asbestos cause of Mesothelioma lung cancer

Treatment options for stage by stage of Malignant mesothelioma

2009-01-20T22:33:00.000-08:00

Treatment by stages
Treatment depends on the location of the cancer, how the disease has spread, your age and overall health.

You could be considered a standard treatment based on their effectiveness in a number of patients in previous studies or may choose to take part in a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the latest information. Are ongoing clinical trials in various parts of the country for many patients with malignant mesothelioma. If you would like more information, call the Information Service on Cancer at 1-800-4-CANCER (1-800-422-6237), TTY 1-800-332-8615, in the United States.Malignant mesothelioma - LOCALIZED (phase I)
If cancer is found only in one part of the chest or abdomen, treatment will probably consist of surgery to remove part of the pleura and some tissue around it.
If cancer is found in a larger part of the pleura, you may receive one of the following treatments:

1. Surgery to remove the pleura and the tissue adjacent to relieve
symptoms, with or without radiation therapy after the operation.

2. Surgery to remove sections of the pleura, the lung, the diaphragm
and the coating of the heart.

3. External beam radiation therapy to relieve symptoms.

4. Clinical trial of chemotherapy followed by surgery within
abdomen.

5. Clinical trial of surgery, radiotherapy and / or chemotherapy.

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Malignant mesothelioma - ADVANCED (phases II, III and IV)
The treatment may be one of the following:
1. Drain liquid from the chest or abdomen (thoracentesis or paracentesis) to
reduce the discomfort. They could also administered drugs in the chest or abdomen to prevent further accumulation of fluid.

2. Surgery to relieve symptoms.

3. Radiation therapy to relieve symptoms.

4. Chemotherapy.

5. A clinical trial of surgery, radiotherapy and chemotherapy.

6. Chemotherapy administered in the abdomen or chest.

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Malignant mesothelioma - RECURRENT
The treatment will depend on several factors, including the location where it has reappeared and cancer treatment given previously. New treatments are being evaluated through clinical trials.

Treatment of malignant mesothelioma

2009-01-20T22:32:00.000-08:00

There are treatments for all patients with malignant mesothelioma. Used three types of treatment:

surgery (removal of the cancer)

radiotherapy (using high doses of X-rays or other high-energy rays
to kill cancer cells)

chemotherapy (using drugs to fight cancer)

Surgery is a common treatment for malignant mesothelioma. The doctor can remove the coating of the chest or abdomen and part of the fabric that is around him. Depending on how far the cancer has spread, you can also remove a lung operation called a pneumonectomy. They also removed part of the muscle that lies below the lungs that helps breathing (diaphragm).
Radiation therapy is the use of high-energy X-rays to eliminate cancer cells and reduce tumors. The radiation may come from a machine outside the body (external radiation) or materials that produce radiation (radioisotopes) and which apply to the area where the cancer cells through thin plastic tubes (internal radiation).

If you have accumulated fluid in the chest or abdomen, the doctor can drain the body by inserting a needle into the chest or abdomen and pulling with a soft suction. If fluid is removed from the chest, the procedure is called thoracentesis, while the procedure is performed in the abdomen is called paracentesis. The doctor may also introduce drugs into the chest through a tube in order to prevent further accumulation of fluid.

Chemotherapy is the use of drugs to eliminate cancer cells. These can be taken orally or injected into a vein or muscle. Chemotherapy is considered a systemic treatment because the drug is introduced into the bloodstream, travels through the body and can eliminate cancer cells throughout the body. In the case of mesothelioma, the drugs can be administered directly into the chest (intrapleural chemotherapy).

Intraoperative photodynamic therapy is a new type of treatment that uses drugs and a special light to kill cancer cells during an operation. For this, is injected into a vein, a drug that makes cancer cells more sensitive to light several days before performing surgery. During the operation to remove as much cancer as possible, using a special light to illuminate the pleura. This treatment is being studied for the early stages of mesothelioma in the chest.

Stages of malignant mesothelioma

2009-01-20T22:29:00.000-08:00

Once detected the malignant mesothelioma, will be more tests to determine whether cancerous cells have spread to other parts of the body. This procedure is known as classification stages. The doctor needs to know the stage at which the cancer to plan treatment. For the classification of malignant mesothelioma are used the following stages.

Localized malignant mesothelioma
Stage I: Cancer is in the coating of the thoracic cavity near the lung or heart or lung or diaphragm.

Advanced malignant mesothelioma
Stage II: the cancer has spread outside the chest coating to the lymph nodes in the area.
Stage III: cancer has spread to the chest wall to the center of the chest, heart, through the diaphragm, abdominal or coating, and in some cases to the adjacent lymph nodes.

Stage IV: The cancer has spread to distant organs or tissues.

Recurrent malignant mesothelioma
Speaking of recurrent disease, we mean that the cancer had reappeared (used) after being treated. You can return to appear in the coating of the chest or abdomen, or elsewhere in the body.

What is malignant mesothelioma cancer?

2009-01-20T22:26:00.000-08:00

Malignant mesothelioma,is a rare form of cancer and it this disease lung cells became cancerous (malignant). For some step amd process malignant tissues cover and surround the chest (the pleura) or in covering the abdomen (peritoneum). Most people with malignant mesothelioma have worked in places where they inhaled asbestos breathing.

You should see a doctor if you lack the breath, pain in the chest or pain or swelling in the abdomen. If you have symptoms, the doctor may send you to a chest X-ray or abdomen.

The doctor can examine the inside of the chest cavity with a special instrument called thoracoscopy. To do this, make a slit through the chest wall and install the thoracoscopy in the chest between two ribs. This test, called thoracoscopy, is usually performed in a hospital. Before the test, will be given a local anesthetic (a drug that causes loss of sensitivity for a short period of time). You may feel some pressure, but generally do not feel pain.

The doctor also can examine the inside of the abdomen (peritoneoscopia) with a special device called peritoneoscopio, which is inserted into an opening made in the abdomen. Usually, this test is also carried out in hospital. Will be given a local anesthetic before they carried out the test.

If abnormal tissue is found, the doctor will have to remove a small piece to be submitted for analysis under a microscope to determine the presence of cancer cells. This process is known as a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopia.

His chances of recovery (prognosis) depends on the size of the cancer, its location, how far has spread, the appearance of cells under a microscope, how the cancer responds to treatment and patient age.

Care, treatment and medicament of maliggn mesothelioma

2009-01-20T22:17:00.000-08:00

The choice of best treatment for each individual depends on many factors, including age, overall health status, stage of disease, the type of cells (which determines the aggressiveness of the cancer) and, above all, by personal desires. For help in the evaluation of this country will find a 'interdisciplinary team (MDT) of doctors, who will discuss your case and I would suggest the strategy of care. Among the members of this team may be a surgeon cardiotorácica, an oncologist, a radioncologo, a specialist in pain control and a specialist in palliative care. Could be involved nurses and other health workers.

The conventional treatment of mesothelioma offers several options to be discussed in detail one by one with the MDT before taking a decision on the therapy to be taken. Be sure to be informed as to risk factors, the prognosis with treatment, the potential side effects and quality of life that each alternative offers.

Surgery
There are two surgical approaches to mesothelioma: pleurectomia / decortication (P / D) and pneumonectomia extrapleurica (EPP). This is very specialized surgery that are not performed at all facilities. Not all of the thoracic surgeons are experienced in this type of intervention. The ultimate aim of these procedures is the removal of the disease at the macroscopic level, with knowledge that residual disease at the microscopic level will remain. Adjuvant therapy, which used other forms of care with the primary therapy, typically aims to remove these residues. The most common forms of therapy are adjuvant chemotherapy and / or radiotherapy.

