Center for Mesothelioma and Asbestos-Related Diseases - Medical Links - 1/1/2003 - Health Asbestos Asbestosis Mesothelioma Lung Cancer

Center for Mesothelioma and Asbestos-Related Diseases

The Thoracic Oncology Program at the University of Maryland Medical Center is one of the pioneering institutions nationally using a finely tuned multidisciplinary approach to the treatment of malignant mesothelioma and other asbestos-related diseases. With our multidisciplinary care program, patients have access to all of the team members in one visit. Treatment with medical, surgical and radiation oncologists is coordinated through one specialized nurse. Communication is maximized and patient stress and inconvenience is minimized. This "one-stop shopping" approach has been found to be the best way to tackle the complex care for this difficult disease.

Mesothelioma

Malignant mesothelioma, an uncommon form of cancer, is a disease in which cancer (malignant) cells are found in the sac lining the lung and chest cavity (the pleura), abdomen (the peritoneum) and the heart (the pericardium). A layer of specialized cells called mesothelial cells lines these cavities, forming tissue called mesothelium. Tumors of the meothelium can be benign (noncancerous) or malignant (cancerous). Most mesothelial tumors are cancerous; therefore, malignant mesothelioma is often simply called mesothelioma.

Pleural Mesothelioma

Pleural mesothelioma is a malignant mesothelioma that spreads within the chest cavity and sometimes involves the lung.

Asbestos exposure is the most common risk factor associated with mesothelioma. Asbestos refers to a family of magnesium-silicate mineral fibers that have been commonly used for insulation and in the shipbuilding and construction industries. A history of asbestos exposure is found in 80 percent of patients who present with mesothelioma. Other factors, which may promote mesothelioma, include: chronic lung infections, tuberculous pleuritis, radiation (Thorotrast) and exposure to the simian virus 40 (SV40) or mineral fibers (Zeolite). Although tobacco smoking has not been associated with the development of mesotheliomas, the combination of smoking and asbestos exposure greatly increases the risk of lung cancer.

• In the United States, 2,000-3,000 patients are diagnosed with malignant pleural mesothelioma each year.
• Mesothelioma affects men more frequently than women and is more common in white Americans.
• The median age of onset of symptoms is 70.
• Seven percent of workers exposed to asbestos become affected.
• The latent period between exposure to asbestos and the onset of symptoms can be 20-40 years.
• The median survival time is between 4-12 months, depending on the stage of presentation. The three-year survival is 10 percent and the overall five-year survival is approximately 5 percent.

The severity of the condition varies from person to person, but in most cases the onset of mesothelioma is usually very slow with the most common presenting symptom being persistent pain localized in the chest. Sometimes the pain is accompanied by severe difficulty in breathing or shortness of breath. Cough, weight loss, fever and night sweats are less common.

Testing

At the University of Maryland Medical Center, a thorough radiologic evaluation is performed to determine diagnosis. The evaluation is used to determine the stage of the tumor and to assist in the design of therapy. Testing may include: a chest X-ray, computed axial tomography (CAT Scan) of the chest and abdomen, and a MRI of the chest. A lung pleural biopsy will generally be necessary.

Treatment Options

The University of Maryland Thoracic Oncology Program has treatment plans that may include surgery, chemotherapy, radiation therapy or a combination of these treatments.

There are three options for treatment depending on severity of disease.

1. Tri-modality Therapy

The unique multidisciplinary approach offered at UMMS involves surgery, radiation therapy and chemotherapy. Although cure is not common in this disease this treatment approach has been successful in slowing the progression of the disease as well as in helping to relieve symptoms.

Current literature states that a single or bi-modality therapy for treatment has not proven successful in improving survival rates and most treatment attempts are usually unsuccessful in curing the disease.

For more information, please visit Lung Surgery for Cancer.
 

2. Chemotherapy Options

• A new drug therapy is being offered to malignant pleural mesothelioma patients at UMMS using an antifolate drug called Pemetrexed (brand name Alimta™). Research trials have reported that patients on this new chemotherapy drug regimen live longer and have less pain than those on an older drug. Pemetrexed is proving effective in targeting key enzymes thought to play a role in allowing the rapid growth of this type of cancer. Pemetrexed is being offered in combination with Gemzar on a Phase II study.

• UMMS is currently involved in a Phase II Study of Single Agent Thalidomide for Unresectable Malignant Pleural Mesothelioma. The principle objective for this study is to establish the activity of thalidomide in patients with mesothelioma, particularly the group of patients not amenable or who already failed to other treatments, e.g. surgery, radiation and chemotherapy.

3. Radiation Therapy

Radiation therapy directed to the area involved may alleviate some pain associated with malignant mesothelioma.

For more information, please visit Chemotherapy and Radiation Therapy.

For more information about the Thoracic Surgery Division, or to make an appointment, call the University Physicians Consultation and Referral Service at: 1-800-492-5538 (patients) or 1-800-373-4111 (physicians).