Asbestos, Lunga and Mesothelioma

How to Find a Cancer Treatment Trial

Introduction

This guide will help you to look for a cancer treatment clinical trial that might benefit you. It is not intended to provide medical advice. You, your health care team, and your loved ones are in the best position to decide whether a clinical trial is right for you.

This guide will help you to

gather the information you need to begin your search for a clinical trial
identify sources of clinical trial listings
learn about clinical trials that may be of benefit to you
ask questions that will help you decide whether or not to participate in a particular trial

A Word About Timing

Many treatment trials will only take patients who have not yet been treated for their condition. Researchers conducting these trials are hoping to find an improved "first-line" treatment option for that type of cancer.

If you are newly diagnosed with cancer, the time to consider joining a clinical trial is before you've had surgery, chemotherapy, radiation, or other forms of treatment (tests to diagnose your cancer are okay). However, don't delay treatment if waiting could harm you. Talk with your doctor about how quickly you need to make a treatment decision.
If you have received one or more forms of treatment and are looking for a new treatment option, there also are many clinical trial options for you. You may want to look for trials that are testing a new follow-up treatment that may prevent the return of your cancer. Or, if your first treatment failed to work, you may want to look for trials of new “second-line” or even “third-line” treatments.

Before You Start: Steps 1-3

This section will help you to

have a better understanding of clinical trials
gather information you will need in order to locate clinical trials that are appropriate for you

Before You Start: Step 1: Understand Clinical Trials

This guide assumes you already know what clinical trials are and why you might want to join one. If you need to, review your understanding of clinical trials before you continue the steps in this guide.

The Learning About Clinical Trials section of this Web site offers a variety of articles to help you understand what cancer clinical trials are, why they are important, and how they work. The articles also describe the different phases of clinical trials and will help you to better focus your search for trials.

Before You Start: Step 2: Talk With Your Doctor

When considering clinical trials, your best starting point is your doctor and other members of your health care team.

Your primary care physician, cancer doctor (oncologist), surgeon, or other health care provider might know about a clinical trial you should consider. He or she can help you determine whether a clinical trial might be a good option.

NOTE: In some cases, your doctor may be reluctant to discuss clinical trials as a treatment option for you. Some doctors are unfamiliar with clinical trials, cautious about turning your care over to another medical team, or wary of the extra time that joining a clinical trial might require of them and their staff. If so, you may wish to get a second opinion about your treatment options and clinical trials.

Remember, you do not always need a referral from your doctor to join a clinical trial.

If you are eligible to join a trial (discussed in Step 3), the final decision is up to you. However, be sure to consider the professional opinions of your doctor. He or she may present very specific reasons why a clinical trial may not be beneficial for you right now.

Before You Start: Step 3: Complete the Diagnosis Checklist

Before you begin looking for a clinical trial, you must know certain details about your cancer diagnosis. You will need to compare these details with the eligibility criteria of any trial in which you are interested. Eligibility criteria are the guidelines for who can and cannot participate in a particular study.

To help you gather the details of your diagnosis so you will know which trials you may be eligible to join, complete the Diagnosis Checklist. The form asks questions about your diagnosis and provides room to write down your answers. Keep this form with you during your search for a clinical trial.

To get the information you need for the form:

Ask a nurse or social worker at your doctor's office for help. Explain to them that you are interested in looking for a clinical trial that may benefit you and that you need these details before starting to look. They will be able to review your medical records and help you fill out the form.
Searching for a Trial:Steps 4-6

You have learned what clinical trials are and how they work, talked with your doctor about your interest in clinical trials, and prepared a checklist of key details about your diagnosis. You are now ready to search for clinical trials.

This section will help you to

find and search trustworthy lists of ongoing clinical trials

compare your Diagnosis Checklist with a trial's eligibility criteria, as provided in the trial's description (also called a protocol summary)

identify those trials that might be good options for you

NOTE: It is important to understand the possible biases and limitations of any clinical trials Web site. To learn more, see How To Evaluate Health Information on the Internet: Questions and Answers.

Searching for a Trial: Step 4Search the PDQ® Clinical Trials Database

There are many nonprofit and for-profit resources in the United States that offer lists of cancer clinical trials. Unfortunately, no single list is complete. Clinical trials are run by many different organizations, so it is hard to collect information about all of them in one place.