Of the two approaches pleurectomia / decortication is seen as less radical because it involves only the removal of the pleura (lining of the lung) without underlying lung resection. In some cases, you can remove the pericardium and diaphragm, depends on the proportions of the tumor. The advantages of this procedure recovery times are generally faster, and benefits for patients who could not tolerate more radical EPP. Among the disadvantages, there is a greater risk of recurrence of the disease due to an inability to remove all the cancerous tumor, and the impossibility of using high doses of radiation because of the potential damage to the underlying lung.

The pneumonectomia extrapleurica is a radical procedure that involves the removal of the lung, the pleura (lining of the lung) of the pericardium surrounding the heart and part of the diaphragm. During surgery, the pericardium and diaphragm are reconstructed with materials like gortex. Patients eligible for this intervention chirugico are only those that meet certain criteria and show the proper functioning lung and heart to be able to tolerate the procedure.

Chemotherapy
Chemotherapy involves the use of anticancer drugs that act by preventing the proliferation of cancer cells. In most cases, combinations of drugs used to increase the effectiveness of therapy. Chemotherapy can be used aggressively to reduce the tumor or in a palliative for symptoms such as pain or shortness breath. The administration of chemotherapy can be injected into a vein or muscle, such as oral medication or may sometimes be administered directly into the pleural or peritoneal cavity. Some of the drugs most commonly used are:

Pemetrexed (Alimta)
Cisplatin (Platinol)
Carboplatin (Paraplatin)
Gemcitabine (Gemza)
Doxorubicin (Adriamycin)
Mitomycin
Raltitrexed (Tomudex)
Vinorelbine (Navelbine)
The search for new drugs by the pharmaceutical companies continue constantly, so it is good to ask your doctor information about the latest drugs and promising. One of these drugs, the Alimta (pemetrexed), was approved in Europe in September 2005.

Radiotherapy
Radiotherapy involves the use of x-rays with high energy to kill cancer cells and reduce tumors. It can be used for aggressive with the surgery to help eliminate the metastatic spread a microscopic level that can cause relapse of the disease, or as a palliative to combat pain caused by tumors that press on the nerve ends or other organs. Radiation has also proved effective in preventing the spread of tumors in locations biopsy and chest tube drainage.

Clinical studies
The purpose of clinical trials is to involve patients in the discovery of better and innovative treatments for their disease. The various studies have different purposes that may include the testing of new drugs, the comparison between different ways of treating a disease or experimenting with different techniques for the prevention of cancer. Clinical studies are divided into three phases. Here are briefly summarized the goals of each stage of experimentation.

Phase I studies are the first phase of the clinical trial. At this point, the drugs were tested only in laboratory conditions, but have proved effective in destroying cancer cells. For these studies, available only in a limited number of institutions of oncology, is recruited only a limited number of participants. The purpose of Phase I studies is to find the maximum dose of the drug tolerated without serious side effects, to understand what are the most common side effects and whether the drug continue to have an anticancer when administered to humans. If the drug shows to have an effect on cancer at a safe dose is tested in Phase II of the trial.

Phase II studies continue to verify the safety of medications or procedures, but also beginning to look more closely at its efficacy in specific types of cancer. For these studies, available in most institutions, is recruiting a higher number of participants. These studies can be "randomized", or different groups of participants are chosen by a computer, rather than from a doctor.

The phase III studies comparing bring new drugs or new procedures promising with the current standard of care. For these studies is recruited a large number of participants from different areas, or who receive the new treatment or the standard. One of the main objectives of the Phase III study is to determine whether the cancer is reduced or slowed by the medication, since the conditions of patients remain stable without the disease progresses and what are the effects of treatment with drugs on the quality of life.

If you are interested in participating in a clinical trial for mesothelioma, your doctor should be able to supply all the information on your suitability and availability of the study in your region.

Who is at risk for developing mesothelioma?

2009-01-20T22:16:00.000-08:00

Those who have worked in direct contact with asbestos or its products carry the greatest risk for developing mesothelioma, however, mesothelioma has been reported in some individuals whose exposure was minimal.

Among the activities at high risk for developing mesothelioma include:

Metal plate workers (including the construction of ships)
Manufacturers of vehicles (including rail vehicles)
Plumbers
Installers of gas
Joiners
Electricians
Workers in the construction industry
Plasterer
Builders
Workmen handyman
Steel erectors
Painters
Workers of sheets
Welders
What types of products usually contain asbestos?
These products generally contain asbestos in different concentrations. This list is not complete and is designed only as a general reference.

Pre-shaped or coatings used for thermal insulation of pipes and boilers
Asbestos in spray used as fire protection in the pipeline, in the margins fender, the panels in the walls, in the axis of the loft, the panels of the ceiling and around steel structures
Assi insulation used for fire protection, thermal insulation, the walls and the pipes
The coverings of asbestos used in the margins fender and spaces of the ceiling
Double-pressed cardboard, paper and paper products used for insulation of electrical equipment, paper asbestos can also be used as a fire retardant coating on the panels of wood fiber
The products of the cement asbestos sheeting and corrugated plates that are used for roofing or wall cladding; cement products were also used in gutters, the rain and water tanks
Structured coatings (such as Artex)
Covering material made of bitumen
Vinyl tiles or thermoplastic

How common is mesothelioma?

2009-01-20T22:14:00.000-08:00

Country cases per million cases per year per year statistics for europe.
Finland 75 (2002) 18
France 870 (2000) 18
Germany 1094 (2001) 16
Great Britain 1862 (2002) 39
Italy 1050 (2000) 21
Netherlands 389 (2000) 30
Norway 57 (2000) 16
Sweden 149 (2003) 20

What causes malignant mesothelioma?

2009-01-20T22:13:00.000-08:00

Mesothelioma is almost always provocated from exposure to asbestos fibers. Many people there were on display in the military life; others because of their work, others, secondly, through contact with workers exposed. Because of its latency, the cancer may not occur for 20-50 years, and beyond, after exposure.

what is the malignant mesothelioma

2009-01-20T22:01:00.000-08:00

Mesothelioma is a rare and virulent form of cancer that affects the lining of the lung cavity, abdominal or lining of the heart. Mesothelioma is caused by exposure to asbestos and affects those who have inhaled asbestos fibers, in many cases even 20-50 years before. Some were exposed at work, others as a secondary means of family members who, without knowing it, have brought home fibers deposited on work clothes or hair or skin.

Although the nature of this disease is serious, there is some hope. Each year, doctors and scientists all over the world are developing new therapies and new discoveries are helping to improve the chances of survival and quality of life of patients. This Web site, Mesothelioma International, helps patients and family members to come into contact with the resources necessary to stay informed and make better decisions about treatment and care possible

malignant mesothelioma prognosis

2009-01-20T17:11:00.000-08:00

Prognosis and prognostic factors of malignant Pleuramesothelioms

Overall, the prognosis of patients at a Pleuramesotheliom malignant disease, with and without therapy bad.

The median survival time is about 7-10 months from time of diagnosis. The duration of survival correlates closely with the tumor stage and the histological subgroups. While in the early stages I / II, the three-year survival probability is about 20%, there is the survival in stage IV only in 1-3 months. Epithelialem Tumortyp patients with stage I represent the best prognostic group dar. patients who are at this stage of an appropriate surgical therapy to be, in some cases can reach a long-term survival.

mesothelioma is wrongful death

2009-01-20T17:10:00.000-08:00

Asbestos is a dangerous and potentially fatal, which was once widely used in a range of factors, from the tile wall and ceiling insulation and automatic brakes. In the past, most people outside of the industry was completely unaware of the dangers with respect to asbestos. However, for some years the dangers and deadly effects of asbestos have become in all too apparent, with more and more cases of the most deadly of these effects - mesothelioma - emerge daily.

