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Mesothelioma Treatment Options

There are treatment options available for patients with all stages of mesothelioma and include surgery, chemotherapy, radiation and new clinical options.
Doctors offer three primary types of treatment to malignant mesothelioma patients: Surgery, chemotherapy and radiation. The types of treatment you receive depend on your diagnosis, the stage and type of your mesothelioma and your overall health.

If the cancer has not yet spread, a combination of radiation, surgery and chemotherapy likely will be offered to you. This combined approach to treatment is called multimodal therapy.

If the mesothelioma already has spread significantly, doctors typically recommend palliative treatments that can help alleviate pain, breathing problems and other cancer symptoms that lessen your quality of life. You are still likely to be offered radiation and chemotherapy, but probably not major surgery options.

Radiation therapy can soothe pain and correct breathing issues by shrinking tumors that press on your nerves, veins and airways. Chemotherapy also shrinks tumors, helping with chest pain and night sweats. Non-curative surgeries can remove tumors that cause troublesome symptoms, or drain fluid that builds up in the chest or abdomen.

You may also want to talk to your doctor about other treatment options beyond surgery, chemotherapy and radiation therapy. Experimental treatments exist, mostly in clinical trials, and sometimes they can make a huge difference.

Some patients also pursue alternative treatments like massage therapy, acupuncture or yoga. These can often be added to standard treatments like chemotherapy, so talk with your doctor about which therapies you'd like to explore.

What Are My Treatment Options?

There are several treatment options for patients with mesothelioma, from surgery to chemotherapy. These treatment options are not typically considered a cure for mesothelioma patients, although patients have reached remission in certain cases. These cases are typically situations where the disease was caught in the earliest stages and treated aggressively by a specialist.

Surgical options are available for both curative and pain-relief purposes for all types of mesothelioma. Recovery from surgery can last several weeks.

Chemotherapy is an effective and viable form of treatment viable for patients with all 4 stages of malignant mesothelioma.

Radiation therapy can be used before and after surgery to help shrink tumors and kill remaining cancer cells in a specific area of the body.

Mesothelioma Multimodal Treatment
Multimodal Treatment
Aggressive surgical treatments combined with chemotherapy and radiation have increased the life expectancy of many patients.

Mesothelioma Clinical Trials
Clinical Trials
Clinical trials offer patients access to emerging treatments such as immunotherapy treatments, gene therapy and photodynamic therapy.


Complementary Mesothelioma Treatments

Treatment for mesothelioma is usually provided by a combination of surgery, chemotherapy, and radiation, or by an emerging treatment such as immunotherapy or gene therapy. However, complementary treatments can provide additional relief from symptoms or help patients during recovery after their primary treatment is delivered.

Palliative Care
In cases where a cure for mesothelioma is not likely, such as with a Stage 4 diagnosis when the cancer has spread throughout the body, palliative care may still be an option. This type of care uses many of the techniques described above, but focuses on relieving the pain and suffering of the patient, rather than trying to eradicate the disease.

For example, one of the most debilitating symptoms of pleural mesothelioma is the build-up of fluid in the pleural space around the lungs. This collection of fluid makes it very difficult to breathe and also can cause severe pain. It greatly impacts the quality of life for the patient and can make it difficult to do every day tasks. The best way to relieve this discomfort is to have the fluid removed by means of a pleurocentesis.

In addition to or as an alternative to invasive procedures, medication to help with pain, difficulty breathing, and other symptoms that may be experienced is often prescribed. Click on the following link to learn more about pain management as well as its associated risks.

Physical Therapy
After the primary treatment, physical therapy is often required to help patients recover from the trauma of the treatment itself. The specific form of physical therapy a patient undergoes will depend on the specific type of treatment they receive, and how their body reacts to it. Common types of physical therapy include cardiovascular training, scar tissue healing, fatigue management, and strength training. While physical therapy will not necessarily help eradicate cancer or prevent recurrence, it can improve a mesothelioma survivor’s quality of life and overall health.

