life expectancy. However, some newer treatments such as mesothelioma gene therapy and photodynamic therapy have shown promise in fighting this cancer and tests are being developed that will help detect the disease at an earlier stage, providing more hope for the meso patient.

Sources
Wagner JC, Sleggs CA, Marchand P (October 1960). "Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province". Br J Ind Med. 17: 260-71.
PMID 13782506
http://medicineworld.org/cancer/mesothelioma
http://www.cancer.org/Cancer/CancerCauses/OtherCarcinogens/Pollution/asbestos

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Mesothelioma Information

As with any disease or health condition, mesothelioma researchers have, over time, collected statistical information about mesothelioma. These statistics can help us learn about the proclivities of the disease and its incidence and potentially help future patients as we learn more about mesothelioma.

Incidence of Diagnosis

New cases of mesothelioma are diagnosed in between 2,500 and 3,000 Americans each year. These numbers, while significant, would indicate that mesothelioma is still a relatively rare disease, though incidence is expected to rise in the next decade according to projections.

Age at Diagnosis

The first diagnosis of mesothelioma typically occurs in men and women between the ages of 50 and 70 years. Mesothelioma patients, certainly, have been diagnosed at ages younger than 50 and older than 70, but diagnoses for those age groups are considered statistical anomalies.

Does Mesothelioma Occur in a Particular Sex or Racial Demographic More than Another?

Mesothelioma is much more common in men than women, due mostly to occupational asbestos exposure being more common among men of industrial labor sites. That is not to say, however, that women cannot be diagnosed with mesothelioma. In fact, recent evidence suggests that mesothelioma incidence in women may rise in the coming years as secondary exposures to asbestos can manifest in the form of a positive mesothelioma diagnosis. Also of note is that mesothelioma is much less common among African Americans than white Americans, the reasons for which researchers are still investigating.

What are Typical Patient Survival Rates Following a Mesothelioma Diagnosis?

As mesothelioma is often diagnosed in its advanced stages, the mesothelioma prognosis is sometimes poor with life expectancy being little more than a year following diagnosis. If diagnosed early enough however, patient prognoses increase dramatically. Patient survival rates are often contingent on the treatments available to the particular patient. In early mesothelioma stages, tumors eligible for mesothelioma surgery and will result in improved prognoses over those who are diagnosed with stage 3 mesothelioma or stage 4 mesothelioma. As new and alternative mesothelioma treatments are researched and employed in the future, it is realistic to anticipate an improvement in patient survival rates.

Other Mesothelioma Information

Mesothelioma Disease

Mesothelioma cancer is a rare disease that attacks the cells of the tissue that lines the body cavity called the mesothelium. Its only known cause is exposure to asbestos fibers.

Mesothelioma Latency Period

Typically, there is a great deal of time between an individual's exposure to asbestos and the development of asbestos-related health complications. Mesothelioma is associated with a long-latency period (often 20-50 years) after exposure. Over a long period of time, lodged asbestos fibers slowly inflame the lung's external tissue, often serving as a pre-cursor to the development of malignant mesothelioma.

Mesothelioma Remission

Mesothelioma is one of the most aggressive types of cancer. Mesothelioma will often quickly metastasize from its origin into the lungs, abdominal cavity, and lymph nodes. As such, very few mesothelioma patients go into remission. However, if treated properly and early enough, many patients have been able to extend survival rates long beyond previous expectations. Treatment options include surgical resection, chemotherapy, and mesothelioma radiation.

Mesothelioma Cure

While advancements in the treatment of malignant mesothelioma have made tremendous forward strides in recent years, there is currently no cure for mesothelioma. Patients who are diagnosed with early-stage disease may survive many years if the cancer is treated early with surgery, chemotherapy, and managed radiation therapy. Many patients have also had success through the utilization of alternative therapies in conjunction with conventional cancer treatments.

Mesothelioma Survivors

While there is currently no cure for mesothelioma, many patients have had success in managing their cancer with not only traditional treatments like chemotherapy and surgical methods, but also through the use of nutritional supplements, palliative therapies, and body-stress reduction techniques. Some patients diagnosed with mesothelioma have survived many years after what was an initially unfavorable prognosis.

