Asbestos Cancer, also called malignant mesothelioma
Malignant mesothelioma is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura) or abdomen (the peritoneum). It is a rare form of cancer. Most people with malignant mesothelioma have worked on jobs where they breathed asbestos.
You should see a doctor if you experience shortness of breath, pain in the chest, or pain or swelling in the abdomen. If there are symptoms, your doctor may order an x-ray of the chest or abdomen.
Your doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time). Some pressure may be felt, but usually there is no pain.
Your doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, a local anesthetic will be given.
If tissue that is not normal is found, the doctor will need to cut out a small piece and have it looked at under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.
The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, your age, how the cancer cells look under the microscope, how the asbestos cancer or malignant mesothelioma responds to treatment.
Wednesday, July 4, 2007
Monday, July 2, 2007
Mesothelioma
Mesothelioma
There are 2 main types of mesothelioma
Pleural mesothelioma
Peritoneal mesothelioma
The pleural type grows in the tissues covering the lungs. The peritoneal type grows in the tissue lining the inside of the abdomen (tummy). Pleural mesothelioma is much more common than peritoneal mesothelioma.
Between 7 and 8 out of 10 (70-80%) cases of mesothelioma are pleural mesothelioma. Peritoneal mesothelioma is much less common, making up between 1 and 2 out of every 10 cases (10 - 20%).
Cell types
Mesothelioma is also grouped according to how the cells look under a microscope. When mesothelioma is grouped this way, there are 3 types
Epitheloid
Sarcomatoid or fibrous
Mixed type (also called Biphasic type)
Between 5 and 7 out of 10 cases (50-70%) of mesothelioma diagnosed are the epitheloid type.
Between 7 and 20 out of every 100 cases (7 – 20%) of mesothelioma diagnosed are sarcomatoid type.
Between 20 and 35 out of every 100 cases (20 – 35%) of mesothelioma diagnosed are mixed and have both epitheloid and sarcomatoid cells.
These types of mesothelioma cells can further divide into other types of cancerous cells called
Clear cell
Small cell
Acinar cell
Tubopapillary cell
With so many different types of cells capable of developing into mesothelioma.
More information
For more about these tissues, look at What is mesothelioma?
Posted by mandeep tondak at 10:34 PM 0 comments
The stages of mesothelioma
Pleural mesothelioma stages
There are two main staging systems in use for pleural mesothelioma. These are called the International Mesothelioma Interest Group (IMIG) system and the Brigham system. In the UK, the system that is mostly commonly used is the IMIG system. Specialists generally don't use the Brigham system any more, but we've left it in here for now in case your own doctor refers to it.
The IMIG system
This is based on the TNM staging system.
The TNM system is the staging system most commonly used in cancer staging generally. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).
Once the TNM categories have been decided, this information is grouped together to give the stage. Stage 1 is the earliest stage and stage 4 is the most advanced stage.
Stage 1a mesothelioma affects the outer layer of the pleura around the chest wall, on one side of the chest only. It may have grown in the pleural tissue covering the diaphragm
Stage 1b mesothelioma has started to spread to the inner pleural layer (closest to the lungs), but remains on one side of the chest.
Stage 2 mesothelioma has spread to both layers of the pleura on one side of the body, and has enlarged to form a tumour mass on the pleural tissue around the lungs, or has started to spread into the diaphragm muscle or the lung tissue
Stage 3 mesothelioma has spread to the chest wall or the covering of the heart (pericardium), but is still potentially removable by surgery. Or it has spread to the lymph nodes on the same side of the chest
Stage 4 mesothelioma cannot be removed by surgery because it has spread to different parts of the chest wall, or grown through the diaphragm into the peritoneum, or to the pleura on the other side of the body, or to the chest organs, or through to the inner layer of the pericardium. Or it has spread to the lymph nodes on the other side of the chest, or above the collarbone. Or has spread to other parts of the body.
The Brigham staging system
This is based on whether the mesothelioma can be removed by surgery and whether the lymph nodes are involved or not. Again there are four stages, which are similar to the TNM system.
Stage 1 mesothelioma can be removed with surgery and there are no lymph nodes containing cancer cells
Stage 2 mesothelioma can be removed with surgery but there are lymph nodes containing cancer cells
Stage 3 mesothelioma cannot be removed with surgery because it has spread into the chest wall, heart, or through the diaphragm into the peritoneum. There may or may not be lymph nodes containing cancer cells
Stage 4 mesothelioma has spread via the bloodstream to other organs in the body such as the liver, brain or bone
Peritoneal mesothelioma stages
There is no established staging system for peritoneal mesothelioma. If your cancer is staged it may be done according to the TNM system. The TNM system is the staging system most commonly used in cancer. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).
