Asbestos Disease

Asbestos Claim News – 1/25/2012: Exposure to asbestos is the link to the development of mesothelioma. People who end up with this disease usually have had some type of previous exposure to asbestos. How this works is not fully understood. It is thought that asbestos fibers are inhaled and first travel through the upper air passages, which include the throat, the trachea (windpipe), and the large bronchi (large breathing tubes of the lungs). These airways are lined with mucus, and therefore most of the fibers are cleared from these upper airways by sticking to this mucus and being coughed up or swallowed. When the fibers continue to travel and reach the small airways (the alveoli), the body’s immune system is able to sur­round, engulf, and remove the smaller fibers by a process known as phagocytosis. The large, long, thin fibers cannot be cleared as easily and may eventually reach the pleura (the lining of the lung and the chest wall), where they may irritate and injure the cells and lead to the development of calcium containing plate­like structures on the pleural lining (pleural plaques), fibrosis (scar tissue formation), or mesothelioma. These same asbestos fibers can also damage cells in the lung itself, which can lead to asbestosis (scar tissue in the lung) and/or lung cancer. Patients with these pleu­ral plaques seem to be at highest risk for developing mesothelioma.

The best way to prevent mesothelioma is to decrease one’s exposure to asbestos in the workplace, at home, and in the environment. The federal government is responsible for developing regulations that deal with asbestos exposure in the workplace. The agency that issues these regulations is known as the Occupational Safety and Health Administration (OSHA). Employ­ers are required to follow these regulations, and there­fore workers who are concerned about asbestos exposure should be discussing these concerns with their employers or union. Also, employees should be using all protective equipment provided to them by their employers and following recommended safety procedures and practices while at work. If you are exposed to asbestos in the workplace, you should be aware of the potential of bringing the fibers home on your clothes, skin, and hair. It is best to change your clothes and shower at work if at all possi­ble. If not, then it is important to do this immediately upon arriving home, which will limit the amount of exposure to others. Remove your clothes and put them in the washing machine as soon as possible.

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Malignant mesothelioma is a rare form of cancer that is found m the lining of the chest and lung (the pleura), the abdomen (the peritoneum), or the saclike space around the heart (the pericardium). Although it is rare, mesothelioma is a very serious disease that is often at an advanced stage when the diagnosis is made. In the United States an estimated 2000 to 3000 new cases of mesothelioma are diagnosed each year. Approximately three fourths of these cases start in the chest cavity and are called pleural mesothe­liomas. Another 10% to 20% begin in the abdomen and are called peritoneal mesotheliomas. Lastly, those that start in the lining around the heart are called pericardial mesotheliomas, but these are extremely rare. Mesothelioma is divided into three main types, based on what the cancer cells look like under the micro­scope. The most frequent type is epithelioid. About 50% to 70% of mesotheliomas are of this type. It usu­ally has the best prognosis or outiook of the three. The second type is called the sarcomatoid, which makes up about 7% to 20% of mesotheliomas. It has a very unpredictable pattern or nature. The last type, called mixed or biphasic, is a combination of the first two types and makes up about 20% to 35% of mesotheliomas. Although there are different types of mesothelioma, the treatment options, at this time, are essentially the same for all types.

Family members of people exposed to asbestos at work are also at an increased risk for mesothelioma. This is because these asbestos fibers are carried home on the clothes, shoes, skin, and hair of these workers and can be inhaled by others. Simian virus 40, or SV40, is a virus that has been asso­ciated with the development of malignant mesothe­lioma. This virus is found in rhesus monkeys and is now widespread among humans. The way this virus was transferred from monkeys to humans is uncertain, but it is postulated that some of the transfer occurred from 1954 to 1963 through SV40-contaminated polio vaccines administered worldwide. Those people who received the injectable form of the polio vaccine are believed to be those at greatest risk. This vaccine doesn’t folly explain the transfer of this virus, because many humans who could not have received the contaminated vaccines are now infected with the SV40 virus. One theory that has been proposed is that the SV40 virus continues to be transferred from monkeys to humans or that humans can pass the virus from person to per­son. The latter theory has been supported by data showing that SV40 can be excreted in human feces, breast milk, and semen. It is unlikely that this virus acts alone in the development of mesothelioma as most cancers have multiple risk factors associated with their development, and most mesotheliomas occur in asbestos exposed individuals. Instead, it is more likely that asbestos and SV40 may act together to develop into mesothelioma.

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Asbestos is associated with lung cancer too! Many studies have shown that the combination of smoking and exposure to asbestos is particularly haz­ardous. The risk of lung cancer is greatly increased in asbestos-exposed individuals who smoke. However, smoking in the absence of asbestos exposure has not been associated with the development of mesothe­lioma. Nevertheless, did you know that certain ciga­rette filters were constructed from asbestos fibers? Fortunately, this brand, Kents, is no longer on the market. Because of the combined effect of smoking and asbestos exposure, it is important for anyone who has ever been exposed to asbestos, or who suspects that he or she may have been exposed to the fibers, to quit smoking, or not to start. People who have been exposed to asbestos should also get regular physical exams and should seek prompt medical treatment for any respiratory illnesses.

