Debbie provided a link to a story published in November 2009 by ABC News that outlines the work of specialists at Austin Health Centre in Victoria. The treatment, spearheaded by Dr. Malcolm Feigen, a radiation oncologist at the Centre, uses high doses of radiotherapy, concentrated on specific areas of the lining of the lungs to target mesothelioma tumors.

According to the ABC report, 13 patients participated in a pilot program to test this new targeted radiotherapy treatment. Most had some surgery prior to the radiotherapy treatment, and some also had chemotherapy before or after the treatment, although Dr. Feigen believes the patients showed the most benefit primarily as a result of the radiotherapy regimen.

Participants in the U.S. clinical trial at the Mesothelioma Center receive a multi-modality therapy that incorporates surgery, chemotherapy and radiation therapy in combination.

Listen to the interview with Dr. Feigen about the Australian research, which was broadcast on ABC’s AM morning current affairs program.

SOURCE: myMeso › Australian doctor researching radiotherapy for treatment of pleural mesothelioma

A champion for the rights of workers who have developed pleural plaques as a result of exposure to asbestos in the workplace is Jarrow MP Stephen Hepburn. In a meeting at the House of Commons on Nov. 27, he argued the issue of pleural plaques is “immensely important” to workers and pensioners, and insisted it is the duty of members of both sides of the House to overturn the “disgraceful and unjust decision by the Law Lords to bar this terrible illness from classification as a designated illness for compensation purposes,” according to a report in The Chronicle.

Hepburn also told the Commons that pleural plaques sufferers are 1,000 times more likely to develop a more serious form of asbestos-related cancer. Mesothelioma is a deadly form of cancer that affects the lining of the chest cavity and lungs (pleural) or the lining of the stomach (peritoneal). It may also rarely affect the lining of the heart (pericardial). There is no known cure for mesothelioma.

During the heated debate, The Daily Mirror reports that statistics were revealed that show mesothelioma rates in the UK have nearly doubled in 10 years. According to the news source, hospitals treated 7,349 cases of mesothelioma in the past year, compared to 3,773 cases during the timeframe of 1998-99. The Mirror calls mesothelioma an “asbestos timebomb,” citing the disease’s long latency period.

The Mirror quotes Hepburn as saying, “We’re seeing the legacy of workers exposed to asbestos in the 1960s.”

SOURCE: myMeso › Startling statistic revealed during UK pleural plaque debate

This issue is available to download online. If you are having trouble downloading the newsletter, or just want an original hard copy, please let me know. I have some extra copies of the newsletter graciously provided to me by the Meso Foundation that I would be happy to send to you. You can also subscribe by visiting the Meso Foundation online at www.curemeso.org. There also is an archive of past newsletters on the site.

Another exciting resource available at the Meso Foundation web site is a video library of presentations from the Symposium. There were so many great speakers, and this is a truly valuable resource for excellent educational information. The video library also provides access to the slides used by conference speakers. There really is a fantastic amount of information here on topics ranging from Advocacy & Advancing the Mission, to Integrative Medicine, Nutrition, Cancer and the Immune System, Peritoneal Mesothelioma, Pleural Mesothelioma, Clinical Trials and much more.

While on the Meso Foundation web site, please join their online Mesothelioma Community, which will allow you to exchange information with others through a Bulletin Board, as well as read a number of blogs touching on a wide variety of topics. You can also subscribe to an e-newsletter that will keep you informed about all the great work the Meso Foundation is accomplishing in its mission to find a cure for mesothelioma.

If you have any questions or need assistance, you may call the Meso Foundation at (805) 456-7272 or call them toll-free at 877-END-MESO.

SOURCE: myMeso › Awareness, educational materials available from Meso Foundation

According to the research summary, the objective of the study was to evaluate the perioperative and long-term outcomes associated with extrapleural pneumonectomy for patients with malignant pleural mesothelioma. Pleural mesothelioma affects the lining of the chest cavity and lungs. Other forms of mesothelioma include pericardial, which affects the lining of the heart and is extremely rare; and peritoneal, which affects the lining of the abdomen. Mesothelioma is atributed almost exclusively to asbestos exposure.

According to the Multimedia Manual of Cardiothoracic Surgery, extrapleural pneumonectomy was introduced in the 1940s for the treatment of extensive infections of the lung and pleural space. Over the past 20 years, the extrapleural pneumonectomy technique has been modified and applied to the treatment of locally advanced malignant pleural mesothelioma, achieving substantial reductions in mortality. The surgery involves the removal of the lung with visceral and parietal pleurae, pericardium and diaphragm.

