Saturday, September 6, 2008

Mesothelioma Specialists

The National Cancer Institute (NCI) has designated 40 cancer centers throughout the United States as "Comprehensive" centers. These elite centers have been recognized for their focus on scientific excellence and have dedicated themselves to the prevention, treatment and cure of cancer. Following is a list of Cancer Centers by state.

For veterans wishing to be treated at a Veterans Health Administration (VA) cancer care facility, click here for a listing by state.

Alabama

UAB Comprehensive Cancer Center
1824 6th Avenue, S.
Birmingham, AL 35294
Request an appointment: (800) UAB-0933 or (205) 975-8222

Arizona

Arizona Cancer Center
1515 N. Campbell Avenue 
Tucson, AZ 85724
Request an appointment: (520) 626-2900

California

City of Hope National Medical Center
1500 E. Duarte Road
Duarte, CA 91010
Request an appointment: (866) 434-HOPE (4673)

University of California, San Diego (UCSD) Moores Cancer Center
3855 Health Sciences Drive
La Jolla, CA 92093
Request an appointment: (866) 773-2703 or (858) 822-6200

UCLA Jonsson Comprehensive Cancer Center
10833 Le Conte Avenue
Los Angeles, CA 90095
Request an appointment: (310) 206-6909, (310) 794-1648 or 
(310) 794-6726

USC/Norris Comprehensive Cancer Center
1441 Eastlake Avenue
Los Angeles, CA 90033
Request an appointment: (323) 865-3000

University of California, Irvine (UCI) Chao Family Comprehensive Cancer Center
101 The City Drive, S.
Orange, CA 92868
Request an appointment: (877) UCI-DOCS (824-3627)

University of California, San Francisco (UCSF) Comprehensive Cancer Center
1600 Divisadero Street
San Francisco, CA 94115
Request an appointment: (888) 689-8273 or (415) 885-7777

Stanford University Comprehensive Cancer Center
875 Blake Wilbur Drive
Stanford, CA 94305
Request an appointment: (877) 668-7535

Colorado

University of Colorado Cancer Center
1665 N. Ursula Street
Aurora, CO 80045
Request an appointment: (800) 473-2288 or (720) 848-0300

Connecticut

Yale Cancer Center
15 York Street
New Haven, CT 06510
Request an appointment: (203) 785-4191

District of Columbia

Lombardi Comprehensive Cancer Center at Georgetown University
3800 Reservoir Road, NW
Washington, DC 20007
Request an appointment: (202) 444-2223

Florida

H. Lee Moffitt Cancer Center & Research Institute
12902 Magnolia Drive
Tampa, FL 33612
Request an appointment: (888) 860-2778 or (813) 979-3980

Illinois

Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Galter Pavilion
675 N. St. Clair, 21st Floor
Chicago, IL 60611
Request an appointment: (866) LURIE-CC (587-4322)

Iowa

University of Iowa Holden Comprehensive Cancer Center
200 Hawkins Drive
Iowa City, IA 52242
Request an appointment: (319) 356-4200 8:00 am - 5:00 pm (M-F)
(800) 777-8442 or
(319) 384-8442 (After hours)

Maryland

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
401 N. Broadway
Baltimore, MD 21231
Request an appointment: (410) 955-5222

Massachusetts

Dana-Farber Cancer Institute
44 Binney Street
Boston, MA 02115
Request an appointment: (877) 332-4294

Michigan

University of Michigan Comprehensive Cancer Center
1500 E. Medical Center Drive
Ann Arbor, MI 48109
Request an appointment: (800) 865-1125

Barbara Ann Karmanos Cancer Institute
4100 John R
Detroit, MI 48201
Request an appointment: (800) KARMANOS (527-6266)

Minnesota

University of Minnesota Cancer Center
425 E. River Road
Minneapolis, MN 55455
Request an appointment: (888) CANCER MN (226-2376)
(Toll Free in IA, MN, ND, SD, WI)
(612) 624-2620 (Outside Area)

Mayo Clinic Cancer Center
200 First Street, SW
Rochester, MN 55905
Request an appointment: (507) 538-3270

Missouri

Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine 
660 S. Euclid Avenue
St. Louis, MO 63110
Request an appointment: (877) 251-6485 or (314) 747-3046

New Hampshire

Norris Cotton Cancer Center
One Medical Center Drive
Lebanon, NH 03756
Request an appointment: (603) 653-9000