Alternative Therapies
Many patients have found relief from physical and emotional symptoms through different forms of alternative treatment, including everything from massage and acupuncture to yoga and art therapy. The important thing is to consult your doctor before trying one of these alternative treatments, to make sure it will not interfere with your primary treatment plan.

Standard And Experimental Mesothelioma Treatments

Treatment for mesothelioma typically involves a combination of surgery, chemotherapy, and radiation therapy. In cases where standard treatments do not work, mesothelioma patients may also be able to try experimental treatments through clinical trials.

While no cure currently exists, mesothelioma patients can usually improve their prognosis through some form of treatment. Even in cases where improving lifespan is not viable, palliative care and alternative therapies often help reduce pain and suffering from symptoms for many individuals with mesothelioma.

Standard Mesothelioma Treatments
The three standard therapies used to treat mesothelioma include surgery, chemotherapy, and radiation. In many cases, mesothelioma specialists will recommend a multimodal approach, which uses a combination of these three types of treatment.

Important considerations in determining a mesothelioma treatment plan include the cancer stage, primary site affected and cell type. Treatment options also depend on whether the cancer is localized to the chest or has spread to the chest wall, diaphragm, or lymph nodes as well as your age and overall health.

Experimental Mesothelioma Treatments
In addition to more conventional therapies, researchers are constantly looking for new ways to treat mesothelioma patients. Some extremely promising emerging treatments have come out of clinical trials, in some cases extending the lives of mesothelioma patients by months or years.

By kickstarting or boosting the immune system, it is possible to enhance the body’s own defenses against cancer.

Gene Therapy
Since cancer is caused by faults in cell DNA, one new way of fighting cancer is by fixing or overwriting problematic genes.

Photodynamic Therapy
Through the novel use of light and photosensitizing drugs, researchers have found a way to kill cancer cells with few side effects.

Source : http://www.mesothelioma.com/treatment/

New Study Shows DNA Screening Can Help With Mesothelioma Treatment

GERMANY - A recently published study shows DNA screening could help doctors more effectively treat mesothelioma patients using platinum-based chemotherapy regimens. Several key genes have been marked as helpful in predicting patients’ responses to their treatments.

The study is called “Screening of Pleural Mesotheliomas for DNA-damage Repair Player by Digital Gene Expression Analysis Can Enhance Clinical Management of Patients Receiving Platin-Based Chemotherapy.”

Chemotherapy was developed in the 1940s and is one of the most widely employed treatments for all types of cancer. Today, over 100 chemotherapy drugs exist on the market. Common chemotherapy drugs used to treat mesothelioma include Alimta, Cisplatin, Carboplatin, Gemcitabine, Onconase, and Navelbine.

Poor efficacy is related to chemotherapy because platinum-compound agents work by inducing damages in the DNA of cancer cells. So the ability of cells to detect and repair the damages could be one of the characteristics that can help predict a patient’s outcome after chemotherapy.

Results in the patients showed DNA damage response “plays a crucial role” in how well mesothelioma cells respond to chemotherapy.

Twenty-four malignant pleural mesothelioma patients participated in the study. Twelve patients got Alimta/Platinol or Alimta/Platinol/Paraplatin after surgery. The other 12 got Platinol followed by Alimta before surgery.

Thirty genes were identified as being related to the cell’s ability to recognize and repair DNA damage. Several of these were associated with mesothelioma spread, treatment response, and overall survival.

Lead author of the study, Dr. Robert Fred Henry Walter of the University of Duisburg-Essen wrote, “CDC25A and PARP1 gene expression were correlated with lymph node spread, BRCA1 and TP73 expression levels with higher IMIG stage.”

Also, it was found that mesothelioma tumor progression may be linked to CHECK1 and XRCC2 expression.

“After a prospective validation, these markers may improve clinical and pathological practice, finally leading to a patient’s benefit by an enhanced clinical management,” concluded the report.

This is another example of a promising experimental therapy to come out of a clinical trial. The next step in determining whether this is a viable and effective treatment is to validate the markers in mesothelioma patients for eventual use in clinical practice.

