Mesothelioma Types

Mesothelioma is a rare type of cancer. Although there is no cure for mesothelioma, early diagnosis provides doctors the opportunity to relieve a great deal of suffering, and prolong and improve many patients’ lives.  These avenues of treatment depend on the extent of the condition and the progession of the disease.

It is caused by exposure to asbestos or asbestos related materials. It is believed that even one single fiber can begin the cascade of events that cause mesothelioma.

Because the time it takes for the asbestos particle to turn cancerous is very great - sometimes between 30 to 40 years - it can be difficult to spot. Most cases of pleural mesothelioma develop in the sac that contains the lungs.

Like most other forms of cancer, mesothelioma is separated into two groups: malignant and benign.

Unfortunately mesothelioma is rarely benign. Usually any mention of the condition refers to its malignant state, known as a tumor.

In most of the cases, a malignant tumor will grow and expand, and can spread cancerous cells into other parts of the body.

To understand mesothelioma is to understand cancer.  Cancer is essentially uncontrolled cellular growth.  Under normal circumstances, body cells in the hair, bone, organs, or blood grow to a certain point, die off, and are replaced by newer, healthier cells.  Unfortunately, most cancer cells are damaged to some degree, and as the body reproduces them they begin to take over for healthy cells, leading to eventual system failure.

There are three main types of malignant mesotheliomas cells: epithelioid, sarcomatoid, and mixed/biphasic.

1. Epithelioid is the most common kind; 50-70% cases reported are of epithelioid type. This type also has the best possibility of survival. The epithelioid type affects the covering surrounding the internal organs and internal surfaces in the body. Under a microscope this type of the disease is seen as a papillary or tubular growth and generally affects membranes and tissues that cover organs and other internal bodily surfaces.
2. Sarcomatoid is much more serious. It affects the secondary tissues such as bone, muscles, cartilage, and/or fat. This cell is much rarer, occurring 7-20% of the time. It appears as spindle-shaped pattern of cells that overlap one another, and generally arises from support tissues. Death usually occurs within six months of diagnosis of sarcomatoid mesothelioma.
3. Mixed/biphasic mesothelioma is not a condition unto itself, but rather it is a combination of the other two types.  It can take on both the good and bad aspects of sarcomatoid and epithelioid mesotheliomas and 20-35% of all mesothelioma cases are mixed or biphasic

There are three main types of mesothelioma. Each affects a different area of the body.  The three types of this deadly cancer are:

• Pleural Mesothelioma
• Peritoneal Mesothelioma
• Benign Mesothelioma

Pleural mesothelioma is found around the pleural cavity (sac) around the lungs and is caused by exposure to asbestos .

It is responsible for 75% of all mesothelioma diagnosed.

The pleura is a sac which contains the lungs and also a thin membrane called the mesothelium which secretes a fluid that enables the lungs to expand and contract during breathing. Inhaling asbestos causes a build-up of fibers inside the lungs. Due to the microscopic size and sharpness of the fibers it is possible for them to penetrate the walls of the lung and enter the pleural cavity. As they migrate from the lung into the pleural cavity, the sharp strands shred and mutilate the mesothelium, destroying it and potentially causing cancer.

Once asbestos fibers invade the pleural cavity, cancerous tumors may develop which thicken the pleural fluid and inhibit proper lung movement.

Tumors can also constrict the lungs and press on the ribcage or other organs resulting in agonizing pain. Also, because the lungs are responsible for re-oxygenating blood, should the cancer advance directly into the lungs it is possible for the cancerous cells to spread into other parts of the body through the bloodstream.

Pleural mesothelioma symptoms:

• Constant chest pain
• Chronic cough that worsens over time
• Coughing up blood
• Difficulty breathing
• Fatigue
• Lung infection (pneumonia, bronchitis)
• Shortness of breath
• Swollen lymph nodes
• Loss of appetite and weight loss
• Wheezing

Pleural mesothelioma is often confused with less serious or deadly diseases such as:

• Pneumonia
• Common Cold
• Whooping cough
• The Flu
• Laryngitis
• Bruised/Broken Ribs due to chest pain
• Sometimes there are no symptoms at all

Common treatments for Pleural Mesothelioma include:

• Surgery: Surgeons can remove all or part of the lung to excise tumors or prevent their spread.  In some occasions fluid needs to be drained from the lungs, or in extreme cases the entire lung needs to be removed.
• Radiation: Cancer is often treated with high doses of radiation.  This treatment uses high energy waves to kill cancerous cells, but unfortunately it also kills healthy cells and causes a number of peripheral health problems.
• Chemotherapy: Strong anti-cancer drugs are pumped directly into the tumors or taken orally can inhibit their growth and spread, but these drugs can also cause severe health problems in other bodily systems.

The asbestos industry allegedly knew of the dangers of their product, but rather than take action to prevent serious harm they hid this information from their workers and the public until the damage had been done.