Mesothelioma Survival Rate

Mesothelioma currently has no known cure and, as such, the survival rate for mesothelioma is low. However, mesothelioma can be managed through the use of many different treatment options. Aggressive therapies like extra-pleural pneumonectomy have extended survival periods long beyond previous expectations of mesothelioma doctors and oncologists.

Mesothelioma Life Expectancy

Life expectancy for those diagnosed with malignant mesothelioma depends on a number of factors including, general patient health, cancer stage at diagnosis, and the eligibility of the patient for certain treatment options. Those diagnosed with early stage cancer who are in generally good health will have a more favorable prognosis than those diagnosed with later-stage disease.

Mesothelioma Prevention

Mesothelioma is known only to be caused by exposure to asbestos, a naturally occurring fibrous mineral that was used for many years as an industrial insulation component. As such, the best mesothelioma prevention is the avoidance of exposure to asbestos. However, in recent years, physicians and cancer specialists have been developing a mesothelioma vaccine that will arm the body's immune system with cancer fighting anti-bodies and antigens in those who are at risk for the development of mesothelioma.

Adult Mesothelioma

Mesothelioma is most common in adults. Adults who have asbestos exposure history are typically those most at risk for the development of malignant mesothelioma. It can take many years for those exposed to asbestos exposure to exhibit the effects of exposure and, as such, mesothelioma is most often diagnosed in older individuals, often up to 40 years following exposure.

Child Mesothelioma

Childhood diagnosis of malignant mesothelioma is extremely rare, although it has been documented. Mesothelioma is known only to be caused by exposure to asbestos and takes many years following exposure to asbestos to manifest in adults. Generally speaking, childhood mesothelioma is considered to be unrelated to asbestos exposure.

Mesothelioma and Women

Many women that have been diagnosed with mesothelioma had no direct exposure to asbestos from working in industrial job settings. Instead they discover that they are victims of second-hand asbestos exposure that occurred while washing their husband's clothes that came home from work with asbestos fibers on them.

Mesothelioma Vaccine

Recent studies by researchers in the Netherlands have found promising results in preventative therapies for mesothelioma. Using cancer-fighting antigens within the body's immune system, mesothelioma patients have responded positively in most cases when treated with the mesothelioma vaccine. The hope is now that this therapy can be applied to those who may be at risk of developing mesothelioma in the future, particularly those who have been exposed to asbestos but have yet to develop asbestos disease.

Medical Timeline

Historical timeline containing important facts and developments related to the manufacture and use of asbestos and documented cases of mesothelioma cancer and other asbestos related diseases.

Source
National Cancer Institute - Mesothelioma: Questions and Answers
http://www.cancer.gov/cancertopics/factsheet/Sites-Types/mesothelioma

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Mesothelioma Stages

Staging is the process of finding out how far the cancer has spread. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. The mesothelioma treatment and life expectancy for patients with the disease largely depends on the stage (extent of spread) of their cancer. Since pleural mesothelioma occurs most frequently and has been studied the most, it is the only mesothelioma for which a staging classification exists.
The staging system most often used for mesothelioma cancer is the Butchart system. This system is based mainly on the extent of the primary tumor mass, and divides mesotheliomas into stages 1 through 4.

Butchart Staging System

• Stage 1: Mesothelioma is present within the right or left pleura, and may also involve the lung, pericardium, or diaphragm (the muscle separating the chest from the abdomen) on the same side.
• Stage 2: Mesothelioma invades the chest wall or involves the esophagus (food passage connecting the throat to the stomach), heart, or pleura on both sides. The lymph nodes in the chest may also be involved.
• Stage 3: Mesothelioma has penetrated through the diaphragm into the peritoneum (lining of the abdominal cavity). Lymph nodes beyond those in the chest may also be involved.
• Stage 4: There is evidence of distant metastases (spread through the bloodstream to other organs).

Another staging system has recently been developed by the American Joint Committee on Cancer (AJCC). This is a TNM system, similar to staging systems used for most other cancers. T stands for tumor (its size and how far it has spread to nearby organs), N stands for spread to lymph nodes and M is for metastasis (spread to distant organs). In TNM staging, information about the tumor, lymph nodes, and metastasis is combined in a process called stage grouping to assign a stage described by numbers from 1 to 4. Minor differences exist between the AJCC TNM staging system and the Butchart staging system.