New Study: Asbestos Exposure on Commercial Ships

A new study on the health risks of asbestos exposure to seamen working on commercial ships was recently published in the medical journal Inhalation Toxicology. According to the results of the study, asbestos exposure is believed to have occurred due to repairs to the ships and maintenance tasks throughout the time that seamen worked on these non-military vessels.

The study measured airborne asbestos on merchant ships and the resulting health of its merchants over time. Previous studies on the communications and actions of U.S. organizations concerning maritime health and safety were also taken into consideration.

According to the study, data from before 1970 was mostly based on studies of workers in manufacturing, milling, and mining industries that used asbestos. This is because in many cases, the health risks of asbestos exposure to merchant seamen were largely unknown until the 1970s and 1980s.

Although asbestos air levels were found to be below 1 f/cc for most repair and maintenance work, a few pleural abnormalities were discovered in some U.S. seamen. This raised a red flag for the U.S. government and several industry and labor organizations.

In the 1990s, increases in lung cancer and mesothelioma were found in studies of seamen, which led researchers to believe there was a causal link between asbestos exposure on ships for seamen and these lung diseases.

In 2008, a similar study was published on asbestos in maritime shipping vessels because the same level of review given to Navy sailors was not being given to merchant seamen, despite the fact that both groups have historically used many tons of asbestos to build and repair their vessels.

Asbestos was often used in sea vessels because it was an effective insulator to prevent condensation, reduce the ventilation needed to cool spaces, allow machinery to operate with decreased heat loss, and prevent workers from needing to come into contact with hot components.

Historical industrial hygiene data from maritime shipping vessels between 1978 and 1992 was used in the 2008 study, including oil tankers and cargo vessels that were docked and/or at sea. Although many samples were collected from suspected asbestos-containing materials, they were not taken during times when interaction with the materials would’ve occurred.

Results of the study showed asbestos levels were consistently below U.S. occupational standards and almost always below the current expectations of 0.1 f/cc. So the mere presence of undisturbed asbestos did not significantly increase exposure.

In 2003, a National Health Institute study concluded mesothelioma cancer should be considered an occupational disease for merchant mariners and that occupational asbestos exposure contributes to their increased cancer mortality.

Mesothelioma victim's family wins asbestos award

A federal jury in Arizona has awarded a total of $17 million to the surviving spouse and children of a worker who died of mesothelioma caused by exposure to asbestos.

In December 2012, George Coulbourn filed a product liability action in Mohave County Superior Court. He alleged he was exposed to companies' asbestos-containing products and/or machinery while working as a machinist for the Norfolk Naval Shipyard in Portsmouth, Virginia, from 1959 to 1966, court records show.

After Mr. Coulbourn died of mesothelioma in August 2013, his spouse and children amended his complaint and brought a wrongful death action, records show.

On Friday, following a three-week trial, a U.S. District Court of Arizona federal jury awarded $6 million to Mr. Coulbourn's widow, Sandra Brown Coulbourn, and $1 million to each of his three children, George Charles Coulbourn Jr., Scott Alan Coulbourn and Shannon Coulbourn Moses, according to court records and a statement by the family's lawyers at Dallas-based Simon Greenstone Panatier Bartlett P.C.

Among the more than 20 defendants are Stamford, Connecticut-based industrial products company Crane Co., which was ordered to pay Mr. Coulbourn's family $5 million in punitive damages, and Cincinnati, Ohio-based valve manufacturer William Powell Company, which was ordered to pay $3 million in punitive damages, according to the verdict.

In addition to the $17 million award, the jury found the U.S. Navy to be 47% responsible for Mr. Coulbourn's injuries and death. Meanwhile, it found Crane and William Powell to be responsible for 20% and 5%, respectively, while other defendants were assessed a 1% or 0% responsibility rating.

Asbestos is addressed in U.S. Occupational Safety and Health Administration standards for the construction industry, general industry and shipyard employment sectors. The standards require that “employers provide personal exposure monitoring to assess the risk and hazard awareness training for operations where there is any potential exposure to asbestos,” among other things.