New Jersey

Cancer Hospital of New Jersey at Robert Wood Johnson University Hospital
195 Little Albany Street
New Brunswick, NJ 08903
Request an appointment: (732) 828-3000

New York

Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263
Request an appointment: (800) ROSWELL (767-9355)

Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, NY 10021
Request an appointment: (800) 525-2225

Herbert Irving Comprehensive Cancer Center
161 Fort Washington Avenue
New York, NY 10032
Request an appointment: (877) NYP-WELL (697-9355)

North Carolina

University of North Carolina (UNC) Lineberger Comprehensive Cancer Center
102 West Drive
Chapel Hill, NC 27599
Request an appointment: (866) 828-0270

Duke Comprehensive Cancer Center
Erwin Road
Durham, NC 27710
Request an appointment: (888) ASK-DUKE (275-3853)

Wake Forest University Comprehensive Cancer Center
Medical Center Boulevard
Winston-Salem, NC 27157
Request an appointment: (800) 446-2255 or (336) 716-2255

Ohio

Case Comprehensive Cancer Center, Ireland Cancer Center
11100 Euclid Avenue
Cleveland, OH 44106
Request an appointment: (800) 641-2422

Comprehensive Cancer Center - Arthur G. James Cancer Hospital & Richard J. Solove Research Institute
300 W. 10th Avenue
Columbus, OH 43210
Request an appointment: (800) 293-5066 or (614) 293-5066

Pennsylvania

Abramson Cancer Center of the University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
Request an appointment: (800) 789-PENN (7366)

Fox Chase Cancer Center
333 Cottman Avenue
Philadelphia, PA 19111
Request an appointment: (215) 728-2570

University of Pittsburgh Cancer Institute
5150 Centre Avenue
Pittsburgh, PA 15232
Request an appointment: (412) 647-2811

Tennessee

Vanderbilt-Ingram Cancer Center
691 Preston Building
Nashville, TN 37232
Request an appointment: (800) 811-8480

Texas

University of Texas M. D. Anderson Cancer Center
1515 Holcombe Boulevard
Houston, TX 77030
Request an appointment: (800) 392-1611 or (713) 792-6161

Vermont

Vermont Cancer Center at the University of Vermont
89 Beaumont Avenue
Burlington, VT 05405
Request an appointment: (802) 656-4414

Washington

Fred Hutchinson Cancer Research Center
1100 Fairview Avenue, N.
Seattle, WA 98109 
Request an appointment: (800) 804-8824 or (206) 288-1024

Wisconsin

University of Wisconsin Comprehensive Cancer Center
600 Highland Avenue
Madison, WI 53792
Request an appointment: (800) 622-8922

 

NATIONAL CANCER INSTITUTE CANCER CENTERS

UC Davis Cancer Center
4501 X Street
Sacramento, CA 95817
Request an appointment: (800) 362-5566 or (916) 734-5900

University of Chicago Hospitals
5841 S. Maryland Avenue
Chicago, IL 60637
Request an appointment: (888) UCH-0200

NYU Cancer Institute
550 First Avenue
New York, NY 10016
Request an appointment: (888) 7-NYU-MED (769-8633)

The Cleveland Clinic, Taussig Cancer Center
9500 Euclid Avenue
Cleveland, OH 44195
Request an appointment: (866) 320-4573 or (216) 444-5501

National Institutes of Health (NIH) Clinical Center, Bethesda, MD

 

Thoughts on choosing a cancer treatment.

Mesothelioma Stages

Doctor-Patient Communication

An open line of communication between a patient and his or her physician is vital when dealing with a serious disease such as mesothelioma. There will be many questions regarding treatment, whether palliative or aggressive, choices to deal with, and life issues to confront. Being informed and proactive in your care will give you a sense of empowerment.

Although most physicians have limited time to spend with each patient at appointments, it is important to address issues as they occur and resolve them to the satisfaction of all parties involved. Initially, this may mean going to your appointment with a list of symptoms or concerns, or questions regarding specific tests that are recommended. Once mesothelioma has been diagnosed, you may have questions regarding treatment options.

Most questions from patients stem from an initial diagnosis of mesothelioma and subsequent treatment options. Following are some frequently asked questions regarding these two important issues.

What Is My Diagnosis?