Thousands of people hurt by this deception are coming forward to collect compensation for their pain and suffering, and you could be the next person to receive restitution for their condition.

Peritoneal mesothelioma is the second most common form. It affects the tissues in the abdomen, namely the stomach and intestines, and it accounts for approximately 10-20% of all reported cases.

Peritoneal mesothelioma is a cancer that affects the thin cell membrane called the peritoneum. 

This collection of cells surrounds the gastrointestinal tract and provides lubrication for the stomach and intestines to move so that they may function properly.

These organs must be able to move properly in order to properly digest and process food, and a failure in the peritoneum can result in severe and debilitating consequences. 

Unfortunately, the symptoms of peritoneal mesothelioma can be so subtle that it can be confused with other, less dangerous diseases, and this aspect of the disease significantly contributes to its already staggering mortality rate.

Common symptoms of peritoneal mesothelioma:

• Stomach pain
• Lower abdominal pain
• Difficulty with bowel movements
• Weight lost
• Nausea
• Loss of appetite
• Weakness
• Abdominal swelling

When asbestos is ingested, minute fibers enter the stomach and penetrate the stomach lining. As more and more fibers penetrate this delicate organ, the cells on the exterior lining begin to mutate into cancerous mesothelioma cells. These cells accumulate into tumors, and eventually overwhelm the peritoneum, killing off healthy stomach cells in the process.

Furthermore, these tumors prevent the peritoneum from making the protective lining that aids the stomach in movement. In less drastic instances, the tumors on the stomach lining grow and exert increasing pressure on surrounding organs causing agonizing pain.

There is no cure for any type of mesothelioma, but certain conditions can aid in treatment. Age, type of cell affected, size and stage of the tumor, and whether or not the tumor responds to treatment greatly affect what course of action doctors can take.

Common treatments for peritoneal mesothelioma:

• Chemotherapy: Strong drugs are used to shrink the size and kill tumors, but these drugs are extremely potent and often cause significant damage to other healthy cells.  These drugs can be taken orally, or in some cases the drugs are directly introduced into the tumors if they are resistant to other treatment
• Radiation therapy:  Radiation is one of the ways to treat peritoneal mesothelioma.  Powerful X-rays can kill diseased cells, but they also can kill healthy cells, and many people undergoing radiation treatment for peritoneal mesothelioma often suffer hair loss and other side effects.
• Surgery:  This most drastic option often involves the removal of the tumor or cancerous tissue in the abdomen or gastrointestinal tract.  The necessity of surgery is generally based on the extent and progression of the cancer.

Vigorous treatment and early diagnosis are often the keys to long term survival. Unfortunately, mesothelioma lies dormant for years, so most victims do not experience any side effects until the cancer is extremely advanced. After the cancer has overwhelmed the stomach, it is rare for patients to survive longer than five years.

Many victims of mesothelioma take comfort in knowing that the asbestos industry will no longer injure innocent people through deception and blatant lies. 

Another source of comfort many victims discover is through the law. 

Thousands of people are taking action against the asbestos industry in order to recover financial restitution for their pain and suffering, and you could be next. 

The rarest form is called pericardial mesothelioma, which affects the sac and lining surrounding the heart.

The heart, as with any organ that requires constant movement to work properly, requires constant lubrication.  Lubrication comes in the form of a thin layer of mucous, and in normal systems the heart beats on as normal. 

Asbestos exposure is the most common culprit of this debilitating form of cancer, a type that usually comprises 5% of all mesothelioma cases.

Inhaled asbestos fibers can pierce and shred the pericardium and cause mutations that can result in mesothelioma. 

Once the cancer begins to spread, it can cause chronic coughing, chest pain, shortness of breath, and heart palpitations. 

Like the other forms of the cancer, decades pass without incident as pericardial mesothelioma slowly destroys the tissues around the heart.

Unfortunately, by the time symptoms appear it is usually far too late to treat pericardial mesothelioma with conventional drugs or therapies.

Common symptoms of pericardial mesothelioma include:

• Shortness of breath
• Different degrees of chest pain
• Heart palpitations
• Irregular heart beat
• Coughing

There are a few marginally effective treatments for victims of pericardial mesothelioma. 

• Radiation treatments are usually the preferred course of action to help slow the spread of the cancer, and chemotherapy can provide help in bolstering the effects of the radiation. 
• Another type of treatment involves “fine needle aspiration” to draw out excess fluid that collects in the pericardium, which can help relieve some symptoms. 
• In rare cases, doctors perform surgery to remove the pericardium, although this is usually a treatment of last resort.  This course of action usually only slows the growth of pericardial mesothelioma, for no amount of surgery, chemotherapy, or radiation will fully eliminate the cancer.

If you or a loved one developed pericardial mesothelioma as a consequence of asbestos exposure, you may have the right to seek financial compensation for your pain and suffering. 

Regardless of the area it affects, mesothelioma is fatal.

