Stomach Cancer

What is stomach cancer?

Stomach cancer is a form of cancer that can begin anywhere in the stomach. A stomach tumor or other type of stomach cancer occurs when cells in the stomach grow out of control and become tumors. Stomach cancer cells take over healthy cells. They may then spread throughout the stomach and then to other organs and parts of the body, especially the esophagus and small intestine.

Stomach cancer often begins with the development of a benign growth known as a polyp. These polyps may lead to a stomach tumor later on. Also see stomach cancer causes.

Stomach cancer statistics

According to the American Cancer Society,

* about 21 thousand Americans are diagnosed with stomach cancer annually
* 13 thousand of these stomach cancer cases will be men
* 8 thousand stomach cancer cases will be women
* average age when stomach cancer is diagnosed is 71.
* about two thirds of stomach cancer cases are diagnosed after age 65.
* a person's risk of developing stomach cancer in their lifetime in the United States is approximately 1 in 100.
* Early stage stomach cancer diagnosis results in a 75 percent chance of survival for at least five years. Diagnosis in the late stages usually results in a 30 percent chance.

Stomach cancer used to be the leading cause of cancer-related deaths in the United States, but the number of cases has been decreasing in recent years.

Stomach cancer is more common worldwide than in the U.S. There are many more cases in Japan, Korea, Great Britain, South America and Iceland. Japan, in fact, has more than 10 times as many cases as the U.S.. However, native Japanese people who move to the United States and adopt American eating habits develop fewer cases of stomach cancer than people in Japan who eat a typical Japanese diet.

Stomach cancer risk factors

Researchers have found evidence that diets that include a lot of salt and nitrates probably increase a person's chances of getting stomach cancer.

Despite mounting belief that certain diets may be a factor, there's no medical evidence yet regarding the cause of stomach cancer. But there are some known risk factors, especially in certain industries. People who work in the coal mining, timber, nickel and rubber industries all have high rates of stomach cancer.

People with a family history of stomach cancer also seem to be at higher risk, as do those who have had stomach surgery for ulcers and pernicious anemia.

There's also a specific type of bacteria known as Helicobacter pylori which has often been found in the stomachs of stomach cancer patients.

Stomach tumor and stomach cancer types

Adenocarcinomas appear and develop in the glandular cells of the stomach lining. This is the most common type of stomach cancer.

Soft tissue sarcomas, which are extremely rare. originate from the cells in the muscle layer of the stomach.

Gastrointestinal stromal tumor (GIST) is another type of sarcoma which originate in the tissues that support the organs of the digestive system. They are also known as GISTs.

Lymphoma is a cancer of the lymphatic system. A MALT lymphoma is the main type to affect the stomach. A MALT lymphoma is also known as a MALToma.

Carcinoid tumor is another type of cancer that can affect the stomach.

Gastric Bypass Stomach Surgery

What is gastric bypass surgery?

Many people mistakenly refer to all "weight loss" stomach surgery procedures as gastric bypass surgery. In fact, gastric bypass surgery refers to surgery that involves not just the stomach, but also the intestines.

Gastric bypass surgery involves re-routing the path that food takes through the digestive system. It "bypasses" a part of the small intestine. As a result, less food is absorbed into the body, cutting down on the amount of fat and the number of calories the body will store.

Gastric bypass surgery is done under general anesthesia and takes approximately one to four hours to complete. Hospital stays range from one to seven days, depending on the type of gastric bypass surgery that's done, and other health factors relevant to the patient.

There are currently two gastric bypass surgeries, the "Roux en Y" procedure and the biliopancreatic diversion bypass.

Roux en Y Gastric Bypass Surgery

The Roux-en-Y-gastric bypass can be done the traditional way, using a large incision in the abdomen. It can also be done laparoscopically, using several small incisions and a special tube equipped with a tiny camera. There less scarring when the procedure is done with a laparoscope, and the recovery time is shorter. But laparoscopic Roux en Y operations haven't been around as long as "open" surgeries, so long term results are unknown.

The Roux-en-Y bypass is being done more often because it's generally simpler than the biliopancreatic diversion bypass.

Biliopancreatic Diversion Bypass Surgery

The biliopancreatic diversion bypass is done less frequently than Roux en Y. It's more complicated because it's done through a large incision in the abdomen, leaves a permanent scar, and requires a longer recovery. There's also a higher risk of nutritional problems.