There are three types of mesothelioma. Pleural mesothelioma is a cancer of the lining of the lung (pleura), peritoneal mesothelioma is a cancer of the lining of the abdominal cavity (peritoneum), and pericardial mesothelioma is a cancer of the lining surrounding the heart (pericardium). Sub-types (or cell types) of mesothelioma are epithelioid (the most common, and considered the most amenable to treatment), sarcomatous (a much more aggressive form), and biphasic or mixed (a combination of both of the other cell types).

The structural appearance of cells under the microscope determine the cell or sub-type of mesothelioma. Epithelioid is the least aggressive; sarcomatoid, the most aggressive. The biphasic or mixed cell type shows structural elements of both of the other two. More on the histologic subtypes of mesothelioma.

 

epithelioid mesothelioma tissue

 

sarcomatoid mesothelioma tissue

Epithelioid mesothelioma tissue

Sarcomatoid mesothelioma tissue

 

biphasic mesothelioma tissue

Biphasic mesothelioma tissue

 

MESOTHELIOMA STAGES

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

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

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

Some elements common to most staging systems are:

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

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

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

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

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

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

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

Butchart System – extent of primary tumor mass

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

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

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

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

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

 

How Was This Diagnosis Determined, and How Accurate Were the Tests?

Although you probably took many different tests leading up to your diagnosis, a tissue biopsy is normally the final determining factor. Following are some tests your doctor may recommend, and what may or may not be concluded from these tests.

  • X-rays, CT scans, and MRIs - See the imaging section for more on these techniques. On conventional x-ray film, mesothelioma appears as a markedly thickened, nodular, irregular pleural-based mass which covers the pleural surface. The tumor often encompasses the involved lung, but is only rarely seen bilaterally. Chest wall, diaphragmatic, and mediastinal invasion may be seen in advanced cases. Moderate to large pleural effusion is often noted on the affected side. On CT scan, pleural thickening greater than 1 cm can be identified in over 90% of cases; thickening which extends into the interlobular fissure is seen in 85% of cases. Absence of pleural thickening does not preclude mesothelioma, and at times, the only CT finding is that of pleural effusion.
  • Cytology - Testing of the pleural fluid for malignant cells is considered to have limited value in diagnosing mesothelioma. Negative or inconclusive readings account for nearly 85% of all fluid tested. Even with a positive fluid report, many doctors prefer to perform a confirming tissue biopsy as long as it does not compromise the patient's health.
  • Needle Biopsy - In this test, done under local anesthetic, a large hollow needle is inserted through the skin and into the chest cavity. The needle is then rotated, and as it is taken out, tissue samples are collected. Because of the small sample size of the tissue, this type of biopsy is considered to be only 25-60% accurate in diagnosing mesothelioma. Because tumor seeding may occur along the needle tract in approximately 20% of patients, local radiation therapy may be used in conjunction with this test.
  • Open biopsy - This type of biopsy is considered to be the most accurate for mesothelioma diagnosis, and is the procedure of choice because it affords the pathologist a larger tissue sample.. It is done in a hospital under general anesthetic. As with a needle biopsy, local radiation may be used because of the possibility of tumor seeding.

Can I Be Treated by the Doctor Who Diagnosed My Mesothelioma?

If the doctor who diagnosed your mesothelioma is your primary physician, he will most likely refer you to a local oncologist for treatment. The oncologist may offer what he or she feels are the best treatment options, or, if their knowledge of this disease is limited, may suggest you seek out a doctor who specializes in mesothelioma. Most often these physicians are located at larger, teaching hospitals such as those listed in the Comprehensive Cancer Center Section. These facilities are ranked as state-of-the-art cancer centers, and are highly respected for their patient care and innovative cancer treatments. If your choice of treatment involves a radical surgical procedure or a clinical trial involving new, as yet unproven drugs, these facilities may be best for you. If your treatment involves an already-approved, standard form of chemotherapy, this can be carried out locally.

What Treatment Options Will I Be Offered?

Treatment options may vary according to the age and over-all health of the patient, and the extent of the disease. It is important to be informed of all available options for your particular case, so that you can make decision on the option you feel most comfortable with. Surgery, chemotherapy, and clinical trials, as well as new approaches such as photodynamic therapy, immunotherapy, and gene therapy may be offered. Speak openly with your doctor regarding suggested procedures. Questions may include:

  • Why is this procedure best for me?
  • What does the procedure entail?
  • What are the advantages/disadvantages of this treatment (i.e, will this procedure limit my eligibility for other treatments)?
  • What are the possible risks or adverse side effects?
  • What are the response, survival, and mortality rates associated with this procedure?

Is Palliative Treatment an Option?