Survival rates are usually 1-5 years after diagnosis, but medical technology is rapidly improving not only the length but also of the quality of life for those victims of asbestos exposure who contracted mesothelioma.

Mesothelioma is truly one of the most devastating diseases imaginable. 

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Mesothelioma Symptoms

Mesothelioma is an extremely malignant and incurable cancer that infects the membrane that surrounds most of the internal organs.
Because mesothelioma is so deadly, early diagnosis and treatment can help prolong life, but the mortality rate for mesothelioma is usually 100% within five years.

Pleural mesothelioma symptoms:
• Constant chest pain
• Chronic cough that worsens over time
• Coughing up blood
• Difficulty breathing
• Fatigue
• Lung infection (pneumonia, bronchitis)
• Shortness of breath
• Swollen lymph nodes
• Loss of appetite and weight loss
• Wheezing

Peritoneal mesothelioma symptoms :

• Stomach pain
• Lower abdominal pain
• Difficulty with bowel movements
• Weight lost
• Nausea
• Loss of appetite
• Weakness
• Abdominal swelling
• Fever
• Anemia - a reduction in the number of red blood cells to below normal; this forces the heart and other organs to work harder to get oxygen where it's needed
Pericardial mesothelioma symptoms:

Shortness of breath
• Different degrees of chest pain
• Heart palpitations
• Irregular heart beat
• Coughing

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How Do I Choose the Best Mesothelioma Clinic?

The best way to find the right mesothelioma clinic for you or your loved ones is to ask around and visit several locations to get an idea of how each one is run. There is no right or wrong opinion in terms of choosing a care provider. You should go with a clinic where the staff makes you feel comfortable, and that is fully equipped to handle the type of care you need. Start by visiting all clinics in your area, talking with the doctors and nurses, and discussing potential options by speaking to friends and family members.

While taking a tour of each facility, you will likely have many questions about the care you would receive as a patient there. Feel free to talk about any of your concerns, and discuss your questions openly with the physicians and nurses you meet. Questions may be about the types of treatment the mesothelioma clinic offers, how often you will receive treatment, how many doctors are in the practice, and what kind of insurance plans are accepted. If you receive a government-funded medical insurance plan, your options may be limited. Ask for a list of clinics that accept government insurance.

You may also wish to discuss the hospital with which the clinic and its doctors are affiliated. If there is more than one hospital in your area, this is an important thing to consider. If you have an emergency situation related to your illness, you will receive better care if you visit the hospital affiliated with your clinic. However, if that hospital is too far away from your home, you may want to consider an option closer to where you live.

If you don’t have insurance coverage or if your policy does not cover your treatment, you may want to find a mesothelioma clinic that provides payment plans for those who self pay. Some may be more agreeable than others, but most clinics will provide non-insured patients with some kind of lowered price or payment plan.

Another good way to find the best mesothelioma clinic is to talk with friends, family members, and colleagues that may have had an experience with a particular doctor or clinic. You can also speak with your general practitioner or family doctor and have him recommend specialists in your area. Since your primary doctor will know your medical history, conditions, and struggles, he may be able to recommend someone who is capable of working with you.

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LPK Law Honors Larry Davis as Stop Mesothelioma's "Advocate of the Month"

Larry Davis was diagnosed with mesothelioma in 2006, but you won't find him sitting on the sidelines of life. Larry Davis is a runner. He has run 18 marathons since his first in 1978 and logs 25 miles per week when not in training.

These days, Larry is running to save his own life. Larry combined his love of running with his passion for mesothelioma advocacy and awareness to found the annual South Florida Miles for Meso 8K Run & 4K Tribute Walk. This annual road race raises money for the Mesothelioma Applied Research Foundation (Meso Foundation), which supports efforts to ban asbestos and research toward a cure for mesothelioma.

For his dedication to the mesothelioma community, Larry Davis has been named Stop Mesothelioma's first "Advocate of the Month." Stop Mesothelioma is a Facebook project created and sponsored by Levy Phillips & Konigsberg, LLP ("LPK Law"), which pledges to donate $1 to mesothelioma research and efforts to ban asbestos for every "Like" the page receives up to $100,000.

Larry's story starts like those of many mesothelioma victims - he was diagnosed with mesothelioma and told he had just six months to live. He was offered chemotherapy and radiation, the traditional approach to mesothelioma treatment. However, Larry decided to forego the traditional treatments. Instead, he decided to work with doctors he felt were more open-minded and offered more radical therapies. He also tried to maintain a more holistic approach to his treatment. Larry continued to run, to keep a positive attitude, and to drink healthy organic vitamin blends. He underwent a progressive tumor removal surgery with Dr. H. Richard Alexander at the University of Maryland Greenebaum Cancer Center and plans to have follow-up treatment with Dr. Dipnarine Maharaj at the South Florida Bone Marrow/Stem Cell Transplant Institute.

