The Stages Of Mesothelioma (Part 2 of 3)

By Thomas J. Lamb at AsbestosHUB.com | December 5, 2009

Last time we briefly outlined the Butchart System of mesothelioma staging.  As a reminder, the Butchart System categorizes the stages of mesothelioma by the size and extent of the tumor.  It is the most widely used system of staging.

Today, we will discuss the TNM System.

TNM System

The TNM System is based on the extent of the tumor, metastasis, and lymph node involvement. TNM stands for T: tumor, N: lymph nodes, M: metastasis.  The TNM System divides malignant mesothelioma into four stages:

Stage 1
Malignant mesothelioma is present in the left or right chest cavity (pleura) and may have metastasized to the lung, the sac around the heart (pericardium) or the diaphragm on the same side. Lymph nodes at Stage 1 are not involved.
Stage 2
Malignant mesothelioma has reached from one side of the chest cavity to a lymph node near the lung area on the same side as the cancer. The cancer has metastasized to the diaphragm, pericardium (sac around the heart) or the lung on the same side as the original cancer.
Stage 3
Malignant mesothelioma has penetrated the chest lining, heart, esophagus, muscle, ribs and vital organs within the chest cavity on the same side as the cancer. Lymph nodes may or may not be involved during this stage.
Stage 4
Malignant mesothelioma has metastasized to the pleural area and the lymph nodes on the opposite side of where the cancerous tumor is located. It may also have reached the chest cavities or lungs on both sides, or may have spread to the abdomen.

 

For more information visit Asbestos-Mesothelioma.com and MedicineNet.com.

Next time, the Brigham System.

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The Stages Of Mesothelioma (Part 1 of 3)

By Thomas J. Lamb at AsbestosHUB.com | December 3, 2009

Mesothelioma is a deadly disease caused by asbestos exposure.  A person that has been exposed to asbestos might go more than 20 years before any signs of this terminal disease present themselves.  

Once malignant mesothelioma has been diagnosed, the next step is a process called staging. Staging is the process of assessing how severe malignant mesothelioma is and whether or not it has spread to other organs (metastasized) or remained in one place (localized). It is been used to estimate a victim’s prognosis and to determine the most suitable therapy.

Use of Imaging to Stage Mesothelioma

When mesothelioma is diagnosed, an imaging procedure is needed to determine the extent of the cancer and how far it has spread (metastasized). The imaging options your physician may use include:

In this three part series we will cover the three systems which are used to categorize these stages of mesothelioma.  First, the Butchart System.

Butchart System of Staging

The Burchart System of staging is the oldest and most commonly used.  It categorizes the stages of mesothelioma based on the size and extent of the tumor.

Stage 1
Malignant mesothelioma has affected the right or left side of the chest cavity (pleura) and may be seen in the diaphragm.
Stage 2
Malignant mesothelioma has been found in the pleura on both sides of the body and may have also moved into the heart, stomach, or esophagus on both sides. Lymph nodes may be affected.
Stage 3
Malignant mesothelioma has reached the abdominal cavity (peritoneum). Lymph nodes past the chest may be affected.
Stage 4
Malignant mesothelioma has reached other organs and has entered the blood stream.

 

For more information visit Asbestos-Mesothelioma.com and MedicineNet.com.

Next time, the TNM System.

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Australian Researchers Pioneering New Mesothelioma Treatment Using Radiotherapy

By Thomas J. Lamb at AsbestosHUB.com | November 18, 2009

Australian researchers have innovated a new mesothelioma treatment using radiotherapy rather than chemotherapy, and the results are looking good.

Radiation Oncologist Dr. Malcolm Feigen has developed a new technique for treating mesothelioma, a terminal cancer caused by asbestos exposure. This breakthrough technique is called radiotherapy.

So far researchers have found that there is a staggering improvement in the patients using radiotherapy than those treated only by chemotherapy. Dr. Feigen reports that there have been no major side effects but some patients are having long-term benefits.