In some circumstances, age, contributing health problems, or advanced disease may make aggressive treatment impossible. In these cases, palliative care (that which treats the symptoms, but not the disease itself) may be appropriate. If you opt for palliative care, it is doubly important to communicate fully with your doctor. Many symptoms of mesothelioma can be alleviated or substantially lessened if you are completely open with your doctor. Each time you have an appointment, tell your doctor how you feel, what discomfort you are experiencing, and your level of pain. A good doctor should be willing to address your questions and concerns.

Check our mesothelioma glossary.

More on tumor markers.

About Mesothelioma - FAQ

What is Mesothelioma?
The National Cancer Institute states that: "Malignant mesothelioma, a rare form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the chest (the pleura), the lining of the abdominal cavity (the peritoneum) or the lining around the heart (the pericardium)."

lung anatomy lung with mesothelioma

What is peritoneal mesothelioma?
Peritoneal mesothelioma is a cancer of the lining of the abdominal cavity. This form of cancer makes up approximately one-fifth to one-third of the total number of mesothelioma cases diagnosed. More on peritoneal mesothelioma.

How do you get Mesothelioma?
Most people with malignant mesothelioma have worked on jobs where they breathed asbestos. Others have been exposed to asbestos in a household environment, often without knowing it. More about the different ways in which people have been exposed to asbestos.

How much exposure does it take to get the disease?
An exposure of as little as one or two months can result in mesothelioma 30 or 40 years later. Mesothelioma cause.

How long does it take after exposure for the disease to show up?
People exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed with mesothelioma because of the long latency period of asbestos disease.

What is the prognosis for mesothelioma?
Like most cancers, the prognosis for this disease often depends on how early it is diagnosed and how aggressively it is treated. Click on Treatment Options to find out more about traditional and new approaches.

Is there any promising research or are there promising drugs for mesothelioma?
Research is being conducted at various cancer centers all over the United States as well as by pharmaceutical companies. To find more about these studies, click on Clinical Trials. To read abstracts of the latest journal articles on mesothelioma research and to access these articles, click on Medical Journal Articles; or Mesothelioma News for news articles. A recent study of Alimta showed patients living much longer with Alitma than other chemotherapy drugs.

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

What kinds of other resources are available for people with mesothelioma?
There are numerous cancer web sites, some specific to mesothelioma. Because they are often difficult to locate, we have listed some relevant medical sites under Leading Cancer Links. We are always on the lookout for more so check our site often.

Mesothelioma Diagnosis

How is mesothelioma diagnosed?

A diagnosis of mesothelioma is most often obtained with careful assessment of clinical and radiological findings in addition to a confirming tissue biopsy. (Learn about typical mesothelioma symptoms.) A review of the patient's medical history, including history of asbestos exposure is taken, followed by a complete physical examination, x-rays of the chest or abdomen, and lung function tests. A CT scan or MRI may also be done at this time. If any of these preliminary tests prove suspicious for mesothelioma; a biopsy is necessary to confirm this diagnosis.

Imaging Techniques and Their Value in Diagnosing and Assessing Mesothelioma

There are several imaging techniques which may prove useful when mesothelioma is suspected due to the presence of pleural effusion combined with a history of occupational or secondary asbestos exposure. While these imaging techniques can be valuable in assessing the possibility of the cancer, definitive diagnosis is still most often established through fluid diagnosis or tissue biopsy.

Some of the most commonly used imaging methods include:

X-ray

A chest x-ray can reveal pleural effusion (fluid build-up) which is confined to either the right (60%) or left (40%) lung. On occasion, a mass may be seen. Signs of prior non-cancerous asbestos disease, such as pleural plaques or pleural calcification, or scarring due to asbestosis may also be noted.

Computed Tomography (CT)

CT scans are also able to define pleural effusion, as well as pleural thickening, pleural calcification, thickening of interlobular fissures, or possible chest wall invasion. CT, however, is not able to differentiate between changes associated with benign asbestos disease (pleural disease), or differentiate between adenocarcinoma of the lung wh

ich may have spread to the pleura verses mesothelioma. CT scans may also be valuable in guiding fine needle aspiration of pleural masses for tissue diagnosis.

Magnetic Resonance Imaging (MRI)

MRI scans are most often used to determine the extent of tumor prior to aggressive treatment. Because they provide images in multiple planes, they are better able to identify tumors as opposed to normal structures. They are also more accurate than CT scans in assessing enlargement of the mediastinal lymph nodes (those lymph nodes which lie between the two lungs), as well as a clear diaphragmatic surface, both of which play an important role in surgical candidacy.