Larry credits his active lifestyle – including his running, continuing to operate his business called Extreme Eyewear, sailing, and traveling with his wife Carol and their award winning dogs – for his ability to keep a positive attitude and persevere through his mesothelioma treatments.

Larry also emphasizes the support his wife Carol has given him in his struggle to beat mesothelioma. "Caregivers don't often get the credit they deserve," says Larry. He proudly notes that Carol will be running the 2012 Boston Marathon in his honor and that Carol's daughter Heather and son-in-law Mark Malovos have also qualified for the Boston Marathon. Larry plans to join them at the finish line.

Despite his ongoing medical treatment, Larry continues to run. In the summer of 2011, Larry was getting ready for a fifth surgery to treat his mesothelioma. Although a prior surgery almost killed him, Larry refused to spend his time worrying. Two weeks before his June 27th surgery, Larry participated in a Father's Day Weekend Triathlon with his daughter Courtney.

It is this zest for life that impacts those around him. Sarah Hager-Karaz, whose husband passed away at the age of 44 from mesothelioma shortly after their first daughter was born, credits Larry Davis with helping her learn to believe in a cure. For Hager-Karaz, running became an outlet while she cared for her husband during his illness and raised their six month old daughter. After meeting Larry, "He instantly became my inspiration. [I felt] a hope I was not able to see with my husband… I looked at Larry and despite all the emotions that meeting him, knowing him and praying for him welled up in me… I suddenly in my heart knew I finally met a man that made me believe in a cure."

The Meso Foundation applauds Larry for his work. According to Mary Hesdorffer, Medical Liaison for the Meso Foundation, "Larry Davis is in the race of his life raising funds to support the Mesothelioma Applied Research Foundations Peer Reviewed Grants Program. Larry leads the pack with many patients following in his footsteps helping the Foundation to raise awareness and fund research for more effective treatments and a cure."

Linda Reinstein, founder of the Asbestos Disease Awareness Organization, also praises Larry’s activism. "Larry is remarkable in every sense of the word," she says. "As a courageous and unwavering leader, Larry has boldly and tirelessly worked to ban asbestos and fund research for a cure. Always speaking the truth, Larry has greatly increased asbestos awareness to prevent exposure. I am honored to call him my friend."

Despite the efforts of Larry and other advocates, asbestos is still not banned in the United States, and you can hear the indignation in Larry's voice when he starts to discuss the fact that companies in the United States still import asbestos today. In an effort to change this fact, Larry actively participates in lobbying efforts to ban asbestos and to raise awareness about the health hazards of its continued use. In June of 2011, just days before his fifth mesothelioma surgery, Larry joined a group of mesothelioma advocates on Capital Hill to lobby for this important change.

LPK Law honors Larry Davis for his work on behalf of mesothelioma victims. "Larry is a tireless advocate for the mesothelioma community" says Sharon J. Zinns, an LPK Law attorney who will be running in the February 2012 South Florida Miles for Meso race. "Not only does Larry advocate for his own best treatment, but he also influences those around him to seek better care. It is because of research funded in part by South Florida Miles for Meso that such care is available. Larry's positive attitude shines through and impacts everyone who has the pleasure to meet him."

Although he is recovering from a medical set back and not currently running every day, Larry expects to be logging miles again soon and looks forward to running the 3rd Annual South Florida Miles for Meso 8K Run & 4K Tribute Walk on February 12, 2012. To register for the race, go to: http://actionagainstasbestos.wordpress.com/south-florida-miles-for-meso-2012. LPK Law is a Presenting Sponsor of the 2012 South Florida Miles for Meso race.

LPK Law is a national law firm that has represented families affected by mesothelioma for more than 25 years. For more information, please call 1-800-MESO-LAW (1-800-637-6529). Visit the Stop Mesothelioma project at http://www.facebook.com/stopmeso.

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Stop Mesothelioma Raises $40,000 in One Week

In just one week, a new Facebook page called Stop Mesothelioma has raised $40,000 in an unprecedented social media campaign. Levy Phillips & Konigsberg LLP ("LPK"), the creator and sponsor of the page, has pledged to donate $1 to mesothelioma research and efforts to ban asbestos for every "Like" the page receives up to $100,000.

LPK announced last week the donation of the first $10,000 to a Florida mesothelioma fundraiser that benefits the Mesothelioma Applied Research Foundation ("Meso Foundation").

Today, LPK announced that it has donated the newly raised $30,000 directly to the Meso Foundation. Jerome H. Block, an LPK partner and asbestos lawyer, said, "We are thrilled to make this donation to the Meso Foundation because they are the leading non-profit seeking a cure for mesothelioma. We are even more thrilled that this money has been generated through a campaign that is raising awareness about the urgent need to cure mesothelioma and ban asbestos."

Each year, the Meso Foundation holds an International Symposium on Malignant Mesothelioma, which brings together patients and leading researchers from around the world. This year’s conference is scheduled for July 12-14, 2012, in Washington, D.C.

