Articles / Case Studies on Peritoneal Mesothelioma

Peritoneal mesothelioma in a 17-year-old boy with evidence of previous exposure to chrysotile and tremolite asbestos.

Abstract: We describe a case of malignant peritoneal mesothelioma arising in a 17-year-old boy. The diagnosis was based on a comprehensive study including light microscopy, histochemistry, immunohistochemistry, evaluation of the clinical course, and autopsy examination. Analytical transmission electron microscopy showed a concentration of 510,000 asbestos fibers/g dry lung tissue. The fibers were represented by chrysotile (62%) and tremolite (38%) asbestos. About 40% of the total fibers were longer than 5 microns. The presence of tremolite fibers was probably due to environmental exposure to contaminated cosmetic talc. This is the first reported case of pathologically proven exposure to asbestos dust in malignant mesothelioma of childhood and adolescence.

Andrion A and Bosia S
Division of Pathological Anatomy, City Hospital, Asti, Italy.
Hum Pathol
1994 Jun, vol. 25, pages 617-622
UNITED STATES

Intraperitoneal cisplatin and etoposide in peritoneal mesothelioma: favorable outcome with a multimodality approach.

Abstract: Ten patients with histologically documented peritoneal mesothelioma were treated with intraperitoneal cisplatin 200 mg/m2, sodium thiosulfate rescue and etoposide 65-290 mg/m2 every 4 weeks for a maximum of six cycles. All had epithelial or mixed epithelial-fibrous histology. Toxicity was tolerable, with 50% sustaining grade 3 or 4 granulocytopenia. There was one episode of neutropenic fever. Grade 2 peripheral neuropathy occurred in one patient, grade 1 in five patients. Complete remission occurred in one of five patients with measurable disease. Median survival for patients whose tumors were surgically debulked to < 2 cm residua prior to treatment was 22 months, while it was 5 months for those with measurable, surgically inaccessible disease (P = 0.0731 by Cox regression proportional hazard model). These data suggest that patients who present with resectable disease may benefit from an aggressive adjuvant approach. This possibility warrants prospective testing in a randomized clinical trial.

Langer CJ and Rosenblum N
Department of Medical Oncology, Fox Chase Cancer Center,
Philadelphia, PA 19111.
Cancer Chemother Pharmacol
1993, vol. 32, pages 204-208
GERMANY

Intestinal obstruction due to diffuse peritoneal fibrosis at 2 years after the successful treatment of malignant peritoneal mesothelioma with intraperitoneal mitoxantrone [published erratum appears in Cancer Chemother Pharmacol 1992;30(3):249]

Abstract: A 44-year-old man who had achieved a complete remission of malignant peritoneal mesothelioma after the intraperitoneal administration of 25mg/m2 mitoxantrone presented with clinical and radiological signs of intestinal obstruction suggestive of recurrent disease at about 2 years following the initial treatment. However, laparotomy revealed extensive adhesive fibrosis but no sign of malignant mesothelioma. The peritoneal complications of intraperitoneal cytostatic treatment are discussed.

Vlasveld LT and Taal BG
Department of Medical Oncology, The Netherlands Cancer Institute,
Antoni van Leeuwenhoek Huis, Amsterdam.
Cancer Chemother Pharmacol
1992, vol. 29, pages 405-408
GERMANY

Malignant peritoneal mesothelioma in childhood with long-term survival.

Abstract: A diffuse, well-differentiated, malignant peritoneal mesothelioma (MPM) developed in a nine-year-old girl. She received limited chemotherapy and radiation therapy and is alive and well without clinical evidence of disease 109 months after diagnosis. The neoplastic cells stained immunohistochemically for cytokeratin and epithelial membrane antigen but were unreactive with B72.3, anti-carcinoembryonic antigen, and anti-Leu-M1. Ultrastructurally, the tumor cells had abundant desmosomes, numerous tonofilament bundles, and variable-length microvilli. These findings confirm the mesothelial nature of the cells. Features consistent with malignancy included DNA aneuploidy by flow cytometric analysis and diffuse peritoneal involvement. The three previously described survivors with MPM were also premenarchal girls. Some MPMs in premenarchal girls have an indolent biologic behavior similar to that of low-grade peritoneal serous neoplasia or well-differentiated papillary mesothelioma in adult women.

Geary WA, Mills SE and Frierson HF, Jr
Department of Pathology, University of Virginia Health Sciences Center, Charlottesville 22908.
Am J Clin Pathol
1991 Apr, vol. 95, pages 493-498

Successful therapy of peritoneal mesothelioma with intraperitoneal chemotherapy alone. A case report.

Abstract: Malignant peritoneal mesothelioma is a disease that remains relatively refractory to conventional intravenous chemotherapy with currently available agents. Single-agent and combination chemotherapy offer a response rate of 20%. Direct intraperitoneal administration of some chemotherapeutic agents results in a significant pharmacologic advantage with much greater area under the concentration versus time curve (AUC). We report a case of a patient with peritoneal mesothelioma treated with combination intraperitoneal cisplatin and Ara-C who achieved a pathologic complete remission. This patient is still alive and has been in complete remission for 53 months. This combination of intraperitoneal chemotherapy deserves further evaluation in malignant mesothelioma.

Garcia Moore ML
Section of Medical Oncology, University of Miami School of Medicine,
Florida 33121.
Am J Clin Oncol
1992 Dec, vol 15, pages 528-530
UNITED STATES

Intraperitoneal chemotherapy for malignant peritoneal mesothelioma [published erratum appears in Eur J Cancer 1991;27(12):1717]

Abstract: 4 patients with malignant peritoneal mesothelioma have been treated with intraperitoneal chemotherapy in the Netherlands Cancer Institute in the recent years. 1 patient achieved a complete remission for 36+ months and another patient had a partial remission that lasted for 10 months. Intraperitoneal chemotherapy alone or in combination with other treatment modalities may yield a response rate of 58% with 24% complete remissions in 70 patients reviewed in the literature. Although these data should be considered with caution because of the heterogenicity of the patient group treated, cisplatin-based intraperitoneal chemotherapy seems to be the best available treatment for malignant peritoneal mesothelioma at present.

Vlasveld LT
Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam.
Eur J Cancer
1991, vol. 27, pages 732-734
ENGLAND

Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma.

Abstract: In an effort to examine the potential clinical utility of intraperitoneal (i.p.) therapy in the management of patients with malignant peritoneal mesothelioma, 19 individuals with this disease were treated with a cisplatin-based i.p. treatment regimen. All but 1 patient also received i.p. mitomycin. The treatment was generally well tolerated, although a maximum of only four or five courses of cisplatin (100 mg/m2 every 28 days) and mitomycin (5-10 mg/treatment given 7 days after each i.p. cisplatin administration) could be administered, the treatment principally being stopped because of disease progression or catheter failure. Of 15 patients with malignant ascites, 7 (47%) experienced control of fluid reaccumulation ranging from 2 months to 73+ months (median 8 months). While the median survival for the 19 patients was only 9 months, 4 (21%) patients survived for more than 3 years from the initiation of therapy, and 2 patients are currently alive and clinically disease-free more than 5 years from the start of the i.p. treatment program. We conclude that a subset of patients with peritoneal mesothelioma, principally those with small-volume residual disease following surgical tumor debulking, can benefit from a cisplatin-based i.p. treatment strategy with control of ascites and prolonged disease-free survival.