Positron Emission Tomography (PET)

PET imaging is now becoming an important part of the diagnosis and evaluation of mesothelioma. While PET scans are more expensive than other types of imaging, and are not always covered under insurance, they are now considered to be the most diagnostic of tumor sites, as well as the most superior in determining the staging of mesothelioma. Further explanation of PET scans.

CT/PET

For patients who may be candidates for aggressive multimodality treatment (surgery, chemotherapy and radiation), accurate clinical staging is extremely important. Integrated CT/PET imaging provides a relatively new tool in this respect, and has become the imaging technique of choice for determining surgical eligibility. By combining the benefits of CT and PET (anatomic and metabolic information) into a single scan, this technology can more accurately determine the stage of the cancer, and can help identify the best treatment option for the patient. Read about a study of CT-PET imaging in preoperative evaluation of patients with malignant pleural mesothelioma.

A needle biopsy of the mass, or the removal and examination of the fluid surrounding the lung, may be used for diagnosis, however, because these samples are sometimes inadequate as far as determining cell type (epithelial, sarcomatous, or mixed) or because of the unreliability of fluid diagnosis, open pleural biopsy may be recommended. In a pleural biopsy procedure, a surgeon will make a small incision through the chest wall and insert a thin, lighted tube called a thoracoscope into the chest between two ribs. He will then remove a sample of tissue to be reviewed under a microscope by a pathologist. In a peritoneal biopsy, the doctor makes a small incision in the abdomen and inserts a peritoneoscope into the abdominal cavity.

Once mesothelioma is suspected through imaging tests, it is confirmed by pathological examination. Tissue is removed, put under the microscope, and a pathologist makes a definitive diagnosis, and issues a pathology report. This is the end of a process that usually begins with symptoms that send most people to the doctor: a fluid build-up or pleural effusions, shortness of breath, pain in the chest, or pain or swelling in the abdomen. The doctor may order an x-ray or CT scan of the chest or abdomen. If further examination is warranted, the following tests may be done:

  • Video-Assisted Thoracoscopic Surgery (VATS)

Over the past decade, the use of video-assisted thoracic surgery (VATS) has become one of the most widely used tools in the diagnosis of mesothelioma. Biopsies of the pleural lining, nodules, masses and pleural fluid can now easily be obtained using this minimally invasive procedure, and other therapies such as pleurodesis (talc) for pleural effusions can be done concurrently.While the patient is under general anesthesia, several small incisions or “ports” are made through the chest wall. The surgeon then inserts a small camera, via a scope, into one incision, and other surgical instruments used to retrieve tissue samples into the other incisions. By looking at a video screen showing the camera images, the surgeon is able to complete whatever procedures are necessary

In many cases, this video-assisted technique is able to replace thoracotomy, which requires a much larger incision to gain access to the chest cavity, and because it is minimally invasive, the patient most often has less post-operative pain and a potentially shorter recovery period.

  • Thoracoscopy

For pleural mesothelioma the doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test is usually done in a hospital with a local anesthetic or painkiller.

If fluid has collected in your chest, your doctor may drain the fluid out of your body by putting a needle into your chest and use gentle suction to remove the fluid. This is called thoracentesis.

  • Peritoneoscopy

For peritoneal mesothelioma the doctor may also look inside the abdomen with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is usually done in the hospital under a local anesthetic.

If fluid has collected in your abdomen, your doctor may drain the fluid out of your body by putting a needle into your abdomen and using gentle suction to remove the fluid. This process is called paracentesis.

  • Biopsy

If abnormal tissue is found, the doctor will need to cut out a small piece and have it looked at under a microscope. This is usually done during the thoracoscopy or peritoneoscopy, but can be done during surgery. More on needle biopsies.

 

Pathology and The Role of Pathologists in the Diagnostic Process

Pathology, or the scientific study of cells, tissue, or fluid taken from the body is an integral part of a mesothelioma diagnosis. Most hospitals have their own pathology labs staffed by board-certified pathologists and licensed technologists. The importance of pathological diagnosis can not be underestimated, since the course of treatment is dependent upon an accurate diagnosis.