Mesothelioma is a malignant cancer that can start in the cavities of the lungs, heart, or dell'addome. This cancer is the direct result of exposure to asbestos disturbance, in which the fibers become dispersed in the air. These asbestos fibers dispersed in air can then be easily ingested or breathed in by those nearby who are not using enough. Once the asbestos fibers are housed in different parts of the body, can not destroy the cells of the immune system, which are known as macrophages. Instead, the asbestos fibers lead to deface the tissue within the body and this is what can lead to mesothelioma and other asbestos-related injuries.

The people who have contracted mesothelioma with asbestos exposure do not realize that something is wrong for years. The period of latency typical for this cancer is around venti - forty years, so that means that those affected can not find out for three or four decades after the exposure. Further delays may be experienced as a result of the symptoms of mesothelioma, which are not very specific in nature - this means that could be easily attributed to other more common disorders. This often leads to a delay in diagnosis, causante further delays when it comes to treatment of the whole system.

There is no known cure for the current mesothelioma, although clinical trials and tests are continually effettuandi. During recent years, many innovations have been made in the treatment of short duration and diagnostic procedures, which gives fresh hope to the victims of this cancer. However, to find a cure, many people continue to lose their lives due to the irresponsibility of various companies and suppliers in decades gone by.

Of course, the victims and their families want to see some form of compensation for pain, suffering and misery caused by asbestos and mesothelioma. Although no amount of money can compensate recover the damage done by unprotected asbestos exposure, may help pay for medical costs and may also provide for the victim's family a financially secure future.

It is important for anyone who is diagnosed with mesothelioma to seek legal advice from a lawyer with experience of mesothelioma immediately. Even if the lawsuit can not be something you want to think about after being treated bombs lle news like this, all the delay could make a difference between supporting millions of dollars for your suffering, expenses and future of your family, or not get nothing. Your lawyer should know the extent of the damage and the stage of your cancer, so it is advisable to provide a medical report from your doctor for your lawyer for a solid cause of mesothelioma and get as much compensation as possible for you and your beloved.

Legal issues and Asbestos

2009-01-20T17:04:00.000-08:00

Took place towards the end of the 70 that legislators and businesses have really started to eliminate the use of asbestos, which can lead to cancer of the deadly mesothelioma. But products already made for distribution were not ever lines of the factory and people are still considering the influences of asbestos.

Last month, the main cruise ship for Scientologists, who have urged all of scientology elite over the years including Tom Cruise, was found to have extreme amounts of blue asbestos. The blue asbestos puts people at greatest risk of all types of asbestos.

Just a chief of staff of the White House for couples of weeks ago during the administration of Jimmy Carter, Hamilton Jordan, who died of mesothelioma at age of 63. How and where he was exposed to asbestos is unclear, but what is clear is most people over the years has however contacted asbestos and early diagnosis is the best defense.

On the coast of Lake Michigan in Illinois, where I spent a sum personally right time with Oprah, and virtually all residents of Chicago, asbestos continues to wash up on props. In an effort to help prevent future cases of mesothelioma and other asbestos-related diseases, the company conservation of Illinois Dunesland is offering tips to beachgoers to minimize inhalation and ingestion of asbestos fibers potentially fatal. The company is critical of the food and drink contaminated beaches, as well as the disturbance of the sand in any way. That is not the recommended comfort in the world for people just looking to enjoy the summer breeze in the windy city.

If you're touching up the old case of asbestos exposure that could be an issue and you should check to make your first professional home. The construction work inside that contains asbestos, but is not a problem until it is undisturbed and not in ventillation systems.

You can find them and a risk for a number of past and present occupations of the ships within the automotive, home inspectors and the list goes unabated.

The general amounts of asbestos have been reduced but is still a major problem. If ever you are exposed to the best thing you have to see a doctor, as I do not even mesothelioma appear many years after exposure to asbestos.

Malignant mesothelioma asbestos

2009-01-20T17:00:00.000-08:00

Malignant mesothelioma is a serious form of cancer linked to exposure to asbestos fibers dell'asbesto the air, or asbestos. Although this cancer can be defined yet rare in recent years there has been an increasing incidence of cases in the population and many observations suggest that the problem Mesothelioma is intended to take even greater dimensions in the years to come.

Mesothelioma affects every two years every one hundred thousand Italian males, especially among those who have been exposed to it or close to asbestos. Mesothelioma is a cancer that arises from mesotelio, the layer of cells covering the serous body cavities (pleura, peritoneum, pericardium, vaginal cavity of the testicles).

Italy was one of the largest producers and users of asbestos until the late'80s, but despite the use of asbestos has been completely banned in 1992, Italy now bear the consequences of exposure levels to which they give place the heavy use of the material from the 50s' in the fields of industrial production of manufactured asbestos-cement, textile and fiber-containing material, the shipbuilding and repair and demolition of railway rolling stock and construction industries.
Macroscopically is a pleural plaque, less frequently nodular. Its development can lead to employment in the pleural space that leads to blockage lung, and in that circumstance requires intervention demolition.

Nearly all reported cases has latency 15-45 years and after 1-2 years and is presented in three different histologic types: epitelioide, sarcomatoide and biphasic.

The diagnosis is histological / radiological and it is good to calretinina.

E 'characterized by aggression and resistance to common treatments, and high mortality:

from the time of diagnosis generally allows an average survival of 7.7 months (range 1-72).

The age group most affected is between 40 and 60 years, men in 60% of cases. The incidence of mesothelioma is increasing throughout the world with about 2.2 cases per million inhabitants.

Being strongly related to industrial work, prohibited or elimination phase is also in third world countries, and since the disease latency time high, analysts expect a peak of around 2020 cases, with a subsequent decline.

Since the tumors are rare, the mesothelioma should be treated in a few specialized centers, where you will find all the different experiences and skills are essential: the thoracic surgeon all'oncologo doctor, radiotherapy. Before choosing the specialist to whom to rely, it is good to ask him his experience in the field, how many cases of mesothelioma addressed, such prospects are able to offer in terms of survival and quality of life. Here, some of the Italian centers that have developed the most extensive case studies:

mesothelioma STRATEGIES FOR THE FUTURE.

2008-07-26T02:38:00.000-07:00

How asbestos causes mesothelioma is still an enigma. The exact molecular pathway of the pathogenesisis obscure as no specific abnormality has been found so far in oncogenes and suppressor genes. The main research efforts must be directed to the detection of specific aberrations at the molecular level. These data have to be combined with chromosomal abnormalities, clinical data, and biological behaviour of this tumour. Such investigations would disclose specific mesothelioma markers useful in diagnosis, therapy and prognosis. The detection of certain surface-antigens on mesothelioma cells make some authors dream of vaccinating high risk individuals.

Another important research area is the resistance to chemotherapy of most mesotheliomas. ....

As no standard treatment is available for mesothelioma patients, each attempt to treat should be considered experimental with only a low chance of benefit. As most patients present in stages I or II, which carry the best prognosis, they will be the obvious target for clinical trials. As in advanced nonsmall cell lung cancer, any progress will only be made by new and/or combined treatment approaches. These must be validated by randomizing them against best supportive care with palliative procedures like pleurectomy. The intraserosal route might also be ideal for reinoculation of adoptive T-cells afterin-vitro activation by IL-2 or after genetic manipulation.

For the time being, the role of the clinician will mainly consist of relieving symptoms of pain, dyspnoea and cough. In view of the better prognosis of limited disease cases, a plea can be made to screen high risk individuals periodically by CT. Subjects who already developed a so-called "benign asbestos pleurisy" have a tremendously increased risk for developing a mesothelioma in later years. According to some, these patients should be treated with a parietal pleurectomy at the time of their first pleurisy.