TNM Staging System

• Stage 1: Mesothelioma involves the right or left pleura. It may also have spread into the lung, pericardium, or diaphragm on the same side. It has not yet spread to the lymph nodes.
• Stage 2: Mesothelioma has spread from the pleura on one side to the nearby peribronchial and/or hilar 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 3: Mesothelioma has spread into the chest wall muscle, ribs, heart, esophagus, or other organs in the chest on the same side as the primary tumor, with or without spread to subcarinal and/or mediastinal lymph nodes on the same side as the main tumor. Subcarinal nodes are located at the point where the windpipe branches to the left and right lungs. Mediastinal lymph nodes are located in the space behind the chest bone in front of the heart. Mesotheliomas with the same extent of local spread as in stage 2 that have also spread to subcarinal and/or mediastinal lymph nodes on the same side are also included in stage 3.
• Stage 4: Mesothelioma has spread into the lymph nodes in the chest on the side opposite that of the primary tumor, or directly extends to the pleura or lung on the opposite side, or directly extends into the peritoneum, or directly extends into organs in the abdominal cavity or neck. Any mesothelioma with evidence of distant metastases (spread to other organs through the bloodstream) or spread to organs beyond the chest or abdomen is included in this stage.

Although the recently developed TNM classification is the most detailed and precise, the original Butchart staging system is still used most often to describe the spread of pleural mesotheliomas. Understanding these staging systems for mesothelioma is important both for estimating and better understanding prognosis, and also for assessing therapeutic options.
Prognostic Factors

Because pleural mesothelioma has been better studied than peritoneal mesothelioma we know more about mesothelioma risk factors associated with prognosis for pleural mesothelioma. Younger age at diagnosis, performance status (functional status) and absence of weight loss are associated with a more favorable mesothelioma prognosis.

Mesotheliomas are usually of three different cell types (histological analysis): 1) epithelial mesothelioma cell type - has the most favorable prognosis; 2) fibrosarcomatous cell type - carries the worst prognosis and 3) Biphasic mesothelioma or mixed cell type - has an intermediate prognosis.

Source
National Cancer Institute - Stages of Malignant Mesothelioma
http://www.cancer.gov/cancertopics/pdq/treatment/malignantmesothelioma/Patient/page2

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Papillary Mesothelioma

Papillary mesothelioma is a very rare form of mesothelioma cancer. It is generally diagnosed in women, usually those who are still in the reproductive stages of their life. This is generating a greater interest for information on mesothelioma and women. It usually develops in the peritoneum - the lining of the abdomen - and, in most cases, is benign. The disease, also known as well-differentiated papillary mesothelioma (WDPM), has also been seen in the tunica vaginalis, part of the male reproductive system as well as in the ovaries, lining of the heart (pericardial mesothelioma), and sometimes the lining of the lungs (pleural mesothelioma).

Papillary mesothelioma tumors generally cause no pain and the mesothelioma prognosis for someone diagnosed with such a tumor is usually positive. Unlike malignant mesothelioma of various types, however, this kind of mesothelioma cannot be definitively linked to asbestos exposure though a connection has been made in some cases.

Because the occurrence of this disease is quite rare, there is no standard mesothelioma treatment at this time. Past reports have shown that mesothelioma doctors who do encounter WDPM have offered surgical removal of the tumor as a possible treatment and others have shrunk the tumor with mesothelioma chemotherapy or radiation. However, it is rare that this kind of tumor spreads to other parts of the body, so mesothelioma surgery is usually the preferred option and generally results in a mesothelioma cure. Reoccurrence of the disease does happen in many cases but is not an indication that the patient will later develop a malignant form of mesothelioma cancer.

Sources
Hoekstra, A., Riben, M., Frumovitz, M. et al. Well-Differentiated Papillary Mesothelioma of the Peritoneum: a pathological analysis and review of the literature. (2005). Gynecologic Oncology; 98(1): 161-167
http://www.ajronline.org/cgi/reprint/155/6/1245.pdf

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Biphasic Mesothelioma

Biphasic mesothelioma is the second most common cellular form of this disease, accounting for 20 to 40 percent of all known cases. As the name implies, biphasic mesothelioma is a mixture of two mesothelioma cell types.