How Does Asbestos Cause Cancer?

Fast Fact: 70-80 percent of people with mesothelioma were exposed to asbestos at work.

Mesothelioma typically develops after people are exposed to asbestos in the workplace – in industrial settings, shipyards, auto repair shops, old houses, schools and public buildings. While it usually takes long-term exposure to put someone at risk, short-term and one-time exposures are also known to cause this cancer.

Asbestos can cause health complications when work duties or other activities disturb asbestos-containing materials and release fibers into the air. When we inhale or swallow these microscopic fibers, our bodies struggle to get rid of them. Over decades, the trapped fibers trigger biological changes that can cause inflammation, scarring and genetic damage that sometimes leads to cancer. The lengthy gap between asbestos exposure and diagnosis is called the latency period.

Asbestos fibers most often become trapped in the lining of the lungs, called the pleura. They also can collect in the lining of the abdominal cavity (peritoneum) or heart (pericardium). Once fibers cause biological damage, the stage is set for the decades-long latency period for the development of malignant mesothelioma.

source : https://www.asbestos.com/mesothelioma/

Fibrous Pleurisy Versus Desmoplastic Variant of Sarcomatoid Mesothelioma

The identification of features of malignancy in a desmoplastic mesothelioma requires adequate tissue and the amount of tissue in a closed pleural biopsy is often insuf- ficient. Large surgical biopsies are generally needed. High-grade sarcomas presenting in the pleura generally do not enter into the differential diagnosis of fibrous pleurisy versus desmoplastic mesothelioma. Features to separate the latter two are shown in Table 3. In the study by Mangano et al,7 the distinction of fibrous pleurisy from desmoplastic mesothelioma could be made by identifying one or more of the following features in a spindle cell proliferation of the pleura: invasive growth, bland necrosis, frankly sarcomatoid areas, and metastatic disease.

Stromal invasion is often more difficult to recognize in spindle cell proliferations of the pleura than in epithelioid proliferations. The invasive malignant cells are often deceptively bland, resembling fibroblasts, and pancytokeratin staining is invaluable in highlighting the presence of cytokeratin-positive malignant cells in regions where they should not normally be present: in the connective tissue,adipose tissue, or skeletal muscle deep to the parietal pleura or invading the visceral pleura and lung tissue (or other extrapleural structures present in the sample) (Figure 4, A and B). Although Mangano et al7 also found bland necrosis of paucicellular fibrous tissue to be a reliable criterion of malignancy, it may be subtle and one may be reluctant to base a diagnosis of malignancy solely on
its presence. Fortunately, most cases that show bland necrosis also show invasive growth. Similarly, the presence of ‘‘frankly sarcomatoid foci’’ is a distinctly subjective determination and one would be reluctant to base a diagnosis of malignancy on its presence alone because reactive processes may show marked cytologic atypia, albeit typically at the surface of the process.

Uniformity of growth and thickness of the process, surface atypia with deep maturation, and perpendicular thinwalled vessels are typical of reactive fibrous pleuritis (Figure 5, A and B), in contrast to the disorganized growth pattern and variable thickness of desmoplastic mesotheliomas. A helpful clue in desmoplastic mesotheliomas is the presence of expansile nodules of varying sizes with abrupt changes in cellularity between nodules and their surrounding tissue.

Are There Different Types of Mesothelioma?

Mesothelioma Claim- There are three main types of mesothelioma. First is Pleural mesothelioma which is basically located in the pleura which serves as the lining of the lungs. This is the most common among the three types. Next is the peritoneal mesothelioma. Peritoneal practically refers to the peritoneum or the abdomen. The tumor starts at the peritoneal lining of the abdominal cavity. Last type of the rarest of them all which is the pericardial mesothelioma which begins at the pericardium that lines the heart.


Asbestos dates all the way back to the ancient Egyptions. And even then, they knew it caused permanent, life-threatening respiratory problems.

