Without a doubt the revelation of the supplement industry these past few years have been the advancement in technology where legal steroidal nutrients are concerned. Through an act, the DSHEA, some steroidal nutrients are now considered legal supplements when they meet three criteria. The first being that they have to be naturally occurring, the second being that they are currently not classified as Schedule III drugs and the last being that they have not been previously pursued as a pharmaceutical prior to their production as a supplement. This has brought us a series of steroidal nutrients we call prohormones. Substances that are largely inactive, but convert to known steroids in the body by way of enzymatic interference. So far precursors to the steroids boldenone, testosterone, nandrolone and DHT have been successfully marketed. It seemed like a ray of light towards making supplementation compete with illegal steroids, a road many are not willing to take. But prohormones had two very distinct problems to overcome.
One was the fact that they are only partially active through conversion to another compound. That meant only a small percentage (ranging from 0.08 to 30%) of what was used was finally converted to an active muscle-building substance. The second problem was that of maximal delivery. When ingested, steroidal nutrients (prohormones and steroids alike) are broken down to a large degree in the body because the liver identifies them as toxins (since they are not usually absorbed by the body, but made by the body from cholesterol). This meant that most of them were only absorbed for 4-6% in the body, with the exception of 1AD (14%) and 1,4-andro (45%). And even those last two were a far cry from what steroids usually deliver.
The World's First Legal Active Steroid.
Speaking of 1AD. It was a novel prohormone, the first marketed since the classic testosterone and nandrolone precursors, invented by the chemist Patrick Arnold. Among those in the supplement industry, it's now a household name. For those of you not so familiar, he is also the owner of LPJ research and Ergopharm, a leading company in the prohormone industry. It converted to something Patrick had dubbed 1-testosterone. A more befitting name would have been dihydro-boldenone. Structurally it's very much like boldenone (equipoise) with that difference that its 4,5-double bond has been broken and two hydrogen atoms attached at those locations. This is the same thing that occurs when testosterone is altered by the 5-alpha-reductase enzyme to form Dihydrotestosterone (DHT). 5-alpha-reduced forms of hormones have two distinct qualities. They are not capable of interacting with the enzyme aromatase, a structure that is responsible for the majority of estrogen in the male body. Even though most of them bind to the enzyme with great affinity, it cannot be structurally altered to form estrogen. In a way this lends them certain anti-estrogenic properties as whatever aromatase enzymes they do take up, cannot be used by testosterone or another aromatizing steroid to form estrogen either, lessening the risk of potential estrogen formation. But most importantly, a lack of estrogenic action makes for smaller, but much leaner results since estrogen is a major culprit in the accumulation of water and body-fat. Another major plus that a 5-alpha-reduced hormone has is that it has higher androgen binding, meaning its more potent in regards to strength and androgenic properties than the base hormone.
So why am I telling you all this? Well shortly after the appearance of 1AD, suddenly some people realized that its conversion product 1-testosterone (or dihydroboldenone) has in fact never been used pharmaceutically and is not a classified Schedule III drug, and with that... completely legal. This meant the answer to the prayers of everyone in this industry as we now possessed a legal steroid to help us bridge the gap between illicit drugs and legal supplementation. To determine what sort of drug we are dealing with here, we look at its closed compound in relation, namely methenolone (as in Primobolan). This is basically the same drug but with a single alteration. It has a 1-methyl group attached to increase its oral bio-availability. The 1-methyl structure does very little otherwise, apart from possibly increase its affinity for serum-binding proteins. One can therefore liken the effects of 1-testosterone to those of Primobolan. In fact they should be almost identical.
The attachment of a methyl group is a common practice to make steroids more orally available, which is our second concern after all in bridging the gap. But its also an alteration to the base nucleus of the steroids and forms a different steroid so to speak, even though the actions may very well be identical. Nonetheless, this difference is the only reason 1-testosterone is a legal supplement. The downside was we are now left with a full-fledged steroid, but only capable of delivering about 14% if ingested.
Solving Delivery:
Oral delivery has always been the method most preferred. But orally meant that most of what you took would ultimately be destroyed by the liver unless protected in some way. The most effective way was to attach a methyl group at the 17-alpha position. This greatly improved uptake, well over 80% in most cases. Unfortunately it was highly liver toxic. 17-alpha-methylation is basically illegal anyway, but even if it hadn't been, few would risk marketing an over the counter supplement that could damage the liver. The liability is too great. In some cases they attempted to attach the methyl structure to the 1 position, as with primobolan and proviron. This had less success and required rather large doses be taken for proper effect. And in this case it was excluded either way, because that would make 1-testosterone into methenolone, which is a Schedule III drug.
Injecting is of course the means of preference among pharmaceuticals. Its delivered into the muscle and released into the blood and doesn't reach the liver until its already traversed your entire circulation at least once. As such it can easily deliver 98-100%. Injecting is, you guessed it, illegal. The danger of promoting intramuscular injection was too great (if a blood vessel was hit and injected into the consequences can be catastrophical). Nonetheless that has not kept some companies from making a few lesser prohormones into an injectable form. Do not be fooled by such things. There is nothing to take care of conversion, requiring large doses be taken, its illegal to attach an ester for prolonged action, which insinuates daily injections and lastly there is no real quality control among supplements, meaning an infection is easily obtained and a company cannot be held responsible, as they will never market it as an injectable.
For those willing to take the risk and looking to cook up a 1-testosterone injection, think again. It turns out this stuff is quite irritating and makes for very, very painful injections. This may very well be why methenolone is preferred over 1-test, and an ester is attached, to make interaction with surrounding structures and thus irritation less of a factor. Needles, I mean needless to say injection was not an option and could invoke any number of legal problems that could easily render the world's first legal steroid, illegal.
Another way of delivery that comes highly praised from the research, is rectal administration. For those of you who have not yet burst out in laughter, it is quite effective and for the first time the idea of lymphatic absorption pops up here. Lots of pharmaceuticals have been made into suppositories and used with great success for a speedy delivery. This includes common pain and discomfort medication. However, two problems arose here as well. The first being that, considering the irritative properties of 1-test on skin and stomach, it may not have been a pleasant thing to shove this stuff where the sun doesn't shine. The other reason clearly being that there is a very small market for a supplement called Rectabol, and that it would not be easy to sell.
Lastly transdermal delivery was an option. It consists of making an alcohol suspension of the steroid and applying it to the skin. The skin can absorb substances that are below 500 in molecular weight and are lipophillic (since skin protects us from the elements, hydrophilic substances pass with great difficulty). On the one hand transdermal delivery is our savior because a good transdermal can deliver 20-25% easily which is a more than noteworthy improvement over the classic prohormones that only provide 4-6% orally, and even 1AD and the subject at hand, 1-testosterone, that deliver roughly 14% (increased resistance to hepatic breakdown due to the structural 1,2-double bond). On the other hand its our enemy, as we already know that the dermis, a layer of the skin has a rate limiting factor. That means even with the best means in the world we can only get about 30% through, maximum. Which leaves us stranded quite distant from actual steroid efficacy.
Nonetheless it's the greatest triumph to date and transdermal 1-test products such as ONE and ONE+ by Avant Labs and Higher Power's Trenabol-X are the most effective supplements currently available over the counter, hormone wise. For the record, transdermal delivery is frowned upon by the FDA as well, stamped as being a pharmaceutical delivery technique not suited for supplementation, which is why all transdermals are marketed as cosmetics. Again 1-test seems to deliver a slight problem with this type of delivery. Its irritative properties can cause rashes and such if the user starts to sweat heavily or body temperature goes up. Its occurrence is not wide-spread, but it does happen.
A Legal Alternative.
The answer was to actually be found in esters. Esters are carbon chains attached to a steroid at the 17-alpha position to make them more lipophillic. When injected intramuscularly that means they will remain in the adipose layers for some period of time (largely dependent on the size of the ester and the time it takes to break it down) and released into the blood stream slowly. This makes for less frequent injections, often only once per week. Obviously this is not where I'm headed. Injecting is illegal, and so are esters.
But the lipophillic property of esters have been put to test in another way. A more recent steroid, called andriol, tried to address oral availability issues with the use of an ester. Namely through lymphatic absorption. To understand this, you need a small notion of what the lymphatic system is and how it works more or less. First of all there is the cardiovascular system which apports nutrients and oxygen to tissues in the body, but also water. It delivers these to the interstitial fluid of tissue, the fluid that is in between different cells. The problem is that eventhough the blood will deliver about 24 liters of water to the cells through its arterial system, only about 20 liters of that is resorbed by the venous system. That means daily 4 liters are left behind. If that fluid were to remain there, we would swell up and explode.
Well, the lymphatic system is the answer to this problem. It's a fine system of capillaries located inside interstitial space that reabsorbs water. It channels all this water through a wide network of filters and delivers it to a place called the angulus venosus, where the vena jugularis interna and the vena subclavia meet, prior to going to the heart. What is of note here is that what passes through the lymphatic system is delivered straight up near the heart and bypasses the liver. Interesting, but it only carries water right ? Wrong. The lymphatic system is very well protected with more filters than anything. Almost nothing passes through. This is absolutely necessary or else any toxin or virus that entered would be delivered to the heart and be spread through the body immediately, often with death as a result. Lymphatic fluid is clear because its basically nothing other than water. Except when it comes from the gastrointestinal tract, then it has a dirty, troubled look to it. That's because in this part of the lymphatic system, fats too are absorbed. This is where it becomes interesting. An ester, as mentioned, increases the lipophillicity of a steroid which is already lipophillic. So you create a superlipophillic substance. So who cares if nothing but fat is absorbed ? Well, making it superlipophillic means it will interact with any type of fat it comes in contact with and bond. Meaning when the fat is absorbed lymphatically, so is the steroid attached to the ester.
This is the way in which the steroid andriol works. It's a form of testosterone, with an extremely long ester attached to it, then submerged in a type of oil (since the fat is what actually gets absorbed) and sealed in a cap. While it showed some clear problems, it was novel, it worked and it did not have toxicity problems like a 17-alpha-alkylated steroid would. And eventhough its rate of delivery showed it to be very inconstant not only from person to person, but even day to day, its average of success was much much higher than any legal system that had been devised to date, including transdermals.
But what does it mean to us? Well one could attempt to attach an ester and wipe his ass with the law, as one company has done, but this is not extremely interesting. And moreover the ester they selected was short and quite useless. This was a first failed attempt. The breakthrough came when a more suited compound was found. Even though they would not ultimately solve the problem, it was the company Syntrax that clearly led the way to breakthrough. They were the first to toy with the idea of lymphatic absorption and came across an ether (tetrahydropyranyl), which would lend similar lipophillic increasing properties to the steroid if attached the steroid. But Syntrax's entire line contained a main flaw. It was not readily absorbed lymphatically.
First of all, the problem was the lack of a fat to serve as a carrier. Without it the steroid would not be absorbed lymphatically. And secondly a number of extremely hydrophilic cap fillers such as barley. This made it so most of the stuff was ultimately passed on to the liver at some time. Case and point is their product Pentabol Extreme, a 5-diol THP ether. If the 5-diol had increased its potency somewhat it would begin to show properties similar to its illegal 17-alpha-alkylated form methandriol, a well-known steroid. Yet the results stayed out. At 3 doses of 225 mg each and per day, Pentabol delivered no mentionable results. That's well over 10 times the dose one would take of methandriol. So what hope did it have to make 1-testosterone more like legal Primo? None, but it did not stop them from trying. The product SAUCE showed no real increase in delivery and provided no better results than the cheaper and more effective transdermals. But Syntrax no doubt laid the foundation for the breakthrough that will follow.
Molecular Nutrition, a small company owned by Bill Llewellyn, known to most of us as the author of Anabolics 2002, was the first to chance it and invest in a properly designed carrier. Molecular took the same THP form of 1-testosterone as a base but mixed it in a fatty environment, in this case sesame oil. The oil would serve as a carrier for the steroid when absorbed lymphatically, effectively by-passing the liver and delivering the steroid through the ductus thoracicus (the main artery in the lymphatic system) to a point of insertion near the heart, from where it would spread quickly throughout the body. They then sealed it in a gel-cap of 1/2 ml, providing us with a legal form of Primobolan at 25 mg per cap. On the one hand the delivery is not as good as 17-alpha methylation, but then neither is 1-methylation, requiring high doses be used of Primo, 150 mg per day. Therefore, for most people an equal dose of this product, dubbed 1T-ethergel should do the trick in giving the same benefits as Primobolan.
Saturday, June 28, 2008
Mesothelioma death rates increased in a Shipyard Workers
A recent study conducted on workers in a US Coast Guard shipyard has found a significantly greater mortality rate associated with lung cancer and mesothelioma compared to the general population. The study also found an increased general mortality rate.
The study followed 4702 (4413 men and 289 women) civilian workers who were employed at the shipyard between January 1950 and December 1964. The study then measured the number of deaths and their causes through 31 December 2001.
The study was conducted by S Krstev, P Stewart, J Rusiecki, A Blair and was published in Occupational and Environmental Medicine. The original study publication is available at http://oem.bmj.com/cgi/content/abstract/64/10/651.
Mesothelioma is a form of cancer that is usually associated with exposure to asbestos. The majority of individuals who are diagnosed with mesothelioma have a history of exposure to asbestos particles at work or home. Family members of workers have also been affected. Renovators of homes containing asbestos cement material are accounting for an increasing number of diagnosed sufferers. Symptoms of mesothelioma may not appear for decades after the exposure to asbestos. Symptoms include abdominal pain and weight loss. Diagnosis of mesothelioma can be difficult due to the fact that the symptoms are similar to other respiratory diseases.
Since mesothelioma is primarily caused by exposure to asbestos, mesothelioma can be best be prevented by avoiding or limiting exposure to asbestos in homes, public buildings, and at work. Workers that may be at risk include miners, factory workers, insulation manufacturers, railroad workers, ship builders, contractors and construction workers, particularly those involved with insulation. If there is a possibility of exposure (such as when renovating old buildings) protective equipment should be used and safety procedures should be applied. Asbestos was commonly used in building materials due to its durability and fire-resistant properties. In addition to buildings, asbestos was used in the manufacture of cars and ships and many other products.
The study followed 4702 (4413 men and 289 women) civilian workers who were employed at the shipyard between January 1950 and December 1964. The study then measured the number of deaths and their causes through 31 December 2001.
The study was conducted by S Krstev, P Stewart, J Rusiecki, A Blair and was published in Occupational and Environmental Medicine. The original study publication is available at http://oem.bmj.com/cgi/content/abstract/64/10/651.
Mesothelioma is a form of cancer that is usually associated with exposure to asbestos. The majority of individuals who are diagnosed with mesothelioma have a history of exposure to asbestos particles at work or home. Family members of workers have also been affected. Renovators of homes containing asbestos cement material are accounting for an increasing number of diagnosed sufferers. Symptoms of mesothelioma may not appear for decades after the exposure to asbestos. Symptoms include abdominal pain and weight loss. Diagnosis of mesothelioma can be difficult due to the fact that the symptoms are similar to other respiratory diseases.
Since mesothelioma is primarily caused by exposure to asbestos, mesothelioma can be best be prevented by avoiding or limiting exposure to asbestos in homes, public buildings, and at work. Workers that may be at risk include miners, factory workers, insulation manufacturers, railroad workers, ship builders, contractors and construction workers, particularly those involved with insulation. If there is a possibility of exposure (such as when renovating old buildings) protective equipment should be used and safety procedures should be applied. Asbestos was commonly used in building materials due to its durability and fire-resistant properties. In addition to buildings, asbestos was used in the manufacture of cars and ships and many other products.
Internet is a Best Choice for Mesothelioma Lawyers
One man’s misery can be another man’s fortune. This seems to be the case with the mesothelioma victims on the one hand and mesothelioma lawyers on the other. An online feeding frenzy is currently taking place. The average mesothelioma case today is settled at around 1 million dollars, and that figure jumps to 6 million dollars when the lawsuit goes to the courts. With such enormous money to be made, legal firms are hungry for a slice of the action, and are shelling out big money for online visitors. The result is that search engines and other sites that can supply them with those visitors are racking up huge revenue.
It works like this. In the sponsored listings of search engines, visitors are auctioned off to the highest bidder. When someone searches “mesothelioma”, the highest-bidding law firms appear. With the keen competition, these firms are paying as much as $100 per mesothelioma-related visitor to their web site. That’s $100 every time someone just clicks on their ad - and a lot of the clicks are from competitors. Less than one in ten visitors may actually submit an inquiry about the services of the legal firm. And only a fraction of the inquiries convert into clients. Therefore, it is costing lawyers tens of thousands of dollars in advertising to secure a single client.
There is something truly obscene about this situation. But, it is inevitable that while there is huge money to be made from litigation, lawyers and publishers will continue to hustle for their slice of the action. You can even find these vultures on YouTube making an undignified pitch for business. If only a portion of the money could be directed to cancer research. Perhaps these legal firms and others who profit from this horrendous disease should consider donating a portion of their gains to research organizations. By doing so, they may appear a little more genuine and less like vultures.
