When Erwin Bergquist, a three-year mesothelioma survivor and patient of Dr. Robert Cameron, came in for his regular check-up in May, 2008, he handed Dr. Cameron a check without saying a word.  The check was for $150,000.00 — the largest single gift from a patient in the history of PHLBI.

The money was earmarked for Dr. Cameron’s IMIS research study, a PHLBI project that will create the world’s first online database of medical records for people with asbestos-related diseases.”

The database will allow researchers to examine anonymous medical records, spot trends, and develop research/prevention strategies based on a large amount of real-world medical data. “This is the first project of its kind for asbestos-related diseases,” says Dr. Cameron, “and Erwin’s donation puts us well over half-way to paying for the entire project, which will cost $250,000. We all owe him a debt of gratitude for this generous gift.”

Erwin gives back in so many  ways.  On his most recent visit to Dr. Cameron in mid-November, 2008, he was leaving the clinic when PHLBI Executive Director Amy Sriberg took him aside and asked a favor:  There was a newly diagnosed gentleman in the clinic, waiting to meet with Dr. Cameron.  He was clearly overwhelmed by his mesothelioma diagnosis and needed some help.  Would Erwin mind taking a moment to speak with this man?  Without hesitation, Erwin headed straight for the treatment room and spoke to the patient until Dr. Cameron arrived.  Email addresses and phone numbers were exchanged.  Erwin’s wife, Jan, waited patiently in the clinic lobby, fully aware of the impact of just one conversation with Erwin. 

Erwin Bergquist’s generosity extends far beyond his extraordinary donation. His kindness, compassion, and positive energy are gifts he shares with everyone fortunate enough to meet him.

Scientific Advisory Board

PHLBI strives to fulfill our mission through collaborative utilization of the knowledge and talents of our Scientific Advisory Board which is responsible for directing our scientific and research activities. Our team of highly acclaimed physicians has already made substantial advancements in the treatment of heart, blood, and lung diseases.

DON’T…

√…tell them that everything’s going to be all right.

√…tell them you know how they feel.

√…try to cheer them up or make them feel better.

√…be afraid to touch them, but don’t force it, either.

√…avoid the subject of cancer if that’s what they want to talk about.

√…discount the real feelings they may be having by telling them not to worry,

      not to be scared, or not to cry.

√…tell them to think of all the good times.

√…share advice unless asked.

DO…

√ Offer your presence often, be a good listener when they are ready to talk.

√ Talk about things other than their cancer.

√ Say, “I love you.”

√ Admit that you don’t know what to say when you really are at a loss for words.

√ Ask what you can do to help – be sincere and specific so that they know you

   mean it.  If they can’t come up with anything, ask again in another week or so.

√ Offer to help by driving them to treatments or doctors’ appointments, taking

   their kids to childcare, and doing housecleaning, gardening, cooking, shopping,  

   yard work, or babysitting.

√ When you’re thinking about them, call them up and tell them.

√ Respect how they choose to deal with their cancer.

√ Be yourself.

√ Tell them about the support, education, and hope they can find at

   The Wellness Community: www.twc-wla.org

The mission of The Wellness Community-West Los Angeles is to help people affected by cancer enhance their health and well-being through participation in a professional program of emotional support, education, and hope.  All programs and services are provided at no cost to participants.

Warren S. Grundfest, MD, FACS

Dr. Grundfest is currently Professor of Biomedical Engineering, Electrical Engineering, and Surgery at UCLA. He received his MD degree from Columbia University in 1980 and trained in General Surgery at UCLA and Cedars-Sinai Medical Center. He was appointed Assistant Director of Surgery at Cedars-Sinai Medical Center and Assistant Clinical Professor of Surgery at UCLA in 1987. He served as a Research Professor in Biomedical Engineering at University of Southern California and as Visiting Associate in Mechanical Engineering at California Institute of Technology.

From 1991-2001 Dr. Grundfest was the Director of the Cedars-Sinai Laser Research and Technology Development Program where he held the Dorothy and E. Philip Lyon Chair in Laser Research. Dr. Grundfest developed a broad range of laser, endoscopic, and minimally invasive surgical devices and techniques to improve the efficacy and decrease the pain and cost of medical therapies. He has received 15 patents for these efforts.

In 1994 he was inducted into NASA’s Space Technology Hall of Fame for the application of Excimer lasers to biologic systems. In 1996 he was elected Fellow, American Institute of Medical & Biologic Engineers (AIMBE), and Fellow, SPIE, for his work in biomedical photonics. Dr. Grundfest served as the first Chair of the UCLA Biomedical Engineering Program from 1999-2002.

Dr. Grundfest served as a member of the Surgery and Bioengineering Study Section of the NIH, external Co-Chair of the NIH BECON Consortium, and Chair of SPIE’s Biomedical Optics Conference for many years. Dr. Grundfest currently consults for the NIH and the FDA and serves as a Senior Technology Advisor to TATRC (Telemedicine and Technology Research Center of the Army). His current research efforts include the development of minimally invasive surgical tools, robotic systems, optical and ultrasonic sensors, haptic feedback systems, and biomedical photonics.

Terry Lynch

Vice President at Large and Health and Safety Director for the International Association Heat & Frost Insulators & Asbestos Workers
Munster, IN

Terry Lynch started his career with the International Association Heat & Frost Insulators & Asbestos Workers in 1970 as an apprentice insulator with Asbestos Workers Local 17 in Chicago, Illinois. After completing his apprenticeship, he received his journeyman card in 1974. In 1980, he was elected Vice President of Local 17 and in 1982 attended the first of five conventions as a delegate representing the Local. In December of 1984, Terry was elected Corresponding Recording and Financial Secretary of Local 17 and in 1986 he was elected as Trustee for the Local Union’s Health, Welfare, Pension and Annuity Funds. Terry served the Local as Chairman of these jointly trusted funds and also for the Joint Apprentice Training Committee. In 1996, Terry was elected as Business Manager of the Heat and Frost Insulators’ Local 17.

In September of 2002, Terry was elected to his current post as International Vice President at Large. Terry also serves his International Union as Legislative Director and Health and Safety Director.

Terry comes from a pipe covering family which includes his grandfather, father, uncle, brother and many cousins. Terry’s son, Jason, now completes the fourth generation of pipe coverers in the family.

Terry has always strived to make life better for his fellow Union members and their families. He looks forward to working with the Pacific Heart, Lung & Blood Institute (PHLBI).

“The time is long past to address the underlying health crisis,” Lynch said recently. “Asbestos has decimated entire generations of insulators. We have known that asbestos is deadly for decades, but next to nothing has been done to wipe out the epidemic of asbestos cancer. Our members want hope. They want more life. They want investment in prevention and early detection strategies. They are at high risk for disease – they need assurance that if they too are diagnosed, at least there will be reasonable, affordable and accessible treatment options. Insulators, as well as all of our brothers and sisters in the building, metal and shipbuilding trades, helped build this great country. We owe it to working families to invest in a cure.”

Terry earned his Bachelor of Arts degree at Northern Illinois University. He is a past Admiral of the Pirates, a group of Union Labor and Management people dedicated to helping special children. Terry also served on the Labor Council with Amalgamated Bank.

Terry has been married for 36 years to his wife Denise. They have one son, Jason, and one grandson, Connor Terrence.

