What is Mesothelioma?

Mesothelioma, more precisely malignant mesothelioma is a rare type of cancer. Malignant (cancerous) cells develop in the mesothelium, the protective sac that covers most of the body’s internal organs. Mesothelioma generally starts in the outer membrane of the lungs (pleura), but can also occur in the lining of the abdominal cavity (peritoneum). Uncommonly, the heart or reproductive organs may be affected. Treatment depends on where the cancer is found and whether it has spread.

Mesothelioma is almost always caused by exposure to asbestos and can develop decades after the exposure.

How do you get malignant mesothelioma?

Mesothelioma is caused by asbestos exposure.  Asbestos, once regarded as a miracle mineral, was popular due its lightweight but tough characteristics as well as for its heat-resistant properties. This naturally occurring mineral was used in many commercial and consumer products, from construction materials such as cement, roofing shingles and insulation, to consumer and industrial applications such as hair dryers, automobile brake pads and pipe insulation.
Most people with malignant mesothelioma worked on jobs where they breathed asbestos. Others were exposed to asbestos in a household environment, often without knowing it.

What happens inside the body?

The cancerous cells clump together in a malignant tumour.  As it grows, the tumour pushes against and into other organs and healthy tissue, causing symptoms.  Because the mesothelium is a flat thin lining, the mesothelioma tumour often takes a diffuse shape.
In its advanced stage the cancer metastasizes through the lymph system and spreads to other parts of the body.  It is still referred to as mesothelioma because it started in the mesothelium. 

How it spreads?

Malignant (cancerous) cells develop in the mesothelium. This protective sac has different names, depending on its location in the body. Those most commonly affected by mesothelioma are:

• Visceral pleura – the membrane that surrounds the lungs
• Parietal pleura – the membrane that lines the chest wall
• Peritoneum – the membrane that forms the lining of the abdominal and pelvic cavities.

Mesothelioma most often starts in the pleura. Normally, the two pleura touch and slide across each other while we breathe, lubricated by a slick of fluid. In cases of pleural mesothelioma, the pleura make more fluid than necessary, which presses on the lung (pleural effusion). Mesothelioma usually develops in only one lung. The tumour tends to grow across the lung until the entire organ is encased.

In about 10 per cent of mesothelioma cases, asbestos fibres that have been swallowed can move through the stomach wall and cause cancer cells to develop in the peritoneum (peritoneal mesothelioma).

Sometimes cancer cells migrate to lymph nodes and other areas of the body (such as the unaffected lung) via the lymphatic system. Uncommonly, the heart or reproductive organs may be affected.

Signs and symptoms of mesothelioma

Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a build-up of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anaemia, 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 anaemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (haemoptysis)

In severe cases, the person may have many tumour masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumours 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 build-up 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 tumours are usually found only on one side of the lungs.

Stages of mesothelioma

To find out how far the cancer has spread process called staging is usually used. Staging of mesothelioma is based on MRI, x-rays, CT scans. The stage (extent of spread) of the cancer influences the choice of the treatment and outlook for patients with mesothelioma. A staging classification exists only for pleural mesothelioma because this disease occurs most frequently and has been studied the most.

There are three staging systems that are currently in use.

Butchart System is the most popular and the oldest staging system. It divides mesotheliomas into four stages. Main markers of this staging are mass and spread, lymph node involvement, and metastasis. The newest system called Brigham System stages mesothelioma according to lymph node involvement and the ability to surgically remove (respectability).

The less staging is the better prognosis has a patient.

1. Butchart System - primary tumour mass extent

Stage I: Mesothelioma can be found in the left or right pleura. The diaphragm on the same side may also be involved.

Stage II: Mesothelioma is presented in the chest wall. It can also involve heart, pleura on both sides and the oesophagus. The involvement of lymph nodes is also possible.

Stage III: Mesothelioma has succeeded in penetration into the lining of the peritoneum or abdominal cavity. The involvement of lymph nodes beyond those in the chest is also possible.

Stage IV: There is metastasis in other organs and spreading through the bloodstream.

2. TNM System is a more recent system used to stage mesothelioma by considering variables such as the tumor size and spread, lymph node involvement, and metastasis. In the TNM system, the disease is divided into four stages: During TNM (tumour, node, and metastasis) doctors look at these three factors to determine the cancer stage:

The size and the location of the primary tumour. (Tumour, T)
Are lymph nodes involved? (Node, N)
Are there metastases in other organs? (Metastasis, M)

Tumour. To describe the stage of mesothelioma TNM system uses the "T" plus a letter or number (0 to 4). Division into smaller groups of some stages is also possible. It helps to describe a patient's condition in more detail. This staging is used to develop the best treatment plan. Below are tumour stages are described:

TX: It is impossible to evaluate the primary tumour.

T0: There are no evidences of tumour.

T1: The tumour can be found in the thin membrane that lines the inner chest walls on the same side of the body (the ipsilateral parietal pleura). The visceral pleura can also be involved.

T1a: There is an involvement of tumour into the ipsilateral parietal pleura but visceral pleura are not involved.