However, the majority of trials listed in most resources are obtained from the Physician Data Query (PDQ) clinical trials database, which is maintained by the U.S. National Cancer Institute (NCI).

The NCI is the U.S. government's chief agency for cancer research and is part of the National Institutes of Health. The PDQ clinical trials database contains a list of more than 2,000 cancer clinical trials worldwide.

NOTE: The U.S. National Library of Medicine maintains a database called ClinicalTrials.gov that includes trials for many diseases and conditions, including cancer. The PDQ and ClinicalTrials.gov databases contain the same cancer treatment trial listings. The main difference is in how information is searched and displayed. You may prefer one way over another.

Important: Get a Copy of the Protocol Summary

Steps 4 and 5 describe where to look for cancer clinical trials. Whichever resource you use, be sure to

get a copy of the protocol summary for each trial you are interested in

What is a protocol? It is the action plan for the trial. The protocol explains what will be done in the trial, how, and why. The protocol should also list the location(s) where the trial will enroll participants.

Both PDQ and ClinicalTrials.gov (Step 4) provide detailed summaries of the official protocols for each trial listed on their Web sites. Other resources (Step 5) may or may not provide protocol summaries.

How to Search PDQ

Search PDQ by telephone

Make a free telephone call - in English or Spanish - within the United States to the National Cancer Institute's Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237). All calls to the CIS are strictly confidential.

When you call the CIS, be ready with the details of your Diagnosis Checklist from Step 3.
The CIS is staffed with understanding and knowledgable information specialists who will search PDQ for you. They can send you the search results and protocol summaries by e-mail, fax, or regular mail. The CIS can also provide you with reliable information about your type of cancer and the current standard therapy for treating it.

Search PDQ through the NCI Web site

You can look for trials yourself using a PDQ search form on the NCI Web site. Remember to print out the protocol summaries for each trial you may be interested in.

The basic search form allows you to search by type of cancer, stage or subtype of cancer, and location of trial (ZIP code).

The advanced search form lets you create your search using more detailed information, such as the hospital or institution involved, type of treatment, and phase of trial.

If you would like help searching PDQ while you're online, consider using LiveHelp. Through LiveHelp, you can communicate confidentially and in real time with a CIS information specialist from the National Cancer Institute. The service is available Monday through Friday from 9:00 a.m. to 11:00 p.m. Eastern time.

Searching for a Trial: Step 5Search Other Resources

While PDQ and ClinicalTrials.gov have the most complete listing of cancer trials, you might want to check a few other resources, as well. Why? Because
some may include a few trials not found in the federal databases
you may prefer their way of assisting you in your search

The other resources discussed in this section are

TrialCheck®
Third-Party Clinical Trial Web Sites
Industry-Sponsored Cancer Trials
Cancer Advocacy Groups
Fee-Based Search Services

Note: Links to external Web sites are provided for convenience and informational purposes only. The inclusion of these links does not constitute an endorsement by the National Cancer Institute. See the full Disclaimer of Endorsement and Liability policy for the NCI Web site.

TrialCheck

TrialCheck is operated and maintained by the Coalition of National Cancer Cooperative Groups (CNCCG). The CNCCG is made up of groups of doctors and other health professionals that carry out many of the large cancer clinical trials in the United States funded by the National Cancer Institute.

TrialCheck includes fewer trials than either PDQ or ClinicalTrials.gov - the two government databases described in Step 4.

However, because TrialCheck helps you search its list through an online form that “interviews” you about your cancer and the kind of treatment(s) you have received, you might prefer this kind of service.

How to search TrialCheck

The Frequently Asked Questions (FAQs) page on the TrialCheck Web site provides helpful information about how to use TrialCheck.

Third-Party Clinical Trial Web Sites

There are a number of clinical trial Web sites that are not operated by funders, sponsors, or the organizations carrying out the trials. Some of these Web sites are operated by private companies - these may be funded through fees that industry sponsors pay to have their trials listed or according to how many participants the Web site refers to them.

