Mesothelioma Site

Mesothelioma is a form of cancer that is almost always caused by exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart,^[1] the pericardium (a sac that surrounds the heart) or tunica vaginalis.

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma.^[2] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases risk of other asbestos-induced cancer.^[3] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Signs and symptoms

Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

• Chest wall pain
• Pleural effusion, or fluid surrounding the lung
• Shortness of breath
• Fatigue or anemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

• Abdominal pain
• Ascites, or an abnormal buildup of fluid in the abdomen
• A mass in the abdomen
• Problems with bowel function
• Weight loss

In severe cases of the disease, the following signs and symptoms may be present:

• Blood clots in the veins, which may cause thrombophlebitis
• Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• Jaundice, or yellowing of the eyes and skin
• Low blood sugar level
• Pleural effusion
• Pulmonary emboli, or blood clots in the arteries of the lungs
• Severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.

Treatment

Treatment of malignant mesothelioma using conventional therapies in combination with radiation and or chemotherapy on stage I or II Mesothelioma have proved on average 74.6 percent successful in extending the patients life span by five years or more [commonly known as remission][this percentage may increase or decrease depending on date of discovery / stage of malignant development] (Oncology Today, 2009). Treatment course is primarily determined by the staging or development. This is unlike traditional treatment such as surgery by itself which has proved only be 16.3 percent likely to extend a patient's life span by five years or more [commonly known as remission]. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.

Surgery

Surgery, by itself, has proved disappointing. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008) A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

Radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.^[18] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.^[19] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.^[20]

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.

Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.

Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.^[21] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

Diagnosis

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).

If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.

If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Typical immunohistochemistry results

Positive	Negative
EMA (epithelial membrane antigen) in a membranous distribution	CEA (carcinoembryonic antigen)
WT1 (Wilms' tumour 1)	B72.3
Calretinin	MOC-3 1
Mesothelin-1	CD15
Cytokeratin 5/6	Ber-EP4
HBME-1 (human mesothelial cell 1)	TTF-1 (thyroid transcription factor-1)

Screening

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.^[4] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.^[5]

Staging

Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.^[6] TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged Ia–IV (one-A to four) based on the TNM status.^[6][7]

Pathophysiology

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.

Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).^[8] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.^[9]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

• Neurofibromatosis type 2 at 22q12
• P16^INK4A
• P14^ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

• Inactivation of tumor suppressor genes
• Activation of oncogenes
• Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
• Activation of DNA repair enzymes, which may be prone to error
• Activation of telomerase
• Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.

Notable people who died from mesothelioma

Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.

Bernie Banton was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian Federal Election.

Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits.^[22] (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.^{[citation needed]})

United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.

After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.

Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.^[23] His mesothelioma has been attributed to his younger years spent working on building sites in London.^[24][25]

Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation died of mesothelioma in 1994.

Scottish Labour MP John William MacDougall died of mesothelioma on August 13, 2008, after fighting the disease for two years.^[26]

Canberra journalist and news presenter, Peter Leonard also succumbed to the condition on 23 September 2008.

Terrence McCann Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006 at his home in Dana Point, California.

Notable people who have lived for some time with mesothelioma

Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the Message"^[27] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another twenty years eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma.

Pleural mesothelioma

Pleural mesothelioma is the most common type of malignant mesothelioma (accounting for an approximate 75% of all documented cases of the disease) and affects the section of the mesothelium called the pleura. Although the most common type of malignant mesothelioma, the disease is still somewhat of a rarity. As a result, pleural mesothelioma is often confused with other types of diseases, such as lung cancer and viral pneumonia. Lung cancer can be caused by asbestos (asbestos lung cancer), though it differs from pleural mesothelioma in that it is a malignancy of the lung tissue itself, as opposed to pleural mesothelioma which is a malignancy of the tissue casing of the lungs. Viral pneumonia shares certain symptomatic similarities with pleural mesothelioma and is often misdiagnosed as such.

The most common presenting symptom of pleural malignant mesothelioma is chronic chest pain. A buildup of fluid inside the pleural space can cause severe and chronic chest pains; this is called pleural effusion. Steps can be taken to drain the fluid and relieve the pain (with the possibility of recurrence) or surgery can be performed to close the pleural space (with virtually no possibility of recurrence). Some of the other notable symptoms associated with pleural mesothelioma include:

• Shortness of breath
• Chronic coughing
• Weight loss
• Fever

Types of Mesothelioma | Facts and Resources

Mesothelioma is a rare type of cancer caused by exposure to asbestos or asbestos related materials. Like most other forms of cancer, it is separated into two groups, malignant and benign. Rarely is mesothelioma benign, so frequently any mention of the condition refers to its malignant state, known as a tumor. A malignant tumor will grow and expand, and can spread cancerous cells into other parts of the body.

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

Epithelioid is the most common kind; 50-70% cases reported are of this type, which also has the best possibility of survival. This type affects the covering surrounding the internal organs and internal surfaces in the body. Sarcomatoid is much more serious, and it affects the secondary tissues such as bone, muscles, cartilage, and/or fat. This cell is much rarer, occurring 7-20% of the time. Mixed/biphasic refers to both types of cancers at once, and make up the rest of the 20-35% of the occurrences.

Aside from the types of cancerous cells, there are three main types of mesothelioma, and each affects a different area of the body. The three types of this deadly cancer are:

• Pleural Mesothelioma
• Peritoneal Mesothelioma
• Benign Mesothelioma

Mesothelioma Applied Research Foundation

The Mesothelioma Applied Research Foundation (Meso Foundation, formerly MARF) is a non-profit organization that funds mesothelioma research, provides services to patients, educates the public, and advocates in Washington, DC for governmental funding for mesothelioma research. The organization's mission is to eradicate mesothelioma as a life-ending disease.

Mesothelioma is a cancer caused by exposure to asbestos.

To date, the Foundation has funded over $5 million in clinical research and is the host of the annual International Symposium on Malignant Mesothelioma.

Legal History

The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al. first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos.^[30] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.^[31] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.

In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.

