Mesothelioma Info - Mesothelioma Lawyer, Asbestos Attorney
Causes of Mesothelioma
Each year in the United States, about 2500 people discover that they have mesothelioma, and almost every one of them remembers being exposed to asbestos. Almost all cases of mesothelioma are linked to asbestos exposure. It usually takes between 10 and 40 years to develop mesothelioma after being exposed to asbestos, so asbestos is especially dangerous to children. The younger the person is at the time of asbestos exposure, the higher their risk for developing mesothelioma.
Mesothelioma treatment options include surgery, chemotherapy, radiotherapy, photodynamic therapy, immunotherapy, gene therapy and intensity modulation radiation therapy; thus far, treatments have been unsuccessful in combating the disease.
The rapidly increasing incidence of malignant pleural mesothelioma underlines the urgency to achieve a consensus in the management of this tumor, which is biologically distinct from most other tumors. For patients with stage I tumors of epithelial type and good performance status, pleuropneumonectomy combined with chemotherapy and radiotherapy provides the best chance of prolonged survival, but further investigation is required to determine the optimum combination of adjuvant therapy.
Debulking pleurectomy/decortication combined with adjuvant therapy is a worthwhile alternative for patients with more advanced disease, impaired performance status or tumors of less favorable histology (sarcomatous or biphasic). More clinical trials are urgently required to identify better adjuvant therapy for tumors containing sarcomatous elements. On currently available evidence, neither radiotherapy nor chemotherapy offer worthwhile prolonged disease control when used in isolation, although both have an important role as part of multimodality therapy. Hyperthermia may enhance the effect of both radiotherapy and chemotherapy, and newer radiosensitizing agents also need evaluating.
Research into immunotherapy and gene therapy suggests that these newer approaches may have a place if tumor volume is small. In practice they will probably need to be combined with other therapeutic modalities, and further clinical trials are required. Consensus in mesothelioma management currently remains elusive but it seems clear that the way forward will involve striving for much earlier diagnosis, the use of multimodality therapy and collaboration between centers with special expertise in mesothelioma treatment to organize multicenter trials.
There is no clear consensus on the treatment of malignant pleural mesothelioma, in contrast to the treatment of most other tumors. This is particularly unfortunate as the natural history of the tumor is one of rapid progression towards death within 12-15 months of first symptoms if untreated [1, 2]. The need to find effective treatment is given added urgency by the dramatically increasing incidence of mesothelioma in most western countries, and this is expected to peak around the year 2020 [3]. It is estimated that mesothelioma deaths in men will double over the next 20 years [3].
The reasons for a lack of consensus in the management of mesothelioma are partly historical, partly related to the unique biology of the tumor and partly due to failure so far to find any single treatment or treatment combination which offers more than short-term tumor suppression in most patients. Historically, the very existence of a primary tumor of the pleura was disputed in the first half of this century [4] and, even when it became accepted as a distinct entity with a clear relationship to asbestos exposure in many patients [5], difficulties were still encountered in distinguishing the tumor from adenocarcinoma in many instances [6]. Until more sophisticated immunocytochemical techniques were developed to distinguish between epithelial mesothelioma and adenocarcinoma, there is no doubt that many cases treated as mesothelioma were, in fact, cases of secondary adenocarcinoma. This added to the confusion in the interpretation of the results of treatment.
The biological behavior of mesothelioma is distinct from that of other solid tumors in that mesothelioma tends to grow in a sheet-like fashion, covering the surface of the parietal and then the visceral pleura; it shows little tendency to invade structures deep into the pleura in the early course of the disease, unless the pleura is breached by needles or tubes, when it will spread readily along needle or tube tracks [7]. Part of the explanation for this unusual behavior appears to lie in the relative lack of proteases in comparison to other solid tumors [8]. In many instances the tumor appears to begin in a multifocal fashion resulting in scattered deposits of tumor with normal pleura intervening, suggesting either that a field change has occurred throughout the pleura, or that the tumor has metastasized locally within the pleural cavity [9]. Because the tumor is either broadly extensive on the pleural surface or multifocal at the time of detection, it does not lend itself to localized surgical excision. Surgical treatment aimed at complete resection therefore has to be much more extensive and is only suitable for a minority of patients (vide infra).
Although much research work is in progress, more innovative approaches to treatment using immunotherapy or gene therapy have yet to make an impact [10]. Preliminary results suggest that they are unlikely to be effective alone and will probably need to be combined with conventional treatment. Further advances will only come from a better understanding of tumor biology [11, 12]. Meanwhile, the poor response to a wide variety of surgical approaches and conventional radiotherapy and chemotherapy, with a large number of different agents, continues to foster a rather nihilistic attitude toward the management of mesothelioma, and many chest physicians and oncologists recommend only palliative treatment to control recurrent pleural effusion [13].
Logically, selection of treatment should, as with other tumors, depend on histological type, tumor stage at the time of presentation and on the patient's performance status, particularly in relation to cardiac and respiratory function.
Mesothelioma Info
If you or a loved one has been diagnosed with malignant mesothelioma or a related asbestos disease such as asbestosis or asbestos lung cancer, you may be entitled to compensation. Contact a mesothelioma lawyer or asbestos attorney to get more information.