T1b: The tumour can be found in the ipsilateral parietal pleura. Visceral pleura are also involved.

T2: There are evidences of involvement of the ipsilateral pleural surfaces. One of the following must also be involved: the diaphragmatic muscle, lung and visceral pleural tumour.

T3: There are evidences of involvement of the ipsilateral pleural surfaces. One of the following body parts must also be invaded: mediastinal fat and/orendothoracic fascia (the membrane that surrounds the thorax.

T4: There are evidences of involvement any of the ipsilateral pleural surfaces. One of the following signs can also be found: any involvement of rib, diffuse or multifocal invasion of soft tissues of the chest wall, invasion of any mediastinal organ(s), invasion through the diaphragm to the peritoneum, invasion into the spine, extension to the internal surface of the pericardium, direct extension to the contra lateral pleura, pericardial effusion with positive cytology, invasion of the myocardium, and/or end thoracic fascia and/or invasion of the brachial plexus.

Node. Lymph nodes that are situated not near the chest in other parts of the body are called distant lymph nodes and near the chest - regional lymph nodes.

NX: It is impossible to assess regional lymph nodes.

N0 (N plus zero): There are no evidences of regional lymph node metastasis.

N1: Metastasis can be found in the hilar lymph node(s) and/or ipsilateral bronchopulmonary.

N2: There is metastasis to the ipsilateral internal mammary or mediastinal lymph node(s) and/or subcarinal lymph node(s).

N3: Metastasis can be found in the hilar lymph node(s), contra lateral mediastinal, internal mammary and/or the ipsilateral or scalene lymph node(s) or contra lateral supraclavicular.

Distant metastasis.  Shows whether the cancer has spread to other organs.

MX: It is impossible to assess distant metastasis.

M0 (M plus zero): There are no evidences of distant metastasis.

M1: There is metastasis.

Cancer stage grouping

The stage of the cancer is determined by combining the T, N, and M classifications.

Stage I: The tumour has not spread to the lymph nodes or other parts of the body but has invaded the ipsilateral parietal pleura, with or without involvement of the visceral pleura. (T1, N0, M0).

Stage IA: The tumour has not spread to the lymph nodes or other parts of the body but has invaded the ipsilateral parietal pleura, without involvement of the visceral pleura. (T1a, N0, M0).

Stage IB: The tumour has not spread to the lymph nodes or other parts of the body but has invaded the ipsilateral parietal pleura, with involvement of the visceral pleura. (T2a, N0, M0).

Stage II: There evidences of tumour invasion into any of the ipsilateral pleural surfaces and one of the following: visceral pleural tumour, the lung invasion or the invasion of the diaphragmatic muscle.

There is no spreading of cancer throughout the body or in the lymph nodes (T2, N0, and M0). Stage III: There are evidences of cancer in any of the ipsilateral pleural surfaces. Also one of the following are involved: the lung or the diaphragmatic muscle.

There is also an involvement of the following: the end thoracic fascia (the membrane that surrounds the thorax), mediastinal fat with spread to the lymph nodes, but not too distant parts of the body. Lymph nodes are also invaded, but not throughout the body (T1 or T2, N1, M0; T1 or T2, N2, M0; T3, any N, M0).

Stage IV: There are evidences of cancer in any of the ipsilateral pleural surfaces. Also one of the following are involved: soft tissues of the chest wall, rib, the spine, the peritoneum through the diaphragm, mediastinal organ(s), and the contra lateral pleura.

There may be an invasion of the myocardium, and/or invasion of the brachial plexus, extension to the internal surface of the pericardium, pericardial effusion with positive cytology. It also means that the cancer has spread to distant lymph nodes, or the cancer has spread to other parts of the body and that the tumour is of any size (T4, Any N, M0; any T, N3, M0; or any T, any N, M1).

3. Brigham System is the latest mesothelioma cancer staging system and is based on tumor resectability (ability to surgically remove) and lymph node status. The Brigham system is divided into four stages:

Stage I: Mesothelioma is resectable and there is no lymph node involvement;

Stage II: The lymph node is involved but mesothelioma is still respectable;

Stage III: There may be an extra thoracic lymph node involvement and the mesothelioma is unresectable and extended into chest wall, heart, or through diaphragm, peritoneum;

Stage IV: Distant metastatic disease.

Types of Mesothelioma

There are five types of mesothelioma. Four of them were malignant, and the condition is benign.

• Pleural Mesothelioma: This type of mesothelioma develops in the lung tissue, known as the pleura. This is the most common form of malignant mesothelioma, about 70 percent of cases of pleural origin.

• Peritoneal Mesothelioma: Forms of mesothelioma develops in the abdominal cavity tissue, known as the peritoneal membrane. Approximately 25% of mesotheliomas are of this type.

• Pericardial Mesothelioma: Forms of mesothelioma develops in the heart tissue called the pericardium. Approximately 5 percent of all cases of pericardial mesothelioma.

• Testicular Mesothelioma: This is the most rare type of malignant mesothelioma, until recently, there have been fewer than 100 cases were recorded. testicular mesothelioma in the tunica vaginalis testis develops.

