A recent article published by the International Journal of Radiation Biology takes an in-depth look at the implications of United States nuclear weapons testing between 1945 and 1962. The study considered asbestos-related medical issues such as mesothelioma and other cancers. Nearly 114,000 veterans were selected as the subjects of this study; each of whom had previously worked in weapons tests that were correlated to high exposure rates.

While previous studies have looked at the potential exposure rates of veterans, the data presented by the International Journal of Radiation Biology is unique because it enabled researchers to project potential exposure rates for specific service based positions. They organize their findings by the unit of measure Standardized Mortality Ratios (SMR). They calculated and organized figures by service, rank and ratings and returned to subjects 65 years after their service to assess their health.

Their data yielded interesting results; mortality rates were not increased in the Army, Air Force or Marines, but were slightly higher in Navy personnel. Those with the highest potential for exposure worked as "machinists' mates, boiler technicians, water tender, pipefitters and firemen." This study concluded that the high rate of mesothelioma related deaths among veterans is due much in part to asbestos exposure amongst naval personnel during their time on ship.

This study was supported through grants from the National Cancer Institute, The Vanderbilt-Ingram Cancer Center and the U.S. Department of Energy, as well as through support from the U.S. Environmental Protection Agency and the National Aeronautics and Space Administration.

John E. Till, Harold L. Beck, John D. Boice Jr., H. Justin Mohler, Michael T. Mumma, Jill W. Aanenson & Helen A. Grogan (2019) Asbestos exposure and mesothelioma mortality among atomic veterans, International Journal of Radiation Biology, DOI: 10.1080/09553002.2018.1551641

Asbestos is a naturally occurring mineral that has been used in numerous products and applications. Over time as asbestos products undergo routine maintenance or even normal wear and tear, asbestos fibers in those products become disturbed. Once the microscopic fibers are released and subsequently inhaled, the insidious fibers work their way into the lining of the lungs, abdomen, heart, and in rare cases, the testicles.

The United States no longer mines or manufactures asbestos itself however the US still imports the mineral. Approximately 95% of all the asbestos imported into the US came by way of Brazil but following an asbestos ban last year in Brazil, Russia has become America's number one asbestos supplier.

The New York Times reported that the Environmental Protection Agency (EPA) has pushed through a measure to review new applications for using asbestos in consumer facing products. According to internal emails at the EPA, the measure was passed despite the objections of the agency's own in-house attorneys and scientists.

The new EPA proposal utilizes the SNUR ("Significant New-Use Rule)," a provision in the Toxic Substances Control Act that mandates EPA approval when a dangerous chemical is being used in a significantly new manner. The new rule explicitly allows for new uses of the extremely dangerous mineral on the condition that the EPA first approves the use case.

Susan Fairchild, an environmental scientist with the EPA since 1991, objected to the agency's new stance on asbestos, stating that "under the EPA's approach, if the agency failed to correctly anticipate some other new use then it seems to me that the manufacture of such a product would not be subject to the new-use rule." Given the EPA's dubious record of regulating large chemical companies and manufacturers the new proposal may carry many dangerous and unintended consequences.

Perhaps almost as concerning as the desire to open the door to new consumer uses of asbestos, the EPA has proposed a new way of evaluating the risk of deadly asbestos exposure. In a paper that the agency itself published entitled, Problem Formulation of the Risk Evaluation for Asbestos the EPA lays the foundation for its methodology in evaluating new use cases. Very worryingly, their approach will not include any information from existing or "legacy" sources despite the exhaustive body of work already done on asbestos related health risks.

Cytoreductive surgery, also known as debulking surgery involves removing the abdominal membrane and scraping away as much diseased tissue as possible. Patients who undergo the surgery tend to live four times as long as patients who decline surgery however the new study out of University of Illinois questions the benefits on the pre or post chemotherapy regime.

Based on the report, patients who underwent surgery alone had the greatest chance for survival of any other class of peritoneal mesothelioma patient.

The median survival times of the groups in the study were as follows:

• No Treatment: 3.6 months

• Chemotherapy Only: 11 months

• Surgery Only: 57.4 months

• Chemotherapy Before Surgery: 52.3 months

• Chemotherapy After Surgery: 55 months

"No difference in overall survival was noted with the addition of chemotherapy to complete debulking regardless of the timing," concludes lead investigator Samer Naffouje, MD, a surgical oncology research fellow at the University of Illinois at Chicago. "Complete debulking remains the standard of treatment for malignant peritoneal mesothelioma." 

It is important to note that although the effectiveness of chemotherapy in conjunction with the surgery provided no benefit, if surgery is not an option then chemotherapy alone was shown to provide a significant increase in survival times.

To view the full report click here.

Mesothelioma is a particularly aggressive form of cancer making compassionate care key from the first appointment. In a study titled "Role of Kindness in Cancer Care," Dr. Berry lays out six ways in which cancer care givers can better serve the intense emotional needs of their cancer patients. The Washington Post detailed the findings of the study.

Deep Listening: Genuine patient-centered care involves not only determining "what's the matter" with the patient but also "what matters to the patient." A mesothelioma diagnosis is accompanied with unsettling uncertainty so feeling heard is vital for mesothelioma patients to feel understood.

Empathy: Nursing scholar Theresa Wiseman identifies four essential attributes of empathy: seeing the world from another's perspective, avoiding judgment when assessing a situation, recognizing the emotion present, and responding to that emotion in a genuinely caring way.

Generous Acts: Kindness often manifests as generous acts. In my study, I asked patients, "Can you think of the best, most meaningful service experience you had as a cancer patient?" Many responses reflected the kindness embedded in generous acts. Even an act as simple as taking the time to teach a mesothelioma patient and their family how to properly utilize a chest drain can go a long way.

Timely care: For patients with aggressive cancers like malignant mesothelioma, being stuck in limbo waiting for test results can be emotionally taxing. Dr. Berry urges providers to offer care in a timely manner to reduce stress and anxiety, although he warns that some delays are unfortunately inevitable.

Gentle Honesty: Most patients want to know the truth but hearing the truth in gentle and carefully selected words can really help establish a productive dialogue between the medical team and patient.

Support for family caregivers: Having a loving and supporting family is an absolute vital part of a mesothelioma patient's care and prognosis. Research shows the benefits of preparing, empowering and assisting a patient's family to effectively care for a loved one.

Dr. Berry concluded that, "These mutually reinforcing manifestations of kindness (exhibited by self-aware clinicians who understand that how care is delivered matters) constitute a powerful and practical way to temper the emotional turmoil of cancer for patients, their families, and clinicians themselves."

Renewing fears earlier this year in the United States, Dutch regulators have pulled two of Claires make-up products off the shelves because of the presence of asbestos. The move impacted all 32 of Claires stores in the Netherlands. According to DutchNews.nl, the move came after the Dutch health inspector found 2% to 5% asbestos in a face powder and 0.1 to 2% of the carcinogenic substance in a contouring powder. There is no safe level of exposure to asbestos and therefore even the small concentration could have dire consequences to include mesothelioma. Additionally, because of the extremely long latency period of mesothelioma, those impacted by the make-up may not know the true extent of their injuries for more than 20 years. The investigation was sparked by the concern that originated in the United States. The article states that "Products containing asbestos are banned in the Netherlands because of the danger to health. The inspectorate has asked the company to withdraw other products made with the same ingredients until further notice."