LPK is a national law firm that has represented families affected by mesothelioma for more than 25 years. For more information, please call 1-800-MESO-LAW (1-800-637-6529).

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Mesothelioma Prognosis

Mesotheliomaprognosis.org was developed with the intent of providing support and information for those diagnosed with mesothelioma, as well as their family and loved ones. Mesothelioma is a rare form of cancer that has been strongly linked to asbestos exposure and currently has no known cure. During the past two decades, doctors, researchers and scientists have attempted to gain more knowledge concerning this disease. As more information becomes available doctors will not only be capable of diagnosing this cancer in its earlier stages, but can also provide more extensive and curative treatment options. This information would also benefit patients directly, serving to promote optimism and improving their overall sense of well-being. 

Prognosis Overview

After being diagnosed with mesothelioma a patient’s doctor or specialist will discuss their prognosis and treatment options with them. Prognosis refers to the likely outcome of the patient’s particular case. Prognosis will also include the patient’s life expectancy, which is dependent upon several factors:

• Cancer type

• Location and size of tumor• Cell type

• Cancer stage at the time of diagnosis• Patient ability to receive and respond to treatment

• Patient’s age and overall health• Amount cancer has metastasized

As it pertains to the cancer mesothelioma, prognosis is usually unfavorable due to the cancer’s long latency period. Malignant mesothelioma often lies dormant in the body for two to five decades following exposure to asbestos, resulting in diagnosis not occurring until the cancer has reached an advanced stage. Later stages of mesothelioma are generally characterized by the malignancy having spread to other organs and systems outside of the point of origin. This metastasis and tumor growth is responsible for the lower treatment success rates which can also affect prognosis.

A doctor’s prognosis of their patient is dependent upon several factors including type, location and size of the tumor, staging, metastasis and the patient’s general health.

Staging

Staging is directly related to a patient’s prognosis, as the stage of the cancer will greatly determine the treatment options available. Mesothelioma, due to its aforementioned latency period, is usually not diagnosed until the cancer is in an advanced stage. There are three distinct staging systems that can be utilized to determine the progression of mesothelioma: the Brigham system, the Butchart staging system, and the TNM system. All three of these systems order the stages one through four, increasing in severity. In stage I of mesothelioma the tumor has yet to spread to other areas of the body and surgery remains an option. As the stages progress and metastases occurs, surgical treatments become less and less likely, affecting prognosis.

Improving Patient Prognosis

There are continual advancements in both research efforts and diagnostic testing associated with mesothelioma. New therapies are also in development, serving as both palliative and curative treatments aimed at complementing more traditional modes of cancer treatment. Recently, the Division of Thoracic Surgery and the Department of Pathology at Brigham and Women’s Hospital in Massachusetts studied 636 patients diagnosed with pleural mesothelioma. Results indicated that those who had an extrapleural pneumonectomy (an aggressive surgical procedure) experienced an extended rate of survival compared to those who underwent less invasive forms of treatment.

Legal Options

A diagnosis of mesothelioma is most often linked to asbestos exposure occurring in either the workplace or home through the use of—or proximity to—materials containing the hazardous mineral. Following diagnosis there can be an overwhelming sense of emotion, as well as mounting medical bills and related financial obligations. Patients, upon learning their prognosis, may also be concerned with the future of their family and loved ones. Fortunately, there are legal options available for mesothelioma victims to assist them in receiving just compensation.

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Obtaining Treatment for Mesothelioma

Mesothelioma treatment is expensive, often in the hundreds of thousands of dollars, with no guarantees or promise of cure. Deciding the right therapies for you or your loved one takes time you do not have. You want the best treatment available, but finding it can seem daunting. Then there is the expense of the various mesothelioma treatment options. Some of the newer treatments may not be covered by insurance, and there will be out-of-pocket expenses. Deciding on the best course of action is important. As part of that course, you should consider consulting with one of our legal experts to learn more about your options. Additionally, our mesothelioma family advocates can assist you with questions regarding the various issues you may have. Paying for Mesothelioma Treatment As previously mentioned, paying for your mesothelioma treatment can cost you in the hundreds of thousands of dollars. You should consider consulting an experienced mesothelioma lawyer to determine if your mesothelioma case warrants time in court. The primary cause of mesothelioma is asbestos exposure and often this exposure occurs on the job. Many companies that made, sold or used asbestos knew the risks of asbestos exposure, and did not take proper precautions to ensure workers or their families were protected. A mesothelioma lawyer well versed in litigating asbestos cases can assist you in determining options you may have that will help off-set some of the exorbitant medical expenses. Cancer Centers We understand that your time is too valuable to spend hours on research. Therefore, the Mesothelioma Family Resource Center has compiled a list of cancer centers for your convenience. These centers are designated by the National Cancer Institute as Comprehensive Cancer Centers and are recognized for scientific excellence and extensive resources. This list will provide a good starting point for you to find treatment facilities in your area. Leading Mesothelioma Doctors Your mesothelioma treatment will be provided by a team of medical professionals, rather than one person. You will want to consult with a number of specialists, including a doctor well versed in the treatment of mesothelioma. The Mesothelioma Family Resource Center has compiled a list of leading mesothelioma doctors across the United States to assist you in finding one in your area. Additionally, we have provided you with information and questions you will want to consider asking your doctor upon your first visit. It is important to be prepared for this visit, so consider taking someone with you to assist in asking questions and documenting information. NOTE: The content contained herein was not prepared by medical professionals and should not be construed as medical advice. Please address all medical questions, concerns, and symptoms with your doctor.

