Epithelial Mesothelioma – Clinical Presentation and Diagnosis

Epithelial (or epithelioid) mesothelioma is the most common histological type of mesothelioma.  Epithelial mesothelioma is a subtype – both pleural and peritoneal mesothelioma may be epithelial or sarcamatoid or biphasic (including both cell types.)

Epithelial mesothelioma has a better prognosis than other subtypes.  Average life expectancy after diagnosis is longer.

As with all types of mesothelioma, asbestos is the cause.  Most people who get it are men past age 50, although it does occur in younger people and in women.  This is largely because the illness typically does not manifest until decades after initial asbestos exposure.  A significant percentage of patients diagnosed at relatively younger age have experienced asbestos exposure during their childhood.  Approximately 70 to 80 percent of mesothelioma cases involve a male patient. This is due to the fact that men are more likely to be employed at jobs that have a heightened risk for asbestos exposure. Common industries linked to asbestos inhalation include construction, auto repair, shipbuilding and naval employment.


October 17th Marks Beginning of National Radon Awareness Week

Radon is the second-leading cause of lung cancer. In an effort to raise awareness about the hazards of radon, the Environmental Protection Agency (EPA) has designated October 17th through October 24th as National Radon Awareness Week.

According to James Gelina, President of the Air Quality Control Agency, “Radon is an odorless, colorless, tasteless gas formed from the natural breakdown of uranium in soil, rock and water.” Though airborne levels of radon are typically diluted enough to not be harmful, high levels can congregate indoors. For those living in houses that reside in areas of high radon soil levels, this inhalation may eventually lead to lung cancer.

It is estimated that radon is responsible for 2.4 million global lung cancer deaths each year. In the United States, the dangerous gas is estimated to cause 15,000 to 22,000 lung cancer deaths annually.

Alarmingly, homes with excessively high levels of radon have been identified in virtually every county in the United States. In states such as Kansas, as many as one in four homes may have hazardous levels of radon. As a result of this, the EPA suggests that all homeowners have their homes checked for elevated radon levels. National Radon Awareness Week is a great time to schedule this important safety procedure.

Presently, the EPA recommends actions be taken to reduce radon concentrations if tested levels exceed four picocuries per liter of air (4 pCi/L). However, exposure levels as low as 2 pCi/L may be concentrated enough to cause health problems.

Radon testing is not expensive or time-consuming. Additionally, if excessive amounts of radon are found, solutions for mitigating the problem are fairly inexpensive. To learn more about scheduling a radon inspection and the dangers of this odorless gas, homeowners are urged to call 1-800-NO-RADON.





Altered Versions of DNA Could Serve as Biomarker for Cancer

In the past few years, new technologies and techniques have become available that allow researchers to quickly sequence large strands of DNA at a fairly affordable cost. Recently, this breakthrough has allowed researchers at Johns Hopkins University to look at DNA mutations as a possible biomarker for cancer.

As cancer cells grow and divide, they shed small fragments of mutated DNA into the circulatory system. The team at Johns Hopkins – led by Dr. Bert Vogelstein and Kenneth W. Kinzler – hypothesized that these DNA mutations could be sequenced and identified as a possible early indicator of cancer.

The process proved time-consuming, as a broad number of DNA mutations are unique in cancer cells. As such, knowing which specific mutation would serve as the best biomarker for cancer served as a major hurdle to the team.

Despite this, the researchers at Johns Hopkins have announced the formation of a lab technique that successfully identifies DNA rearrangements caused by cancer mutation. The process works by quickly sequencing DNA fragments in the blood stream.

Though very promising, a major drawback to the process is cost. Due to the need to sequence a patient’s entire genome, the estimated price tag of testing a single patient is $5,000.

According to the team’s research, which was published in the March issue of Nature, mitochondrial DNA rearrangements may serve as more cost-effective biomarkers for cancer. The reason for this is twofold. For one, mitochondrial DNA is incredibly small compared to a cell’s main strand of DNA, with just 16,000 genome units (a cell’s nucleus has three billion genome units). For two, mitochondrial DNA mutations occur in approximately 80 percent of all cancers, making the new technique a near universal option for future cancer diagnosis.

Even with these potential cost savings, fees associated with DNA sequencing will need to drop further in order to be feasible for widespread use. Still, given the strong sensitivity of the procedure, many are hopeful for the future of DNA as a cancer biomarker. According to Dr. Vogelstein, “There is no question from a research point of view that this approach has the potential to track patients and tumors better than with the conventional approach.”