Markman M and Kelsen D
Breast/Gynecology Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
J Cancer Res Clin Oncol
1992, vol. 118, pages 547-550
GERMANY

Articles / Case Studies on Pericardial Mesothelioma

Primary pericardial mesothelioma:

Yuko Kobayashi1, , Ryusuke Murakami1, Junko Ogura1, Kanae Yamamoto1, Taro Ichikawa1, Kouichi Nagasawa2, Masaru Hosone3 and Tatsuo Kumazaki4
(1) Department of Radiology, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(2) Department of Internal Medicine, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(3) Department of Pathology, Tama-Nagayama Hospital, Nippon Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(4) Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan

Abstract. The imaging features of primary pericardial mesothelioma have rarely been described. Herein we present a case report of its diagnostic-pathologic features. Chest computed tomography (CT) revealed an irregularly enhanced mass occupying the entire pericardial space and surrounding the superior vena cava. At autopsy, the tumor was found to fill the pericardial space completely, and to extend to the superior vena cava through the superior pericardial sinus. The CT features of the tumor were correlated well with those revealed at autopsy, and provided satisfactory information regarding the presence and the extension of the tumor.

Article/Cases Studies on Desmoplastic Malignant Mesothelioma or Malignant Mesothelioma

Desmoplastic malignant mesothelioma is the growth of fibrous or connective tissues around the tumor of the lining of the lung or chest cavity. The term "desmoplastic" refers to the growth of fibrous or connective tissue. "Desmo-" comes from the Greek "desmos" meaning "a fetter or band" and "-plastic" is also borrowed from the Greek, from "plassein" meaning "to form" = to form a band or fetter

Kannerstein M, Churg J: Desmoplastic diffuse mesothelioma. In: Progress in Surgical Pathology, Vol. II (Fenoglio CM, Wolff M, eds.), New York: Masson Pub., 1980, pp. 19-29.

Machin T, Mashiyama ET, Henderson JAM, McCaughey WTE: Bony metastases in desmoplastic pleural mesothelioma. Thorax 43:155-156, 1988.

Hillerdal G: Malignant mesothelioma 1982: Review of 4710 published cases. Br J Dis Chest 77:321-343, 1983.

McCaughey Wte: Criteria for diagnosis of diffuse mesothelial tumors. Ann NY Acad Sci 132:603-613, 1965.

Adams VI, Unni KK, Muhm JR, Jett JR, Ilstrup DM, Bernatz PE: Diffuse malignant mesothelioma of pleura: Diagnosis and survival in 92 cases. Cancer 58:1540-1551, 1986.

Obers VJ, Leiman G, Girdwood RW, Spiro FI: Primary malignant pleural tumors (mesothelioma) presenting as localized masses: Fine needle aspiration cytologic findings, clinical and radiologic features and review of the literature. Acta Cytolog 32:567-575, 1988.

Solomons K, Polakow R, Marchand P: Diffuse malignant mesothelioma presenting as bilateral malignant lymphangitis. Thorax 40:682-683, 1985.

Alexander E, Clark RA, Colley DP, Mitchell SE: CT of malignant pleural mesothlioma. AJR 137:287-291, 1981.

Mirvis S, Dutcher JP, Haney PJ, Whitley NO, Aisner J: CT of malignant pleural mesothelioma. AJR 140:665-670, 1983.

Lorigan JG, Libshitz HI: MR imaging of malignant pleural mesothelioma. J Comput Asst Tomogr 13:617-620, 1989.

Harwood TR, Gravey DR, Yokoo H: Pseudomesotheliomatous carcinoma of the lung: A variant of peripheral lung cancer. Am J Clin Pathol 65:159-167, 1976.

Whitaker D, Shilkin KB: Diagnosis of pleural malignant mesothelioma in life: A practical approach. J Pathol 143:147-175, 1984.

Roberts GH, Campbel GM: Exfoliative cytology of diffuse mesothelioma. J Clin Pathol 25:577-582, 1972.

Sterrett GF, Whitaker D, Shilkin KB, Walters MNI: Fine needle aspiration cytology of malignant mesothelioma. Acta Cytologica 31:185-193, 1987. Churg J, Rosen SH, Moolten S: Histological characteristics of mesothelioma associated with asbestos. Ann NY Acad Sci132:614-622, 1965.

Adams VI, Unni KK: Diffuse malignant mesothelioma of pleura: Diagnostic criteria based on an autopsy study. AM J Clin Pathol 82:15-23, 1984.

Yousem SA, Hochholzer L: Malignant mesotheliomas with osseous and cartilaginous differentiation. Arch Pathol Lab Med 111:62-66, 1987.

The onset of pleural diffuse malignant mesothelioma is usually insidious. Chest pain and dyspnea are the most frequent initial complaints; cough, weight loss, and asthenia tend to develop somewhat later. Infrequently, diffuse malignant mesothelioma may present as recurrent pneumothorax. (Situnayake RD, Middleton WG.

Recurrent pneumothorax and malignant pleural mesothelioma. RespirMed 1991;85:255-6.) , miliary dissemination in the absence of clinically identifiable pleural- based tumor. (Musk AW, Dewar J, Shilkin KB, Whitaker D. Miliary spread of malignant pleural mesothelioma without a clinically identifiable pleural tumor. Aust NZ J Med 1991;21:460-2.) , or enlargement of ipsilateral supraclavicular lymph nodes (Sussman J, Rosai J. Lymph node metastasis as the initial manifestation of malignant mesothelioma: report of six cases. Am J Surg Pathol 1990;14:819-28.)

The most distressing symptom as the disease progresses is pain due to infiltration of the chest wall. The pain is often of an aching, nonpleuritic type and may be referred to the abdomen or shoulder. Evidence of pleural effusion is the most frequent finding on initial physical and radiographic examination.
(Legha SS, Muggia FM.

Pleural mesotheliomas. Clinical features and therapeutic implications. Ann Intern Med 1977;87:613-21.) , and a small proportion of diffuse malignant mesotheliomas are preceded for periods ranging from 1 to 7 years by recurrent pleural effusions. Close to 10 percent of patients have radiologic evidence of tumor without effusion.

Asbestos workers may have recurrent pleural effusions with associated fibrous pleurisy (asbestos pleurisy) in the absence of any tumor. (Gaensler EA, Kaplan AI. Asbestos pleural effusion. Ann Int Med 1971;74:178-91.) Chest roentgenogram and computerized tomographic (CT) scan may show a diffusely nodular or irregularly thickened pleura , hilar or mediastinal masses, or masses of apparent pulmonary origin. (Heller RM, Janower ML, Weber AL. The radiological manifestations of malignant pleural mesothelioma. Am J Roentgenol 1970;108:53-9.) .

The radiologic appearance may change markedly within a short time . Radiologic evidence of asbestosis is uncommon, whereas pleural plaques are seen quite frequently. Effusions are often blood stained, and may be massive and require frequent tapping.

They tend to disappear in the later stages of the disease with advancing neoplastic thickening of the pleura and obliteration of the pleural cavity. Contraction of the affected hemithorax often occurs in the late stages, with pulling of the mediastinal structures to the affected side.