Mesothelioma is a form of cancer linked to asbestos exposure. In fact, 70% to 80% of mesothelioma cases are caused by a history of exposure to asbestos. It can take decades for the symptoms to appear. Each year, approximately 2,000 to 3,000 new cases of mesothelioma are reported. In the past 20 years, the number of reported cases has increased significantly. Although it can take up to 50 years for symptoms to manifest, mesothelioma patients experience a host of symptoms. These include shortness of breath, or a wheezing and hacking cough, which often lead to chest or abdominal pain. In the more serious cases, individuals may have bowel blockages, anaemia, a bloody cough, and jaundice. It is extremely difficult to secure accurate statistics about how many individuals suffer from mesothelioma because in the early stages, the symptoms are quite similar to various other conditions. This often leads to a misdiagnosis of the disease. In addition, when an accurate diagnosis is finally made, the disease has typically already progressed to a more advanced stage. With the renovation craze that has occurred in the past 2 or 3 decades in countries such as Australia and the US, it is expected that the high rates of diagnosis will continue for decades to come. And as long as there is money to be made from this disease, the vultures will also be around.
It works like this. In the sponsored listings of search engines, visitors are auctioned off to the highest bidder. When someone searches “mesothelioma”, the highest-bidding law firms appear. With the keen competition, these firms are paying as much as $100 per mesothelioma-related visitor to their web site. That’s $100 every time someone just clicks on their ad - and a lot of the clicks are from competitors. Less than one in ten visitors may actually submit an inquiry about the services of the legal firm. And only a fraction of the inquiries convert into clients. Therefore, it is costing lawyers tens of thousands of dollars in advertising to secure a single client.
There is something truly obscene about this situation. But, it is inevitable that while there is huge money to be made from litigation, lawyers and publishers will continue to hustle for their slice of the action. You can even find these vultures on YouTube making an undignified pitch for business. If only a portion of the money could be directed to cancer research. Perhaps these legal firms and others who profit from this horrendous disease should consider donating a portion of their gains to research organizations. By doing so, they may appear a little more genuine and less like vultures.
Mesothelioma is a form of cancer linked to asbestos exposure. In fact, 70% to 80% of mesothelioma cases are caused by a history of exposure to asbestos. It can take decades for the symptoms to appear. Each year, approximately 2,000 to 3,000 new cases of mesothelioma are reported. In the past 20 years, the number of reported cases has increased significantly. Although it can take up to 50 years for symptoms to manifest, mesothelioma patients experience a host of symptoms. These include shortness of breath, or a wheezing and hacking cough, which often lead to chest or abdominal pain. In the more serious cases, individuals may have bowel blockages, anaemia, a bloody cough, and jaundice. It is extremely difficult to secure accurate statistics about how many individuals suffer from mesothelioma because in the early stages, the symptoms are quite similar to various other conditions. This often leads to a misdiagnosis of the disease. In addition, when an accurate diagnosis is finally made, the disease has typically already progressed to a more advanced stage. With the renovation craze that has occurred in the past 2 or 3 decades in countries such as Australia and the US, it is expected that the high rates of diagnosis will continue for decades to come. And as long as there is money to be made from this disease, the vultures will also be around.
Malignant Mesothelioma Diagnosis
When there is reason to suspect you may have a mesothelioma, one or more cancer diagnostic methods will be used by your doctor.
Patient medical history and physical examination
First, a full medical history is taken to establish cancer risk factors and presence of any possible symptoms. The medical history interview includes questions to determine where you may have been exposed to asbestos.
Next, a complete physical exam is conducted with the intent of revealing signs of malignant mesothelioma cancer or any other health problems. New patients with pleural mesotheliomas (malignant mesotheliomas of the chest) often have pleural effusion (fluid in their chest cavity) that is caused by the cancer. Ascites (fluid in the abdominal cavity) appears in cases of peritoneal mesothelioma, and pericardial effusion (fluid in the pericardium) may be found in cases of pericardial mesothelioma which can also be detected during the physical exam.
Imaging tests
A chest x-ray may reveal irregular thickening of the pleura, pleural calcifications (mineral deposits), lowering of the lung fissures (spaces between the lobes of the lungs), or a build up of fluid in the pleural space. These findings may suggest there was asbestos exposure leading to the development of a malignant mesothelioma.
Medical imaging studies including x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans will help determine the location, size, and extent of the cancer. The electronic CT scan uses a rotating x-ray beam to create a series of images of the body from many angles. A medical computer combines these images to produce very detailed cross-sectional images for parts of the body. If it is needed to highlight details on the CT scan, the patient may be asked for permission to have a mostly harmless dye injected into the bloodstream. The MRI uses magnetic fields and not x-rays to create pictures of selected areas of the body. And as with a CT scan, the computer will generate a cross-sectional image.
Testing of Fluid and Tissue Samples
Lung Fluid Testing
When a patient has a pleural effusion, a small sample of this fluid can be extracted from the patient by inserting a needle into the chest cavity. Another similar technique can be used to take a sample of abdominal fluid and pericardial fluid. The patient's fluid sample is then tested in a lab to show its chemical make-up and analyzed under a microscope to determine the presence or absence of cancer cells.
Tissue Sample
A sample of tissue from a pleural or pericardial tumor can be taken using a relatively new sample technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. The doctor can then see the cancer tumor through the thoracoscope and can use special forceps to take a tissue biopsy. In much the same fashion a laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In thd procedure a flexible tube attached to a video camera is inserted into the abdominal cavity via small frontal incisions. Fluid can also be collected during thoracoscopy or laparoscopy.
Surgery
Surgery, either a thoracotomy (opening of the chest cavity) or a laparotomy (opening of the abdominal cavity), will allow a surgeon to remove a larger sample of tumor or in some cases to remove it entirely.
Oral Exploration
For those patients who might have pleural malignant mesothelioma, the doctor may also do a bronchoscopy. In this procedure a flexible lighted tube is inserted through the mouth, down the trachea, and into the bronchi to see if there are other masses in the airway. Any small samples of abnormal-appearing tissue can be removed for testing.
Lymph Node Analysis
The cancer patient may also have a mediastinoscopy. During this procedure a lighted tube is inserted under the sternum (chest bone) at the level of the neck and then moved way down into the chest. In this way the surgeon is then able to view the lymph nodes in this region and take samples to check for malignant mesothelioma.
The lymph nodes are small collections of immune system cells that help the body fight infections and different types of cancers. Lung cancers frequently spread to lymph nodes, but the mesotheliomas rarely do this. An examination of the lymph nodes will allow the doctor to determine whether a lung cancer is still localized or if it has begun to spread. It can also help the doctor in distinguishing lung cancer from malignant mesothelioma.
Magnification to Aid Detection/Recognition
Even with fluid samples from the area around the lungs, abdomen, or heart, it can often be difficult to diagnose malignant mesothelioma and it is even hard to diagnose malignant mesothelioma with tissue from biopsies. This is because mesothelioma cells are difficult to tell apart from several other types of cancer cells when viewed under the microscope. For example, pleural mesothelioma can resemble various types of lung cancer, and peritoneal mesothelioma can resemble various cancers of the ovaries. For this reason special laboratory cancer tests are often done to pinpoint mesothelioma amidst several other cancer possibilities.
These specal lab tests use techniques to identify certain chemicals known to be present in mesotheliomas and are known to be different than those present in cancer of the lung or ovary. An electron microscope may also be helpful in diagnosing mesothelioma. The scanning electron microscope has a magnification power 100 times greater than the normal light microscope which is generally used in cancer diagnosis. This allows detection of the small parts of the cancer cells that distinguish mesothelioma cancer from other types of cancer.
The big difficulty in distinguishing between malignant mesothelioma and other forms of cancer or benign, non-cancerous pleural inflammation is the primary problem posed during making the initial diagnosis. The most popular medical diagnostic tools presently remain the open pleural biopsy performed during thoracoscopy which allows for direct inspection of the inside of the chest, and provides much information on the involvement of the other organs and any spread of disease. The less successful diognostic procedures are CT guided pleural biopsy or blind pleural biopsy. Along with the gross appearance of the tumor, pathologists often rely on a panel of histochemical and immunohistochemical stains to diagnose or exclude malignant mesothelioma. Currently the chemicals linked to prognosis of malignant mesothelioma are under study, but have not been validated for the general use for this type of cancer..
Prognostic Factors
Because pleural mesothelioma has been better studied than peritoneal mesothelioma we know more about the factors that are associated with the prognosis for pleural mesothelioma. A younger age at diagnosis, performance status (functional status), and the absence of a weight loss are associated with a more favorable prognosis for the disease.
Mesotheliomas are usually of three different cell types (histological analysis): 1) epithelial cell type - which has the most favorable cancer prognosis; 2) fibrosarcomatous cell type - which carries the worst prognosis, and 3) mixed cell type - has an intermediate prognosis for the patient.
Patient medical history and physical examination
First, a full medical history is taken to establish cancer risk factors and presence of any possible symptoms. The medical history interview includes questions to determine where you may have been exposed to asbestos.
Next, a complete physical exam is conducted with the intent of revealing signs of malignant mesothelioma cancer or any other health problems. New patients with pleural mesotheliomas (malignant mesotheliomas of the chest) often have pleural effusion (fluid in their chest cavity) that is caused by the cancer. Ascites (fluid in the abdominal cavity) appears in cases of peritoneal mesothelioma, and pericardial effusion (fluid in the pericardium) may be found in cases of pericardial mesothelioma which can also be detected during the physical exam.
Imaging tests
A chest x-ray may reveal irregular thickening of the pleura, pleural calcifications (mineral deposits), lowering of the lung fissures (spaces between the lobes of the lungs), or a build up of fluid in the pleural space. These findings may suggest there was asbestos exposure leading to the development of a malignant mesothelioma.
Medical imaging studies including x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans will help determine the location, size, and extent of the cancer. The electronic CT scan uses a rotating x-ray beam to create a series of images of the body from many angles. A medical computer combines these images to produce very detailed cross-sectional images for parts of the body. If it is needed to highlight details on the CT scan, the patient may be asked for permission to have a mostly harmless dye injected into the bloodstream. The MRI uses magnetic fields and not x-rays to create pictures of selected areas of the body. And as with a CT scan, the computer will generate a cross-sectional image.
Testing of Fluid and Tissue Samples
Lung Fluid Testing
When a patient has a pleural effusion, a small sample of this fluid can be extracted from the patient by inserting a needle into the chest cavity. Another similar technique can be used to take a sample of abdominal fluid and pericardial fluid. The patient's fluid sample is then tested in a lab to show its chemical make-up and analyzed under a microscope to determine the presence or absence of cancer cells.
Tissue Sample
A sample of tissue from a pleural or pericardial tumor can be taken using a relatively new sample technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. The doctor can then see the cancer tumor through the thoracoscope and can use special forceps to take a tissue biopsy. In much the same fashion a laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In thd procedure a flexible tube attached to a video camera is inserted into the abdominal cavity via small frontal incisions. Fluid can also be collected during thoracoscopy or laparoscopy.
Surgery
Surgery, either a thoracotomy (opening of the chest cavity) or a laparotomy (opening of the abdominal cavity), will allow a surgeon to remove a larger sample of tumor or in some cases to remove it entirely.
Oral Exploration
For those patients who might have pleural malignant mesothelioma, the doctor may also do a bronchoscopy. In this procedure a flexible lighted tube is inserted through the mouth, down the trachea, and into the bronchi to see if there are other masses in the airway. Any small samples of abnormal-appearing tissue can be removed for testing.
Lymph Node Analysis
The cancer patient may also have a mediastinoscopy. During this procedure a lighted tube is inserted under the sternum (chest bone) at the level of the neck and then moved way down into the chest. In this way the surgeon is then able to view the lymph nodes in this region and take samples to check for malignant mesothelioma.
The lymph nodes are small collections of immune system cells that help the body fight infections and different types of cancers. Lung cancers frequently spread to lymph nodes, but the mesotheliomas rarely do this. An examination of the lymph nodes will allow the doctor to determine whether a lung cancer is still localized or if it has begun to spread. It can also help the doctor in distinguishing lung cancer from malignant mesothelioma.
Magnification to Aid Detection/Recognition
Even with fluid samples from the area around the lungs, abdomen, or heart, it can often be difficult to diagnose malignant mesothelioma and it is even hard to diagnose malignant mesothelioma with tissue from biopsies. This is because mesothelioma cells are difficult to tell apart from several other types of cancer cells when viewed under the microscope. For example, pleural mesothelioma can resemble various types of lung cancer, and peritoneal mesothelioma can resemble various cancers of the ovaries. For this reason special laboratory cancer tests are often done to pinpoint mesothelioma amidst several other cancer possibilities.
These specal lab tests use techniques to identify certain chemicals known to be present in mesotheliomas and are known to be different than those present in cancer of the lung or ovary. An electron microscope may also be helpful in diagnosing mesothelioma. The scanning electron microscope has a magnification power 100 times greater than the normal light microscope which is generally used in cancer diagnosis. This allows detection of the small parts of the cancer cells that distinguish mesothelioma cancer from other types of cancer.
The big difficulty in distinguishing between malignant mesothelioma and other forms of cancer or benign, non-cancerous pleural inflammation is the primary problem posed during making the initial diagnosis. The most popular medical diagnostic tools presently remain the open pleural biopsy performed during thoracoscopy which allows for direct inspection of the inside of the chest, and provides much information on the involvement of the other organs and any spread of disease. The less successful diognostic procedures are CT guided pleural biopsy or blind pleural biopsy. Along with the gross appearance of the tumor, pathologists often rely on a panel of histochemical and immunohistochemical stains to diagnose or exclude malignant mesothelioma. Currently the chemicals linked to prognosis of malignant mesothelioma are under study, but have not been validated for the general use for this type of cancer..
Prognostic Factors
Because pleural mesothelioma has been better studied than peritoneal mesothelioma we know more about the factors that are associated with the prognosis for pleural mesothelioma. A younger age at diagnosis, performance status (functional status), and the absence of a weight loss are associated with a more favorable prognosis for the disease.
Mesotheliomas are usually of three different cell types (histological analysis): 1) epithelial cell type - which has the most favorable cancer prognosis; 2) fibrosarcomatous cell type - which carries the worst prognosis, and 3) mixed cell type - has an intermediate prognosis for the patient.
The Legal History of Mesothelioma
Each year, approximately 2,000 to 3,000 new cases of mesothelioma are reported. In the past 20 years, the number of reported cases has increased significantly. Although it can take up to 50 years for symptoms to manifest, mesothelioma patients experience a host of symptoms. These include shortness of breath, or a wheezing and hacking cough which often lead to chest or abdominal pain. In the more serious stages of this disease, individuals may have bowel blockages, anaemia, a bloody cough, and jaundice. Unfortunately, it is extremely difficult to secure accurate statistics about how many individuals suffer from Mesothelioma because in the beginning stages, the symptoms are quite similar to various other conditions. This often leads to a misdiagnosis of the disease. In addition, when an accurate diagnosis is finally made, mesothelioma has typically already progressed to a more advanced stage. Mesothelioma is most often caused by previous exposure to asbestos. In fact, 70% to 80% of mesothelioma cases are caused by this type of exposure. In most cases, the infected person was either directly or indirectly exposed to asbestos and it may have happened when they worked in a factory or lived in an environment where the chemical was present. Commonly, the affected person was unaware of the asbestos. For instance, an employer could have taken over a site that was previously used by another company to produce asbestos related materials. One could be exposed simply by washing the clothes of an employee who worked there and was directly exposed to it. There are also numerous other ways that someone can be indirectly affected.There are many asbestos related products in our homes. In the past, some companies put asbestos in home insulation, carpet pads, and other products, even thought they realized that it was potentially dangerous. This can be dangerous news for the family who lives in one of these homes. Since the beginning of the 1900’s, it was recognized that asbestos was a workplace hazard. Between 1945 and 1966, a type of commercial asbestos mining took place in Western Australia. A group of the miners were tracked in a study, and after 10 years, there were no deaths that could be blamed on Mesothelioma. However, just nine years later, there were about 85 Mesothelioma related deaths in this evaluated group. Another nine years later, the mesothelioma death count of miners in the Western Australia group had risen to a staggering 539 deaths.
1929 began the very first of the lawsuits that were brought against employers and asbestos manufacturers. The case was settled, however the lawyer agreed not to pursue any more cases. In 1960, an enlightening article was the first to point out asbestos as the main cause of Mesothelioma. The article actually referred to over 30 case studies of people who had suffered from Mesothelioma in South Africa. In Western Australia where the miners were tracked, mine waste containing asbestos was used to cover playgrounds and schoolyards. An important publication by the British Journal of Industrial Medicine in 1965 brought to light the fact that people who lived in asbestos mining towns, but didn’t work in the mines, were contracting Mesothelioma. However, the mine in Western Australia continued to pump out these harmful chemicals, practically handing them out to children, mothers, grandparents, and other people.