Chemotherapy treatment can only do so much. Usually patients experience short-term benefits. However, often the cancer keeps coming back. Yet the new radiotherapy is proving fight tumors and keep them from returning.

Dr. Feigen says, “…with radiotherapy it doesn’t come back in the same area and if we find patients early enough we may be able to stop any further developments of their disease.” Dr. Feigen says that on average the treatment has given patients two more years of life. For those diagnosed with mesothelioma and others who have been exposed to asbestos, this is great news.

For a more on this encouraging development, see the article, Breakthrough in fight against mesothelioma, over at ABC News (Australia Broadcasting Corporation).

Topics: Exposure, Facts, Medicine, Resources | 1 Comment »

Large Asbestos Jury Verdict For Mesothelioma Victim Reversed By Florida Appeals Court

By Thomas J. Lamb at AsbestosHUB.com | November 3, 2009

As we reported back in Spring of 2008, a Miami-Dade County jury found Honeywell International negligent for selling asbestos brakes awarding Stephen E. Guilder and his family almost $24.2 million.  Asbestos News Minute covered this story, as well.

Now, after Mr. Guilder’s death and over a year later, Florida’s 3rd District Court of Appeal has reversed this decision. The Daily Business Review reports, from Law.com:

The 3rd DCA reversed on several grounds, agreeing with Honeywell that Senior Judge Richard Yale Feder erred by allowing into evidence a prejudicial letter from a Bendix employee to an asbestos supplier in the 1960s which illustrated Honeywell’s knowledge of asbestos dangers. The appellate court ruled the judge should have redacted a prejudicial section.

The three-judge panel also determined Feder should have included third parties on the verdict form so jurors could apportion comparative fault and Guilder’s children were not entitled to loss of consortium.

Guilder’s initial victory was one of the highest ever awarded to a single mesothelioma victim back in April 2008. He suffered from peritoneal mesothelioma, the rare form of deadly cancer caused by asbestos exposure.

After losing their father and being stripped of their award, the family suffers.

Honeywell, on the other hand, is “pleased”.

Watch a report on this new development on Asbestos News Minute.

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Estate Of Niagra Falls Plant Worker Awarded $2.25 Million In Asbestos Lawsuit

By Thomas J. Lamb at AsbestosHUB.com | October 26, 2009

Almost 4 years after his death, a worker from the Niagra Falls Hooker Chemical plant gained victory over Fisher Controls, a St. Louis-based supplier of industrial control valves.  The plant worker was diagnosed with mesothelioma after working on these valves for 18 years.  The valves contained gaskets made of asbestos.

Most disturbing is that the company knew of asbestos’ deadly effects as early as 1946, 40 years before this Niagra Falls man had worked with the valves, and still did nothing.  They made no effort to provide warning to those using their product.  Thus the jury decided to hold Fisher Controls wholly responsible for the worker’s asbestos-related cancer and his death.

The Buffalo News reports, “Court officials said the verdict, which includes a $750,000 punitive damages award, marks both the first time Fisher Controls has been found liable for using asbestos in its products and the first punitive damages award in a New York State asbestos case in more than 20 years.”

It was a bittersweet victory for the family and friends of this gentleman.  We hope that the resolution of this case will serve as an example and a warning to those companies who would bypass safety for profit.

Watch it on Asbestos News Minute.

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On The Other Side Of Mesothelioma: A Doctor’s Story Of His Own Diagnosis

By Thomas J. Lamb at AsbestosHUB.com | October 20, 2009

As healthcare professionals, doctors have a particular point of view when it comes to their patients. They have their routines for delivering bad news and treatment. Yet, there comes a time that doctors must become patients. As doctors, they have the unique position of caregiver and cared-for. When they are treated by colleagues they have a primacy of perspective that gives them an advantageous viewpoint through which to analyze healthcare professionals. They can see how the manner with which patients are dealt may not be effective or even humane.