Keep the following points in mind:

Most third-party clinical trials Web sites list or link to trials in PDQ or ClinicalTrials.gov.
They may include a few more trials than you'll find in the federal databases, but they may also include fewer.
Unlike the federal databases, these sites may not regularly update their content or links.
Unlike the federal databases, these sites might require you to register to search for trials or to obtain contact information about the trials that interest you.

Links to several third-party Web sites are listed below. Clicking on the links will help you learn more about the sites and what they have to offer in addition to their clinical trial listings.

Industry-Sponsored Cancer Trials

Pharmaceutical and biotechnology companies sponsor many of the cancer clinical trials being carried out in the United States. Some of these trials are listed in the federal databases (PDQ and ClinicalTrials.gov), but many are not.

Federal law requires that U.S. researchers submit to ClinicalTrials.gov all phase II, III, and IV trials of therapies for serious or life-threatening illnesses (including cancer) conducted as part of the approval process overseen by the U.S. Food and Drug Administration. However, this law is difficult to enforce and for business reasons, some drug companies have preferred to keep details about their clinical trials from the public.

How to search for industry-sponsored trials

If you are aware of an experimental cancer treatment and know the company that manufactures it, search the Internet to find the Web site of the company. Find the company's customer service telephone number. When you call, ask to speak to the company's clinical trials department. Tell them you are looking for a trial that you might be eligible to join.

Cancer Advocacy Groups

Cancer advocacy groups work on behalf of people diagnosed with cancer and their loved ones. They provide education, support, financial assistance, and advocacy to help patients and families who are dealing with cancer. These organizations recognize that clinical trials are important to the cancer treatment process and, thus, work to educate and empower people to find information and access to treatment.

Because they work hard to know about the latest research advances in cancer treatment, these groups will sometimes have information about certain key government-sponsored trials, as well as some potentially significant trials sponsored by pharmaceutical companies or cancer care centers.

How to search for trials through a cancer advocacy group

Contact the advocacy group for the type of cancer you are interested in and ask what they can tell you about ongoing clinical trials. The nonprofit Marti Nelson Cancer Foundation maintains a partial list of such groups on its CancerActionNow.org Web site.

Fee-Based Private Search Services

A number of private services will, for a fee, locate clinical trials for you. While having someone search for you may ease your stress, it is important to keep in mind that several of the resources mentioned earlier in this guide provide elements of this kind of service for free. Also, be sure to ask the following questions:

What list or lists of clinical trials does the service search? Are those lists likely to provide you with an unbiased and largely complete source of options?
Does the service receive any money for directing patients to certain trials or for including certain trials in their list?

Searching for a Trial: Step 6
Make a List of Potential Trials

At this point you have created a Diagnosis Checklist, identified one or more trials you might be interested in, and obtained a protocol summary for each one.

This section will help you

take a closer look at the protocol summaries
narrow your list to those trials you would like to get more information about

Now it's time to take a closer look at the protocol summaries you have obtained for the trials you're interested in. You should remove from your list those trials you aren't actually able to join and come up with one or more top possibilities.

What follows are some key questions to consider about each trial. However, don't worry if you cannot answer all of these questions just yet. The idea is to narrow the list if you can, but don't give up on one that you're not sure of.

Note: Ideally, you should consult your doctor during this process, especially if you find the protocol summaries difficult to understand. But you can probably do Step 6 yourself if the protocol summary is relatively complete and easy to understand.

Trial objective. What is the main purpose of the trial? Is it to improve your chances of a cure? To slow the rate at which your cancer may grow or return? To lessen the severity of treatment side effects? To establish whether a new treatment is safe and well tolerated? Read this information carefully to learn whether the trial's main objective matches your goals for treatment.
Eligibility criteria. Do your diagnosis and current overall state of health match the eligibility criteria (sometimes referred to as enrollment or entry criteria)? This may tell you whether you could qualify for the trial. If you're not sure, keep the trial on your list for now.
Trial location. Is the location of the clinical trial manageable for you? Some trials are available at more than one site. Look carefully at how often you will need to receive treatment during the course of the trial, and decide how far and how often you are willing to travel. You will also need to ask if the sponsoring organization will provide for some or all of your travel expenses.
Study duration. How long will the study run? Not all protocol summaries list this information. If they do, consider the time commitment and whether it will work for you and your family.

If, after considering these questions, you are still interested in one or more of the clinical trials you have found, then you are ready for Step 7.

