Mesothelioma
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Mesothelioma is a rare form of cancer almost always caused by exposure to asbestos dust.
You need not have worked with asbestos in order to develop the disease as it can be caused by only small amounts of exposure. It is not uncommon for people to have been diagnosed with mesothelioma who have lived near asbestos factories or who have washed their husband’s clothing.
The risk of developing the disease increases depending on how much asbestos dust you have breathed in, the more you have breathed in the more at risk you are of developing the disease.
Mesothelioma affects the linings of the chest wall (pleural mesothelioma) or the lining of the stomach or abdomen (peritoneal mesothelioma).
It is difficult to diagnose and quite often a biopsy needs to be carried out to diagnose mesothelioma.
Unlike lung cancer there is no known connection between cigarette smoking and the development of mesothelioma.
The development of the disease can take between 10 – 40+ years after exposure to asbestos dust.
The courts have adopted a special procedure to deal with mesothelioma cases, which means your case will be dealt with a lot quicker.
Diagnosing Mesothelioma
Mesothelioma is very difficult to diagnose, sometimes it can take months to actually diagnose. The first step is usually to drain the build up of fluid between the two layers of the pleura surrounding the lung. (Pleural effusion).
The fluid is then tested, this is known as cytology, although this alone does not usually diagnose mesothelioma.
This is usually then followed by a biopsy, either a CT guided needle biopsy, a video assisted thoracoscopic or an open biopsy where a surgeon opens the chest cavity. Radiotherapy is sometimes used around the site of the biopsy to prevent the tumour spreading.
A biopsy involves removing some of the tissue from the pleura and analysing it using special tests.
Sometimes more than one biopsy needs to be done in order to diagnose mesothelioma.
Mesothelioma – Symptoms
Pleural Mesothelioma
The very early stages of mesothelioma generally do not cause many symptoms.
Once symptoms do start they usually are:-
- Breathlessness
- A persistant cough
- Weight loss
- Pains in the lower back or the side of the chest. The pains are casued by a build up of fluid between the two layers of the pleura surrounding the lung. This is known as a pleural effusion.
These symptoms are all more likely to be caused by some other illness, rather than by mesothelioma. If you have these symptoms, see your doctor. This is particularly important if you have been exposed to asbestos in the past.
Peritoneal mesothelioma
Again the very early stages of mesothelioma generally do not cause many symptoms.
Once symptoms do start they usually are:-
- Pain in the abdomen (tummy)
- Swelling in the abdomen resulting from the accumulation of fluid (Ascites).
- Feeling or being sick
- Poor appetite
- Weight loss
- Diarrhoea or constipation
Again these symptoms are all more likely to be caused by some other illness, rather than by mesothelioma. If you have these symptoms, see your doctor. This is particularly important if you have been exposed to asbestos in the past.
Treatments
Alimta
Alimta is a type of chemotherapy for the treatment of patients with mesothelioma. Alimta is given with cisplatin, another anti-cancer medicine (chemotherapy).
In a dramatic turnaround the National Institute for Clinical Excellence (NICE) has allowed the NHS to administer Alimta to mesothelioma patients. Originally NICE ruled that there was not enough evidence that Alimta was better than cheaper treatments.
Alimta, also known by the generic name (pemetrexed) is not a cure for mesothelioma, however clinical trials have shown it is associated with an increased survival for mesothelioma patients.
Alimta works by blocking certain enzymes that play a part in the rapid production of cancer cells.
Alimta is administered intravenously (IV) every 21 days. This procedure takes about 10 minutes. About 30 minutes after the Alimta is given, cisplatin is infused slowly for approximately 2 hours.
Before receiving Alimta, it is imprtant to tell your doctor if you are allergic to any drugs, or if you have kidney or liver disease, a weak immune system, or excess fluid in the space around your lung, liver, or other internal organs.
To protect your stomach, blood cells, bone marrow and avoid the unwanted side effects of treatment without reducing its effectiveness folic acid and Vitamin B12 (also known as cyanocobalamin) are prescribed before treatment with Alimta begins and are continued throughout treatment.
Vitamin B12 is given as an injection into a muscle, usually a week before the first treatment and then after every third treatment with Alimta (this may very slightly).
Folic acid is usually taken as a tablet. It is usually started a few days before the first treatment begins and then taken every day until three weeks after treatment with Alimta.
Common side effects of Alimta are lowered resistance to infection, bruising or bleeding, anaemia, tiredness and feeling weak, mouth sores and ulcers, nausea and vomiting, loss of appetite, diarrhoea and skin changes.
Dr Jonathan Lieberman
Coramsine
Coramsine is the latest drug to currently be undergoing extensive clinical trials as a treatment for various cancers including mesothelioma by Perth biotech Solbec Pharmaceuticals.
Derived from Devil’s Apple (Solanum linnaeanum), a native Australian plant, Coramsine is composed of two agents, glycoalkaloids solasonine and solamargine. These agents work together as active cancer fighters. These agents bind to a cancer cell’s receptors located on the cell membrane and gain access into the cell. They then rupture the cellular functions eventually causing it to burst.
The drug is currently in the middle stages of clinical trials.
When Coramsine is used in combination with CpG, an immune triggering compound, Coramsine killed cancer cells and increased the ability of the body’s immune system in rejecting cancerous growths.
In a study known as ‘The Mouse that Wouldn’t Die’ a mouse was infected with mesothelioma and was treated with Coramsine and CpG. The mouse not only overcame the mesothelioma but also managed to develop a resistance to it.
The company is preparing to conduct human trials of the combination therapy.
Dr Jonathan Lieberman
Vinflunine
‘Vinflunine’ (pronounced VIN-floo-neen) has been created by hospitals in Europe in order to treat mesothelioma.
Although not a cure of mesothelioma, research has shown that patients who have been treated with the new drug have produced higher survival rates. In England and France 67 patients were tested with the drug. These patients had not received chemotherapy or radiation and showed that the drug had improved the patients’ response rates by 13.8 percent.
The results mean further evaluation will be made into Vinflunine in the future.
Dr Jonathan Lieberman