Subcutaneous tumor nodules may appear in the chest wall, especially in relation to aspiration needle or thoracoscopy tracts and thoracotomy scars The tumor may occasionally present as a mass in the chest wall or mimic Pancoast's tumor.

Tumors of the Serosal Membranes.
Battifora H, McCaughey WT. Tumors of the serosal membranes.
Atlas of Tumor Pathology, 3rd Series Fascicle 15.
Washington, D.C., Armed Forces Institute of Pathology, 1995.
key words: AFIP, serosa, peritoneum, peritoneal, pleura, pleural

Packet No.: 2
68658

Nodules of fibrous tumor sometimes infiltrate alveolar spaces in the adjacent lung or the soft tissues of the chest wall. In most instances, cellular areas with sarcomatous characteristics can be found in parts of the tumor, although a careful search is sometimes necessary.

In about one third of cases, epithelial- type tumor elements, usually of tubular or papillary form, are seen at least focally and may be accompanied by obvious sarcomatous areas. Zones of bland infarct-like necrosis are quite common. As such zones are rarely seen in inflammatory fibrosis, they help to distinguish desmoplastic mesothelioma from fibrous pleurisy.

It has been suggested that the most cellular tissue found in desmoplastic mesothelioma is at the mediastinal aspect of the pleura. (Henderson DW, Shilkin KB, Whitaker D, et al. Unusual histological types and anatomic sites of mesothelioma. In: Henderson DW, Shilkin KB, Langlois SL, Whitaker D, eds.

Malignant mesothelioma. New York: Hemisphere Publishing, 1992:140-63.) A feature frequently seen in desmoplastic mesothelioma and rarely, if ever, in fibrosing pleuritis is focal invasion into the underlying pulmonary parenchyma along interlobular septa and fissures and into subserosal adipose tissue in the parietal pleura . Such areas of focal invasion may be made apparent by immunostaining with antibodies to low molecular weight cytokeratins . (Battifora H. The pleura. In: Sternberg SS, ed. Diagnostic surgical pathology. New York: Raven Press, 1989:829-55.)

Nonetheless, even when abundant decortication material is available, and numerous samples are taken, confident differentiation between desmoplastic mesothelioma and fibrous pleurisy may be difficult or impossible.

It should be remembered that there are many causes of benign diffuse pleural fibrosis, one of which is asbestos. (Gaensler EA, Kaplan AI. Asbestos pleural effusion. Ann Int Med 1971;74:178-91.) Asbestos is also the main cause of the discrete fibrous plaques that are frequently seen on the parietal pleura in persons exposed to asbestos.

Tumors of the Serosal Membranes.
Battifora H, McCaughey WT. Tumors of the serosal membranes.
Atlas of Tumor Pathology, 3rd Series Fascicle 15.
Washington, D.C., Armed Forces Institute of Pathology, 1995.
key words: AFIP, serosa, peritoneum, peritoneal, pleura, pleural

Packet No.: 4
68659

In cases in which only small biopsy specimens are available, localized malignant fibrous tumors of the pleura (so-called malignant localized mesothelioma) may enter into the differential diagnosis because of the dense fibrosis that occurs in some of them.

Immunostaining for low molecular weight keratins helps in diagnosis since desmoplastic mesotheliomas nearly always express keratin, whereas benign localized fibrous tumors do not. Ultrastructurally, desmoplastic mesothelioma is similar to conventional sarcomatoid mesothelioma, but with more cells with the appearance of myofibroblasts. (d'Andiran G, Gabbiani GA. Metastasizing sarcoma of the pleura composed of myofibroblasts. In: Fenoglio CM, Woolf M, eds. Progress in surgical pathology. New York: Masson Publishing, 1980:34-40.)

However, the frequent expression of cytokeratins by the cells of desmoplastic mesothelioma sets them apart from myofibroblasts. (Battifora H. The pleura. In: Sternberg SS, ed. Diagnostic surgical pathology. New York: Raven Press, 1989:829-55.) .

Tumors of the Serosal Membranes.
Battifora H, McCaughey WT. Tumors of the serosal membranes.
Atlas of Tumor Pathology, 3rd Series Fascicle 15.
Washington, D.C., Armed Forces Institute of Pathology, 1995.
key words: AFIP, serosa, peritoneum, peritoneal, pleura, pleural.

What Caused Mesothelioma Information on Asbestos

Information on Asbestos FAQ's

What is asbestos?

Asbestos is a mineral. It is mined in much the same way that other minerals, such as iron, lead, and copper, are. Asbestos is composed of silicon, oxygen, hydrogen, and various metal cations (positively charged metal ions). There are many varieties of asbestos: the three most common are chrysotile, amosite, and crocidolite. Chrysotile fibers are pliable and cylindrical, and often arranged in bundles. Amosite and crocidolite fibers are like tiny needles.

The first commercial asbestos mine -- a chrysotile mine -- opened in Quebec, Canada, in the 1870's. Crocidolite asbestos was first mined in South Africa during the 1980's. Amosite asbestos also comes from Africa and was first mined in 1916. Unlike most minerals, which turn into dust particles when crushed, asbestos breaks up into fine fibers that are too small to be seen by the human eye. Often individual fibers are mixed with a material that binds them together, producing asbestos containing material (ACM).

What type of asbestos causes mesothelioma?

Chrysotile asbestos is the main cause of malignant pleural mesothelioma. The three most common forms of asbestos are chrysotile, amosite, and crocidolite. Chrysotile asbestos or white asbestos accounts for approximately 95% of the asbestos used in US production of asbestos products and is the only member of the serpentine group of minerals.

Why has asbestos been so widely used?

Asbestos appealed to manufacturers and builders for a variety of reasons. It is strong yet flexible, and it will not burn. It conducts electricity poorly, but insulates effectively. It also resists corrosion. Asbestos may have been so widely used because few other available substances combine the same qualities.

How many products contain asbestos?

One study estimated that 3,000 different types of commercial products contained asbestos. The amount of asbestos in each product varied from as little as one percent to as much as 100 percent. Many older plastics, paper products, brake linings, floor tiles and textile products contain asbestos, as do many heavy industrial products such as sealants, cement pipe, cement sheets, and insulation. The final Asbestos Ban and Phaseout Rule prohibits the manufacture, processing and importation of most asbestos products.

How long has asbestos been in use?

Asbestos was first used in the United States in the early 1900's, to insulate steam engines. But until the early 1940's, asbestos was not used extensively. However, after World War II, and for the next thirty years, people who constructed and renovated schools and other public buildings used asbestos and asbestos -containing materials (ACM) extensively. They used ACM primarily to fireproof, insulate, soundproof, and decorate. The Environmental Protection Agency (EPA) estimates that there are asbestos containing materials in most of the nation's approximately 107,000 primary and secondary schools and 733,000 public and commercial buildings.

