Mesothelioma Pages

Dr. Richard Alexander, Jr., M.D., of the University of Maryland School of Medicine believes peritoneal mesothelioma is a distinctly different disease from the more common pleural mesothelioma, and therefore necessitates it’s own treatment.

Usually caused by asbestos fibers, mesothelioma is a rare cancer which can take twenty to thirty years to develop in the lining of the lungs and abdominal cavities. Most mesothelioma patients have no idea their bodies are harboring the cancer until it is too late to treat anything but the pain. There are no known curative mesothelioma treatments. Early detection is often hindered by the long development time and when the symptoms do begin to show they often mimic treatable disease such as pneumonia.

Mesothelioma is thought to affect three thousand Americans each year and a rising fifteen to twenty thousand worldwide. Ten percent of all known mesothelioma cases in America are specifically peritoneal mesothelioma—a cancer of the lining of the abdomen.  Pleural mesothelioma, the more common type, is a cancer of the mesothelium—the lining of the lungs.

Many physicians are prescribing palliative care for mesothelioma patients. The short life expectancy for patients with mesothelioma is a painful one. Routine chemotherapy treatment brings its own set of negative side effects, which lower the patient’s already failing quality of life.

Dr. Alexander says a growing number of practitioners are choosing multi-modal therapies for the treatment of peritoneal mesothelioma. Typically, this approach begins with surgery to remove as many tumors and affected cancerous tissues as possible. Surgery is followed by chemotherapy.

When chemotherapy is prescribed for pleural mesothelioma, cisplatin if the standard drug administered. Due to its complex tumor pattern, peritoneal mesothelioma is responding to a unique chemotherapy bath. The chemotherapy drug is heated to a temperature that is more affective against the cancerous cells. The cancerous tissues are bathed in the heated solution.

Mesothelioma is a common cancer amongst long-time employees of industries such as shipbuilding and mining. The toxic chemical asbestos, which causes the disease, has long been proved a dangerous heath risk although it has been used in multiple industries for decades. Asbestos materials continue to be used around the world and the number of mesothelioma cases is expected to rise. A growing patient base will necessitate continual advances in treatment and diagnoses of mesothelioma. Dr. Alexander suggests collaborative efforts amongst medical institutions to make positive changes in mesothelioma treatment and patient care.

The American Journal of Respiratory and Critical Care Medicine has published the findings of a study done at Oxford University, which may aid in earlier detection of the rare and fatal cancer, pleural mesothelioma.

English researchers used the biomarker mesothelin, a protein made by the cells of the mesothelium—the lining of the heart, lungs and abdominal cavities, which hosts the cancer mesothelioma. Also called MSLN, mesothelin is normally present on the mesothelium and in the pleural fluid of healthy lining.

The researchers tracked one hundred sixty-seven possible cases of mesothelioma.  They found the mesothelin levels in patients with malignant pleural mesothelioma was 6.9 times higher than mesothelin levels in patients with other types of cancer. The mesothelin levels were also 10.9 times higher in malignant mesothelioma cases than in cases with benign results.

Like many other forms of cancer, mesothelioma is difficult to diagnose. It can take decades to develop and symptoms, when they become recognizable, often mimic diseases as common as pneumonia and influenza. One third of all patients tested for mesothelioma receive inconclusive cytology reports. The need for early detection is a dire one.

Mesothelioma is caused almost solely by fibers of the toxic chemical asbestos. Once diagnosed, the prognosis is always bleak. Patients’ life expectancy following diagnosis ranges from six months to five years, averaging eighteen months. About three thousand Americans suffer with mesothelioma each year, and the fifteen to twenty thousand cases thought to occur each year worldwide is rising.

There are no known curative treatments for mesothelioma. It is routinely treated in the western world with casplatin, a standard chemotherapy drug. Advances continue in palliative care for mesothelioma patients due to the pain and discomfort associated with the disease.

Asbestos use continues around the world, particularly in developing countries where occupational health standards are low and the job market is slim.  A rapidly increasing number of mesothelioma and related chronic and fatal respiratory illness are expected in the near future. In 2009 the World Health Organization estimated ninety thousand cases annually if conditions did not change.