Immunotherapy has been touted as an excellent treatment alternative for those suffering from especially aggressive cancers such as peritoneal mesothelioma and small cell lung cancer. However, the Associate Director of the Johns-Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy warns about the dangers of potential side effects from the novel therapy. Dr. Suzanne L. Topalian stated that scientists still need to develop a better system of biomarkers to predict the probability of adverse side effects. Dr. Topalian added that there is a need for oncologists to "become more educated on how to use these drugs." It is believed that immunotherapies have provided added benefits for mesothelioma patients because asbestos also inflames the patient's immune system. Immunotherapy has also shown success when treating rare forms of ovarian cancer as well as some other molecularly complex lung cancers. The Baltimore examiner wrote that "the results may have to do with a mutated gene in kidney cancer. The gene acted as a sort of master regulator of the other genes, controlling which ones were turned on and when. These regulated genes were normal and produced proteins that were not recognized as abnormal by the immune system." Presence of the master gene may be the reason that immunotherapy has such variable results depending on the patient. Scientists must work to create a more accurate pinpointing of the biomarkers to increase the predictability of the immune system therapies.

Pulmonary Cancer experts at several French institutions published a study in BMC Cancer on a home based rehab treatment for lung cancer and mesothelioma patients. Previous research studies have concluded that patients who are less active are more likely to have a lower quality of life post cancer treatment. The French study looked at 71 patients who had undergone chemotherapy for either lung cancer of mesothelioma. The rehab program involved both low impact physical exercise as well as psychosocial management to help deal with the anxiety and depression associated with cancer treatment protocols. The physical test included a six minute walk test and a 6 minute stepper test. The 47 patients who completed the program saw improvements in their performance on both tests. The exercise regimen helped to counter fatigue and muscle weakness that comes with chemotherapy treatment. The study had no negative effects for patients. The French study stated: "Home-based pulmonary rehabilitation was feasible and safe in patients with advanced lung cancer or malignant pleural mesothelioma. Exercise capacities stability in patients who completed the PR program suggests that PR might be beneficial. Further studies are warranted to confirm and to improve the potential value of PR in these patients."

A team of researchers from Northwestern University found that patients diagnosed with Huntington's Disease are far less likely than the average population to be diagnosed with cancer. The university researchers reported that understanding the elements of the Huntingtons disease that help to eliminate cancer cells could lead to a breakthrough treatment for all types of cancer including mesothelioma. Huntingtons disease is a rare neurodegenerative disorder that impacts approximately 30,000 Americans each year. The Huntington gene mutates in those afflicted with the disease. The mutated gene causes an oversupply of repeating RNA sequences which is deadly to nerve cells in the brain. The Northwestern scientists found that those same mutated Huntington genes are even more deadly to cancer cells. Lead author of the study, Marcus Peter, stated that, "this molecule is a super assassin against all tumor cells. We've never seen anything this powerful." The research team devised a way to deliver mutated Huntington genes (the killer molecule by way of a nano-particle) to test mice with ovarian cancer tumors. The results from the initial experiments were extremely promising. The Northwestern team found that following the treatment the tumor growth in the mice was significantly reduced, there was no toxicity in the mice, and the tumors didn't even build up a tolerance or resistance to the Huntington molecule.

Prof. Ravindra Fernando claims that there are "no adverse health effects from the use of white Chrysotile asbestos roofing tiles in the country." Although cited as an expert by the Sri Lankan Minister of Science, Fernando's conclusions are at best terrible science and at worst an attempt to collude with asbestos industry insiders in his country. The quasi state-endorsed claims are a tragic reminder of the corporate conspiracy to cover the killer effects of asbestos that occurred decades earlier in the United States and much of the western world.

In a letter to the newspaper Dr. Aseni Wickramatillake, a health industry consultant wrote a rebuttal to Professor Fernando's article. Dr. Wickramatillake wrote that Fernando's "views go contrary to studies in the United States by the Environmental Protection Agency (EPA), the National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety and Health Administration (OSHA), as well as internationally by the World Health Organisation (WHO), and the Internationals Agency for Research on Cancer (IARC). All these institutions document that chrysotile asbestos is indeed carcinogenic and OSHA even states, as have scientists in the past, that there is no known safe level of exposure to asbestos."

Fernando also claims that chrysotile asbestos fibers don't remain in the lungs as long as amphibole asbestos fibers. While this is typically true, it is also extremely misleading because chrysotile fibers are far more likely to make its way to the pleura or lining of the lungs. The spread to the lining of the lungs and abdomen is the key distinguishing feature of mesothelioma -- a particularly asgressive form of asbestos related cancer.

There ae now approximately 1.8 million homes in Sri Lanka with asbestos roofing sheets and the trend is that more and more houses are being built with the asbestos sheets rather than the clay tile from which they used to be constructed. As the asbestos industry goes through a resurgence in Sri Lanka, it's likely that the Sri Lankan citizens will continue be fed lies about the safety of asbestos products. To read Fernando's misinformed article click here and click here to read a rebuttal from a more educated Sri Lankan citizen.

A new report studying the mortality rates of mesothelioma from 2009 to 2013 found that countries vary significantly. The report was compiled by Omar Abdel-Rahman, an oncologist from Ain Shams University in Cairo, Egypt. The ten countries with the greatest number of per capita deaths (between 2009-2013) per 100,000 people from mesothelioma include:

• United Kingdom - 6.25
• The Netherlands - 5.29
• Australia - 4.93
• Switzerland - 3.84
• Belgium - 3.37
• Malta - 3.29
• Croatia - 3.12
• Finland - 2.66
• Norway - 2.91
• Luxembourg - 2.49

Countries with the least number of per capita mesothelioma deaths include:

• Portugal - 0.64
• Latvia - 0.67
• Hungary - 0.69
• Mexico - 0.71
• Czech Republic - 0.71
• Argentina - 0.86
• Belize - 0.86
• Poland - 1.08
• Israel - 1.17
• Japan - 1.35

The United States falls in the center of the pack with a per capita death rate of 1.47 per 100,000. While the United States does have a lower per capita number, the US does have one of the greatest numbers of deaths in terms of actual people who die from mesothelioma because of its huge population. The United Kingdom has the highest number of mesothelioma deaths. Researchers hypothesize that this may be due to the rebuilding effort after World War II. Because of the enormous number of structures that had to be rebuilt following Germany's bombing campaigns, asbestos was much more prevalent than elsewhere in the world. The mortality rates provide a look into how the agressive asbestos-related cancer has impacted people around the world, the results may not fully track for the accuracy of the national data where the statistics were collected. Abdel-Rahman's data may also be skewed towards places where the population is so small that incidental mesothelioma deaths look much more significant on a per capita basis. To view the full report click here.

Kristina Warner wanted to see what was contained in her daughter's makeup kit so she sent it in for testing to The Scientific Analytical Institute in Greensboro, North Carolina. No one could have anticipated that the results would come back positive for asbestos. WPRI-TV reported that after additional testing Claire's found was done, they found that 17 samples of makeup from Claire's stores in nine different states, including eye shadows, blushes, and compact powders. The frightening number of positive results lends to credence to the idea that this was not an isolated event. Because there are no safe levels of exposure to asbestos, the threat posed to the make-up users is grave. While it is not likely that a child will develop asbestos-related cancer from limited exposure there is still a possibility which should have been entirely avoided. A representative for Claire's told WPRI-TV: "We work closely with our vendors to ensure our products are tested and assessed in line with the relevant country regulations and guidelines. As a result of today's inquiry from WPRI-TV, we have taken the precautionary measure of pulling the items in question from the sale, and will be conducting an immediate investigation into the alleged issues.