Gastric bypass surgery has helped hundreds of thousands of morbidly obese people lose weight and enjoy a better quality of life. They feel that they look better, they're able to get around more easily, and there's usually an overall improvement in their health.

Nonetheless, gastric bypass surgery is serious, and no one should take gastric bypass operation lightly.

Note: Lap-Band surgery is a form of weight loss surgery, but it doesn't involve an intestinal bypass element. Therefore it isn't really gastric bypass surgery, and is covered elsewhere on this website.

Indigestion

Indigestion - Causes and Relief


If you’ve ever had to suffer through indigestion, you know very well how much of a problem this condition can be. For some people, indigestion is a mild and occasional nuisance. For others, it’s a serious, bothersome condition that can affect sleep, enjoyment of meals and general well being. Here’s what you really need to know about indigestion.

Indigestion is medically known as dyspepsia and is the term used to describe one or more symptoms related to eating such as:

• feeling full during a meal
• feeling uncomfortably full after a meal
• feeling sick and bloated after a meal
• burning and pain in the upper abdomen

This is a very common digestive condition in adults and can occur every day or just once in a while. There are different causes of indigestion. Some include GERD (gastroesophageal reflux disease), cancer, peptic ulcer disease, and more. It’s also possible for a person to have indigestion with no obvious cause.

While indigestion is a very uncomfortable condition, there are some things you can do to find relief. For example, eating small meals several times a day instead of just three large meals can help aid digestion.

Avoiding smoking, alcohol, caffeine and carbonated beverages can also help reduce indigestion. You should also avoid medications that irritate the lining of the stomach such as aspirin.

Some people find antacids to be helpful in treating occasional indigestion and also avoid eating right before bed. When you lie down after eating, your food does not have a chance to settle and digest properly. There are also some prescription drugs that are helpful in severe indigestion cases. You will need to speak with your doctor about these to be sure they are right for your case.

Emotional stress also leads to indigestion so try to avoid it as much as possible and learn new ways to manage the stress in your life that can’t be avoided. If your indigestion continues or becomes very severe with vomiting and pain, it could be a sign that something more serious is wrong. You should see your doctor to be sure.

What Is Acid Reflux?

What Is Acid Reflux?

Acid reflux, which is known medically as gastroesophageal reflux disease or GERD and is often called "heartburn" by the general public, occurs when liquid content of the stomach back up into the esophagus. This liquid contains stomach acid which can irritate and inflame the tissue of the esophagus, causing a burning sensation in the esophagus in the chest area near the heart: thus the name "heartburn."
When acid from the stomach backs up in this way, it is described as "reflux."

The liquid might also contain a a digestive enzyme called pepsin, or in some cases, even bile from the duodenum (the area where the stomach attaches to the small intestine). These may have a role in causing acid reflux, although it is believed to be a lesser role.

A certain amount of reflux occurs in almost everyone at one time or another. But those who suffer from GERD, the refluxed liquid contains a higher level of acid. The reflux also reaches a high level in the esophagus, covering (and possibly damaging) a larger area of tissue.

GERD is a considered to be a chronic condition, although treatment and preventive steps may reduce its severity.

During the day, the effects of acid reflux are less likely to occur. When a person is standing upright, or sitting, any reflux is likely to be carried back to the stomach quickly by gravity. Swallowing also carries saliva down the esophagus (saliva contains a natural bicarbonate which helps neutralize acid). Therefore acid reflux is more likely to occur when a person is asleep: gravity isn't a factor because the body is usually in a horizontal position, and swallowing stops. Therefore, refluxed liquid stays in the esophagus for a longer time.

Types of mesothelioma

Types of mesothelioma

There are a number of different kinds of mesothelioma. Although many people believe mesothelioma is a lung disease, it can also occur in other parts of the body.

Pleural malignant mesothelioma is the most common type. It affects tissue around the lungs.

Peritoneal mesothelioma occurs in the tissue of the abdomen.

Pericardial mesothelioma affects the tissue surrounding the heart. This type is extremely rare.

Mesothelioma of the tunica vaginalis occurs in the lining around the testicles. This type is also extremely rare.

Symptoms

Symptoms vary depending on location.

Pleural mesothelioma symptoms:

* Dry cough.
* Pain while coughing.
* Discomfort when breathing.
* Chest pain beneath the rib cage.
* Shortness of breath.
* Unexplained weight loss.
* Unusual lumps of tissue under the skin on your chest.