Researchers selected 70 patients between October 1994 and April 2008 to undergo the procedure. Prognostic factors included age, gender, side of disease, asbestos exposure, histology, positron emission tomography, date of surgery, neoadjuvant chemotherapy, completeness of cytoreduction, lymph node involvement, peioperative morbidity, adjuvant radiotherapy and pemetrexed-based chemotherapy.

The mean age of patients was 55 years. The median survival was 20 months, with a 3-year survival of 30 percent. Analyses showed improved survival for patients with asbestos exposure, negative lymph node involvement, and receipt of adjuvant radiation or postoperative pemetrexed-based chemotherapy.

The study was conducted by physicians from the University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital; The Baird Institute for Applied Heart and Lung Surgical; Department of Medical Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital; and Department of Radiation Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital; all in Sydney, Australia.

SOURCE: myMeso › Study supports extrapleural pneumonectomy to treat select mesothelioma patients

The principal investigator for the studay is Dr. Raffit Hassan of the NCI Center for Cancer Research.

According to the NCI bulletin, researchers hope an experimental immunotoxin called SS1 (dsFv)-PE38 (or SS1P) can improve the outcome of patients with unresectable (or inoperable) mesothelioma. Clincial trial information says that SS1P is a “genetically engineered biological agent in which part of a bacterial toxin is linked to an antibody that recognizes the protein mesothelin.”

Mesothelin is the protein found on the surface of epithelial mesothelioma cells and other types of cancer cells. It is hoped that combining SS1P with chemotherapy will lead to increased antitumor activity, as compared with either treatment alone.

“Given the marked synergy between SS1P and chemotherapy in preclinical studies, combining them could potentially result in increased antitumor activity in patients,” Dr. Hassan is quoted in the Bulletin.

For more information, see the Entry Criteria.

Find trial contact information online or call the NCI Clinical Trials Referral Office at 1-888-NCI-1937. The call is toll-free and confidential.

SOURCE: myMeso › Clinical trial for pleural mesothelioma

According to the report, the study involved 20 patients treated between 2002 and 2004 who received Alimta and Gemzar every 21 days, along with folic acid, vitamin B12 and dexamethasone. Cancer Consultants reports overall response rate was 15 percent, disease control rate was 50 percent, median time to disease progression was 10.4 months and the median survival time was 26.8 months. Additionally, the report notes that toxicities were tolerable.

Cancer Consultants notes that peritoneal mesothelioma makes up less than 20 percent of all cases of mesothelioma, with pleural mesothelioma being more common. Peritoneal mesothelioma is a specific form of mesothelioma that affects the peritoneum, which is the serous membrane that forms the lining of the abdominal cavity.

Pleural mesothelioma is the most common form of the disease, making up about 75 percent of all cases. Pleural mesothelioma affects the outer lining of the lungs and chest cavity.

Because of its relative rarity, there have been few studies of chemotherapy as a treatment for peritoneal mesothelioma, and there are no controlled trials of various treatment options available for peritoneal mesothelioma.

Traditional therapy for peritoneal mesothelioma has involved surgical debulking followed by systemic and/or intraperitoneal chemotherapy.

Cancer Consultants, which delivers educational programs and resources to more than 18 million targeted seekers of cancer information, has been producing and distributing cancer information for patients and professionals since 1998.

The publication notes that this study is one of the first devoted to systemic chemotherapy treatment for peritoneal mesothelioma and as such provides an important baseline for research.

SOURCE: myMeso › Drug combo effective for peritoneal mesothelioma

It is hoped the new treatment will replace or delay the need for the standard treatment in these cases, a pleural pneumonectomy, which involves removal of the lung and which can be extremely debilitating to patients.

According to a press release from the medical center, Dr. Robert Taub, the study’s principal investigator, director of the Mesothelioma Center at NewYork-Presbyterian/Columbia and professor of clinical medicine at Columbia University College of Physicians and Surgeons, says, “Current surgical and chemotherapy treatments of patients with malignant pleural mesothelioma are unsatisfactory, and have not been shown to significantly prolong survival. In this study, we will investigate whether a combination of chemotherapy and radiation targeted directly at the lung’s lining can improve outcomes while avoiding surgery. In addition, this approach has shown to have minimal toxic side effects compared to systemic chemotherapy.”

The Mesothelioma Center is the only one nationwide that is offering this experimental therapy to treat pleural mesothelioma.