The most common and easiest form of mesothelioma to treat is pleural epithelioid and even the most common form of mesothelioma is considered a rare cancer, impacting approximately 3,500 people per year. Bi-phasic peritoneal mesothelioma is far rarer. Bi-phasic means that the cell type is a mixture of epithelioid and sarcomatoid. Peritoneal means that the cancer is in the lining of the abdomen rather than in the lungs. In the past those with a bi-phasic cell type didn’t have a hope of

There has been an exciting new development in the treatment of bi-phasic peritoneal mesothelioma. The treatment protocol is called cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). The new treatment involves surgically removing as much of the peritoneal mesothelioma tumor as possible, then rinsing the body cavity with chemotherapy drugs to prevent new tumors from forming.

While 5 year post-surgical survival outcomes are still more common in epithelioid cell type patients, it no longer impossible for bi-phasic cell type patients to achieve the same results."Long-term survival is achievable in patients with low-volume biphasic mesothelioma after complete macroscopic cytoreduction," writes lead study author Konstantinos I. Votanopoulos MD, PhD, FACS, of Wake Forest Baptist Health in North Carolina. "Biphasic peritoneal mesotheliomas should not be considered as an absolute contraindication for CRS/HIPEC if there is low-volume disease and if complete cytoreduction can be achieved."

With the more complete resection of the abdominal lining, 64.5 percent of epithelioid mesothelioma patients were still living 5 years later contrasted with the of 50.2 percent of biphasic patients who were alive.

To read the full article check it out here in the Journal of Surgical Oncology.

tThe new research shows that for years scientists have been attempting to devise a treatment to cause the death of cancer cells but in fact, they may have been unknowingly causing the cancer cells to spread. The new study, published in the Journal of Experimental Medicine, found that scientists could resolve this tumor growth paradox by targeting the resolvins within the tumor instead. This finding could have a very large impact on enhancing cancer treatments, including mesothelioma.

The researchers found that when the cancerous cell itself is attacked, there is a "cellular debris" that is left behind. The cellular waste triggers an inflammation response which tricks the body into rapidly producing more cancerous cells. However, targeting the resolvins blocked the debris creating tumor growth as well as blocking the cancerous cells from spreading.

One of the head researchers of the study Dr. Huang when interviewed by Medical News Today, stated, "In brief, we learn that when it comes to cancer therapy: Thou shall not kill -- or kill gently and remove dead bodies immediately." Huang continued, "Targeting the resolvin pathways provides an entirely new, non-toxic, and non-immunosuppressive approach to cancer therapy."

The new findings provide hope for better enhancements for all cancer treatment protocols, including mesothelioma and other asbestos related cancers.

Researchers from the Australian National University (ANU) in Canberra published a new landmark study in the journal, Lancet Public Health, examining the impact of living in a house containing loose fill asbestos. The two year study analyzed 17,248 people who had lived in around 1,000 houses with loose-fill asbestos insulation over 30 years.

Dr. Rosemary Korda, the lead author of the study, concluded that people who live in homes that have the loose-fill asbestos insulation have a 2.5 times greater risk of being diagnosed with a fatal form of cancer.

“The ACT Asbestos Health Study examined risks for people who had lived in a house with loose-fill asbestos, and we found that loose-fill asbestos insulation is very likely to be unsafe. Our findings have important health, social financial and legal implications for governments and communities in which asbestos has been used to insulate houses.”

Other key finding from the study include:

The association between living in a loose-fill asbestos house and mesothelioma was much weaker than that seen in studies where people were exposed to asbestos through their work; and

Rates of colorectal cancer rates were elevated in both men (32 per cent higher) and women (73 per cent higher) who had lived at a house with loose fill asbestos. These were higher than expected and might be due to unavoidable limitations in the study's design.

Despite the fact that the study was conducted in Australia, the results are instructive to the millions of people in the United States and Canada residing in homes containing loose fill asbestos insulation.

According to Dr. Korda, the study was drawn from information encompassing the medical records of more than one million people who lived in the Australian Capital Territory between 1983 and 2013. Data was drawn from health insurance enrollment lists, national death registrations, and a database of cancer patients. It compared the statistics of those whose homes had been insulated with loose-filled asbestos against those whose homes had not used the material.

In addition to finding a higher incidence of mesothelioma in those who lived in the loose-fill asbestos insulated homes, they also found that rates of colorectal cancer were higher.

While smoking is the number one cause of cancer related deaths in the United States, asbestos remains the number one cause of cancer related occupational deaths. Smoking cigarettes does increase the risk of various forms of cancer and even increases the risk of asbestos related ailments such as asbestosis but cigarette smoking does not significantly increase the probability of being diagnosed with mesothelioma.

The Difference Between Smoking Related Lung Cancer and Mesothelioma

There are three main differences between smoking related lung cancer and mesothelioma:

Where the cancer originates: smoking lung cancer actually originates in the lungs where mesothelioma originates in the lining of the lungs (most commonly) or the lining of the peritoneal (abdominal cavity), heart, and sometimes in the testicles.

What happens when you quit: When you quit smoking your body immediately begins to heal. The earlier you quit the more fully your body will recover. However, once you move on from your jobsite exposure, the asbestos fibers will remain in the lungs indefinitely. Asbestos fibers do not dissolve or pass through the body after they are inhaled or swallowed.

Toxin Penetration: The toxins in cigarette smoke cannot reach the depths that asbestos fibers can reach which further explains why smoking cannot be a risk factor for mesothelioma.

Epithelioid

• Common Location: Lungs
• Frequency: 65-75% of cases
• Average Life Expectancy: 18-24 months

Epithelioid is the most common cell type found in mesothelioma patients. The epithelioid cells are uniform in shape. When viewed under a high magnification microscope the epithelioid cells appear have a uniform and elongated pattern. The uniform pattern makes these cells easier to distinguish from other cancer cells. Epithelioid cell type is the slowest spreading of the three mesothelioma cell types and typically has the most favorable prognosis.

Sarcomatoid

• Frequency: 15-20% of cases
• Common Location: Lungs, Abdominal Cavity
• Average Life Expectancy: 4-6 months

Sarcomatoid mesothelioma is a much less common cell type than epithelioid. While most sarcomatoids will be found in the lungs it is also associated with the peritoneal (abdominal) mesothelioma. These cells are spindle-shaped and arranged in a chaotic fashion. Sarcomatoid is the most aggressive form of mesothelioma. It originates in the muscles and bones and will often metastasize; making it the most difficult mesothelioma form to treat.

Biphasic

• Frequency: 25%-35%
• Common Location: Lungs, Abdominal Cavity
• Average Life Expectancy: 10-15 Months

Biphasic Mesothelioma cells are a mixture between epithelioid and sarcomatoid. Generally the epithelioid and the sarcomatoid cells are grouped together in different parts of the tumor. Aggressiveness of the malignant cells and the life expectancy largely depend on the amount of epithelioid cells versus sarcomatoid cells. The more the epithelioid cells there are compared to sarcomatoid cells the better the prognosis is for the patient.

Medical researchers out of Glenfield Hospital in Leicester, England published a report in Interactive Cardiovascular and Thoracic Surgery which concluded that surgery is not necessarily riskier for elderly mesothelioma patients than it is for younger patients. The report was a seven year study, following the surgical outcomes of 282 pleural mesothelioma patients who underwent extended pleurectomy and decortication.

Dr. Annabel Jane Sharkey "There was no intergroup difference in length of hospital stay or in in-hospital, 30-day or 90-day mortality." The study found that the biggest deciding factor in the probability of a successful surgical outcome is whether or not a patient had chemotherapy before or after the surgery.

The English study found that "it is possible to safely perform an EPD on patients older than 70 years, with no detriment to short- or long-term outcomes. Age itself was not a prognostic factor for poor overall survival outcomes, and as such, it should not be used in isolation as a selection factor when determining suitability for this type of surgery."

