Tuesday 25 December 2018

UNDERSTANDING WHAT MESOTHELIOMA IS


Mesothelioma is a rare form of cancer that arises in the mesothelium, a thin membrane that protects your internal organs and allows them to move freely without damage-causing friction. You have several of these membranes in your body: the pleura surround the lungs; the peritoneum protects your abdominal cavity (stomach, intestines, and other organs); and the pericardium envelops your heart.  Mesothelioma can occur in any of these membranes, but pleural mesothelioma is by far the most common, accounting for about 70 percent of all mesothelioma cases. Although some people may have a genetic predisposition for developing mesothelioma, nearly all cases arise from exposure to asbestos. Men typically are at greater risk than women, but women also get this disease.  This chapter provides an overview of mesothelioma, starting with a look at who’s at risk for developing mesothelioma, how your respiratory system works and how mesothelioma affects your body. Look for cross-references to other chapters for more detailed information. 

 WHO’S AT RISK
 Between 2,500 and 3,000 new cases of mesothelioma are diagnosed each year. Anyone who has been exposed to asbestos is at risk for developing mesothelioma, and, although your risk increases with the length of time you were exposed to asbestos, even small exposures to asbestos can cause mesothelioma.
Ironically, your risk also increases with the length of time that elapses after your exposure to asbestos.
Mesothelioma has a very long latency period – that is, the period between exposure to asbestos and the onset of symptoms of the disease. 
  Mesothelioma typically doesn’t appear until at least a decade after asbestos exposure; in some cases, the latency period has been 50 years or longer.
Sometimes, mesothelioma results from exposure to naturally occurring asbestos, but the most common causes are exposure to asbestos in the workplace or from products used in the home (see Chapter 2 for examples of such products). Spouses and family members of workers also may have been exposed to asbestos dust and fibers from the clothing the workers wore home from the job site. Here are some quick facts about mesothelioma and risk factors:
· Men are more commonly diagnosed than women, because men more typically worked in jobs where they were exposed to asbestos. These high-risk jobs include electricians, shipyard workers, factory workers, pipefitters, oil refinery workers, auto mechanics, machinists, and steel workers. (See Chapter 2 for more on how asbestos was used and the most dangerous jobs relating to asbestos exposure.) Older men account for more than 90 percent of all new mesothelioma diagnoses each year. Although no one knows exactly why, Caucasian men are statistically more likely to develop the disease than African-American or Hispanic men.

 · Women who worked in factories had increased direct exposure to asbestos and are more likely to be diagnosed with mesothelioma later in life.

· Women whose husbands, fathers, or other household members worked in high-exposure jobs also are at risk of developing mesothelioma from secondary exposure to the asbestos dust and fibers on work clothes. Children in these homes also are at risk from secondary exposure.

 · People who used asbestos-containing products in their homes are at increased risk of developing mesothelioma.

· Because of mesothelioma’s long latency period, people over the age of 50 are more likely to be diagnosed with the disease. Most mesothelioma diagnoses come in patients between the ages of 50 and 70; those who are diagnosed earlier may have a better chance of long-term survival.

 · People serving as first responders – fire-fighters, police officers, rescue workers and recovery personnel – may be exposed to asbestos at disaster sites, such as the World Trade Center.

 · Armed service personnel, especially those serving on ships in the Navy or Coast Guard, also are at higher risk of developing mesothelioma.

TAKING ASBESTOS FOR GRANTED PUT MY FATHER’S LIFE IN DANGER


The dangers of asbestos, even one exposure, are so frightening to me that I am paralyzed at the thought of someone coming in contact with it.  Even the potential that you could be exposed is enough to bring tears to my eyes and cause serious anxiety. This applies to anyone, even a stranger, but what do you do when someone you care about doesn’t take these dangers seriously?

It is so painful when someone you love, someone who has walked this horrible mesothelioma road along with you, fails to take into account the possible ramifications of what could be caused by their negligence.  My heart breaks for anyone who may come into contact with them who could also be exposed, and therefore, at risk.  I am angered by their utter disregard for the memory of my father who lost his life to mesothelioma; it almost feels like they’re saying he died in vain.

It hurts when you try to explain to someone why you are concerned and they brush it off, simply saying, “It’s fine, I was careful!” or, even worse, “You’re just being ridiculous.”  Is it fine that I’m left without a father, my mother without a husband, and my daughter without her grandfather?  Is it ridiculous that I want to spare others from what my family had to endure?  I don’t think so.

Some may say that this is overreacting, but to me, it feels like underreacting (if that’s a real thing).  Families are torn apart each and every day by this cancer that could have been prevented by the elimination and proper removal of asbestos.  If human lives were put in front of the dollar, we would be in a different situation right now with the continued spread of mesothelioma.