The study is being conducted at the Mesothelioma Center within the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital and Columbia University Medical Center. According to the release, participating patients will receive several rounds of targeted chemotherapy using the drugs cisplatin and doxorubicin via surgically implanted catheters. Some patients will be randomly selected to receive additional systemic (intravenous) chemotherapy using the drugs cisplatin and pemetrexed. All patients will receive targeted radiotherapy using the P-32 radioisotope.

Patients may elect to receive additional surgical treatment, including removal of the affected lung lining or lung. Subsequently, patients will be offered outpatient systemic chemotherapy with cisplatin and pemetrexed.

For more information, visit www.hiccc.columbia.edu.

SOURCE: myMeso › Clinical trial for mesothelioma at NY hospital

According to PharmaLive, Arenegyr is a vascular targeting agent with a unique mode of action, and a first-in-class compound in the class of peptide/cytokine complexes able to selectively target the tumor vasculature. Unique biological properties include induction of tumor vascular permeability and normalization, and a direct biological anti-tumor activity.

PharmaLive quotes MolMed’s president and CEO, Claudio Bordignon, as saying, “Orphan drug designation for Arenegyr in mesothelioma represents a fundamental acknowledgement of the interesting early efficacy and safety results achieved in an ongoing Phase II trial, with 53 patients recruited so far, and which we just presented at the ASCO (American Society of Clinical Oncology) Annual meeting 2008.

He went on to say, “The analysis of preliminary study results presented at ASCO, conducted on 41 patients, already gave evidence of substantial clinical benefits in terms of long-lasting disease control and promising survivals in chemo-pretreated mesothelioma patients. In particular, it shows improved overall survival, and nearly doubled progression-free survival with respect to best supportive care data reported in literature.”

Bordignon said consolidated results relating to survival data will be available in December.

SOURCE: myMeso › Arenegyr granted orphan drug status

However, down at the end of the article, you learn that risk begins to drop FIFTY YEARS after exposure ends. The report also says that it looks like men have the highest risk of developing lung cancer 30-39 years after exposure, and women are at highest risk 20-29 years after exposure. Then risk begins to drop. Begins.

The decline refers to pleural mesothelioma. The report says that the risks for peritoneal mesothelioma continue to rise, even 40 years after exposure has ended.

It’s a puzzling article, since it SOUNDS like good news, but then as you read along it doesn’t really sound all that great.

Check it out here.

SOURCE: myMeso › Cancer risk decreases after asbestos exposure?

ADAO secured a senate resolution declaring April 1 as Asbestos Awareness Day, and April 1-7 as Abestos Awareness Week. You can visit the ADAO online.

Today also is Asbestos Awareness Day in Montgomery, Alabama, as designated by mayoral proclamation, signed by Montgomery Mayor Bobby Bright. The local effort strives to bring the message of asbestos awareness and education to the community and to bring attention to the national effort to ban asbestos.

Asbestos exposure can lead to asbestos-related disease including asbestosis, lung cancer and malignant mesothelioma. Many symptoms of mesothelioma and other asbestos diseases do not appear for 20 or more years, making it difficult to diagnose early. For this reason, the cancer is often diagnosed in late stages, making it too often deadly.

In the U.S. current statistics show 2,000-3,000 people are diagnosed with malignant pleural mesothelioma each year, and 10,000 Americans or more die each year from all asbestos-related disease.

SOURCE: myMeso › Today is Asbestos Awareness Day

When Charlene Kaforey, 48, was diagnosed with pleural mesothelioma in July 2007, she immediately began seeking out information and treatment options.

The prognosis for mesothelioma is still bleak. There is no cure, and most studies estimate survival time between 4-12 months, depending on the stage of presentation. Charlene’s mesothelioma was diagnosed relatively early, so she was hopeful.

She visited mesothelioma specialist Dr. David J. Sugarbaker at Brigham & Women’s Hospital in Boston, Mass., Dr. Valerie W. Rusch at Memorial Sloan Kettering Cancer Center in New York, and Dr. Harvey Pass at the NYU Cancer Institute.

Immediately, doctors talked about extrapleural pneumonectomy, a surgery to remove the entire lung, entire diaphragm, and the lining of the chest cavity and the heart. Surgery would be followed by 6 weeks of radiation, and possibly chemotherapy. One doctor even talked about performing a heated chemotherapy wash of the chest cavity while on the operating table. At that time, they believed Charlene was a stage I, and such surgeries could give her a 40 percent chance of a 5 year survival. One doctor mentioned getting her as much as 10 years.