In the United States, the first asbestos caused Mesothelioma lawsuit was filed in 1966. This took place in Beaumont, Texas. This case was lost, however, immediately after, a co-worker of the man to file the first lawsuit filed one as well. He won and was awarded $80,000.00. During the years which followed this lawsuit, many others were filed by victims suffering from asbestos related Mesothelioma. In fact, it came to light that in most places infested with asbestos, the senior managers knew all about the link between asbestos and Mesothelioma, but hid it from the employees purposely. When the lawsuits began popping up, even more companies worked as hard as they could to cover their tracks. Many managers were not allowed to discuss asbestos related Mesothelioma at all. It was known as the “hush hush” policy. The managers knew about the link between asbestos and Mesothelioma and hid it from the employees, taking away their option of saving themselves from the damaging effects of asbestos.
In fact, a very important deposition was taken by one senior manager that proved just that. Stating that the disease was terrible, had no cure, and that it would damage a man’s health, the manager asked other managers to keep quiet about the whole thing. His reasoning was that the men would eventually be compensated for their disease. However, there was no reason to let them know about the condition they might already have, because the company still had many years to benefit from the experience and knowledge of these men. The men were then kept in the dark about the dangers they were exposed to everyday. They were never given a chance to decide against working there because of the asbestos. They didn’t know. Basically, many years of life were taken away from these men, and with the management knowing that they would suffer because they could be “paid off” later.
In June, 1982, a retired boiler-maker of Unarco, James Cavette won a record $2.3 million dollars in compensatory awards, and $1.5 million in punitive damages. In June, 1982, Unarco filed bankruptcy. They manufactured Unibestos, which they sold to Pittsburg Corning in 1962. One of the biggest portions of the asbestos litigation history was also in 1982, when the Johns-Manville Corporation filed for Chapter 11 Bankruptcy. This company manufactured building and fireproofing materials from the time they opened in 1958. With the Chapter 11 Bankruptcy, the company was able to suspend all personal injury lawsuits filed against them.
Currently, most people know about the dangers of asbestos and what it can do to a person’s body, in addition to causing Mesothelioma. It is a known fact that the majority of Mesothelioma cases are caused by asbestos. This affects not just the people who were exposed to the asbestos at their jobs, but their family members and in some cases, others in towns that were covered somehow with asbestos, such as in the Western Australian town. Today, the cases of asbestos related Mesothelioma are taken very seriously, and companies have given up trying to hide their awareness and negligence.
As litigation continued from that first lawsuit through the 1980’s and 90’s, lawyers began representing large numbers of victims who had been exposed to asbestos and getting “mass settlements”. While this wasn’t a good thing for the companies being sued, they were able to save on transaction costs, including lawyer’s fees and other defense fees. This also made it difficult for the companies to thoroughly evaluate each and every claim. This means that particularly weak cases sailed through and received payment when they might have lost in a one-on-one lawsuit. However, very strong cases which might have been awarded much more in a one-on-one case were settled for less.
At one point in the 90’s, there was quite a lull in the number of asbestos related lawsuits filed, so most people thought that the worst of the storm was over. Many different businesses had filed bankruptcy and gone out of business, and many of the Mesothelioma victims had died. What happened next actually changed the course of the lawsuits. With the popularity of the internet growing, lawyers were getting in touch with people who suffered from asbestos related injuries, and those lawyers had a different set of targets. They began to go after the companies that were not so directly involved with the damaging asbestos. For example, the companies that produced the materials, and company owners who had purchased firms that were once used for asbestos related materials.
One victim, who was diagnosed with Mesothelioma in 2004, filed suit against Asbestos Corporation Limited. They are the owners and former operators of several Asbestos mining companies in Canada. The plaintiff who suffered with the symptoms of Mesothelioma was a boiler room worker with the Navy for 10 years. During this time, he was exposed to asbestos frequently. He was awarded $1.1 million dollars, his wife was awarded $400,000 for loss of companionship, and they were awarded an additional $10 million dollars because the defendant acted with “oppression and malice”.
On March 8, 2006, a jury awarded James Morrison $5,150,000 for Mesothelioma. James had worked as an HVAC mechanic in the 70’s and 80’s in California. At 52 years old, and a life-long non smoker, James is dying of cancer. His condition is terminal. This is the first case ever filed against the Copeland Refrigerator Company. On May 18, 2006, a Sunnyvale man was awarded $5,900,000.00. A 74 year old business tech sued the Kaiser-Gypsum company. The victim, Robert Johnson, was exposed to asbestos when he was remodeling his homes in the 60’s, and in the 70’s when he supervised the building of his own home.
There are many cases that will be filed in the future from the 60’s and 70’s exposure era. Many of the claimants will exhibit Mesothelioma symptoms, whereas others will not. In fact, an individual may suffer from the disease and not even suspect that something is wrong for many years to come. The symptoms of Mesothelioma can take up to 50, and even 60 years, to show up. So, many of those workers are still not experiencing symptoms even though they have been exposed to asbestos. The truth is that a lot of them will begin to experience symptoms and upon going to the doctor, they will find out that they too, are victims of Mesothelioma.
The companies that are being sued are terrified of class action and individual cases like this, and today, there are still many Mesothelioma cases which have not been settled. These companies are trying to somehow stop these class action cases. They argue that they should reserve the resources they have to settle with the victims which have malignant Mesothelioma. In their view, the victims which have damaging, but not malignant conditions caused by Asbestos, are entitled to little or nothing. The difficult thing about that is this:
Even if victims do not develop malignant mesothelioma, severe asbestosis and pleural thickening can cause horrendous suffering. What essentially happens is that the victim is slowly strangled to death by his or her own lung tissue. The disease keeps getting worse as well, whether the exposure to asbestos has stopped or not. The average case today is settled at around 1 million dollars, and that figure jumps to 6 million dollars when the lawsuit goes to the courts. It’s no wonder that the companies are terrified of the lawsuits placed against them, while the families of the victims are terrified that their loved ones will not be around long enough to benefit from the settlements.
1929 began the very first of the lawsuits that were brought against employers and asbestos manufacturers. The case was settled, however the lawyer agreed not to pursue any more cases. In 1960, an enlightening article was the first to point out asbestos as the main cause of Mesothelioma. The article actually referred to over 30 case studies of people who had suffered from Mesothelioma in South Africa. In Western Australia where the miners were tracked, mine waste containing asbestos was used to cover playgrounds and schoolyards. An important publication by the British Journal of Industrial Medicine in 1965 brought to light the fact that people who lived in asbestos mining towns, but didn’t work in the mines, were contracting Mesothelioma. However, the mine in Western Australia continued to pump out these harmful chemicals, practically handing them out to children, mothers, grandparents, and other people.
In the United States, the first asbestos caused Mesothelioma lawsuit was filed in 1966. This took place in Beaumont, Texas. This case was lost, however, immediately after, a co-worker of the man to file the first lawsuit filed one as well. He won and was awarded $80,000.00. During the years which followed this lawsuit, many others were filed by victims suffering from asbestos related Mesothelioma. In fact, it came to light that in most places infested with asbestos, the senior managers knew all about the link between asbestos and Mesothelioma, but hid it from the employees purposely. When the lawsuits began popping up, even more companies worked as hard as they could to cover their tracks. Many managers were not allowed to discuss asbestos related Mesothelioma at all. It was known as the “hush hush” policy. The managers knew about the link between asbestos and Mesothelioma and hid it from the employees, taking away their option of saving themselves from the damaging effects of asbestos.
In fact, a very important deposition was taken by one senior manager that proved just that. Stating that the disease was terrible, had no cure, and that it would damage a man’s health, the manager asked other managers to keep quiet about the whole thing. His reasoning was that the men would eventually be compensated for their disease. However, there was no reason to let them know about the condition they might already have, because the company still had many years to benefit from the experience and knowledge of these men. The men were then kept in the dark about the dangers they were exposed to everyday. They were never given a chance to decide against working there because of the asbestos. They didn’t know. Basically, many years of life were taken away from these men, and with the management knowing that they would suffer because they could be “paid off” later.
In June, 1982, a retired boiler-maker of Unarco, James Cavette won a record $2.3 million dollars in compensatory awards, and $1.5 million in punitive damages. In June, 1982, Unarco filed bankruptcy. They manufactured Unibestos, which they sold to Pittsburg Corning in 1962. One of the biggest portions of the asbestos litigation history was also in 1982, when the Johns-Manville Corporation filed for Chapter 11 Bankruptcy. This company manufactured building and fireproofing materials from the time they opened in 1958. With the Chapter 11 Bankruptcy, the company was able to suspend all personal injury lawsuits filed against them.
Currently, most people know about the dangers of asbestos and what it can do to a person’s body, in addition to causing Mesothelioma. It is a known fact that the majority of Mesothelioma cases are caused by asbestos. This affects not just the people who were exposed to the asbestos at their jobs, but their family members and in some cases, others in towns that were covered somehow with asbestos, such as in the Western Australian town. Today, the cases of asbestos related Mesothelioma are taken very seriously, and companies have given up trying to hide their awareness and negligence.
As litigation continued from that first lawsuit through the 1980’s and 90’s, lawyers began representing large numbers of victims who had been exposed to asbestos and getting “mass settlements”. While this wasn’t a good thing for the companies being sued, they were able to save on transaction costs, including lawyer’s fees and other defense fees. This also made it difficult for the companies to thoroughly evaluate each and every claim. This means that particularly weak cases sailed through and received payment when they might have lost in a one-on-one lawsuit. However, very strong cases which might have been awarded much more in a one-on-one case were settled for less.
At one point in the 90’s, there was quite a lull in the number of asbestos related lawsuits filed, so most people thought that the worst of the storm was over. Many different businesses had filed bankruptcy and gone out of business, and many of the Mesothelioma victims had died. What happened next actually changed the course of the lawsuits. With the popularity of the internet growing, lawyers were getting in touch with people who suffered from asbestos related injuries, and those lawyers had a different set of targets. They began to go after the companies that were not so directly involved with the damaging asbestos. For example, the companies that produced the materials, and company owners who had purchased firms that were once used for asbestos related materials.
One victim, who was diagnosed with Mesothelioma in 2004, filed suit against Asbestos Corporation Limited. They are the owners and former operators of several Asbestos mining companies in Canada. The plaintiff who suffered with the symptoms of Mesothelioma was a boiler room worker with the Navy for 10 years. During this time, he was exposed to asbestos frequently. He was awarded $1.1 million dollars, his wife was awarded $400,000 for loss of companionship, and they were awarded an additional $10 million dollars because the defendant acted with “oppression and malice”.
On March 8, 2006, a jury awarded James Morrison $5,150,000 for Mesothelioma. James had worked as an HVAC mechanic in the 70’s and 80’s in California. At 52 years old, and a life-long non smoker, James is dying of cancer. His condition is terminal. This is the first case ever filed against the Copeland Refrigerator Company. On May 18, 2006, a Sunnyvale man was awarded $5,900,000.00. A 74 year old business tech sued the Kaiser-Gypsum company. The victim, Robert Johnson, was exposed to asbestos when he was remodeling his homes in the 60’s, and in the 70’s when he supervised the building of his own home.
There are many cases that will be filed in the future from the 60’s and 70’s exposure era. Many of the claimants will exhibit Mesothelioma symptoms, whereas others will not. In fact, an individual may suffer from the disease and not even suspect that something is wrong for many years to come. The symptoms of Mesothelioma can take up to 50, and even 60 years, to show up. So, many of those workers are still not experiencing symptoms even though they have been exposed to asbestos. The truth is that a lot of them will begin to experience symptoms and upon going to the doctor, they will find out that they too, are victims of Mesothelioma.
The companies that are being sued are terrified of class action and individual cases like this, and today, there are still many Mesothelioma cases which have not been settled. These companies are trying to somehow stop these class action cases. They argue that they should reserve the resources they have to settle with the victims which have malignant Mesothelioma. In their view, the victims which have damaging, but not malignant conditions caused by Asbestos, are entitled to little or nothing. The difficult thing about that is this:
Even if victims do not develop malignant mesothelioma, severe asbestosis and pleural thickening can cause horrendous suffering. What essentially happens is that the victim is slowly strangled to death by his or her own lung tissue. The disease keeps getting worse as well, whether the exposure to asbestos has stopped or not. The average case today is settled at around 1 million dollars, and that figure jumps to 6 million dollars when the lawsuit goes to the courts. It’s no wonder that the companies are terrified of the lawsuits placed against them, while the families of the victims are terrified that their loved ones will not be around long enough to benefit from the settlements.
Insomnia
Insomnia means you have trouble falling asleep or staying asleep, or you wake too early. You wake feeling un-refreshed and you feel tired during the day.
For some people, insomnia lasts a night or two. For others, it tortures them for months or even years. Doctors used to think of insomnia only as a symptom of a disease such as depression or anxiety or a result of chronic pain. However, research shows it may be a condition by itself.
Insomnia might also be related to lifestyle. Do you go to bed too late? Do you exercise too close to bedtime? Do you drink caffeinated coffee after dinner?
Insomnia is a serious problem for millions of Americans. More than half of adults in the United States have insomnia a few nights a week or more, according to the National Sleep Foundation. That's troubling because sleep is one of the most basic of human needs and one of the most crucial. If you don't sleep well or get enough sleep, your quality of life suffers. Lack of sleep affects how well you do your job, how quickly your mind works and possibly even your weight and how well your immune system fights disease. Plus, drowsy drivers are a hazard. Yet many people suffer for months or even years before getting help.
Not everyone needs the same amount of sleep. Some need eight hours while others need less. So, it's up to you to decide if you aren't getting enough or not sleeping well.
Prognosis
Insomnia is usually treatable whether it is a symptom of a disease or a condition itself. Getting treatment for an underlying condition, lifestyle changes and medication may help.
More on Insomnia
Sleepless in America
Sleep Shortage Doubly Dangerous
What Is Insomnia?
Uncovering How Men and Women Sleep
Grow Old, Sleep Less?
Do Sleepless Nights Ruin Your Day?
Can Lack of Sleep Make You Gain Weight?
Restless Legs, Restless Nights
Asleep at the Wheel? The Problem of Excessive Sleepiness
In the Encyclopedia:
Cognitive-behavioral therapy
Narcolepsy
Central nervous system depressants
Sleep disorders
Anti-insomnia drugs
Symptoms of Insomnia
Difficulty falling asleep
Waking up frequently during the night
Waking up too early in the morning
Waking up tired
For some people, insomnia lasts a night or two. For others, it tortures them for months or even years. Doctors used to think of insomnia only as a symptom of a disease such as depression or anxiety or a result of chronic pain. However, research shows it may be a condition by itself.
Insomnia might also be related to lifestyle. Do you go to bed too late? Do you exercise too close to bedtime? Do you drink caffeinated coffee after dinner?
Insomnia is a serious problem for millions of Americans. More than half of adults in the United States have insomnia a few nights a week or more, according to the National Sleep Foundation. That's troubling because sleep is one of the most basic of human needs and one of the most crucial. If you don't sleep well or get enough sleep, your quality of life suffers. Lack of sleep affects how well you do your job, how quickly your mind works and possibly even your weight and how well your immune system fights disease. Plus, drowsy drivers are a hazard. Yet many people suffer for months or even years before getting help.
Not everyone needs the same amount of sleep. Some need eight hours while others need less. So, it's up to you to decide if you aren't getting enough or not sleeping well.
Prognosis
Insomnia is usually treatable whether it is a symptom of a disease or a condition itself. Getting treatment for an underlying condition, lifestyle changes and medication may help.
More on Insomnia
Sleepless in America
Sleep Shortage Doubly Dangerous
What Is Insomnia?
Uncovering How Men and Women Sleep
Grow Old, Sleep Less?
Do Sleepless Nights Ruin Your Day?
Can Lack of Sleep Make You Gain Weight?
Restless Legs, Restless Nights
Asleep at the Wheel? The Problem of Excessive Sleepiness
In the Encyclopedia:
Cognitive-behavioral therapy
Narcolepsy
Central nervous system depressants
Sleep disorders
Anti-insomnia drugs
Symptoms of Insomnia
Difficulty falling asleep
Waking up frequently during the night
Waking up too early in the morning
Waking up tired
Asthma
Definition
Asthma is a long-lasting inflammatory lung disease, characterized by:
* Constriction of the airways in the lungs
* Swelling of the lining of the bronchial tubes in the lungs
* Secretion of excessive amounts of thick mucus
This inflammation is activated by irritants or allergens, called triggers. As a result, you may have trouble breathing, be short of breath, wheeze and cough. Sometimes your symptoms can become severe enough to warrant treatment in an emergency room.
Asthma usually begins in childhood, although onset in adulthood is not uncommon. About 20 million people in the United States have asthma. And more than 70 percent of people with asthma have allergies.
Treatment focuses on:
* "Rescue," usually by means of a device called an inhaler when your symptoms are severe enough to cause trouble breathing.
* Prevention of symptoms, by a combination of managing triggers (eliminating dust, for example) and medications.
Prognosis
There is no known cure for asthma. In most people, symptoms get less severe as they get older. However, asthma can be a complication for older adults who develop other respiratory problems, such as emphysema. Effective management of your condition can help you live a healthy and full life.