Characteristics

Unlike the more common epithelioid type, biphasic mesothelioma cells lack a specific structure. This type of mesothelioma is a mix of epithelioid and sarcomatoid cells. Whereas the former has a clearly visible nucleus and is found in uniform, organized arrangements and tend to be of a single shape, sarcomatoid cells are more oval or oblong shaped and have no easily identifiable nucleus. Although both mesothelioma types are present in a biphasic tumor, they have a tendency to form in differentiated groups; they are not usually found in the same area of the tumor.

Diagnosis and Treatment
 
Mesothelioma cancer is exceptionally difficult to diagnose, which is why a mesothelioma diagnosis is usually not made until stage 3 mesothelioma or stage 4 mesothelioma is reached. It is important to confirm a history of asbestos exposure, as mesothelioma symptoms are similar to a wide range of respiratory illnesses.
Mesothelioma doctors usually take an x-ray; if there is cause for concern, the patient is referred to a radiology lab, where more advanced images are taken. If abnormal areas are discovered, a tissue sample, or biopsy is taken to confirm the diagnosis.

A recent test developed by a Japanese biotech company, called MESOMARK™, may help pathologists in diagnosing mesothelioma at an earlier stage, when it is most treatable.
Treatment in most cases is limited to palliative ones, since the disease is usually diagnosed too late for mesothelioma surgery. Mesothelioma is usually treated with a multi-modal therapy involving a combination of radiation and chemotherapy; surgical techniques may be used to relieve the symptoms, but in the later stages are usually not effective in treating the disease.

Sources:
Dodson, R. and Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. (Boca Raton: Taylor & Francis, 2006).
Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. (New York: Springer, 2005.)
Galateau-Salle, Francoise. Pathology of Malignant Mesothelioma. (London: Springer-Verlag London Limited, 2006).
Bruce, W., Robinson, A., & Philippe Chahinian. "Mesothelioma". Informa Health Care, 2002. (ISBN 9058231801)

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Sarcomatoid Mesothelioma

Mesothelioma is a cancer that attacks the lubricative layer lining the inside of the chest and abdomen and the internal organs. Pathologists categorize mesothelioma cancer cases according to levels of criteria, which are as follows:

Location:
•    Lungs (pleural mesothelioma)
•    Abdomen (peritoneal mesothelioma)
•    Heart (pericardial mesothelioma)

Stage:
•    Stage 1 Mesothelioma - Cancer cells have started to form
•    Stage 2 Mesothelioma - Cancer has spread locally
•    Stage 3 Mesothelioma - Cancer has spread to adjoining areas
•    Stage 4 Mesothelioma - Cancer has begun to metastasize

Cellular Structure:
•    Epithelial (organized and structured)
•    Sarcomatoid (random and irregular)
•    Biphasic (a mix of epithelial and sarcomatoid)
•    Desoplastic (a variation of the sarcomatoid variety)

Cellular structure is determined by an actual visual examination of the cells under a microscope.

About Sarcomatoid Mesothelioma

Sarcomatoid Mesothelioma accounts for approximately 10 to 15 percent of all diagnoses. The mesothelioma cell types in this case are elongated and spindle-shaped, and are arranged in a rather haphazard way. Sarcomatoid cells also lack a nucleus, unlike epithelioid cells, which have clearly visible nuclei.
The desoplastic variety of sarcomatoid mesothelioma is difficult to distinguish from healthy tissue in many cases, making an accurate mesothelioma diagnosis challenging.

Diagnosis

Once mesothelioma symptoms have been cataloged and a history of asbestos exposure determined, the next step is to look inside the body - initially with x-rays, followed up by more sophisticated imaging such as CT scans or MRIs. If these images reveal serious abnormalities, a biopsy (tissue samples) will be ordered. These are examined and analyzed at a lab, which usually confirms or contradicts the diagnosis.

When it comes to the sarcomatoid mesothelioma, traditional methods of biopsy pose additional challenges; the normal "needle core" method often results in false information, as sarcomatoid cells are often similar in appearance to benign fibrous tissue. Additionally, histological methods of diagnosis often make it difficult to distinguish between sarcomatoid mesothelioma and other types of unrelated sarcomatoid cancers.
A precise and accurate diagnosis is vital, because a misdiagnosis can lead to an inappropriate course of mesothelioma treatment being prescribed; it is a good idea to get a second and even a third opinion if mesothelioma is suspected.