How are people exposed to asbestos? When asbestos fibers are in the air, people may inhale them. Because asbestos fibers are small and light, they can stay in the air for a long time. People whose work brings them into contact with asbestos—workers who renovate buildings with asbestos in them, for example— may inhale fibers that are in the air: this is called occupational exposure. Workers' families may inhale asbestos fibers released by clothes that have been in contact with ACM: this is called paraoccupational exposure. People who live or work near asbestos-related operations may inhale asbestos fibers that have been released into the air by the operations: this is called neighborhood exposure. The amount of asbestos a worker is exposed to will vary according to:

• The concentration of fibers in the air
• Duration of exposure
• The worker's breathing rate (workers doing manual labor breathe faster)
• Weather conditions
• The protective devices the worker wears

It is estimated that between 1940 and 1980, 27 million Americans had significant occupational exposure to asbestos. People may also ingest asbestos if they eat in areas where there are asbestos fibers in the air.

When is ACM most likely to release asbestos fibers?

Damaged ACM is more likely to release fibers than non-damaged ACM. In a 1984 survey, EPA found that approximately 66 percent of those buildings that contained asbestos contained damaged ACM. If ACM, when dry, can be crumbled by hand pressure -- a condition known as "friable" -- it is more likely to release fibers than if it is "non-friable." Fluffy, spray-applied asbestos fireproofing material is generally considered "friable." Some materials which are considered "non-friable," such as vinyl-asbestos floor tile, can also release fibers when sanded, sawed or otherwise aggressively disturbed. Materials such as asbestos cement pipe can release asbestos fibers if broken or crushed when buildings are demolished, renovated or repaired. ACM which is in a heavy traffic area, and which is therefore often disturbed, is more likely to release fibers than ACM in a relatively undisturbed area.


How can asbestos be identified?

While it is often possible to "suspect" that a material or product is/or contains asbestos by visual determination, actual determinations can only be made by instrumental analysis. Until a product is tested, it is best to assume that the product contains asbestos, unless the label, or the manufacturer verifies that it does not.

The EPA requires that the asbestos content of suspect materials be determined by collecting bulk samples and analyzing them by polarized light microscopy (PLM). The PLM technique determines both the percent and type of asbestos in the bulk material. EPA Regional Offices can provide information about laboratories that test for asbestos.

Does asbestos exposure cause health problems?

Some people exposed to asbestos develop asbestos-related health problems; some do not. Once inhaled, asbestos fibers can easily penetrate body tissues. They may be deposited and retained in the airways and lung tissue. Because asbestos fibers remain in the body, each exposure increases the likelihood of developing an asbestos-related disease. Asbestos related diseases may not appear until years after exposure. Today we are seeing results of exposure among asbestos workers during World War II.

A medical examination which includes a medical history, breathing capacity test and chest x-ray may detect problems early. Scientists have not been able to develop a "safe" or threshold level for exposure to airborne asbestos. Ingesting asbestos may be harmful, but the consequences of this type of exposure have not been clearly documented. Nor have the effects of skin exposure to asbestos been documented. People who touch asbestos may get a rash similar to the rash caused by fiberglass.

What illnesses are associated with asbestos exposure?

Asbestosis

Asbestosis is a serious, chronic, non-cancerous respiratory disease. Inhaled asbestos fibers aggravate lung tissues, which causes them to scar. Symptoms of asbestosis include shortness of breath and a dry crackling sound in the lungs while inhaling. In its advanced stages, the disease may cause cardiac failure.

There is no effective treatment for asbestosis; the disease is usually disabling or fatal. The risk of asbestosis is minimal for those who do not work with asbestos; the disease is rarely caused by neighborhood or family exposure. Those who renovate or demolish buildings that contain asbestos may be at significant risk, depending on the nature of the exposure and precautions taken.

Lung Cancer

Lung cancer causes the largest number of deaths related to asbestos exposure. The incidence of lung cancer in people who are directly involved in the mining, milling, manufacturing and use of asbestos and its products is much higher than in the general population. The most common symptoms of lung cancer are coughing and a change in breathing. Other symptoms include shortness of breath, persistent chest pains, hoarseness, and anemia.

People who have been exposed to asbestos and are also exposed to some other carcinogen — such as cigarette smoke — have a significantly greater risk of developing lung cancer than people who have only been exposed to asbestos. One study found that asbestos workers who smoke are about 90 times more likely to develop lung cancer than people who neither smoke nor have been exposed to asbestos.

Mesothelioma

Mesothelioma is a rare form of cancer which most often occurs in the thin membrane lining of the lungs, chest, abdomen, and (rarely) heart. About 3000 cases are diagnosed each year in the United States. Virtually all cases of mesothelioma are linked with asbestos exposure. Approximately 2 percent of all miners and textile workers who work with asbestos, and 10 percent of all workers who were involved in the manufacture of asbestos-containing gas masks, contract mesothelioma.

People who work in asbestos mines, asbestos mills and factories, and shipyards that use asbestos, as well as people who manufacture and install asbestos insulation, have an increased risk of mesothelioma. So do people who live with asbestos workers, near asbestos mining areas, near asbestos product factories or near shipyards where use of asbestos has produced large quantities of airborne asbestos fibers.

The younger people are when they inhale asbestos, the more likely they are to develop mesothelioma. This is why enormous efforts are being made to prevent school children from being exposed.

Other Cancers

Evidence suggests that cancers in the esophagus, larynx, oral cavity, stomach, colon and kidney may be caused by ingesting asbestos. For more information on asbestos-related cancers, contact your local chapter of the American Cancer Society.

Who regulates asbestos?

The U.S. Environmental Protection Agency and the Occupational Safety and Health Administration (OSHA) are responsible for regulating environmental exposure and protecting workers from asbestos exposure. OSHA is responsible for the health and safety of workers who may be exposed to asbestos in the work place, or in connection with their jobs. EPA is responsible for developing and enforcing regulations necessary to protect the general public from exposure to airborne contaminants that are known to be hazardous to human health.

The EPA's Worker Protection Rule (40 CFR Part 763, Subpart G) extends the OSHA standards to state and local employees who perform asbestos work and who are not covered by the OSHA Asbestos Standards, or by a state OSHA plan. The Rule parallels OSHA requirements and covers medical examinations, air monitoring and reporting, protective equipment, work practices, and record keeping. In addition, many State and local agencies have more stringent standards than those required by the Federal government. People who plan to renovate or remove asbestos from a building of a certain size, or who plan to demolish any building, are required to notify the appropriate federal, state and local agencies, and to follow all federal, state, and local requirements for removal and disposal of regulated asbestos-containing material (RACM).

EPA's advice on asbestos is neither to rip it all out in a panic nor to ignore the problem under a false presumption that asbestos is "risk free." Rather, EPA recommends a practical approach that protects public health by emphasizing that asbestos material in buildings should be located, that it should be appropriately managed, and that those workers who may disturb it should be properly trained and protected. That has been, and continues to be, EPA's position. The following summarizes the five major facts that the Agency has presented in congressional testimony:

FACT ONE:
Although asbestos is hazardous, human risk of asbestos disease depends upon exposure.

FACT TWO:
Prevailing asbestos levels in buildings -- the levels school children and you and I face as building occupants -- seem to be very low, based upon available data. Accordingly, the health risk we face as building occupants also appears to be very low.

FACT THREE:
Removal is often not a school district's or other building owner's best course of action to reduce asbestos exposure. In fact, an improper removal can create a dangerous situation where none previously existed.

FACT FOUR:
EPA only requires asbestos removal in order to prevent significant public exposure to asbestos, such as during building renovation or demolition.