Peritoneal mesothelioma symptoms:

* A change in your bowel habits, including frequent constipation or diarrhea.
* Abdominal pain.
* Abdominal swelling.
* Lumps in the abdomen.
* Unexplained weight loss.


Little is known about the symptoms of the pericardial and tunica vaginalis types of mesothelioma because they are so rare.

Treatment

Unfortunately, mesothelioma usually isn't diagnosed until it has reached a later stage. Since it is an aggressive form of cancer, a cure is often impossible.

However, there are a number of treatment options that are used, and they vary depending on the type of cancer the patient has contracted along with a number of other factors like the overall health of the patient.

Surgery If the disease is diagnosed in an early stage, surgeons may try one of several types of to remove the cancer. These include:


Procedures to decrease fluid buildup in the chest which may cause breathing difficulty.

Removing the tissue around the lung or abdomen. A pleurectomy involves removing the tissue around the lungs. A peritonectomy removes the tissue lining around the abdomen.

Surgery known as debulking is intended to remove as much of the cancer as possible.

Surgeons may remove a lung and the surrounding tissue.


Chemotherapy This involves the use of chemicals to kill cancer cells.

Radiation This type of therapy employs high-energy beams that are directed to a specific area or areas affected by the cancer.

Combination therapy This involves using surgery, chemotherapy and radiation together. This is an extremely grueling type of treatment that isn't appropriate for everyone. Combination therapy appears to offer the most promising possibility for short term treatment, but in many cases, the cancer eventually returns.

Prevention

Prevention may be impossible for those who have been exposed to asbestos over an extended period of time. The following workers should take care to observe their employers' safety rules and procedures regarding asbestos exposure.

* Auto mechanics
* Construction workers
* Factory workers
* Gas mask manufacturers
* Insulation manufacturers
* Miners
* Railroad workers
* Ship builders


It's also important to remember that many older homes have asbestos components. But removing it can be extremely dangerous because of asbestos dust and fibers that can get into the air and therefore, into your lungs.

Check the Environmental Protection Agency website for advice on dealing with asbestos in the home.

. Mesothelioma Treatment

A. Mesothelioma Treatment

The conventional therapies are not very successful for the mesothelioma treatment. The survival time for the patients is only 6 -12 months. The malignancy of the mesothelioma is affected by many factors. One such thing is the long latency period between disease development and exposure to the asbestos.
B. Surgery

Surgery is one of the treatments on mesothelioma. The surgery can be performed alone or in combination with post and pre operative adjuvant therapy. But the results of the surgery attempted either alone or with post and pre operative therapy is found to be disappointing because the survival rate of the patients [five years] is less than 10%. The most common surgery is pleurectomy. Here the lining of the chest is completely removed. Extra pleural pnemorectomy is not very common.
C. Radiation Therapy

Mesothelioma is highly resistant to radiation therapy. But still this treatment is attempted to reduce the sufferings that arise because of mesothelioma growth. This radiation therapy is applied chest drain insertion site most commonly. This prevents the tumor growth along the wall of the chest.D. Chemotherapy

Pemetrexed is the drug that was approved by the food and administration of United States of America in the year 2004 for the treatment of pleural malignant mesothelioma. Pemetrexed is administered with cisplatin. In order to reduce the side effects of the pemetrexed, folic acid is used.
E. Immunotherapy

Immunotherapy is the other treatment option for mesothelioma. Immunotherapy produces variable results. Bacillus calmette- Guerin is found to effective in boosting the immune response for the cancer of the urinary bladder. But the same therapy attempted for mesothelioma provides no relief to the patients. Vitrolysis by LAK cells [followed by interleukin- 2 activation] is effective in destroying the mesothelioma cells.

But the biggest disadvantage here is that the suffering of the patients because of the side effects of this therapy. This treatment was really stopped because of the very serious side effects of the interleukin-2 toxicity. The most common side effect is cachexia and fever. Interferon alpha is really producing encouraging results of late. There is nearly fifty percent reduction in the tumor mass. The side effects are very, very less in this therapy.

Diagnosis Mesothelioma

Diagnosis Mesothelioma is found to be a difficult task for the medical professionals. The main misleading fact in the diagnosis mesothelioma for the health care professional is that the symptoms resemble to those of other conditions.