Sure, my words might cause some dissension, but I’m not afraid or ashamed to stand up for a cause that I believe in, one that is so real to me… too real.  So, please, don’t be afraid to fight.  Fight to be heard, fight to have your concerns addressed in a real way.  Fight for those who cannot fight for themselves.

RADIATION TREATMENT DOSING TECHNIQUE HAS SHOWN PROMISE FOR MESOTHELIOMA


Advances in imaging technology for early detection of mesothelioma as well as immunotherapy used in multimodal treatments have recently shown great promise to extend life expectancy for mesothelioma patients.

Now, another adjuvant treatment is being developed for treating pleural mesothelioma called non-ablative hypofractionated hemithoracic radiation treatment.

A study published in September 2018 by Dr. Marc de Perrot, the man who pioneered the SMART treatment for pleural mesothelioma, and Dr. John Cho, the resident Radiation Oncologist at The Princess Margaret Cancer Center in Toronto, Canada, outlined the results of a series of tests conducted to determine the viability of this new radiation treatment.

They found several advantages to using hypofractionated radiation to slow or halt future metastasis of this aggressive cancer.

What are the Benefits of Hypofractionation?
Hypofractionation means that the dose of each blast of radiation administered to the tumor site is higher and more focused, allowing for fewer sessions in a shorter period of time immediately before or following a surgical procedure to resect the tumor.

Normofrationation on the other hand, which is currently utilized more often in the treatment of various types of cancer, is the administration of low doses of radiation, over a longer period, and with more frequent sessions.

The difference between these two methods is striking given the overall health of the study’s test subjects and their improved prognoses following treatment with the newer hypofractionated method. Patients who have to endure weeks of radiation treatments through the normofractionated method often develope pneumonitis, caused by damage to healthy cell DNA from the longer duration of treatment.

The study highlighted the specific benefits of the hypofractionated method stating that:

“Hypofractionated radiation has several advantages. It can be completed over a few days rather than a few weeks; it can be delivered in the induction or the adjuvant setting in combination with radical surgery; for a given total dose, it delivers much greater biological effect (compared to normofractionation); and, perhaps more importantly, it may provide a specific activation of the immune system directed against the tumor that could provide a platform for immunotherapy.”

A Potential New Standard of Treatment
Dr. de Perrot went on to say that the hypofractionation method limits and even halts the growth of most tumors in new areas such as the point of entry for surgery, which is often at risk of being seeded by cancer cells during the resection of diseased tissue.

The non-ablative hypofractionated radiation treatment is so encouraging primarily because of its ability to work well as a part of multimodal treatment plans that are being used more often to treat mesothelioma.

Dr. de Perrot also noted in his report that one of the reasons for this success is due to the immune response to non-ablative radiation, which doses are too low to remove the disease at a macroscopic level. When the non-ablative hypofractionated method is used, it triggers immune responses in the tumor cells and causes an upregulation and production of T cells that activate what are known as cytotoxic CD8+ T cells, which speed up cell death.

This opens new doors for patients with more aggressive or advanced stages of mesothelioma since this treatment can be used alongside immunotherapy treatments and radical surgery. With the promising results that this study has produced, it is likely that with more research this procedure could become a standard in care for mesothelioma patients.

BLOOD TEST IN STUDY FOR PREDICTING LUNG CANCER RECURRENCE COULD AID GUIDE MESOTHELIOMA TREATMENT


In January, MesotheliomaHelp reported on the use of a Biocept, Inc. blood test as a possible early detection tool for mesothelioma. Now, the company reports it is testing the same tool to determine if it can help predict disease recurrence in lung cancer patients.

According to a July 23 press release from Biocept, Inc., the company is partnering with UC San Diego Moores Cancer Center with two clinical studies – one to predict cancer recurrence and another to predict treatment response. The studies will use Biocept’s Target Selector liquid biopsy assays to detect circulating tumor cells and circulating tumor DNA. To determine accuracy of the tests, the results will be compared with findings from CT or PET scans.

Even though there have been advances in the effectiveness of chemotherapy and radiation, the two organizations note the risk for “post-resection [after surgery] disease recurrence” in stage II or stage III cancers remains “unacceptably high.”  The teams collaborating on the clinical studies are looking at lung, breast and colon cancer patients with Stage II or III recurrent cancer. They hope to find a way to predict disease recurrence in high risk patients via a blood sample, using biomarkers as a guide.