Asbestos Workers Union Joins New Medical Foundation’s Quest for Cure of Asbestos and Benzene-Related Cancers (3/20/06)

Andrea Scott

Andrea K. Scott, Esquire is an attorney specializing in bioethics, regulatory affairs and the introduction of new medical technologies. Scott earned her undergraduate degree form Princeton University (BA, magna cum laude) and a graduate degree from Yale University (MA with honors) before working as an anthropologist in pre-Columbian Mayan and Chinese epigraphy and iconography. She won a National Science Foundation doctoral fellowship while at Yale and received an honorary doctorate from the University of Marroquin in Guatemala. Scott obtained her law degree from the University of Virginia School of Law where she was a member of the Editorial Board of the Law Review. Her Note, “Anencephalic Infants as Organ Donors” was published in the University of Virginia Law Review. After her first year at law school, she served as a Law Intern to the Honorable John W. Bissell of the United States District Court, New Jersey and the United States Court of Appeals for the Third Circuit (sitting by designation).

Scott was retained by Dr. Jonas Salk to serve as Chief Biomedical Ethics Officer to the Salk Foundation to assist with clinical trials for Salk’s prophylactic AIDs vaccine in Africa and Asia. Dr. Salk chose Scott because of her record as both an archeologist and bioethicist in resolving problems generated by the introduction of novel medical technologies and practices in third world countries. Scott has also served as a Trustee to the Albert B. Sabin Vaccine Institute, Bioethics Advisor to Lawrence Livermore National Laboratory’s Center for Health Care Technologies. For years, Scott was a Visiting Lecturer in Law and Medicine at Loma Linda University Medical Center and Graduate School. She also acted as General Counsel to the Loma Linda Medical Research Board of Advisors.

Scott has consulted for various national governmental agencies such as the United States Agency for International Development [USAID], the Food and Drug Administration [FDA], and the National Institutes of Health [NIH]. She has been a member and officer of numerous technological societies, including the Center for Telemedicine Law, The Institute of Electrical and Electronics Engineers [IEEE], the International Society for Optical Engineering [SPIE], the Biomedical Optics Society [BIOS], the IEEE Engineering, Medicine and Biology Society [EMBS], the IEEE Workforce Committee and the SPIE / American Institute of Medical and Biological Engineering [AIMBE] Joint Working Committee on Health Care Technology Policy, for which she co-chaired the Subcommittee on Bioethics and Regulatory Affairs, as well as the University of Virginia Ad Hoc Bioethics Committee.

Scott’s client list is unusually diverse, including individuals, small startup groups, national Fortune 500 corporations and multinational companies. She was a consultant to General Electric Medical Systems for their Second Generation Imaging Program and bioethics advisor to their International Clinical Investigations Program [CIP]. As an expert at trial, Scott has worked for both plaintiffs and defendants. Benchmark cases include Dow Corning Corporation et al. v. Hartford Accident & Indemnity Co. et al.; 3M Corporation et al. V. Hartford Accident & Indemnity Co. Et al. regarding the silicon breast implant dispute; In re Maureen Helmick, which involved the role of managed care and a patient’s right to die; and Mullen v. Nezhat et al. The Nezhat case involved a broad array of bioethics issues from fraud by the medical device industry in the introduction of new medical technology to effective testing in clinical trials, licensing, privileging and credentialing, fraudulent medical advertising, fraudulent research and publication, informed consent, waivers of patient rights and billing fraud.

Scott’s work as an archeologist took her to Asia, Central America, the Mediterranean and Africa. Her familiarity with foreign cultures and languages is key to her method of resolving seemingly discordant ethical issues in law and medicine within Third World countries and allowed her to generate policy guidelines resulting in legislation implemented on three continents. During the 1980s, while conducting archeological research in Guatemala, Scott founded and chaired the Guatemalan-North American Association [GNAA], a non-profit inter-American relief organization promoting medical, healthcare and agricultural assistance to Guatemala’s Mayan Indian populations in both the Highlands and Peten jungle. Scott convinced political factions at war for more than three decades to adopt a strict “hands off” policy, allowing relief efforts to move forward without interference and violence. Lending support to this and other human rights initiatives by Scott were USAID, members of the military from the USA, Russia, Cuba and Canada, and thirteen political factions of Guatemala, as well as the Protestant and Catholic Churches and members of the private sector in each participating nation

Articles/Publications

Scott has published on a wide variety of subjects in bioethics, including anencephalic infants as organ donors; technology introduction, assessment and dissemination; technology transfer; allocation of health care resources; telemedicine; gender discrimination in the medical community; church versus state in medical practice; in vitro fertilization within the context of divorce; the body as property; rights and responsibilities of physicians; dangers inherent in managed medical care systems; the right of patients to refuse medical attention; embryonic stem cell research; and neuroethics. [Publications available upon request.]

Terry McCann, 1934-2006

Terry McCann was diagnosed with malignant pleural mesothelioma in June of 2005. Terry waged a valiant fight against this deadly disease with the assistance of his treating physician, Dr. Robert Cameron, a dedicated member of PHLBI’s Scientific Advisory Committee. Terry is renowned for outstanding personal achievements in amateur wrestling, philanthropy, and volunteerism. In every aspect of his life, Terry demonstrated a drive to be the best and a desire to help others around him be their best.

Terry’s impressive list of amateur wrestling accomplishments began in 1952 when he won the Illinois High School State Wrestling Championship. He then went on to wrestle for the University of Iowa where he continued his winning-ways, becoming a three-time All-American and a two-time NCAA Champion in 1955 and 1956. Terry also won three consecutive AAU National Championships and posted the only undefeated international record of his time. Terry then reached the pinnacle of his sport when he went to the 1960 Rome Olympics, soundly defeated all of his competition, and won a Gold Medal.

Returning from Rome with Olympic gold, Terry remained involved in the wrestling community by volunteering his time to coach young wrestlers. In the 1970s, he coached several All State wrestlers and a total of 47 National Champions. Terry says that his payment for coaching was seeing each young man win his own championship.

After achieving great coaching success, Terry co-founded the United States Wrestling Federation which later became USA Wrestling, the governing body of wrestling across the world. Terry is a member of the U.S. Wrestling Hall of Fame, the International Wrestling Hall of Fame, the Amateur Wrestling Hall of Fame, and the United States Olympics Hall of Fame

In the mid 1970s, Terry moved his family to Southern California. He was not in California very long before he took up surfing. Using the same traits that made him an Olympic Gold Medalist, Terry acquired the skills to become a great surfer. His newly found passion led him to join the Surfrider Foundation, an environmental organization focused on keeping beaches clean. In 1993, Terry ran for a position on the Board of Directors and was elected President of the foundation. He made tremendous positive changes to an ailing foundation and increased surfer awareness to all-time highs. Before the onset of symptoms from mesothelioma, Terry surfed daily and was a proud member of the San Clemente “morning crew” which went out every morning at sunrise.

He also achieved great personal success in his professional life, where most of his time was spent as an executive for non-profit institutions. Terry was the CFO of Lions International, the largest service organization in the world. He also served as the Executive Director or Toastmasters International for 30 years.

It was a great honor and privilege to work with Terry McCann.

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These are terms you may come across as you do your research on the topic of mesothelioma. This information is not intended to replace a visit to the Doctor.

A

abdomen (ab-do-men) – The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

asbestos (as-bes-tus) – A mineral with long, thin fibrous crystals.  The inhalation/ingestion of asbestos can cause serious illnesses, including asbestosis, and malignant mesothelioma.

advance directives: legal documents that tell the doctor and family what a person wants for future medical care in the event that the patient becomes unable to make decisions for him or herself. This may include whether to start or when to stop life-sustaining treatments. Another type of advance directive lets you choose a person to make decisions for you later if you become unable to do it for yourself.

alveoli: (al-vee-o-lie): air sacs of the lungs.

angiogenesis: (an-jee-o-jen-uh-sis): the formation of new blood vessels. Some cancer treatments work by blocking angiogenesis, thus preventing blood from reaching the tumor.

anti-emetic: (an-tie-eh-meh-tik): a drug that prevents or relieves nausea and vomiting, common side effects of chemotherapy.

antibody: a protein produced by immune system cells and released into the blood. Antibodies defend the body against foreign agents, such as bacteria. These agents contain certain substances called antigens. Each antibody works against a specific antigen. See also antigen.

antigen: (an-tuh-jen): a substance that causes the body’s immune system to respond. This response often involves making antibodies. For example, the immune system’s response to antigens that are part of bacteria and viruses helps people resist infections. Cancer cells have certain antigens that can be found by lab tests. They are important in cancer diagnosis and in watching response to treatment. Other cancer cell antigens play a role in immune reactions that may help the body’s resistance against cancer.