Obviously, the main task of the authorities is to avoid and reduce asbestos exposure by appropriate legislation. However, with the latency period in mind, mesothelioma must be expected to occur up to 40 years after its industrial and consumer use stopped.

In addition the basic comprehension of the role of growth factors, oncogenes and suppressor genes may lead to an improved more accurate diagnosis and a novel optimized biotherapy perhaps resulting in a cure of this harsh merciless disease.

treatment for mesothelioma

2008-07-26T02:37:00.000-07:00

TREATMENT

There is no standard treatment for mesothelioma, as one of the therapeutic modalities; surgery, radio-or chemotherapy; has been shown in randomized prospective studies to improve survival compared to natural history. The following is a summary of published experience (25).

1: Radical surgery or extrapleural pleuropneumonectomy is a major surgical procedure aiming at removing the tumour by excising lung, ipsilateral parietal and mediastinal pleura, diaphragm and pericardium. Prolene patches are inserted to close the pleural cavity from the peritoneum. The procedure does not provide microscopically tumour-free margins and must be followed by adjuvant therapy. In view of the significant operative mortality (>15%), its application is reserved for a minority of patients with disease confined to stage I and medically fit to undergo the procedure. This selection bias accounts for the observed survival advantage which is, however, not statistically significant.

2: Pleurectomy offers best local control of pleural fluid, with acceptable mortality (<3%). Its use can be advocated in patients with good performance status, rapid and symptomatic fluid accumulation and a good expanding lung. No influence on survival is observed.

3: Radiotherapy is also problematic since differences between tumour cytotoxicity and pulmonary tolerance are small and radiation pneumonitis may significantly impair quality of life. There is no evidence that radiosensitizers improve responsiveness to external radiation. Radiotherapy has limited usefulness in the palliation of painful lumps, vena cava superior compression and the prevention of metastatic seeding along a thoracic puncture site.

4: The response rate to single agent chemotherapy is low (<20%) with the highest response rate for doxorubicin, mitomycin and ifosfamide. Combination of several drugs has not resulted in a cumulative response, neither has dose-intensification of one of them. Only a few randomized trials have been conducted, showing no obvious advantage of one drug regimen above the other. So, no standard systemic chemotherapy can be proposed.

5: The combination of pleurectomy with or without intraoperative brachytherapy, followed by externalbeam radiotherapy has led to prolonged survival in highly selected patients, but the overall results have been disappointing. Radical surgery followed by combination chemotherapy and limited field radiotherapy has led to a median survival of 16 months and an overall 3 year survival of 42% in 32 patients with epithelial cell type disease. Pleurectomy followed by intrapleural and systemic chemotherapy resulted in a median survival of 17 months and a overall 2-year survival of 40%.

From these phase II studies it appears that combined modality treatment is feasible and may prolong survival in carefully selected patients. The results should however be confirmed in a prospective randomized manner based on careful pre-treatment staging. As long as no chemotherapy regimen is identified to be active in >30-40% of patients, there is no place for any approach using induction (or neo-adjuvant)chemotherapy, followed by surgery in responders.

6: Intracavity therapy in mesothelioma is theoretically attractive because it may expose the tumour to very high concentrations of drug while sparing normal tissues from drug-related systemic toxicity. Preliminary results with cytotoxic agents have shown good pleurodesis, but less cytolysis than expected. Intrapleural immunotherapy with gamma interferon and interleukin-2 have been associated with an objective response rate of 16% mostly in stage I patients (17). The major theoretical obstacle to tumour control by the intrapleural route is the shallow depth of free-surface drug diffusion and the dispersion of the drug throughout the pleural space. This form of therapy may only be useful in selected patients with early stage disease or in combination with surgical resection of all gross tumour.

7: The use of photodynamic therapy following surgical resection has been investigated in a phase I trial. Its preliminary data regarding toxicity and feasibility are sufficiently promising to proceed further to a phase II study. Other proposed experimental procedures are intrapleural hyperthermia and gene therapy. At the time of writing, little is known about their possible clinical application.

DIAGNOSTIC PROCEDURES AND STAGING MESOTHELİOMA

2008-07-26T02:35:00.000-07:00

Malignant mesothelioma remains a diagnostic challenge for the clinician and the pathologist. An

adequate biopsy specimen should be obtained. The sensitivity of the cytological examination of pleural fluid and "simple" pleural biopsy is low, the former because of the difficult differentiation from reactive mesothelial cells, the latter because mesothelioma mostly arises from the lower part of the parietal and/or the diaphragmatic pleura, out of reach for the "blind" technique of pleural biopsy.

Needle aspiration or biopsy under CT or ultrasound guidance can be helpful in obtaining a pathology specimen. The size of the sample will, however, often be too small to allow the pathologist to make a confident diagnosis and perform immunohistochemistry. We restrict this technique to those patients who are unwilling or unable to undergo a thoracoscopy.

Thoracoscopy (or pleuroscopy) is an endoscopic technique which is gaining more and more popularity in the hands of experienced pulmonologists and thoracic surgeons. As a diagnostic technique it can be performed under local anesthesia with sedation. After aspiration of pleural fluid, a pneumothorax is installed. Complete inspection of the involved hemithorax is frequently possible (16). Biopsy under direct vision of macroscopic abnormal and normal parietal, diaphragmatic, costal and visceral pleura impossible. The size and number of the samples is seldom limited by pain or dyspnea. Disease extent in the thorax can be appreciated as a first step in staging. When intrapleural therapy is considered (see further) talc or another sealing agent can be sprayed and/or a drain/portacath left in place. This safe and accurate technique has a good cost-benefit ratio, low toxicity and high sensitivity in the diagnosis of mesothelioma.

Surgical biopsy is the method of choice in patients without pleural fluid. Since mesothelioma is generally locally invasive, extensive work-up of other sites is usually unnecessary, unless the patient has specific symptoms, or is included in a clinical trial....

As disease extent is one of the most important prognostic factors and intrapleural treatment likely to be the most active in disease confined to the pleural cavity, it will become of crucial importance to properly select stage I disease patients for clinical trials. We and others feel that CT is unable to confidently differentiate between local and locally invasive disease in the diaphragm, chest wall, pericardium and mediastinum. Magnetic Resonance Imaging (MRI) will undoubtedly become the procedure of choice for staging mesothelioma, for it allows sagittal and coronal reconstructions and hence better visualization of possible involvement of different layers of the adjacent structures. Confirmation of disease extentshould then be sought by means of thoracoscopy........

CLINICAL AND RADIOLOGICAL PRESENTATION OF MESOTHELİOMA- NATURAL HISTORY.

2008-07-26T02:33:00.000-07:00

CLINICAL AND RADIOLOGICAL
PRESENTATION - NATURAL HISTORY.

Mesothelioma is difficult to diagnose. A high degree of suspicion is warranted whenever a patient with presumed asbestos exposure presents with dyspnea and/or chest pain. Clinical and radiological examination will disclose evidence of a large pleural effusion; about 5% of patients have bilateral disease at initial presentation. The majority of patients have a good performance status (WHO 1-2) at diagnosis, reflecting the loco regional spreading of the tumour. Patients with late stage disease often develop tumour fever, a palpable chest lump and a characteristic scoliosis toward the side of the lesion.

As the lung is encompassed by tumour and cannot fully expand, the mediastinum is pulled to the ipsilateral side. Metastatic pleural effusions always displace the mediastinum to the contralateral side with increasing volume. In one third of mesothelioma patients pleural plaques and calcifications are visible on the conventional chest X-ray. Computed tomography (CT) will, in about 50% of patients; reveal pleural calcification not large enough to be seen on chest roentgenogram. Its main importance is determining disease extent and evaluation of response to therapy. Obviously, CT cannot differentiate between a metastatic pleurisy and a mesothelioma.