Treatments for Mesothelioma
Current research focuses on causes, prevention, and improving accuracy of diagnosis and effectiveness of mesothelioma treatments. In spite of advances in research, there is still a great deal to be learned. Mesothelioma treatments that combine surgery, radiation therapy, and chemotherapy, called multimodality therapy, are now being studied. These may provide the most promising option for some patients. New chemotherapy drugs and other types of mesothelioma treatments are the subjects of current clinical trials.
Gene Therapy
A new approach to mesothelioma treatment is gene therapy, using special viruses that have been modified in the laboratory. In gene therapy, the modified virus is injected into the pleural (chest) space and infects the mesothelioma cells. The virus injects a gene into the tumor that heightens the effects of a mesothelioma-fighting drug.
Immunotherapy
Immunotherapy - treatment methods that fight mesothelioma through the body's immune system - is being evaluated in clinical trials. With immunotherapy, substances called biological response modifiers (BRMs) may be made by the body or in a laboratory. BRMs are used to boost, direct, or restore the body's natural ability to defend itself against cancer. This type of mesothelioma treatment is also called biologic therapy or biotherapy.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is a new radiotherapy technique that has proven to be effective in controlling localized malignant mesothelioma. IMRT mesothelioma treatment delivers high doses of radiation to mesothelioma tumors, regardless of their size or shape. Precise targeting of radiation makes IMRT a preferred mesothelioma treatment over standard radiotherapy, in which the healthy tissue surrounding the tumor may also be exposed to high levels of radiation. Tumors that would once have been considered untreatable because of their proximity to vital organs can now be treated using IMRT.
Chemotherapy
Chemotherapy is the use of cancer-fighting drugs in the treatment of mesothelioma. Although chemotherapy has long been used in the treatment of mesothelioma, the search for safer and more effective chemotherapy drugs is ongoing.
Alimta is the brand name for one such drug, chemically similar to folic acid, which is being tested for the treatment of mesothelioma. Alimta is used alone for the treatment of locally advanced or metastatic lung cancers whose growth has not been slowed by traditional chemotherapy treatments. When used in conjunction with cisplatin, Alimta is the only agent approved by the Food and Drug Administration for specific use in combating malignant pleural mesothelioma.
Anti-angiogenesis drugs are relatively new mesothelioma treatments that have been successful in shrinking and killing cancerous cells in animals. Although the success of anti-angiogenesis drugs in humans has not been proven, they are expected to yield similar results. Veglin is an anti-angiogenesis drug designed to target a wide range of cancers, including malignant mesothelioma.
How is mesothelioma diagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient’s medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is mesothelioma treated?
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
There are 2 main types of mesothelioma
Pleural mesothelioma
Peritoneal mesothelioma
The pleural type grows in the tissues covering the lungs. The peritoneal type grows in the tissue lining the inside of the abdomen (tummy). Pleural mesothelioma is much more common than peritoneal mesothelioma.
Between 7 and 8 out of 10 (70-80%) cases of mesothelioma are pleural mesothelioma. Peritoneal mesothelioma is much less common, making up between 1 and 2 out of every 10 cases (10 - 20%).
Cell types
Mesothelioma is also grouped according to how the cells look under a microscope. When mesothelioma is grouped this way, there are 3 types
Epitheloid
Sarcomatoid or fibrous
Mixed type (also called Biphasic type)
Between 5 and 7 out of 10 cases (50-70%) of mesothelioma diagnosed are the epitheloid type.
Between 7 and 20 out of every 100 cases (7 – 20%) of mesothelioma diagnosed are sarcomatoid type.
Between 20 and 35 out of every 100 cases (20 – 35%) of mesothelioma diagnosed are mixed and have both epitheloid and sarcomatoid cells.
These types of mesothelioma cells can further divide into other types of cancerous cells called
Clear cell
Small cell
Acinar cell
Tubopapillary cell
With so many different types of cells capable of developing into mesothelioma.
More information
For more about these tissues, look at What is mesothelioma?
Posted by mandeep tondak at 10:34 PM 0 comments
The stages of mesothelioma
Pleural mesothelioma stages
There are two main staging systems in use for pleural mesothelioma. These are called the International Mesothelioma Interest Group (IMIG) system and the Brigham system. In the UK, the system that is mostly commonly used is the IMIG system. Specialists generally don't use the Brigham system any more, but we've left it in here for now in case your own doctor refers to it.
The IMIG system
This is based on the TNM staging system.
The TNM system is the staging system most commonly used in cancer staging generally. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).
Once the TNM categories have been decided, this information is grouped together to give the stage. Stage 1 is the earliest stage and stage 4 is the most advanced stage.