In a sobering account of one doctor’s diagnosis of mesothelioma, “A patient’s journey” (BMJ, subscription required), Dr. Kieran Sweeney seeks to expose the dire shortcomings of healthcare professionals’ interactions with their patients. Through conversation, facial expressions, and mannerisms a doctor has a profound effect on how a patient copes with being diagnosed with a terminal disease. Dr. Sweeney hopes to make a change in the way that doctors currently conduct themselves when addressing the needs of sick patients.

Dr. Sweeney’s story opens in the hospital. He was there for testing and no one seemed to want to let him know exactly what was going on.  What follows is shocking:

While I was having the check film, my wife asked the specialist (cancer) nurse why everyone was so downcast. At that point, everyone around knew I had a mesothelioma, except me. I learnt about it by reading the discharge summary over a glass of sauvignon blanc with lunch at home: malignant mesothelioma. ‘Patient is aware of the diagnosis,’ said the discharge summary.

From there on out, Dr. Sweeney had entered “the kingdom of the sick,” as he called it. He quickly became entirely disconcerted by the healthcare professionals treating him and through his story offers some suggestions:

…one’s journey to this bleak place can be rendered more bearable if everyone who shares a professional role at the various staging posts bears the bleakness of the terminus in mind. Some simple ground rules could improve the nature of the professional patient interaction, if not actually displace its underlying, transactional mindset.

Please can all healthcare professionals stop asking patients to “Do this for me?” I’m not doing it for them, I’m doing it for me. The key point here is about locus of control. If I am asked, or more often instructed, to do something “for me”—meaning the health professional— then the locus of control for the transaction lies with that person. But the focus of the transaction should be me, the patient. Structured in that way, the “for me” defines the interaction as transactional—I am cared for—but not relational: one is left with the feeling that the professional does not care about me but does something to me.

Please can we avoid crass attempts at humour? There is nothing funny about clutching a plastic bag with all your clothes in, except your pants, socks, and shoes—just stop and think what that must be like—while trying to secure a hospital gown around you, and following, like some faithful gun dog, a radiology attendant who without introduction commands you, with a broad grin to acknowledge his witty lack of grammar, to “follow I!”

His point is not to completely categorize all healthcare professionals as out-of-touch, insensitive stoics. He intends to show that what doctors mean to convey and what they actually convey can end up being quite different. Not only this, but many times members of the same healthcare team have very different, sometimes contradictory, approaches to the personal aspect of treating the patient. He urges that this issue must be addressed.

Being a patient diagnosed with mesothelioma is especially difficult. There just aren’t the same resources available. With awareness groups such as Asbestos Disease Awareness Organization, this is hopefully something that will continue to change. Yet as it stands, mesothelioma patients truly need their doctors to treat them, not as just another patient, but personally, as individuals.

Dr. Sweeney closes stating:

In the care I have received, the transactions have been timely and technically impeccable. But the relational aspects of care lacked strong leadership and at key moments were characterised by a hesitation to be brave. What I have always feared in illness was anonymity, being packaged, losing control, not being able to say “this is who I am.” In the end, one is left alone, here, in the kingdom of the sick.

His story is a call to action. Perhaps the suggestions he’s provided will be taken to heart by many clinicians whose intentions are assuredly not to be cold and impersonal. The healthcare community needs stories like these, and not just from doctors, in order to evaluate and train themselves in the highly delicate art of patient relations.

With a subscription to BMJ you can read Dr. Kieran Sweeney’s full story about his diagnosis of mesothelioma, “A pateint’s journey”.

 

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Asbestos Disease Awareness Organization Updates Resources And Awareness Links

By Thomas J. Lamb at AsbestosHUB.com | October 15, 2009

Dedicating its efforts to the memory of  “June Breit and the thousands of other victims silenced by asbestos”, the Asbestos Disease Awareness Organization (ADAO) has released an awareness and resources update. 