The following are findings which can be helpful in this differential diagnosis:

1: circumferential "rind-like" thickening (>1 cm) of the parietal pleura;

2: nodular masses on the lower parietal, diaphragmatic, pericardial or mediastinal pleura;

3: volume loss of the involved hemithorax;

4: involvement of the visceral pleura in the main lung fissure.

The latter is often also visible on the roentgenogram of the chest and represents one of the most specific radiological signs in the presence of a known asbestos exposure (13).

The natural history of mesothelioma is dismal with a median survival of less than 1 year (8-11 months). Patients generally die of local extension and respiratory failure. Tumour extension in surrounding organs may result in small bowel obstruction, arhythmias or heart failure. Invasion of thoracic wall and spine can result pain syndromes which are difficult to treat.

At autopsy 50% of mesothelioma patients have distant metastases. Five year survival rates are <5%, mostly occurring in patients with good initial performance score, limited disease extent and epithelial histology. These are the foremost important prognostic factors, as ascertained by uni- and multivariate analyses in the limited number of prospective randomized studies(14).

EPIDEMIOLOGY OF MESOTHELIOMA.

2008-07-26T02:31:00.000-07:00

Malignant mesothelioma is a neoplasm arising from mesothelial cells, most often of the pleura and peritoneum. Very rarely is the tunica vaginalis testis or the pericardium the primary site. ...

There is evidence that the incidence in the Western world is increasing and will peak around the years 2000-2010. This increase cannot be solely attributed to a better recognition of the disease by improved pathology techniques.....

It has been quite difficult to estimate a dose-response relationship for asbestos and mesothelioma, and hence comparison between different fiber types, handling processes in different studies has also been difficult. The risk of developing a mesothelioma varies, depending on the duration and intensity of exposure. As the presence of pleural plaques on the chest roentgenogram reflects significant exposure to asbestos, an increased risk - estimated at 1/1700 - for mesothelioma may be expected in these subjects. Families of asbestos workers have an approximately 1% risk; in most cases this risk arises because of contamination of work clothes or manufactured articles.....

Clinicians are sometimes confronted with patients without any admitted asbestos exposure, neither professional, occasional or familial. These cases represent either this spontaneous "background incidence", or result from an some unobserved exposition in childhood, as asbestos has been extensively used in the past in industrial and consumer applications. ....

Familial clustering of mesothelioma indicate that host genetic factors may act; perhaps by rendering the host more susceptible to asbestos exposure. Case reports of mesothelioma developing in childhood and even in utero for which no risk factors could be identified indicate that there are probably as yet unknown factors involved in the pathogenesis of this peculiar neoplasm (5).

Treatment of mesothelioma

2008-07-26T02:27:00.000-07:00

Malignant mesothelioma is an insidious neoplasm with a dismal prognosis and a median survival of six to 18 months [1,2]. It arises from mesothelial surfaces of the pleural and peritoneal cavities, the tunica vaginalis, or the pericardium. This card will discuss the treatment of malignant mesothelioma. The epidemiology, pathology, clinical presentation, and staging of this disorder are discussed separately. (See card "Epidemiology and pathology of malignant mesothelioma" and see card "Clinical presentation and staging of malignant mesothelioma").

For many years, a nihilistic attitude has existed among many physicians and surgeons caring for patients with malignant mesothelioma because of the tumor's characteristically poor response to multiple forms of therapy. Much of this nihilism has been justified, but emerging therapies may offer hope for improved palliation, prolonged survival, and even possible cures in some patients.

CHEMOTHERAPY--Despite multiple single-agent and combination chemotherapy trials over the past two decades in patients with mesothelioma, there is currently little indication for primary use of this modality. Response rates to single-agent chemotherapy have been dismal, ranging from zero to 20 percent. Doxorubicin has the highest single-agent response rate, while methotrexate and cisplatin have demonstrated little efficacy.

Combination therapy with mitomycin and cisplatin showed significant activity in animal studies but only 25 percent total response rates in clinical trials [1,2].

RADIATION THERAPY--Palliative radiotherapy with an attempt to treat the entire involved pleural surface is technically difficult and associated with a high risk of radiation pneumonitis, myelitis, hepatitis, and myocarditis. Mesothelioma is more responsive to radiation therapy than non-small cell lung cancer, but it is not as sensitive as small cell carcinoma.

There have been anecdotal reports of long-term survivals following high-dose external-beam irradiation and even intrapleural administration of radioactive isotopes. Most studies have shown no significant effect upon overall survival in patients with mesothelioma [2]. However, radiation therapy may play a role by preventing chest wall recurrences after thoracoscopy /thoracotomy and in improving local control after pleurectomy or extrapleural pneumonectomy [1,2].

SURGICAL APPROACHES--Although potentially associated with substantial morbidity, surgical treatment of mesothelioma has made the greatest strides in palliating the major symptoms of the disease and has achieved some improvement in survival. The increased use of thoracoscopy has permitted the earlier diagnosis of more patients with mesothelioma, at which point they may be candidates for more aggressive attempts at surgical "cure."

PLEURODESIS--By far the most common and bothersome symptom in mesothelioma is persistent dyspnea from large, unilateral pleural effusions. A reasonable palliative approach is complete drainage of the pleural effusion (by tube thoracostomy or video thoracoscopy) and introduction of an irritative agent into the pleural space (by injection or insufflation) to produce pleurodesis.

At present, the most widely-used compound for pleurodesis is sterile, asbestos-free talc, administered either as a powder or a slurry. Unfortunately, chemical pleurodesis is often unsuccessful in patients with mesothelioma because of:

·Bulky tumor in the pleural space.

·"Trapping" of the lung by a thick visceral pleural peel of tumor.

PLEURECTOMY--Parietal pleurectomy, i.e. open surgical stripping of the pleura and pericardium from the apex of the lung to the diaphragm, is more successful than talc pleurodesis in reducing the recurrence of pleural effusion in mesothelioma. However, pleurectomy alone has not been shown to prolong survival.

Investigators at the Memorial-Sloan Kettering Cancer Center evaluated the combination of parietal pleurectomy with post-operative intrapleural therapy and/or external beam irradiation. They demonstrated a median survival of 22.5 months and a 2-year survival rate of 41 percent in a select group of 27 patients, predominantly with the epithelial subtype [2-4]. Although uncontrolled, these results are better than the usual six to 18 month median survival [1,2].

EXTRAPLEURAL PNEUMONECTOMY--Extrapleural pneumonectomy (EPP) is a radical surgical procedure involving complete removal of the ipsilateral lung along with the parietal and visceral pleura, pericardium with portions of the phrenic nerve, and the majority of the hemidiaphragm. This procedure alone is an excellent means of palliating the profound dyspnea and orthopnea associated with the severe ventilation/perfusion mismatch resulting from lung encasement by tumor. However, EPP has not been shown to significantly prolong survival without adjuvant therapy.

·One group has combined EPP with sequential postoperative chemotherapy (doxorubicin, cyclophosphamide, and cisplatin for four to six cycles) and up to 5500 cGy of adjuvant XRT to the postoperative hemithorax [3,5].

·Other groups have used intracavity chemotherapy or irradiation postoperatively.

·Researchers at the National Cancer Institute are currently investigating post-resectional, photodynamic therapy with/without adjuvant chemo/immunotherapy [6].

EPP in these contexts is designed as a cytoreductive, not a curative procedure. It is associated with significant morbidity and an operative mortality that ranges from five to 35 percent, depending upon the experience of the center and the preoperative condition of the patient. Therefore, patients must be carefully selected.

