Diagnostic Tests for Mesothelioma

If mesothelioma is suspected, the physician will want to confirm that the disease is present, where it is located, determine the type and size of the cancer, and determine whether or not the disease has spread. There are several tests available to help answer these questions.

Initial Considerations for Diagnosis

Preliminary factors that should be discussed with a physician before a diagnosis of mesothelioma include:
Medical history: a physician will need to discuss past and present health issues, most importantly respiratory problems. The doctor should ask the patient about a family history of cancer as well as if they previously or currently smoke.
Physical Examination: key signs a doctor should be on the lookout for include evidence of a pleural effusion or pleural mass, a reduction of chest expansion capabilities, a lack of breathing sounds, mediastinal displacement, tenderness in a localized area and any protruding tumors.
Prior asbestos exposure: The American Cancer Society states that 80% of mesothelioma cases are caused by prior exposure to asbestos. Most commonly in professional environments such as power plants and chemical plants, countless men and women have been exposed to this toxic fiber including 25 million members of the armed forces.
While as many as 3,000 new patients are being diagnosed with mesothelioma annually, it is imperative to do preliminary testing to accurately establish a mesothelioma case.

Imaging Tests

Chest X-ray: This is typically the first imaging test your doctor will order. It is usually not the sole determinant of a proper prognosis, and so additional tests may be ordered.
CT Scan: Sometimes referred to as a CAT scan, this is similar to an X-ray but produces multiple images that are then assimilated by a computer to allow viewing of the tissue in greater detail. Patients receiving a CT scan are sometimes injected with a dye that will create greater contrast, thus providing greater detail.
PET Scan: Cancerous cells use and absorb sugars differently than healthy cells. This allows a PET scan to be an efficient method of detecting them. Patients are given an injection of glucose and then a scanner is used to identify any cells that are absorbing the glucose abnormally.
MRI: An MRI creates highly detailed images in three dimensions that allow a trained radiologist to identify any suspicious areas. This procedure uses a magnetic field and radio waves to produce the images.

Tissue and Fluid Tests

It is normal for a doctor to perform a biopsy of the suspicious area. This involves retrieving a sample of the tissue or fluid and then testing the sample for cancerous cells. There are four main types of biopsies that a doctor may choose to order.
Fine Needle Aspiration: Mesothelioma typically leads to a build-up of fluids in the area afflicted, such as the mesothelium, or lining, in the chest cavity. To perform a fine needle aspiration, the doctor uses an extremely thin, long needle to extract a fluid sample.
Thoracoscopy: If the doctor wishes to confirm or eliminate symptoms of pericardial or pleural mesothelioma, a thoracoscopy might be ordered. This involves a tiny incision in the chest wall in order to obtain a tissue sample.
Laparoscopy or Bronchoscopy: These two procedures are conducted on different areas of the body. A bronchoscopy may be ordered to check the airway and trachea. A laparoscopy involves the removal of a sample of the tissue from the peritoneal area.
Mediastinoscopy: This test is used to examine the lymph nodes located in the neck and chest to see if the cancer has spread from its initial site.

Blood Tests

Thanks to recent breakthroughs of specific biomarkers in the blood, doctors can now detect mesothelioma in earlier stages. That being said, elevated levels of certain biomarkers  in a patient's blood does not necessairly mean that a cancer is present.
Mesomark assay - The Mesomark assay test determines the amount of soluble Mesothelin-Related Peptides (SMRP) in a patient's serum. Doctors can then measure the amount to determine if mesothelioma is present. Presence of SMRP in a patient's blood can be detected even in the earlier stages of the cancer, which gives hope for future diagnosis of mesothelioma.
miRview - This diagnostic test allows physicians to differentiate malignant mesothelioma from other forms of metastatic carcinomas affecting the membranes around the lung.  MiRview does this by testing a tissue-specific microRNA biomarker from the tumor in order to differentiate between mesothelioma and other cancers.

Diagnosis Codes for Mesothelioma

Standardized codes have been assigned to the various types of mesothelioma. Patients may not regularly encounter these codes, however, it is helpful to have them available should the doctor refer to them or a patient encounter them while performing research.