Despite proof that the dust associated with asbestos mining and milling causes asbestos related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.

By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.

In Armley, Leeds, England the J W Roberts asbestos incident involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company's factory. One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.^[32]a

Legal issues

The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). Today, you may see a commercial stating something like, "Mesothelioma is a rare type of cancer caused by asbestos particles. Asbestos particles can be found in lumberyards, shipyards or any of the heating or automotive industries." The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.^[28] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, Congress has not stepped in and there are no federal laws governing asbestos compensation.^[29]

Mesothelioma and Lung Cancer

Pleural mesothelioma and lung cancer are both serious illnesses, but they are not the same. Pleural mesothelioma – sometimes called “asbestos lung cancer” – is really not a form of lung cancer because it does not develop in the tissue of the lungs. Instead, it is a cancer of the lining that surrounds the lung (the “pleura”).

Mesothelioma is caused almost exclusively by asbestos exposure. It is considered a “signature disease” for asbestos exposure, which means that, if you have mesothelioma, it can be assumed that you had exposure to asbestos at some point in your life. Smoking does not cause mesothelioma.
Lung cancer can be caused by asbestos exposure; it can also be caused by smoking. In fact, someone who smokes and was exposed to asbestos has a much higher risk of getting lung cancer. See Asbestos and Smoking.

Pain Management for Mesothelioma

Mesothelioma is undoubtedly a horrific condition, more so in the later stages of the disease. Pain Management for mesothelioma is one of the most challenging parts of treating this disease in order to improve the quality of life for victims. Part of the trouble stems from the fact that the drugs required to treat mesothelioma pain can cause almost as much discomfort as the disease itself or can negatively interact with pain-relieving drugs.

Basic types of pain management

Victims of early mesothelioma can treat their pain with a number of over-the-counter pain relievers such as aspirin, ibuprofen (Advil and Motrin), and Tylenol. Unfortunately mesothelioma quickly progresses past the point where it is easily managed by simple analgesics. Pain management for mesothelioma is different depending on the type of mesothelioma. Pleural mesothelioma can cause mild pain at first in the chest and back and peritoneal mesothelioma can cause abdominal or pelvic discomfort and bowel obstruction.

Advanced mesothelioma pain management

Advanced mesothelioma is far more complicated to treat. Doctors usually use one of two routes to attempt to bring relief to victims enduring the agony of advanced malignant mesothelioma. Increasingly powerful opiate drugs such as morphine fentanyl, vicodin, oxycodone, and hydromorphone are strong enough to eliminate a great deal of pain, but have to be strictly monitored by a doctor.

Epidural drug treatment

Another way doctors manage pain is through epidural implants. Doctors install a permanent catheter into the spinal column, where a machine introduces preset amounts of strong pain killers directly into the nervous system. Epidural implants also reduce the number of hospital visits because patients can easily manage their pain while at home or from caregiving facilities.

Other options for victims of mesothelioma

Victims of mesothelioma deserve the best and most powerful pain management, because they suffer agony beyond description. If you or someone you know developed mesothelioma because of asbestos or other causes, you may be entitled to take legal action against those responsible. Let a dedicated and experienced asbestos attorney help you discover your rights and get you the justice you deserve today.

Peritoneal mesothelioma

Peritoneal mesothelioma is the second most common type of malignant mesothelioma (accounting for an approximate 10% to 20% of all documented cases of the disease) and affects the section of the mesothelium called the peritoneum (the mesothelial lining of the abdomen). Peritoneal mesothelioma is most often caused by the ingestion of carcinogenic asbestos fibers. Inhaled asbestos fibers can become lodged in mucous lining the mouth and esophagus. Once swallowed, it travels through the digestive system where it can potentially become lodged and develop into a tumor.

Some of the notable symptoms that are associated with peritoneal mesothelioma include:

• Swelling
• Abdominal pain (resulting from fluid buildup in peritoneal space)
• Weight loss
• Abdominal mass
• Lowered red blood cell count (anemia)
• Fever
• Bowel obstruction
• Blood clotting problems

Pericardial mesothelioma

Pericardial mesothelioma is much less common than malignant mesothelioma of the pleura or peritoneum. In fact there are only about 150 cases ever reported in the medical literature. It affects the section of the mesothelium called the pericardium (the mesothelial lining of the heart). People in the fourth to seventh decades of life are most likely to have this cancer, and there is a 2:1 male to female ratio. Currently, surgical excision (removal) of the pericardium is the treatment for pericardial mesothelioma, primarily to lessen symptoms of constriction around the heart.

Symptoms that are associated with pericardial mesothelioma include:

• Chest pain
• Fluid buildup around the heart
• A mass in the space between the lungs
• Abnormal or difficult breathing (dyspnea)
• Chronic coughing
• Irregular heartbeat (palpitations)

Asbestosis

Asbestosis is a chronic inflammatory medical condition affecting the parenchymal tissue of the lungs. It occurs after long-term, heavy exposure to asbestos, e.g. in mining, and is therefore regarded as an occupational lung disease. Sufferers have severe dyspnea (shortness of breath) and are at an increased risk regarding several different types of lung cancer.

As clear explanations are not always stressed in non-technical literature, care should be taken to distinguish between several forms of relevant diseases. According to the World Health Organisation (WHO), these may be defined as; asbestosis (the subject of this article), lung cancer, and mesothelioma (generally a very rare form of cancer, but increasing in frequency as people exposed to asbestos age).

Who Gets Mesothelioma?

Who gets mesothelioma can depend greatly in a number of conditions. Asbestos exposure is not limited to manufacturing work sites. Schools, churches, office buildings, and recreational centers contained significant amounts of asbestos until only a few decades ago. While those who worked in asbestos quarries and manufacturing centers are the most at risk, significant amounts of unrelated people were indirectly endangered. Furthermore, asbestos contamination affected many occupations not directly involved in the asbestos production or construction industries.