B

biopsy (by-op-see) – The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. When only a sample of tissue is removed, the procedure is called an incisional biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy, core biopsy, or fine-needle aspiration.

bronchi: (brong-ki): in the lungs, the two main air passages leading from the windpipe (trachea). The bronchi provide a passage for air to move in and out of the lungs.

bronchiole: (brong-key-ol): one of the smaller sub-divisions of the bronchi.

bronchoscope (bron-ko-skope) – A thin, lighted tube used to examine the inside of the trachea and bronchi, the air passages that lead to the lungs

bronchoscopy (bron-kos-ko-pee) – A procedure in which a thin, lighted tube is inserted through the nose or mouth. This allows examination of the inside of the trachea and bronchi (air passages that lead to the lung), as well as the lung. Bronchoscopy may be used to detect cancer or to perform some treatment procedures.

C

cancer – A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body. There are several main types of cancer: Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system.

carcinogen: (car-sin-o-jin): any substance that causes cancer or helps cancer grow. For example, tobacco smoke contains many carcinogens that greatly increase the risk of lung cancer.

cell: the basic unit of which all living things are made. Cells replace themselves by splitting and forming new cells (this process is called mitosis). The processes that control the formation of new cells and the death of old cells are disrupted in cancer.

centimeter: a metric measure of length ( 1/100 of a meter).  It takes about 2 ½ centimeters to equal 1 inch.

chemotherapy: (key-mo-ther-uh-pee): treatment with drugs to destroy cancer cells. Chemotherapy is often used, either alone or with surgery or radiation, to treat cancer that has spread or come back (recurred), or when there is a strong chance that it could recur. Often referred to as chemo.  Chemo drugs commonly used to treat mesothelioma are: pemetrexed (label name: Alimta) and carboplatin (label name: Cisplatin) and Onconase.

chest x-ray – An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.

clinical trials: research studies to test new drugs or other treatments to compare current, standard treatments with others that may be better. Before a new treatment is used on people, it is studied in the lab. If lab studies suggest the treatment will work, the next step is to test its value in patients. These human studies are called clinical trials. The main questions the researchers want to answer are:

• Does this treatment work?
• Does it work better than what we’re now using?
• What side effects does it cause?
• Do the benefits outweigh the risks?
• Which patients are most likely to find this treatment helpful?

complementary therapy: treatment used along with standard medical treatment. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient’s sense of well-being.  Patients thinking about using any alternative or complementary therapy should discuss it first with a member of their health care team, since many of these treatments are unproven and some can be harmful.

complete blood count (CBC): A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood.

computed tomography: (tah-mahg-ruh-fee): an imaging test in which many x-rays are taken from different angles of a part of the body. These images are combined by a computer to make cross-sectional pictures of internal organs. Except for the injection of a dye (needed in some but not all cases), this is a painless procedure that can be done in an outpatient clinic. It is often referred to as a “CT” or “CAT” scan.

cytokine: (sy-toe-kine): A substance that is produced by cells of the body’s immune system that can affect the immune response. Cytokines can also be produced in the lab and given to people to help the body’s immune responses against cancer.

cytology – (sy-tahl-uh-jee): the branch of science that deals with the structure and function of cells. Also refers to tests to diagnose cancer and other diseases by looking at cells under a microscope.

D

DNA or Deoxyribonucleic acid: (dee-ok-see-ri-bo-new-clee-ick): the genetic “blueprint” found in the nucleus of each cell. DNA holds genetic information on cell growth, division, and function.

diagnosis – The process of identifying a disease by the signs and symptoms.

durable power of attorney for health care: a legal document that allows you to appoint a person to make medical decisions for you if you become unable to do so for yourself. This is a type of advanced directive.

dysphagia: (dis-fay-zhe-uh): having trouble swallowing or eating.

E

emesis: (em-eh-sis ): vomiting

epidemiology: (ep-ih-deem-ee-ahl-uh-jee): the study of diseases in populations by collecting and analyzing statistical data. In the field of cancer, epidemiologists look at how many people have cancer; who gets specific types of cancer; and what factors (such as environment, job hazards, family patterns, and personal habits, such as smoking and diet) play a part in the development of cancer.

etiology: (ee-tee-ahl-uh-jee): the cause of a disease.  Research is showing that both genetics and lifestyle are major factors in many cancers.

extra-pleural pneumonectomy (EPP): a radical surgery for patients with malignant mesothelioma, which removes the entire affected lung and sacs

 F

fine-needle aspiration – The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy.

G

gene therapy: a new type of treatment in which defective genes are replaced with normal ones. The new genes are delivered into the cells by viruses or proteins.

H

hemoglobin (hee-muh-glow-bun) – The substance inside red blood cells that binds to oxygen and carries it from the lungs to the tissues.

hospice: a special kind of care for people in the final phase of illness, as well as their families and caregivers. The care usually takes place in the patient’s home or in a home-like facility.

Hyperthermic chemotherapy:  heated chemotherapy agents used to eradicate remaining mesothelioma cells.

I

imaging studies: methods used to make pictures of internal body structures. Some imaging methods used to help diagnose or stage cancer are x-rays, CT scans, magnetic resonance imaging (MRI), and ultrasound.

immune system: the system by which the body resists infection. The immune system may also help the body fight some cancers.

immunotherapy: (im-yuh-no-ther-uh-pee): treatments that promote or support the body’s immune system response to a disease such as cancer.

informed consent: a legal document that explains a course of treatment, the risks, benefits, and possible alternatives; also the process by which patients agree to treatment.

interferon: (in-ter-feer-on): a protein produced by cells. Interferon helps regulate the body’s immune system, boosting activity when a threat is detected. Scientists have learned that interferon can help fight against cancer.

interleukins: (in-ter-loo-kins): See cytokine.

L

laparotomy (lap-a-rah-toe-mee) - A surgical incision made in the wall of the abdomen.

lung – one of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

lymph nodes: small bean-shaped collections of immune system tissue, such as lymphocytes, found along lymphatic vessels. They remove cell waste, germs, and other harmful substances from lymph. They help fight infections and also have a role in fighting cancer, although cancers sometimes spread through them. Also called lymph glands.

lymphatic system: the tissues and organs (including lymph nodes, spleen, thymus, and bone marrow) that produce and store lymphocytes (cells that fight infection) and the channels that carry the lymph fluid. The entire lymphatic system is an important part of the body’s immune system. Invasive cancers sometimes get into the lymphatic vessels (channels) and spread (metastasize) to lymph nodes.