To make a diagnosis, pathologists examine tissue under a microscope, and based on established criteria, make a determination of benign vs. malignant cells. (More on biopsy tissue processing.) Subsequently, the type of cancer is determined. Although most pathologists have a general expertise of various diseases, a small number acquire training in a subspecialty, such as mesothelioma. These are physicians who have received world-wide recognition as premier experts, and have achieved high acclaim for their research, published articles and abstracts, and teaching. For a list of expert pathologists in the field of mesothelioma diagnosis, please call the MW toll free at 1-877-367-6376 or fill in the form at the bottom of this page specifying your request.

Knowing the stage is a factor in helping the doctor form a treatment plan. Mesothelioma is considered localized if the cancer is confined to the pleura, or advanced if it has spread beyond the pleura to other parts of the body such as the lungs, chest wall, abdominal cavity, or lymph nodes.

Immunohistochemical Markers for Mesothelioma

A diagnosis of any specific type of cancer often means ruling out other cancers in the process. This is true in the case of mesothelioma, where the most common “differential diagnosis” is that of adenocarcinoma versus mesothelioma.

During the biopsy procedure, the surgeon removes tissue samples to be sent to the laboratory. In the lab, slides are produced and then viewed and analyzed by a pathologist. These tissue specimens arrive at the lab with a request form that details patient information and history along with a description of the site in the body from which the specimen was obtained. Each individual specimen is numbered for each patient.

The pathologist then does a “gross examination” which consists of describing the tissue, and then placing it in a plastic cassette. The cassettes are then placed in a fixative that preserves the tissue permanently. Once the tissue has been fixed, it is processed into a paraffin block that will allow the pathologist to slice off thin microscopic sections that will then be stained to determine the patient’s diagnosis.

Immunohistochemistry is defined as “a method of analyzing and identifying cell types based on the binding of antibodies to specific components of the cell”. It is this process that helps diagnose mesothelioma versus adenocarcinoma (or other types of cancer).

Early on, the “markers” which helped distinguish mesothelioma from adenocarcinoma were “negative markers”; those expressed in adenocarcinomas, but not in mesotheliomas. This made it more difficult to confirm a diagnosis, because pathologists were dealing with the absence of, rather than the presence of certain markers. Some of these markers, which are normally “positive” in an adenocarcinoma diagnosis and “negative” in a mesothelioma diagnosis, are carcinoembryonic antigen (CEA), CD 15 (LeuM1), epithelial glycoprotein (Bg8), tumor glycoprotein (BerEp4) and tumor glycoprotein (MOC-31).

In more recent years, “positive markers” expressed by mesotheliomas have come to the forefront. Some of the markers which are normally “positive” in mesotheliomas and “negative” in adenocarcincomas are calretinin, cytokeratin 5, HBME-1, mesothelin, N-cadherin, thrombomodulin, vimentin and Wilm’s tumor gene product (WT-1).

It is important to remember that while the above markers are commonly used to help diagnose the epithelial sub-type of mesothelioma, that they may also be expressed in other types of cancer, and may not necessarily apply to the bi-phasic or sarcomatoid sub-types of mesothelioma. Your doctor can always contact a more specialized lab if he/she feels your diagnosis is in any way inconclusive.

Peritoneal Mesothelioma

Peritoneal Mesothelioma (Abdominal Mesothelioma)

Malignant peritoneal mesothelioma
Abdominal cavity showing the location of the peritoneum; peritoneal mesothelioma.
is an extremely rare condition. Only 100 to 500 cases are diagnosed in the US each year, making up less than 30% of all mesothelioma cases.

Peritoneal mesothelioma is a cancer affecting the abdominal lining, or peritoneum (paira-tin-e-um), which is why is is sometimes referred to as abdominal mesothelioma. This membrane supports and covers the organs of the abdomen.

The peritoneum is made of two parts, the visceral and parietal peritoneum. The visceral peritoneum covers the internal organs and makes up most of the outer layer of the intestinal tract. Covering the abdominal cavity is the parietal peritoneum.

Cells in these linings secrete a fluid which allows organs to move against one another. For instance, as the intestines move food through the body. The cells of the mesothelium are designed to create fluid, but the cancer causes them to overproduce, creating a build up of excess fluid in the abdominal cavity.

Because pleural mesothelioma is more common and often spreads to the peritoneal cavity, it is important to determine if pleural mesothelioma is the primary cancer.

How does asbestos cause peritoneal mesothelioma?

Although there's no definitive explanation, it is widely believed that asbestos causes peritoneal mesothelioma in one of two ways. First, asbestos fibers may be ingested, and when in the intestinal tract, the fibers may work themselves into the peritoneal cavity and peritoneum. Second, they may be inhaled and transported through the lymph node system to the peritoneal cavity.