Diagnosis Mesothelioma by Imaging

Mesothelioma diagnosis begins with the close interaction with the patient’s anamnesis mainly the history of the exposure to asbestos, which is the precursor of Mesothelioma. The common diagnosis of Mesothelioma depends on the Lung function tests and X-rays of the chest (irregular thickening of the pleura) or abdomen. Diagnosis mesothelioma by imaging can be performed by the following procedures:

* Computed Tomography scan (CT scan)
* Magnetic Resonance Imaging (MRI)
* Positron Emission Tomography (PET)

A CT Scan and MRI

Diagnosis Mesothelioma can be achieved by performing either A CT scan or MRI scan. In A CT scan, X-ray machine is going to be useful. Here, pictures of the areas inside the body is taken in a continuous manner and is easily viewed by through the computer, which is lined to the x-ray machine.

In MRI scan, the detailed picture of the internal organs can easily be viewed and is achieved by a powerful magnet connected to the computer. The detailed picture of your internal organs can easily be achieved by MRI scan by printing the results directly from the computer.

Positron Emission Tomography (PET)

This type of diagnosis Mesothelioma is having more advantage than the CT scan and MRI scan. In the Positron Emission Tomography (PET) scans use both tracers and cameras to identify the biological changes in the cells and to spot dangerous neoplastic growth.Confirmative Diagnosis

“Diagnosis Mesothelioma” has been performed by so many ways and means. But Biopsy will give us a confirmative diagnosis. In Biopsy, a sample cancerous tissue will be removed from the site of infection. The site of infection is ascertained either by Thoracoscopy or Peritoneoscopy. Another modern technology called mediastinoscopy is useful in detecting mesothelioma in lymphnodes of mediastinum (lymphnode concerned with Lungs).

In Thoracoscopy, a small incision is made on the chest wall and a small, thin, lighted tube (Thoracoscope) is placed in between the two ribs. This will enable the doctor to see the affected tissue on the lung and the tissue samples may be obtained from the affected tissue to provide confirmative diagnosis Mesothelioma.

In peritoneoscopy, the physician may take a look into the abdominal area. A small nick is made in the abdomen and peritoneoscope is inserted through that nick. The required tissue sample will be obtained through this tube for conducting Biopsy. A more elaborate diagnostic surgery is being carried out, if these methods of collecting biopsy don’t prove fruitful results.

In mediastinoscopy, the surgeon inserts a lighted mediastinoscope in the incision made in the chest area to collect samples of the tissue. Mediastinoscopy is used for diagnosis mesothelioma in the lymphnodes of mediastinum. The sample tissue collected from the mediastinal area is subjected for different tests for differential diagnosis of Mesothelioma from other types of infection.

Diagnosis Mesothelioma by Staging

Diagnosis Mesothelioma helps to find out the stage of the disease. Staging diagnosis helps a lot to the health care provider to plan the treatment accordingly because the localized mesothelioma will become generalized by spreading from original membrane surface to other parts of body which includes kidney, liver, chest wall, lymph nodes and lungs.

What is Mesothelioma?

Mesothelioma refers to progressive growth of malignant cells found in the mesothelium, a thin sheet that covers and protects the vital organs of the body, such as the lungs.



mesothelioma cancer pictureCancerous cells are described as malignant neoplasms. They demonstrate uncontrolled cell growth that follows no physiologic demand. When an abnormal cell is transformed by the genetic mutation of the cellular DNA, cancerous cells are formed. The cells infiltrate the tissues that surround them and gain access to lymph and blood vessels, which carry the cells to other areas of the body.



Normally, cancerous cells that develop in the mesothelium and eventually lead to mesothelioma are caused by glass-like particles that stick in the lungs. These particles come from asbestos, the common element used in building infrastructures. Asbestos is very popular in the industrial and construction field because of its high resistance against fire.



People who are exposed to asbestos have been found out to be the common patients diagnosed with mesothelioma. This is because the particles from asbestos that stick within the lungs tend to create cancerous cells. The damage caused by the process develops a disease process that triggers the growth of cancerous cells, where cell membranes are altered.


Overview of Mesothelioma and Compensation



Statistics show that nearly 80% of people afflicted with mesothelioma were working in the industrial field and construction area. Although mesothelioma is not a single disease with a single cause, the greatest common factor in developing the disease is asbestos.



Hence, society deems it necessary for these industries or employers, in general, to be responsible in providing the right compensation to their employees.