Candidates for this multimodal approach must initially undergo extensive preoperative evaluation, including chest MRI with sagittal views to assess mediastinal and diaphragmatic involvement, full pulmonary function testing with quantitative ventilation-perfusion scanning for patients with borderline FEV1, and echocardiography to evaluate mediastinal invasion and ventricular function (which is crucial before treatment with anthracycline chemotherapy). Patients greater than 55 years of age may not be candidates for EPP, even if they meet other criteria, because of the increased perioperative mortality rate with older patients.

One group has demonstrated improved short- and long-term survival in patients with mesothelioma using this combined-modality approach [3,5].

·Median overall survival was 16 months, but was improved to 24 months for those with the epithelial subtype.

·Patients who had epithelial mesothelioma and no mediastinal lymph node involvement at resection had a remarkable five-year survival rate of 45 percent.

RECOMMENDATIONS--Our currently recommended course of definitive treatment is to offer EPP with adjuvant chemotherapy +/- local radiotherapy for healthy patients under age of 55 with early-stage mesothelioma (IMIG stage Ia, Ib, II) (show figure), epithelioid histology, and no evidence of mediastinal lymph node involvement. Talc pleurodesis is utilized as a palliative procedure for patients with non-bulky mesothelioma who do not otherwise meet the above criteria. Decortication (visceral/parietal pleurectomy) is viable palliative option for those with more extensive stage mesothelioma. Because of the risk of seeding the peritoneal cavity, we do not recommend routine use of pleuroperitoneal shunts for this disease.

TREATMENT OF NON-PLEURAL FORMS OF MESOTHELIOMA--Patients with peritoneal mesothelioma may have an improved prognosis relative to the pleural form. This may reflect the technical ease of delivery of intraperitoneal chemotherapy as well as the capacity for multiple resections and debulking of peritoneal masses. One third of 25 selected patients with peritoneal mesothelioma in phase II series from the Dana-Farber Cancer Institute remain disease-free two to three years after treatment [7].

There is no effective therapy for mesothelioma of the pericardium or tunica vaginalis, and these neoplasms share the dismal prognosis of the pleural form of the disease [1].

NEW THERAPEUTIC APPROACHES--Despite the small, but significant improvement in survival achieved with intensive multimodality therapy for mesothelioma, it is obvious that less morbid and more effective interventions are needed. Several investigators over the past two decades have attempted to treat this disease primarily by direct instillation of chemotherapeutic and other compounds into the pleural space with minimal success [4,5,8]. Based upon reports that mesothelioma patients with greater amounts of intratumoral lymphocytic infiltration had improved median survival rates, several groups have studied immunotherapy as an alternative means of achieving better tumor response rates [9,10].

IMMUNOTHERAPY--The use of compounds to stimulate an antitumor immune response against pleural malignancy stemmed from the observation that patients who developed empyemas post-thoracotomy for primary lung carcinoma had improved survival rates. Subsequently, intrapleural BCG was studied as a surgical adjuvant, but no significant benefit was seen. Several systemic forms of immunotherapy have been administered to patients with mesothelioma, including interleukin-2 (IL-2) and interferon-gamma (IFN-gamma), both of which demonstrated limited efficacy and substantial adverse effects. Subcutaneous IFN-alpha-2a was found to have some efficacy--one complete response and three partial responses out of 25 patients studied--and was well-tolerated [11].

One group has pioneered the intrapleural administration of immunostimulants to treat mesothelioma, demonstrating significant responses to both intrapleural IL-2 and IFN-gamma [12-14]. Most impressive were the results of intrapleural IFN-gamma in patients with early stage mesothelioma (Butchart Stage I and II) [13,14].

·Eighty-nine patients were treated over 46 months with an overall response rate of 20 percent.

·Eight patients (nine percent) had histologically confirmed complete responses, and nine (10 percent) had partial responses with greater than 50 percent reduction in tumor volume.

·Overall, patients with Stage I disease had a response rate of 45 percent.

New immunotherapy trials in Australia have demonstrated some significant regression with direct intratumoral injection of GM-CSF on a repeated basis. (A. Davidson, personal communication)

GENE THERAPY--Researchers at the University of Pennsylvania Medical Center are currently conducting a phase I clinical trial of gene therapy for malignant mesothelioma. This is the first gene therapy trial to be approved in the United States as primary therapy for any malignancy. Their approach involves intrapleural instillation of replication-deficient, recombinant adenovirus (rAd) which has been genetically engineered to contain the herpes simplex virus thymidine kinase gene (HSVtk).

It is hoped that this approach will induce the following effects:

·Administration of AdHSVtk into the pleural cavity of a patient with mesothelioma will transduce the tumor cells, enabling them to express viral tk, and conferring upon them exquisite sensitivity to the normally non-toxic antiviral drug ganciclovir (GCV).

·Viral tk, unlike mammalian kinases, can catalyze the rate-limiting step of the production of GCV-triphosphate (GCV-PPP), a strong cellular toxin which inhibits function of DNA polymerase.

·The so-called "bystander effect" may allow GCV-PPP and possibly other toxic metabolites to pass through gap junctions between transduced and non-transduced tumor cells.

Established mesothelioma tumors have been successfully eradicated with this approach in several animal models [15-19]. To date, 8 patients have been successfully treated in the Phase I study with minimal adverse effects and some definitive evidence of tk gene transfer [20].

Other gene therapy approaches to the treatment of mesothelioma under investigation in other laboratories include:

·A vaccinia virus-IL-2 construct for direct intratumoral injection [21].

·A recombinant Ad containing the wild-type p53 gene, which is purported to transduce mesothelioma cells, causing overexpression of wild-type p53 and inducing apotosis [22].

adrenalin makes a man feel less pain than women

2008-06-20T07:29:00.001-07:00

The results of a study conducted in a German hospital that masculinity hormone known as testosterone seems to reduce sensitivity to pain and also affects the quality of feeling, especially in light of the brain that real women would be more edgy pain.

Proved a pilot study involving people who held them to the process of changing sex hormones that masculinity make men feel the pain as less severe than felt by women or feel pain in a manner different from what is by women.

According to persons with common sex hormone were receiving treatment for their condition and then conducted operations for them to turn them into men of the sensitivity of the pain in their lives male less than it was before the process of changing their sex as women.

Hormone testosterone

He said Dr. Hartmut Jubilo, director of a hospital in Pine agent, Germany, the hormone known as testosterone masculinity seems to reduce sensitivity to pain. He added that the persons who conducted them sex change operations were receiving treatment testosterone preparation for the operation and thus increased their ability to bear the pain, pointing out that no change is not only the capacity to withstand pain, but the quality of feeling pain, explaining that the brain among women is More edgy pain.

He pointed out that the number of women who feel migraine and chronic pain than men, pointing at the same time that up to 70 per cent of women suffer from headaches compared with 52 per cent of men.

anti cancer Medicine is underway

2008-06-20T07:25:00.000-07:00

The doctors specializing in cancer control that the growing use of medications that hamper the growth and spread of the disease known remedies target, have improved in recent years ways to treat cancer.

The newspaper Washington Times reported that over the field of medicine over the past few decades, several phases of progress in the fight against cancer, and that the world has become today's medicines and treatment plans of new and modern means of helping to care for cancer patients.

According to the National Institutes of Health commissioned the American Cancer last year, only about 219 billion dollars in the form of pay medical expenses directly and labour productivity, and every year the disease infected about half a million people in the United States.

The American Cancer Society expects that 1.4 million are diagnosed case of cancer this year and nearly 565,650 people due to illness, and about 170 thousand case related to smoking.

The National Institutes of Health estimated that 1.8 million Americans have history with the disease were alive in January 2004, which means that some people cured of the disease, others are still opposed by many of the disease and can be subject to the treatment.