Friday, September 5, 2008

Mesothelioma Attorney

Questions to ask when selecting a mesothelioma attorney.

These pages provide consumer tips for how to deal with the financial aspects of selecting a mesothelioma attorney.   They do not provide any information regarding the medical aspects of this serious disease.

Since so much is at stake, selecting the right mesothelioma lawyer is very important.   According the Wall Street Journal, lawyers say a typical mesothelioma award in a mesothelioma settlement is $1 million, and attorneys get 40% of this amount.   If the case actually goes to trial, the average award was $6 million in 2001, which was triple the amount awarded just two years earlier.

So, mesothelioma attorneys are very eager to find mesothelioma patients.   And it's vital that patients select the mesothelioma attorneys that are best for them.

A Brief Background on Your Legal Rights Regarding Mesothelioma

Companies that manufacture products that contain asbestos have known for over 60 years that asbestos can cause serious diseases.

Unfortunately, because many of these companies wanted to increase their profits, they kept this information quiet, thereby seriously endangering their workers.  

There are now laws that help protect the workers who have been harmed by their exposure to these asbestos-related products.  

However, since representing mesothelioma can be so profitable to attorneys, it is important that people who have mesothelioma be especially careful selecting attorneys who are really qualified to represent them.   Therefore, we have created a list of...

Important Questions to Ask When Selecting a Mesothelioma Attorney

Question #1 to Ask When Selecting a Mesothelioma Attorney:

What is your personal experience in representing mesothelioma patients?   Your goal is to find out how many cases the attorney has actually handled.  

You also want to know: how many of these were settled, and how many of these went to trial?   What were the results of each case?

You should ask the same questions about his or her law firm.   You're goal is to find out about the firm -- is this an area the firm specializes in?

Question #2 to Ask When Selecting a Mesothelioma Attorney:

Next, you want to ask if the lawyer intends to actually handle your case him or herself.   Many attorneys simply refer these cases to another law firm and receive part of the fee in exchange.   This may not be in your best interest.

Click here for more questions to ask when selecting a mesothelioma lawyer 

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Mesothelioma Symptoms

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion (discussed below). The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

PLEASE KEEP IN MIND THAT THESE SYMPTOMS MAY BE CAUSED BY MESOTHELIOMA OR BY OTHER LESS SERIOUS CONDITIONS. ONLY A DOCTOR CAN MAKE A DEFINITIVE DIAGNOSIS.

Information on the symptoms, diagnosis, staging, and treatment of peritoneal mesothelioma.

Information on the symptoms, diagnosis, staging, and treatment of pleural mesothelioma.

Pleural Effusion

One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these membranes are covered with mesothelial cells which, under normal conditions, produce a small amount of fluid that acts as a lubricant between the chest wall and the lung. Any excess fluid is absorbed by blood and lymph vessels maintaining a balance. When too much fluid forms, the result is an effusion.

Types

Pleural effusion is broken down into two categories, transudates and exudates. A transudate is a clear fluid that forms not because the pleural surfaces are diseased, but because of an imbalance between the normal production and removal of the fluid. The most common cause of transudative fluid is congestive heart failure. An exudate, which is often cloudy and contains many cells and proteins, results from disease of the pleura itself, and is common to mesothelioma. To determine whether a fluid is a transudate or exudate, a diagnostic thoracentesis, in which a needle or catheter is used to obtain a fluid sample, may be conducted.

Symptoms

As the volume of fluid increases, shortness of breath, known as "dyspnea", and sometimes pain, ranging from mild to stabbing, may occur. Some patients may experience a dry cough. When the doctor listens to the patient’s chest with a stethoscope, normal breath sounds are muted, and tapping on the chest will reveal dull rather than hollow sounds.

Diagnosis

Diagnosis of pleural effusion is usually accomplished with a simple chest x-ray, although CT scans or ultrasound may also be used. A special x-ray technique, called a lateral decubitus film, may be used to detect smaller effusions or to enable the physician to estimate of the amount of fluid present. If the underlying cause of the effusion is readily apparent (such as in the case of severe congestive heart failure), sampling of the fluid may not be necessary, however, because pleural effusion may be symptomatic of a number of disease processes from benign to malignant, a fluid sample is generally taken. Diagnostic thoracentesis, in which cells are extracted from the pleural cavity, is commonly done when the possibility of mesothelioma exists, however, in up to 85% of cases, the fluid tests negative or inconclusive even though cancer is present. It is ultimately a needle biopsy of the pleura (lining of the lung) or an open surgical biopsy which confirms a mesothelioma diagnosis.