More on Asthma in Adults
Basic Information About Asthma
Asthma Glossary
In the Encyclopedia:
Allergic rhinitis
Allergies
Anoxia
Antiasthmatic drugs
Asthma
Asthma Symptoms
Wheezing
Tightness in chest
Difficulty breathing
Asthma is a long-lasting inflammatory lung disease, characterized by:
* Constriction of the airways in the lungs
* Swelling of the lining of the bronchial tubes in the lungs
* Secretion of excessive amounts of thick mucus
This inflammation is activated by irritants or allergens, called triggers. As a result, you may have trouble breathing, be short of breath, wheeze and cough. Sometimes your symptoms can become severe enough to warrant treatment in an emergency room.
Asthma usually begins in childhood, although onset in adulthood is not uncommon. About 20 million people in the United States have asthma. And more than 70 percent of people with asthma have allergies.
Treatment focuses on:
* "Rescue," usually by means of a device called an inhaler when your symptoms are severe enough to cause trouble breathing.
* Prevention of symptoms, by a combination of managing triggers (eliminating dust, for example) and medications.
Prognosis
There is no known cure for asthma. In most people, symptoms get less severe as they get older. However, asthma can be a complication for older adults who develop other respiratory problems, such as emphysema. Effective management of your condition can help you live a healthy and full life.
More on Asthma in Adults
Basic Information About Asthma
Asthma Glossary
In the Encyclopedia:
Allergic rhinitis
Allergies
Anoxia
Antiasthmatic drugs
Asthma
Asthma Symptoms
Wheezing
Tightness in chest
Difficulty breathing
How is Mesothelioma Treated
Like most cancers, the outlook for recovery (prognosis) for people with mesothelioma depends on when the disease is diagnosed and how aggressively it is treated. The treatment plan depends on the stage and location of the cancer, as well as the age and desires of the patient. Treatment generally involves some combination of:
Surgery (to remove the cancer or buildup of fluid)
Radiation (the use of high-energy X-rays to kill cancer cells)
Chemotherapy (drugs that kill cancer cells)
Surgery
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest (pleurectomy) or abdomen, and some of the surrounding tissue to get out all of the cancer. Depending on how far the tumor has spread, a lung may also be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm is also removed.
If fluid has collected in your chest or abdomen, your doctor may drain the fluid out by putting a needle into the area and using gentle suction to remove the fluid. Removal of chest fluid for diagnosis or for therapy is called thoracentesis; removal of abdominal fluid is called paracentesis.
Radiation
Radiation therapy uses high-energy X-rays to kill cancer cells or reduce the size of the tumor. Radiation may be administered from a machine outside the body (external radiation therapy) or by inserting materials that produce radiation (radioisotopes) through thin plastic tubes into the cancer area (internal radiation therapy).
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. The drugs may be taken as pills or they may be put into your body by a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the blood, travels through the body (that is, through your entire system), potentially killing cancer cells anywhere in the body. For mesothelioma, chemotherapy may also be put directly into your chest (intrapleural chemotherapy). Recent approval of a new program using pemetrexed (Alimta®) and gemcitabine (Gemzar®) have shown beneficial results and good tolerability.
Treatment by stage
Therapies will vary according to the stage of disease, which is determined at the time of diagnosis. If the cancer is localized (found in only one place in the chest), treatment probably will consist of surgery to remove the tumor and surrounding tissue. If the cancer is present in a larger area, treatment may involve more extensive surgery, external radiation and/or chemotherapy.
Treatment for advanced disease may include thoracentesis or paracentesis to reduce discomfort, as well as drugs placed directly into the chest to prevent further fluid buildup. Surgery and radiation may relieve symptoms, and various types of chemotherapy may be used.
Other treatments
Not all patients respond to standard therapy, and some standard treatments have undesirable side effects. For these reasons, new approaches to therapy are currently being evaluated in clinical trials. These new therapies often combine traditional treatments with something entirely new.
Recent studies reported at the American Society of Clinical Oncology showing that combining a new drug called Alimta® (pemetrexed) with cisplatin have shown good results.
Clinical trials
Clinical trials are currently underway to test new drugs and procedures to fight mesothelioma.
Surgery (to remove the cancer or buildup of fluid)
Radiation (the use of high-energy X-rays to kill cancer cells)
Chemotherapy (drugs that kill cancer cells)
Surgery
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest (pleurectomy) or abdomen, and some of the surrounding tissue to get out all of the cancer. Depending on how far the tumor has spread, a lung may also be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm is also removed.
If fluid has collected in your chest or abdomen, your doctor may drain the fluid out by putting a needle into the area and using gentle suction to remove the fluid. Removal of chest fluid for diagnosis or for therapy is called thoracentesis; removal of abdominal fluid is called paracentesis.
Radiation
Radiation therapy uses high-energy X-rays to kill cancer cells or reduce the size of the tumor. Radiation may be administered from a machine outside the body (external radiation therapy) or by inserting materials that produce radiation (radioisotopes) through thin plastic tubes into the cancer area (internal radiation therapy).
Chemotherapy
Chemotherapy uses drugs to kill cancer cells. The drugs may be taken as pills or they may be put into your body by a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the blood, travels through the body (that is, through your entire system), potentially killing cancer cells anywhere in the body. For mesothelioma, chemotherapy may also be put directly into your chest (intrapleural chemotherapy). Recent approval of a new program using pemetrexed (Alimta®) and gemcitabine (Gemzar®) have shown beneficial results and good tolerability.
Treatment by stage
Therapies will vary according to the stage of disease, which is determined at the time of diagnosis. If the cancer is localized (found in only one place in the chest), treatment probably will consist of surgery to remove the tumor and surrounding tissue. If the cancer is present in a larger area, treatment may involve more extensive surgery, external radiation and/or chemotherapy.
Treatment for advanced disease may include thoracentesis or paracentesis to reduce discomfort, as well as drugs placed directly into the chest to prevent further fluid buildup. Surgery and radiation may relieve symptoms, and various types of chemotherapy may be used.
Other treatments
Not all patients respond to standard therapy, and some standard treatments have undesirable side effects. For these reasons, new approaches to therapy are currently being evaluated in clinical trials. These new therapies often combine traditional treatments with something entirely new.
Recent studies reported at the American Society of Clinical Oncology showing that combining a new drug called Alimta® (pemetrexed) with cisplatin have shown good results.
Clinical trials
Clinical trials are currently underway to test new drugs and procedures to fight mesothelioma.
Wednesday, June 25, 2008
Physical activity's effect on breast cancer
Physical activity's effect on breast cancer varices:
The results of a literature review of published studies confirm that while all women are likely to reduce their risk of breast cancer with regular physical activity, certain subgroups benefit more than others.
According to the report posted online by the British Journal of Sports Medicine, postmenopausal women and those with a normal body mass index (BMI) are among the groups that achieve the greatest risk reduction with physical activity. BMI is the ratio of height to weight.
The findings also indicate that certain activities influence the risk reduction more than others. For instance, recreational physical activity cut the risk of breast cancer to a greater extent than did work-related activity.
Dr. C. M. Friedenreich, from the Alberta Cancer Board in Calgary, Canada, and Dr. A. E. Cust, from the University of Melbourne in Australia, examined how the timing, type, and level of physical activity affects the breast cancer risk. Their literature search identified 62 studies.
Forty-seven of the 62 (76 percent) studies indicated there was an anti-breast cancer effect for increased physical activity, with typical risk reductions of 25 percent to 30 percent, the authors report. In 28 of 33 studies, they found evidence of a dose-response effect, which means more exercise correlated with more benefits.
In terms of activities, recreational activity, vigorous activity, and lifetime or later life activity provided the strongest reductions in breast cancer risk.
In addition to postmenopausal women and those with a normal BMI, other subgroups most likely to benefit from physical activity were non-white women, women who have given birth, and those without a family history of breast cancer.
Exercise also had a greater effect in reducing hormone receptor-negative tumors than hormone receptor-positive tumors, the findings indicate.
"Further observational epidemiological research is needed to clarify the biological mechanisms underling the association between physical activity and reduced breast cancer risk," Friedenreich and Cust conclude, "especially with regard to the type, duration and intensity of activity and to explain differences in population subgroup effects."
SOURCE: British Journal of Sports Medicine, May 12, 2008.
The results of a literature review of published studies confirm that while all women are likely to reduce their risk of breast cancer with regular physical activity, certain subgroups benefit more than others.
According to the report posted online by the British Journal of Sports Medicine, postmenopausal women and those with a normal body mass index (BMI) are among the groups that achieve the greatest risk reduction with physical activity. BMI is the ratio of height to weight.
The findings also indicate that certain activities influence the risk reduction more than others. For instance, recreational physical activity cut the risk of breast cancer to a greater extent than did work-related activity.
Dr. C. M. Friedenreich, from the Alberta Cancer Board in Calgary, Canada, and Dr. A. E. Cust, from the University of Melbourne in Australia, examined how the timing, type, and level of physical activity affects the breast cancer risk. Their literature search identified 62 studies.
Forty-seven of the 62 (76 percent) studies indicated there was an anti-breast cancer effect for increased physical activity, with typical risk reductions of 25 percent to 30 percent, the authors report. In 28 of 33 studies, they found evidence of a dose-response effect, which means more exercise correlated with more benefits.
In terms of activities, recreational activity, vigorous activity, and lifetime or later life activity provided the strongest reductions in breast cancer risk.
In addition to postmenopausal women and those with a normal BMI, other subgroups most likely to benefit from physical activity were non-white women, women who have given birth, and those without a family history of breast cancer.
Exercise also had a greater effect in reducing hormone receptor-negative tumors than hormone receptor-positive tumors, the findings indicate.
"Further observational epidemiological research is needed to clarify the biological mechanisms underling the association between physical activity and reduced breast cancer risk," Friedenreich and Cust conclude, "especially with regard to the type, duration and intensity of activity and to explain differences in population subgroup effects."
SOURCE: British Journal of Sports Medicine, May 12, 2008.
Colostomy for Colon Cancer
You do not always need a colostomy for the treatment of colon cancer. In fact this has become less and less common as surgical methods have improved over the years. Surgery is the most common treatment for colon cancer. If the cancer is limited to a polyp, the patient can undergo a polypectomy (removal of the polyp), or a local excision, where a small amount of surrounding tissue is also removed. If the tumor invades the bowel wall or surrounding tissues, the patient will require a partial resection of the bowel (removal of the cancer and a portion of the bowel) and removal of local lymph nodes to determine if the cancer has spread into them. After the tumor is removed, the two ends of the remaining colon are reconnected, allowing normal bowel function. In some situations, it may not be possible to reconnect the colon, and a colostomy is necessary. A colostomy is when the surgeon passes the end of the colon through the abdominal wall and connects it to the outside of the abdomen, creating an outlet for stool to pass through. Equipment, known as "appliances" are attached to the abdominal wall to collect the stool.
There are times when a colostomy is necessary temporarily. After the patient has had some treatment with chemotherapy and radiation, the surgeon may be able to reverse the colostomy by reconnecting the bowel ends. Whether or not a patient has a temporary, permanent, or no colostomy at all is determined by the size and location of the tumor, which the surgeon evaluates by CT scan and during surgery.
There are times when a colostomy is necessary temporarily. After the patient has had some treatment with chemotherapy and radiation, the surgeon may be able to reverse the colostomy by reconnecting the bowel ends. Whether or not a patient has a temporary, permanent, or no colostomy at all is determined by the size and location of the tumor, which the surgeon evaluates by CT scan and during surgery.
Coffee, Tea Don't Raise Breast Cancer
Coffee and tea don't raise breast cancer risk (NEW YORK -Reuters Health) - Results from a decades-long study may enable women to drink coffee or tea without worry that doing so will increase their risk for breast cancer, study findings suggest.
"In this large cohort of women, with 22 years of follow-up, we observed no association between coffee (caffeinated or decaffeinated) and tea consumption and the risk of breast cancer," Dr. Davaasambuu Ganmaa told Reuters Health.
"Coffee and tea are remarkably safe beverages when used in moderation," said Ganmaa, of the Harvard School of Public Health in Boston, Massachusetts.
Ganmaa and colleagues assessed coffee, tea, and caffeine consumption among 85,987 women who participated in the Nurses' Health Study. The women were between 30 and 55 years old at the start of the study.
Over 22 years of follow up, 5,272 women developed breast cancer.
After accounting for other factors potentially associated with breast cancer risk, such as age, smoking status, body mass, physical activity, alcohol intake, family history, menopausal status, history of hormone therapy, and number of children, the researchers found no elevated risk of breast cancer among women who reported drinking 4 or more cups of caffeinated or decaffeinated coffee or tea per day, compared with those who drank less than 1 cup daily.
They also found no apparent association between the occurrence of breast cancer and intakes of other caffeinated soft drinks and chocolate, which contribute to overall caffeine intake.
When the researchers further assessed breast cancer risk specifically among postmenopausal women, they found a modestly reduced risk associated with the highest versus the lowest caffeine intake. But, "this relation needs to be examined further," the investigators note.
Ref: International Journal of Cancer, May 2008
"In this large cohort of women, with 22 years of follow-up, we observed no association between coffee (caffeinated or decaffeinated) and tea consumption and the risk of breast cancer," Dr. Davaasambuu Ganmaa told Reuters Health.
"Coffee and tea are remarkably safe beverages when used in moderation," said Ganmaa, of the Harvard School of Public Health in Boston, Massachusetts.
Ganmaa and colleagues assessed coffee, tea, and caffeine consumption among 85,987 women who participated in the Nurses' Health Study. The women were between 30 and 55 years old at the start of the study.
Over 22 years of follow up, 5,272 women developed breast cancer.
After accounting for other factors potentially associated with breast cancer risk, such as age, smoking status, body mass, physical activity, alcohol intake, family history, menopausal status, history of hormone therapy, and number of children, the researchers found no elevated risk of breast cancer among women who reported drinking 4 or more cups of caffeinated or decaffeinated coffee or tea per day, compared with those who drank less than 1 cup daily.
They also found no apparent association between the occurrence of breast cancer and intakes of other caffeinated soft drinks and chocolate, which contribute to overall caffeine intake.
When the researchers further assessed breast cancer risk specifically among postmenopausal women, they found a modestly reduced risk associated with the highest versus the lowest caffeine intake. But, "this relation needs to be examined further," the investigators note.
Ref: International Journal of Cancer, May 2008
Visualize Gene Regulation in Living Cells
NCI Scientists Visualize Gene Regulation in Living Cells
A research team led by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), has applied advanced imaging methods and computer simulations to be able to glance at the regulation of a cancer-related gene in a living cell. They found that the efficiency with which the components of the cell's gene reading machinery come together has an impact on gene expression, the process by which a gene translates its information into a new protein. The findings, published in the May 23, 2008 issue of Molecular Cell, shed new light on the means by which living cells regulate gene activity.
"Each new discovery in the realm of gene regulation gives us a fuller appreciation of how a cell controls the expression of its own genetic program," said NCI Director John E. Niederhuber, M.D. "These findings remind us that the puzzle is not yet complete, that there are nuances to how genes are translated that we do not yet completely understand."
A key question regarding how the cell controls gene expression relates to interactions between genes and certain gene reading proteins, and between genes and transcription factors, which regulate gene transcription from DNA to RNA. The process requires the assembly of numerous transcription complexes, particularly one called RNA polymerase, at the site of a gene's promoter (the stretch of DNA before the start of a gene to which transcription factors bind) at the right time.
From earlier work done primarily by NCI researchers, the interactions among transcription factors, and between them and their target DNA, is known to be highly dynamic. What has remained unclear is whether this dynamic nature itself serves some role in regulating gene activity.
To understand the regulatory implications of this dynamism, a team of scientists probed the relationships between a large gene-reading complex known as RNA pol I and genes that encode ribosomal RNAs (rRNAs), which are key components of the cell's protein manufacturing machinery. The rRNA genes are excellent models for studying the dynamics of regulation because their transcription factors are well known, and their interactions with RNA pol I can be visualized using quantitative live-cell fluorescent microscopy, a sophisticated technique for analyzing the activities of proteins and genes in living cells in real-time.
The group's data suggest that there is indeed a regulatory role for these dynamic relationships. RNA pol I is not a single protein but rather a complex of subunits that assemble into the full polymerase when needed. According to the researchers' observations, as the cell increases rRNA production, some of the subunits associate more stably with the gene and assemble active and complete RNA pol I complexes more efficiently. As a result, the cell's production of rRNA increases.
The scientists then interfered with the interactions between the RNA pol I subunits and another transcription factor, thereby mimicking the conditions of a cell that was able to produce rRNA at a high rate. As a result, the efficiency of RNA pol I assembly and the pace of rRNA output both decreased dramatically.
The findings suggest that the efficiency with which the RNA pol I complex assembles all its subunits--which is controlled by a dynamic interplay of polymerase and non-polymerase transcription factors-- plays a significant role in determining when a given gene is turned on. While the group looked only at RNA polymerase I, other research suggests that the phenomena they observed may represent a general mechanism for regulating gene transcription.
The team that led this research included Tom Misteli, Ph.D., head of the Cell Biology of Genomes Group within the Laboratory of Receptor Biology and Gene Expression at NCI's Center for Cancer Research, Stan Gorski, Ph.D., and Sara Snyder, Ph.D. (Reference from Cancer.gov).