10 Years in, Human Genome Mapping Yields No ‘Major Breakthroughs’

Ten years ago, scientists completed the first draft of the human genome project – a highly publicized effort that was supposed to lead to significant breakthroughs in our understanding – and subsequent treatment – of cancer. However, after a decade of study, many scientists are expressing their disappointment in the level of payoff earned from the expensive and time-consuming genome project.

Of course, that’s not to say that mapping the human genome has not been helpful. For example researchers now know that about 21,000 genes make up the human genome responsible for coding our cells and tissues. Previously, it was thought that as many as 100,000 genes could contribute to this portion of our genetic makeup. Additionally, many of these genes have been identified as contributors to cancer development.

Still, according to Robert Weinberg, co-founder of the Whitehead Institute for Biomedical Research in Cambridge, Massachusetts, no “major breakthroughs” have yet been gleaned from human genome mapping.

While there is no doubt that human genome mapping has been helpful, Weinberg suggests that the exorbitant amount of time and money spent on coding our genome could have been better spent on more traditional research efforts – “The question is how much bang we’ve gotten for the buck, and from certain perspectives it’s been modest.”

It is estimated that the National Human Genome Research Institute in Bethesda, Maryland receives $500 million in annual funding.

However, not all researchers are as quick to abandon the benefits of genome mapping. According to Francis Collins, director of the National Institutes of Health, “The promise of a revolution in human health remains quite real…those who somehow expected dramatic results overnight may be disappointed.”

From its outset, the human genome mapping project was meant to identify key targets within the human body for cancer treatment. By identifying pertinent genes within our system that affect the growth and spread of cancer, it is believed that effective cancer treatments can be produced.

Many new and viable paths for cancer treatment have already been identified thanks to the genome mapping project. However, techniques that target these identified genes have yet to reveal any major breakthroughs in treatment.




Everything related to cancer is stressful

Coping with the side effects of cancer treatment, for instance hair loss, tiredness (fatigue), changes in weight, along with how disrupted your life may appear – all contribute to the stress. Everything related to cancer can be stressful. It is normal to be worried and upset about it, and as such some amount of distress is naturally expected when you come to know that you have cancer. However, sometime the normal distress levels can increase to the extent that they start creating problems with your treatment, make it difficult for you to cope up with the disease, and affect most other aspects of your life.

You should not consider yourself as weak in case you become highly distressed and are not able to perform even normal activities. Here, we shall try to describe the various distress levels, ranging from the normal to high levels. We will then offer you specific ideas on how to manage your feelings so that they may help you cope in a better manner.

To cope with distress, you first need to have a doctor and health care team with whom you feel safe and are comfortable with. You need to talk to them about your feelings. Usually, they can guide you to the help that you may require. Keep in mind that they are treating YOU, and not just the cancer, and they expect that you will keep them informed about your experiences and feelings. Understand that only you can do that.

Although most of the information provided here may appear to be meant for cancer patients, it can also be useful for the partner and family members of the person with cancer. Loved ones are an important source of support, and it is necessary to care about their well-being as well. In case you are a partner or family member who is feeling distressed, you can freely inform the health care team that you require their help with your distress.

Is Cancer Coverage Too Optimistic?

Newspaper and magazine stories related to cancer are biased towards optimism, according to a research study conducted at the University of Pennsylvania.

The study, which was reported in the March 22 issue of Archives of Internal Medicine, involved the review of 436 cancer-related stories that were published in national magazines and large-scale newspapers from 2005 to 2007 (these articles were randomly selected from a larger pool of 2,228 articles).

Based on these sample articles, it was found that pronounced focus was given to aggressive cancer treatments and overall cancer survival. Subjects that were found to be under-reported include cancer death, failure of treatments, adverse affects of treatments and end-of-life palliative care.

Specifically, it was concluded that 32 percent of articles reviewed focused on the topic of cancer survival, while only 7.8 percent focused on the topic of death and dying. Additionally, only 13 percent of all articles reviewed reported that “aggressive cancer treatments can fail.”

As suggested by Jessica Fishman, a lead author of the paper, “It is surprising that few articles discuss death and dying considering that half of all patients diagnosed as having cancer will not survive,” Fishman adds, “The findings are also surprising given that scientists, media critics and the lay public repeatedly criticize the news for focusing on death.”