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Mesothelioma

The Mesothelioma Family Resource Center is dedicated to providing information on mesothelioma, including the latest mesothelioma treatment options and legal precedents. It is our strongest desire to equip you with knowledge about this cancer and your options.

What is Mesothelioma?

Mesothelioma is a rare form of asbestos cancer that develops in the mesothelial cells. These cells form tissue that surround or line the lungs, heart, and stomach. The mesothelial cells protect these organs by producing a lubricating fluid that allows them to move smoothly.

Asbestos is the overwhelming cause of mesothelioma in the United States. Typically the asbestos exposure occurred in an occupation or work environment over a prolonged period of time. However, it is also well-established that bystander (working near others using asbestos products) and household exposures (exposure from family members and their work clothes in the home) are known causes of mesothelioma. There is no known safe level of exposure to asbestos.

Types of Mesothelioma

There are three types of mesothelioma:  Pleural Mesothelioma, Peritoneal Mesothelioma, and Pericardial Mesothelioma.

• Pleural Mesothelioma accounts for 75% of all diagnoses.
• Peritoneal Mesothelioma accounts for less than 20% of all mesothelioma cases.
• Pericardial Mesothelioma is the most rare and accounts for very few cases.

Risk Factors

A risk factor is anything that increases your chance of getting a disease. While you may have one or many of the risk factors associated with a disease, such as mesothelioma, that does not mean that you will get the disease.

The main risk factor for mesothelioma is asbestos exposure. Prolonged exposure to asbestos through a job, or during a building demolition or remodel increases your chances. Other recognized, but very rare, known causes include exposure to zeolites (minerals primarily located in Turkey), therapeutic thoratrast radiation, and chronic inflammation of the pleura. However, there have been very few reported cases of mesothelioma from causes other than asbestos.

Symptoms of Mesothelioma

Mesothelioma symptoms include but are definitely not limited to:

• shortness of breath
• chronic cough,
• chest pain
• fatigue

Often mesothelioma is misdiagnosed because the symptoms are common to other ailments, such as colds and flu.

Stages of Mesothelioma

Stages of mesothelioma were established by the Mesothelioma Interest Group and adopted by the American Joint Committee on Cancer (AJCC), and are similar to the staging system used by most other cancers.   At this time, the staging system is only applied to mesothelioma around the lung, and uses Roman numerals from I to IV (1 to 4) to describe the severity of the cancer.

Key Statistics

Each year, between 2,000 and 4,000 people are diagnosed with mesothelioma. This cancer has a very long latency stage, and most often shows up late in life and primarily in men. Unfortunately, mortality is very quick after diagnosis, typically because mesothelioma is often far advanced by the time a diagnosis is made.