A research team led by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), has applied advanced imaging methods and computer simulations to be able to glance at the regulation of a cancer-related gene in a living cell. They found that the efficiency with which the components of the cell's gene reading machinery come together has an impact on gene expression, the process by which a gene translates its information into a new protein. The findings, published in the May 23, 2008 issue of Molecular Cell, shed new light on the means by which living cells regulate gene activity.
"Each new discovery in the realm of gene regulation gives us a fuller appreciation of how a cell controls the expression of its own genetic program," said NCI Director John E. Niederhuber, M.D. "These findings remind us that the puzzle is not yet complete, that there are nuances to how genes are translated that we do not yet completely understand."
A key question regarding how the cell controls gene expression relates to interactions between genes and certain gene reading proteins, and between genes and transcription factors, which regulate gene transcription from DNA to RNA. The process requires the assembly of numerous transcription complexes, particularly one called RNA polymerase, at the site of a gene's promoter (the stretch of DNA before the start of a gene to which transcription factors bind) at the right time.
From earlier work done primarily by NCI researchers, the interactions among transcription factors, and between them and their target DNA, is known to be highly dynamic. What has remained unclear is whether this dynamic nature itself serves some role in regulating gene activity.
To understand the regulatory implications of this dynamism, a team of scientists probed the relationships between a large gene-reading complex known as RNA pol I and genes that encode ribosomal RNAs (rRNAs), which are key components of the cell's protein manufacturing machinery. The rRNA genes are excellent models for studying the dynamics of regulation because their transcription factors are well known, and their interactions with RNA pol I can be visualized using quantitative live-cell fluorescent microscopy, a sophisticated technique for analyzing the activities of proteins and genes in living cells in real-time.
The group's data suggest that there is indeed a regulatory role for these dynamic relationships. RNA pol I is not a single protein but rather a complex of subunits that assemble into the full polymerase when needed. According to the researchers' observations, as the cell increases rRNA production, some of the subunits associate more stably with the gene and assemble active and complete RNA pol I complexes more efficiently. As a result, the cell's production of rRNA increases.
The scientists then interfered with the interactions between the RNA pol I subunits and another transcription factor, thereby mimicking the conditions of a cell that was able to produce rRNA at a high rate. As a result, the efficiency of RNA pol I assembly and the pace of rRNA output both decreased dramatically.
The findings suggest that the efficiency with which the RNA pol I complex assembles all its subunits--which is controlled by a dynamic interplay of polymerase and non-polymerase transcription factors-- plays a significant role in determining when a given gene is turned on. While the group looked only at RNA polymerase I, other research suggests that the phenomena they observed may represent a general mechanism for regulating gene transcription.
The team that led this research included Tom Misteli, Ph.D., head of the Cell Biology of Genomes Group within the Laboratory of Receptor Biology and Gene Expression at NCI's Center for Cancer Research, Stan Gorski, Ph.D., and Sara Snyder, Ph.D. (Reference from Cancer.gov).
U.S. Cancer Group Launches Mass Cancer Study
WASHINGTON (Reuters) - The American Cancer Society said it was looking for half a million volunteers willing to let researchers watch them for the next 20 years to see if they get cancer.
The aim is to match similar big studies in Europe and Asia that are looking on a large scale for the environmental and lifestyle factors that cause cancer, the second-leading cause of death in the United States after heart disease.
"This type of study involves hundreds of thousands of people, with diverse backgrounds, followed for many years, with collection of biological specimens and assessments of dietary, lifestyle and environmental exposures," Eugenia Calle, managing director of analytic epidemiology at the American Cancer Society, said in a statement.
"It also requires active follow-up to discover if and when study participants develop cancer."
The group will recruit men and women between the ages of 30 and 65 who have never been diagnosed with cancer. They will give blood to be tested and answer questionnaires at various times over the next 20 years.
Similar big studies have confirmed the link between cigarette smoking and lung cancer, shown that obesity increases the risk of several cancers, and linked aspirin use to a lower death rate from colon cancer.
They have also found evidence that defied conventional wisdom, such as the Women's Health Initiative study that found hormone replacement therapy actually raises the risk of breast cancer, stroke and heart attack.
The aim is to match similar big studies in Europe and Asia that are looking on a large scale for the environmental and lifestyle factors that cause cancer, the second-leading cause of death in the United States after heart disease.
"This type of study involves hundreds of thousands of people, with diverse backgrounds, followed for many years, with collection of biological specimens and assessments of dietary, lifestyle and environmental exposures," Eugenia Calle, managing director of analytic epidemiology at the American Cancer Society, said in a statement.
"It also requires active follow-up to discover if and when study participants develop cancer."
The group will recruit men and women between the ages of 30 and 65 who have never been diagnosed with cancer. They will give blood to be tested and answer questionnaires at various times over the next 20 years.
Similar big studies have confirmed the link between cigarette smoking and lung cancer, shown that obesity increases the risk of several cancers, and linked aspirin use to a lower death rate from colon cancer.
They have also found evidence that defied conventional wisdom, such as the Women's Health Initiative study that found hormone replacement therapy actually raises the risk of breast cancer, stroke and heart attack.
New Palpable Mass
Management of the patient with a breast mass varies according to age, history and clinical findings. Detection of a breast mass often creates anxiety for the woman and her family, requiring sensitive provider/patient communication. Important questions to consider when assessing the index of suspicion of a breast mass (lesion) detected on CBE include:
* Is it an asymmetrical finding in both breasts?
* Is it a three dimensional discrete palpable mass?
* What is the location and depth?
* Is it mobile or fixed?
* What is the size and shape?
* What is the consistency?
* Is it tender or non-tender?
Normal glandular tissue is generally mirrored in the contralateral breast. A discrete palpable mass is three-dimensional, different from surrounding tissues and usually asymmetric. Clinical signs that are suggestive of benignity, but are not diagnostic, include a mass that is soft, rubbery and mobile. Features suggestive of malignancy include a mass that feels firm or hard, is fixed, has an irregular shape, is solitary, and feels much different from the surrounding breast tissue (Barton, 1999; Goodson, 1996).
CBE is a screening method, not a diagnostic test. Regardless of age, every clinically suspicious lesion requires further evaluation. CBE finds 4% to 7% of cancers that are normal or benign on mammography (Green 2003, Bobo 2000, Beyer 2003, Georgian-Smith 2000). Thus, an abnormal CBE in the presence of a negative mammogram requires further follow-up. The leading cause of physician delay in the diagnosis of breast cancer continues to be inappropriate judgment that a mass is benign without performing a biopsy. Reducing delay in diagnosis requires less reliance on CBE to determine the benignity of a mass as well as less reliance on benign mammographic reports in deciding not to biopsy a mass (Goodson, 2002). Physical exam alone is approximately 70% accurate; mammography alone is approximately 85% accurate; minimally invasive tissue diagnosis alone is approximately 95% accurate. While physical exam and mammogram alone can detect many cancers, no single test by itself allows for detection of all breast cancers. The best clinical approach to the diagnosis and management of patients with a palpable mass is the combination of all three tests – physical exam, radiographic imaging and pathology (biopsy or FNA). This diagnostic triad is known as the "triple test." The diagnostic accuracy of these three tests taken together approaches 100% (Morris, 2002; Vetto, 2003). Clinicians should select the "triple test" method as it helps make an evidence-based decision about clinical management. If one of the "triple test" components is discordant, the entire diagnosis is uncertain and each of the "triple test" findings will need to be reviewed before proceeding.
Pre-menopausal Women
In patients younger than 30 years of age, or patients who are pregnant, ultrasound may be the first or sole breast imaging modality performed (Mehta, 2003 and Baker, 2000). For patients 30-49 years of age with a new palpable mass, a cyst is the most likely diagnosis and can be confirmed or ruled-out by fine needle aspiration (FNA) or ultrasound (a diagnostic imaging modality). If the degree of suspicion is very low (the palpable mass is a "ridge" and is two-dimensional, rather than three-dimensional), it is acceptable to repeat the screening CBE at a more optimal time of the menstrual cycle. Any palpable mass that persists and has not been proven to be a simple cyst, must receive additional diagnostic work-up until a final diagnostic status is determined.
Post-menopausal Women
Since the risk of breast cancer increases with age, clinicians need to be more suspicious of a dominant mass or asymmetric thickening in the breasts of postmenopausal women. Cystic findings decrease after menopause, although cysts, pain, and discharge can be found in women taking hormone replacement therapy. Diagnostic imaging evaluation is usually the first-line investigation of a palpable breast mass in postmenopausal women.
Regardless of age, it is important to request a diagnostic imaging evaluation for a palpable mass, and NOT a screening mammogram.
* Is it an asymmetrical finding in both breasts?
* Is it a three dimensional discrete palpable mass?
* What is the location and depth?
* Is it mobile or fixed?
* What is the size and shape?
* What is the consistency?
* Is it tender or non-tender?
Normal glandular tissue is generally mirrored in the contralateral breast. A discrete palpable mass is three-dimensional, different from surrounding tissues and usually asymmetric. Clinical signs that are suggestive of benignity, but are not diagnostic, include a mass that is soft, rubbery and mobile. Features suggestive of malignancy include a mass that feels firm or hard, is fixed, has an irregular shape, is solitary, and feels much different from the surrounding breast tissue (Barton, 1999; Goodson, 1996).
CBE is a screening method, not a diagnostic test. Regardless of age, every clinically suspicious lesion requires further evaluation. CBE finds 4% to 7% of cancers that are normal or benign on mammography (Green 2003, Bobo 2000, Beyer 2003, Georgian-Smith 2000). Thus, an abnormal CBE in the presence of a negative mammogram requires further follow-up. The leading cause of physician delay in the diagnosis of breast cancer continues to be inappropriate judgment that a mass is benign without performing a biopsy. Reducing delay in diagnosis requires less reliance on CBE to determine the benignity of a mass as well as less reliance on benign mammographic reports in deciding not to biopsy a mass (Goodson, 2002). Physical exam alone is approximately 70% accurate; mammography alone is approximately 85% accurate; minimally invasive tissue diagnosis alone is approximately 95% accurate. While physical exam and mammogram alone can detect many cancers, no single test by itself allows for detection of all breast cancers. The best clinical approach to the diagnosis and management of patients with a palpable mass is the combination of all three tests – physical exam, radiographic imaging and pathology (biopsy or FNA). This diagnostic triad is known as the "triple test." The diagnostic accuracy of these three tests taken together approaches 100% (Morris, 2002; Vetto, 2003). Clinicians should select the "triple test" method as it helps make an evidence-based decision about clinical management. If one of the "triple test" components is discordant, the entire diagnosis is uncertain and each of the "triple test" findings will need to be reviewed before proceeding.
Pre-menopausal Women
In patients younger than 30 years of age, or patients who are pregnant, ultrasound may be the first or sole breast imaging modality performed (Mehta, 2003 and Baker, 2000). For patients 30-49 years of age with a new palpable mass, a cyst is the most likely diagnosis and can be confirmed or ruled-out by fine needle aspiration (FNA) or ultrasound (a diagnostic imaging modality). If the degree of suspicion is very low (the palpable mass is a "ridge" and is two-dimensional, rather than three-dimensional), it is acceptable to repeat the screening CBE at a more optimal time of the menstrual cycle. Any palpable mass that persists and has not been proven to be a simple cyst, must receive additional diagnostic work-up until a final diagnostic status is determined.
Post-menopausal Women
Since the risk of breast cancer increases with age, clinicians need to be more suspicious of a dominant mass or asymmetric thickening in the breasts of postmenopausal women. Cystic findings decrease after menopause, although cysts, pain, and discharge can be found in women taking hormone replacement therapy. Diagnostic imaging evaluation is usually the first-line investigation of a palpable breast mass in postmenopausal women.
Regardless of age, it is important to request a diagnostic imaging evaluation for a palpable mass, and NOT a screening mammogram.
Cancer Causes
Cancer is a group of more than 100 different diseases. Cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. All organs of the body are made up of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be benign or malignant.
Malignant tumors are cancer. Cancer cells can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.
Most cancers are named for the type of cell or the organ in which they begin. When cancer spreads, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if lung cancer spreads to the liver, the cancer cells in the liver are lung cancer cells. The disease is called metastatic lung cancer (not liver cancer).
Our current understanding of the causes of cancer is incomplete, but it is clear that cancer is not caused by an injury, such as a bump or bruise. And although being infected with certain viruses may increase the risk of some types of cancer, cancer is not contagious. No one can "catch" cancer from another person.
Cancer develops gradually as a result of a complex mix of factors related to environment, lifestyle, and heredity. Scientists have identified many risk factors that increase the chance of getting cancer. They estimate that about 80 percent of all cancers are related to the use of tobacco products, to what we eat and drink, or, to a lesser extent, to exposure to radiation or cancer-causing agents (carcinogens) in the environment and the workplace. Some people are more sensitive than others to factors that can cause cancer.
Many risk factors can be avoided. Others, such as inherited risk factors, are unavoidable. It is helpful to be aware of them, but it is also important to keep in mind that not everyone with a particular risk factor for cancer actually develops the disease. In fact, most do not. People at risk can help protect themselves by avoiding risk factors where possible and by getting regular checkups, so that if cancer develops, it is likely to be found early.
Below are some of the factors that are known to increase the risk of cancer:
1. Tobacco
2. Diet
3. Sunlight
4. Alcohol
5. Radiation
6. Chemicals and Other Substances
7. Hormone Replacement Therapy
8. Diethylstilbestrol (DES)
Malignant tumors are cancer. Cancer cells can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.
Most cancers are named for the type of cell or the organ in which they begin. When cancer spreads, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if lung cancer spreads to the liver, the cancer cells in the liver are lung cancer cells. The disease is called metastatic lung cancer (not liver cancer).
Our current understanding of the causes of cancer is incomplete, but it is clear that cancer is not caused by an injury, such as a bump or bruise. And although being infected with certain viruses may increase the risk of some types of cancer, cancer is not contagious. No one can "catch" cancer from another person.
Cancer develops gradually as a result of a complex mix of factors related to environment, lifestyle, and heredity. Scientists have identified many risk factors that increase the chance of getting cancer. They estimate that about 80 percent of all cancers are related to the use of tobacco products, to what we eat and drink, or, to a lesser extent, to exposure to radiation or cancer-causing agents (carcinogens) in the environment and the workplace. Some people are more sensitive than others to factors that can cause cancer.
Many risk factors can be avoided. Others, such as inherited risk factors, are unavoidable. It is helpful to be aware of them, but it is also important to keep in mind that not everyone with a particular risk factor for cancer actually develops the disease. In fact, most do not. People at risk can help protect themselves by avoiding risk factors where possible and by getting regular checkups, so that if cancer develops, it is likely to be found early.
Below are some of the factors that are known to increase the risk of cancer:
1. Tobacco
2. Diet
3. Sunlight
4. Alcohol
5. Radiation
6. Chemicals and Other Substances
7. Hormone Replacement Therapy
8. Diethylstilbestrol (DES)
Colon Cancer
What is Colon Cancer?
Any cancer that starts in the colon (large intestine) is called colon cancer. Cancers are formed by abnormal cells that grow and divide without control. These cancer cells replace normal cells and form a tumor or lump. As a tumor gets bigger, it can grow into nearby tissues and organs. Cancer cells can spread to other parts of the body through the blood or lymph vessels. Most colon cancers start in the cells that line the inside of the large intestine. Tumor cells grow there, invade through the layers of the colon, and spread to lymph nodes and other tissues. Colon cancer is one of the most common cancers in the US, with about 130,000 new cases a year.
What is the colon and what does it do?
The large intestine (colon) is the last part of the digestive system before wastes leave the body.
The colon is divided into five parts:
1. Cecum - part closest to the small intestine
2. Right colon
3. Transverse colon – part that connects the right and left
4. Colon
5. Left colon
6. Sigmoid colon - part just above the rectum
The large intestine is separated from the small intestine by a circle of muscle called the ileocecal valve. It controls the flow of fluid from the small to the large bowel. The large intestine absorbs water and some nutrients, and eliminates wastes from our diets.
There are five layers of tissue that make up the colon:
1. Lining layer (lamina propria)
2. Muscular layer for the lining (muscularis mucosa)
3. Support tissue for lining layers (submucosa)
4. Muscle (muscularis)
5. Outside covering layer (serosa)
Colon cancer usually starts in the lining layer. It grows larger and deeper through the other layers, spreading to nearby tissues and lymph nodes. The tumor can make a hole in the colon into the abdomen or into another organ. The intestines can keep working even though a cancer has started in one part of it. This means a colon cancer can get quite large or deep before it is diagnosed.
What are the symptoms of colon cancer?
Symptoms caused by colon cancer are from the tumor taking up space inside the intestine, from the loss of small amounts of blood from the tumor into the bowel, and from the tumor growing through the intestine into the abdomen or other organs. A tumor can cause a blockage or obstruction so the stool cannot pass by easily. The cancer tissue can bleed into the intestine, making the person anemic. Some symptoms are caused by cancer cells invading other tissues or putting pressure on nerves. Colon cancer usually grows for some time before it causes any symptoms. When symptoms occur they include:
• abdominal pain
• change in bowel habits
• weight loss (without dieting)
• weakness or tiredness (due to anemia—a low blood count)
• nausea and vomiting
• swelling of the abdomen
• rectal bleeding
• bloody or black, sticky bowel movements
• rectal pain
These symptoms can have other causes and should be checked by a doctor.