Treatment Options

Although the details will differ depending on the individual case, all forms of cancer are treated through some combination of surgery, radiation therapy, and chemotherapy. How these are administered depends on the location and stage of the cancer.
Unfortunately, sarcomatoid mesothelioma is notoriously resistant to treatment, and the mesothelioma prognosis is not good. The average mesothelioma survival rate between diagnosis and death is seven months.

Source
Hammer, Samuel P. "Macroscopic, Histologic, Histochemical, Immunohistochemical, and Ultrastructural Features of Mesothelioma." Society of Ultrastructural Pathology Companion Meeting, 27 February 2005, http://sup.ultrakohl.com/Uscap/uscap05/meso1.pdf

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Epithelial Mesothelioma

Epithelial mesothelioma cells have a definite structure with visible nuclei. This is the most common variant of this type of mesothelioma cancer, accounting for about 60 percent of all cases. This type of mesothelioma develops when malignant cells develop on any of the mesothelial linings. When examined under a microscope, these mesothelioma cell types are of a uniform size and shape, and resemble normal, healthy epithelial cells.
Epithelial mesothelioma cells also bear a strong resemblance to adenocarcinoma cells, which are also associated with lung tissue. Patients who have been diagnosed with adenocarcinoma should also be examined for mesothelioma diagnosis as well.

Variants

Papillary mesothelioma is an example of epithelial mesothelioma; other variants include any of the following:
•    Signet Ring
•    Single File
•    Adenoid Cystic
•    Glandular
•    Tubulopapillary
•    Histiocytoid
•    Microcystic
•    Macrocystic
•    Glomeruloid
•    Diffuse - NOS
•    Small Cell
•    Deciduoid
•    Pleomorphic
•    In Situ
•    Mucin Positive
•    Well-Differentiated Papillary
•    Gaucher Cell-Like

What differentiates these various types are the shape, size and formation of the cells. This can determine what course of mesothelioma treatment is appropriate for the patient's situations.

Epithelial Mesothelioma and Asbestos
 
Once asbestos fibers are inhaled, they become lodged in the lung tissue, where they remain indefinitely. Mesothelioma is associated with hard, crystalline amphibole asbestos, which consists of hard, needle-like fibers that literally bore through lung tissue over time, causing chronic inflammation that ultimately results in malignancy. The mesothelioma latency period, can be anywhere from five to seventy-five years. Mesothelioma symptoms are similar to those of other respiratory illnesses, which is why a mesothelioma diagnosis has historically been so difficult to make.

Sources
Dodson, R. and Hammar, S. Asbestos: Risk Assessment, Epidemiology, and Health Effects. (Boca Raton: Taylor & Francis, 2006).
Pass, I., Vogelzang, N., Carbone, M. Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. (New York: Springer, 2005)

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Mesothelioma Cell Types

Malignant mesothelioma can also be classified by different cancer cell types, each of which tends to behave differently. There are three classifications assigned to malignant mesothelioma cell types.

Epithelial Mesothelioma is the most common cell type and accounts for approximately 50-75% percent of all diagnosed cases each year. These cells are uniform in shape, with an elongated pattern that makes them easily distinguishable when viewed under high magnification. These types of mesothelioma cancer are adenocarcinomas, malignancies which are more commonly associated with pure lung cancers as opposed to cancers of the mesothelium.

Sarcomatoid mesothelioma is a less common cell type, accounting for between 7 and 20% of mesothelioma diagnosis cases each year. These cells grow forth out of supportive structures, such as muscles and bones.

Biphasic mesotheliomas are those with a mix of epithelial and sarcomatoid cell types. Mesothelioma treatment options do not vary greatly between cell types, but often sarcomatoid mesotheliomas are more difficult to treat as a result of the surrounding affected tissues from which they spread.

Thoracoscopy and the use of special stains can be helpful in identifying cellular classifications, though obtaining adequate tissue samples often require more invasive mesothelioma surgery.

Source:
National Cancer Institute.
Mesothelioma Treatment-Health Professional Information. Cellular Classification.
http://www.peacehealth.org/kbase/nci/ncicdr0000062895.htm

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