One of the doctors talked about limiting the surgery to a pleurectomy/decortication, a technique to remove the parietal pleura from the lung. The median survival after pleurectomy for malignant mesothelioma ranges from 6-21 months, and 9-40 percent of patients survive up to 2 years. However in later stages, the survival rates are almost identical between the two surgeries.

Research is still unclear as to whether extra-pleural pneumonectomy provides significantly greater benefits than pleurectomy, and if either is significantly more effective than non-surgical options.

Charlene didn’t have a lot of tumor bulk, so she was sent for a mediastinoscopy, a biopsy surgery that allows doctors to view the middle of the chest cavity and to remove lymph nodes from between the lungs to test them for cancer or infection. They found that Charlene did have lymph node involvement.

“I went from a Stage I to Stage III overnight,” she says. “It was shocking.”

Because of the lymph node involvement, doctors recommended she postpone considering pleurectomy or pneumonectomy and undergo chemotherapy. Survival rates from either surgery for a Stage III patient is much less, and only 25 percent survive 20 months, with less than 10 percent surviving 5 years. Both surgeries involve significant mortality rates and require 6-9 months recovery time.

“Looking at it now, I feel in some ways that having the lymph node involvement was a godsend for me,” Charlene says. “I mean, my condition was more serious, but because I was doing the chemotherapy, it gave me time to look for more information and to really think more about my options. Otherwise, I would have rushed into a very serious surgery with a long, difficult recovery and I’d probably be without a lung and diaphragm right now.”

Charlene offers one word of caution to meso patients.

“While you may feel time is of the essence, don’t rush into a procedure until you really understand what is involved, and what benefits you can expect to receive, what the risks and complications are, how long and difficult the recovery will be,”she said.

She talked to other meso patients and read everything she could get her hands on. Quality of remaining life is a big issue to consider.

“I realized that I might have only 18 to 30 months maximum to live, and that I would spend at least 9 months in a brutal recovery. I was feeling good with little to no symptoms. I couldn’t justify giving up my good health to surgery, knowing I may never feel good again, and might have only another 9 months of poor quality life after recovering from the surgery,” Charlene says.

Next: Charlene explores alternative medicine

SOURCE: myMeso › Living with Meso – Charlene’s story, Part 2

Frustrated, in the fall of 2006 she tried a new medication for a two-week protocol, plus a gluten-free diet for six months, and finally experienced some relief. But then, six months later, the pain and discomfort returned.

Since she had been off Crohn’s medications during the experiment with her diet, doctors decided it would be a good time to try some new tests, and included a CT scan. In March 2007, tests showed nothing wrong with Charlene’s stomach, but something odd at the base of her left lung. The doctor conducting the scan didn’t think it was anything serious, but recommended that she follow up with her primary care physician anyway.

In May 2007, Charlene received a chest CT scan, which revealed three spots on her left lung. Doctors suspected lymphoma. A cardio-thoracic specialist followed up with a PET scan, which showed the same three spots. He recommended a “wait and see” approach, suggesting they could check the area again in three to six months.

“I didn’t want to wait,” Charlene said.

At her request, doctors did a lung biopsy in July, and she was told she has mesothelioma.

The actual number of tiny tumors inside her chest were “too numerous to count,” and obviously most of those had not shown up on her scans.

“I’d never heard of it,” she says. “There are a few commercials on TV, but other than hearing the word, I was not familiar with it. Most people I tell just look at me, and they’ve never heard of it either.”

The diagnosis was particularly surprising, since the average median age of onset of symptoms is 70, according to most studies, and mesothelioma usually affects men more frequently than women. Charlene said she was exposed to asbestos when she was a child, but she cannot discuss the details because she is currently pursuing legal action.

“When you think of the numbers of people that have been exposed to asbestos in their lives, you wonder why there are few people that get [mesothelioma], as compared to other types of cancer. It’s still pretty rare,” Charlene said.

In the U.S. current statistics show between 2,000-3,000 people are diagnosed with malignant pleural mesothelioma each year. However, 10,000 Americans die each year from all asbestos-related diseases, according to statistics compiled by the Environmental Working Group. And, mesothelioma was not tracked as a specific cause of death by federal health officials until 1999, EWG points out, so actual totals for mesothelioma may be much higher.

“There is a possibility that my brother and my parents could be at risk of mesothelioma, because they would have been exposed at the same time as me,” Charlene worries. “You just don’t know what causes you to get it, and not someone else.”

As she continued to research her new diagnosis, Charlene was disheartened to find that the outlook for most mesothelioma patients is bleak. The Center for Mesothelioma and Asbestos-Related Diseases at the University of Maryland Medical Center estimates median survival time between 4-12 months after discovery.