FACT FIVE:
EPA does recommend in-place management whenever asbestos is discovered. Instead of removal, a conscientious in-place management program will usually control fiber releases, particularly when the materials are not significantly damaged and are not likely to be disturbed.

What are EPA's regulations governing asbestos?

TSCA

In 1979, under the Toxic Substances Control Act (TSCA), EPA began an asbestos technical assistance program for building owners, environmental groups, contractors and industry. In May 1982, EPA issued the first regulation intended to control asbestos in schools under the authority of TSCA; this regulation was known as the Asbestos-in-Schools Rule. Starting in 1985, loans and grants have been given each year to aid Local Education Agencies (LEAs) in conducting asbestos abatement projects under the Asbestos School Hazard Abatement Act (ASHAA).

AHERA

In 1986, the Asbestos Hazard Emergency Response Act (AHERA; Asbestos Containing Materials in Schools, 40 CFR Part 763, Subpart E) was signed into law as Title II of TSCA. AHERA is more inclusive than the May 1982 Asbestos-in-Schools Rule. AHERA requires LEAs to inspect their schools for asbestos containing building materials (ACBM) and prepare management plans which recommend the best way to reduce the asbestos hazard. Options include repairing damaged ACM, spraying it with sealants, enclosing it, removing it, or keeping it in good condition so that it does not release fibers.

The plans must be developed by accredited management planners and approved by the State. LEAs must notify parent, teacher and employer organizations of the plans, and then the plans must be implemented. AHERA also requires accreditation of abatement designers, contractor supervisors and workers, building inspectors, and school management plan writers. Those responsible for enforcing AHERA have concentrated on educating LEAs, in an effort to ensure that they comply with the regulations. Contractors that improperly remove asbestos from schools can be liable under both AHERA and NESHAP. For more information on AHERA, request the pamphlet entitled "The ABC's of Asbestos in Schools" from the EPA Public Information Center.

ASBESTOS BAN & PHASEOUT RULE

In 1989 EPA published the Asbestos: Manufacture, Importation, Processing, and Distribution in Commerce Prohibitions; Final Rule (40 CFR Part 763, Subpart I). The rule will eventually ban about 94 percent of the asbestos used in the U.S. (based on 1985 estimates). For example, asbestos containing drum brake linings and roof coatings will be banned. The rule will be implemented in three stages between 1990 and 1997.

NESHAP

The Clean Air Act (CAA) of 1970 requires EPA to develop and enforce regulations to protect the general public from exposure to airborne contaminants that are known to be hazardous to human health. In accordance with Section 112 of the CAA, EPA established National Emission Standards for Hazardous Air Pollutants (NESHAP). Asbestos was one of the first hazardous air pollutants regulated under Section 112. On March 31, 1971, EPA identified asbestos as a hazardous pollutant, and on April 6, 1973, EPA promulgated the Asbestos NESHAP in 40 CFR Part 61, Subpart M. The Asbestos NESHAP has been amended several times, most recently in November 1990. For a copy of the Asbestos NESHAP contact the Asbestos NESHAP Coordinators listed in the Appendix.

What are the basic requirements of the Asbestos NESHAP?

The Asbestos NESHAP is intended to minimize the release of asbestos fibers during activities involving the handling of asbestos. Accordingly, it specifies work practices to be followed during renovations of buildings which contain a certain threshold amount of friable asbestos, and during demolitions of all structures, installations, and facilities (except apartment buildings that have no more than four dwelling units). Most often, the Asbestos NESHAP requires action to be taken by the person who owns, leases, operates, controls, or supervises the facility being demolished or renovated (the "owner"), and by the person who owns, leases, operators, controls or supervises the demolition or renovation (the "operator").

The regulations require owners and operators subject to the Asbestos NESHAP to notify delegated State and local agencies and/or their EPA Regional Offices before demolition or renovation activity begins. The regulations restrict the use of spray asbestos, and prohibit the use of wet applied and molded insulation (i.e., pipe lagging). The Asbestos NESHAP also regulates asbestos waste handling and disposal.

Why was the Asbestos NESHAP recently amended?

The Asbestos NESHAP was amended for several reasons. EPA wanted to clarify existing regulatory policies, and to add regulations which explicitly address monitoring and record keeping at facilities which mill, manufacture, and fabricate asbestos. Also, because of the high risk associated with the transfer and disposal of ACM, EPA also wanted to strengthen the requirements which govern asbestos waste disposal by requiring tracking and record keeping. Furthermore, EPA determined that the Asbestos NESHAP needed to take into account the availability of improved emission controls. EPA also wanted to make the NESHAP consistent with other EPA statutes that regulate asbestos.

What sources are now covered by the asbestos NESHAP?

The following activities and facilities are currently regulated by the Asbestos NESHAP:

• The milling of asbestos.
• Roadways containing ACM.
• The commercial manufacture of products that contain commercial asbestos.
• The demolition of all facilities.
• The renovation of facilities that contain friable ACM.
• The spraying of ACM.
• The processing (fabricating) of any manufactured products that contain asbestos.
• The use of insulating materials that contain commercial asbestos.
• The disposal of asbestos-containing waste generated during milling, manufacturing, demolition, renovation, spraying, and fabricating operation.
• The closure and maintenance of inactive waste disposal sites.
• The operation of and reporting on facilities that convert asbestos containing waste material into non-asbestos material.
• The design and operation of air cleaning devices.
• The reporting of information pertaining to process control equipment, filter devices, asbestos generating processes, etc.
• Active waste disposal sites.

What were the major changes to the Asbestos NESHAP?

Milling, Manufacturing, and Fabricating Sources
Businesses which are involved in asbestos milling, manufacturing, and fabricating now must monitor for visible emissions for at least 15 seconds at least once a day (during daylight hours), and inspect air cleaning devices at least once a week. The facilities must maintain records of the results, and submit each quarter a copy of the visible emissions monitoring records if visible emissions occurred during the quarter. Facilities that install fabric filters (to control asbestos emissions) after the effective date of the revision must provide for easy inspection of the bags.

Demolition and Renovation
All facilities which are "demolished" are subject to the Asbestos NESHAP. The definition of demolition was expanded to include the intentional burning of a facility, in addition to the "wrecking or taking out . . . any load-supporting structural member of a facility." Owners and operators of all facilities which are to be demolished, and of facilities that contain a certain amount of asbestos which are to be renovated, must now provide more detailed information in notifications, including the name of the asbestos waste transporter and the name of the waste disposal site where the ACM will be deposited.

Owners and operators must give a 10-day notice for planned renovations and demolitions. They must renotify EPA in advance of the actual start date if the demolition or renovation will begin on a date other than the one specified in the original notification. Telephone re-notifications are permitted, but must be followed by written notice.

Starting one year after promulgation of the regulation, a person trained in the provisions of the Asbestos NESHAP, and in the methods of complying with them, must supervise operations in which ACM is stripped, removed or otherwise handled. This supervisor is responsible for all on-site activity. Before wetting is suspended, the EPA administrator must approve. When wetting of asbestos during its removal is suspended due to freezing temperatures, owners or operators must measure the air temperature in the work area three times during the workday, and must keep those records for at least two years.