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Types of Mesothelioma

There are several types of mesothelioma. All but one are cancerous, and most are aggressive and deadly. Some types denote the area of the body that is affected. These include pleural, peritoneal, and pericardial. Other types denote the type of cell affected. These include epithelial and sarcomatoid. Mesothelial cells produce a lubricating fluid that protects organs as they function and move. Pleural Peritoneal Pericardial Benign Malignant Epithelial Sarcomatoid Biphasic Papillary Pleural Mesothelioma Pleural mesothelioma, which begins in the lungs, is the most common type of mesothelioma accounting for 75% of all diagnoses. The root cause is exposure to asbestos. Many professions and jobs utilized and were exposed to asbestos without taking precautions, thereby putting their workers at risk to breathe in the asbestos fibers that eventually cause mesothelioma. The cancer attacks the lining of the lungs and ribs, known as the pleura. Because the symptoms of mesothelioma take twenty or more years to present themselves, the disease is usually in the advanced stages before a diagnosis is made. The symptoms for pleural mesothelioma are common and often misdiagnosed. This creates even more delays in completing the appropriate diagnosis and seeking proper treatment. If you have been exposed to asbestos, notify your physician to assist with the correct diagnosis of your symptoms. Otherwise, your doctor may assume more common medical ailments, such as pneumonia, to explain your condition. Some symptoms of pleural mesothelioma include: Coughing Fever Shortness of breath Weight loss Peritoneal Mesothelioma Peritoneal mesothelioma, which affects the stomach and abdomen, is second most common after pleural mesothelioma and accounts for less than 20% of all mesothelioma cases. This type of mesothelioma is often caused by ingesting asbestos fibers. The fibers can become trapped in the digestive system, creating a tumor. As with other mesothelioma types, peritoneal mesothelioma has a long latency period thereby delaying diagnosis and impeding treatment. Because the symptoms are common to other ailments, diagnosis can be delayed. Some symptoms of peritoneal mesothelioma include: Swelling Abdominal pain Fever Weight loss Pericardial Mesothelioma Pericardial mesothelioma is the rarest form of mesothelioma and accounts for very few cases. Thisasbestos cancer affects the heart and its surrounding cavity. As with other mesothelioma types, pericardial mesothelioma has a long latency period thereby delaying diagnosis and impeding treatment. Some symptoms of pericardial mesothelioma include: Persistent coughing Chest pain Palpitations Shortness of breath If you have been exposed to asbestos, make sure to notify your doctor so appropriate measures can be taken to ensure a correct diagnosis of your symptoms. Benign Mesothelioma Unlike all other forms of mesothelioma, benign mesothelioma is not cancerous. A tumor forms in the mesothelial layer around the heart, lungs, stomach or elsewhere in the abdomen and grows larger. However, it is not cancerous and does not spread to nearby tissues or other areas of the body. The symptoms of benign mesothelioma are often similar to those of other types of mesothelioma, and depend, somewhat, on what area's mesothelial lining is affected. Typically, they include: Pressure, tightness, swelling or pain in the affected area For peritoneal (abdomen): nausea, loss of appetite, bowel obstruction For pericardial (heart): heart palpitations, shortness of breath, persistent cough For pleural (lungs): shortness of breath, wheezing, persistent cough Treatment for benign mesothelioma is usually surgery. The prognosis after surgery is excellent. Malignant Mesothelioma Malignant mesothelioma is a general term that encompasses all cancerous types of mesothelioma. To learn more about each of the types of mesothelioma including symptoms, diagnosis, treatment and survival, follow these links: Pleural Peritoneal Pericardial Epithelial Mesothelioma Epithelial mesothelioma is a malignant form of mesothelioma that specifically affects the epithelial cells. Epithelial cells build the tissue and membranes that line and protect the outside of organs as well as the abdominal cavity (peritoneum). 50% - 70% of all diagnosed cases of malignant mesothelioma are classified as epithelial, or epithelioid, mesothelioma. The symptoms of epithelial mesothelioma depend on the area or organ where the cancer is located such as the lungs, stomach or abdomen, or heart or if it has spread to other areas of the body. Sarcomatoid Mesothelioma Sarcomatoid mesothelioma is another form of malignant mesothelioma. It is responsible for between 7% and 20% of all mesothelioma cases. This type of mesothelioma can occur in most areas of the mesothelioid layer, and is classified by cell shape (oval-ish, irregular) and nucleus appearance (less visible, vague). Symptoms are similar to other types of mesothelioma and depend on the area the disease begins and the stage of the disease. Sarcomatoid mesothelioma may be confused with other sarcoma types of cancer, and as a result may be more difficult to diagnose. There is some evidence to suggest that this type of mesothelioma may be even more aggressive and resistant to treatment than other types. Biphasic Mesothelioma Biphasic mesothelioma is diagnosed when a tumor is found in the patient that contains both epithelial mesothelioma cells and sarcomatoid mesothelioma cells—either mixed together or in separate areas of the tumor. Symptoms and treatment of the disease are similar to other types of mesothelioma and depend on the area the cancer begins, the stage the disease is in, and other factors. Papillary Mesothelioma Papillary mesothelioma is a very rare form of mesothelioma that is not well understood. It can occur in the heart, lungs, stomach or abdomen like other forms of mesothelioma, but also occurs in the ovaries and testicles. Some cases of papillary mesothelioma have been associated with asbestos exposure, others have not. In a good portion of the cases that have been reported, the disease did not spread to other areas of the body, but it did show a high rate of recurrence. A uniform method of treatment has not been established, but surgery and chemotherapy have most often been used. Prognosis after treatment for this form of mesothelioma is often much better than other types of malignant mesothelioma.

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PERITONEAL MESOTHELIOMA

Peritoneal mesothelioma, a cancer of the lining of the abdominal cavity, is less common than the pleural form, comprising approximately one-fifth to one-third of the total number of mesothelioma cases diagnosed. According to the SEER (Surveillance, Epidemiology, and End Results) database, these diagnoses are approximately 54.7 per cent male versus 45.3 per cent female, with the median age being 65-69. The latency period appears to be shorter for asbestos-exposed individuals with symptoms appearing 20-30 years after exposure rather than the 30-40 year latency more commonly associated with pleural mesothelioma.

Symptoms

Clinical symptoms at the time of presentation may include abdominal pain, abdominal mass, increased abdominal girth, distention of the abdomen, ascites (fluid in the abdomen), fever, weight loss, fatigue, anemia and digestive disturbances. Some patients complain of more non-specific symptoms for a number of months prior to a confirmed diagnosis. In a percentage of cases, peritoneal mesothelioma is found incidentally when the patient has sought help for another health problem such as gallbladder, hernia or pelvic mass.