The low mortality
According to the American Cancer Society, the cancer mortality rates declined since the early nineties, despite population growth and the increasing number of elderly.

A report of the General in 2007 that death rates from the most common types of cancer - prostate, breast, lung and colon - and cancers generally continued to decline last year.

The researchers attributed the progress in the fight against cancer to several factors combined, such as early detection and better understanding of its causes and how to develop technical and improved diagnosis, treatment and new drugs.

He pointed out that doctors increased use of medications that hamper the growth and spread of the disease known remedies target, in recent years have improved the treatment of the disease significantly, since these drugs by targeting certain molecules that cause or help in the spread of the disease.

By focusing on molecular and cellular changes of the disease, could be targeted treatments more effective and less harmful to normal cells.

The Washington Times that the Human Genome Project has enabled scientists to identify the genetic changes and genetic gained contributing to the increased exposure to cancer, and doctors finally allowed to calculate the risk based on each patient individually.

The doctors said that the field of medicine moving towards the day when cancer therapy always a chronic, and this is what happened with AIDS.

The newspaper concluded that the National Institutes of Health budget increased from 7.6 billion dollars in 1990 to 28.5 billion dollars in 2006, also increased the budget of the National Cancer Institute of 1.6 billion dollars in 1990 to 4.8 billion in 2006.

Total spending is still on cancer each year amounts to about 11.5 billion dollars, which represents one sixth of money spent annually on carbonated drinks

Mesothelioma Clinical Trials

2008-06-16T05:12:00.000-07:00

The aim in clinical trials in patients who have to involve the discovery of new and better treatments for their illnesses. Several clinical studies have different objectives, which may include tests, new drugs, a comparison of different ways to deal with the disease or test various techniques to prevent cancer. Clinical trials are divided into three phases. A brief summary of what each phase of the trial is trying to achieve are described below.

Phase I trials of the first phase of the system of clinical trials. At this stage, the drug had been tested only in the laboratory, but has had a devastating effect on cancer cells. These tests n'enrôlent a limited number of participants, and they are only available in some institutions of cancer. The aim Phase I trials to determine the maximum tolerated dose of medicine without side effects, which cause serious side effects are more common, and if the drug is still anticancer activity when administered to humans. If the drug shows the impact of cancer a safe dosage, the drug has been tested in Phase II clinical trials.

The written phase II will continue to test the safety of medications or procedures, but also to begin a more careful look at the effectiveness of certain types of cancer. These tests include a large number of participants, and it can be scattered in different institutions. These tests can be "randomly", which means that different groups of participants are chosen by computer, rather than a doctor.

Phase III trials comparing the new medicines or procedures, promising the current standard treatment. A large number of participants from widely scattered areas of participating in these tests, and want to get new therapy is the standard treatment. One of the most important objectives is to Phase III trials is to determine if the cancer has decreased or slowed down, medication, how long the patient remains stable without the progression of the disease and how the management of the drug affects the quality of life of the patient.

Radiation Therapy mesothelioma

2008-06-16T05:08:00.000-07:00

Radiation therapy requires the use of X-rays, high energy to kill cancer cells and reduce the tumors. It can be used in conjunction with the surgery will help remove the microscopic aggressively from seed, which may cause a recurrence of an illness or palliativement treat pain caused by tumors that compress the nerve endings, or any other body. Radiation therapy has also proved to be effective to prevent the seeding of tumor biopsy sites, or a chest tube drainage.

Chemotherapy mesothelioma

2008-06-16T05:07:00.000-07:00

Chemotherapy is used in cancer drugs, that the work is to prevent the cancer cells to multiply. In most cases, a combination of drugs used to increase efficiency. Chemotherapy can reduce the aggressiveness of the tumor, or palliativement reduce the severity of symptoms such as shortness of breath or pain. The chemotherapy may be administered by injection into a vein or muscle, ingestion or can be provided directly into the peritoneal cavity, or pleural. The drugs most commonly used are:

Pemetrexed (Alimta)
Cisplatin (Platinol)
Carboplatin (Paraplatin)
Gemcitabina (Gemzar)
Doxorubicin (Adriamycin)
Mitomycin
Raltitrexed (Tomudex)
Vinorelbiinin (Navelbine)
New drugs are constantly examine the pharmaceutical companies, so please do not hesitate to consult your doctor about new drugs more and more promising. Such a drug, Alimta (pemetrexed) has been approved in Europe in September 2005.

Surgery mesothelioma

2008-06-16T04:58:00.000-07:00

There are two main surgical approaches, mesothelioma, pleurectomy / decortication (P / D) and pleuropneumonectomy extrapleurale (PPEP). They are a very specialized surgery, and that may not be offered in all schools. All of thoracic surgeons is not responsible for this type of surgery. The ultimate objective of these procedures is to remove a large part of the disease, knowing that most likely are still in the remainder of microscopic disease. The adjuvant therapy, in which new forms of treatment used in combination with therapy for primary, typically seeks to remove residual disease. The most common adjuvant radiation therapy and / or chemotherapy.

The pleurectomy / decortication considered to be the least radical of the two approaches, because it means that the abolition of the pleura (lining of the lung), without the abolition of the lung-sub-jascent. In some cases, the pericardium and diaphragm need to be removed, depending on the size of the tumor. The advantages of this process is the time of recovery in general, more quickly, and the benefit of patients who can not tolerate more radical PPEP. Disadvantage include an increased risk of a recurrence of the disease, it is impossible to remove the tumor, and the impossibility of applying high doses of adjuvant rays, as the possible damage to the underlying lung.

The pleuropneumonectomy extrapleurale more radical is a process in which the abolition of the lung, the pleura (lining of the lung), the pericardium around the heart and part of the diaphragm. At a time surgery, diaphragm and pericardium must be reconstructed with a material similar to Gortex. To be eligible for such surgery, patients must meet certain criteria and to demonstrate stage lung function and cardiac appropriate to be able to withstand the procedure.

General information on mesothelioma treatment

2008-06-16T04:56:00.000-07:00

The best treatment option for you as a person, will mostly depend on many factors such as your age, overall health, stage of cancer, cell type (which determines the aggressiveness of the cancer) and, most importantly, your personal desires. To help you evaluate these options, "a multidisciplinary team (MDT) doctors discuss your case and offer their treatment strategy. This team may include a cardio-thoracic surgeon, a medical oncologist, a radiologist oncologist, a specialist in pain management and a specialist in palliative care. Nurses and other health care providers may also be involved in your care.

The conventional treatment of mesothelioma offers several options, and you should thoroughly discuss each option with your EMD before deciding treatment. Make sure you have information on risk factors, the prognosis of the treatment, the potential secondary effects and quality of life that each option offers.

The stages of mesothelioma

2008-06-16T04:53:00.001-07:00

Knowledge of the stages of your mesothelioma is a factor that will help your doctor to formulate a treatment plan. The classification most definitive and most widely used system is the International Classification for TGM diffuse malignant pleural mesothelioma, also called the International System of the group concerned with mesothelioma (International Mesothelioma Interest Group System). This system takes into consideration the primary tumor (T), the lymph nodes (G) and metastasis (M). There is no classification system established for peritoneal mesothelioma. The peritoneal patients can be classified according to the system TGM General for cancer, or on the burden this tumor (ie., Imperceptibly large, moderately large, etc.).. The system TGM is very thorough and difficult to interpret by laymen, what follows is a simplified version. Phase I is the earliest; Phase IV the most advanced.

Stage I

Mesothelioma involves the right or left pleura and may also extend to the lung, pericardium, or diaphragm on the same side. The nodes are not involved.

Stage II

Mesothelioma extends to the pleura on one side to the lymph nodes near the lung on the same side. It has also been extended to the lung, pericardium, or diaphragm on the same side.

