Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Complex interactions between carcinogens and the host genome may explain why only some develop cancer after exposure to a known carcinogen. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly being recognized as important.

Genetic abnormalities found in cancer typically affect two general classes of genes. Cancer-promoting oncogenes are often activated in cancer cells, giving those cells new properties, such as hyperactive growth and division, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in diverse tissue environments. Tumor suppressor genes are often inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate DNA replication, control over the cell cycle, orientation and adhesion within tissues, and interaction with protective cells of the immune system.

Cancer is usually classified according to the tissue from which the cancerous cells originate, as well as the normal cell type they most resemble. These are location and histology, respectively. A definitive diagnosis usually requires the histologic examination of a tissue biopsy specimen by a pathologist, although the initial indication of malignancy can be symptoms or radiographic imaging abnormalities. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. The prognosis of cancer patients is most influenced by the type of cancer, as well as the stage, or extent of the disease. In addition, histologic grading and the presence of specific molecular markers can also be useful in establishing prognosis, as well as in determining individual treatments.

 

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• How is mesothelioma staged?

  Staging is the process of finding out how far the cancer has spread. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. The treatment and outlook for patients with mesothelioma largely depends on the stage (extent of spread) of their cancer. Since pleural mesothelioma occurs most frequently and has been studied the most, it is the only mesothelioma for which a staging classification exists.

  The staging system most often used for mesothelioma is the Butchart system. This system is based mainly on the extent of the primary tumor mass, and divides mesotheliomas into stages I through IV.

  Butchart Staging System

  
  
• Stage I: Mesothelioma is present within the right or left pleura, and may also involve the lung, pericardium, or diaphragm (the muscle separating the chest from the abdomen) on the same side.
• Stage II: Mesothelioma invades the chest wall or involves the esophagus (food passage connecting the throat to the stomach), heart, or pleura on both sides. The lymph nodes in the chest may also be involved.
• Stage III: Mesothelioma has penetrated through the diaphragm into the peritoneum (lining of the abdominal cavity). Lymph nodes beyond those in the chest may also be involved.
• Stage IV: There is evidence of distant metastases (spread through the bloodstream to other organs).

Another staging system has recently been developed by the American Joint Committee on Cancer (AJCC). This is a TNM system, similar to staging systems used for most other cancers. T stands for tumor (its size and how far it has spread to nearby organs), N stands for spread to lymph nodes and M is for metastasis (spread to distant organs). In TNM staging, information about the tumor, lymph nodes, and metastasis is combined in a process called stage grouping to assign a stage described by Roman numerals from I to IV. Minor differences exist between the AJCC TNM staging system and the Butchart staging system.

TNM Staging System

• Stage I: Mesothelioma involves the right or left pleura. It may also have spread into the lung, pericardium, or diaphragm on the same side. It has not yet spread to the lymph nodes.
• Stage II: Mesothelioma has spread from the pleura on one side to the nearby peribronchial and/or hilar lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.
• Stage III: Mesothelioma has spread into the chest wall muscle, ribs, heart, esophagus, or other organs in the chest on the same side as the primary tumor, with or without spread to subcarinal and/or mediastinal lymph nodes on the same side as the main tumor. Subcarinal nodes are located at the point where the windpipe branches to the left and right lungs. Mediastinal lymph nodes are located in the space behind the chest bone in front of the heart. Mesotheliomas with the same extent of local spread as in stage II that have also spread to subcarinal and/or mediastinal lymph nodes on the same side are also included in stage III.
• Stage IV: Mesothelioma has spread into the lymph nodes in the chest on the side opposite that of the primary tumor, or directly extends to the pleura or lung on the opposite side, or directly extends into the peritoneum, or directly extends into organs in the abdominal cavity or neck. Any mesothelioma with evidence of distant metastases (spread to other organs through the bloodstream) or spread to organs beyond the chest or abdomen is included in this stage.

Although the recently developed TNM classification is the most detailed and precise, the original Butchart staging system is still used most often to describe the spread of pleural mesotheliomas. Understanding these staging systems for mesothelioma is important both for estimating and better understanding prognosis, and also for assessing therapeutic options.

Prognostic Factors

Because pleural mesothelioma has been better studied than peritoneal mesothelioma we know more about factors associated with prognosis for pleural mesothelioma. Younger age at diagnosis, performance status (functional status) and absence of weight loss are associated with a more favorable prognosis.

Mesotheliomas are usually of three different cell types (histological analysis): 1) epithelial cell type - has the most favorable prognosis; 2) fibrosarcomatous cell type - carries the worst prognosis and 3) mixed cell type - has an intermediate prognosis.

Malignant Mesothelioma

Malignant mesothelioma is an uncommon form of cancer and of all asbestos related diseases, the most serious. The symptoms associated with the disease make it difficult for doctors to diagnose. Often, by the time that a proper diagnosis is made, the disease has progressed to a point where patients do not respond well to treatment therapy. Malignant mesothelioma is caused almost exclusively by the inhalation of airborne asbestos particles. Another unique factor associated with the disease is that there can be a long latency period between the time an individual is exposed to asbestos and the actual manifestation of the disease in the form of malignant mesothelioma.

Pleural Mesothelioma – affects the chest and lungs

Malignant pleural mesothelioma often originates within the chest cavity and can, at times, involve the lung. This particular form of mesothelioma can metastasize to numerous organs in the body – even the brain - and tends to do so more frequently than not.

Pleural mesothelioma is not always easily detectable. Frequently, in the early stages of the disease, symptoms may be mild. Patients usually report pain in one area of the chest that never seems to go away, weight loss and fever. Occasionally, other symptoms are more severe and include problems with breathing due to fluid build up in the chest. A CT Scan of the chest area has proven to be the best test for identifying how far along the disease has progressed.