M

magnetic resonance imaging (MRI): a method of taking pictures of the inside of the body. Instead of using x-rays, MRI uses a powerful magnet to send radio waves through the body. The images appear on a computer screen as well as on film. Like x-rays, the procedure is physically painless, but some people may feel confined inside the MRI machine.

malignant (ma-lig-nant) – cancerous.

malignant mesothelioma: (mee-so-thee-lee-oh-mah) a rare form of cancer that usually develops in the membranes lining the chest (pleural cavity) or in the membranes of the abdominal cavity (peritoneum).  In very rare cases, it will develop in the membrane around the heart (pericardium).

mediastinoscopy: (me-dee-uh-stine-ah-skuh-pee): examination of the chest cavity using a lighted, flexible tube inserted under the chest bone (sternum). This allows the doctor to see the lymph nodes in this area and remove samples to check for cancer.

mesothelium: (mee-soh-thee-lee-um) protective sacs that cover most of our internal organs.  The mesothelium sacs are actually a flat layer of cells which produce lubricating fluid.

metastasis: (meh-tas-tuh-sis): cancer cells that have spread (metastasized) to one or more sites elsewhere in the body, often by way of the lymph system or bloodstream. Regional or local metastasis is cancer that has spread to the lymph nodes, tissues, or organs close to the primary site. Distant metastasis is cancer that has spread to organs or tissues that are farther away (such as when prostate cancer spreads to the bones, lungs, or liver).The plural of this word is metastases.

micrometastases: (mike-row-muh-tas-tuh-sis): the spread of cancer cells in groups so small that they can only be seen under a microscope.

millimeter: (1,1000 of a meter) a metric measure of length. About 25 millimeters equals 1 inch.

N

neuropathy: (nur-ah-puth-ee): nerve abnormality or damage which causes numbness, tingling, pain, muscle weakness, or even swelling. It may be caused by injury, infection, disease (cancer, diabetes, kidney failure, or poor nutrition, for example), or by drug treatments. Peripheral neuropathy is a type of neuropathy that starts in nerves farthest away from the brain, such as the hands and feet.

P

palliative treatment: (pal-ee-uh-tiv): treatment that relieves symptoms, such as pain, but is not expected to cure the disease. Its main purpose is to improve the patient’s quality of life. Sometimes chemotherapy and radiation are used in this way.

pathologist (pa-thol-o-jist): A doctor who identifies diseases by studying cells and tissues under a microscope.

pericardium (per-ih-car-dee-um):  the membrane around the heart

peritoneum (payr-ih-toh-nee-um): The tissue that lines the abdominal wall and covers most of the organs in the abdomen.

platelet (plate-let):  A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called a thrombocyte.

pleura (ploor-a):  A thin layer of tissue covering the lungs and lining the interior wall of the chest cavity. It protects and cushions the lungs. This tissue secretes a small amount of fluid that acts as a lubricant, allowing the lungs to move smoothly in the chest cavity as you breathe.

pleurectomy with decortication (PD):  a surgical procedure for patients with malignant pleural mesothelioma, which removes the affected lining of the lungs but leaves the lungs in place.

pleurodesis: (plu-rod-is-sis): injection of a sclerosing agent between the layers of the pleura that causes them to fuse to seal off leaks. This procedure helps prevent fluid or air from building up in the pleural cavity, the area between the pleura. See pleura.

pnuemonectomy: (new-muh-neck-tuh-me): surgery to remove a lung.

positron emission tomography (PET): (pahs-uh-trahn ee-mish-uhn tom-ahg-ruh-fee): a PET scan creates an image of the body (or of biochemical events) after the injection of a very low dose of a radioactive form of a substance such as glucose (sugar). The scan computes the rate at which the tumor is using the sugar. In general, high-grade tumors use more sugar than normal and low-grade tumors use less. PET scans are especially useful in taking images of the brain, although they are becoming more widely used to find out if cancers of the breast, colon, rectum, ovary, or lung have spread. PET scans may also be used to see how well a tumor is responding to treatment.

prognosis (prog-no-sis) - a prediction of the course of disease; the outlook for the chances of survival.

protein (pro-teen) – A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

protocol: (pro-tuh-call): a formal outline or plan, such as a description of what treatments a patient will receive and exactly when each should be given.

pulmonologist: a doctor who has specialized experience and knowledge in the diagnosis and treatment of pulmonary (lung) conditions and diseases.

R

radiation oncologist: a doctor who specializes in using radiation to treat cancer.

radiation therapy: treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (brachytherapy or internal radiation). Radiation therapy may be used to shrink the cancer before surgery, to destroy any remaining cancer cells after surgery, or as the main treatment. It may also be used as palliative treatment for advanced cancer.

radiologist: a doctor with special training in diagnosis of diseases by interpreting or reading x-rays and other types of diagnostic imaging studies; for example, CT and MRI scans.

recurrence: the return of cancer after treatment. Local recurrence means that the cancer has come back at the same place as the original cancer. Regional recurrence means that the cancer has come back after treatment in the lymph nodes near the primary site. Distant recurrence is when cancer spreads (metastasizes) after treatment to distant organs or tissues.

S

sclerosing agent: Irritant used to create scar tissue. (see pleurodesis)

sedimentation rate – The distance red blood cells travel in one hour in a sample of blood as they settle to the bottom of a test tube. The sedimentation rate is increased in cases of inflammation, infection, cancer, rheumatic diseases, and diseases of the blood and bone marrow.

stage – The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

staging: the process of finding out whether cancer has spread and if so, how far. There is more than 1 system for staging different cancers. The TNM staging system, which is the most common, gives 3 key pieces of information: T refers to the size of the tumor; N describes the cancer spread to nearby lymph nodes; and M shows whether the cancer has spread (metastasized) to other organs. Letters or numbers after the T, N, and M give more details about each of these factors. The TNM descriptions can be grouped together into a simpler set of stages, labeled with Roman numerals I to IV. In general, the lower the number, the less the cancer has spread. A higher number means a more serious cancer.

systemic therapy: treatment that reaches and affects cells throughout the body; for example, chemotherapy.

T

thoracoscopy: The use of a thin, lighted tube to examine the inside of the chest.

thoracotomy (thor-a-kah-toe-mee): An incision into the chest.

tissue: A group or layer of cells that work together to perform a specific function.

trachea (tray-kee-uh): The airway that leads from the larynx to the lungs. Also called the windpipe.

tumor (too-mer): an abnormal lump or mass of tissue. Tumors can be benign (non-cancerous) or malignant (cancerous).

U

ultrasound: an imaging method in which high-frequency sound waves are used to outline a part of the body. The sound wave echoes are picked up and displayed on a monitor.

W

white blood cell (WBC): refers to a blood cell that does not contain hemoglobin. White blood cells include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. These cells are made by bone marrow and help the body fight infection and other diseases.

X

x-ray – one form of radiation that can be used at low levels to produce an image of the body on film or at high levels to destroy cancer cells.

From left:  Julie Belvedere, Noella Belvedere at the PHLBI information table set up at their Camarillo restaurant, Ottavio’s on 11/3/08.

 On November 3, 2008 the family of Ottavio Belvedere generously donated proceeds from every meal sold at their family restaurant, Ottavio’s, to the Pacific Heart, Lung & Blood Institute.  In addition, generous donations were collected from the majority of restaurant patrons and staff. 

Founded by Ottavio Belvedere in California in 1969, the family-owned and operated authentic Italian restaurant has been a favorite for generations of Camarillo families, many of whom turned up at the fundraiser with checks in hand!

The Belvedere family announced that the fundraiser would become a yearly event, in memory of Ottavio Belvedere, a loving husband, father, and grandfather who passed away from mesothelioma in 2007.  Ottavio’s wife, Noella, requested that all donations benefit the Punch Worthington Research Laboratory at UCLA, funded by PHLBI, to expedite the research efforts of Lab Director Dr. Robert Cameron, the renowned mesothelioma surgeon who treated her husband.  Noella Belvedere: “I know that Ottavio received the best treatment available from Dr. Cameron, and I want to ensure that others can benefit from his research efforts into promising therapies for mesothelioma patients.”