Of the articles, 35 percent were found to deal with the topic of breast cancer. Another 15 percent of the articles dealt with the specialized topic of prostate cancer. Roughly 20 percent of all articles tackled cancer from a general perspective, with no specific type of cancer chosen for focus.




Exercise for the cancer patient

Exercise is not only safe for most people receiving cancer treatment, but it may also allow you to feel a lot better. It has been noticed that moderate exercise helps with a variety of problems including anxiety, fatigue, heart and blood vessel fitness and muscle strength. Most cancer patients can do some kind of exercise. For instance, walking is supposedly a good way to make the right start and keep moving when you may be experiencing stress. Before you start, it would help if you discuss your exercise plans with your doctor. Based on your existing fitness levels, you may require help from a physical therapist in order to initiate an exercise program that may be useful for you.

Always remember that even when exercise may prove useful towards reducing distress levels in some individuals, it alone may not be enough for people experiencing moderate to severe distress.

How to know whether your stress levels are normal or more severe

It is difficult to answer this question because a certain amount of stress is “normal” (expected) when you are diagnosed with cancer. But specific signs and symptoms may serve as warning signals that your distress levels have exceeded normal levels and are becoming serious. These include:

  1. Feeling extremely overwhelmed, similar to a panic state
  2. Being inundated with a sense of dread
  3. Experiencing so much sadness that you think it is impossible to undergo treatment
  4. Feeling extraordinarily angry and irritable
  5. Feeling powerless to cope with fatigue, pain and nausea
  6. Fuzzy thinking, poor concentration and unexpected memory problems
  7. Finding it difficult to make decisions even about little things
  8. Experiencing despair and hopelessness – thinking what’s the point in continuing?
  9. Thinking all the time about the cancer and/or death
  10. Problems such as difficulty in sleeping or waking early (getting less than 4 hours of sleep)
  11. Loss of appetite (reduced appetite or no appetite) for some weeks
  12. Family problems and conflicts that appear impossible to resolve
  13. Rethinking your religious beliefs and faith that may have comforted you earlier
  14. Feeling useless and worthless

At times, certain incidents from the past can contribute to the distress levels being experienced by you and your family. It may require you to get help more urgently. Here are some examples:

  1. Death of a relative who have had cancer
  2. A critical illness or death of one of your loved one
  3. A history of depression or suicidal thought and tendencies
  4. Painful memories from the past that keep coming back as panic attacks or nightmares

In case any of these experiences apply to you or a member of the family, talk to your nurse or doctor. You or the member of the family may require help to deal with the distress.

Nowadays, doctors, nurses and other health care professionals are well aware that emotional distress is a part of cancer, and that it must be treated alongside the physical signs and symptoms of cancer. Most of the renowned cancer treatment centers have started asking each and every patient about their distress.

Colorado Man Indicted for Posing as Asbestos Inspector

A Colorado man accused of impersonating a licensed asbestos technician has been indicted for setting off an emergency asbestos incident.  A grand jury voted to indict Michael Merit of Parker, Colorado, after he took on a job from a local firm in charge of demolishing trailer homes in the nearby town of Elizabeth.  Resource Center, the company that hired Mr. Merit, was led to believe that he had a state license to inspect structures for asbestos and could conduct air quality tests and other asbestos testing on the homes targeted for demolition.

According to the indictment, Mr. Merit carried out asbestos tests on the mobile homes from November 2007 until January 2008.  Instead of using proper techniques to implement the tests, Mr. Merit allegedly used bogus testing methods and provided false lab reports stating that no asbestos was present in the targeted structures.  The indictment also stated that he signed documents allowing Resource Center to demolish the homes and sent the false reports to the state Department of Public Health and Environment.

In Colorado, as with most other states, demolition firms are not allowed to raze an older structure without a certified asbestos inspection.  The measure, which is also enforced at the federal level by the US environmental Protection Agency, is in place to prevent the dangerous dust from becoming airborne and affecting demolition workers.  Workers who handle asbestos must use special breathing masks and wear protective coveralls to prevent them from inhaling the fibers and contracting serious respiratory disorders.