Stage 1a mesothelioma affects the outer layer of the pleura around the chest wall, on one side of the chest only. It may have grown in the pleural tissue covering the diaphragm
Stage 1b mesothelioma has started to spread to the inner pleural layer (closest to the lungs), but remains on one side of the chest.
Stage 2 mesothelioma has spread to both layers of the pleura on one side of the body, and has enlarged to form a tumour mass on the pleural tissue around the lungs, or has started to spread into the diaphragm muscle or the lung tissue
Stage 3 mesothelioma has spread to the chest wall or the covering of the heart (pericardium), but is still potentially removable by surgery. Or it has spread to the lymph nodes on the same side of the chest
Stage 4 mesothelioma cannot be removed by surgery because it has spread to different parts of the chest wall, or grown through the diaphragm into the peritoneum, or to the pleura on the other side of the body, or to the chest organs, or through to the inner layer of the pericardium. Or it has spread to the lymph nodes on the other side of the chest, or above the collarbone. Or has spread to other parts of the body.
The Brigham staging system
This is based on whether the mesothelioma can be removed by surgery and whether the lymph nodes are involved or not. Again there are four stages, which are similar to the TNM system.
Stage 1 mesothelioma can be removed with surgery and there are no lymph nodes containing cancer cells
Stage 2 mesothelioma can be removed with surgery but there are lymph nodes containing cancer cells
Stage 3 mesothelioma cannot be removed with surgery because it has spread into the chest wall, heart, or through the diaphragm into the peritoneum. There may or may not be lymph nodes containing cancer cells
Stage 4 mesothelioma has spread via the bloodstream to other organs in the body such as the liver, brain or bone
Peritoneal mesothelioma stages
There is no established staging system for peritoneal mesothelioma. If your cancer is staged it may be done according to the TNM system. The TNM system is the staging system most commonly used in cancer. The TNM system describes the extent of the primary tumour (T), the absence or presence of cancer in nearby lymph nodes (N), and the absence or presence of distant metastases (M).
Treatments for Mesothelioma
Current research focuses on causes, prevention, and improving accuracy of diagnosis and effectiveness of mesothelioma treatments. In spite of advances in research, there is still a great deal to be learned. Mesothelioma treatments that combine surgery, radiation therapy, and chemotherapy, called multimodality therapy, are now being studied. These may provide the most promising option for some patients. New chemotherapy drugs and other types of mesothelioma treatments are the subjects of current clinical trials.
Gene Therapy
A new approach to mesothelioma treatment is gene therapy, using special viruses that have been modified in the laboratory. In gene therapy, the modified virus is injected into the pleural (chest) space and infects the mesothelioma cells. The virus injects a gene into the tumor that heightens the effects of a mesothelioma-fighting drug.
Immunotherapy
Immunotherapy - treatment methods that fight mesothelioma through the body's immune system - is being evaluated in clinical trials. With immunotherapy, substances called biological response modifiers (BRMs) may be made by the body or in a laboratory. BRMs are used to boost, direct, or restore the body's natural ability to defend itself against cancer. This type of mesothelioma treatment is also called biologic therapy or biotherapy.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is a new radiotherapy technique that has proven to be effective in controlling localized malignant mesothelioma. IMRT mesothelioma treatment delivers high doses of radiation to mesothelioma tumors, regardless of their size or shape. Precise targeting of radiation makes IMRT a preferred mesothelioma treatment over standard radiotherapy, in which the healthy tissue surrounding the tumor may also be exposed to high levels of radiation. Tumors that would once have been considered untreatable because of their proximity to vital organs can now be treated using IMRT.
Chemotherapy
Chemotherapy is the use of cancer-fighting drugs in the treatment of mesothelioma. Although chemotherapy has long been used in the treatment of mesothelioma, the search for safer and more effective chemotherapy drugs is ongoing.
Alimta is the brand name for one such drug, chemically similar to folic acid, which is being tested for the treatment of mesothelioma. Alimta is used alone for the treatment of locally advanced or metastatic lung cancers whose growth has not been slowed by traditional chemotherapy treatments. When used in conjunction with cisplatin, Alimta is the only agent approved by the Food and Drug Administration for specific use in combating malignant pleural mesothelioma.
Anti-angiogenesis drugs are relatively new mesothelioma treatments that have been successful in shrinking and killing cancerous cells in animals. Although the success of anti-angiogenesis drugs in humans has not been proven, they are expected to yield similar results. Veglin is an anti-angiogenesis drug designed to target a wide range of cancers, including malignant mesothelioma.
How is mesothelioma diagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient’s medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is mesothelioma treated?
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
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