Pleural mesothelioma is notoriously difficult to diagnose because of how many different diseases it mimics. Studies have found that the tumor suppressing protein BAP1 is found in 70% to 90% of pleural mesothelioma patients but only in 20% of non-mesothelioma patients.

Zy Guo, author of the report concluded that, "It is therefore recommended that BAP1 can be used in conjunction with other immunohistochemical markers to improve the diagnostic accuracy of malignant mesothelioma." The hope is that BAP1 can help provide a more accurate diagnosis earlier which is critical to extending mesothelioma survival rates and increasing standards of living for patients.

Diagnosing mesothelioma is incredibly difficult and complex because of how many different diseases the cancer mimics. Diagnosis requires many different steps from body scans to the more invasive thoracoscopy procedure used to take a lung tissue sample. For more frail and elderly patients, the thoracoscopy is too invasive which then makes accurate diagnosis next to impossible.

The team of Japanese researchers from Hyogo Prefectural Amagasaki General Medical Center evaluated the diagnostic value of two types of protein biomarkers by studying 240 patients over a two year period. The study focused on soluble mesothelin-related peptide (SMRP) and cytokeratin 19 fragment/carcinoembryonic antigen (CYFRA 21-1/CEA) both of which are found in pleural effusion (lung fluid).

The report concluded that, "Combination of these biomarkers helped to rule out malignant pleural mesothelioma effectively among patients at high risk of suffering MPM and would be valuable especially for old frail patients who have difficulty in undergoing invasive procedures such as thoracoscopy."

To see the full study click here.

Lymph vessels: These are like veins except instead of carrying blood they carry lymph

Lymph: is a clear watery fluid that carries waste products away from your veins and tissues. Lymph als carries oxygen and other nutrients to the cells.

Lymph nodes: filter that lymph fluid to prevent infection and viruses from spreading throughout the body.

Lymphatic system: Is made up of the 500 - 800 nodes including tonsils, adenoids, spleen and thymus, and the vessels that carry the lymph.

Lymph Nodes and Cancer

The lymphatic system filters out contaminants before they hit the blood stream. Sometimes lymph nodes can catch stray cancer cells and trap them in the lymph nodes. This always presents a danger that the lymphatic system may be compromised by the cancer cells and spread to each node.

When the cancer hits a local lymph node that signals that the cancer is at stage 3 and but when the cancer spreads to distant nodes that signals the cancer is at stage 4.

To read more about the lymphatic system check out the American Cancer Society's full article here:

From 1952 to 1956, Lorillard sold approximately 11.7 billion cigarettes laced with the deadly asbestos fibers without ever disclosing that asbestos was in fact the secret fiber in the filter. The asbestos based filters were marketed as the safest cigarette filter ever made despite containing the deadliest asbestos of the six asbestos fibers.

In the past several months there have been two major cases that have shown a light on cigarette manufacturers role in causing mesothelioma. DeLisle's Florida based mesothelioma lawsuit against cigarette maker R.J. Reynolds resulted in a jury award of $8 million in damages. The award was reversed on appeal when R.J. Reynolds argued that the testimony of three of the expert witnesses in the trial should not have been allowed however the Florida Supreme Court has agreed to hear a an appeal on that reversal.

In another lawsuit filed in California widow saw settlements by all of the cigarette companies accused of liability except for R.J. Reynolds, and the jury decided against that company leading to the $3.75 million judgment, plus costs and interest. The court rejected R.J. Reynolds appeal.

Myth #1: Asbestos Is Banned In the United States

While asbestos has been banned in over 55 countries it is still legal in the United States. It’s possible that this myth originated because asbestos was briefly banned in the 1980s before being overturned in the courts. You can still find up to 1% asbestos content in brakes, gaskets, and other parts however this percentage is much lower than it once was.

Myth #2: There are Safe Levels Of Asbestos

There is no safe level of exposure to asbestos. Asbestos is a fiberous and friable mineral. The fibers can break down to even smaller fibers becoming airborne when disturbed. The asbestos particles are shaped like little hooks that once inhaled latch on to the lungs. This myth probably confuses level of exposure with containment. Asbestos that is properly contained is fairly safe, it’s when the material becomes disturbed that the real danger is posed.

Myth #3: Only Long Term Exposure Is Deadly

Just like there is no level of exposure that is safe, there is no length of time that is safe either. It is true that the more you are exposed to the deadly mineral the more likely you are to get an asbestos related disease, that doesn’t mean that long term exposure is required for fatal consequences. This myth is likely due to the long 15-50 year latency periods of the various asbestos related diseases.

Myth #4: There Aren’t Any Asbestos Alternatives

This is more an unsupported excuse for keeping asbestos legal than anything else. There are plenty of other alternatives. While these alternatives may not be as cheap as asbestos they are certainly less deadly.

• Silica fabrics that resist fire/heat as well as mildew
• Cellulose fiber made from newsprint, making it a “green” option
• Flour fillers made from nut shells or grain hulls (and therefore, another green option)
• Polyurethane foam spray used for insulation and other applications
• Thermoset plastic flour, often used in electrical insulation and auto parts

Myth #5: Asbestos Only Impacts the Lungs

Asbestos is most likely to impact the lungs compared to all other areas of the body but it’s not the only body part that is impacted. Asbestos manifests in the lungs approximately 75% of the time, in the abdomen 20% of the time, and then more rarely the lining of the heart or testicles.

The campaign explains that contractors who try to cut corners to avoid proper safety procedures risk not only the lives of their workers but the future of their business because the failure to properly identify and remove asbestos can carry stiff penalties.

The new campaign comes at a time where the organization has issued more asbestos related orders than all of 2016. WorkSafeBC has issued 450 orders so far for 2017 with 60 being orders to stop work. Al Johnson, VP of prevention services at WorkSafeBC said "That leads to project delays and additional costs. We take it seriously and want everyone to take it seriously as well."

Mr. Johnson added that they have also issued 30 penalties this year. The latest was issued to Hiltec Demolition for $20,000. According to records, WorkSafeBC observed four workers, one of whom was a supervisor, exiting the house in their street clothes and without any personal protective equipment. Uncontained drywall debris was visible in the house as well as in the back of the firm's vehicle. Click here to read the full article.

The dangers highlighted in Canada are also present here in the United States. Contracting and construction work have become the professions most at risk for dangerous asbestos exposure. It's vital that the proper identification and removal safeguards be employed to ensure worker safety.

Yearly CT scans may help increase the chance of catching the aggressive cancer at a stage where treatment protocols are more effective.

Physical symptoms of mesothelioma mimic many other diseases but it is especially important to pay attention to symptoms if you have worked with or know that you have been exposed to asbestos. Also if you lived with a family member who worked around asbestos it is important to pay attention to physical symptoms. The American Cancer Society details the following as symptoms of malignant mesothelioma.

Pleural (Lungs) Mesothelioma Symptoms

• Pain in the side of the chest or lower back
• Shortness of breath
• Cough
• Fever
• Excessive sweating
• Fatigue
• Weight loss (without trying)
• Trouble swallowing (feeling like food gets stuck)
• Hoarseness
• Swelling of the face and arms

Peritoneal (abdomen) Mesothelioma Symptoms

• Abdominal (belly) pain
• Swelling or fluid in the abdomen
• Weight loss (without trying)
• Nausea and vomiting
• Constipation

In most cases these symptoms are due to another illness but if you know that you are at risk because of past exposure it is very important to find out whether you do have mesothelioma. Early detection is critical to living as long as possible with the highest quality of life.