This update includes important excerpts from the recent statement by the US Surgeon General Steven K. Galston about National Asbestos Awareness Week.  It provides several educational resources about asbestos and asbestos-related diseases, including many sites which are multilingual.  Finally, the update has a section suggesting what you can do to help raise awareness about asbestos.

I suggest visiting the ADAO website for the details of the update yourself.  However, the “Prevention and Advocacy” suggestions are worth repeating, here. 

From the update:

SAMPLE FACEBOOK and TWITTER MESSAGE: “Asbestos is a carcinogen. Ban asbestos now. Send your Congressional Representatives a letter from www.banasbestos.us ”

Forward the www.banasbestos.us link to your contacts, post your message on FaceBook and send on Twitter. Ask your friends, families and colleagues them to send letters and messages too!

It’s an easy cut and paste to help raise awareness about this deadly substance that continues to inhabit so many of our public buildings, transportation, and even entire towns.

Topics: Resources | 1 Comment »

A Closer Look At Mesothelioma Types: Pericardial Mesothelioma (Part 3 of 3)

By Thomas J. Lamb at AsbestosHUB.com | October 12, 2009

Pericardial mesothelioma is very rare. It occurs as a result of extended exposure to asbestos. This type of mesothelioma is characterized by the growth of cancer cells around the heart.

The pericardium is a fluid filled sac which surrounds the heart. It serves as protection by keeping the heart from being irritated by surrounding membranes and by preventing the heart from overexpansion during increased blood flow. Pericarduim

                       Photo courtesy of the National Heart Lung And Blood Institute.

Pericardial mesothelioma is caused by fiber particles which become wedged inside the pericardial fluid. These stuck fibers create scar tissue which then leads to the formation of cancerous cells. As a result, the heart beat becomes irregular and the heart inflamed.

Unfortunately, as is the case with all types of mesothelioma, the disease is often diagnosed in the late stages. This leaves few options for treatment. The treatment options currently used for pericardial mesothelioma are frequently radiation therapy and chemotherapy. These types of treatments are quite effective, but with them runs a risk of damaging healthy cells while ridding the body of the unhealthy cells. Surgery is also sometimes used to remove cancer cells.

A great resource on pericardial mesothelioma can be found at PericardialMesothelioma.org.

For more information, visit AsbestosLegalWatch.com.

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A Closer Look At Mesothelioma Types: Peritoneal Mesothelioma (Part 2 of 3)

By Thomas J. Lamb at AsbestosHUB.com | October 6, 2009

Peritoneal mesothelioma is a cancer affecting the abdominal lining, or peritoneum, and is sometimes referred to as abdominal mesothelioma. This membrane supports and covers the organs of the abdomen. Malignant peritoneal mesothelioma is an extremely rare condition; only 100 to 500 cases are diagnosed in the US each year, making up less than 20% of all mesothelioma cases.

Peritoneal MesotheliomaThe peritoneum is made of two parts, the visceral and parietal peritoneum. The visceral peritoneum covers the internal organs and makes up most of the outer layer of the intestinal tract. The parietal peritoneum covers the abdominal cavity. Cells in these linings secrete a fluid which allows organs to move against one another. The cells of the mesothelium are designed to create fluid, but the cancer causes them to overproduce, creating a build up of excess fluid in the abdominal cavity. Because pleural mesothelioma is more common and often spreads to the peritoneal cavity, it is important to determine if pleural mesothelioma is the primary cancer.

Treatment of Peritoneal Mesothelioma

In the February 2008 edition of the American Journal of Clinical Oncology, researchers from Columbia University reported that combined resection, intraperitoneal chemotherapy, and whole abdominal radiation therapy and found it to be an effective treatment for malignant peritoneal mesothelioma.

The latency period for abdominal mesothelioma appears to be 20-30 years, which is shorter than the time it takes to develop pleural mesothelioma in the lungs and it is much less common, making up less than 20% of all cases.