Mesothelioma in Military War Veterans – Navy personnel

Military war veterans – Navy personnel in particular - are at risk of developing mesothelioma because they were exposed to significant levels of asbestos in shipbuilding, insulation, and fire retardant materials on ship and at base. Military necessity outweighed health concerns, and thousands of innocent people and their families are now paying the price for this oversight. Even though veterans of the military cannot sue the government because of asbestos-related diseases, there are other ways to take action against those responsible. Furthermore, civilian military workers are also covered by the provisions of many special mesothelioma legal actions.

Mesothelioma in Mechanics and other Workers

Workers are the people at most risk of developing mesothelioma, because they worked directly or indirectly with the deadly materials. There are dozens of at risk jobs, but some are more dangerous than others. These include:

• Automotive mechanics
• Boiler makers
• Bricklayers
• Building Inspectors
• Carpenters
• Electricians
• Insulators
• Iron workers
• Laborers
• Longshoremen
• Maintenance workers
• Merchant marines
• Millwrights
• Painters
• Plasterers
• Plumbers
• Roofers
• Sheet metal workers
• Tile setters
• Welders

Family members of workers exposed to asbestos.

Perhaps the most tragic aspect of mesothelioma is the innocent family members of workers that had no direct exposure to the material but suffer from the disease nonetheless. Workers who dealt with this deadly material often carried microscopic asbestos fibers home with them in their clothes and hair, which caused secondary exposure to their families and friends. Over time, these innocent victims can develop mesothelioma, asbestosis, and other fatal conditions.

Other people that get mesothelioma.

There are other people that get mesothelioma besides other workers and their family members. Because asbestos was used in thousands of different industries in thousands of different locations, people with no exposure to asbestos in the workplace are now suffering from this disease. Asbestos insulation in churches, schools, recreation centers, and shopping centers can be responsible for a mesothelioma, asbestosis, or lung cancers.

Victims of Mesothelioma.

If you are an unfortunate victim of asbestos-related mesothelioma, regardless of how you developed it, you may be entitled to take legal action against those responsible for your condition. Asbestos litigation is one of the most potent legal tools for victims of mesothelioma to reclaim the life stolen from them by the greed and deception of asbestos companies. Contact a dedicated and experienced mesothelioma attorney today.

Mesothelioma causes

Mesothelioma causes are limited to direct and secondary asbestos exposure. Asbestos exposure is known to be responsible for a variety of health issues, including:

• Malignant mesothelioma
• Asbestos lung cancer
• Asbestosis
• Diffuse pleural thickening
• Fibrosis

Asbestos as a cause of mesothelioma was discovered in connection with occupational exposure to the mineral. Asbestos miners, factory workers, shipyard workers and construction workers were the most likely to contract the deadly disease and amongst the first victims. Mesothelioma is a latent disease that can take anywhere from 30 to 40 years to become symptomatic. A number of cases of mesothelioma where therefore reported within similar windows of time, displaying similar occupational backgrounds. Establishing the link back to asbestos (which was already linked to a number of aforementioned diseases) was a relatively simple task.

Although other causes of mesothelioma have not been ruled out, asbestos exposure is the only known cause thus far.

Mesothelioma of the tunica vaginalis testis

Mesothelioma of the tunica vaginalis testis is the least common type of malignant mesothelioma (amounting to less than 100 of all documented cases of the disease) and affects the section of the mesothelium called the tunica vaginalis testis (the mesothelial lining around the testes). Most patients are in their 50s or older, but about ten percent of the patients are younger than 25 years. Patients generally present with a hydrocele (an accumulation of serous fluid in a sac-like cavity (as the scrotum)) or hernia. Treatment is usually a high inguinal orchiectomy (surgical excision of the entire affected testis through an incision in the lower abdomen - called also orchidectomy). Prognosis is somewhat better than for pleural mesothelioma.

Symptoms that are associated with this cancer include:

• Hydrocele (a fluid filled sac attached to a testicle)
• Suspected hernia

MESOTHELIOMA STAGES

Treatment options are often determined by the stage of mesothelioma a patient is in. There are three staging systems currently in use for pleural mesothelioma and each one measures somewhat different variables; peritoneal mesothelioma is not staged.

Staging is the term used to describe the extent of a patient's cancer, based on the primary tumor and its spread in the body. It can help the medical team plan treatment, estimate prognosis and identify clinical trials for which the patient may be eligible.

Staging is based on a knowledge of how the cancer develops, from the primary tumor, to the invasion of nearby organs and tissues, to distant spread or metastasis. Staging systems have evolved over time, and they continue to change as scientists learn more about cancer. Some staging systems cover many different types of cancer, while others focus on more specific cancers. The TNM (primary tumor, regional lymph nodes, distant metastasis) is the most common staging system for mesothelioma.

Some elements common to most staging systems are:

• Location of the primary tumor.
• Size and number of the tumors.
• Lymph node involvement.
• Cell type and tumor grade.
• Metastasis.

Many cancer registries, such as the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER) use summary staging, a system used for all types of cancer. Summary staging groups cancer into five main categories:

• In situ - cancer that is present only in the layer of cells in which it began.
• Localized - cancer that is limited to the organ in which it began with no evidence of spread.
• Regional - cancer that has spread from the primary site to nearby lymph nodes or organs.
• Distant - cancer that has spread from the primary site to distant lymph nodes or organs.
• Unknown - cases where not enough information exists to indicate stage.

Several types of testing may be used to help doctors determine stage, and to formulate a treatment plan.

• Physical examinations. The doctor examines the body by looking, feeling and listening to anything out of the ordinary.
• Imaging techniques. Procedures such as x-rays, CT scans, MRIs and PET scans may show the location, size of the tumor and whether the cancer has spread.
• Laboratory tests. Studies of blood, urine, fluid and tissue can provide information about the cancer. Tumor markers, sometime elevated when cancer is present, may provide information.
• Pathology reports. Results of the examination of tissue samples can include information about the size of the tumor(s), extension into adjacent structures, type of cells and grade of the tumor. Results of the examination of cells in fluid, such as that from a mesothelioma-related pleural effusion, may also provide information.
• Surgical reports. Observations about the size and appearance of the tumor(s), lymph nodes and nearby organs.