The researchers used the US government's SEER database to formulate incidence rates for malignant pleural mesothelioma in both men and women in rural and urban areas over a span of 40 years (1973-2012). Meghan, lead author on the paper, wrote "The results suggest that differences in ambient asbestos concentrations, which have been reported to be 10-fold or greater across regions in the United States, have not influenced the risk of pleural mesothelioma," concludes.

The report published in Occupational and Environmental Medicine included WHO data from 230 countries spanning between 1994 and 2014.

Within the totality of the data, researchers honed in on 59 countries that had kept more reliable records on mesothelioma diagnoses. Between those 59 countries there were more than 15,000 people who died of malignant mesothelioma. The international research team extrapolated their findings to conclude that there is just about 10 people out of every 1,000,000 people or approximately 38,400 people per year globally.

Chimed-Ochir Odgerel, one of the lead researchers out of Japan wrote that "The global numbers and rates of mesothelioma deaths have increased over time. Our rates are within the range of previously reported values but higher than the most recently reported values."

New asbestos exposure risk isn't the same as it used to be. It's no longer those working in shipyards and asbestos laden ships that have the greatest risk of exposure. Construction trades are now at the greatest risk of contracting mesothelioma. As the old asbestos filled structures continue to deteriorate construction workers remain at risk. There are many cases where asbestos may not even be disclosed to workers in advance so the correct safety procedures won't end up being followed.

If you suspect exposure there are still no reliable forms of early detection. A CT scan may be your best bet in catching the aggressive cancer early.

The data was even worse for other asbestos related conditions. Of the total population of the study only three were diagnosed over their lifetime with an asbestos related disease while 22 asbestos related conditions were diagnosed with an autopsy. The study's author recognizing the issue with living asbestos related diagnoses, stated that, "Where clinical features suggest asbestos-related diseases but the chest radiograph is negative, more sophisticated imaging techniques or immunohistochemistry for asbestos-related cancers should be used."

Researchers found that doctors were only able to correctly diagnose mesothelioma 40% of the time. It is possible that much of these findings could be skewed by the level of specialized knowledge of the doctors performing the diagnoses. The conclusion in the South African study highlight the importance of the skill and familiarity of the doctors examining those who have had exposure to asbestos products.

Italian researchers published a report in Biomedicine and Pharmacotherapy studying the effects that powerful phytochemicals found in fruits and vegetables had on mesothelioma. Authors of the study wrote that currently "only one compound - ursolic acid found in apple peels - has been shown to regulate microRNAs in malignant mesothelioma cells." However, the researchers remain hopeful that other compounds may also show success in regulating microRNA's.

Dr. Abu Sayeed, an author of the study stated that "In this paper, we have introduced some dietary phytochemicals (curcumin, epigallocatechin gallate, quercetin, genistein, pterostilbene, resveratrol, capsaicin, ellagic acid, benzyl isothiocyanate, phenethyl isothiocyanate, sulforaphane, indole-3-carbinol, 3,3'-diindolylmethane, diallyl disulphide, betulinic acid, and oleanolic acid) which have shown microRNA regulatory activities in various cancers and could regulate malignant mesothelioma microRNAs."

The new research out of Italy is the last in a string of reports touting the benefits of regulating microRNAs through the natural compounds found in fruits and vegetables. MicroRNA regulation can help lead to reductions in tumor growth and in some cases even tumor size. These new findings give hope to the prospect of elongating mesothelioma survival times.

The report, published in Occupational and Environmental Medicine studied the cases of 1,800 cement workers in Pavia, Italy.

Researchers found a mesothelioma diagnosis for the cement workers was correlated with the amount of asbestos exposure however there was no correlation with latency period (the amount of time since the last exposure). The risk plateau described in the study occurs after approximately 40 years, after which the researchers assert that risk of a pleural mesothelioma diagnosis actually decreases.

The authors of the report stated, "Our results do not support the hypothesis that pleural malignant mesothelioma risk indefinitely increases after exposure, suggesting instead that the alternative hypothesis of a risk plateau or decrease after a time since first exposure of more than 40 years is more consistent with the observed data."

One of the shortfalls of the report was that it only studied workers from one sector. However, the one sector report did confirm findings from an earlier study. The previous large population study was also Italian but it studied 51,000 workers in multiple industrial sectors.

It is also important to note that the risk plateau does not seem to apply to the much rarer peritoneal malignant mesothelioma.

Some of the most interesting conclusions from the study entitled, "Patterns of care and survival among patients with malignant mesothelioma in the United States," include:

• People who are over 70 are much less likely to receive any mesothelioma treatment
• 29.3% of the pleural mesothelioma patients and 21.5% of non-pleural mesothelioma patients received absolutely no treatment at all
• Without treatment, mesothelioma survival rates re as low as just a few months
• When researchers averaged pleural mesothelioma patients who received treatment and those who didn't the median survival span was 9 months.
• Average life expectancy for those with non pleural mesothelioma patients is 18 months, double that of pleural mesothelioma patients.
• In conjunction with other finding from multiple other reports, there is no single treatment that works best. The best approach is a multimodal approach using a combination of various treatment protocols.

The researchers concluded that more needs to be done to standardize treatments. The report found that there were disparities in treatment received most likely due to the rarity of the aggressive cancer. The researchers stated that more needs to be done to ensure that the same level of care for each patient.

The report, published in the Journal of Clinical Oncology, studied 6,645 pleural mesothelioma cases. Trimodal therapy includes surgical intervention followed by chemotherapy and radiationtherapy.

Dr. David Nelson, the lead author of the study and thoracic surgeon stated that "Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based and multimodality therapies."

The trimodal therapy worked best on those with the epithelioid mesothelioma subtype. For those with epitheloid mesothelioma survival times were increased by an average of nine months. While the trimodal therapy provided the greatest increase to patient survival time, the surgery does not come without risk. Pleural mesothelioma is extremely invasive and carries the potential for serious complications. Approximatley 6% of the patients studied died within one month and 15.5% died within 3 months of the surgical intervention.

The news is sure to come as a sigh of relief for those patients current undergoing or scheduled for the medical procideure.

What Is A Medical Thoracoscopy?

It's a minimally invasive medical procedure used as a tool to help diagnose various lung diseases such as pleural mesothelioma. The procedure involves a small probe that physicians use to see of the surface of the lungs. This visibility helps the doctor to diagnose the source of the excess fluid.

It's important not to confuse the medical thoracoscopy with a surgical thoracoscopy, a very highly invasive surgical procedure.

Additional Benefits of a Medical Thoracoscopy

Mesothelioma is a notoriously difficult to diagnose because its symptoms are so similar to those of several other diseases. The medical thoracosopy has not only helps to diagnose the cause of the pleural effusion but also take lung tissue to help increase accuracy of the diagnosis even more. In addition the procedure can also serve as a means to administer medication.

Author Yang-Bing Wu, MD concluded that the "Medical thoracoscopy is a valuable and safe tool in diagnosing malignant pleural effusion and minimal complication rates."

The report included 47,219 patients diagnosed with Hodgkin's lymphoma and 252,090 patients diagnosed with non-Hodgkin's lymphoma between 1973 and 2014.

The report concludes that, "Mesothelioma risk was increased among HL and NHL patients treated with radiotherapy but not without radiotherapy." Not surprisingly the patients who lived the longest after radiation therapy had the greatest chance of being diagnosed with mesothelioma.

It's important to note that the risk of mesothelioma after being treated with mesothelioma is still extremely rare. Of the almost 300,000 patients who had lymphoma and were treated with radiotherapy 28 developed mesothelioma. In a similar Italian study published in 2016, of the 935,637 patients analyzed by University of Bologna researchers, 301 were later diagnosed with mesothelioma. Most of the mesothelioma cases that developed were pleural.