With the staggering rise in mesothelioma cases globally and the grim prognosis, the Oxford University findings are a welcome addition to mesothelioma research. The road from findings to diagnoses, however, will need to be a short one if these studies, and those like it, are to prove an effective response to the growing need.

The number of individuals suffering with mesothelioma is rising around the world. In 2009 the World Health Organization estimated ninety thousand cases globally each year. Developing countries continue to use the disease causing material, asbestos, even though the risks are known. In America the regulations on asbestos use are high, but about three thousand mesothelioma cases still occur annually. Many of these cases, as well as other fatal and chronic conditions, are associated with asbestos exposure in the work place.

Mesothelioma is a cancer of the mesothelium, the lining of the lungs and other thoracic and abdominal organs. Caused by asbestos fibers, which mutate the membrane cells in the lung lining, mesothelioma is an aggressive cancer with a short and painful prognosis. Although it can take several decades for symptoms to be seen, once diagnosed, many patients have only a six to twenty-four month survival time.

Many negative side affects are associated with mesothelioma treatments. Chemotherapy causes several conditions that lower chances for survival. In mesothelioma patients, neotropenia and anemia are common responses to chemotherapy. In these illnesses, the blood looses white and red blood cells, respectively, leaving the patient fatigued, weak and susceptible to infection. Loss of energy and strength from the results of chemotherapy lower quality of life and the patient’s ability to fight the cancer.

With a rising number of patients worldwide, the timing could not be better for new treatment options. AstraZeneca’s new drug raltitrexed, brand name Tomudex ®, is now available for use in Portugal, Hungary and the Czech Republic. Raltitrexed has shown beneficial results in clinical tests when used in conjunction with cisplatin. Cisplatin is a long-standing chemotherapy drug used regularly against mesothelioma.

In clinical testing, patients administered both raltitrexed and cisplatin showed higher response to treatment rates, extended survival times, and longer progression-free survival times than patients given cisplatin alone. On a molecular level, raltitrexed actually does less to the cells than cisplatin, but in this case it works in favor of the patient. Cisplatin ultimately kills the cells it bonds with, without a safeguard against it bonding with healthy cells close to the cancer. Raltitrexed only halts the growth and division of cells. Fast growth and cell division characterizes most cancers, including mesothelioma.

Patients using raltitrexed are experiencing a higher quality of life and longer life expectancy. As palliative and curative treatments advance in the arena of mesothelioma response, raltitrexed may be used in both aggressive and non-aggressive treatment schedules.

Dr. Jennifer Temel of the Massachusetts General Hospital believes that there may be more to palliative care than quality of life improvement. A study in which she was the lead author was recently published in the New England Journal of Medicine. In it, she argues that palliative options could actually improve survival in patients suffering from various cancers, including mesothelioma.

“Integrating palliative care early in the treatment of patients with advanced lung cancer,” states the study, “not only improved their mood and quality of life, it also extended their lives.”

Dr. Temel hopes that other cancer care centers will perform further research pertaining to palliative care in order to confirm, clarify or contextualize her own findings.

Mesothelioma is a terminal cancer caused almost exclusively by exposure to asbestos fibers. While the disease can take several decades to present from the time of initial exposure, once it is diagnosed the prognosis is very grim. Mesothelioma patients can usually expect to survive the cancer for no more than about eighteen months. While the survival time varies with age and eligibility for radical treatments, it virtually never exceeds a few years and often falls within just six months.

Palliative treatment refers to medical treatment regimens aimed at increasing patient comfort rather than destroying malignant tissue. In the case of rapidly progressing, aggressive cancers such as mesothelioma, attempts to destroy the cancer are often fruitless and end instead in dramatically reduced quality of life for the patient. Instead, palliative treatments are offered which treat pain, discomfort, fluid build-up that impedes mobility or respiration, and other unfavorable symptoms. Palliative care allows patients to further enjoy the time they have remaining, and lets them focus on seeing to important issues instead of struggling with unending pain.

Massachusetts General Hospital Center for Thoracic Cancer is well known for their outstanding palliative treatment. The cancer center provides “individualized, compassionate care and the most advanced treatments for patients with thoracic cancers,” which include esophageal cancer, thymoma, and mesothelioma among others. Dr. Temel’s recent study asserts that palliative care may have some therapeutic value in addition to its obvious experiential value.