The state health department authorized the demolitions based on the fraudulent documentation.  After the company leveled three of the houses, a neighbor notified the state about the potential presence of asbestos in the demolished structures.  State officials ordered a halt to the demolitions and declared an asbestos emergency.  When state investigators arrived at the site, they determined that the debris from the demolished mobile homes contained over 160 square feet of asbestos-laced materials.

Inspectors determined that the circumstances merited an environmental emergency due to the “sudden discharge of a hazardous substance”.  Air quality tests revealed high levels of asbestos in and around the debris.  Since the company did not know about the asbestos, they did not exercise the required precautions, such as wetting down the debris to prevent hazardous fibers from becoming airborne, nor did they use waste receptacles specifically designed to contain asbestos dust.

The state health department, the Environmental Crime Task Force and the state prosecutor’s office conducted the subsequent criminal investigation into Mr. Merit’s alleged fraud.  Prosecutors have yet to set a trial date for Mr. Merit and have not announced any criminal charges against Resource Center.  The health department and the environmental agencies are reviewing the case to determine if the company knowingly violated any rules or if they were unwitting victims.

Many older structures, including trailer homes, contain asbestos as part of wall insulation, ceiling tiles and carpet backing.  When asbestos fibers become airborne, the thin slivers can work their way into the lungs.  The most serious disease associated with asbestos exposure is mesothelioma, a form of cancer that targets the fluid lining around the lungs.  Patients with malignant mesothelioma typically live less than a year.






A certain amount of distress is normal

If you or one of your loved one has cancer, it is normal to experience some amount of distress. To some extent, cancer-related distress is because of the fears and attitudes people generally have about cancer. For instance, one of the greatest fears people have is that a cancer diagnosis implies death. But it is wrong to make misleading assumptions that cancer always results in the death of the patient. Currently, around 11 million Americans who were earlier diagnosed with cancer are alive.

The word “distress” has several different meanings. Here, this word will be used to describe unpleasant emotions and feelings that may create problems for you while you are trying to manage your cancer and its treatment. Family members and friends of cancer patients are also likely to experience distress. It is often difficult to cope with the variety of changes occurring in your life as a result of cancer in a loved one.

If you are distressed, it may imply that you feel:

  1. Hopeless
  2. Sad
  3. Afraid
  4. Powerless
  5. Anxious
  6. Guilty
  7. Discouraged
  8. Panicky
  9. Uncertain
  10. Depressed

The stress you experience while trying to cope with cancer can affect other areas of your life as well, apart from your feelings. Its effects may be noticeable on your thoughts, your actions and behavior and your interactions with other people.

It is normal for people to feel disturbed when they come to know that they have cancer – irrespective of the significant advancements made in cancer treatment. All of a sudden, many different aspects of life start to appear vague and uncertain. People with cancer are afraid and concerned about the potential changes that may happen in their body. They may be concerned about how their family members and friends will deal with their cancer and all the unexpected or unpleasant things they may experience. More often, people with cancer are worried about the future. They often wonder, “Why me?” and “Will I die?”

Once you know that you or one of your family members has cancer, you may not feel safe any longer. You may feel vulnerable, exposed, weak, and afraid. These feelings normally last throughout the duration of the treatment and may be accompanied by sadness and anxiety.

It is quite normal to be worried while you are waiting to receive the first treatment. “It was one of the worst times for me when I was waiting to be administered my first chemo treatment,” said a cancer patient. “However, I felt okay when the treatment was over because it was not as bad as I had thought it would be. I started feeling better because I was finally taking appropriate steps to fight cancer.” Waiting for cancer surgery can also be an unpleasant experience. Often, people not only worry about the cancer, but also about whether their cancer is constantly growing as they wait for the surgery. Your fears related to the potential changes that can occur in your body as a result of surgery can also contribute significantly to your distress. Also, you may be concerned about home and work life and how they may change due to the cancer. Financial and insurance issues may also add to your concerns.

For some patients, their most difficult time comes after their cancer treatment. Instead of feeling happy about the fact that treatment is finally over, they start feeling even more distressed. As one patient said, “Now I am on my own, and I am simply trying to make out what might happen next.” It can be quite scary to visit the oncologist (cancer doctor) when the treatment is over. Almost everyone seems afraid that their cancer will come back (recur). Feelings like this are normal, too. “Each time I experience aches and pains, I feel as if the cancer is coming back – even when it is just some random pain in my big toe,” said one patient.