Asbestos is a naturally occurring group of minerals that have been mined and used in different industries since the late 1800s. It is an extremely poor conductor of heat and does not conduct electricity, and therefore it has been widely used as an insulator. The flexible asbestos fibers are woven after being separated into thin threads. The fibers tend to break easily, and the dust that is formed from them breaking can float in the air and stick to clothes. The fibers can also be inhaled or swallowed and can result in serious health problems, including asbestosis, lung cancer, and mesothelioma.

There are six types of asbestos: amosite, crocidolite, anthophyllite, actinolite, tremolite, and chrysotile. The first five types are called amphibole asbestos, and they all have needlelike fibers. Chrysotile has a different texture, composition, and behavior than amphibole asbestos. Although some findings suggest that amphi­bole asbestos is more cancer causing than chrysotile, the topic remains controversial. Mesothelioma has a very long latency period (the time from the initial asbestos exposure to the development of cancer), making it doubly treacherous. This latency period can be anywhere from 25 to 40 years. The length of time it takes patients to report symptoms varies but can range from two weeks to two years, with the average being about two months. As many as 25% of patients with the disease can have symptoms for six months or more before seeking medical attention. Due to its slow onset, the disease tends to affect people between 50 and 70 years of age. It affects men three to five times more often than women and is less common in African Americans than in Caucasians. The right side of the chest is affected more than the left. The right lung is bigger than the left lung, or the right lung is of greater size and volume than the left lung.

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If you experience shortness of breath, pain in the chest or abdomen, swelling in the abdomen, or any other unusual symptom, see your doctor! The doctor will take a history from you and perform a physical exam. In listening to your chest, the doctor may not hear breath sounds clearly on one side or may hear scratchy sounds in the chest (rub). Or the doctor may notice that your abdomen is swollen. After the examination, the doctor mil link the symptoms you reported to the findings on the physical exam. The doctor will want to know whether you have had other symptoms, like fever, chills, pain, or unusual lumps on the torso. The doctor will also want to know whether your appetite is good and whether you have lost any weight. He or she may ask about asbestos exposure and cigarette use.

A patient with a large, unexplained fluid accumulation in the chest or abdomen and who has a small or moder­ate amount of thickening of the pleura should have a biopsy performed, using semi-invasive techniques (tech­niques that require only local anesthesia and that do not involve cutting into the chest or abdomen). For exam­ple, the biopsy might involve an initial thoracentesis (drainage of fluid in the chest) or paracentesis (drainage of fluid in the abdomen) and a pleural biopsy. These are relatively safe procedures that can be performed by a pulmonologist (lung physician), a radiologist, or a sur­geon. A local anesthetic (a numbing medicine such as lidocaine) is given to temporarily reduce the feeling in the area before the needle is inserted. It is important that you get the best information avail­able regarding your particular condition in order to decrease confusion, establish confidence in the treat­ment team, and have every opportunity to fight the disease and live as long as possible. In the majority of cases, your physician -will inform you whether the institution he or she is associated with has a special interest in the disease and treats more than 50 cases of mesothelioma per year. If those resources are not at your physician’s disposal, he or she should recommend a second opinion at a cancer center, which is a spe­cialized institution to which he can refer you for mesothelioma. You should not lose your primary physician or the physician who made this initial diag­nosis as your advocates.

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Oncology is a branch of medicine that deals with can­cer, and an oncologist is a specialized doctor who treats people with these cancers. Depending on your particular treatment plan and which cancer center you are referred to, you may be seen first by a medical oncologist (a specially certified physician who treats cancer and delivers chemotherapy), a thoracic surgical oncologist (a general thoracic surgeon whose practice is almost exclusively the treatment of cancers in the chest and who does not perform heart surgery), or a radiation oncol­ogist (a physician who delivers radiation). Mesothe­lioma is a very rare disease and therefore should be managed by doctors who have experience in treating it. The ideal situation is to be referred to a cancer center that deals with the disease in a multimodal way. That is, one that has a team of physicians from medicine, surgery, and radiation; nurses; and pain specialists who meet and discuss every patient in an individual­ized fashion. This group of specialists is called the multidisciplinary team. The key words here are “expe­rience” and “protocols.” You should insist on seeing individuals experienced in treating mesothelioma and who offer clinical trials (protocols) studying new ways to treat the disease.

It is important that you and your doctor communicate clearly and understand each other well. Before you visit a center or a specific doctor, see whether either has a website that you can visit. You may be pleasandy surprised that a lot of your questions about the place or physician j^ou are visiting are dealt with on this web­site. Nevertheless, how comfortable you are with your doctor will determine what questions you are able to ask and how successful your visit will be. If you don’t understand something that your doctor tells you, let him or her know this! You should be able to receive the information in a form that is understandable to you. Ask the doctor to speak in simple terms if you find the language too complex. If you have concerns about any­thing that is said, speak up and discuss these issues. Take the time to repeat back to the doctor what you heard so that he or she knows what information to reinforce and what to correct. Talk with your doctor about what your knowledge is of the disease and its treatment and any concerns and/or fears you may have.

Telling family members about a diagnosis of mesothe­lioma is a difficult thing to do. They may experience a lot of the same emotions that you do, including fear, worry, concern, anger, and sadness. These emo­tions need to be expressed, even when they are strong. The best recommendation is to communicate openly and honestly with one another. This enables you and your family to cope better with the cancer diagnosis. The entire adult family should discuss all aspects of the disease before you start treatment. This includes the type of mesothelioma, the prognosis, treatment options, goals of treatment, and side effects expected.

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