How is colon cancer diagnosed?
A patient’s medical history and physical exam are the first steps in making a diagnosis of any disease. The medical history includes many details of a person’s health. In particular, the history will focus on the digestive tract—changes in eating habits, changes in bowel movements, abdominal pain or bloating, and how food affects any of the symptoms. In the case of colon cancer, the patient’s history may include information about other diseases such as:
• Inflammatory bowel disease
• Granulomatous colitis
• Previous colorectal cancer or polyps
• Radiation of the pelvis
• Gi surgery in the past, including gallbladder removal
• Family history of polyps or colon cancer
The physical exam will focus on areas of discomfort in the abdomen, the presence of a mass (a lump) in the abdomen, an enlarged liver, fluid or swelling in the abdomen, any skin color change (yellow jaundice), or enlarged lymph nodes. The stool must be checked for blood. The rectum and anus need to be checked for lumps by digital (finger) exam.
After the history and physical exam, some diagnostic tests may be ordered. Blood tests and a chest x-ray check a patient’s general health. Some blood tests that may be done include:
• Blood count- to check for anemia and iron deficiency
• Liver enzymes- for possible spread to the liver
• CEA-marker protein that may increase
Special tests that are useful in diagnosing colon cancer are:
1. CT scan—x-rays made in thin cross-sections of the abdomen. This set of x-rays can show a tumor in the colon, as well as its spread to nearby tissues and lymph nodes. This test is especially useful for finding disease spread to the liver.
2. Colonoscopy—this test uses a thin, flexible tube with a camera in it to look at the inside of the colon (large intestine) and rectum. The camera images are displayed on a TV monitor allowing the doctor to see the inside of the entire large intestine. The colonoscope is passed through the anus and rectum into the colon and up through the large intestine. A biopsy can be taken of any tissue that looks abnormal. Lumps of tissue inside the colon called polyps can be removed. In preparation for the test, the patient drinks only liquids the day before, including a fluid that helps clean out the bowel. The procedure is done using sedation for relaxation. It is not a painful procedure and does not require anesthesia.
What is a biopsy? What does it mean to a patient?
A biopsy is a small piece of tissue or group of cells used to diagnose a disease. The tissue is taken from a spot suspected of being abnormal. Then the biopsy tissue is looked at under a microscope by a pathologist. The diagnosis is based on the appearance of the tissue and cells. The biopsy result is used to decide the patient’s treatment.
What if the biopsy shows colon cancer?
If the biopsy shows cancer, the next step is to find out how much disease there is. You need to know:
• How widespread is the disease in the colon
• How many layers has it spread through
• Has it spread beyond the colon into the lymph nodes, into nearby tissues, or to distant lymph nodes and other organs
What tests are used to find the spread of colon cancer?
• CT scans—these are X-rays that show cross-section pictures of the body. CT images let the radiologist see the abdominal organs in many ways, going across, as well as up and down, the body. An abdominal CT scan shows the stomach, lymph nodes, liver, gallbladder and bile ducts, pancreas, small and large intestines, kidneys, major blood vessels, and part of the spine. The patient may need to drink a contrast solution to help outline the digestive organs. An IV is used to give the patient contrast “dye” that travels through the blood. Contrast dye in the blood makes a person feel very warm for a brief time, and causes a sensation of needing to pee urgently. Both feelings pass quickly. CT scans are not painful but do require lying on a table for about 30 minutes.
• Laparoscopy—this procedure lets the surgeon look inside the abdomen with a laparoscope, a thin tube with a small camera in the end. The laparoscope is inserted through a small abdominal incision. It transmits pictures from inside the abdomen to a TV monitor so the surgeon can see what tissues look normal and which do not. This helps plan the patient’s surgery and other treatments. This procedure is used for small intestine disease much more often than for colon cancer. Laparoscopy is done in the operating room with the patient under general anesthesia.
The information about the patient including the medical history, physical exam, blood tests, x-rays, special scans, and procedures are used to describe the patient’s stage of disease and plan the best treatment for that disease.
Any cancer that starts in the colon (large intestine) is called colon cancer. Cancers are formed by abnormal cells that grow and divide without control. These cancer cells replace normal cells and form a tumor or lump. As a tumor gets bigger, it can grow into nearby tissues and organs. Cancer cells can spread to other parts of the body through the blood or lymph vessels. Most colon cancers start in the cells that line the inside of the large intestine. Tumor cells grow there, invade through the layers of the colon, and spread to lymph nodes and other tissues. Colon cancer is one of the most common cancers in the US, with about 130,000 new cases a year.
What is the colon and what does it do?
The large intestine (colon) is the last part of the digestive system before wastes leave the body.
The colon is divided into five parts:
1. Cecum - part closest to the small intestine
2. Right colon
3. Transverse colon – part that connects the right and left
4. Colon
5. Left colon
6. Sigmoid colon - part just above the rectum
The large intestine is separated from the small intestine by a circle of muscle called the ileocecal valve. It controls the flow of fluid from the small to the large bowel. The large intestine absorbs water and some nutrients, and eliminates wastes from our diets.
There are five layers of tissue that make up the colon:
1. Lining layer (lamina propria)
2. Muscular layer for the lining (muscularis mucosa)
3. Support tissue for lining layers (submucosa)
4. Muscle (muscularis)
5. Outside covering layer (serosa)
Colon cancer usually starts in the lining layer. It grows larger and deeper through the other layers, spreading to nearby tissues and lymph nodes. The tumor can make a hole in the colon into the abdomen or into another organ. The intestines can keep working even though a cancer has started in one part of it. This means a colon cancer can get quite large or deep before it is diagnosed.
What are the symptoms of colon cancer?
Symptoms caused by colon cancer are from the tumor taking up space inside the intestine, from the loss of small amounts of blood from the tumor into the bowel, and from the tumor growing through the intestine into the abdomen or other organs. A tumor can cause a blockage or obstruction so the stool cannot pass by easily. The cancer tissue can bleed into the intestine, making the person anemic. Some symptoms are caused by cancer cells invading other tissues or putting pressure on nerves. Colon cancer usually grows for some time before it causes any symptoms. When symptoms occur they include:
• abdominal pain
• change in bowel habits
• weight loss (without dieting)
• weakness or tiredness (due to anemia—a low blood count)
• nausea and vomiting
• swelling of the abdomen
• rectal bleeding
• bloody or black, sticky bowel movements
• rectal pain
These symptoms can have other causes and should be checked by a doctor.
How is colon cancer diagnosed?
A patient’s medical history and physical exam are the first steps in making a diagnosis of any disease. The medical history includes many details of a person’s health. In particular, the history will focus on the digestive tract—changes in eating habits, changes in bowel movements, abdominal pain or bloating, and how food affects any of the symptoms. In the case of colon cancer, the patient’s history may include information about other diseases such as:
• Inflammatory bowel disease
• Granulomatous colitis
• Previous colorectal cancer or polyps
• Radiation of the pelvis
• Gi surgery in the past, including gallbladder removal
• Family history of polyps or colon cancer
The physical exam will focus on areas of discomfort in the abdomen, the presence of a mass (a lump) in the abdomen, an enlarged liver, fluid or swelling in the abdomen, any skin color change (yellow jaundice), or enlarged lymph nodes. The stool must be checked for blood. The rectum and anus need to be checked for lumps by digital (finger) exam.
After the history and physical exam, some diagnostic tests may be ordered. Blood tests and a chest x-ray check a patient’s general health. Some blood tests that may be done include:
• Blood count- to check for anemia and iron deficiency
• Liver enzymes- for possible spread to the liver
• CEA-marker protein that may increase
Special tests that are useful in diagnosing colon cancer are:
1. CT scan—x-rays made in thin cross-sections of the abdomen. This set of x-rays can show a tumor in the colon, as well as its spread to nearby tissues and lymph nodes. This test is especially useful for finding disease spread to the liver.
2. Colonoscopy—this test uses a thin, flexible tube with a camera in it to look at the inside of the colon (large intestine) and rectum. The camera images are displayed on a TV monitor allowing the doctor to see the inside of the entire large intestine. The colonoscope is passed through the anus and rectum into the colon and up through the large intestine. A biopsy can be taken of any tissue that looks abnormal. Lumps of tissue inside the colon called polyps can be removed. In preparation for the test, the patient drinks only liquids the day before, including a fluid that helps clean out the bowel. The procedure is done using sedation for relaxation. It is not a painful procedure and does not require anesthesia.
What is a biopsy? What does it mean to a patient?
A biopsy is a small piece of tissue or group of cells used to diagnose a disease. The tissue is taken from a spot suspected of being abnormal. Then the biopsy tissue is looked at under a microscope by a pathologist. The diagnosis is based on the appearance of the tissue and cells. The biopsy result is used to decide the patient’s treatment.
What if the biopsy shows colon cancer?
If the biopsy shows cancer, the next step is to find out how much disease there is. You need to know:
• How widespread is the disease in the colon
• How many layers has it spread through
• Has it spread beyond the colon into the lymph nodes, into nearby tissues, or to distant lymph nodes and other organs
What tests are used to find the spread of colon cancer?
• CT scans—these are X-rays that show cross-section pictures of the body. CT images let the radiologist see the abdominal organs in many ways, going across, as well as up and down, the body. An abdominal CT scan shows the stomach, lymph nodes, liver, gallbladder and bile ducts, pancreas, small and large intestines, kidneys, major blood vessels, and part of the spine. The patient may need to drink a contrast solution to help outline the digestive organs. An IV is used to give the patient contrast “dye” that travels through the blood. Contrast dye in the blood makes a person feel very warm for a brief time, and causes a sensation of needing to pee urgently. Both feelings pass quickly. CT scans are not painful but do require lying on a table for about 30 minutes.
• Laparoscopy—this procedure lets the surgeon look inside the abdomen with a laparoscope, a thin tube with a small camera in the end. The laparoscope is inserted through a small abdominal incision. It transmits pictures from inside the abdomen to a TV monitor so the surgeon can see what tissues look normal and which do not. This helps plan the patient’s surgery and other treatments. This procedure is used for small intestine disease much more often than for colon cancer. Laparoscopy is done in the operating room with the patient under general anesthesia.
The information about the patient including the medical history, physical exam, blood tests, x-rays, special scans, and procedures are used to describe the patient’s stage of disease and plan the best treatment for that disease.
What is MASS?
Would it be more difficult to pull an elephant or a mouse?
If you pulled each animal with the same amount of force, the elephant would respond less to pulling, even if he didn’t pull back at all. That’s because an elephant has more mass than a mouse.
Mass is the amount of material in an object. Mass stays the same no matter what force is acting on the object. This makes mass different from weight, which depends on both the amount of mass and the amount of gravity. This means that even though our elephant weighs less on the moon, his mass stays the same.
If you pulled each animal with the same amount of force, the elephant would respond less to pulling, even if he didn’t pull back at all. That’s because an elephant has more mass than a mouse.
Mass is the amount of material in an object. Mass stays the same no matter what force is acting on the object. This makes mass different from weight, which depends on both the amount of mass and the amount of gravity. This means that even though our elephant weighs less on the moon, his mass stays the same.
Thursday, June 12, 2008
Mesothelioma Cancer - Aggressive and Invasive
Mesothelioma Cancer - Aggressive and Invasive
Mesothelioma cancer (MC) is an aggressive and invasive form of cancer, and it quickly spreads over the surface of the lungs, abdominal organs or heart. In the simplest terms, is a cancer of the mesothelium, the membrane that covers the organs in the body. It is a rare form of cancer; only 2,000-3,000 new mesothelioma cases are reported each year.
Most of the people who develop mesothelioma cancer have worked in an environment where they have inhaled particles of asbestos. Depending on what type of mesothelioma cancer is involved, how advanced it is, and other factors, life expectancy (or the median life-span after diagnosis) ranges from four months to two years. Recently, however, some advances have been made in treatment, particularly in multimodal treatment (using more than one treatment method to attack the disease) that have helped patients live longer. There are also continually new mesothelioma cancer treatments developed and combinations of treatments being tried that show promise.
Also remember that a median is just a mid-point; if the median length of life after diagnosis is a year, that means that half of the patients diagnosed live longer than a year. Many will live much longer: for an enlightening look at what that means, you can read “The Median is not the Message,” by Stephen Jay Gould.
Although exposure to asbestos has been greatly reduced since it became clear that it was responsible for serious illness, it can take 30 to 50 years for the disease to show up after exposure. (This isn’t universal, however; there are rare cases of children and adolescents who are diagnosed with mesothelioma cancer.) As a result of the delay in onset, the number of cases increased as the exposure to asbestos fibers decreased for most people.
The mesothelium is actually made up of two layers of tissue: one covers the organ, and the other forms a sac around the area, with a lubricating fluid between the layers to facilitate movement (like the expansions and contractions of a beating heart, or the expansion of your lungs as you breathe in and out.) The mesothelium has different names in different areas of the body. For example, the mesothelial membrane that surrounds the lungs is the pleura, so malignant pleural mesothelioma is cancer that starts in the membrane around the lungs. The mesothelium that lines the abdomen and covers most of the abdominal organs is the peritoneum, and the one around the heart is the pericardium. Most cases of malignant Mesothelioma cancer are pleural; the next most common type is peritoneal mesothelioma cancer.
From the mesothelium, cancerous cells can invade nearby organs, tissue, or lymph nodes, or metastasize elsewhere in the body.
The single greatest risk factor for mesothelioma cancer is exposure to asbestos. Most reported cases occur in people who have occupational exposure to asbestos, but there are some cases of second-hand exposure, where the patient is the spouse of someone who works with asbestos, and may carry the fibers home. There are cases where the patient has had no known exposure to asbestos, but these are scarce.
Asbestos and Mesothelioma Cancer
Asbestos is a fibrous mineral that has been widely used in many industrial products since the late 1800s, and especially since World War II. Because heat and chemical exposure do not affect it, and it does not conduct electricity, it has been used in products like insulation, roofing shingles, flooring materials, cement, brake linings, and fabrics. Floating particles of asbestos – often released during manufacturing, or more recently, when asbestos-containing materials are removed from buildings – can be inhaled or swallowed; these particles can cause serious illness.
In addition to its link with Mesothelioma cancer, asbestos exposure can increase the risk of lung cancer and other forms of cancer, as well as asbestosis, which is a non-malignant, chronic respiratory illness. Tobacco use does not appear to exacerbate the risk of Mesothelioma cancer when combined with asbestos exposure, but the combination does significantly increase the risk of lung disease in general.
Other possible causes
For those patients with little or no documented exposure to asbestos, there are several possibilities. First of all, it has not been determined how much asbestos exposure is required to cause MC; it may be that very small amounts (that would perhaps never be noticed) can cause the disease.
Zeolite is another fibrous mineral that is not asbestos; it has been implicated as the probable cause of an epidemic of MC in a small village in Turkey.
MC has also been known to occur in conjunction with chronic inflammation and scarring caused by other respiratory illnesses. It is also likely that there is a genetic component to the development of the illness; it tends to run in families, and while all of the family members have exposure to asbestos, MC only occurs in a very small percentage of people who were exposed to it occupationally.
Radiation therapy could also be a cause; MC has been associated with radiation treatments for other illnesses.
Other possibilities have been suggested, but not proven. They include chemical exposure and viral infection, which have caused malignant MC in some animal studies.
Mesothelioma Cancer Symptoms
The first symptoms of pleural MC may be chest pain or shortness of breath; some people may also be hoarse or have difficulty swallowing, or coughing up blood. Also, more than half of the patients with pleural MC have lower back pain or pain at the side of the chest.
Usually, the first symptom of peritoneal MC is abdominal pain or swelling, which may look like weight gain around the waist. Because the first signs of the disease are-often flu-like symptoms, many people are either diagnosed accidentally, when a tumor is discovered in the process of diagnosing unrelated symptoms, or are not diagnosed at all until the cancer is so advanced that it causes abdominal swelling. Other symptoms are weight loss, nausea, lack of appetite, and weakness.
Mesothelioma Cancer Diagnosis
There are various tests used to diagnose MC once your doctor thinks you may have it:
Medical history and physical examination
First, your medical history will be taken to establish when symptoms occurred, and whether there are any factors in your history or environment that would put you at greater risk for the disease. This may help determine if you have been exposed to asbestos at some point.
There will also be a thorough physical exam, in which the doctor looks for signs of malignant MC or other health problems. Pleural mesothelioma will often cause pleural effusion, or fluid in the chest cavity; fluid in the peritoneum or the pericardium (which can be caused by mesotheliomas in those areas) can also be detected by an exam.
Imaging
Chest x-rays can show irregular thickening of the pleura, calcifications (or mineral deposits) in the pleura, lowering the spaces between the lobes of the lungs, or fluid in the pleura. Often, these symptoms are associated with asbestos exposure that leads to malignant MC.