Next: Charlene begins her fight.

SOURCE: myMeso › Living with Meso – Charlene’s story, Part 1

What is Mesothelioma?

Mesothelioma cancer, or malignant mesothelioma, is an extremely rare disease generally affecting the lining of the lungs, and, more rarely, the abdominal cavity and/or the heart. Mesothelioma cancer is most strongly associated with exposure to asbestos, and can remain latent in those exposed for 30 to 40 years.

There are three types of mesothelioma cancer: pleural, in which the cancer affects the lining of the lungs/chest;  peritoneal, which affects the lining of the abdominal cavity; and pericardial, which affects the lining of the heart.

Pleural mesothelioma is the most common form of malignant mesothelioma, accounting for approximately three out of every four cases. The pleura is defined as the outer lining of the lungs and chest cavity. Pleural mesothelioma typcially has a latency period of 30-40 years or longer.

Peritoneal mesothelioma generally accounts for about 25 percent of maglignant mesothelioma cases diagnosed each year. It can have a shorter latency period than pleural mesothelioma, developing in 20-30 years or shorter. It affects the peritoneum, which is the lining of the abdominal cavity. Peritoneal mesothelioma generally occurs more often in males than females.

Pericardial mesothelioma, which affects the pericardium, the lining of the heart, is extremely rare. This form of malignant mesothelioma is usually fatal, due to its difficulty in diagnosis and treatment. It is generally diagnosed in a very late stage, and surgical or other treatment options are dangerous and difficult.

Mesothelioma in general is fairly rare in the United States. There are an estimated 2,000 to 3,000 new cases of mesothelioma each year in the United States. However, in European countries, especially the UK, as well as in Australia, the rate of mesothelioma is increasing.

For years, mesothelioma was thought to be  rare in people under age 55. Traditionally seen primarily in older men, usually with a background of working in a factory, shipyard, mine or other environment with heavy asbestos exposure, today more and more cases of secondary exposure are being diagnosed, and it is affecting greater number of women.

The average age for someone with mesothelioma used to be around 72, but each year it seems mesothelioma affects younger people, and a greater number of women. Last year, a 3-year-old girl was diagnosed with mesothelioma, stunning the physicians who were treating her.

Mesothelioma is a serious disease. By the time the symptoms appear and cancer is diagnosed, the disease is often advanced. The average survival time is about 1 year. The 5-year relative survival rate is around 10%, but this rate has been slowly improving.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Many of these patients live much longer than 5 years after diagnosis, and 5-year rates are used to produce a standard way of discussing prognosis.

Five-year relative survival rates do not include patients dying of other diseases and are considered to be a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. That means that relative survival only talks about deaths from mesothelioma. Of course, 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. They may no longer be accurate. Improvements in treatment result in a more favorable outlook for recently diagnosed patients.

Symptoms of Mesothelioma

Early symptoms of mesothelioma can be very general. Thus, they are often ignored.

Symptoms of pleural mesothelioma (lining of the chest) can include:

* pain in the lower back or at the side of the chest

* shortness of breath

* trouble swallowing

* hoarseness

* cough

* fever

* sweating

* tiredness

* weight loss

* swelling of the face and arms

* muscle weakness

Symptoms of peritoneal mesothelioma (lining of the abdominal cavity) include:

* belly pain

* weight loss

* nausea

* vomiting

* fluid or a lump in the abdomen

Symptoms of pericardial mesothelioma (lining of the heart) include:

* constrictive pericarditis

* pericardial effusion

* cardiac tamponade

* heart failure caused by myocardial infarction

Of course, these same symptoms can also be caused by other minor ailments. But if you have worked with asbestos and you have any of these symptoms, you should see your doctor right away.

Diagnosing Mesothelioma

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. As a rule, a chest x-ray is not useful in finding mesothelioma early.

One test being studied is a blood test. This test measures the levels in the blood of a certain protein that is higher in people who have lung damage due to asbestos. It is even higher if the person has mesothelioma.

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.

New developments in Diagnosis of Mesothelioma

A recently published report in the Journal of the American Medical Association holds out hope for earlier detection of mesothelioma, a deadly cancer linked to asbestos exposure.

Researchers compared three types of endoscopic collection for accuracy in detecting cancerous cells in the lymph nodes to determine their accuracy.

Typically, doctors use several different techniques to diagnose lung cancers, including mesothelioma. Those techniques include physical exams, chest X-rays, CT scans and surgical biopsies to examine the cells in the lungs and the lymph nodes.