Issues on mesothelioma and compensation focus more on the privileges endowed to employees who have been sick with mesothelioma after being exposed to asbestos at work. The underlying connection between mesothelioma and compensation is seen in the lawsuits filed against the employers. Generally, these legal actions are done to claim financial damages from the company, who is entirely accountable for the safety of their employees working environment and for the implementation of safety gear against such hazards as asbestos.



Compensation for mesothelioma cases usually covers medical bills and other expenses related to mesothelioma, such as loss for daily wages or inability to provide their family with the quality life due to their non-working status.



People who are generally entitled for mesothelioma compensation are those who worked in the building, custodial, construction, shipyard, and automotive industry.



More information about mesothelioma and compensation:



1. It must be a cancer

Not everyone who had been exposed to asbestos can immediately file for mesothelioma compensation. The number one factor to consider for such claims is the development of cancer. The gravity of asbestos exposure will determine the condition that states one's eligibility for mesothelioma compensation.



2. Find a good lawyer

Not all mesothelioma lawyers can help you in claiming your compensation. Moreover, most mesothelioma lawyers that render services for mesothelioma compensation charge high fees. Hence, not everybody can afford to hire a mesothelioma lawyer.

However, some lawyers are willing to provide a "no win, no pay" agreement. By the time they win the case, the lawyer shares a certain percentage on the compensation. Hence, it is best that you find a good lawyer for you to obtain the right claims for you.



3. State laws

Mesothelioma compensation may vary from one state to another. This means that the existing state laws regarding mesothelioma lawsuits will be applicable only within its jurisdiction. Hence, not all provisions stated in a certain mesothelioma compensation are applicable on the other mesothelioma cases in different states.
Indeed, mesothelioma compensation can be very helpful in answering financial problems caused by mesothelioma. Reports show that mesothelioma patients can claim as much as $3 million. So if you have been diagnosed with mesothelioma, file your mesothelioma compensation now.

Mesothelioma and Compensation -- Who is Responsible?

Compensation is the greatest factor that drives people; it is considered as the greatest motivator of all things. Yet, compensation instigates more than plain monetary satisfaction. Above all things, it can give back whatever was lost.



Such is the case with mesothelioma and compensation. People who have acquired mesothelioma deem it necessary to receive the proper compensation they deserve. Why? Simply because it is not their intention to get sick with mesothelioma.

Mesothelioma

Mesothelioma
Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart,[1] the pericardium (a sac that surrounds the heart) or tunica vaginalis.
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing mesothelioma.[2] Unlike lung cancer, there is no association between mesothelioma and smoking.[3] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Mesothelioma
Classification and external resources


Large mesothelioma around the right lung (left side of image) on CT scan. See diagnosis for legend.

ICD-10
C45.

ICD-9
163

ICD-O:
9050-9055
OMIM
156240

DiseasesDB
8074

MedlinePlus
000115

eMedicine
med/1457

MeSH
D008654

Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
• chest wall pain
• pleural effusion, or fluid surrounding the lung
• shortness of breath
• fatigue or anemia
• wheezing, hoarseness, or cough
• blood in the sputum (fluid) coughed up (hemoptysis)
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
• abdominal pain
• ascites, or an abnormal buildup of fluid in the abdomen
• a mass in the abdomen
• problems with bowel function
• weight loss
In severe cases of the disease, the following signs and symptoms may be present:
• blood clots in the veins, which may cause thrombophlebitis
• disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• jaundice, or yellowing of the eyes and skin
• low blood sugar level
• pleural effusion
• pulmonary emboli, or blood clots in the arteries of the lungs
• severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
[edit] Diagnosis


CT scan of a patient with mesothelioma, coronal section (the section follows the plane the divides the body in a front and a back half). The mesothelioma is indicated by yellow arrows, the central pleural effusion (fluid collection) is marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney, (8) right kidney, (9) liver.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
Typical immunohistochemistry results

Positive Negative
EMA (epithelial membrane antigen) in a membranous distribution CEA (carcinoembryonic antigen)

WT1 (Wilms' tumour 1)
B72.3

Calretinin
MOC-3 1

Mesothelin-1
CD15

Cytokeratin 5/6
Ber-EP4

HBME-1 (human mesothelial cell 1)
TTF-1 (thyroid transcription factor-1)