PHLBI IS ENORMOUSLY GRATEFUL TO THE BELVEDERE FAMILY FOR THEIR ONGOING SUPPORT OF DR. ROBERT CAMERON AND MESOTHELIOMA RESEARCH.

WHAT IS MALIGNANT MESOTHELIOMA?

Malignant mesothelioma (MM) is a rare form of cancer that usually develops in the lining of the chest or abdomen and affects approximately 3,000 people every year. Specifically, mesothelioma affects protective sacs known as mesothelium that cover most internal organs.  Mesothelium sacs are actually a flat layer of cells which produce lubricating fluid.  However, like any form of cancer, MM begins when a cell or group of cells undergoes a change that causes it to grow uncontrollably.  The cancer can then metastasize or spread throughout the body’s blood vessels or lymph system to other areas inside the body.

Pleural: Mesothelioma found in the pleura (the thin layer of tissue that lines the chest cavity and covers the lungs) is known as pleural mesothelioma and accounts for approximately 90% of all mesothelioma cases.

Peritoneal: Mesothelioma located in the thin layer of tissue that lines the abdomen and covers most of the organs in the abdomen is known as peritoneal mesothelioma. 

Sub Types: There are two common cell types for MM known as epithelial and sarcomatoid type. Epithelial malignant mesothelioma is the most common and accounts for 50-70% of all MM. Epithelial mesothelioma is so called because it affects the epithelial or tissue membranes that line internal organs. Approximately 60% of all epithelial cases occur in the pleural tissues of the lungs, usually the right lung. Patients who develop epithelial type mesothelioma often have a better prognosis and an increased chance of survival time because it is the least aggressive type.

Sarcomatoid mesothelioma is the second most common type which accounts for 7-20% of mesothelioma cases. This type of mesothelioma affects the connective tissues.

Patients can also develop a combination of epithelial and sarcomatoid known as biphasic mesothelioma. This occurs approximately 20-30% of the time. Patients should know which type of mesothelioma they have so that they may pursue the most appropriate treatment option first. For epithelial or biphasic patients who are predominantly epithelial, surgery may be the best initial treatment.

HOW MANY PEOPLE GET MESOTHELIOMA EACH YEAR?

Mesothelioma is relatively rare. Somewhere between 2,000 and 4,000 new cases are reported each year. It is more common among men than women in North America. However, this does not necessarily mean that men have a higher likelihood of developing mesothelioma. Traditionally, more men than women have worked with and been exposed to asbestos either through their occupation or through their household work. Thus, because a disproportionately larger number of men than women have been exposed to asbestos, it is understandable that more men than women develop malignant mesothelioma.

Mesothelioma (MM) has an unusually long latency period, meaning that after asbestos exposure, symptoms usually do not appear for 20 – 50 years.  MM has also been documented in a very wide age range. Once symptoms do occur, the cancer can progress quickly. Patients diagnosed with mesothelioma should seek immediate treatment from a specialist.

WHAT CAUSES MESOTHELIOMA?

Known asbestos exposure is reported in the majority of mesothelioma cases. Asbestos increases the risk of lung cancer, asbestosis, and other diseases, but most notably mesothelioma.

When asbestos is inhaled, it can cause pleural mesothelioma which occurs inside the chest and grows throughout the pleural space around the lungs. When asbestos is ingested, it can cause peritoneal mesothelioma which affects the abdomen and nearby organs.

WHAT ARE THE SYMPTOMS?

MM has a long latency period. Symptoms may not appear for anywhere from 10 to 50 years after exposure to asbestos. Common symptoms of malignant pleural mesothelioma include:

• Shortness of breath
• Pain in lower back or side of the chest
• Painful breathing
• Dry (nonproductive) cough
• Fatigue or lack of energy
• Weight loss
• A hoarse or husky voice
• Sweating and fevers
• Difficulty swallowing
• Unusual lumps of tissue under skin on the chest
• Pleural effusion: fluid accumulates in the pleura, which are membranes that line the lungs
• Thrombocytosis: a blood disorder in which the body produces a surplus of platelets (thrombocytes).

Common symptoms of peritoneal mesothelioma include:

• Abdominal pain
• Abdominal swelling
• Change in bowel habits, such as frequent diarrhea or constipation
• Bowel obstruction
• Lumps of tissue in the abdomen
• Unexplained weight loss
• Swelling in the abdomen due to fluid accumulation
• Nausea
• Anemia
• Swelling of the feet
• Thrombocytosis

What is pleural effusion?

Pleural effusion is the build-up of fluid between the visceral pleura (the membrane lining the lung) and the parietal pleura (the membrane lining the thoracic wall). The extra fluid surrounding the lung compresses it and may cause shortness of breath, chest pain, and dry cough.

What is thrombocytosis?

Thrombocytosis is an abnormal and unhealthy increase in platelet production in the blood. Some cancers can cause reactive or secondary thrombocytosis and is exhibited in 60%-90% of mesothelioma patients. Patients with this condition often exhibit no symptoms for a long period of time. However, some may be at risk for blood clot, stroke, or heart attack.

How is mesothelioma diagnosed?

X-rays, chest and lung function tests, CT scans, and MRI’s are all common methods of obtaining images of suspected regions affected by mesothelioma. Biopsies examined by a pathologist are needed to confirm a diagnosis. If mesothelioma is diagnosed, further staging tests will be performed to gain more information about the patient’s specific case.

What can a chest film show?

An x-ray provides an image of the heart, blood vessels, lungs, and any calcium deposits present in the chest. It can show pericardial and pleural effusion and can detect tumorous nodules. A chest x-ray can also show evidence of pleural plaques, which are benign, often partly calcified, scattered areas of scar tissue on the lining of the lungs. Pleural thickening is scarring throughout the tissue surrounding the lung and may be diffuse throughout the pleura; it can also be detected by x-ray.

Can a chest film show parenchymal pulmonary fibrosis?

Pulmonary fibrosis is a fiber-induced disease of the lung tissue. The stiffness in lung tissue leads to shortness of breath and dry cough and may include fatigue, weight loss, and muscle ache. A chest x-ray is usually not enough to diagnose pulmonary fibrosis so a high-resolution CT scan and pulmonary function test are also needed.

What advantages do PET/CT and MRI imaging techniques have over chest film?

PET (positron emission tomography) scans show changes in certain tissues and/or organs. PET scans can determine the extent of cancer or how the body is responding to treatment. CT scans use a computer to combine multiple x-rays into a two-dimensional cross-sectional image. These images can show the location and extent of the tumor and may indicate any spreading into the lymph nodes. A PET/CT combines both technologies into one scan. It can more accurately determine stage and surgical candidacy.

MRI (magnetic resonance imaging) creates a detailed cross-sectional image of the body and may provide greater contrast between normal tissues and tumor. Both of these techniques provide a clearer and more detailed image than a normal chest x-ray.

Can these imaging techniques show irregularities or tumor involvement in chest wall, pericardium, diaphragm, and lymph nodes?

CT scans can show chest wall and pericardium involvement, but MRIs are generally more accurate in assessing lymph node and/or diaphragm involvement. PET and PET/CT scans are considered the best images to determine staging and surgical candidacy and to track the effects of treatment.

What can you learn from cytology?

Cytology is a diagnostic method that analyzes fluid samples taken from the body. Cytology tests detect presence of disease (i.e. cancer) and classify the findings. A pathologist examines cell samples under a microscope for abnormalities that may indicate cancer. A cytology specimen usually is easier to obtain and causes less discomfort to the patient than a tissue biopsy. Addition, cytology is generally safer and less costly. In many cases, cytology fluid is just as accurate as tissue biopsy, but sometimes the latter is more precise and may often be used to confirm cytology results.

How is a thoracentesis performed?