• Benign Mesothelioma: Forms of benign mesothelioma generally develops in the pleura. This is the only form of mesothelioma is a result of healing and recovery is possible, though it may be a precursor of asbestos related problems in the future.

Diagnosis

The symptoms of mesothelioma may be caused by this condition or may be due to other, less serious conditions. It is important to see a doctor about any symptoms. Only a doctor can make a diagnosis.

Diagnosis of mesothelioma may include:

• Medical history, including history of asbestos exposure
• Physical examination
• Blood tests
• Chest x-rays
• CT scans
• Drainage and laboratory analysis of the pleural fluid
• Tissue sample (biopsy) to help differentiate mesothelioma from another condition known as ‘benign asbestos related pleural disease’.

Treatment

Treatment depends on the type of mesothelioma, the stage (extent) of disease and the person’s preference. Options may include:

• Pleurectomy – surgery to remove the affected tissue. The affected lung may also be removed in whole (pneumonectomy) or in part (lobectomy). Usually only small tumours are treated with surgery. A person’s life span may be prolonged for a few months or years.

• Phototherapy – a procedure sometimes used during pleurectomy. Stray cancer cells within the chest are highlighted with special dye and killed by laser.

• Thoracentesis – a procedure that removes fluid from the pleural cavity through a needle inserted between the ribs.

• Pleurodesis – a special powder is inserted between the pleural layers to cause inflammation and stop production of excess fluid. This is performed using a slender instrument (endoscope) inserted into the chest.

• Paracentesis – a procedure in which a thin needle or tube is put into the abdomen to remove fluid from the peritoneal cavity (the space within the abdomen that contains the intestines, the stomach and the liver).

• Peritoneal surgery – surgery to remove tumours in the abdominal cavity. Bowel symptoms can often improve following this procedure.

• Chemotherapy – the use of cancer-killing drugs that can shrink the cancer and ease symptoms. Chemotherapy is often recommended if the cancer has returned following other treatment or if other treatments are inappropriate.

• Radiotherapy – x-ray treatment to kill cancer cells. Only small areas can be treated or else the healthy cells of the lungs, heart and liver may be damaged. Radiotherapy is often used to ease pain and breathlessness.

Risk Factors of Developing Mesothelioma

There are a number of different factors that establish the likelihood of developing Mesohelioma

• The amount\concentration of airborne asbestos one has been exposed to
• The duration of time one has been exposed
• The size of the asbestos fibres
  Smaller fibres are more likely to remain in the lungs, while larger fibres are more likely to be filtered out by the throat and lungs.
• The form and state of the asbestos
  In a stable matrix material such as asbestos-cement sheeting, the fibres will most likely not become airborne unless they are improperly handled or damaged.
  Asbestos not in the form of a stable matrix material will far easily release fibres in high concentrations when damaged.

Mesothelioma Lawsuits

   
Lawyers may be considered sharks or grave diggers, the lowest of the lowest as they search for clients who are dead and dying, they are admittedly not the most loved of human professionals. Yet, while they may seem to be without a conscience the fact is, they give you hope.

If you suffer from mesothelioma because of the negligence of an employer or organization then you are due compensation. No, getting a lawyer will not cure mesothelioma, nor will it alleviate your suffering. However, being compensated for someone's negligence will allow you to ensure that the expensive treatment required for mesothelioma does not alter your life nor the life of your loved ones.

Mesothelioma law is basically about being compensated by the makers and distributors of asbestos.The best way to get compensation is by hiring the right lawyer!
If you want to legally claim that the mesothelioma you or your loved one contracted was a result of exposure to an asbestos zone, you must be able to prove that exposure. Try your best to remember the details of your exposure, the product name, or the location, your lawyers and investigators will get the details all you need to give them is the basics.

Mesothelioma is common in Australia

Australia has one of the highest rates of mesothelioma in the world. This is due to the high rate of asbestos use and mining over many years. In 2007 there were nearly 600 people diagnosed with mesothelioma in Australia. Of these new cases, 81 per cent were men.

In Victoria there are over 160 cases diagnosed each year. Experts believe the number of people diagnosed with asbestos-related diseases will not peak until 2020 with a possible 13,000 more new cases of mesothelioma in Australia each year.

Where to get help

• Your doctor
• Asbestos Diseases Foundation of Australia Tel. (02) 9637 8759
• Asbestos Diseases Society of Australia Tel. 1800 646 690
• Cancer Council Helpline Tel. 13 11 20
• Multilingual Cancer Information Line Tel. (03) 9209 0169
• Peter MacCallum Cancer Centre Tel. (03) 9656 1111
• WorkSafe Victoria Tel. (03) 9641 1444 or 1800 136 089
• Environment Protection Authority Victoria Tel. (03) 9695 2722
• Department of Health, Environmental Health Unit Tel. 1300 761 874
• Asbestos Victims Association South Australia Tel. (08) 8212 6008 or 1800 665 395 (SA country only)
• Asbestos Diseases Society of Victoria – Information, Support and Counselling Service Tel. (03) 9329 9584 or 1300 659 226