Source: http://www.cancer.gov/clinicaltrials/finding/treatment-trial-guide

Malignant mesothelioma is a disease in which malignant (cancer) cells form in the lining of the chest or abdomen.

Malignant mesothelioma is a disease in which malignant (cancer) cells are found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) or the peritoneum (the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen). This summary is about malignant mesothelioma of the pleura.

Being exposed to asbestos can affect the risk of developing malignant mesothelioma.

Many people with malignant mesothelioma have worked or lived in places where they inhaled or swallowed asbestos. After being exposed to asbestos, it usually takes a long time for malignant mesothelioma to occur. Other risk factors for malignant mesothelioma include the following:

Living with a person who works near asbestos.
Being exposed to a certain virus.

Possible signs of malignant mesothelioma include shortness of breath and pain under the rib cage.

Sometimes the cancer causes fluid to collect around the lung or in the abdomen. These symptoms may be caused by the fluid or malignant mesothelioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

Trouble breathing.
Pain under the rib cage.
Pain or swelling in the abdomen.
Lumps in the abdomen.
Weight loss for no known reason.

Tests that examine the inside of the chest and abdomen are used to detect (find) and diagnose malignant mesothelioma.

Sometimes it is hard to tell the difference between malignant mesothelioma and lung cancer. The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, exposure to asbestos, past illnesses and treatments will also be taken.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following: The number of red blood cells, white blood cells, and platelets.
The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
The portion of the blood sample made up of red blood cells.
Sedimentation rate: A procedure in which a sample of blood is drawn and checked for the rate at which the red blood cells settle to the bottom of the test tube.
Biopsy: The removal of cells or tissues from the pleura or peritoneum so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the cells or tissues include the following:
Fine-needle aspiration biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a needle biopsy.
Thoracoscopy: An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest.
Peritoneoscopy: An incision (cut) is made in the abdominal wall and a peritoneoscope (a thin, lighted tube) is inserted into the abdomen.
Laparotomy: An incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease.
Thoracotomy: An incision (cut) is made between two ribs to check inside the chest for signs of disease.
Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
Cytologic exam: An exam of cells under a microscope (by a pathologist) to check for anything abnormal. For mesothelioma, fluid is taken from around the lungs or from the abdomen. A pathologist checks the cells in the fluid.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer.
The size of the tumor.
Whether the tumor can be removed completely by surgery.
The amount of fluid in the chest or abdomen.
The patient's age and general health, including lung and heart health.
The type of mesothelioma cancer cells and how they look under a microscope.
Whether the cancer has just been diagnosed or has recurred (come back).

After malignant mesothelioma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

The process used to find out if cancer has spread outside the pleura or peritoneum is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the spread of the cancer in order to plan treatment. The following tests and procedures may be used in the staging process:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of the chest and abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the chest or abdomen. This procedure is also called nuclear magnetic resonance imaging (NMRI).

The stages of malignant mesothelioma are divided into two groups.

Malignant mesothelioma stages are grouped into localized and advanced.

Localized malignant mesothelioma (stage I)

In localized malignant mesothelioma, cancer is found in the lining of the chest wall and may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.

Advanced malignant mesothelioma (stage II, stage III, and stage IV)

Advanced malignant mesothelioma includes stage II, stage III, and stage IV.

In stage II, cancer is found in the lining of the chest wall and the lymph nodes on the same side of the chest. Cancer may also be found in the lining of the lung, the lining of the diaphragm, or the lining of the sac that covers the heart on the same side of the chest.
In stage III, cancer has spread to any of the following areas:
The chest wall.
The mediastinum.
The heart.
Beyond the diaphragm.
The peritoneum.

Cancer may have also spread to lymph nodes on the other side of the chest or outside the chest.
In stage IV, cancer has spread to distant organs or tissues.

Recurrent Malignant Mesothelioma

Recurrent malignant mesothelioma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the chest or abdomen or in other parts of the body.
Source: http://www.cancer.gov

What is asbestos?

"Asbestos" is the name given to a group of minerals that occur naturally as bundles of fibers which can be separated into thin threads. These fibers are not affected by heat or chemicals and do not conduct electricity. For these reasons, asbestos has been widely used in many industries. Four types of asbestos have been used commercially:

Chrysotile, or white asbestos;
Crocidolite, or blue asbestos;
Amosite, which usually has brown fibers; and
Anthophyllite, which usually has gray fibers.