After Mesothelioma is Confirmed

A primary care physician will likely refer the patient to an oncologist, or a doctor who specializes in cancer, who has experience treating mesothelioma. The oncologist can help determine which treatment options are best for each case. Patients are also encouraged to perform their own research, providing education on the various options available in order to better discuss them with the physician. Patients are also advised to locate any available sources of support during this difficult time.

Mesothelioma Resources

Getting a diagnosis of mesothelioma can be a daunting time for a patient and his or her loved ones. Patients may have countless questions running through their head and want answers. Mesotheliomasymptoms.com has a resource that has answers. Written by Michael Todd Sapko MD, PhD, the mesothelioma E-book addresses information regarding symptoms, diagnosis and treatment of this devastating disease. Download your free copy of this book here.
Additionally, anyone affected by mesothelioma is urged  to get a Mesothelioma Information Packet delivered free of charge to their residence within 24 hours. For any further questions call 1-855-584-0411.
References:
MayoClinic
American Cancer Society
University of Southern California - Mediastinum
American Cancer Society - Radiology Tests
Fujirebio Diagnostics, Inc.
Rosetta Genomics
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Radiation Therapy

Radiation therapy has an extensive history as a treatment for mesothelioma cancer. Over the years, the therapy has evolved and the delivery system is much more exact, resulting in improved outcomes. Individuals suffering from mesothelioma are often treated with a combination of radiation therapy and chemotherapy. Radiation therapy may also be used to remove the cancerous tissue after a person has undergone surgery. In some cases, radiation therapy is used to alleviate some of the symptoms associated with mesothelioma to make the person more comfortable.  

External Beam Radiation

There are two types of radiation therapy used for the treatment of mesothelioma. External beam radiation is probably the most well-known and commonly used type. A machine is used to deliver a beam of radiation to the exact location in the body that is infected with cancer. The machine does not make physical contact with the patient. This treatment method is painless and typically done in an outpatient facility.

The radiation used to kill off cancer cells is very powerful. As a result, healthy cells are frequently killed off during the course of the treatment, which causes some unpleasant side effects. The length of the treatment process will vary depending on the type and location of a person’s cancer. Typically, individuals will undergo five treatments a week for anywhere from one to several weeks. The radiation procedure lasts about 30 minutes each session.

Brachytherapy

Brachytherapy is the second method of radiation therapy used to treat mesothelioma. This type of therapy involves radiation being shot directly into the cancerous tumor. This is a relatively new procedure, but shows promise in treating patients with mesothelioma. This type of radiation therapy is more exact, so fewer healthy cells are destroyed during the treatment process.
Brachytherapy involves the placement of radioactive rods or seeds near the tumor site. A general anesthesia is used, along with catheters, to implant the seeds or rods. The implants can be left in for a short period or permanently. The rods stop emitting radiation after anywhere between three and twelve months. This type of therapy is usually given on an outpatient basis as well.

Side Effects

Both methods of radiation therapy used for mesothelioma treatment have several side effects. These can include severe fatigue, skin issues like redness or drying, and digestive problems. Nevertheless, radiation therapy causes fewer side effects than chemotherapy and remains a valid treatment option.
References:
American Cancer Society
National Cancer Institute
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Asbestos Group Hires Former Tobacco PR Agency to Defend Material