Staging information should be provided to the patient by his doctor so that potential treatment plans can be discussed. Stage of the mesothelioma, as well as consideration of other factors such as age, health status and the patient's wishes may dictate different treatment options.

The oldest staging system and the one most often used is the Butchart System which is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages. The more recent TNM system considers variables of tumor in mass and spread, lymph node involvement, and metastasis. The Brigham System is the latest system and stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement.

Butchart System – extent of primary tumor mass

• Stage I: Mesothelioma is present in the right or left pleura and may also involve the diaphragm on the same side.
• Stage II: Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.
• Stage III: Mesothelioma has penetrated through the diaphragm into the lining of the abdominal cavity or peritoneum. Lymph nodes beyond those in the chest may also be involved.
• Stage IV: There is evidence of metastasis or spread through the bloodstream to other organs.

TNM System -- variables of T (tumor), N (lymph nodes), M (metastasis)

• Stage I: Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.
• Stage II: Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
• Stage III: Mesothelioma is now in the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side with or without spread to lymph nodes on the same side as the primary tumor.
• Stage IV: Mesothelioma has spread into 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 directly extends into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

Brigham System: (variables of tumor resectability and nodal status)

• Stage I: Resectable mesothelioma and no lymph node involvement
• Stage II: Resectable mesothelioma but with lymph node involvement
• Stage III: Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
• Stage IV: Distant metastatic disease

Mesothelioma Common Questions

What is Mesothelioma? What is the difference between pleural mesothelioma and peritoneal mesothelioma?

Malignant mesothelioma is a disease in which a cancerous tumor grows on the mesothelium - the sac lining the internal body cavities. The specific type of mesothelioma is named for the tissue where the cancer started. Pleural mesothelioma starts in the chest, in the pleura that surrounds the lungs (outer lining of the lungs and internal chest wall). It makes up about 70% of mesothelioma cases. Peritoneal mesothelioma starts in the lining of the abdominal cavity.

Although sometimes referred to as "asbestos lung cancer", mesothelioma is not the same as lung cancer. Lung cancers occur inside the lung itself; mesothelioma occurs in the lining of the lung. Mesothelioma is rare, striking fewer than 3000 Americans per year.

How do you get malignant mesothelioma?
Mesothelioma is caused by asbestos exposure. Asbestos, once regarded as a miracle mineral, was popular due its lightweight but tough characteristics as well as for its heat-resistant properties. This naturally occurring mineral was used in many commercial and consumer products, from construction materials such as cement, roofing shingles and insulation, to consumer and industrial applications such as hair dryers, automobile brake pads and pipe insulation.

Most people with malignant mesothelioma worked on jobs where they breathed asbestos. Others were exposed to asbestos in a household environment, often without knowing it.

How much exposure does it take to get the disease? What is the latency period?
Very little exposure can result in mesothelioma. Sometimes people who worked with asbestos for as little as one or two months get mesothelioma. The "latency period" refers to the time between asbestos exposure and diagnosis of the disease. For mesothelioma, the latency period can be decades long, and people exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed.

What are the symptoms of mesothelioma?
Our mesothelioma symptoms page goes into detail about the signs of this cancer. Please note that it is important to seek professional medical advice when trying to diagnose for mesothelioma. The major symptoms include:

• Shortness of breath caused by expanding pleural effusion
• Persistent dry cough

Other symptoms may include:

• Fatigue
• Night sweats
• Fever
• Pain under the rib cage
• Swelling or lumps in the abdomen
• Unexpected weight loss

How do doctors treat malignant mesothelioma?
Each patient has an individualized treatment plan which takes into account the type and stage of the cancer as well as the patient's overall health. Traditional mesothelioma treatments include surgery, chemotherapy, radiation or a combination of these. Contact us at 1-877-367-6376 if you want to talk about reviewing treatment options.

Is there any promising research or are there promising new drugs for mesothelioma?
Scientists and doctors are engaged in research at various cancer centers all over the United States. Researchers are constantly trying to develop new and more effective drugs as well as new treatment techniques. In the past few years, there have been several major advances in the management of mesothelioma, including more accurate staging, improvements in surgical techniques and postoperative care, new chemotherapy regimens, and new radiotherapy techniques such as intensity-modulated radiation therapy. Some of this research is being conducted through clinical trials, for which you may be eligible. Please call us if you need additional information on current trials.

What should I do if I think I've been exposed to asbestos but don't have mesothelioma?
You probably will not get this rare disease, but you should remain vigilant and get regular check-ups. Let your doctor know about your asbestos exposure.

I was exposed to asbestos when I was in the military. Could that be how I got mesothelioma?
The armed forces used asbestos extensively in the 20th Century, and because of the long latency period only now are many veterans getting mesothelioma. People were exposed in all branches of the service, in a variety of jobs. We have worked with veterans from all over the country. We can help you find VA resources and medical assistance. Our veterans section goes into more detail or feel free to call us at 1-877-367-6376.

Where can I find information on living with mesothelioma?
Mesothelioma Aid is a good website for resource for families dealing with mesothelioma. It includes advice and referrals to other resources for coping with cancer, caregiving, financial challenges, and support groups. Alternatively, contact us here at Mesothelioma Web for help finding resources for living with this disease.

What other resources are available for people with malignant mesothelioma?
Should you need more information or have additional questions, please contact us and we can refer you to sources that could answer your specific question. We can be reached at 1-877-367-6376.

US Court of Appeals Rules on Minnesota Asbestos Standards

The Eighth Court of Appeals has issued a ruling on a case regarding the North Shore Mining Company and the standards for asbestos exposure levels in the state of Minnesota. The case centers on a measure known as the "control city standard". This standard calls for atmospheric fiber levels at the North Shore Mining facility in the town of Silver Bay to be no higher than those measured in "control city". St. Paul, the state capital, is the control city against which such measurements are taken in Minnesota.

The court's ruling dictates that, while the control city standard will still apply for any permit requirements for the facility, it will not be part of any injunction issued by the federal government. In short, the court ruled that state pollution standards are an issue for the states, not for federal authorities, while keeping the current standard intact.