Problem #1: Loss of Appetite

• Try eating a large meal when you feel up to it no matter what time it is.
• Calorie rich liquid diets sometimes make it easier to consume more
• Try eating several smaller meals rather than a few larger ones
• Exercise tends to stimulate appetite

Problem #2 Nausea

• Although it may be counterintuitive, you should try and eat something, nausea is made worse by an empty stomach
• Eat something light like saltine crackers or plain yogurt
• Try to avoid liquids that you know cause you bloating with your meals

Problem #3 Diarrhea

• Drink lots of fluids to replace those that have been lost
• Make sure to eat foods rich in sodium and potassium to replace lost minerals
• Avoid foods high in fiber, greasy foods, milk, and alcohol

Problem #4 Dry Mouth

• Always keep a water bottle handy throughout the day
• Sweet or tart foods may help stimulate saliva production
• Chewing gum may help but avoid alcohol

Problem #5 Weight Loss

• Eat when its meal time even if you're not hungry
• Eat calorie rich foods like peanut butter so you don't need to eat as large of a portion
• Liquid smoothies or shakes may be easier to get down and can be rich in nutritional value

For more information on food related cancer issues please review the National Cancer Institutes, "Eating Hints: Before, During, and After Cancer Treatment."

Sarcomatoid is the least common form of mesothelioma, however it is typically the most aggressive of the three mesothelioma types. Prognosis for sarcomatoid is usually poor because treatment is very difficult. Italian researchers from the University of Salento discovered that the experimental platinum based drug, Ptac2S, was more effective in reducing the spread of sarcomatoid malignant pleural mesothelioma cells in mice than cisplatin. Cisplatin is the standard chemotherapy treatment used to treat the vast majority of mesothelioma patients.

The researchers published their findings in the journal, Plos|One. The very promising results showed that Ptac2S reduced the growth rate of sarcomatoid cells up to 50 percent and decreased tumor mass by 53 percent. The new findings far outpaced the results for the industry standard cisplatin, which showed just a 12 percent tumor mass reduction. The lead researcher Antonella Muscella wrote, "Results confirm that Ptac2S is a promising therapeutic agent for malignant mesothelioma, giving a substantial starting point for its further validation."

Ptac2S showed promise in another very important aspect of treatment as well as tolerability. The platinum based drug actually manifested fewer negative side effects when compared to cisplatin. Cisplatin while toxic to cancerous cells can also target healthy cells, leading to severe side effects. Muscella wrote that "During observation time, no health problems were observed [while on Ptac2s] and the overall behaviour was similar to that of the control animals."

The results showed that Ptac2S was more toxic to cancerous cells than cisplatin while at the same time remaining less toxic than cisplatin to healthy cells. Muscella reported "We conclude by pointing out that Ptac2S is effective in pleural mesothelioma and that these new acquisitions enhance the knowledge of the anti-tumour activity of this compound."

According to the National Cancer Institute, the one year survival rate for peritoneal mesothelioma is 40%. The British study details two cases of peritoneal mesothelioma where the patients were treated apitolsib and are still alive after 10 and 13 years. The two female patients both had relapsed under the standard chemotherapy with cisplatin treatment protocol before being treated with the apitolsib.

Apitolsib operates by inhibiting important cell signaling pathways making it harder for certain kinds of mesothelioma tumors to grow unchecked. Lead author of the study, Saoirse Dolly wrote, "These case presentations highlight a subgroup of rare MPeM that behave indolently that is compatible with long-term survival. This series identifies the use of targeted therapies with PI3K-mTOR-based inhibitors as a novel approach, warranting further clinical assessment."

The researchers are hopeful that these preliminary results will encourage more early phase clinical trials to confirm the efficacy of the new drug treatment.

The study examined the international clinical trial with over 500 patients to see whether AstraZeneca’s drug could in fact extend average survival rates. The clinical trial started in 2013.

The double-blind trial was conducted at 105 sites in 19 different countries. The patients had either pleural or peritoneal mesothelioma. Over a period of seven months some patients were administered Tremelimumab while others, who were selected at random, were given a placebo. Neither the doctors nor the patients knew who was given the drug versus the placebo.

The report concluded that "Tremelimumab did not significantly prolong overall survival compared with the placebo in patients with previously treated malignant mesothelioma." While the results of the study were disappointing there is still hope that the when used in combination with other medications that Tremelimumab will be able to increase the efficacy other drugs.

A mesothelioma diagnosis is a very overwhelming experience. Because mesothelioma impacts approximately 2500 to 3000 new people each year it is termed an orphan disease. Orphan diseases tend to suffer from a lack of information and resources and even a lack of medical professionals with the specialized knowledge requisite to provide adequate treatment.

Knowledge is a very helpful tool to help deal with the anxiety of uncertainty that often accompanies this asbestos related cancer. Cancer.net has compiled a list of important questions that you should ask your medical team after being diagnosed with mesothelioma.

Questions to ask after getting a diagnosis

• What type of mesothelioma do I have?
• Where exactly is the tumor located?
• Can you explain my pathology report (laboratory test results) to me?
• What is the stage of the cancer?
• What does this mean?
• What is my prognosis?

Questions to ask about choosing a treatment and managing side effects

• What treatment options are available?
• What clinical trials are available for me?
• Where are they located, and how do I find out more about them?
• What treatment plan do you recommend? Why?
• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
• Who will be part of my health care team, and what does each member do?
• Who will be leading my overall treatment?
• What are the possible side effects of this treatment, both in the short term and the long term?
• How can I keep myself as healthy as possible during treatment?
• In addition to treating my cancer, what can be done to treat my symptoms and side effects (such as pain medications or appetite stimulants)?
• How will this treatment affect my daily life?
• Will I be able to work, exercise, and perform my usual activities?
• Could this treatment affect my sex life? If so, how and for how long?
• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
• If I'm worried about managing the costs of cancer care, who can help me?
• What support services are available to me? To my family?
• Who should I call for questions or problems?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?
• How long will the operation take?
• How long will I be in the hospital?
• Can you describe what my recovery from surgery will be like?
• What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy or chemotherapy

• What type of treatment is recommended?
• What is the goal of this treatment?
• How long will it take to give this treatment?
• What side effects can I expect during treatment?
• What are the possible long-term side effects of having this treatment?
• What can be done to relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back?
• Should I watch for specific signs or symptoms?
• What long-term side effects or late effects are possible based on the cancer treatment I received?
• What follow-up tests will I need, and how often will I need them?
• How do I get a treatment summary and survivorship care plan to keep in my personal records?
• Who will be leading my follow-up care?
• What survivorship support services are available to me? To my family?

If your medical team doesn't have the answer to any of these questions or can't answer one of your other questions feel free to reach out and we can connect you with expert oncologists in the field to get you the answers you deserve.

The study, titled, A pilot study of zoledronic acid in the treatment of patients with advanced malignant pleural mesothelioma, focused on eight patients who had progressed on prior treatments or had not received systemic therapy due to poor performance status.

The demographics of the eight patients included all males (7 Caucasian and 1 African-American) with a median age of 62 years (age range 49 - 77). As a standalone treatment the bone health drug had only a modest impact with a composite response rate of 12.5 percent and a clinical benefit rate (response and stability of the disease) of 37.5 percent.

Despite the modest impact as a standalone treatment the University of Alabama Researchers maintain hope that when combined with other therapies, zoledronic acid still may be valuable as a form of multimodal treatment. Lead author of the report, Muhammad Omer Jamil wrote, "Our findings suggest that zoledronic acid has single-agent activity in [malignant pleural mesothelioma] treatment. Zoledronic acid can mitigate angiogenesis at subcellular level by mevalonate pathway inhibition and is beneficial in antitumor therapy."