Chrysotile asbestos, with its curly fibers, is in the serpentine family of minerals. The other types of asbestos, which all have rod-like fibers, are known as amphiboles. Asbestos fiber masses tend to break easily into a dust composed of tiny particles that can float in the air and stick to clothes. The fibers may be easily inhaled or swallowed and can cause serious health problems.

How is asbestos used?

Asbestos was mined and used commercially in North America beginning in the late 1800s. Its use increased greatly during World War II. Since then, it has been used in many industries. For example, the building and construction industry has used it for strengthening cement and plastics as well as for insulation, fireproofing, and sound absorption. The shipbuilding industry has used asbestos to insulate boilers, steampipes, and hot water pipes. The automotive industry uses asbestos in vehicle brakeshoes and clutch pads. More than 5,000 products contain or have contained asbestos. Some of them are listed below:

Asbestos cement sheet and pipe products used for water supply and sewage piping, roofing and siding, casings for electrical wires, fire protection material, electrical switchboards and components, and residential and industrial building materials;
Friction products, such as clutch facings, brake linings for automobiles, gaskets, and industrial friction materials;
Products containing asbestos paper, such as table pads and heat-protective mats, heat and electrical wire insulation, industrial filters for beverages, and underlying material for sheet flooring;
Asbestos textile products, such as packing components, roofing materials, and heat- and fire-resistant fabrics (including blankets and curtains); and
Other products, including ceiling and floor tile; gaskets and packings; paints, coatings, and adhesives; caulking and patching tape; artificial ashes and embers for use in gas-fired fireplaces; plastics; vermiculite-containing consumer garden products; and some talc-containing crayons.

In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. Additionally, asbestos was voluntarily withdrawn by manufacturers of electric hair dryers. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; uses established prior to 1989 are still allowed. The EPA has established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure to occupants by removing the asbestos or encasing it. In June 2000, the CPSC concluded that the risk of children’s exposure to asbestos fibers in crayons was extremely low. However, the U.S. manufacturers of these crayons agreed to reformulate their products within a year. In August 2000, the EPA recommended that consumers reduce possible asbestos exposure from vermiculite-containing garden products by limiting the amount of dust produced during use. The EPA suggested that consumers use vermiculite outdoors or in a well-ventilated area; keep vermiculite damp while using it; avoid bringing dust from vermiculite use into the home on clothing; and use premixed potting soil, which is less likely to generate dust.

The regulations described above and other actions, coupled with widespread public concern about the hazards of asbestos, have resulted in a significant annual decline in U.S. use of asbestos: Domestic consumption of asbestos amounted to about 719,000 metric tons in 1973, but it had dropped to about 9,000 metric tons by 2002. Asbestos is currently used most frequently in gaskets and in roofing and friction products.

What are the health hazards of exposure to asbestos?

Exposure to asbestos may increase the risk of several serious diseases:

Asbestosis—a chronic lung ailment that can produce shortness of breath, coughing, and permanent lung damage;
Lung cancer;
Mesothelioma—a relatively rare cancer of the thin membranes that line the chest and abdomen; and
Other cancers, such as those of the larynx, oropharynx, gastrointestinal tract, and kidney.

Who is at risk?

Nearly everyone is exposed to asbestos at some time during their life. However, most people do not become ill from their exposure. People who become ill from asbestos are usually those who are exposed to it on a regular basis, most often in a job where they work directly with the material or through substantial environmental contact.

Since the early 1940s, millions of American workers have been exposed to asbestos. Health hazards from asbestos fibers have been recognized in workers exposed in shipbuilding trades, asbestos mining and milling, manufacturing of asbestos textiles and other asbestos products, insulation work in the construction and building trades, brake repair, and a variety of other trades. Demolition workers, drywall removers, and firefighters also may be exposed to asbestos fibers. As a result of Government regulations and improved work practices, today’s workers (those without previous exposure) are likely to face smaller risks than did those exposed in the past.

Although it is known that the risk to workers increases with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their first exposure. It can take from 10 to 40 years for symptoms of an asbestos-related condition to appear.