The state agency responsible for environmental issues has called for testing the air quality around the state's taconite mines before issuing permits. The state also wants firms to use the best technology available for testing and potential remediation on such sites to keep the measures of airborne asbestos at or below the control city level. The control city standard came about due to a federal ruling made in 1974. Recently, that ruling has been dismissed, which prompted attorneys for North Shore to move that the control city standard be disregarded as a criterion for permits.

No definitive statements have been made to see if North Shore has either the legal grounds or the inclination to plead their case before the U.S. Supreme Court. Officials with both North Shore and their parent firm have stated on numerous occasions that the fibers freed from the raw ore in the process of making the taconite pellets are not related to asbestos and do not pose a menace to the health of the surrounding population.

Fibers similar to asbestos have been detected in the air around the north shore of Lake Superior for several decades. Another federal court ruling prohibited the company, then known as Reserve Mining, from dumping waste rock into the lake. Previous studies had shown that a high concentration of taconite fibers in water could lead to health problems. In response, the firm began dumping its waste rock into landfills.

An investigation into cancer diagnoses in the area has uncovered a remarkably high incidence rate of lung cancer, mesothelioma and other lung disorders in that portion of the state. Researchers from the University of Minnesota School of Medicine are conducting a study on miners in the Iron Range area to determine why a high percentage of workers in the area's taconite plants have developed these diseases.

Chuck Laszewski, a spokesman for the environmental group Minnesota Center for Environmental Advocacy, stated that he favored the court's ruling. Although he was disappointed that the grounds for the federal standard were dismissed, Mr. Laszweski was pleased that the effect of keeping the control city standard was still in place, even if the implementation was to be at the state level.

Sources: Duluth News Tribune, WDIO

Residents Must Vacate North Dakota Apartment Building Due to Asbestos

Officials in Ward County, North Dakota have ordered that residents of the Emerson Apartment complex, in the town of Minot, vacate the property by the 15th of October and not allow for future tenants. The county now owns the building, which sits near the county courthouse, and is examining its options on how to deal with the site. Last week, members of the County Commission deliberated over the future of the building, which is contaminated with asbestos. After the residents have vacated the building, the commission will decide if the asbestos needs to be removed before or after the building's demolition, or if it would be feasible to remodel the building and remove the asbestos during the process.

According to Mr. Dana Larsen, a highway engineer for Ward County, a complete run of tests still needs to be conducted to determine the level and extent of asbestos use in the building's original construction materials. He said that the pipes in the building would need to be tested to ascertain the amount of asbestos insulation used and how the dangerous material was distributed throughout the structure. Mr. Larsen estimates that the asbestos remediation and cleanup would run from $125,000 to $150,000.

The commission agreed to allow Mr. Larsen to pursue grants that would alleviate some of the costs of asbestos removal at the site. However, they have not yet agreed as to what should become of the building and the site. County Commissioner John Fjeldahl moved that the building should be put up for sale, but no other members of the commission seconded the motion. Commissioner Jerome Gruenberg has stated that the county should attempt to remove all of the asbestos from the site before putting the building on the market. Commissioner Jack Nybakken proposed that the building stay open due to the city's current housing crunch. While the previous meeting resulted in a four-to-one vote in favor of demolition, the county has yet to set plans in motion for the building to come down.

Commission Chairman Bruce Christiansen mentioned that the building presents a serious environmental and fire hazard. He also expressed his fears about how the building had become a serious problem for the neighborhood and that the decisions regarding its fate would carry "great ramifications and consequences".

Bruce Walker, a representative with the property management firm First Minot Management, remarked to the commission that the city is suffering from a housing shortage and that availability for housing is at the lowest level in a quarter-century. He also told commissioners that the site does not require demolition and needs to be kept available for tenants who may not have anywhere else to go. According to Mr. Walker, the building is "safe now" and that the asbestos contamination is "not an issue". His firm has offered to keep the property open for renters for the next two years while the council decides on whether to sell the building to another party, keep it and remove the asbestos, or carry out their previous vote for demolition.

Sources: KFYR-TV, Minot Daily News, KXMB

New Castle, Del. Church School Tagged for Improper Asbestos Removal

Century-old St. Peter the Apostle Catholic Church has been charged for violating seven statutes instituted by the Delaware Department of Natural Resources and Environmental Control, or DNREC, regarding asbestos removal.

During the summer of 2009, asbestos was removed from St. Peter's parochial elementary school by volunteers rather than by a DNREC-mandated certified asbestos remediation and removal contractor.

The charges, all relating to unlawful removal of asbestos by uncertified workers, and disposal of hazardous solid waste in a manner not approved by DNREC, date to August 25.

The elementary school, located at 521 Harmony St., was built in 1960 to serve students from kindergarten through Grade 8 and currently offers a full curriculum, as well as a modern library, food service program, an extended care program for latchkey kids, and a gymnasium built in the 1950s. Current enrollment is 240, with about 25 students at each grade level. St. Peter's also supports a middle school for Grades 6 through 8, but a former high school was closed in 1970.

The illegal asbestos removal occurred on or about August 17, in the school's cafeteria and gymnasium, according to DNREC head of Environmental Crimes Unit William P. McDaniel. The complaint about the illegal asbestos removal wasn't received until about August 24, however. The complaint presumably from one of the staff arriving early in preparation for the 2009-2010 school year, and a DNREC inspection occurred the next day.

DNREC lodged seven individual charges against the church in a local Justice of the Peace Court. They are: three counts of asbestos removal by an uncertified worker; one count of non-DNREC-approved hazardous waste disposal; one count of failing to seal off a work area to prevent asbestos fibers from become airborne and dispersed; one count of leaving a visible residue of asbestos at the end of the removal; and one count of failing to maintain asbestos disposal records.

Asbestos isn't dangerous if undisturbed. Once removed and broken, however, as was the case with cafeteria and gymnasium floor tiles, the fibers can be ingested or inhaled and lead to such illnesses as asbestosis, lung and digestive system cancers, and mesothelioma.