X-rays, CT (computed tomography) scans and MRI (magnetic resonance imaging) scans can help locate the cancer and determine its size and extent. CT and MRI scans both take multiple images of the scanned area from different positions, and use computer processing to produce detailed images that are cross-sections. CT scans use x-rays, sometimes with the injection of a non-toxic dye (to highlight details); the MRI uses magnetic fields to create its images.
Testing fluid and tissue samples
If your doctor sees that fluid has collected in the mesothelial tissue, it can be sampled with a needle and tested. Analysis of the fluid can provide more information about the cause of the effusion, and may show the presence of cancer cells. Using fluid to diagnose mesothelioma cancer is not as precise as using tissue samples, though, so it may be necessary to follow the sampling of fluid with a tissue biopsy.
If there is a tumor, a tissue sample can be taken using thoracoscopy or laparoscopy, where a thin tube with a camera connected to it can be inserted into the chest or abdomen to see the tumor and get a sample of it. (Fluid can also be collected this way.) The procedure requires only small incisions.
Surgery
Surgery can be used to remove part or all of a tumor from the chest cavity or the abdomen. The procedure of opening the chest cavity is called thoracotomy; a laparotomy is the opening of the abdominal cavity.
Oral exploration
If a patient might have pleural mesothelioma, a bronchoscopy may be performed. This is where a flexible lighted tube is inserted through the mouth into the trachea and the bronchi to look for abnormal tissue and take samples.
Lymph Nodes
Another procedure your doctor may recommend is a mediastinoscopy. A lighted tube is inserted under the sternum (the breastbone) into the chest from the neck. It is possible to see the lymph nodes using this procedure, and to take samples to analyze for malignancy.
The lymph nodes are masses of immune system cells that are about the size of a bean. They help the body fight infection and cancer. Examining the lymph nodes can determine whether the cancer has spread or not; also, because lung cancer spreads to the lymph nodes more often than mesothelioma, it may help distinguish between lung cancer and mesothelioma.
Even with tissue samples, it has traditionally been difficult to see the cells well enough to distinguish mesothelioma from different types of cancer. One of the biggest problems in diagnosing mesothelioma is that it can look just like other kinds of cancer at first.
A recent breakthrough in diagnosis that will undoubtedly have an effect on the series of diagnostic tests above was reported in November 2003.² A new blood test is being developed that can detect the presence of high levels of a distinct kind of molecular marker which is peculiar to mesothelioma, SMR (or soluble mesothelin-related proteins). In one trial, 84% of the mesothelioma patients showed high levels of SMR, while less than 2% of those with other forms of lung cancer did.
Even more promising than being able to diagnose mesothelioma in a minimally invasive way is the possibility of predicting mesothelioma in people who have no symptoms. SMR levels can be higher several years before the onset of symptoms, so by doing a blood test on people who have been exposed to asbestos, it is possible to find the disease while the chances of treating it successfully are much higher.
Mesotheliomas usually fall into one of these three types:
1. epitheloid (making up about 50%-70% of the total occurrences)– this has the best chance of survival
2. sarcomatoid (7%-20%) – this has the worst chance for survival.
3. mixed or biphasic (20%-35%) – this falls between the other two
Treatment options are the same for all types.
There is a type of tumor that was originally called benign mesothelioma, because it appeared to form in the same location as malignant mesothelioma. These are actually fibrous tumors that are usually benign, although they can become cancerous. Doctors now understand that they don’t originate from mesothelial cells, but from tissue under the mesothelium, so they are not related to malignant mesothelioma. Whatever their source, however, they are not easy to differentiate from malignant mesothelioma without biopsy, so they need to be mentioned in this context.
Mesothelioma cancer (MC) is an aggressive and invasive form of cancer, and it quickly spreads over the surface of the lungs, abdominal organs or heart. In the simplest terms, is a cancer of the mesothelium, the membrane that covers the organs in the body. It is a rare form of cancer; only 2,000-3,000 new mesothelioma cases are reported each year.
Most of the people who develop mesothelioma cancer have worked in an environment where they have inhaled particles of asbestos. Depending on what type of mesothelioma cancer is involved, how advanced it is, and other factors, life expectancy (or the median life-span after diagnosis) ranges from four months to two years. Recently, however, some advances have been made in treatment, particularly in multimodal treatment (using more than one treatment method to attack the disease) that have helped patients live longer. There are also continually new mesothelioma cancer treatments developed and combinations of treatments being tried that show promise.
Also remember that a median is just a mid-point; if the median length of life after diagnosis is a year, that means that half of the patients diagnosed live longer than a year. Many will live much longer: for an enlightening look at what that means, you can read “The Median is not the Message,” by Stephen Jay Gould.
Although exposure to asbestos has been greatly reduced since it became clear that it was responsible for serious illness, it can take 30 to 50 years for the disease to show up after exposure. (This isn’t universal, however; there are rare cases of children and adolescents who are diagnosed with mesothelioma cancer.) As a result of the delay in onset, the number of cases increased as the exposure to asbestos fibers decreased for most people.
The mesothelium is actually made up of two layers of tissue: one covers the organ, and the other forms a sac around the area, with a lubricating fluid between the layers to facilitate movement (like the expansions and contractions of a beating heart, or the expansion of your lungs as you breathe in and out.) The mesothelium has different names in different areas of the body. For example, the mesothelial membrane that surrounds the lungs is the pleura, so malignant pleural mesothelioma is cancer that starts in the membrane around the lungs. The mesothelium that lines the abdomen and covers most of the abdominal organs is the peritoneum, and the one around the heart is the pericardium. Most cases of malignant Mesothelioma cancer are pleural; the next most common type is peritoneal mesothelioma cancer.
From the mesothelium, cancerous cells can invade nearby organs, tissue, or lymph nodes, or metastasize elsewhere in the body.
The single greatest risk factor for mesothelioma cancer is exposure to asbestos. Most reported cases occur in people who have occupational exposure to asbestos, but there are some cases of second-hand exposure, where the patient is the spouse of someone who works with asbestos, and may carry the fibers home. There are cases where the patient has had no known exposure to asbestos, but these are scarce.
Asbestos and Mesothelioma Cancer
Asbestos is a fibrous mineral that has been widely used in many industrial products since the late 1800s, and especially since World War II. Because heat and chemical exposure do not affect it, and it does not conduct electricity, it has been used in products like insulation, roofing shingles, flooring materials, cement, brake linings, and fabrics. Floating particles of asbestos – often released during manufacturing, or more recently, when asbestos-containing materials are removed from buildings – can be inhaled or swallowed; these particles can cause serious illness.
In addition to its link with Mesothelioma cancer, asbestos exposure can increase the risk of lung cancer and other forms of cancer, as well as asbestosis, which is a non-malignant, chronic respiratory illness. Tobacco use does not appear to exacerbate the risk of Mesothelioma cancer when combined with asbestos exposure, but the combination does significantly increase the risk of lung disease in general.
Other possible causes
For those patients with little or no documented exposure to asbestos, there are several possibilities. First of all, it has not been determined how much asbestos exposure is required to cause MC; it may be that very small amounts (that would perhaps never be noticed) can cause the disease.
Zeolite is another fibrous mineral that is not asbestos; it has been implicated as the probable cause of an epidemic of MC in a small village in Turkey.
MC has also been known to occur in conjunction with chronic inflammation and scarring caused by other respiratory illnesses. It is also likely that there is a genetic component to the development of the illness; it tends to run in families, and while all of the family members have exposure to asbestos, MC only occurs in a very small percentage of people who were exposed to it occupationally.
Radiation therapy could also be a cause; MC has been associated with radiation treatments for other illnesses.
Other possibilities have been suggested, but not proven. They include chemical exposure and viral infection, which have caused malignant MC in some animal studies.
Mesothelioma Cancer Symptoms
The first symptoms of pleural MC may be chest pain or shortness of breath; some people may also be hoarse or have difficulty swallowing, or coughing up blood. Also, more than half of the patients with pleural MC have lower back pain or pain at the side of the chest.
Usually, the first symptom of peritoneal MC is abdominal pain or swelling, which may look like weight gain around the waist. Because the first signs of the disease are-often flu-like symptoms, many people are either diagnosed accidentally, when a tumor is discovered in the process of diagnosing unrelated symptoms, or are not diagnosed at all until the cancer is so advanced that it causes abdominal swelling. Other symptoms are weight loss, nausea, lack of appetite, and weakness.
Mesothelioma Cancer Diagnosis
There are various tests used to diagnose MC once your doctor thinks you may have it:
Medical history and physical examination
First, your medical history will be taken to establish when symptoms occurred, and whether there are any factors in your history or environment that would put you at greater risk for the disease. This may help determine if you have been exposed to asbestos at some point.
There will also be a thorough physical exam, in which the doctor looks for signs of malignant MC or other health problems. Pleural mesothelioma will often cause pleural effusion, or fluid in the chest cavity; fluid in the peritoneum or the pericardium (which can be caused by mesotheliomas in those areas) can also be detected by an exam.
Imaging
Chest x-rays can show irregular thickening of the pleura, calcifications (or mineral deposits) in the pleura, lowering the spaces between the lobes of the lungs, or fluid in the pleura. Often, these symptoms are associated with asbestos exposure that leads to malignant MC.
X-rays, CT (computed tomography) scans and MRI (magnetic resonance imaging) scans can help locate the cancer and determine its size and extent. CT and MRI scans both take multiple images of the scanned area from different positions, and use computer processing to produce detailed images that are cross-sections. CT scans use x-rays, sometimes with the injection of a non-toxic dye (to highlight details); the MRI uses magnetic fields to create its images.
Testing fluid and tissue samples
If your doctor sees that fluid has collected in the mesothelial tissue, it can be sampled with a needle and tested. Analysis of the fluid can provide more information about the cause of the effusion, and may show the presence of cancer cells. Using fluid to diagnose mesothelioma cancer is not as precise as using tissue samples, though, so it may be necessary to follow the sampling of fluid with a tissue biopsy.
If there is a tumor, a tissue sample can be taken using thoracoscopy or laparoscopy, where a thin tube with a camera connected to it can be inserted into the chest or abdomen to see the tumor and get a sample of it. (Fluid can also be collected this way.) The procedure requires only small incisions.
Surgery
Surgery can be used to remove part or all of a tumor from the chest cavity or the abdomen. The procedure of opening the chest cavity is called thoracotomy; a laparotomy is the opening of the abdominal cavity.
Oral exploration
If a patient might have pleural mesothelioma, a bronchoscopy may be performed. This is where a flexible lighted tube is inserted through the mouth into the trachea and the bronchi to look for abnormal tissue and take samples.
Lymph Nodes
Another procedure your doctor may recommend is a mediastinoscopy. A lighted tube is inserted under the sternum (the breastbone) into the chest from the neck. It is possible to see the lymph nodes using this procedure, and to take samples to analyze for malignancy.
The lymph nodes are masses of immune system cells that are about the size of a bean. They help the body fight infection and cancer. Examining the lymph nodes can determine whether the cancer has spread or not; also, because lung cancer spreads to the lymph nodes more often than mesothelioma, it may help distinguish between lung cancer and mesothelioma.
Even with tissue samples, it has traditionally been difficult to see the cells well enough to distinguish mesothelioma from different types of cancer. One of the biggest problems in diagnosing mesothelioma is that it can look just like other kinds of cancer at first.
A recent breakthrough in diagnosis that will undoubtedly have an effect on the series of diagnostic tests above was reported in November 2003.² A new blood test is being developed that can detect the presence of high levels of a distinct kind of molecular marker which is peculiar to mesothelioma, SMR (or soluble mesothelin-related proteins). In one trial, 84% of the mesothelioma patients showed high levels of SMR, while less than 2% of those with other forms of lung cancer did.
Even more promising than being able to diagnose mesothelioma in a minimally invasive way is the possibility of predicting mesothelioma in people who have no symptoms. SMR levels can be higher several years before the onset of symptoms, so by doing a blood test on people who have been exposed to asbestos, it is possible to find the disease while the chances of treating it successfully are much higher.
Mesotheliomas usually fall into one of these three types:
1. epitheloid (making up about 50%-70% of the total occurrences)– this has the best chance of survival
2. sarcomatoid (7%-20%) – this has the worst chance for survival.
3. mixed or biphasic (20%-35%) – this falls between the other two
Treatment options are the same for all types.
There is a type of tumor that was originally called benign mesothelioma, because it appeared to form in the same location as malignant mesothelioma. These are actually fibrous tumors that are usually benign, although they can become cancerous. Doctors now understand that they don’t originate from mesothelial cells, but from tissue under the mesothelium, so they are not related to malignant mesothelioma. Whatever their source, however, they are not easy to differentiate from malignant mesothelioma without biopsy, so they need to be mentioned in this context.
Screening and diagnosis
Screening and diagnosis
If you have signs and symptoms that might indicate mesothelioma, your doctor will conduct a physical exam, paying particular attention to areas where you're experiencing pain. He or she checks for any lumps or other unusual signs. Your doctor may order other tests to determine the cause of your signs and symptoms, including:
* Chest X-ray. X-rays may show abnormalities if you have pleural mesothelioma.
* Chest or abdominal CT scan. Computerized tomography (CT) may reveal abnormalities in your chest or abdomen if you have mesothelioma.
It's not uncommon for mesothelioma to be misdiagnosed initially because mesothelioma is rare and its signs and symptoms aren't specific. Your doctor will likely rule out other more common conditions before considering mesothelioma.
Biopsy
Biopsy, a surgical procedure to remove a small portion of the mesothelium for laboratory examination, is the only way to determine whether you have mesothelioma. Depending on what area of your body is affected, your doctor selects the right biopsy procedure for you. Options include:
* Fine-needle aspiration. The doctor removes fluid or a piece of tissue with a small needle inserted into your chest or abdomen.
* Thoracoscopy. Thoracoscopy allows the surgeon to see inside your chest. In this procedure, the surgeon makes one or more small incisions between your ribs. He or she inserts a tube with a tiny video camera to see inside your chest cavity — a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow your surgeon to cut away a piece of tissue.
* Laparoscopy. Laparoscopy allows the surgeon to see inside your abdomen. Using one or more incisions into your abdomen, the surgeon inserts a tiny camera and special surgical tools to obtain a small piece of tissue for examination.
* Thoracotomy. Thoracotomy is surgery to open your chest to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
* Laparotomy. Laparotomy is surgery to open your abdomen to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
Once the tissue sample has been collected through biopsy, the sample is analyzed under a microscope. This determines whether or not the abnormal tissue is mesothelioma. Biopsy samples also allow your doctor to test for the type of cells involved in your mesothelioma. The type of mesothelioma you have is used to determine your treatment plan.
Staging
Once mesothelioma is diagnosed, your doctor orders other tests to determine the extent of the cancer and whether it has spread — a process called staging. Imaging procedures allow doctors to see inside your chest or abdomen to determine the stage of mesothelioma. Options include:
* Chest X-ray
* CT scans of the chest and abdomen
* Magnetic resonance imaging (MRI)
* Positron emission tomography (PET)
Once the extent of mesothelioma is determined, a stage is assigned. Staging helps your doctor determine your prognosis and the best treatment plan. The stages of mesothelioma are:
* I. Stage I mesothelioma is considered localized cancer, meaning it's limited to one small area of the chest or abdomen.
* II. Stage II mesothelioma is considered advanced cancer. Mesothelioma at this stage involves the mesothelium and has also spread to other structures directly adjacent to the tumor, such as the lungs or the diaphragm.
* III. Stage III mesothelioma is also considered advanced cancer. Mesothelioma at this stage meets the same requirements as stage II, but has also spread to the lymph nodes in the region.
* IV. Stage IV mesothelioma is an advanced cancer that has spread to distant areas (metastasized). Mesothelioma most commonly spreads (metastasizes) to the brain and areas of the lung that are away from the tumor.
If you have signs and symptoms that might indicate mesothelioma, your doctor will conduct a physical exam, paying particular attention to areas where you're experiencing pain. He or she checks for any lumps or other unusual signs. Your doctor may order other tests to determine the cause of your signs and symptoms, including:
* Chest X-ray. X-rays may show abnormalities if you have pleural mesothelioma.
* Chest or abdominal CT scan. Computerized tomography (CT) may reveal abnormalities in your chest or abdomen if you have mesothelioma.
It's not uncommon for mesothelioma to be misdiagnosed initially because mesothelioma is rare and its signs and symptoms aren't specific. Your doctor will likely rule out other more common conditions before considering mesothelioma.
Biopsy
Biopsy, a surgical procedure to remove a small portion of the mesothelium for laboratory examination, is the only way to determine whether you have mesothelioma. Depending on what area of your body is affected, your doctor selects the right biopsy procedure for you. Options include:
* Fine-needle aspiration. The doctor removes fluid or a piece of tissue with a small needle inserted into your chest or abdomen.
* Thoracoscopy. Thoracoscopy allows the surgeon to see inside your chest. In this procedure, the surgeon makes one or more small incisions between your ribs. He or she inserts a tube with a tiny video camera to see inside your chest cavity — a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow your surgeon to cut away a piece of tissue.