Experienced doctors report that patients typically experience symptoms 6 months to 2 years before diagnosis. When the patient goes to the doctor, the patient, the family, and the doctor all usually think something else is wrong. Men often first show up with an inguinal hernia (a bulge in the groin) or an umbilical hernia (bulge around the belly button.) The first indication of a problem for some women comes during a pelvic examination when a tumor mass is discovered.

Late-stage peritoneal mesothelioma symptoms include bowel obstruction and increased tendency of the blood to clot. Blood tests show increased platelet count in half of peritoneal patients, although this is of little use in diagnosis because it can be caused by so many disorders. Anemia and low albumin levels are also found.

Diagnosis

As with all mesotheliomas, the diagnosis of peritoneal mesothelioma can be challenging. CT findings may help differentiate between the two clinical types of peritoneal mesothelioma, termed “dry” or “wet”, since their appearances are very different upon imaging. In the “dry” type, CT may reveal multiple small masses or a single dominant localized mass. There is normally little or no ascites. In the “wet” type, CT may reveal widespread small nodules, but no dominant mass. Ascites is usually present.

If fluid is present, it may be removed in a procedure called paracentesis. Unfortunately, as is the case with pleural mesothelioma, fluid analysis offers limited diagnostic value. It is normally a tissue biopsy obtained in a laproscopic exploratory that will yield a definitive diagnosis.

Staging

There is currently no established staging system for peritoneal mesothelioma, and if the disease is staged, it is normally done in accordance with the TNM system, the most common general cancer staging system. This system refers to the status of the tumor (T), lymph nodes (N) and metastases (M). There are general categories which may also be somewhat helpful in determining stage.

The first category shows a localized lesion able to be completely resected (entirely removed). In the second category, the disease is contained within the abdominal cavity on peritoneal and organ surfaces where debulking (the removal of as much, but not all of the tumor) is possible. Category three shows disease contained within the abdominal cavity with invasion of organs such as the colon or liver. Category four shows disease extending outside the abdominal cavity.

Mesothelioma specialist Clare Verschraegen wrote that she categorizes peritoneal mesothelioma into four categories. The least developed is when the tumor has not spread and can be removed with surgery. This is equivalent to stage I in the Butchart classification.

The next is when the cancer has spread to the periconal and organ surfaces and surgery will result only in a debulking of the tumor, not removal of all malignant tissue. The next stages are when the cancer metasticises to other organs, and when it gets into the lymph nodes.

Treatment

In recent years, multimodality treatment of peritoneal mesothelioma has become more common for a select patient population, since surgery alone and/or intraperitoneal chemotherapy alone have proven to be similarly ineffective. Cytoreductive (debulking) surgery involves the removal of all or nearly all visible tumor, and, depending on the physician’s choice, may be combined with Intra-Peritoneal Hyperthermic Chemotherapy (IPHC), intraperitoneal chemotherapy and/or radiation. Dr. Paul Sugarbaker has written “intraperitoneal chemotherapy gives high response rates within the abdomen because the peritoneal space to plasma barrier provides dose intensive therapy.” Since it is not always possible to remove all tumors, the prognosis for long-term survival may be based on the completeness of cytoreduction as established by the following criteria:

Complete cytoreduction:

CC-0 No peritoneal seeding is visualized within the operative fields.

CC-1 Nodules of less than 2.5 cm persist after cytoreduction. Nodules of this size are thought to be penetrable by intracavitary chemotherapy, therefore cytoreduction is termed complete.

Incomplete cytoreduction:

CC-2 Nodules of between 2.5 and 5 cm persist after cytoreduction.

CC-3 Nodules of greater than 5 cm or a merging of unresectable tumor nodules at any site within the abdomen or pelvis.

For patients found to have widespread disease, where surgery is not looked at as “potentially curative”, palliation of symptoms may be accomplished by debulking. Since peritoneal mesothelioma is a rare malignancy, specialized treatments should be conducted by doctors familiar with the disease.

More on systemic therapy for peritoneal mesothelioma.

A recent clinical trial found pemetrexed (Alimta) to be an effective chemotherapy agent in treatment of peritoneal mesothelioma, either along or with a platinum-based drug such as cisplatin. This success mirrors previous findings about pemetrexed for treatment of pleural mesothelioma.

Sources for information on this page:

Surgial Oncology Associates – Management of Peritoneal Surface Malignancy Using Intraperitoneal Chemotherapy and Cytoreductive Surgery: A Manual for Physicians and Nurses

Cancer Research UK – Peritoneal mesothelioma treatment

NCI: Malignant Mesothelioma Treatment

The Annals of Thoracic Surgery, Staging in Malignant Mesothelioma, Published March 2006.

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