The revisions also clarify EPA's position regarding the handling and treatment of non- friable asbestos material. The owner and operator must inspect the site for the presence of non-friable ACM, and include in the notification an estimate of how much non-friable ACM is present. Also, the owner and operator must describe the procedures to be followed if unexpected ACM is found in the course of demolition or renovation, and if non-friable asbestos becomes friable in the course of renovation or demolition.

Waste Transport and Disposal

Vehicles used to transport ACM must be marked according to new guidelines during loading and unloading. Labels indicating the name of the waste generator and the location where the waste was generated must be placed on containers of RACM. When ACM waste is transported off-site, a waste shipment record (WSR) must be given to the waste site operator or owner at the time that the waste is delivered to the waste disposal site. The owner or operator must send a signed copy of the WSR back to the waste generator within 30 days, and attempt to reconcile any discrepancy between the quantity of waste given on the WSR and the actual amount of waste received. If, within 15 days of receiving the waste, the waste site owner or operator cannot reconcile the discrepancy, he or she must report that problem to the same agency that was notified about the demolition or renovation.

New disposal sites must apply for approval to construct, and must notify EPA of the startup date. Existing disposal sites must supply EPA with certain information concerning their operations, such as the name and address of the owner or operator, the location of the site, the average weight per month of the hazardous materials being processed, and a description of the existing emission control equipment.

If a copy of the WSR signed by the waste site owner or operator is not received by the waste generator within 35 days of the date that the waste was accepted by the initial transporter, the waste generator must contact the transporter and/or disposal site owner or operator to determine the status of the waste shipment. If a signed copy of the WSR is not received within 45 days of the date that the waste was accepted by the initial transporter, the waste generator must submit a written report to the same agency that was notified about the demolition or renovation.

Owners of disposal sites must record on the deed to the disposal site that the property has been used for ACM disposal. They must also keep records that show the location, depth, area and volume of the asbestos waste; they must indicate on the deed that these records are available. Owners of inactive disposal sites must obtain written approval before they excavate or otherwise disturb ACM waste that has been deposited on the site.

Where can I get more information?

There are ten EPA Regional Offices around the country. You can obtain more information about the Asbestos NESHAP by contacting your EPA Regional Office's NESHAP coordinator or the appropriate State or local agency.

You can obtain more information about AHERA by contacting your EPA Regional Asbestos Coordinator (RAC). You may also call the EPA Toxic Substances Control Act (TSCA) Hotline to ask general questions about asbestos, or to request asbestos guidance documents. The Hotline number is (202) 554-1404.

The EPA Public Information Center can send you information on EPA regulations. You can reach the center at (202) 382-2080 or (202) 475-7751.

The Office of the Federal Register (202-382- 5475) can send you copies of any regulations published in The Federal Register, including the Asbestos NESHAP.

Finally, the EPA has an Asbestos Ombudsman to provide information on the handling and abatement of asbestos in schools, the work place and the home. Also, the EPA Asbestos Ombudsman can help citizens with asbestos-in-school complaints. The Ombudsman can be reached toll-free at (800) 368-5888, direct at (703) 557-1938 or 557-1939.

ASBESTOS VICTIMS UNDER ATTACK

It has recently been reported, in the New York Times and Wall Street Journal, among others, that thousands of allegedly unimpaired individuals are filing asbestos personal injury lawsuits. These news reports state that these asbestos claims may threaten the financial well-being of numerous large corporations. Corporate and insurance company officials are quoted on the need for federal legislation, to control asbestos cases. In their words, they want to make sure money goes to those who are truly sick.

It is important to see the big lie behind these news stories.

Persons who have suffered a detriment at the hands of another are entitled to seek redress in our courts. There has never been a requirement that persons be impaired or disabled in order to seek redress; it is enough that they are injured. The presence of greatly elevated levels of asbestos fibers in one's lungs is clearly a detriment. Most persons who have never been heavily exposed to asbestos would never trade lungs with a Navy veteran, even if that Navy veteran had not yet suffered an impairment or disability. Asbestos-exposed individuals have a far greater risk of developing mesothelioma (a cancer of the lung or stomach lining), lung cancer, or asbestosis later in life. It should be left to juries to decide if the presence of those fibers constitutes an injury under the law.

Access to our judicial system is an important right; the judicial system protects Americans from large corporations who sell unsafe products, and conceal the dangers of those products from the public.

Instead, the large corporations which brought the asbestos nightmare upon us, and their insurance companies, now seek federal legislation, to restrict access to, or take the place of, the American jury system. The legislation which has thus far been proposed would appoint a board of review, and make it mandatory that any asbestos case be reviewed by the board to determine if any individual had a right to compensation. All cases would be delayed, so that some claimants would die before their cases could be reviewed, and most cases would be rejected.

The reason for this proposal should be obvious. After years of consistently losing before juries, the asbestos companies, and insurance companies, are once again watching out for the almighty dollar, over the rights of injured persons. This is exactly what these companies did in the 1920s, 1930s, 1940s, 1950s, and later, as they did all they could to keep their knowledge of asbestos hazards from being made public.

The corporations and insurance companies say they want to make sure that badly injured individuals receive compensation. This is hypocritical, as these same companies have fought, and lost, valid claims for decades. Now, all of a sudden, they say they're concerned about victims. Don't believe them.

The number of asbestos claims is not slowing down largely because the asbestos companies kept selling asbestos products, even into the 1980s. They lied to their customers, saying the products were safe, and kept asbestos products in the market long after they should have been gone.

If you have an asbestos claim, or if you have been heavily exposed to asbestos but have not yet been diagnosed with an asbestos-related disease or cancer, you may wish to contact your congressional representative. Let Congress know that the asbestos companies don't deserve to be bailed out by federal legislation, which will greatly restrict or eliminate your rights.

ASBESTOS EXPOSURE CAUSES LUNG CANCER

Everybody knows smoking causes lung cancer; even tobacco company officials know it, though they don’t admit it. But did you know that asbestos exposure also causes lung cancer? It certainly does, and a smoker who also has a past history of asbestos exposure has a ninety times greater chance of developing it. If you have a history of asbesots exposure, consider that the next time you light up.

The asbestos manufacturers actually knew in the 1930s that there was a high rate of lung cancer among asbestos factory workers, miners, and end users of asbestos-containing products. Like the tobacco companies, they didn’t tell the public about the cancer risk. Numerous studies through the 1940s and 1950s confirmed this medical knowledge, and a study by Dr. Selikoff in 1964 eliminated all doubt.

It requires a heavy exposure to asbestos, over many years, to cause lung cancer. Many shipyard laborers and trademen fit this description, especially 20-year Navy boiler tenders, engine men, water tenders, firemen, and other ratings which required work in engine and fire rooms on ships. Many of these men are being diagnosed with, and, unfortunately, dying from lung cancer.

Asbestos-Exposed Persons with Lung Cancer Are Entitled to Substantial Compensation, Even If They Smoked

Many people have asked the question: “I know persons with asbestos-related disease are entitled to compensation. But I also smoked, in addition to my asbestos exposure. Can I obtain compensation from the asbestos companies, even though I also smoked?” The answer to that question is a clear, emphatic YES. This is because, under California law, you are not required to prove that asbestos was the only cause of your lung cancer; you only need to prove that it was a contributing cause of it.