Treatment

Pleural effusion caused by heart failure or infection can usually be resolved by directing treatment at the cause, however, when testing has realized no diagnosis, and fluid continues to build or recur, doctors may recommend chest tube drainage and chemical pleurodesis. Chemical pleurodesis is a technique in which a sclerosing agent is used to abrade the pleural surfaces producing an adhesion between the parietal and visceral pleurae. This will prevent further effusion by eliminating the pleural space. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is administered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution which forms a wet slurry that can roll around the pleural cavity.

Fatigue in Mesothelioma Patients

Mesothelioma Pain

Early Diagnosis Is Critical For Effective Treatment of Mesothelioma

Cancer is one of the most fatal diseases nowadays. It doesn?t choose its victims. Men and women alike, old and young die of cancer. Mesothelioma is a rare form of cancer that affects the mesothelium, specifically the Pleura (membrane that surrounds the lungs) and the Peritoneum (membrane surrounding the abdomen). Both Pleural Mesothelioma and Peritoneum Mesothelioma are primarily caused by the inhalation or exposure to asbestos, an incombustible fibrous mineral of impure magnesium silicate used in various industrial products. About 30 to 50 per cent of the total Mesothelioma cancer patients had not been exposed to asbestos, yet they have acquired the disease. Cancer specialists continue to study this rare kind of cancer so as to provide the public clear and exact information with regard to its cause, nature and cure.

Like many other forms of cancer, Mesothelioma has different stages. The earliest stage is still curable since only one layer of the pleura is affected. Surgery is the number one option for patients with Stage I Mesothelioma. The doctor removes the part of the lining of the lungs or chest (in case of Pleural Mesothelioma) and the lining of the abdomen (in case of Peritoneal Mesothelioma). In Stage II Mesothelioma, surgery can still be executed although some lymph nodes may have already been infected by the malignant Mesothelioma cancer cells. The diaphragm may also be removed; in severe cases, the Mesothelioma patient has to sacrifice one of his lungs.

Usually, surgery comes with systemic treatments, which include radiotherapy and chemotherapy. Through radiotherapy, Mesothelioma cancer cells are killed; however, only the cells in the treated area die. High energy rays used in radiotherapy or radiation therapy may either come from an external machine or from thin plastic tubes positioned into the tissues where Mesothelioma cancer-stricken cells are found. Inside the plastic tubes are radiation-emitting materials that kill the malignant cells. The use of an external machine is called external radiation therapy while the other is called internal radiation therapy. Also, a radioactive substance such as radiolabeled monoclonal antibody is circulated around the body during radiotherapy.

Chemotherapy is the use of anti-cancer drugs to kill the malignant cells. In treating Mesothelioma, the anti-cancer drugs are usually given to the patient through intravenous injection (within the vein). Oncologists are still studying the possibility of treating Mesothelioma through intracavitary chemotherapy (within the chest or abdomen). Some Mesothelioma patients also undergo Photodynamic therapy, a kind of cancer therapy that combines the use of drug (photosensitizer) with a specific kind of light. The photosensitizing agent when exposed to the light produce oxygen that destroys nearby malignant cancer cells. The drug is injected into the bloodstream and is absorbed by the cells.

In order to relieve the symptoms of Mesothelioma such as the pain in the chest or abdomen due to the build up of fluid, a physician drains the fluid by using a needle. The procedure is known as thoracentesis (removal of fluid in the chest) or paracentesis (removal of the fluid in the abdomen). To prevent further accumulation of the lubricating fluid in the membranes of the chest or abdomen, drugs are given through a tube in the affected organ.

Although the said treatments to Mesothelioma have been proven effective, chance of recovery and survival still depends on the size or extent of the cancer. Chances are higher when Mesothelioma is still in its early stages. Surgery is only advisable only up to the second stage of the Mesothelioma cancer wherein only one part or smaller portions of the membranes are affected. A patient diagnosed with stage IV Mesothelioma (diffuse Mesothelioma) has only about 4-24 months to live. Furthermore, the age of the patient and his general health condition is also crucial to his recovery. Older patients do not respond well to certain cancer treatments such as surgery because their tissues, organs and other body parts are more delicate.