Asbestosis, a respiratory ailment, is usually the result of long-term asbestos exposure. Mesothelioma, on the other hand, can be contracted during a single asbestos exposure, and - after lying dormant for decades - become so pervasive that most patients diagnosed with this form of cancer are seldom given more than a year or 18 months to live. In fact, the Centers for Disease Control (or CDC), the U.S. Department of Labor's Occupational Safety and Health Administration (or OSHA), and the American Cancer Society all agree that there is no safe, minimum asbestos exposure level; an hour or a lifetime can trigger mesothelioma.

Under U.S. Environmental Protection Agency Asbestos Hazard Emergency Response Act (AHERA) regulations, adapted by various state environmental agencies, all schools in the United States - whether public, private or parochial - are required to create, maintain and disseminate an asbestos reporting, monitoring and mitigation plan, via a designated liaison, which insures that initial and timely asbestos inspections (and mitigations) are performed by a licensed individual or firm; that parents and staff are notified of both the plan (on a regular basis) and of asbestos "events"; and that maintenance personnel are trained in asbestos recognition and safe handling.

Apparently, the impetuous volunteers who undertook to remove the tiles were either not aware of said plan, or did not understand the ramifications. Parents who learned of the removal after the fact were reportedly quite upset that the job was allowed to take place without notification - in fact, without church official's knowledge. In fact, one parent, a supervisor for a union-approved asbestos remediation crew, said he was appalled at the lack of communication that allowed such a thing to happen, and at how poorly the removal was handled.

Nothing has been said about air quality tests to determine if asbestos contamination has occurred, but DNREC regulations will likely mandate them.

Sources: DelawareOnline.com. St. Peter the Apostle Catholic Church website, Delaware Dept of Natural Resources and Environmental Control

May Whitney Elementary in Lake Zurich Suffers Ongoing Asbestos Concerns

In August of 2007, storms and flooding in Lake Zurich, Illinois led to the closure of May Whitney Elementary School at 120 North Church St. after crews found evidence of post-storm asbestos and mold contaminating the building.

After considering the costs and the health threat represented by the contamination, Whitney school officials decided not merely to delay the start of school, but to move the 440 Whitney students next door for the entire school year.

This building, at 100 Church Street, is connected to Whitney school by a hallway. Constructed in 1929 as Lake Zurich High School and later repurposed as Middle School North, the building is fully as old and in need of repair as Whitney. Used for storage before Whitney students moved in, it allowed lengthy renovations to Whitney itself, but presented some of the same risks as post-flood Whitney.

Whitney has since reportedly been rendered safe, but tests conducted over the summer of 2008 showed the persistent presence of asbestos and lead, and skeptical parents - remembering the mold horror of a year earlier, when many of the students reported diffuse illnesses - remain uncertain if the building is truly safe for their children.

Arguments by Wheaton-based AR Remediation Corporation's spokeswoman, Kathleen Wahl, that the presence of a compound does not indicate a hazard, have failed to reassure, as have remarks by Community Unit School District 95 architectural consultant Fred Schuster, who insists that the building is in good, safe and sound condition, though Schuster has acknowledged the continuing presence of asbestos in mechanical rooms, floor tiles and some bricks.

A reported leak on August 28 of this year, between the repaired section of the roof and the old roof, was also said to pose no apparent threat, either in terms of asbestos or lead, and the problem was finally addressed on August 31 when it stopped raining.

But it is the presence of these persistent leaks - seven documented in the 2008-09 school year alone - that have parents concerned as they consider the effect of such leaks in areas that are inaccessible to asbestos inspection; that is, where district officials consider asbestos to be in effect "out of harm's way" even if damaged by water.

There are 22 such areas, according to the most recent inspection, most of them above ceilings or behind walls. According to District 95 Director of Facilities Richard Marzec, the potential for the aforementioned leaks to release asbestos into the air is "extremely small".

Though most experts agree asbestos isn't dangerous unless tampered with, the U.S. Centers for Disease Control (CDC), The U.S. Dept. of Labor's Occupational Health and Safety Administration (OSHA), and the American Cancer Society all agree that there is no minimum safe level of asbestos exposure; a single incident or a lifetime can lead to mesothelioma, a particularly lethal form of cancer.

The twice-yearly inspections at Whitney are part of a plan mandated by the Illinois Department of Health; said plan based on the U.S. Environmental Protection Agency's Asbestos Hazard Emergency Response Act (AHERA) guidelines. These guidelines direct all U.S. schools to prepare a report of asbestos locations within the school; disseminate the report - and all planned or active asbestos remediation activities - to parents, teachers and school staff on a regular basis; hire licensed, qualified asbestos remediation experts to prepare plans, perform inspections and undertake remedial actions; and instruct maintenance staff on the recognition of, and appropriate handling of, asbestos.

While parents worry at the start of another Whitney Elementary School year, District 95 officials face the prospect of about $45 million in needed upgrades, a budget crisis made worse by falling property tax revenues in the wake of the housing bubble and widespread foreclosures, and a recession that is predicted to linger well into 2010.

As one district official has pointed out, the process of making district schools safe for students is a case of "Band-Aid fixes" rather than major repairs. The statement, though an accurate assessment of the district's budget capabilities, is nonetheless far from reassuring to parents who watch their young children go off to school in a nearly century-old building known to contain asbestos.

To receive a FREE Mesothelioma Web information packet** or to make a request, please fill out the following form :

Name:

Phone:

Email:

Street Address:

City, State, Zip:

Comments:

** Packet includes information on specialists,treatments, clinical trials, cancer links, and how to access legal and financial resources. You will be contacted by a Mesothelioma Web coordinator who will be available to discuss questions you might have.

Getting checked out and treated for asbestos diseases

Asbestos cancer, mesothelioma, and asbestosis can lie dormant for decades before symptoms start to show. Doctors who suspect mesothelioma will ask about your exposure to asbestos, and most people find this difficult to remember, especially if it happened decades ago. Check out our list of Naval Vessels for places where you might have been exposed, as well as our list of shipyards and asbestos-containing materials used by the military. If you worked with any of these materials or in any of these locations, be sure to tell your doctor during examinations. Early Detection is the best defense against asbestos diseases.