Depression can appear at any point during the journey of living with mesothelioma. It is a serious condition that can carry with it serious health impacts. Depression has been shown to decrease survival rates and the efficacy of treatment. Cancer.net lists the following as Risk Factors for Depression:

• Previous diagnosis of depression or anxiety
• Family history of depression or anxiety
• Lack of support of friends or family
• Financial burdens

It's very important to make sure that you keep your healthcare team updated with any changes in mood. According to Cancer.net explaining symptoms of depression is difficult but you should make sure to alert your medical professional of:

• Your feelings
• Specific sources of concern
• Physical symptoms
• The effect on your daily life

The researchers’ data showed that the virus (MV-Edm) may actually have the capability of seeking out and destroying the malignant mesothelioma cells while at the same time leaving the healthy cells intact.

Dr. Jacobson, the lead author on the study wrote, “MV-Edm treatment of mesothelioma reduced cell viability and also invoked apoptotic cell death.” The test showed promising results because the measles virus had a special attraction to protein CD46 - a protein that is overexpressed within malignant mesothelioma patients.

The most exciting aspect of the treatment testing was the low rates of negative effects because the virus leaves the healthy cells alone. We remain hopeful that with additional research these treatment protocols may provide a whole new standard of mesothelioma care.

In a report published in the medical journal Lung Cancer, doctors from the University of Alabama found that one third of the mesothelioma patients studied received at least some benefit while none of the patients reported negative side effects.

The study covered eight individuals with late stage mesothelioma. The median age of the patient was 62 and 6 of the patients studied had epithelioid mesothelioma - the most common form. All of the patients in the study had failed to respond to other treatments or were too ill to be considered for surgical treatments.

The zoledronic acid did not have a significant impact on mesothelioma survival times however it did shrink or stop tumor growth in over one third of the patients. It took an average of two months for the tumors to start growing again. Remarkably, none of the patients were subjected to negative side effects. Compared to treatments such as chemotherapy which can carry severe negative effects and toxicity levels the zoledronic acid’s benefits are even more apparent. Dr. Jamil, the head researcher on the study stated that, “Zoledronic acid shows modest clinical activity without significant toxicity in patients with advanced malignant pleural mesothelioma.”

Understanding the intricacies and patterns of the spread of cancer is therefore vital to improving cancer treatment standards.

Researchers at Johns Hopkins published a study in Nature Communications detailing their findings on cancer cell metastasis. Lead researcher Hasini Jayatilaka stated, “We found that it was not the overall size of a primary tumor that caused cancer cells to spread, but how tightly those cells are jammed together when they break away from the tumor. At a fundamental level, we found that cell density is very important in triggering metastasis.”

The researchers then constructed an experiment to help inhibit metastasis. In the study tumors were treated with two drugs - one approved for treating arthritis and the other being tested for breast cancer treatment. While this drug combination failed to stop the growth of the primary tumor it did significantly limit the spread of the cancer. Jayatilaka stated, “We discovered a new signaling pathway that, when blocked, could potentially curb cancer’s ability to metastasize.”

A study in Molecular Medicine Reportsprovides some evidence that a compound in these vegetables may actually improve the efficacy of cisplatin. Most malignant mesothelioma patients will receive chemotherapy in conjunction with cisplatin as part of a multimodal treatment protocol. In the study scientists gave patients a combination of sulforaphane and cisplatin. According to the article, “Combination treatment with the two compounds exhibited synergistic growth-inhibiting and apoptosis-promoting [cell death] activities, as demonstrated by a series of proapoptotic events.”

The study is careful to point out that just because the researchers are using a compound found in cruciferous vegetables doesn’t mean that you can reproduce the same effects by eating the vegetables yourself. For more information on what to eat in your specific case, the researchers remind you that you should consult your doctor and dietician.

Some health advocates fear that those who are already sick will be the most impacted by a new version of the bill.

The Kaiser Family Foundation warns that without the protections of the Affordable Healthcare Act patients may find themselves staring down the barrel a several thousand dollar medication bill may face insurers who do not offer policies which cover prescription drug cost. Another fear for mesothelioma patients is in the case that the insurers are able to reimpose annual or lifetime care limits. Because of the cost of mesothelioma care, limits could be quickly exhausted. As we wait for the latest version of the Healthcare Bill we hope for the best outcome for our brother and sisters - our loved ones, impacted by this terrible disease.

The Australian researchers have published a study in the Journal of Thoracic Oncology which reports that the PD-L1 protein can be deactivated from the inside.

These finding are critical because overexpression of the tumor hiding protein is highly correlated with negative treatment outcomes and shorter survival times. Too much PD-L1 leads to a higher probability of a biphasic or sarcomatoid subtype diagnosis which leads to shorter survival. The average survival time when there is no overexpression of the protein is 9.2 months, more than double the 4 month average survival time of a mesothelioma patient with overexpressed PD-L1. Author of the study,

The TNM system is a tool that help doctors explain the tumor, nodes, and metastases.

T stands for the primary tumor. A designation of TX means that the tumor can’t be measured. T0 however means that the doctor hasn’t found or found any evidence of a tumor. Tis means that the cancer cells have only penetrated the shallowest layer of tissue. Tis is commonly referred to as pre-cancer. A number in front of the T such as T1 or T2 refers to the actual size of the primary tumor. Larger numbers indicate a larger tumor.

N signals whether the cancer has spread to the lymph nodes. NX means that the nearby lymph nodes cannot be analyzed. N0 means that the nodes are not infected with cancer. N followed by a digit such as N1 or N2 describes the spread of the cancer to the surrounding lymph nodes. The greater the number the more widespread the cancer and the higher number of lymph nodes impacted.

The M in the staging system signals whether the cancer has metastasized - or spread to alternate parts of the body. M0 means that medical staff was unable to find that the cancer spread. M1 is used to describe cancer which has metastasized to the rest of the body.

In addition to the TNH staging system, a Roman numeral system is used to describe how far the cancer has advanced. The system begins with I for beginning stages and IV for the most advanced stage.

The article, published in Tumor Biology, analyzed over 21 studies which included 2,457 patients with various types of cancer.

BAP1 is a protein which helps to suppress tumors. Researchers believe that mutative iterations of the protein may help to explain why certain people exposed to asbestos manifest malignant mesothelioma while others who were exposed do not.

The study finds however that the BAP1 mutation has little correlation with actual survival rates. Surgeon and one of the study’s authors, Dr. Wang states that “Although the pooled results demonstrated that BAP1 mutation was a negative indicator of overall survival and disease-free survival, this prognostic value was only applicable to uveal melanoma and clear cell renal cell carcinoma, but not to malignant pleural mesothelioma or cholangiocarcinoma.” In fact, for mesothelioma it is possible that the mutation actually has a minimal positive impact on mesothelioma survival rates.

This conclusion means tht previous studies concluding that the VEGF inhibitor had dose limiting side effects may have been premature.

Author of the study, Dr. Ann Tsao stated that, “Cediranib combined with cisplatin-pemetrexed has a reasonable toxicity profile and preliminary promising efficacy,” Cediranib operates by latching onto the VEGF receptor sites inside cancer cells thus stopping the proteins from having an impact on those cells. Previous studies have shown that the inhibitors do help to reduce tumor growth in alveolar soft part sarcoma. The next step for the treatment protocol will be phase II clinical trials. Researchers maintain hopes that cediranib will effectively increase chemotherapy efficacy.

Immunotherapy is used to jumpstart the patient’s compromised immune system so it can seek and destroy the malignant tumor cells. Researchers found that while on their own each drug does help to slow tumor growth, the best results are achieved when a combination of the drugs are administered. 26% of patients in the study who received the drug combination had a reduction in their tumor size.