In this procedure, a needle is inserted through the chest wall to remove fluid from the pleural space (between the lungs and the chest wall). Thoracentesis is a relatively safe procedure, and is used to collect sample fluid to aid in diagnosis. It may also relieve some symptoms due to pleural effusion.

How is a paracentesis performed?

Similar to a thoracentesis, a paracentesis removes peritoneal fluid. In this procedure, a needle is inserted through the belly to draw out the fluid. The sample is then analyzed in the lab for diagnosis of infection or cancer. Paracentesis may also relieve pain or other symptoms caused by the accumulation of fluid.

How is a needle biopsy performed?

There are two types of needle biopsy. One is called fine needle aspiration, in which a small amount of fluid is drawn out using a thin needle and a syringe. The other is called core biopsy and removes a small cylinder of tissue using a larger needle.

Can a needle biopsy help determine the cell type of the tumor?

A needle biopsy can be inadequate to determine cell type because of the unreliability of fluid diagnosis. An open pleural biopsy may be recommended for positive cell type diagnosis.

How is a bronchoscopy performed?  

This is a diagnostic procedure in which the throat, larynx, trachea, and lower airways are examined using a viewing instrument called a bronchoscope which is inserted through the nose or mouth. A flexible bronchoscope is a long, lighted tube which gives a view of the upper airways but also allows tissue biopsy.

A rigid bronchoscope usually requires general anesthesia and uses a straight metal tube. This may be used when there is bleeding or obstruction in the airway or if a larger tissue sample is needed. Bronchoscopy will look for abnormal areas and identify the cause of any airway problems, and it may also take tissue samples for lab analysis.

What is immunohistochemical staining?

This technique is used to detect disease markers for various cancers in a biopsy. A sample of cells is collected. If abnormal, these cells will have specific antigens. The particular antibodies for these substances are marked for visibility then mixed with the sample. In this way, the disease marker can be identified by the antigen-antibody interaction.

How is mesothelioma staged?

The stage of mesothelioma reflects its progression. Knowing the stage of mesothelioma may indicate which treatment option is best. Currently many different staging systems exist for pleural mesothelioma but none exist for peritoneal mesothelioma. Different staging systems emphasize various areas of progression from the lymph nodes to tumor size. Talk to your doctor about the importance of your stage and what that means for treatment. Then, seek a second opinion from another doctor regarding your potential treatment options.

The TNM System

The TNM system combines information about the tumor size (T), the lymph nodes (N), and metastasis (M) to track the progression of disease. First, a number is assigned to each of these three variables, then the variables are grouped to give the overall stage. The stages are characterized as follows:

Stage I- Tumor involvement in the left or right pleura lining the chest, possible limited involvement of lung, pericardium, or diaphragm, no lymph node involvement

Stage II- Tumor has spread from lining of chest to outer lining of the lung, diaphragm or the lung itself, no lymph node involvement or metastasis to distant sites

Stage III- Tumor spread from lining of chest to outer lining of the lung, diaphragm or the lung itself, possible involvement in muscle or other organs, possible nearby lymph node involvement, no distant metastases

Stage IV- Extensive tumor spreading and/or extensive lymph node involvement, includes metastases to distant sites

The Butchart System

Another method of staging is called the Butchart system which is the oldest staging system and is similar to the TNM system.

Stage I- Tumor involvement in left or right pleura and possibly diaphragm

Stage II- Tumor spread to chest wall, or esophagus, heart or pleura on both sides

Stage III- Tumor spread to lining of abdominal cavity, lymph node involvement

Stage IV- Evidence of distant metastasis or spread through bloodstream

The Brigham System

A third, newer method is the Brigham system which classifies mesothelioma into four stages mainly according to tumor resectability, that is the ability for the tumor to be removed surgically, and lymph node involvement.

Stage I- Resectable tumor, no lymph node involvement

Stage II- Resectable tumor, lymph node involvement

Stage III- Unresectable tumor that has spread into chest wall, heart, diaphragm and/or peritoneum, possible lymph node involvement

Stage IV- Unresectable, distant metastases

How is mesothelioma treated?

Surgery, radiation, and chemotherapy are the most common forms of cancer treatment. Surgical resection of a mesothelioma tumor can either be accomplished through an extra-pleural pneumonectomy (EPP) where the entire affected lung and sacs are removed or through a less radical pleurectomy decortication (P/D) where only the affected lining is removed leaving the lung in place. Much debate and research exists regarding these two methods of surgical resection.

Other forms of surgical treatment options include a pleurodesis where a sclerosing agent such as talc powder is injected into the chest to prevent further fluid accumulation. Surgery with hyperthermic chemotherapy is another option where heated chemotherapy agents are washed through the incision to eradicate remaining mesothelioma cells.

Chemotherapy and radiation are also frequently administered for mesothelioma patients. Most patients undergo chemotherapy using a combination of pemetrexed (Alimta) and carboplatin (Cisplatin). Onconase is another chemotherapy agent frequently used.

Beyond this, a thoracentesis or paracentesis may be performed to remove fluid build up around the cancerous region. Many clinical trials are in progress throughout the nation to study other avenues of treatment.

What are the available methods for controlling a pleural effusion?

Talc pleurodesis is a palliative, not curative, method of relieving symptoms caused by pleural effusion. In this surgical procedure, the space between the layer of tissue surrounding the lungs and lining the chest wall is eliminated by creating inflammation to join the tissues together. In this way, it does not allow any space for fluid build-up.

What is the difference between a talc pleurodesis and a chemical pleurodesis?

Chemical pleurodesis is only given during a radical surgery. Rather than using talc, a different chemical is used as the irritant to join the pleural tissues together.

What are the surgical options for treating mesothelioma?

Thoracoscopy with pleurodesis- a procedure using a thoracoscope to look inside the chest cavity. During this procedure, a pleurodesis may be performed to help alleviate chest pain and shortness of breath due to pleural effusion.

Pleurectomy/decortication (P/D) – a lung-sparing surgery which involves the removal of the membrane lining the thoracic wall and decortication of the membrane lining the lung. Part of the diaphragm and/or the pericardium may also be removed, depending on the extent of the tumor.

Extra-pleural pneumonectomy (EPP) – a surgery which removes one lung and part of the membrane lining the thoracic wall. It also removes the diaphragm and the pericardium.

What radiation therapy is available to mesothelioma patients?

Radiation is often used as an adjuvant therapy to kill any remaining cancer cells after surgery. It may also be used as the main therapy for patients who are not surgical candidates. There are three main types of radiation procedures for mesothelioma patients: Intensity Modulated Radiation Therapy (IMRT), Radiofrequency Catheter Ablation (RFA), and Interventional Radiology (IR).

IMRT uses very small beams to target a tumor from many angles. Radiation is generally delivered in treatments over four to eight weeks, and the amount of radiation depends on the size, location, and type of cancer as well as the patient’s general health and concurrent medical therapies he or she is receiving.

In contrast, RFA is a procedure in which a thin tube or needle is inserted through the skin to the site of the cancer. Hot chemotherapy agents are delivered through this catheter to target the affected area with minimal damage to the surrounding healthy structures.

Finally, in IR procedures, the treatment tools are inserted through a small nick in the skin, which generally does not require stitches or anesthesia. Radiation can be delivered as a surgical procedure called intra-operative catheter ablation. However, RFA and IR are generally less risky and patients can resume normal activities more quickly afterward.

What chemotherapies are available to mesothelioma patients?

The most common chemotherapy treatment uses Alimta with Cisplatin. Both are cytotoxic chemotherapy drugs which block the growth of tumors. This treatment is typically administered every three weeks in which Alimta is given by IV first, followed by Cisplatin thirty minutes later.

Should chemotherapy be administered before, during or after surgery?