Frequently serum markers are used to diagnose of various forms of cancer. Mesothelioma cannot be diagnosed using this method as no serum markers currently exist. If high levels of hyaluronic acid are present it may be possible to distinguish mesothelioma from other types of cancer or to determine the effectiveness of a treatment protocol.

The survival rate for patients diagnosed with pleural mesothelioma typically is not high. Patients typically do not live beyond seventeen months from the onset of symptoms. Only 8% of those diagnosed with mesothelioma will live three to five years from the onset of symptoms.

Peritoneal Mesothelioma – affects the abdomen

Peritoneal mesothelioma originates in the abdomen and will frequently spread to other organs in area including the liver, spleen or bowel. Severe abdominal pain is the most common complaint that patients present to their doctor. There may also be a discomfort level with fluid build up in the abdomen as well. Other symptoms of peritoneal mesothelioma may include difficult bowel movements, nausea and vomiting, fever and swollen feet.

The survival rate is even worse for those diagnosed with peritoneal mesothelioma will patients typically surviving only ten months from time that they first started experiencing the symptoms noted above.

Pericardial Mesothelioma – affects the heart

Pericardial mesothelioma is the least common form of mesothelioma. Pericardial mesothelioma, as the name suggests, involves the heart. This rare type of mesothelioma invades the pericardium, the sac that surrounds the heart. As the cancer progresses, the heart is not able to deliver oxygen as efficiently to the body causing further decline in health at an increasingly rapid rate. The symptoms most commonly associated with pericardial mesothelioma mimic those of a heart attack: nausea, pain in the chest and shortness of breath.

Benign Mesothelioma – affects the peritoneum

Cystic mesothelioma primarily affects women of younger age and affects the peritoneum. This type of mesothelioma is not frequently diagnosed and is also not a malignant form of the disease. It is, however, extremely difficult to identify and requires specialized microscopes and immunologic techniques to aid in diagnosis.

Who has the right to file for compensation for mesothelioma?

A mesothelioma lawsuit can be filed by a person who has developed mesothelioma through exposure to asbestos. In the event that the person has passed away, the lawsuit can be filed by a family member or the executor of the deceased’s estate. A lawsuit can also be filed by a family member who has developed the disease through close contact with the person who was exposed to asbestos.

How long does the process take?

The process can take quite a while, although there is no set time and some lawyers will get your case sorted faster than others. The more research that is required to put a solid case together, the longer it will take.

How long do I have to file my claim?

This differs from state to state but generally the time limit is one to two years from diagnosis. It is important that you check on the time limitation for your state and act within the limitations otherwise you may not be eligible to claim. If you are claiming on behalf of the deceased, time limitations still apply and it is probably even more important to act quickly because of the time limits and the research required by the lawyer.

What if I don’t know where and when I was exposed to asbestos?

It is helpful if you know this and will certainly speed up the process, but if you don’t remember the lawyer will be able to help. A private investigator can be hired through the lawyer (paid for by the lawyer) who will do the necessary research to clarify when and where the exposure took place and which company or companies are responsible.

How can I afford legal assistance?

You won’t need to worry about having cash up front because mesothelioma lawyers usually work on a no win no fee basis. You will not have to pay a penny unless you receive compensation, and then the lawyer will take a percentage of the compensation as his fee.

How much will I get?

It’s impossible to say how much you will get as it depends on the merits of your case. Your lawyer will discuss this with you in more detail when you go through the details of your claim, but past settlements have notched up hundred of thousands of dollars and even multi-million dollar payouts.

Where can I find a mesothelioma lawyer?

There are now many mesothelioma lawyers and you should have no problem finding one. The Internet is a good place to start your search, as many mesothelioma lawyers advertise there. You can check out many credentials and assess the experience of individual law firms by searching on the Internet. However, try to find a lawyer that has experience of working with mesothelioma lawsuits as they will already have a network of resources and contact that could help to process your case more quickly.

Will the lawsuit be filed in the state where I live?

Not necessarily. Your lawyer will select the state in which you have the best chance of success and where you are likely to get the highest compensation. This will make no difference to you as you will not have to pay any extra and may end up getting far more compensation in another state.

Will my case go to court?

Again, it is impossible to say until your lawyer has tried to settle out of court. However, most mesothelioma cases are settled out of court and this saves both sides money because taking the case to court can get costly.

Mesothelioma is one of the deadliest diseases known to man; the average life span of an inflicted person from the time of diagnosis until death is less than 24 months. It’s a disease that strikes approximately 3,000 United States citizens each and every year; hard working people who have labored for a lifetime to provide for their families, doing the work that keeps this country running and a great place to live. They worked in factories, at shipyards, in mines, for the US military, as engineers, as pipefitters, as steel workers, as auto mechanics, and in so many other professions. They came home to their loved ones exhausted and covered in dirt and dust; tired, but content that they had a job and were providing for their family. Content that they were putting food on the table and a house over their loved one’s heads. Content that they were working to make a better life for their families in this generation and the next...

But what they didn’t know was that while they were working so hard, they were not only slowly killing themselves, but those that they were working so hard to help; their family, their loved ones.

Mesothelioma is a disease that is almost 100% preventable; the only known cause is via exposure to the deadly mineral Asbestos. It comes from inhaling the particles of dust as the asbestos degrades; eating away at the lining of your lungs and developing into a deadly cancer. Dust that was inhaled in clouds of white powder, dust that was carried home on the clothes of the men who built this country, dust that was cleaned from the clothes by the wives and children who supported their sole provider at home, dust that was packed around the heating systems in houses and offices and schools, dust that carried a deadly price; and dust made a fortune in blood money for the companies that produced it.