The Montreal Gazette reports that “Anti-asbestos activists in Malaysia and Canada say a global asbestos lobby group has hired the Washingtonbased APCO Worldwide public relations company to persuade the Malaysian government not to ban chrysotile asbestos.” Asbestos mining and export has come under heavy fire from critics lately as proponents of the mineral attempt to reopen the last such mine in Canada.
The Gazette goes on to explain that the Philip Morris tobacco company hired APCO Worldwide in the early 1990s to “set up a group called The Advancement of Sound Science Coalition,” following the U.S. Environmental protection Agency’s classification of secondhand smoke an established human carcinogen. During the public relation company’s employment by Philip Morris, the Canadian news source explains the “coalition's mission was to dismiss concern about second-hand smoke as ‘junk science,’ and to fight anti-smoking regulations.”
APCO will likely attempt to create a similar campaign regarding the Malaysian government’s efforts to ban asbestos, as backers of the reopening of the Jeffrey Mine attempt to persuade the public that this material can be used safely. According to the news source, anti-asbestos activist Kathleen Ruff said the company brought in Dr. David Bernstein, “a Switzerland-based toxicologist who has produced studies on smoking funded by the tobacco industry as well as studies on chrysotile asbestos funded by the asbestos industry” to attempt to convince the Malaysian government.
The Montreal Gazette goes on to explain that Ruff, a “human rights adviser with the Ottawa-based Rideau Institute, sent a letter to APCO Worldwide president Margery Kraus on Thursday, demanding the company inform the government of Malaysia that it was hired by the International Chrysotile Association.” In that letter she said that all scientific evidence proves that asbestos causes a number of lethal illnesses and its safe use is not possible. In that letter, the Gazette reports that she also explained that only organizations standing to profit from the sale of asbestos defend its use.
The news source explains that APCO Worldwide president, Krauss, was unavailable for comment. However, the Canadian news source explains that “A spokesperson for Baljit Chadha of Balcorp Ltd., the lead proponent of the Jeffrey Mine expansion, said the comparison to the tobacco lobby is unmerited.”
According to that spokesman, cigarettes possess no “socio-economic benefit,” while asbestos is used to produce inexpensive housing in developing nations, the Gazette reports.

Reference:
Lalonde, Michelle. (September 30, 2011) “PR agency used by tobacco firm hired by asbestos group.” Retrieved on October 3, 2011 from the Montreal Gazette.
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Promising Mesothelioma Chemo Drug Fails Phase III Trial

According to MedPage Today, the drug known as Vorinostat (Zolinza) “failed to extend survival as a second-line therapy in patients with malignant pleural mesothelioma.”  The news source explains that this phase III trial, “the largest of its kind in advanced mesothelioma, failed to meet its primary endpoint of lengthening overall survival in those who failed prior chemotherapy,” Lee Krug, M.D. at a New York cancer center explained.
Krug reported these findings at a session of the European Multidisciplinary Cancer Congress, explaining there was no statistically-important improvement in overall survival with the use of this treatment compared to placeboes, MedPage reports.
The trial had a total of 660 patients enrolled at 92 sites, MedPage explains. The median age of these patients was 65. According to the results of the trial, “Krug and colleagues found no overall survival benefit with the drug, with a median of 30.7 weeks compared with 27.1 weeks in the placebo group,” the medical site reports.
The cancer center doctor went on to explain that the average survival rate for advanced mesothelioma patents is “about a year from diagnosis, with 2,000 to 3,000 cases reported annually in the U.S.,” MedPage explains. Most cases of mesothelioma result from exposure that took place as many as five decades ago, with the medical news site reporting that these cases  are “expected to peak between 2015 and 2020 since the product has fallen out of use.”
The article goes on to explain that this Vorinostat trial was important because currently no second-line chemotherapy option exists for patients who have failed the first-line therapies with other drugs. First-line options currently used include Alimta combined with either cisplatin or carboplatin.
According to the medical resource, “adverse events were comparable between groups, although they were slightly higher with vorinostat,” though Krug explained this was to be expected with the medication’s natural toxicities, which include dehydration and fatigue. Krug also went on to explain that tumor pain was also greater with the group taking the placebo.
The news source explains that this was the largest drug study ever performed for mesothelioma. The news source also goes on to cite Rolf Stahel, MD, PhD, of University Hospital Zurich, a doctor not involved with the study, as stating that “newer molecular approaches, such as HSP90 inhibitors, may hold more promise for treating the disease.”
Reference:
Fiore, Kristina. (September 28, 2011) “ECCO-ESMO: Drug for Mesothelioma Fails Trial.” Retrieved on September 29, 2011 from MedPage Today.
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Major U.K. Retailer Fined £1 Million for Asbestos Violations

According to a report from BBC News this week, U.K. retail giant Marks & Spencer has received a £1 million fine due to a failure to protect customers and staff from a potential risk of asbestos exposure. The fine was levied by Judge Christopher Clark of the Bournemouth Crown Court, who explained that the exposure dated back to 2006 and 2007 at two stores in Reading and Bournemouth.