Stage III

Mesothelioma invades the chest wall, muscle, ribs, heart, esophagus or other organs in the chest on the same side with or without spread to the lymph nodes on the same side as the primary tumour.

Stage IV

Mesothelioma spreads to the lymph nodes in the chest on the side opposite the primary tumor, or extends to the pleura or lung on the opposite side, or spreads directly to the organs of the abdominal cavity or neck. All distant metastases is included in this stage.

Symptoms and diagnosis of mesothelioma

2008-06-13T05:29:00.000-07:00

Symptoms
Early symptoms of mesothelioma are non-specific and can delay the diagnosis. In general, breathlessness, chest pain and persistent cough are common symptoms of pleural mesothelioma, but in some cases, they may not be sufficiently serious to push the patient to a medical consultation. Some patients complain of pain on the shoulder blade or lower back. These symptoms most often occur 2-3 months before a confirmed diagnosis. In peritoneal mesothelioma, abdominal pain and swelling, nausea or vomiting, intestinal obstruction and weight loss are the most common symptoms. More important, these symptoms are not specific and mesothelioma can be symptoms of other conditions. The assessment by a qualified doctor is always recommended.

While mesothelioma progresses, the pleural effusion (accumulation of fluid between the two pleural layers) occurs in 95% of patients, and this symptom, which ultimately leads patients to consult their doctor. During this visit, a chest x-ray can confirm the outpouring. A thickening of the pleura may also be noted at this time. If the physician suspects cancer, it can send the patient to a hospital consultant specializing in lung cancer and mesothelioma.

When your doctor recommends you, the following information should you be given:

The place where you are sent.

When the appointment is made.

Who you are visiting.

To test how can you expect.

When the result of testing is available.

The National Health Institute has developed the following general guidelines to address a patient suspected of cancer, in force since June 2005. These guidelines may not apply to all individuals, and you should still discuss the details of your specific case with your team medical care, so you can play a proactive function in your treatment and care.

An evaluation of the emergency will be made by your doctor and will be based on the following criteria:

To address immediately: The patient requires a consultation in the hours following.

A address as a matter of urgency: The patient will be seen within 15 days.

No urgent: All other addresses.

Once the urgency determined, your doctor will send all information regarding your case to your specialist for evaluation.

Diagnostic

A diagnosis of mesothelioma is often obtained from a careful evaluation of clinical and radiological findings, plus a biopsy of tissue confirmation. Some tests that your specialist may recommend and their diagnostic value and evaluation of mesothelioma are presented below.

Computer-assisted tomography (CT)

The CT scans can reveal a pleural effusion, as well as pleural thickening, pleural calcification, thickening of cracks or interlobular possible invasion of thoracic walls. However, CT cannot tell the difference between changes associated with asbestos benign disease, or between an Aden carcinoma of the lung and mesothelioma. The CT scans may also be of value to guide the fine needle aspiration of the masses pleural tissue for diagnosis. This scanner usually takes 10-30 minutes, but can vary depending on the patient.

Magnetic Resonance Imaging (MRI)

The MRI scanners are often used for determining of the extent of a tumor before an aggressive treatment. They provide images in multiple plans and peuvnt therefore better identify tumors compared to normal structures. They are also more accurate than CT estimate for the enlargement of lymph nodes mediastinal housed between the two lungs, and a surface diaphragmatic clear, both have an important function for the surgical option. The MRI scanner usually takes 20-40 minutes, but may vary depending on the patient.

Tomography positron emission (PET)

The imaging PET is currently occupies an important part of diagnosis and evaluation of mesothelioma. The PET is considered the best diagnostic tumor sites, and the best to determine the stage of mesothelioma. PET scanners are relatively new and can therefore not be available in all institutions; it may be necessary to travel to find a specialist center that has one.

An analysis of fluids

Analyze the liquid pleural to find malignant cells have only limited diagnostic value for mesothelioma. The thoracentesis diagnosis by which cells are extracted from the pleural cavity is commonly made when there is a suspicion of mesothelioma. Unfortunately, the results are negative or inconclusive in almost 85% of tests. Even in the case of a positive outcome of liquid, doctors may opt for a biopsy confirmation of the moment that this is not at the expense of patient health.

Analysis of tissue (biopsy)

In most cases, finally takes needle biopsy pleura, or a surgical biopsy confirmed the diagnosis of mesothelioma. At a pleural biopsy procedure, the surgeon makes a small incision in the chest wall and inserted into the chest between two ribs a thin-lighted tube called thorascope. It will remove a tissue sample, which will then be examined under a microscope by a pathologist. In peritoneal biopsy, the surgeon makes a small incision in the abdomen and inserts a peritoneoscope in the abdominal cavity.

mesothelioma diagnosis

2008-06-13T05:19:00.000-07:00

What is mesothelioma?

The malignant mesothelioma is a rare form of cancer that begins in the m0sothelium, which is a membrane covering and protecting most internal organs of the body. The mesothelium is composed of two layers, one that surrounds the organ itself, and the other forms a sac surrounding it completely.

A small quantity of liquid is normally produced between these two layers, lubricating the movement of bodies protected. When normal cells mesothelium lose their control and spread quickly, they produce mesothelioma. The form of mesothelioma is the most common "pleural" mesothelioma. It occurs in the pleura, the lining of the lungs. Other forms are "Peritoneal" mesothelioma reaching the peritoneum, lining the abdominal cavity and mesothelioma "pericardial" of the pericardium, the lining of the heart.

What causes mesothelioma?

Mesothelioma is almost always caused by exposure to asbestos fibres. Many people have been exposed to the army, others by their occupation, and others, secondarily in contact with exposed workers. Because of the latent cancer, it may appear that 20 to 50 years or more after exposure.

Does the mesothelioma is common?

On the basis of information obtained from the Finnish Institute of Occupational Health in Helsinki, the incidence of mesothelioma in Western Europe is supposed to reach its peak between 2010 and 2020. Below are the statistics on the incidence currently available per country.

Country cases per year per million cases per year
Finland 75 (2002) 18
France 870 (2000) 18
Germany 1094 (2001) 16
Great Britain 1862 (2002) 39
Italy 1050 (2000) 21
Holland 389 (2000) 30
Norway 57 (2000) 16
Sweden 149 (2003) 20

Who are under the the risk of developing mesothelioma?

Those who have worked directly with asbestos or asbestos products run the greatest risk of developing mesothelioma, however, mesothelioma has been reported in some individuals who have had minimal exposure.

Among the shops at high risk of developing mesothelioma are:

The iron carpenter (including shipbuilding)
The manufacturers of the chassis of the vehicle (including rail vehicles)
Plumbers
Gas Installers
Carpenters
Electricians
Workers building
Plasterer
Entrepreneurs
Do-It-Yourself
Steel Manufacturers
Painters
Toliers
Welders

What types of products typically contain asbestos?

The following products are commonly content variable rates of asbestos. This list does not include everyone and is a source of general information.

Shielding or pre-cast used in the thermal insulation on pipes and boilers

The projected asbestos used as protection against fire in ducts, firewall, panels, partitions, soffit boards, ceiling panels and around construction structural steel

Insulation panels used as protection against fire, thermal insulation, separations and conduits

Jam asbestos used as a firewall in the false ceilings

Cardboard wrapped, paper and paper products used for the isolation of electrical equipment; paper asbestos can also be used as a setback incombustible on panels Fiberboard

Products of asbestos cement sheets and corrugated plates used to cover walls or ceilings; cement products were also used in gutters, drains rainwater and water reservoirs

The textured surfaces (such as Artex)

Equipment coverage bitumen roof

Tile floor vinyl or thermoplastic