Chemotherapy is not always used in conjunction with surgery. However, if it is used, it is generally administered after surgery.

Can survival rates be affected by additional therapy?

Surgery is often followed by radiation, chemotherapy, or both. Additional treatments are used to try to eliminate any microscopic fragments of cancer left behind by surgery.

FOR ADDITIONAL INFORMATION, PLEASE CONTACT:  AMY SRIBERG, EXECUTIVE DIRECTOR  PACIFIC HEART, LUNG & BLOOD INSTITUTE AT (310) 478-4678 OR ASRIBERG@PHLBI.ORG

Normally, cells grow and die naturally in a controlled way. However, cancer cells grow continuously without forming a mass (tumor). A benign mass does not usually spread (metastasize) and does not pose a threat. On the other hand, malignant cancer cells can metastasize and cause new tumors to grow throughout the body.

Chemotherapy is the general term for any cancer treatment involving the use of chemical agents to stop cancer cells from multiplying. A chemotherapy regimen (a treatment plan and schedule) usually includes specific drugs designed to kill cancer cells. These drugs may be administered through a vein (intravenously), injected into a body cavity (such as the pleural space) through a shunt or tube, or delivered orally in the form of a pill.

Because chemotherapy agents cannot distinguish between cancer cells and healthy cells, it destroys not only the fast-growing cancer cells but also other fast-growing cells in your body, including hair and blood cells. Additionally, vital organs such as the brain, kidneys, lungs, and liver may also be subject to the lethal components of chemotherapy, so it is important for your doctor to continuously monitor your body’s response to the treatment dosage. Doctors will often perform several tests before administering chemotherapy to ensure that patients are healthy enough to undergo the selected regimen.

Malignant mesothelioma has “slow-growing” cancer cells, called epithelial type, and “fast-growing” cancer cells, called sarcomatoid type. The biphasic cell type of mesothelioma has mixed characteristics of the epithelial and sarcomatoid type. As a result, different types of chemotherapy drugs target the growth patterns of these two types of mesothelioma.

Each chemotherapy drug works differently and are effective at a specific time in the life cycle of the cells it targets. Patients may get treatment every day, every week, or every month. Sometimes patients may have breaks between treatments so that their bodies have a chance to build new healthy cells. Your doctor will determine the chemotherapy drug that is right for you.

Is Chemotherapy Right For Me?

Every patient responds differently to chemotherapy for reasons not completely known. Sometimes mesothelioma patients may develop a resistance to a chemotherapy agent. Other times, if a tumor has already developed to a large extent, chemotherapy may not be able to sufficiently treat the tumor. For these reasons, mesothelioma patients often undergo several treatment options to combat their cancer, including surgery which can physically reduce tumor size and enables chemotherapy to be more effective. Patients should get second opinions from surgeons before undergoing chemotherapy as a first line of treatment.

When chemotherapy is used, it is often administered as a combination of two or more agents (protocols). Cancer cells use various pathways in order to multiply (replicate). A single agent can only impede one specific pathway that a cancer cell uses to replicate. This allows some cancer cells using different pathways to continue multiplying unimpeded. Combination treatment such as Alimta with Cisplatin work together to impede more cancer cells from multiplying.

Chemotherapy protocols have changed and continue to change quickly. Multimodality treatment employing surgery, with Gemcitabine (Gemzar) Cisplatinum, Carboplatinum and other chemotherapies are now being adapted to use monoclonal antibodies like Iressa and Tarceva as well as anti-angiogenesis drugs like bevacizumab and endostatin as well as new targeted drugs like deacetylase inhibitor SAHA, to attack the tumor from multiple directions at once. Drugs like Interferon, Thalidomide and Cox2 inhibitors like Celebrex are being tried in various combinations to boost the effectiveness of chemotherapies.

Side Effects

During chemotherapy patients may have no side effects or just a few. There are two broad categories of chemotherapy side effects. The first and most familiar category consists of side effects that you are aware of if they occur (often called “patient-felt toxicities”). Some common examples are fatigue, nausea, vomiting, pain, and hair loss.

There is another group of side effects, such as changes in your blood cells that you may not be aware of if they occur (often called “paper toxicities”). This second category of side effects will be monitored through laboratory tests and managed by your physician. The kind of side effects a patient may have depends on the type and dose of chemotherapy. Both types of side effects could be serious if not treated.

Though a few side effects can be permanent, many are temporary. Healthy cells usually recover after chemotherapy, so most side effects gradually go away after treatment is stopped.

ALIMTA

Treatment options for non-small cell lung cancer and mesothelioma differ depending upon type of cancer, stage, size, and location of the tumor. ALIMTA as a single-agent is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after prior chemotherapy.

ALIMTA, when given with Cisplatin, is the first and only chemotherapy drug to be approved by the Food and Drug Administration (FDA) for the treatment of patients with malignant pleural mesothelioma (MPM) when surgery is not an option. In the clinical studies for MPM, patients also received Cisplatin (a platinum agent), another widely used chemotherapy drug.

The arrival of Alimta, the first drug that showed a significant response in mesothelioma as a single agent is now being tested in clinical trials looking at combination therapies.

Ifosfamide

The ifosfamide chemotherapy drug, Ifex, has been used in to treat such cancers such as testicular cancers, sarcomas, lung cancer, and bladder cancer. Recently, it has shown promise in treating sarcomatoid mesothelioma, as well. Ifosfamide is a cell-cycle non-specific alkylating agent that inhibits the cellular division process of tumor cells, causing them to die. Ifosfamide may be able to better target sarcomatoid mesothelioma versus the FDA approved Alimta and Cisplatin combination that may be better geared towards epithelial mesothelioma.  Patients should discuss ifosfamide chemotherapy options with their treating physicians.

Treatment Info: Distributed by Bristol-Myers Squibb Company, Ifex is used in combination with a prophylactic agent called mesna to combat potential bladder damage.  Over a thirty minute time period, ifosfamide is given intravenously at a dose of 1.2 g/m² for five days. Treatment is given in three-week cycles. Ifosfamide may also be administered with doxorubicin, cisplatin, or other chemotherapy agents.  Side effects may include hair loss, nausea, poor appetite, and blood in the urine (hemorrhagic cystitis). Less common side effects are central neural toxicity, such as sleepiness, confusion, or hallucinations; and blood and fertility problems.

Cisplatin

Cisplatin is a chemotherapy drug distributed by Bristol-Myers Squibb as the brand name Platinol-AQ. It has been used to treat several types of cancers, including non-small lung cancer, and is one of the common choices for the chemotherapy treatment of malignant pleural mesothelioma. The drug is a cell cycle non-specific alkylating agent that attacks the DNA of tumor cells and inhibits the growth process, causing them to die.

Treatment Info: As a single agent, or in combination with other chemotherapy drugs, cisplatin is administered intravenously every three or four weeks. Dosage is determined on a case by case basis and can range from 20 mg/m2 per cycle to 100 mg/m2 per cycle usually calculated by bodily surface area.  Common side effects are nausea and kidney problems. More rarely, this drug may also damage hearing or cause allergic-type reactions.

Carboplatin

The chemotherapy drug, carboplatin (brand name Paraplatin) is distributed by Bristol-Myers Squibb. It has primarily been used to treat ovarian cancer but is used for other types of cancers as well. For mesothelioma patients who do not tolerate Cisplatin chemotherapy well, carboplatin may be substituted. Associated with lower toxicity levels, carboplatin is a metal salt alklating agent that damages tumor cell DNA and causes them to die.

Treatment Info: As a single agent, this drug may be administered intravenously at a dosage of 360 mg/m² on Day One of a four week cycle. Common side effects may include nausea, hair loss, taste changes, and weakness. Less commonly, patients may experience abdominal pain, diarrhea, mouth sores, numbness in the extremities, dizziness or confusion, kidney problems, hearing loss, or cardiovascular problems.