Therefore, in the case of a 20-year Navy boiler tender, or similar rating, who also smoked for many years, and then is diagnosed with lung cancer many years later, substantial compensation may be obtained.

Lung Cancer Can Be Successfully Treated— But You Need to See a Doctor to Find Out

Most shipyard workers, especially Navy 20-year men with engine or boiler-related ratings, are at high risk of developing lung cancer. Yet, many are reluctant to see a doctor. That attitude is understandable; no one wants to find out they’re sick. But that attitude is also wrong, because lung cancer can be successfully treated…and defeated. The key is early detection. Think of your family, and all of those who care about you, then get in to see a doctor.

What Caused Mesothelioma - Asbestos Exposure

Where was I Exposed to Asbestos?

The main risk factor for mesothelioma is asbestos exposure. The use of the material has been banned in the United States since approximately 1975, but about 8 million Americans may already have been exposed through various jobs, such as miners, ship builders, factory and railroad workers, mechanics and construction workers (particularly those responsible for installing brakes in automobiles and insulation in buildings). Many men who served in the Navy were exposed to significant amounts of asbestos on their ships.

Asbestos is not only found in the workplace. It may still be found in 10-15% of schools (about 110,000) throughout America. The asbestos fibers have also been known to be picked up through clothing or other articles. After exposure to the airborne fibers, the risk of lung cancer is 7 times greater than that of the general population (smokers who are exposed to asbestos have a risk 50-90 times greater yet).

Not all workers exposed to asbestos will develop diseases related to their exposure. In fact, many will experience no ill effects.

Asbestos that is bonded into finished products such as walls, tiles, and pipes poses no risk to health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When asbestos particles are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease. Once these fibers work their way into body tissues, they may stay there indefinitely.

The risk of developing asbestos-related diseases varies with the type of industry in which the asbestos exposure occurred and with the extent of the asbestos exposure. In addition, different types of asbestos fibers may be associated with different health risks. For example, results of several studies suggest that exposure to amphibole forms of asbestos are more likely than exposure to chrysotile asbestos form to cause lung cancer, asbestosis, and, in particular, mesothelioma. Even so, no fiber type can be considered harmless, and proper safety precautions should always be taken by people that work under asbestos exposure.

Medical Procedures

The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient's age and general health. Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered.

There are a number of treatment options available to mesothelioma patients. Extrapleural pneumonectomy in selected patient with very early stage disease may improve recurrence-free survival, but its impact on overall survival is unknown. Pleurectomy and Decortication can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumors. The use of radiation therapy in pleural mesothelioma has been shown to alleviate pain in the majority of patients treated. Unfortunately, the duration of symptom control is short-lived. Single agent and combimed chemotherapy have reported higher response rates in STAGE II patients, but the toxicity reported is also higher, and there is no evidence that combination treatments result in longer survival or longer control of the symptoms.

Standard Treatments

There are treatments for all patients with malignant mesothelioma.

Three kinds of treatment are used:

chemotheraphy (using drugs to fight the cancer).

surgery (taking out the cancer).

radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) chemotherapy (using drugs to fight the cancer).

Surgery is a common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). If fluid has collected in the chest or abdomen, the doctor may drain the fluid out of the body by putting a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. The doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).

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

Side Effects

Cancer treatments all have side effects. It is hard to kill cancer cells at the same time as keeping all healthy cells safe. Side effects of treatment depend on the type of treatment and the person’s overall health when treatment starts.

Experimental Treatments

Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. Clinical trials, therefore, are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for many patients with malignant mesothelioma.

These new approaches often combine two or more traditional treatments or consist of other promising innovations.

Peritoneal Mesothelioma

Cancer of the Stomach Lining

Peritoneum mesothelioma or Peritoneal mesothelioma is mesothelioma cancer in the lining that surrounds the abdomen (stomach).

Diffuse malignant peritoneal mesothelioma is mesothelioma cancer in the lining that surrounds the abdomen (stomach). Diffuse means that is the cancer is spread out.

Peritoneal or Peritoneum is a smooth membrane, which lines the cavity of the abdomen (stomach). It helps to protect the contents of the abdomen. It also produces a lubricating fluid. This helps the organs to move smoothly inside the abdomen as we move around.

Peritoneal mesothelioma accounts for approximately 10% of mesothelioma cases.

Symptoms of Peritoneal Mesothelioma

When the symptoms of peritoneal mesothelioma appear, they typically include abdominal pains,abdominal weakness, weight loss, loss of appetite, nausea, and abdominal swelling. Fluid often accumulates in the peritoneal space, a condition known as ascites. Over time the wasting symptoms can become more and more severe. The growing peritoneal mesothelioma tumor can exert increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. If the peritoneal mesothelioma tumor presses upward, it can impair breathing capacity. If the peritoneal mesothelioma tumor pushes against areas with many nerve fibers, and the bowel distends, the amount of pain can increase.

Malignant Mesothelioma Diagnosis

If there is reason to suspect you may have a mesothelioma, one or more diagnostic methods will be used by your doctor.

Medical history and physical examination

A complete medical history is taken to establish risk factors and presence of symptoms. This interview includes questions to determine in which environment you may have been exposed to asbestos.

A thorough physical exam is conducted with an eye towards revealing signs of malignant mesothelioma and any other health problems. Patients with pleural mesotheliomas (malignant mesotheliomas of the chest) often have pleural effusion (fluid in their chest cavity) caused by the cancer. Ascites (fluid in the abdominal cavity) in cases of peritoneal mesothelioma, and pericardial effusion (fluid in the pericardium) in cases of pericardial mesothelioma can also be detected during a physical exam.

Imaging tests

A chest x-ray may show irregular thickening of the pleura, pleural calcifications (mineral deposits), lowering of the lung fissures (spaces between the lobes of the lungs), and fluid in the pleural space. These findings suggest asbestos exposure leading to the development of a malignant mesothelioma.

Imaging studies such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans will help determine the location, size, and extent of the cancer. The CT scan uses a rotating x-ray beam to create a series of pictures of the body from many angles. A computer combines these pictures to produce detailed cross-sectional images of a selected part of the body. To highlight details on the CT scan, you may be asked for permission to have a harmless dye injected into a vein. MRI uses magnetic fields instead of x-rays to create images of selected areas of the body. As with the CT scan, a computer generates a detailed cross-sectional image.

Tests of Fluid and Tissue Samples

Fluid

If the patient has a pleural effusion, a sample of this fluid can be extracted by inserting a needle into the chest cavity. A similar technique can be used to obtain abdominal fluid and pericardial fluid. The fluid sample is then tested to show its chemical make-up and analyzed under a microscope to determine the presence of cancer cells.

Tissue

A tissue sample of a pleural or pericardial tumor can be obtained using a relatively new technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. The doctor can see the tumor through the thoracoscope and can use special forceps to take a tissue biopsy. In much the same fashion, laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In this procedure, a flexible tube attached to a video camera is inserted into the abdominal cavity via small frontal incisions. Fluid can also be collected during thoracoscopy or laparoscopy.

Surgery

Surgery, either a thoracotomy (opening of the chest cavity) or a laparotomy (opening of the abdominal cavity), allows the surgeon to remove a larger sample of tumor or, at times, to remove it entirely.