There is some evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma. This risk is thought to result from exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. This type of exposure is called paraoccupational exposure. To decrease these exposures, people exposed to asbestos at work are required to shower and change their clothing before leaving the workplace.

How great is the risk?
Not all workers exposed to asbestos will develop diseases related to their exposure. The risk of developing asbestos-related diseases varies with the type of industry in which the exposure occurred and with the extent of the exposure. Asbestos that is bonded into finished products such as walls and tiles poses no risk to health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When asbestos fibers are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease.

In addition, different types of asbestos fibers may be associated with different health risks. For example, results of several studies suggest that amphibole forms of asbestos may be more harmful than chrysotile, particularly for mesothelioma. Even so, no fiber type can be considered harmless, and people working with asbestos should always take proper safety precautions to limit exposure.

How great is the risk?

Not all workers exposed to asbestos will develop diseases related to their exposure. The risk of developing asbestos-related diseases varies with the type of industry in which the exposure occurred and with the extent of the exposure. Asbestos that is bonded into finished products such as walls and tiles poses no risk to health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When asbestos fibers are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease.

In addition, different types of asbestos fibers may be associated with different health risks. For example, results of several studies suggest that amphibole forms of asbestos may be more harmful than chrysotile, particularly for mesothelioma. Even so, no fiber type can be considered harmless, and people working with asbestos should always take proper safety precautions to limit exposure.

How does smoking affect risk?

Many studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. Smokers who are also exposed to asbestos have a greatly increased risk of lung cancer. However, smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma.

There is evidence that quitting smoking will reduce the risk of lung cancer among asbestos-exposed workers. People who were exposed to asbestos on the job at any time during their life or who suspect they may have been exposed should not smoke. If they smoke, they should stop.

Who needs to be examined?

Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job or at home via a family contact should inform their physician of their exposure history and any symptoms. Asbestos fibers can be measured in urine, feces, mucus, or material rinsed out of the lungs. A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. It is important to note that chest x-rays cannot detect asbestos fibers in the lungs, but they can help identify any lung changes resulting from asbestos exposure. Interpretation of the chest x-ray may require the help of a specialist who is experienced in reading x-rays for asbestos-related diseases. Other tests also may be necessary.

As noted earlier, the symptoms of asbestos-related diseases may not become apparent for many decades after exposure. If any of the following symptoms develop, a physical examination should be scheduled without delay:

Shortness of breath;
A cough or a change in cough pattern;
Blood in the sputum (fluid) coughed up from the lungs;
Pain in the chest or abdomen;
Difficulty in swallowing or prolonged hoarseness; and/or
Significant weight loss.

How can workers protect themselves?

Employers are required to follow regulations dealing with asbestos exposure on the job that have been issued by the Occupational Safety and Health Administration (OSHA), the Federal agency responsible for health and safety regulations in maritime, construction, manufacturing, and service workplaces. The Mine Safety and Health Administration (MSHA) enforces regulations related to mine safety. Workers should use all protective equipment provided by their employers and follow recommended work practices and safety procedures. For example, National Institute of Occupational Safety and Health (NIOSH)-approved respirators that fit properly should be worn by workers when required.

Workers who are concerned about asbestos exposure in the workplace should discuss the situation with other employees, their employee health and safety representative, and their employers. If necessary, OSHA can provide more information or make an inspection. Regional offices of OSHA are listed in the “United States Government” section of telephone directories’ blue pages (under “Department of Labor”). Regional offices can also be located at http://www.osha-slc.gov/html/RAmap.html on the Internet, or by contacting OSHA’s national office at:

Source: http://www.cancer.gov/cancertopics/factsheet/Risk/asbestos.

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What is Mesothelioma?

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

What is the mesothelium?

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

How common is mesothelioma?

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

What are the risk factors for mesothelioma?

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person’s risk of developing cancer of the air passageways in the lung.

Are new treatments for mesothelioma being studied?

Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI’s cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI’s Cancer.gov Web site, located at http://www.cancer.gov/clinical_trials on the Internet, provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.

How is mesothelioma treated?

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient’s age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

How is mesothelioma diagnosed?

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient’s medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.

Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

What are the symptoms of mesothelioma?

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

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