The Columbia University study involved 27 patients with malignant peritoneal mesothelioma and followed a regimen involving several steps:

The multimodality of therapy proved effective, showing a median survival of 70 months and a three-year survival of 67%. It is interesting to note that seven patients in the study went a full 17 months before seeing any evidence of the disease.

For more information, visit AsbestosLegalWatch.com.

 

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A Closer Look At Mesothelioma Types: Pleural Mesothelioma (Part 1 of 3)

By Thomas J. Lamb at AsbestosHUB.com | October 2, 2009

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

Roughly 80% of malignant pleural mesothelioma cases start as pleural plaques. Pleural plaques are smooth, white, raised irregular areas of fibrous collagen tissue that develop on the pleura and vary in size from small to large. Pleural plaques are not considered pre-malignant, but they are an indication of exposure to asbestos (and thus indicate an increased risk of its associated diseases). They do not require treatment, but their presence should prompt regular medical check-ups.

To date, treatment options for mesothelioma have been limited as only a small number of patients respond to surgical intervention; however, recent efforts have focused on exploring new combinations of therapies for treating malignant pleural mesothelioma and extending survival.

Surgery

There have been some encouraging preliminary results in comparing surgery to conventional chemotherapy. At the American Society of Clinical Oncology meeting in Chicago in Pleural Plaques2007, results were presented of a multi-center Phase II feasibility study of trimodal therapy for malignant pleural mesothelioma. Patients had four cycles of cisplatin and premextred chemotherapy, followed by an extrapleural pneumonectomy (explained in detail below), followed by hemithoracic radiation. Median survival time for the group was 16.6 months.

Extrapleural Pneumonectomy

Extrapleural pneumonectomy (EPP) is a surgical procedure that involves the removal of the lung along with its coverings. Of all treatment approaches attempted, extrapleural pneumonectomy has been most consistently associated with long-term disease-free survival. Also, with the lung removed, a higher amount of radiation can be delivered.

Once the patient is under complete general anesthesia, an incision is made extending from below the shoulder blade, around the side along the curvature of the ribs to the front of the chest on the side of the diseased lung (thoracotomy). Next, the surgeon collapses the diseased lung, cuts off its major blood vessels, and the lung’s main bronchial tube (air tube) will be clamped and cut and the lung removed. The pleura is then removed from the chest wall.

Systemic Therapy

Pemetrexed (Alimta) and Combinations

Table

Vinorelbine Plus Platinum

Investigators in Denmark have explored the use of combining vinorelbine rather than pemetrexed in combinations with platinum agents cisplatin and carboplatin. The vinorelbine and cisplatin group were mostly in advanced states (stage III or IV) and had a median survival rate of 11.6 months. The vinorelbine plus carboplatin group median survival rate exceeds nine months for stage III and IV patients in the study.

Other Targeted Therapies

Angiogenesis Inhibitors

Cancer cells have the ability to spread, called metastasis, which means they can penetrate into lymphatic and blood vessels, circulate through the bloodstream, and Angio 1then invade and grow in normal tissues elsewhere. Cancer researchers studying the conditions necessary for cancer metastasis have discovered that one of the critical events required is the growth of a new network of blood vessels. This process of forming new blood vessels is called angiogenesis.

Tumor angiogenesis is the proliferation of a network of blood vessels that penetrates into cancerous growths, supplying nutrients and oxygen and removing waste products. Tumor angiogenesis starts with cancerous tumor cells releasing molecules that send signals to surrounding normal tissue. The signal activates genes that make proteins to encourage growth of new blood vessels.

Angio 2Scientists studying tumor growth found that cancer cells grew into tiny tumors but failed to link up to the organ’s blood vessels. Without angiogenesis, tumor growth stopped.

A drug trial using a combination of gemcitabine and cisplatin plus bevacizumab as angiogenesis inhibitors showed, unfortuntely, that this drug combination did not show any significant improvement in progression-free survival.

Other trials with targeted drugs in an attempt to use angiogenesis inhibitors as a way to stop cancer progression are underway.

For more information, visit AsbestosLegalWatch.com.

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