“The current standard of care to assess disease recurrence is CT imaging, which may only detect recurrence after significant organ damage has occurred,” said Razelle Kurzrock, M.D., Center for Personalized Cancer Therapy and Clinical Trials Office director, Moores Cancer at UC San Diego Health. “Detecting disease recurrence in these patients with a blood sample may enable more rapid and comprehensive treatment options.”

When surgeons operate on cancer patients, it is with a goal to remove as much of the malignancy as possible, and to achieve a macroscopically-complete resection, which refers to the removal of all visible tumor cells. However, it is the microscopic cells that may be left behind that can thrive and spread, leading to recurrence.

Mesothelioma, an unusual form of cancer caused by the dangerous asbestos. Exposure to airborne asbestos fibers, often has a complex growth pattern making complete surgical removal a very difficult task. Use of a simple blood test that could predict a mesothelioma patient’s potential for recurrence and response to treatments could mean extended survival.

“We believe that clinical results from our patented technologies can provide physicians with important information to better predict a patient’s response to therapy and monitor their disease progress and recurrence, which can lead to better patient outcomes,” said Biocept’s President and Chief Executive Officer Michael Nall.

Although mesothelioma and  lung cancer are distinct cancers, the treatment protocol is similar. The mesothelioma community closely follows lung  cancer research in the hopes that the results translate to pleural mesothelioma care. The results of these studies will be followed closely. Approximately 3,000 Americans are diagnosed each year with the terminal cancer.

Keeping sharing simple...

SPREADING THE AWARENESS FOR LUNG CANCER


One of the most important things to focus on this November during Lung Cancer Awareness Month is educating yourself about this disease and some of the related illnesses, like mesothelioma, which is often confused with lung cancer.

Lung cancer is the number one cause of cancer deaths for men and women. Over 150,000 people died from lung cancer in 2017, with another 220,000 new patients being diagnosed that same year. Smoking, radon, and asbestos inhaled over time all dramatically increase the risk of developing lung cancer.

While it is not lung cancer, mesothelioma is a type of cancer that is caused by the inhalation of asbestos fibers which become lodged in the pleural lining (the membrane surrounding the lungs and other vital organs) and over time can damage cells causing tumor growth.

Over 3,300 people are diagnosed with mesothelioma each year, with nearly 46,000 having died directly from mesothelioma between 1999-2015. This number has started to rise as the population ages and mesothelioma tumors begin to form after the characteristically long latency period.

Exposure to asbestos has become marginally less common since many of the products that used asbestos in the past are no longer permitted. However, since there exists no ban on the toxic substance, and with increasing imports to the United States in the last couple of years, new exposure will continue to occur.

For those who have been exposed in the past to asbestos through their occupation or proximity, it is vital to notify your doctor of your exposures and get screened for possible abnormalities.

Importance of Early Detection for Mesothelioma
Since mesothelioma can sometimes take more than 40 years to develop and show symptoms, it makes early detection even more important. Most of the time, a patient’s mesothelioma will not be detected until it has progressed into the third and fourth stages.

This is why if you have a history of exposure to asbestos, getting imaging tests done is extremely important. If abnormalities are found in X-rays or CT Scans, then doctors will take a biopsy of pleural tissue to determine if cancerous cells are present.

If the detection of mesothelioma happens at an early stage, then patients have many options for treatment including radical surgery in the form of a P/D or an EPP. There are also other treatments like radiation, chemotherapy, and new immunotherapy drugs which have started to show real promise in clinical trials.

Recently, there has been a new push to research mesothelioma treatments and early detection methods. As mesothelioma cases continue to rise in the United States, we have yet to witness the full toll that asbestos exposure will take on this country, and the rest of the world, once more people start exhibiting symptoms.

Most developing countries rely on cheap building materials for construction to speed up growth. This opens up huge markets for asbestos manufacturers from Russia and China (the two largest suppliers of raw asbestos) to operate in with impunity, even though the continued use of asbestos has been empirically proven to be deadly.

Questions to Ask Your Doctor
If you are diagnosed with mesothelioma, there are a few important questions you should ask your doctor if you wish to fully understand your diagnosis. Here at the Mesothelioma Guide, our Patient Advocate, Jenna Campagna, RN, has compiled five of the most important questions for patients to ask their physicians after being diagnosed with mesothelioma:

What cell type do I have?
How advanced/What stage is my cancer?
What is my outlook and life expectancy?
What are my treatment options?
What is the goal of treatment?
With Lung Cancer Awareness Month underway, you can continue showing your support for patients suffering from lung cancer, and other diseases like mesothelioma, by continuing to educate yourself about these conditions and spread awareness. The more people know about these illnesses, the more research will be done to help those who are affected.