Mesothelioma

Mesothelioma is a malignant tumor that forms in the mesothelium – the thin, slippery, lining around the lung (pleura), abdomen (peritoneum), or rarely the heart (pericardium) or testis (tunica vaginalis). While the mesothelium itself is not a vital organ, its close proximity to the vital organs combined with the quickly growing, invasive nature of the tumor are what make meso such a serious cancer.

Types

There are three main types of mesothelioma tumor cells. Epitheliod is the most common, and is somewhat less aggressive than the second type, sarcomatoid. The last type, called mixed or biphasic, is a combination of the first two types. Treatment options vary based upon the type of mesothelioma you have, so it is important to ask your doctor for this information.

Chances of Developing Mesothelioma

Approximately 3,000 Americans are diagnosed with mesothelioma each year. This makes it extremely rare compared to other cancers.

Risk factors

Meso is usually caused by asbestos exposure, as much as ten to fifty years earlier. You may have been exposed in a heavy asbestos-use setting like industry or the Navy. But even very low incidental or second-hand exposures can cause meso in some cases.

A Diagnosis of Mesothelioma - Now What?

Learning that you have mesothelioma (meso) can be overwhelming. This cancer is very rare and usually described as incurable. You may be unclear about what meso is and if it can even be treated. The first thing you should know is – you are not alone. The Mesothelioma Applied Research Foundation is the national nonprofit providing hope to patients and their families and helping them access the resources necessary to deal with a mesothelioma diagnosis.

In just the past few years, real progress has been made. New chemotherapy treatments are available. Innovative protocols involving surgery, chemotherapy, and radiation are advancing. Other promising treatments like gene therapy, immune therapy, and biochemical factors are now being offered to patients in clinical trials. The Meso Foundation can help you learn about and access these treatments. We can connect you with patients doing well five, ten, even fourteen years following diagnosis. Most importantly, we can provide you and your family hope and support in your own battle against the cancer.

Incidentally, spontaneous remission of mesothelioma has been observed: (Schilder et al., 2004 ^[1]). We have looked at cases from a psychological perspective. As a child, our patient frequently had no choice but to comply with his many older brothers and sisters. In his 20s, he was exposed to asbestos. In the years preceding his illness, various superiors had been criticizing and revising his craftsmanship (carpentry) and his way of working. He had felt too old to look for another job. Epithelial mesothelioma was diagnosed histologically.

Epithelial mesothelioma, as it appeared under the microscope

A surgical procedure was advised. The patient's wife quit her job and sat next to his bed, up to 8 or 9 hours a day. The patient was advised against the proposed surgery by various familymembers and friends. In a crisis of powerlessness and indecisiveness, during which he was "disagreeable", "slammed the table with his fist and stated "I want things the way I want them," the patient decided on surgery. Upon surgey, resection turned out to be impossible, Following the unsuccessful surgical attempt and given his severe medical condition, the patient was being put on leave with pay. Freed from his job, he traveled with his wife.He felt as if he were "living in a dream", which was different from "living behind the glass." The tumor regressed spontaneously in a period of 8 months, as confirmed by CT scans. The patient subsequently continued with his carpentry, but at his own pace and according to his own design. Five years later his chest X ray remained clear. Following another 6 months, we interviewd him for the first time. This was followed by a second interview conducted by a psychotherapist researcher. The interviews, and one particular remark in the second interview, had left the patient "worrying and gloomy"; "everything had been dragged up", he said. Five months thereafter a recurrence was diagnosed and was treated successfully with radiotherapy. Both 2 and 3½ years later additional recurrences were noted, which were not amenable to further treatment. Looking at psychosocial factors, we see that a shift from powerlessness to autonomy occurred after family’s and friends’ advice against surgery. Their advice in some way was advice to die. It is interesting to note that this time the patient breaks away from what seems to be a learned complying, passive coping response. This case confirmed our hypothesis that spontaneous regression of cancer is preceded by the development of autonomy. It shows that the situation that called for this change had a repetitive characteristic: Itwas the kind of situation the patient had encounteredmore often complying to multiple others, but this time complying meant dying, and now a different coping ensues. Also, the patient had no reflexive, cognitive understanding of what was going on, but he strongly experienced his situation and behaved accordingly. It seems that in psycho-oncological coping and transformation, experiential awareness is more important than cognitive-reflexive understanding, in calling for change.