[edit] Screening
There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[4] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.[5]
[edit] Staging
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
[edit] Pathophysiology
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres.
Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).[6] However, there is now evidence that smaller particles may be more dangerous than the larger fibers.[1][2] They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.[3]
Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:
• Neurofibromatosis type 2 at 22q12
• P16INK4A
• P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:
• Inactivation of tumor suppressor genes
• Activation of oncogenes
• Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
• Activation of DNA repair enzymes, which may be prone to error
• Activation of telomerase
• Prevention of apoptosis
Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
[edit] Epidemiology
[edit] Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year.[7] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[8] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States [4]. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
[edit] Risk factors
Working with asbestos is the major risk factor for mesothelioma.[9] Mesothelioma is now known to occur in those who are genetically pre-disposed to it. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[10]
[edit] Exposure
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related mesothelioma.
[edit] Occupational
Exposure to asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
[edit] Paraoccupational secondary exposure
Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
[edit] Asbestos in buildings
Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
[edit] Environmental exposures
Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in Cappadocia, Turkey, an unprecedented mesothelioma epidemic caused 50% of all deaths in three small villages. Initially, this was attributed to erionite, however, recently, it has been shown that erionite causes mesothelioma mostly in families with a genetic predisposition[11].
[edit] Treatment
Treatment of malignant mesothelioma using conventional therapies has not proved successful and patients have a median survival time of 6 - 12 months after presentation[citation needed]. The clinical behaviour of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favours local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
[edit] Surgery
Surgery, either by itself or used in combination with pre- and post-operative adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
[edit] Radiation

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Radiation Oncology/Lung/Mesothelioma
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[12] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
[edit] Chemotherapy
In February 2004, the United States Food and Drug Administration approved pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma. Pemetrexed is given in combination with cisplatin. Folic acid is also used to reduce the side-effects of pemetrexed.
[edit] Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
[edit] Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[13] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
[edit] Notable people who died from mesothelioma
Mesothelioma, though rare, has had a number of notable patients. Hamilton Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist, died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British science fiction writer Michael G. Coney, responsible for nearly 100 works also died in 2005. American film and television actor Paul Gleason, perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006. Mickie Most, an English record producer, died of mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist building designs, died in 1997.
Bernie Banton was an Australian workers' rights activist, who fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company. He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations. Mesothelioma eventually took his life along with his brothers and hundreds of James Hardie workers. James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48hrs to live. Australian Prime Minister-elect Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian Federal Election.
Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979. He was not offered surgery or chemotherapy because doctors felt the cancer was too advanced. McQueen sought alternative treatments from clinics in Mexico. He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery. He may have been exposed to asbestos while serving with the U.S. Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in car racing suits.[14] (It is also reported that he worked in a shipyard during World War II, where he might have been exposed to asbestos.[citation needed]
United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
After a long period of untreated illness and pain, rock and roll musician and songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall of 2002. Refusing treatments he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind including the song "Keep Me in Your Heart," which speaks of his failing breath. Zevon died at his home in Los Angeles, California, on September 7, 2003.
Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.[15] His mesothelioma has been attributed to his younger years spent working on building sites in London.[16][17]
Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation died of mesothelioma in 1994.
Scottish Labour MP John William MacDougall died of mesothelioma on August 13th, 2008, after fighting the disease of two years.[18].
Canberra journalist and news presenter, Peter Leonard also succumbed to the condition on 23 September 2008.
Terrence McCann Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006 at his home in Dana Point, California.
[edit] Notable people who have lived for some time with mesothelioma
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the Message"[19] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another twenty years eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma.
Author Paul Kraus was diagnosed with mesothelioma in June 1997 following an umbilical hernia operation. His prognosis was "a few months." He continues to survive using a variety of integrative and complementary modalities and has written a book about his experience.
[edit] Legal issues
Main article: asbestos and the law
The first lawsuits against asbestos manufacturers were in 1929. Today, you may see a commercial stating something like, "Mesothelioma is a rare type of cancer caused by asbestos particals. Asbestos particals can be found in lumberyards, shipyards or any of the haeting or automotive industries." Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars. [20] The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases. However, to date, Congress has failed to enact significant asbestos reforms. [21]
[edit] Legal History
The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos.[22] The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.[23] The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.
Despite proof that the dust associated with asbestos mining and milling causes asbestos related disease, mining began at Wittenoom in 1943 and continued until 1966. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.
By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.
[edit] References
The first version of this article was adapted from a public domain U.S. National Cancer Institute fact sheet at http://www.cancer.gov/cancertopics/factsheet/Sites-Types/mesothelioma