If you’ve been diagnosed with mesothelioma, our site has extensive information on treatment. Contact us if you need help finding a doctor or medical center that can handle this form of cancer.

The VHA has designated Comprehensive Cancer Centers throughout the country. These are large hospitals with experienced oncologists and nursing staffs. The VA also has established, at a community level, outpatient clinics that provide medical care for eligible veterans. Click here for a list of outpatient clinics by state.

MESOTHELIOMA GLOSSARY

• Abdominal mesothelioma
  Another name for peritoneal mesothelioma. Cancer of the lining of the abdominal cavity.
• Acute pain
  Pain that comes on quickly and may be severe, but lasts a relatively short period of time.
• Adenocarcinoma
  cancer that forms in the cells of glands or in parts of the body that produce mucous. Also called "nonsmall cell lung cancer". Tumors include cube or column-shaped cells found along the outer edges of the lungs and under the membrane lining of the bronchi.
• Adjuvant therapy
  Chemotherapy drugs (including hormones) given after surgery or radiation or both to help prevent the cancer from coming back.
• Alopecia
  Autoimmune disease occurring on areas of the body (most commonly the scalp) where a person’s immune system attacks hair follicles suppressing and arresting hair growth.
• Alveoli
  Tiny structures inside the lungs responsible for pulmonary gas exchange. Asbestos fibers become lodged in these structures which may lead to scarring.
• Anemia
  Having too few red blood cells. Common side effect of chemotherapy. Symptoms of anemia include feeling tired, weak, and short of breath.
• Angiogenesis
  The formation of new blood vessels. Angiogenesis is essential for the growth of tumors. Tumor cells release chemicals to encourage blood vessel growth.
• Angiogenesis Inhibitor
  A chemical which signals the process of angiogenesis to stop and thereby prevents the formation of blood vessels. In anticancer therapy, an angiogenesis inhibitor prevents the growth of blood vessels from surrounding tissue to a solid tumor.
• Antiangiogenesis
  Prevention of the growth of new blood vessels. Drug designers use this strategy to try to slow tumor growth.
• Asbestos
  A mineral fiber. Breathing high levels of asbestos fibers can lead to lung cancer.
• Ascites
  An accumulation of fluid in the peritoneal cavity symptomatic of mesothelioma and also found in patients with cirrhosis. More on ascites.
• Biologic therapy
  Treatment that stimulates the body's immune defense system to fight infection and disease. Also called immunotherapy. Some doctors consider this a type of chemotherapy, but it is usually classified as a separate type of treatment.
• Brachytherapy
  One of the earliest forms of cancer treatment, brachytherapy involves the insertion of small tube-like seeds that contain a dose of radiation into or directly next to a tumor. This has largely been replaced by external radiation therapy but is still a common treatment for prostate cancer.
• Breakthrough pain
  Pain that occurs in patients with chronic pain that is controlled by medications. The pain "breaks through" the normal control.
• Carcinogen
  A substance that is known to cause cancer. Asbestos can be considered a carcinogen because it can cause mesothelioma. More about carcinogens.
• Carcinomatosis
  This term generally refers to cancer metastasis (spread) to numerous regions of the body where it can attack a wide variety of organs, as well as soft, connective or bone tissues (for example) simultaneously.
• CAT scan
  Computerized tomography - a diagnostic medical test that uses X-Rays to create a 3-dimensional image of part of the body. Also called CT scans.

More on medical imaging.

• Chemotherapy
  The use of anticancer drugs, generally administered through an IV, to treat cancer.
• Chronic pain
  Pain that may range from mild to severe and persists or progresses over a long period of time.
• Clinical Trials
  Medical studies designed to compare a well-known, or standard, treatment with a new or alternative treatment. Clinical trials are usually done in three phases. Phase I tests the safety of the treatment on a small number of patients. Phase II assesses the effectiveness of the treatment and usually involves a larger group of people. Phase III provides in-depth information about the effectiveness and safety, by comparing experimental treatment with the standard protocol. Phase III trials usually involve several thousand patients nationwide.
• Combination Chemotherapy
  The use of more than one drug to treat cancer.
• Decortication
  A surgical procedure involving the removal of the membrane or outer cover of an organ. The procedure is commonly performed on mesothelioma patients if the lung is constricted and cannot be totally inflated.
• Diagnostic
  The use of skilled and scientific methods to establish the cause and nature of a disease.
• Double-Blind
  Clinical trial in which participants do not know what treatment they are receiving. The doctors and nurses treating them don't know either. Researchers keep this information secret until each patient's health status is known, usually after at least a year or more of treatments.
• Dyspnea
  Shortness of breath; difficulty breathing..
• Epidemiology
  The study of a disease that is widespread and rapidly spreading.
• Epithelial Cells
  One of the 4 main bodily tissues, they often compose the linings of organs and membranes as well as the skin. These cells line the insides of the lungs.
• Etiology
  The science and study of the causes, origins and reasons of diseases and their mode of operation.
• Gene Therapy
  A technique for modifying genes responsible for disease development. Still largely experimental.
• Immunotherapy
  A treatment which activates the bodies own immune system to destroy disease. Treatment of disease by stimulating the body s own immune system. This is a type of therapy currently being researched as a treatment for cancer.
• Intensity Modulated Radiation Therapy (IMRT)
  High-precision radiation therapy technique uses computer-controlled x-ray beams so that the radiation delivery conforms to the shape of the tumor. It does this by modulating-or controlling-the intensity of the radiation beam to focus a higher radiation dose to the tumor while minimizing radiation to surrounding healthy tissues.
• Laparoscope
  A small telescoping rod inserted into the body during laparoscopy. It often contains an illuminating device and a camera to transmit images to the operating physician. It can also have a small component capable of removing tissue for sampling.
• Laparoscopy
  A minimally invasive surgical procedure where small incisions are made in the abdominal area and a laparoscope is inserted into the body. Often used for biopsies it can also be used for minor surgeries.
• Macrophages
  Cells that digest pathogens and cellular debris. When trying to digest inhaled asbestos fibers in the lungs, they often split open and their internal fluids then damage the alveoli. The damage is then multiplied as more macrophages try to digest the particle and eventually fibrosis may develop.
• Markers
  Physiological indications of the presence of cancer. Mesothelioma is often diagnosed with the immunohistochemical markers.
• Mediastinoscopy
  A surgical procedure to examine the inside of the upper chest between and in front of the lungs (also known as the mediastinum). During a mediastinoscopy, a thin scope (mediastinoscope) is inserted through a small incision. A tissue sample (biopsy) can be collected through the mediastinoscope and then examined.
• Mesothelin
  A glycosylphosphatidylinositol-linked glycoprotein. A cell surface antigen. The biological function is not known, but the protein is expressed in large quantities in mesothelial cells, and in mesotheliomas and other cancers.
• Mesothelioma
  A form of cancer where the primary tumor is on the mesothelium - the internal lining of body cavities. Mesothelioma is a carcinoma. It is called pleural mesothelioma when the pleural cavity is affected and peritoneal mesothelioma when the tumor is in the abdominal cavity. Most mesothelioma cases can be traced to inhalation of asbestos fibers.
• Mesothelium
  Membrane that lines the pleura, peritoneum, and pericardium and produces lubricating fluids to allow the heart and lungs to glide against neighboring structures
• Metastasis/Metastasized
  The spread of cancer cells to distant areas of the body through the lymph system or bloodstream.
• MRI
  magnetic resonance imaging - a diagnostic medical test that uses magnetic fields to create a 3-dimensional image of part of the body.
• Multimodality therapy
  Click here for explanation
• Oncogenesis
  The development of cellular changes leading to the development of a malignant tumor
• Opioids
  Powerful prescription medications that are administered to relieve severe pain. Common opioids are endorphin, fentanyl and methadone.
• Palliative
  Treatment that is not expected to cure, but rather to slow down the progress of a disease and make the person comfortable and as happy as possible throughout the process.