It was first discovered between the 1920s and 1930s that repetitive exposure to asbestos was linked to the rare but aggressive form of cancer called mesothelioma. Asbestos has been used far and wide, most commonly in commercial and industrial applications. Practically every person has been exposed to the toxic mineral; which actually carries airborne carcinogenic fibers that can easily be ingested by individuals.

Many occupations had put people at risk due to constant exposure to asbestos. Military veterans, construction workers and the like mostly have developed mesothelioma and have filed lawsuits reaching up to thousands. Plaintiffs claim that companies who used asbestos as well as the companies that manufactured products that contained the mineral were aware of the risks of serious adverse asbestos related diseases and ignored to accommodate the safety of the public. They are being charged with negligence, among others.

Plaintiffs are seeking compensation for medical expenses, pain and suffering, punitive damages, lost wages, loss of quality of life, and even funeral expenses death in the case of family members that filed lawsuits in behalf of a deceased loved one. Family members of the deceased loved one who had developed asbestos-related diseases or mesothelioma can also charge defendants with wrongful death.

Many plaintiffs have been awarded in the millions of dollars through verdicts in these lawsuits. Some start as far as $5.1 million and have gone up to $250 million. Each of these lawsuits, of course, has been awarded because of different circumstances unique to each case.

While there are no class action lawsuits regarding mesothelioma, there is a mass tort. This tort is the longest running in the history of the United States, as it is the most expensive mass tort in the country as well.

Many companies have also filed for bankruptcy due to constant payments for suits and settlements. Some companies, however, had created asbestos bankruptcy trusts so that plaintiffs can still claim compensation for damages by companies who have eventually ran out of business.

Mesothelioma Litigation

Filed lawsuits started in the 1960s, with workers, consumers and even families filing for these thousands of mesothelioma lawsuits. These lawsuits are against companies that manufactured products that contain products, or companies that allowed the installation of these products.

Over the years, juries have found that asbestos companies acted with malice due to the concealment of the dangers of asbestos. Because of the disregard for public safety, the cancer that could have been prevented has now become widespread.

Those diagnosed with asbestos related diseases including mesothelioma can claim compensation for the negligence of asbestos companies. Most plaintiffs filed lawsuits to gain compensation for medical expenses, pain and suffering, lost wages, loss of quality of life, and funeral expenses. It is common that these cases are settled outside of the court in spite of some lawsuits leading to beneficial jury verdicts.

Families who have lost loved ones due to asbestos related diseases are able to file wrongful death lawsuits, as well as military veterans who were exposed to the mineral while serving in the military are able to file lawsuits against manufacturers and can claim with the United States Department of Veteran Affairs for Veterans Affairs disability benefits.

Other people can also file claims against a company that is no longer operational. Claims with an asbestos bankruptcy trust that was created by these companies can be restored to plaintiffs who were damaged through exposure to the mineral.

Mesothelioma cases cannot be handled as class action lawsuits because of the variety of each case, covering various companies as defendants. Another reason for these lawsuits’ inability to be handled as class actions is because they normally take a lengthy time to settle and mesothelioma patients may not survive these long trials.

Mass torts give plaintiffs the freedom to keep their own lawyers. Mass torts work in such a way that the cases are grouped together to be more efficient, thereby saving time and money. Asbestos litigation is the longest running and one of the most expensive mass torts in the history of the United States because the litigation started in the 1970s. The litigation has cost defendants billions of dollars.

Roby Worthington, a former employee of U.S. Steel, won a verdict worth $250 million in 2003. Worthington worked for the company from 1950 to 1981 and was diagnosed with mesothelioma. Three years later, David Bakkie was awarded $18.5 million because of the occupational setting of the plastic molder worker from 1974 to 1975. Bakkie was diagnosed with the same disease in 2005. The construction worker was exposed to asbestos in the 60s and 70s. He was diagnosed with the rare cancer they year before.

In 2007, family members of Richard Walmach, a United States Navy machinist mate, received $5.1 million through a verdict. The veteran died in 2006 of mesothelioma. Bobbie Izell won a favorable jury verdict in 2012. Veterans are often exposed to asbestos because of the military ships, army proving grounds and military bases across the world.