Treatment

Because meso is so serious and can advance rapidly, finding the right doctor and the right treatment are essential. It is important that you carefully evaluate your treatment options.

Chemotherapy

Chemotherapy can be used as the primary type of treatment to help keep meso from spreading, to shrink the tumor, or to relieve symptoms. However, chemotherapy is more commonly combined with other forms of treatment, like surgery and radiation. In mesothelioma, there is one FDA-approved chemotherapy, Alimta, which when combined with another drug, Cisplatin, does increase overall survival. Experts may use several other drug combinations rather than, or following, treatment with Alimta/Cisplatin. These include gemcitabine, doxorubicin and vinorelbine. There are also a number of clinical trials of promising new drugs now available for meso patients.

Surgery

Three types of surgical procedures generally may be performed on patients with pleural mesothelioma:

Thoracoscopy

The use of a scope to look inside the chest in order to get a diagnosis of mesothelioma or to help treat shortness of breath by removing fluid around the lung.

Pleurectomy/Decortication

This involves the removal of the mesothelium/pleura of the lung and as much of the tumor as possible.

Extrapleural Pneumonectomy

This involves the removal of the entire lung and pleura on the affected side of the chest. Protocols combining surgery to reduce tumors, plus chemotherapy applied during the surgery, are achieving considerable success in peritoneal mesothelioma especially. A number of patients are doing well many years after treatment with these protocols.

Radiation

Mesothelioma is not a radiosensitive disease, so radiation is usually offered as part of a treatment which includes surgery and chemotherapy. Vital organs are protected and radiation is applied to areas where there is a chance that the disease might recur. Radiation is also sometimes given to areas of bony disease to assist with pain control.

Caring for someone with Mesothelioma

The Mesothelioma Applied Research Foundation maintains an extensive website to help patients and families gather as much information as possible, as well as an updated database of treatment centers and research trials throughout the country. The Foundation’s Medical Liaison is available to assist patients and families locate resources applicable to their unique situations. The Foundation also offers travel grants to those lacking the means to afford travel to a meso specialist.

Getting Connected
Along with finding the right treatment option, finding sources of support is critically important. Having a good support system can make all the difference during times of difficulty or crisis. The Meso Foundation offers an extension to your existing support system, including a meso community forum where you can chat with other patients and their families, get support, learn more about mesothelioma, read articles by the world’s leading experts, and find other valuable resources.

Additionally, the Mesothelioma Applied Research Foundation holds an annual Symposium that brings together the world’s leading mesothelioma experts to discuss the advances being made in mesothelioma treatment and to answer your questions. Each year patients and their families from around the nation and even internationally come together at this event to learn as much as they can, connect with others within the meso community, and create avenues of support and friendship that break the fear and isolation created by this disease.

• Identifying a mesothelioma specialist if needed
• Reviewing treatments and treatment options
• Providing advice on side effects of the various therapies and symptom management of the disease
• Assistance in understanding the basics of the disease and gaining familiarity with the complex medical terms
• Connecting you with other patients who have successfully completed their treatments and are willing to share their stories and provide hope during this frightening time
• Financial aid
• Other support services and referrals

Mesothelioma is a difficult disease, but there is hope. Patients are benefiting from new and better treatment options. The key is to take action. Get informed quickly and make the best decisions you can to develop a treatment plan. The Foundation’s Medical Liaison, a nurse practitioner with more than a decade of clinical and research expertise in meso, is available to help you get detailed information about meso, treatment options, and various resources you might need.

To speak with our Medical Liaison, call:
(877) EndMeso (363-6376) toll free.
www.curemeso.org