More.

• Paracentesis
  Medical procedure that uses a needle remove/drain fluid accumulated in the abdominal cavity (peritoneal fluid). These fluid deposits are also called ascites.

Used in the diagnosis of mesothelioma. More.

• Parenchyma
  The functional parts of an organ. For instance alveoli are part of the parenchyma of the lung.
• Pericardium
  A protective layer of tissue enveloping the heart and the origins of many important blood vessels. The fibrous layer of the pericardium anchors the heart to surrounding tissue and prevents it from overfilling with blood. The serous layer prevents friction as the heart pumps.
• Peritoneal mesothelioma
  Cancer of the peritoneum, which is the inside lining of the lower part of the chest.
• Peritoneum
  Lining of the abdominal organs and cavity.
• Permissible Exposure Limit
  A parameter used in assessment of workplace hazards. Click here for an explanation of PELs.
• Phagocytosis
  Process wherein a cell surrounds large particles and envelops them through the cell membrane. (See Macrophages)
• Photodynamic therapy
  New cancer therapy. Patients are injected with a photosensitized chemical designed to be absorbed by the cancerous cells, not the healthy cells. The area is then irradiated with light that activates the chemical and causes the cancerous cells to die.
• Pleura
  The thin covering that protects and cushions the lungs and chest cavity. The pleura is made up of two membrane (layers of tissue) that are separated by a small amount of fluid.
• Pleural Effusions
  Collection of fluid in the pleural space between the lung and the chest wall.
• Pleural fluid
  A serous fluid found within the pleural cavity between the parietal and visceral pleura
• Pleural mesothelioma
  Cancer of the mesothelium lining around the lungs. The most common type of mesothelioma.
• Positron Emission Tomography
  PET, or Positron Emission Tomography, is a procedure that produces powerful images of the body's biological functions and is being used more and more frequently in the treatment and monitoring of malignant diseases. Unlike conventional imaging, PET does not show the body's anatomy, rather it shows the chemical function or metabolism of an organ or tissue.
• Pneumonitis
  This is a broad term that refers to variant forms of lung tissue inflammation, which can be caused by infections such as pneumonia (one form of pneumonitis). Pneumonitis can also result from allergic reactions to inhaled particulates in the air, as well as from radiation therapies delivered to the upper thoracic (chest) region of the body.
• Prognosis
  A doctor’s opinion on the progression of a patient’s condition and chances for improvement/recovery.
• Proto oncogenes Genes that code for cell growth regulation and differentiation. They can lead to malignant tumors if they are mutated or over expressed.
• Radiation therapy
  The use of high-energy rays or subatomic particles to treat disease. Types of radiation include x-ray, electron beam, alpha and beta particle, and gamma ray.
• Stroma
  The non-functioning supportive framework of an organ. The mesothelium which lines the pleura, peritoneum, and pericardium can be considered stroma.
• Thoracentesis
  Removal of fluid from the pleural cavity in the chest by inserting a needle into the chest. Used in diagnosis of mesothelioma.
• Thrombocytopenia
  Thrombocytopenia is a reduced platelet (thrombocyte) count. It occurs when platelets are lost faster than they can be replaced. It can be caused by a failure in platelet production or a severe injury.

More.

• Tomotherapy
  A form of Intensity Modulated Radiation Therapy that integrates a CT Scan in the treatment to better target tumors and reduce radiation to healthy tissue. The scan allows greater precision for the radiation treatment by pinpointing tumor mass. Tomotherpy.
• Tumor Suppressor Gene
  A gene that when activated can halt a cell’s cycle or encourage apoptosis reducing the probability that a damaged cell will evolve into a tumor cell.
• Video-Assisted Thoracoscopic Surgery
  A technique used to diagnose and treat problems in the chest, which has found increasing use in mesothelioma diagnosis in recent years. The doctors inserts a fiber-optic camera (called a thorascope) into the chest.