Mesothelioma Class Action Lawsuit

Mesothelioma Suit- While mesothelioma is almost limited to the exposure to asbestos, the mineral, on the other hand, can also lead to other illnesses like lung cancer and asbestosis. Workers in various industries have been faced with hazardous amounts of asbestos in practically every phase in production.

There have been many alternatives for asbestos that have been proven to be safer for people, but many companies still opt to use the toxic mineral because it is more affordable than its fire-resistant counterparts.  Companies and manufacturers are aware of the health risks associated with asbestos use and exposure but never actually publicized the dangers of it. Because of this outright disregard for public health, the companies have suffered the consequences of paying billions of dollars for lawsuits and settlements related to asbestos. Almost a hundred companies have declared bankruptcy because of this.

Because of the widespread use of asbestos in the 20th century, practically every person in the world has already been exposed to the airborne carcinogen. The risk of exposure to asbestos is normally minimal in individuals; however, abundant and frequent exposure, which is an often occurrence in occupational environments, is more perilous.

Persons who have mesothelioma have developed the disease through the inhalation of asbestos. The microscopic fibers make their way to the end points of small airways in the body. These, in turn, become wedged in the lining of either the chest or the lungs. After some time, these lodges cause scarring and genetic changes in an individual – basically developing pleural mesothelioma. Fibers that find their way in the lining of the abdomen causing peritoneal mesothelioma are those consumed orally, like through contaminated drinking water or through coughing.

As mentioned before, the development of mesothelioma takes a long time. Same goes for its diagnosis. Because the symptoms can be mistaken for other more common illnesses, patients don’t pay much attention to them. Various tests are also needed prior to diagnosis, including chest X-rays, CT scans, MRI scans, PET scans, and biopsies. Biopsies are crucial in determining if a certain patient has cancer or not.

The International Mesothelioma Interest Group (IMIG) system is the formal system used to determine which stage a patient’s mesothelioma is in. The IMIG system divides cancer stages into four, using Roman numerals from I to IV. However, peritoneal mesothelioma has no formal staging system.

Mesothelioma has several treatment options, depending on the patient. Thus, specialists of this certain kind of cancer create customized treatment plans for every patient in order to get the best results and treatment. Doctors consider the following factors in planning treatment options for patients with mesothelioma: cancer stage, mesothelioma subtype, overall health, and the patient’s ability to perform day to day activities.

Standard therapies for mesothelioma include surgery, chemotherapy, and radiation therapy – as with most cancer types. However, many medical experts have been conducting clinical trials to figure out new ways of treating the rare cancer disease. Unfortunately, there have been poor survival rates of mesothelioma in patients due to its aggressiveness.

FDA Warnings and Reports

Reports that date as far back as the 1920s have said that medical evidence had already surfaced regarding the association of asbestos exposure to the rare cancer and other similar illnesses as reported today. Many manufacturers and asbestos product-using companies opted to neglect the data presented.

Medical literature has reported that the average survival rate for mesothelioma patients range from four to 18 months. A factor to this low survival rate is also attributed to late diagnosis or the inability to diagnose a mesothelioma patient in the early stages of the cancer. Doctors typically tell patients that the prognosis is only about a year.

In January 1997, a group of doctors and medical professionals convened to discuss Simian Virus 40 (SV40): A Possible Human Polyomavirus Workshop; where the professionals present ideas and findings regarding cancer and its tumors, including mesothelioma. The workshop was created due to reports that showed the presence of the SV40 viral sequences in tissue, including rare tumors in humans.

The FDA also discussed drugs intended to treat mesothelioma in the Drug Safety Newsletter of Spring 2008. Pemetrexed was the first approved drug for malignant pleural mesothelioma. It was approved by the FDA in February 2004.

As seen in the FDA website, a 2007 brochure from MESOMARK was sent out to patients diagnosed with malignant mesothelioma. Mesomark assay is the first blood serum based test sensitive and is the most reknowned blood test for mesothelioma. The FDA approved blood test checks the blood levels for a protein from the cancerous cells called mesothelin-related peptide or SMRP.