Pulmonary fibrosis (scarring in the lungs) caused by asbestos inhalation is more commonly referred to as asbestosis, a respiratory disease that causes chronic inflammation in the lungs. The word asbestos is derived from Greek and means “inextinguishable.” Extended inhalation of asbestos fibers can cause inflammation of the parenchymal tissue (the tissue characteristic of an organ, as distinguished from associated connective or supporting tissues) in the lungs. Chronic inflammation causes scar tissue to form inside the lung which inhibits the lungs from expanding and contracting normally, diminishing the ability to breathe.

Symptoms of Asbestosis:

• Dypsnea (Shortness of breath upon exertion)
• Dry (non-productive) cough
• Tightness in the chest
• Chest pain
• Nail abnormality
• Clubbing of the fingers
• Pleural plaques (calcification of the lungs)
• Pleural effusions (fluid accumulation in the lungs)

The severity of this disease may depend on the duration of asbestos exposure and the amount of asbestos inhaled.  A diagnosis of asbestosis does not mean you have cancer, however, asbestosis can become a serious or fatal health concern.  It can also lead to the development of other diseases such as lung cancer or malignant mesothelioma.

Causes of Asbestosis

When we inhale, air passes through our nose or mouth into our throat, though the larynx and into the trachea. The trachea is the main passageway into the lungs and splits into two branches called bronchi. One of the bronchi carries air into the left lung and the other carries air into the right lung.

Within the lungs, bronchi branch further into smaller and smaller airways until they eventually end in microscopic air sacs called alveoli.

Alveoli are made of thin, elastic walls that allow oxygen to flow into the bloodstream and remove carbon dioxide from the bloodstream to expel it from the body.

Sometimes we also inhale various microorganisms, dust, and other foreign materials, but usually these particles are trapped by microscopic hairs on the surface of our airways known as cilia. Cilia sweep particles into our upper airway where they are swallowed and digested or coughed out.

Occasionally unwanted particles do get into our lungs but our body has a series of built-in immune cells that destroy them. The immune cells in the alveoli are known as macrophages which ingest and destroy particles such as dust or chemicals.

However, asbestos fibers are more resistant to breakdown than dust particles. When asbestos fibers are inhaled into the lungs, macrophages leak a substance designed to destroy the particles. This process usually fails because asbestos fibers are too long and too durable. Instead, the leaked chemical causes the alveoli to become inflamed. Over an extended period of time, this inflammation causes scarring or fibrosis.

The scarring inhibits alveoli from exchanging oxygen and carbon dioxide which diminishes the capabilities of the lungs.

Treatment Options for asbestosis

Currently, no treatment exists to reverse the effects of asbestos in the lungs. Treatment for asbestosis includes draining fluid build-up and  administering aerosol medication to thin fluid secretions. In some cases oxygen masks may be helpful.

Preventing progression of the disease may be accomplished by eliminating exposure to carcinogens such as asbestos and by giving up smoking.  Smoking cessation may also prevent the heightened risk of lung cancer or emphysema that could further reduce lung capacity.

Patients with asbestosis should be mindful of other diseases that might impair lung capacity such as pneumonia. Treat the common cold or the flu promptly and have your doctor monitor your condition with X-rays and CT scans.

Prevention of asbestosis

Patients can take preventive measures by reducing their level of exposure to asbestos. Generally, many homes built before the 1970s contained asbestos products as insulation, decorative material, in paint, roofing, vinyl floor tiles, and in other products. Talk to a professional about removing asbestos materials if they are at risk of being disturbed such as in a remodeling project or if they are disintegrating. For more information into this area, contact PHLBI’s administrative office at (310) 478-4678 or info@phlbi.org

Radiation treatment is usually the last step in a tri-modal treatment approach for mesothelioma patients, and often follows surgery and chemotherapy. Full chest radiation destroys residual cancer cells that surgery and chemotherapy may be unable to eliminate.

Following the surgical removal of a lung in an extrapleural pneumonectomy (EPP) procedure, radiation has proven to be quite successful. Radiologists can readily administer the radiation without concern for damaging nearby organs because the lung has been removed.

Patients who have undergone the lung-sparing pleurectomy with decortication (P/D) procedure should take precaution in finding a radiologist. Because the lung is left intact, too much radiation can damage and complicate recovery. Work with your doctor to find an experienced radiologist who has treated other mesothelioma patients.

Intensity Modulated Radiation Therapy (IMRT)

Intensity modulated radiation therapy (IMRT) aims very small beams, or beamlets, at a tumor from many angles. IMRT delivers a high dose of radiation to the cancer while minimizing dosage to nearby sensitive organs. Each beam has a number of sub-beams or segments, and the intensity of each segment is varied according to the treatment plan.

During treatment, the radiation intensity of each beamlet is controlled, and the beam shape changes hundreds of times during each treatment. As a result, the radiation dose bends around important healthy tissues in a way that is impossible with other techniques. Because of the complexity of these motions, physicians use special high-speed computers, treatment-planning software, diagnostic imaging and patient-positioning devices to plan treatments and control the radiation dose during therapy.

For IMRT to be effective, the anatomical position of the tumor and surrounding healthy tissues must be accurately defined. Computed tomography (CT), positron emission tomography (PET) and magnetic resonance (MR) imaging provide the necessary three-dimensional anatomical information.

It’s also important to accurately position and immobilize the patient during treatment. This may be done with special head frames (if the head or brain is being treated), or with advanced imaging devices such as electronic portal imaging and scanning ultrasound, which provide daily information about the location of internal organs. Some organs, such as the prostate, move due to normal daily volume changes in the bladder and rectum. Gold seeds may be placed into the prostate to track prostate movement daily and ensure more precise targeting.

A device called a multileaf collimator adjusts the size and shape of the computer-determined radiation beams. The collimator, a computer-controlled mechanical device, consists of up to 120 individually adjusted metal leaves. These leaves move across the irradiated tissue while the beam is on, blocking out some areas and filtering others to vary the beam intensity and precisely distribute the radiation dosage.

Radiation oncologists usually administer a regimen of IMRT treatments over four to eight weeks. The total dose of radiation and the number of treatments given depend on the size, location, and type of cancer; the patient’s general health; and other medical therapy the patient is receiving.

Radiofrequency Catheter Ablation (RFA)

Ablation is a medical term that refers to any procedure performed to destroy diseased or damaged tissue in the body. Radiofrequency Catheter Ablation (RFA) is a technique in which a thin tube, or catheter, is inserted through the skin or threaded through the blood vessels to the site of disease. Extreme heat or cold, alcohol, chemotherapy drugs or other therapies are delivered through the catheter to the diseased tissue.

Specifically, RFA treats disease with heat, a technique preferred by many cancer experts because it can reliably destroy a small, targeted area of tissue without affecting healthy affecting structures beyond the treatment site. With RFA, the doctor can pinpoint target areas with accuracy while monitoring and controlling the temperature of heat therapy.

Interventional Radiology (IR)

Catheter ablation also can be performed by surgeons as a surgical procedure called intra-operative catheter ablation. There are a number of differences between surgical and interventional radiology (IR). IR treatment tools are usually inserted through a small nick in the skin. There are no surgical incisions, no stitches and no scars. General anesthesia is not needed for many IR procedures, and in most cases they are less painful and have fewer risks and complications than surgery.

Most conditions treated with IR can be done in an outpatient setting, or require hospitalization for only a brief time. Patients treated with IR can expect shorter hospital stays – and faster recoveries – than surgical patients. Many people resume normal activities within a few days after RFA or other IR procedures.