Lung cancer is one of the most common cancers worldwide, and the outcomes are typically unpromising. The low survival rates for lung cancer are often attributed to the difficulty of diagnosing the disease early enough for effective treatment.

This is especially true of mesothelioma, a disease that affects the tissues of the lining between the chest wall and the lungs. Often, by the time mesothelioma is detected, the cancer has reached untreatable stages.

Because of this, researchers are increasingly turning to new methods of detection that may identify deadly cancers at earlier stages when chemotherapy, surgery and other treatments may be effective.

The most accurate methods of diagnosis to date involve collecting cell samples from the lungs or lymph nodes for examination under a microscope. The most common method for collecting these cells is a mediastinoscopy, which is an invasive surgery that involves anesthesia and incision. The surgeon makes an incision at the top of the breast bone and inserts a thin, lighted tube into the chest cavity to withdraw cell and fluid samples.

Mediatinoscopy is typically used to determine whether fluids in the chest cavity contain cancerous cells or asbestos fibers.

In the past few years, doctors have developed less invasive procedures to collect tissue samples from the chest. These procedures use an endoscope, a small medical device that consists of a camera mounted on a flexible tube. Ultrasound probes, needles and other instruments can be inserted through the tube to remove samples for biopsy. These endoscopic procedures are far less invasive than more traditional methods, reducing the risks to patients who undergo them.

In the study reported in JAMA, researchers compared three different procedures using an endoscope, each of them considered minimally invasive:

• Transbronchial needle aspiration (TBNA)

• Endobronchial ultra-sound guided fine needle aspiration (EBUS-FNA)

• Transesophegeal endoscopic ultrasound-guided fine needle biopsy (EUS-FNA)

In each procedure, an endoscope was used to remove tissues or fluids with a fine needle. The researchers then compared the findings among the three methods to determine which was the most sensitive for detecting the presence of cancerous cells in the lymph nodes of the chest.

The study consisted of tests taken on 138 patients in the U.S. who were believed to have lung cancer. Each patient underwent all three procedures in sequence.

The results of the study showed:

- 30% (42) of the patients had malignant lymph nodes

- EBUS-FNA detected 29 of the cancers. TBNA only detected 15

- EUS-FNA and EBUS-FNA used in combination detected 93% of the cancers.

The combination was also able to detect malignancies in patients who would not have been identified by CT scans of the chest. The results of the study suggest that the minimally invasive procedures may be a viable alternative to more invasive standard procedures for evaluation patients believed to have lung cancer.

The lower risks associated with the procedure will make the diagnostic process more comfortable for patients and provide for a shorter recovery time.

Reference: Wallace, M, Pascual, J, Raimondo, M, et al. Minimally invasive endoscopic staging of suspected lung cancer. Journal of American Medical Association. 2008. 299(5) 540-546. Source: www.asbestos.com

New System May Give Lung Cancer Patients Hope

The Associated Press Aug. 31, 2007 http://www.msnbc.msn.com/id/20533486

Thousands more lung cancer patients each year could be offered surgery or other aggressive therapy under a new system that classifies many tumors as more treatable than in the past.

It is the first big overhaul of a decades-old method used to predict survival and help determine whether a lung cancer patient will have surgery, chemotherapy or be treated at all.

The new guidance is to be presented at a conference of lung cancer specialists in Seoul, South Korea, that starts Saturday. It is expected to be adopted by policy-making groups in the next year. Lung cancer is the world’s top cancer killer, claiming 1.3 million lives each year.

In the United States, 213,380 new cases and 160,390 deaths from the disease are expected this year. Nearly 60 percent of people die within one year of diagnosis, and nearly 75 percent die within two years, American Cancer Society statistics show.

In treating it, doctors use a formula called tumor staging. It is based on a tumor’s size, how far it has spread and other factors to predict a patient’s survival odds and to guide treatment.

More precise sorting

The current system was developed from about 5,000 tumor samples from University of Texas M.D. Anderson Cancer Center in Houston decades ago — before improved scanning technology was available to evaluate a cancer’s spread.

The new plan is based on 100,000 tumor samples from around the world including Asia, where lung cancer rates are projected to climb because of trends in smoking, unhealthy lifestyles and aging populations. It keeps four broad groupings but sorts people more precisely based on refined understanding of tumor characteristics.

The result: “There will clearly be shifting of patients from categories not operable to operable” — as many as 10,000 a year in the United States, said Dr. David Johnson, a lung cancer specialist at Vanderbilt University in Nashville, Tenn. He reviewed the plan, which was partly published in a medical journal recently.