Oral Exploration

For patients who might have pleural malignant mesothelioma, the doctor may also do a bronchoscopy. In this procedure a flexible lighted tube is inserted through the mouth, down the trachea, and into the bronchi to see if there are other masses in the airway. Small samples of abnormal-appearing tissue can be removed for testing.

Lymph Node Analysis

The patient may also have a mediastinoscopy. During this procedure a lighted tube is inserted under the sternum (chest bone) at the level of the neck and moved down into the chest. The surgeon is then able to view the lymph nodes in this region and take samples to check for malignant mesothelioma.

Lymph nodes are bean-sized collections of immune system cells that help the body fight infections and cancers. Lung cancers frequently spread to lymph nodes, but mesotheliomas rarely do this. Examination of the lymph nodes allows the doctor to determine whether a cancer is still localized or if it has begun to spread. It can also aid the doctor in distinguishing lung cancer from malignant mesothelioma.

Magnification to Aid Detection/Recognition

Even with fluid samples from the area around the lungs, abdomen or heart, it is often difficult to diagnose malignant mesothelioma. It is even hard to diagnose malignant mesothelioma with tissue from biopsies. This is because mesothelioma cells are difficult to distinguish from several other types of cancer when viewed under the microscope. For example, pleural mesothelioma can resemble various types of lung cancer, and peritoneal mesothelioma can resemble various cancers of the ovaries. In recognition of this dilemna, special laboratory tests are often done to pinpoint mesothelioma amidst several possibilities.

These lab tests use special techniques to identify certain chemicals known to be present in mesotheliomas, and as importantly, known to be different than those present in cancer of the lung or ovary. The electron microscope may also be helpful in diagnosing mesothelioma. The electron microscope has a magnification power 100 times greater than the light microscope which is generally used in cancer diagnosis. This allows detection of the small parts of the cancer cells that distinguish mesothelioma from other types of cancer.

The difficulty in distinguishing between malignant mesothelioma and other forms of cancer or benign, noncancerous pleural inflammation is the primary problem posed during the initial diagnosis. The most favorable diagnostic tools presently remain the open pleural biopsy performed during thoracoscopy which allows for direct inspection of the inside of the chest, and provides information on the involvement of the other organs and any spread of disease. Less successful procedures are CT guided pleural biopsy, or blind pleural biopsy. In addition to the gross appearance of the tumor, pathologists often rely on a panel of histochemical and immunohistochemical stains to diagnose or exclude malignant meosothelioma. Currently chemicals linked to prognosis of malignant mesothelioma are under study, but have not been validated for the general use.

Prognostic Factors

Because pleural mesothelioma has been better studied than peritoneal mesothelioma we know more about factors associated with prognosis for pleural mesothelioma. Younger age at diagnosis, performance status (functional status) and absence of weight loss are associated with a more favorable prognosis.

Mesotheliomas are usually of three different cell types (histological analysis): 1) epithelial cell type - has the most favorable prognosis; 2) fibrosarcomatous cell type - carries the worst prognosis and 3) mixed cell type - has an intermediate prognosis

Mesothelioma Symptoms Information

Symptoms for Pleural Mesothelioma (involving the lung / chest area) are:
chest pain and pain in the lower back
difficulty breathing
coughing
weight loss
fever
muscle weakness and sensory loss
swelling of the face and arms
hoarseness
coughing up blood Symptoms of Peritoneal Mesothelioma (involving the abdominal / stomach cavity, liver, spleen or the bowel) are:
abdominal bloating due to fluid accumulation in the abdominal cavity
nausea & vomiting
swelling of the feet
fever
impaired bowel function.
Unfortunately, the early mesothelioma symptoms are often ignored or mistaken for minor ailments because they are not specific to the disease.Therefore, it is critical to investigate one's exposure to asbestos. While pain in the lower back or at the side of the chest, shortness of breath, trouble swallowing, cough, fever, sweating, fatigue and weight loss may be common to many minor ailments, it is the knowledge that these mesothelioma symptoms are present in a person with a high likelihood of asbestos exposure that should raise a red flag.
Mesothelioma symptoms and signs from mesotheliomas depend upon location of the mesothelioma, its size and whether it is benign or malignant Benign forms of the disease are generally asymptomatic The symptomatology of malignant mesotheliomas is due to tumour growth resulting in invasion of surrounding structures and/or the production of fluid (pleural effusion, ascites, or pericardial effusion). Chest pain may be caused by invasion of the chest wall. Pleural effusion causes collapse of adjacent lung and shortness of breath Mesothelioma symptoms of distant spread are possible, but uncommon since the tumour is usually a local problem and blood borne spread is uncommon Patients with more advanced disease may be ill generally with fever, night sweats and weight loss Involvement of the membrane around the heart (pericardium) may cause heart rhythm disturbances

How Is Malignant Mesothelioma Diagnosed

If there is a reason to suspect you may have mesothelioma, your doctor will use one or more methods to find out if the disease is present. The first step in diagnosing mesothelioma is recognizing your symptoms.
Signs and Symptoms of Mesothelioma
Early symptoms of mesotheliomas are not specific to the disease. People often ignore them or mistake them for common, minor ailments. Most people with mesothelioma have symptoms for only 2 to 3 months before they are diagnosed. About one-fourth of people have symptoms for at least 6 months before they are diagnosed.
Over half of patients with pleural mesothelioma have pain in the lower back or at the side of the chest. Many report shortness of breath. A smaller percentage have trouble swallowing, cough, fever, sweating, fatigue, and weight loss. Other symptoms include hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, and sensory loss.
Symptoms of peritoneal mesothelioma include abdominal (belly) pain, weight loss, nausea, and vomiting. There may also be fluid or a mass in the abdomen.
If you have any of these symptoms and have been exposed to asbestos you should see a doctor right away.

Pleural Mesothelioma - Cancer of the Lung Lining

Pleural Mesothelioma, pleura mesothelioma or malignant pleural mesothelioma is mesothelioma cancer in the lining of the lungs. This is different from lung cancer, which refers to any type of malignant tumor that originates in the lungs.

The pleura, is the tissues lining or covering that surrounds the lungs.
There are 2 pleura. These can be called pleural membranes. The gap between them is called the pleural space. The pleura are fibrous sheets. They help to protect the lungs. They produce a lubricating fluid that fills the gap between the 2 pleura. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe.

Pleural mesothelioma is the most common form of mesothelioma accounting for 80-90% of mesothelioma cases.

In general, the clinical presentation of pleural mesothelioma may include the following:

• Cough
• Shortness of breath, difficulty breathing
• Difficulty sleeping
• Pain in the chest and abdominal regions, which is generally unresponsive to analgesics
• Progressive loss of appetite and weight loss
• Pleural effusions (fluid in the chest cavity)

Management of pleural mesothelioma depends largely on the staging of the tumor. Early diagnosis and surgical intervention may lengthen life expectancy. Depending on the age and physical condition of the patient, however, surgery may not be a viable option. In addition to surgical options, radiation treatment and chemotherapy may be helpful in the overall therapeutic programfor treating pleural mesothelioma. Pain management and home care are typical alternatives in the later stages of pleural mesothelioma