* Laparoscopy. Laparoscopy allows the surgeon to see inside your abdomen. Using one or more incisions into your abdomen, the surgeon inserts a tiny camera and special surgical tools to obtain a small piece of tissue for examination.
* Thoracotomy. Thoracotomy is surgery to open your chest to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
* Laparotomy. Laparotomy is surgery to open your abdomen to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
Once the tissue sample has been collected through biopsy, the sample is analyzed under a microscope. This determines whether or not the abnormal tissue is mesothelioma. Biopsy samples also allow your doctor to test for the type of cells involved in your mesothelioma. The type of mesothelioma you have is used to determine your treatment plan.
Staging
Once mesothelioma is diagnosed, your doctor orders other tests to determine the extent of the cancer and whether it has spread — a process called staging. Imaging procedures allow doctors to see inside your chest or abdomen to determine the stage of mesothelioma. Options include:
* Chest X-ray
* CT scans of the chest and abdomen
* Magnetic resonance imaging (MRI)
* Positron emission tomography (PET)
Once the extent of mesothelioma is determined, a stage is assigned. Staging helps your doctor determine your prognosis and the best treatment plan. The stages of mesothelioma are:
* I. Stage I mesothelioma is considered localized cancer, meaning it's limited to one small area of the chest or abdomen.
* II. Stage II mesothelioma is considered advanced cancer. Mesothelioma at this stage involves the mesothelium and has also spread to other structures directly adjacent to the tumor, such as the lungs or the diaphragm.
* III. Stage III mesothelioma is also considered advanced cancer. Mesothelioma at this stage meets the same requirements as stage II, but has also spread to the lymph nodes in the region.
* IV. Stage IV mesothelioma is an advanced cancer that has spread to distant areas (metastasized). Mesothelioma most commonly spreads (metastasizes) to the brain and areas of the lung that are away from the tumor.
Current Research
Current Research
Research involving more advanced diagnostic procedures and treatment for mesothelioma is ongoing. The advancements described here may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
Researchers are evaluating new treatments for mesothelioma, including multiple new drugs, gene therapy, and immunotherapy. Research projects at various universities are underway to identify genes that become mutated that may cause mesothelioma and to find blood markers (a substance found in higher than normal amounts in the blood of someone with cancer) that could help detect early stage mesothelioma.
Research involving more advanced diagnostic procedures and treatment for mesothelioma is ongoing. The advancements described here may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
Researchers are evaluating new treatments for mesothelioma, including multiple new drugs, gene therapy, and immunotherapy. Research projects at various universities are underway to identify genes that become mutated that may cause mesothelioma and to find blood markers (a substance found in higher than normal amounts in the blood of someone with cancer) that could help detect early stage mesothelioma.
Financial Support
Financial Support
Mesothelioma victims may need assistance
Several Important Topics that mesothelioma patients should address include:
The need for family openness in discussing and finding solutions to financial and investment matters
The importance of practicing basic financial planning, for example, all adults should have a will and other essential paperwork in place, make a budget, and monitor cash flow.
Mesothelioma victims may need assistance from the following:
Licensed Certified Financial Planners - they can help with managing and structuring your money.
Hospital Billing Representatives - they can help with insurance questions and issues.
Insurance Agents/Specialists - they can provide assistance on insurance coverage issues.
Bankers and Bank Trust/Loan Officers - they may be able to lend money.
Social Security/Medicare/Medicaid Representatives - they may assist in providing additional sources of income and cover certain hospital payments or prescription costs.
Attorneys - they can often recover significant compensation from the Asbestos issues, help draft a will and prepare health care powers of attorney and other important documents.
Call us at 1-800-780-2686 or email us with a specific request.
Mesothelioma victims may need assistance
Several Important Topics that mesothelioma patients should address include:
The need for family openness in discussing and finding solutions to financial and investment matters
The importance of practicing basic financial planning, for example, all adults should have a will and other essential paperwork in place, make a budget, and monitor cash flow.
Mesothelioma victims may need assistance from the following:
Licensed Certified Financial Planners - they can help with managing and structuring your money.
Hospital Billing Representatives - they can help with insurance questions and issues.
Insurance Agents/Specialists - they can provide assistance on insurance coverage issues.
Bankers and Bank Trust/Loan Officers - they may be able to lend money.
Social Security/Medicare/Medicaid Representatives - they may assist in providing additional sources of income and cover certain hospital payments or prescription costs.
Attorneys - they can often recover significant compensation from the Asbestos issues, help draft a will and prepare health care powers of attorney and other important documents.
Call us at 1-800-780-2686 or email us with a specific request.
Mesothelioma & the Law
Mesothelioma & the Law
What are mesothelioma lawsuits and how do they arise?
Mesothelioma lawsuits are filed by the victims of mesothelioma to avail reparations for medical expenses, pain & suffering and loss of income associated with the growth of this disease. Mesothelioma is a kind of cancer, which is inflicted by exposure to asbestos most frequently used in industrial and residential places till the late seventies. The numbers of mesothelioma victims were on the rise as the employers continued using these hazardous materials despite knowing the harmful consequences of them. Thus the poor workers, who were ignorant of the potential health risks that they were about to confront, were the unfortunate victims.
In case the victim dies there is a provision that one of the family members or the executor of his estate can file the lawsuit. On the other hand a family member who has contracted the disease from the victim of mesothelioma can also file a lawsuit.
Thus, if an individual is victimized owing to the negligence of another person, he has absolute right to take legal actions in the court of law for compensation. An individual needs to first consult with an attorney who deals with asbestos litigation and on his discretion the victim can file the suit.
How long does the process take and what are the end results?
These lawsuits tend to be cumbersome and longwinded. It could also stretch to years even to reach any settlement. Again all lawsuits are not necessarily longwinded; some of them take lesser time. However, in some of the cases the victims receive negligible amount of money, most of which are used to meet the lawyer's and the court's expenses. Nevertheless victims of mesothelioma should exhibit their rights and fight for their compensation. Again, mesothelioma lawsuits are generally settled out of court before they are set for trail. This actually makes more sense because it curtails court expenses for both the parties.
What can you do if you are uncertain about exposure to asbestos?
If you don't know where and when you were exposed to asbestos, you should speak to your lawyer who will help you out. The lawyer may possibly hire a professional investigator who can make the necessary investigations so as to find out where the exposure had occurred and who are the ones that can be held responsible.
How much do you have to pay?
Factually, you need not pay unless and until you receive your compensation. It is only then that your lawyer shall take a percentage out of the compensation as his remuneration.
How much can you expect as compensation?
Well it depends on how creditable your case is. You will find that past settlements amounted to quite a ransom. But in the recent past with the subsequent increase in the number of mesothelioma lawsuits, there is a sleek chance to realize the entire amount.
The history of mesothelioma lawsuits
According to U.S mesothelioma history, the first ever mesothelioma lawsuit was filed in 1966 against the careless use of asbestos. But unfortunately the verdict went against the case. For the second time, another suit was put forward for a co-worker and this time the case was won. This gave impetus to all those helpless victims who craved for justice as innumerable mesothelioma lawsuits cropped up simultaneously.
Mesothelioma lawsuits also tells us that how ignorant people were initially about the causes and the aftereffects of the deadly disease. But now with the intervention of the law firms the victims of mesothelioma are provided with all-round assistance as regards lawful solutions to their righteous problems.
What are mesothelioma lawsuits and how do they arise?
Mesothelioma lawsuits are filed by the victims of mesothelioma to avail reparations for medical expenses, pain & suffering and loss of income associated with the growth of this disease. Mesothelioma is a kind of cancer, which is inflicted by exposure to asbestos most frequently used in industrial and residential places till the late seventies. The numbers of mesothelioma victims were on the rise as the employers continued using these hazardous materials despite knowing the harmful consequences of them. Thus the poor workers, who were ignorant of the potential health risks that they were about to confront, were the unfortunate victims.
In case the victim dies there is a provision that one of the family members or the executor of his estate can file the lawsuit. On the other hand a family member who has contracted the disease from the victim of mesothelioma can also file a lawsuit.
Thus, if an individual is victimized owing to the negligence of another person, he has absolute right to take legal actions in the court of law for compensation. An individual needs to first consult with an attorney who deals with asbestos litigation and on his discretion the victim can file the suit.
How long does the process take and what are the end results?
These lawsuits tend to be cumbersome and longwinded. It could also stretch to years even to reach any settlement. Again all lawsuits are not necessarily longwinded; some of them take lesser time. However, in some of the cases the victims receive negligible amount of money, most of which are used to meet the lawyer's and the court's expenses. Nevertheless victims of mesothelioma should exhibit their rights and fight for their compensation. Again, mesothelioma lawsuits are generally settled out of court before they are set for trail. This actually makes more sense because it curtails court expenses for both the parties.
What can you do if you are uncertain about exposure to asbestos?
If you don't know where and when you were exposed to asbestos, you should speak to your lawyer who will help you out. The lawyer may possibly hire a professional investigator who can make the necessary investigations so as to find out where the exposure had occurred and who are the ones that can be held responsible.
How much do you have to pay?
Factually, you need not pay unless and until you receive your compensation. It is only then that your lawyer shall take a percentage out of the compensation as his remuneration.
How much can you expect as compensation?
Well it depends on how creditable your case is. You will find that past settlements amounted to quite a ransom. But in the recent past with the subsequent increase in the number of mesothelioma lawsuits, there is a sleek chance to realize the entire amount.
The history of mesothelioma lawsuits
According to U.S mesothelioma history, the first ever mesothelioma lawsuit was filed in 1966 against the careless use of asbestos. But unfortunately the verdict went against the case. For the second time, another suit was put forward for a co-worker and this time the case was won. This gave impetus to all those helpless victims who craved for justice as innumerable mesothelioma lawsuits cropped up simultaneously.
Mesothelioma lawsuits also tells us that how ignorant people were initially about the causes and the aftereffects of the deadly disease. But now with the intervention of the law firms the victims of mesothelioma are provided with all-round assistance as regards lawful solutions to their righteous problems.
Adult Clinical Trials
About Clinical Trials
When locating clinical trials, it is important to remember that no single resource, including the NCI, lists every cancer clinical trial. For more up-to-date information about a specific cancer treatment research study, you will need to make an appointment with a Massachusetts General Hospital Cancer Center clinician at 877-789-6100 who has access to OncPro, a proprietary database that contains information about every research study found within the Dana-Farber/Partners CancerCare (DF/PCC) and the Dana-Farber/Harvard Cancer Center. The clinical trials available on OncPro are only available to those participating clinicians and therefore, may not be found on the Internet.
The Massachusetts General Hospital Cancer Center is initiating new clinical trials for patients in the following areas:
* The ExCel clinical trial comparing exemestane (an aromotase inhibitor), and placebo in post-menopausal women at increased risk of breast cancer. The study's purpose is to determine whether this treatment may prevent breast cancer in this population.
* New imaging called tomosynthesis for Breast Cancer
* Trials including the use of Proton Beam Therapy
* Others
Each year over 15,000 new cancer cases are treated with thousands participating in cancer clinical trials. Improvements in cancer treatment are the most common subject of clinical trials. These trials test many types of treatments, such as new drugs, vaccines, new approaches to surgery or radiation therapy, or new combinations of existing treatments. Novel areas include the exciting new fields of clinical genetics, angiogenesis, vaccines, and gene therapy.
There are over 300 different trials underway at this time, addressing each of the different kinds of cancer seen in our hospital. In the past, clinical trials were sometimes seen as the last resort for patients who had no other choices. Today, however, there are clinical trials for individuals who are seeking initial treatment for an early stage of cancer.
To find out about eligibility and participation contact your clinician at the Cancer Center or call 877-789-6100.
Participating in a Clinical Trial
Clinical trials are available for many types and stages of cancer. However, in order to help answer specific scientific questions, there are fixed eligibility criteria for each trial. A patient will only be offered participation in a clinical trial if an assessment by a Cancer Center physician finds that they meet these criteria. For eligible patients, the decision to participate in a trial ultimately rests with them.
The Importance of a Clinical Trial
Every advancement in the treatment of cancer has resulted from clinical trials -- research involving patients in which physician-investigators evaluate, through a carefully designed and monitored scientific study, whether a new therapy may benefit patients.
The Cancer Center participates in clinical trials through Dana-Farber Partners/CancerCare (DF/PCC) -- the result of the joining of Massachusetts General Hospital, Dana-Farber Cancer Institute and Brigham & Women's Hospital to create an integrated program in adult cancer care and research. This collaboration has not only fostered a greater exchange of ideas, which is the lifeblood of research, but it has also improved the efficiency and speed with which discoveries can make their way from the laboratory bench to the patient's bedside.
The high volume of cancer patients served by the three institutions makes it possible for physician-investigators to conduct a wide variety of clinical research trials designed to answer many critical questions. For example, Dana-Farber/Partners CancerCare activates 10 new cancer trials each month and now has 350 clinical trials under way.
Currently, more than 2,100 patients are involved in clinical trials within the DF/PCC, offering them access to promising new therapies and, at the same time, providing valuable information that may lead to better treatments for all cancer patients.
The development of new and better treatments for all patients depends on clinical research. The Massachusetts General Hospital Cancer Center's commitment to clinical research reflects its dedication to improving the lives of cancer patients today and tomorrow.
Find A Clinical Trial
The Massachusetts General Hospital Cancer Center is a founding member of a Harvard Medical School consortium designated by the National Cancer Institute as a comprehensive cancer center. This prestigious seven-member center comprises the largest research collaboration in the country. There are approximately 300 clinical trials are available for enrollment each year.
When locating clinical trials, it is important to remember that no single resource, including the NCI, lists every cancer clinical trial. For more up-to-date information about a specific cancer treatment research study, you will need to make an appointment with a Massachusetts General Hospital Cancer Center clinician at 877-789-6100 who has access to OncPro, a proprietary database that contains information about every research study found within the Dana-Farber/Partners CancerCare (DF/PCC) and the Dana-Farber/Harvard Cancer Center. The clinical trials available on OncPro are only available to those participating clinicians and therefore, may not be found on the Internet.
The Massachusetts General Hospital Cancer Center is initiating new clinical trials for patients in the following areas:
* The ExCel clinical trial comparing exemestane (an aromotase inhibitor), and placebo in post-menopausal women at increased risk of breast cancer. The study's purpose is to determine whether this treatment may prevent breast cancer in this population.
* New imaging called tomosynthesis for Breast Cancer
* Trials including the use of Proton Beam Therapy
* Others
Each year over 15,000 new cancer cases are treated with thousands participating in cancer clinical trials. Improvements in cancer treatment are the most common subject of clinical trials. These trials test many types of treatments, such as new drugs, vaccines, new approaches to surgery or radiation therapy, or new combinations of existing treatments. Novel areas include the exciting new fields of clinical genetics, angiogenesis, vaccines, and gene therapy.
There are over 300 different trials underway at this time, addressing each of the different kinds of cancer seen in our hospital. In the past, clinical trials were sometimes seen as the last resort for patients who had no other choices. Today, however, there are clinical trials for individuals who are seeking initial treatment for an early stage of cancer.
To find out about eligibility and participation contact your clinician at the Cancer Center or call 877-789-6100.
Participating in a Clinical Trial
Clinical trials are available for many types and stages of cancer. However, in order to help answer specific scientific questions, there are fixed eligibility criteria for each trial. A patient will only be offered participation in a clinical trial if an assessment by a Cancer Center physician finds that they meet these criteria. For eligible patients, the decision to participate in a trial ultimately rests with them.
The Importance of a Clinical Trial
Every advancement in the treatment of cancer has resulted from clinical trials -- research involving patients in which physician-investigators evaluate, through a carefully designed and monitored scientific study, whether a new therapy may benefit patients.
The Cancer Center participates in clinical trials through Dana-Farber Partners/CancerCare (DF/PCC) -- the result of the joining of Massachusetts General Hospital, Dana-Farber Cancer Institute and Brigham & Women's Hospital to create an integrated program in adult cancer care and research. This collaboration has not only fostered a greater exchange of ideas, which is the lifeblood of research, but it has also improved the efficiency and speed with which discoveries can make their way from the laboratory bench to the patient's bedside.
The high volume of cancer patients served by the three institutions makes it possible for physician-investigators to conduct a wide variety of clinical research trials designed to answer many critical questions. For example, Dana-Farber/Partners CancerCare activates 10 new cancer trials each month and now has 350 clinical trials under way.
Currently, more than 2,100 patients are involved in clinical trials within the DF/PCC, offering them access to promising new therapies and, at the same time, providing valuable information that may lead to better treatments for all cancer patients.
The development of new and better treatments for all patients depends on clinical research. The Massachusetts General Hospital Cancer Center's commitment to clinical research reflects its dedication to improving the lives of cancer patients today and tomorrow.
Find A Clinical Trial
The Massachusetts General Hospital Cancer Center is a founding member of a Harvard Medical School consortium designated by the National Cancer Institute as a comprehensive cancer center. This prestigious seven-member center comprises the largest research collaboration in the country. There are approximately 300 clinical trials are available for enrollment each year.
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