The stage of the tumor at diagnosis is the best predictor of survival. Only 20 percent of cases are diagnosed in Stages 1 or 2, when tumors are small and confined to a lung, Johnson said. About 30 percent to 40 percent are found in Stage 4, after they have widely spread. The rest are in the middle.

Five-year survival rates are 47 percent for Stage 1 and 26 percent for Stage 2, but only 8 percent for Stage 3, and 2 percent for Stage 4, according to the American College of Surgeons.

Most lung cancers are the type called ”non-small cell,“ which is covered by the new staging system. The system was developed by the International Association for the Study of Lung Cancer, a group of lung cancer specialists from around the world.

Changing groupings

Dr. Peter Goldstraw, a surgeon at the Royal Brompton Hospital in London, led the project, and Canadian scientists independently validated the recommended changes by comparing survival across geographic regions.

Among the changes: creating more sub-stages for tumor size, reassigning some large tumors to a more advanced stage, reclassifying tumors that have spread into the fluid surrounding the lung, and recognizing that spread to certain lymph nodes is more dangerous than its spread to others.

“By changing some of these groupings, some patients will get moved to an earlier stage of disease for which we tend to be more aggressive” in treatment, said Dr. Joan Schiller, a lung cancer specialist at the University of Texas Southwestern Medical Center in Dallas .

“Before, a patient may have only been offered chemotherapy. They may now be offered chemotherapy and radiation,” or more intense radiation, she said. Conversely, some people thought to have earlier-stage tumors now will be grouped with those whose tumors have widely spread, and discouraged from undergoing therapies that have little chance of helping them.

“In some cases, patients were getting inappropriately aggressive treatment,” Schiller said.

Some people with very small tumors may get away with less therapy — taking out just a segment of lung instead of an entire lobe, said Dr. Stephen Swisher, a chest surgeon at M.D. Anderson.

The impact of the changes in Europe and Japan is unclear because doctors in those countries tend to remove whole lungs rather than lobes to treat lung cancer, Johnson noted. Doctors hope that ultimately survival will improve, but that won’t happen “unless we get patients into the right hands” and they get correct treatment, Johnson said.

Revising the staging system also will do little good if doctors don’t do the right tests to properly stage a tumor, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. Staging for lung and other types of cancer should become even more precise in the near future as biomarkers and gene tests are developed to better sort patients, he added.

© 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Risk Factors for Mesothelioma

The main risk factor for developing mesothelioma is exposure to asbestos.

Asbestos refers to a family of fibrous minerals made of silicate. Asbestos was once used in many products such as insulation, floor tiles, door gaskets, soundproofing, roofing, patching compounds, fireproof gloves and ironing board covers, and even brake pads.

As the link between asbestos and mesothelioma has become well known, the use of this material has almost stopped. Most use stopped after 1989, but it is still used in some products. Experts have linked this drop in asbestos use to the fact that the rate of development of mesothelioma is no longer increasing [in the U.S.].

Still, up to 8 million Americans may already have been exposed to asbestos. Exposure to asbestos particles suspended in air and building materials is much less hazardous except when they are being removed.

Since asbestos is a naturally occurring mineral, it can also be found in dust and rocks in certain parts of the United States as well as the world.

According to the U.S. Environmental Protection Agency, as many as 733,000 schools and public buildings in the country today contain asbestos insulation. As many as 10% to 15% of schools in the United States may contain asbestos insulation.

People who may be at risk for occupational asbestos exposure include some miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with installing insulation.

Several studies have shown that family members of people exposed to asbestos at work have an increased risk of developing mesothelioma, because asbestos fibers are carried home on the clothes of the workers.

The incidence rate for mesothelioma in men is dropping, probably because they are no longer being exposed directly to asbestos in their work. But the incidence rate for mesothelioma in women is steady, which suggests that they are being exposed in a way that is not directly tied to work, but more to their environment either at home or work. One example would be asbestos in buildings where they work or live.

A study from California also links mesothelioma to naturally occurring asbestos deposits in mountains.

Another important point about asbestos and mesothelioma is that the risk of mesothelioma does not drop with time after exposure to asbestos. The risk appears to be lifelong and undiminished.

There are 2 main forms of asbestos — serpentine and amphiboles. Serpentine fibers are curly and pliable. Chrysotile is the only type of serpentine fiber and it is the most widely used form of asbestos. Amphiboles are thin, rod-like fibers. There are 5 main types — crocidolite, amosite, anthrophylite, tremolite, and actinolyte. Amphiboles (particularly crocidolite) are considered to be the most carcinogenic (cancer-causing).