According to the BBC, the Reading location was said to have been undergoing a remodeling project a few years ago when asbestos tiles fell from the ceiling and onto the floor of the store. In that case, the judge claimed that the company essentially turned a blind eye to the event, primarily because of a cost issue. In the BBC article, Judge Clark claimed that the inaction was a result of a “tension between health and safety and profit,” which caused “lamentable problems.”
The news source reports that the fine relates back to “two charges under the Health and Safety at Work Act 1974 of failing to ensure the health and safety of its staff and others at the Reading store in July.” Marks & Spencer was fined £500,000 for each of the occurrences at the Reading and Bournemouth stores.
Willmott Dixon Construction is the Hertfordshire contractor who was found guilty of violating the Health and Safety Work Act on two occasions, the news source reports. Another contractor, PA Realisations of Manchester, was also found guilty of violating health regulations in the Reading location of Marks & Spencer.  A third contractor, Styles & Wood Limited, also of Manchester, had previously pleaded guilty to violating the Health and Safety at Work Act in the Reading location, the BBC writes.
Representatives from Marks & Spencer have generally remained silent on the proceedings. However, the news source reports they did express their displeasure with the ruling, saying they were “very disappointed with the result of this case, as we believe that we have always acted responsibly and with a safety first attitude.” The company further claimed in the article that the safety of their employees, customers, and contractors is “of the utmost importance” to them.
The trial that had lasted nearly three months revealed that contractors at each of the Marks & Spencer locations had failed to follow any guidance on asbestos removal during the refurbishment process.
Asbestos, which was a frequently-used material throughout the 20th century, has been known to cause a deadly cancer known as mesothelioma, which is characterized by its short life expectancy and dangerous latency period. According to an executive from Health & Safety in the U.K., the BBC reports that this fiber is responsible for nearly 4,000 deaths per year.
Reference:
BBC News Staff. (September 28, 2011) “Marks & Spencer fined £1m over asbestos risk.” Retrieved on September 28, 2011 from BBC News.
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Prevention

Reducing your exposure to asbestos may lower your risk of mesothelioma.

Find out whether you work with asbestos
Most people with mesothelioma were exposed to the asbestos fibers at work. Workers who may encounter asbestos fibers include:

Miners
Factory workers
Insulation manufacturers
Ship builders
Construction workers
Auto mechanics

Ask your employer whether you have a risk of asbestos exposure on the job.

Follow your employer's safety regulations
Follow all safety precautions in your workplace, such as wearing protective equipment. You may also be required to shower and change out of your work clothes before taking a lunch break or going home. Talk to your doctor about other precautions you can take to protect yourself from asbestos exposure.

Be safe around asbestos in your home
Older homes and buildings may contain asbestos. In many cases, it's more dangerous to remove the asbestos than it is to leave it intact. Breaking up asbestos may cause fibers to become airborne, where they can be inhaled. Consult experts trained to detect asbestos in your home. These experts may test the air in your home to determine whether the asbestos is a risk to your health. Don't attempt to remove asbestos from your home — hire a qualified expert. The Environmental Protection Agency offers advice on its website for dealing with asbestos in the home.
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Mesothelioma Life Expectancy

Mesothelioma supportCurrently no cure for mesothelioma exists and the American Cancer Society explains that patients generally have a short average mesothelioma life expectancy of four to 18 months after diagnosis. Only 10% of mesothelioma patients survive more than five years after initial diagnosis. Since its recognition as a lethal form of cancer that develops after asbestos exposure, doctors and scientists have struggled to identify a course of treatment that can improve the prognosis for patients today.
Nevertheless, efforts today still generally focus on prolonging the overall quality of life and life expectancy of these patients instead of finding a cure. Among these treatments are experimental and alternative therapies meant to relieve symptoms and improve a patient’s ability to lead a normal life.
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