However, even the more commonly used chrysotile fibers are associated with malignant (cancerous) mesotheliomas and should be considered dangerous as well.

When asbestos fibers are inhaled, most are cleared in the nose, throat, trachea (windpipe), or bronchi (large breathing tubes of the lungs). Fibers are cleared by sticking to mucus inside the air passages and being coughed up or swallowed. The long, thin, fibers are less readily cleared, and they may reach the ends of the small airways and penetrate into the pleural lining of the lung and chest wall. These fibers may then directly injure mesothelial cells of the pleura, and eventually cause mesothelioma.

Asbestos fibers can also damage cells of the lung and result in asbestosis (formation of scar tissue in the lung), and/or lung cancer.

The risk of lung cancer among people exposed to asbestos is increased by 7 times, compared with the general population. Indeed, asbestosis, mesothelioma, and lung cancer are the 3 most frequent causes of death and disease among people with heavy asbestos exposure.

Peritoneal mesothelioma, which forms in the abdomen, may result from coughing up and swallowing inhaled asbestos fibers. Cancers of the larynx, pancreas, esophagus, colon, and kidney may also come from asbestos exposure, but the increased risk is small.

The risk of developing a mesothelioma is related to how much asbestos a person was exposed to and how long this exposure lasted. People exposed at an early age, for a long period of time, and at higher levels are most likely to develop this cancer.

Mesotheliomas take a long time to develop. The time between first exposure to asbestos and diagnosis of mesothelioma is usually between 20 and 50 years.

Other Asbestos-Related Cancer

Asbestos Related Lung CancerLung cancer, or bronchial carcinoma, occurs in several forms. The most common causes of lung cancer are smoking and asbestos.

This web site has focused on the most lethal of the lung cancers – mesothelioma. Not every asbestos-related lung cancer, however, is a mesothelioma. Other thoracic carcinomas, such as adenocarcinoma, are also caused by exposure to asbestos.

The connection between asbestos exposure and lung cancer was noted as early as 1925, and confirmed over the next 70 years by many epidemiologic studies of asbestos-exposed workers.

The four main types of commercially used asbestos, chrysotile, amosite, anthophyllite, and mixtures containing crocidolite, have all been associated with an increased risk of lung cancer. About one in seven people who suffer from asbestosis, a lung disease resulting from high exposure to asbestos, eventually develop lung cancer.

Asbestos is estimated to account for 3,400 to 8,500 new lung cancer cases in the United States each year. Like mesothelioma, the latency period between asbestos exposure and the development of asbestos related lung cancer may be two, three, four, or even more decades.

Very often, asbestos-related cancer victims also suffer from asbestosis, a scarring of the lung tissue caused by asbestos exposure. About one in seven people with asbestosis will eventually develop lung cancer.

Although commonly associated with lung cancer, adenocarcinoma is a type of cancer that develops in cells lining glandular types of internal organs, such as the lungs, breasts, colon, prostate, stomach, pancreas, and cervix.

Another type of adenocarcinoma, mucinous adenocarcinoma, accounts for only 10-15% of all adenocarcinomas and is particular to aggressive carcinomas that are comprised of at least sixty percent mucus. Non-small cell lung cancers make up over three quarters of all new lung cancer cases in the United States.

While there is only one type of small cell lung cancer, there are three types of non-small cell lung cancer. The three types of non-small cell lung cancer are squamous carcinoma, large cell carcinoma, and adenocarcinoma. When adenocarcinoma develops in the lung’s air sacs, it is called bronchioalveolar adenocarcinoma. About forty percent of all lung cancer cases diagnosed today are adenocarcinoma.

The progression of adenocarcinoma is quite unpredictable. In most cases, adenocarcinoma spreads slowly and causes very few lung cancer symptoms. But it can also be extremely invasive, aggressively spreading through the body and causing death before it can be treated. Given the disease’s variability, the five-year prognosis for patients with adenocarcinoma is dim: most are given only a 10 percent chance of survival.

Sometimes, tumors spread to the liver, adrenal glands, and bones, making adenocarcinoma much more difficult to treat. Symptoms of adenocarcinoma lung cancer may include shortness of breath, the coughing up of blood, fatigue, chest pains, and unexplained weight loss. Adenocarcinoma is usually treated with surgery, radiation therapy, and chemotherapy.

SOURCE: myMeso › What is Mesothelioma?