An author of the study, Dr. Scherpereel, stated that “Mesothelioma cells build a protective tumor microenvironment to shield themselves against the immune system’s attacks and even act against anti-tumor immune response. Therefore, therapies that shift tumor microenvironment from a state of immune suppression to one of immune activation may hold promise in malignant pleural mesothelioma.

The most common side effects reported about the treatment included thyroid problems, colon inflammation, and skin rash

The study found that calretinin has an unusually high degree of sensitivity with respect to mesothelioma detection.

Currently diagnosis requires a tissue biopsy followed by an analysis of the tissue called immunohistochemistry. Because of the invasiveness of the biopsy this process only occurs after all other markers show the potential presence of mesothelioma which tends to prevent a diagnosis until mesothelioma is in a late stage. Using blood based biomarkers may provide a way for more frequent testing so that the aggressive cancer may be caught early.

The study found that on its own calretinin is slightly more sensitive than mesothelin in the detection of mesothelioma however, when paired with mesothelin the sensitivity for detection rose from 66% to 75%. Early detection is key to survival rates and improving the efficacy of treatment protocols. The German study provides a real hope for increasing early detection of mesothelioma in its various types.

According to the researchers mice with malignant mesothelioma who were given Pravastatin prior to being subjected to radiation experienced less damage to vital organs than mice who did not receive the drug.

Hiroshi Doi, the head researcher of the report stated that, “The pravastatin group showed significantly lower apoptotic indices in all examined parts of the intestine and tended to show reduced apoptosis [cell death] in the lung.” Moreover, the study concluded that use of the cholesterol drug improved the body’s resistance to radiation while at the same time not decreasing the efficacy of the treatment. The authors of the article conclude that Pravastatin may in fact “increase the therapeutic index of radiotherapy.”

Immunotherapy as a Treatment Protocol

Just as with many other forms of cancer, mesothelioma tumors are able to grow by essentially camouflaging itself to avoid the body’s immune system. Immunotherapy relies on substances or drugs to help jump-start the immune system to start recognizing and fighting the malignant mesothelioma cells with the purpose of stopping tumor growth. The issue is the level responsiveness of the individual immune system or getting the immune system to respond and start fighting the malignant cells. Biologist, Dr. Dash states that certain altered viruses “Would expand the range of patients who will respond to and benefit from immune therapy.”

Using Altered Viruses

Virotherapy relies on the use of viruses that have been altered to target malignant and cancerous cells while at the same time sparing the surrounding healthy tissues. The Minnesota based biologists wrote that “In pre-clinical models of different thoracic cancers, it has been found that these viruses can induce immunogenic cell death, increase the number of immune mediators brought into the tumor microenvironment and broaden the neoantigen-specific T cell response.” The conclusions from the study provide some hope for increasing the efficacy of immunotherapy and perhaps even extending survival times and quality of life.

The majority of mesothelioma diagnoses come once the cancer is already in a very advanced stage which limits treatment options and the efficacy of those treatment options. A new study out of the United Kingdom signals that a simple blood test may be the answer to that problem.

The report, published in the British Journal of General Practice studied over 50,000 cancer cases. While the study did not specifically deal with mesothelioma, it did not focus on any other specific type of cancer either suggesting that the method has a broad range of applicability. The blood test focused on whether the patient had an elevated platelet count. One of the most salient results from the study included a group of patients with high platelet counts who later developed lung or colo-rectal cancer had no other cancer symptoms other than the elevated counts.

Ms. Baily, a co-author of the report stated that “This is a clue which can be used in practice by GPs to help them select patients for further investigation, most excitingly in some patients who may not already have other symptoms of cancer to achieve earlier diagnosis.” With early dignosis it may be possible to provide longer more productive treatment outcomes for mesothelioma patients.

The FDA recently announced that Novacure’s Tumor Treating Fields (TTFields) delivery system is being granted Humanitarian Use Device (HUD) status which is the first step in receiving the Humanitarian Device Exception (HDE) status. The HDE designation would allow the treatment to be marketed in conjunction with the standard chemotherapy care.

The TTfields device emits low-intensity electricity through a portable device that a patient can carry around with them. The electricity is able to prevent cancerous cells from multiplying as quickly by inhibiting the cell division process. Prelimary results have shown significant increases in survival times. Novacure’s CEo stated that “We believe that treatment with TTFields affects fundamental aspects of cell division and may have broad applicability across a variety of solid tumors. We are pleased to receive HUD designation as it is a major step towards a second regulatory approval for TTFields in the United States.”

By tracking soluble mesothelin-related protein (SMRP) levels in the blood doctors can determine the efficacy of the treatments being used.

There are many prognostic tools that doctors use to predict the outcome of treatments such as age, overall health, and at which stage the cancer is caught. Seeking more reliable prognosis tools, the research team analyzed 579 cases. Dr. Long Tian, an author of the study stated that, “The results showed that soluble mesothelin level was significantly correlated with the survival of malignant pleural mesothelioma.”

The tests confirmed that those with the highest level of SMRP in the blood had the worst prognosis. Used in conjunction with other bio-markers SMRP analysis will likely provide the highest degree of accuracy.

The study published in Oncotarget conducted an analysis of 10 other studies which covered the cases of 1,500 mesothelioma patients.

NLR is a marker for inflammation in the body and therefore NLR provides a snapshot of the overall health of the immune system, a function vital to fight malignant cancer cells and to fight against new tumors. Improved treatment strategies could be key in extending survival times or quality of life during those survival times. NLR has also shown promise in helping approving mesothelioma patients for clinical trials.

Myth #1 Mesothelioma Only Affects Senior Citizens

Because mesothelioma typically takes 10 to 50 years to manifest the largest demographic of those suffering from mesothelioma are over the age of 65 but it’s a misconception to say that they’re the only ones. There are a growing number of individuals much younger who have been devastated by the disease. Unfortunately, we have come across cases in our practice where young girls who helped their fathers with clothing contaminated with asbestos from the job site be subsequently diagnosed with mesothelioma. The worrying trend is also a product of asbestos in schools that are failing to properly contain the mineral and preventing disturbances which can lead to deadly exposure.

Myth #2 It’s Caused by Smoking

Smoking does not cause mesothelioma, nor does smoking make you more likely to be diagnosed with mesothelioma. This misconception may exist because smokers who are also exposed to asbestos have a greater chance of being diagnosed with lung cancer

Myth #3 Only Long Term Exposure Causes Mesothelioma

While long term exposure does increase the chances of a mesothelioma diagnosis, it is not required. Modern medical surveys and the Environmental Protection Agency have said in no uncertain terms that there is no safe level of exposure.

Myth #4 Mesothelioma Only Impacts the Lungs

Approximately 75% of all cases are pleural or based in the lungs but there are several other forms. The next most common type is peritoneal which impacts the lining of the abdomen. Pericardial mesothelioma which effects the lining of the heart is a rarer form which impacts approximately 1% of those diagnosed. Even rarer than pericardial is the testicular form (men) as well as the papillary form (women).

Myth #5 Asbestos is Banned in the United States

Although over 55 countries have banned the deadly mineral, the United States still actively imports asbestos into the country. While many new uses have been banned by the US Government there are still certain permitted applications.

The study focuses on sarcomatoid mesothelioma - one of the rarest and deadliest forms.

The plant based drug has been the subject of much research in the mesothelioma field due to its natural anti-inflammatory properties. While curcumin has shown promising results, it’s still in the animal test phase. One of the author’s of the study, Dr. Pouliquen stated that, ““The treatment of tumor-bearing rats with 1.5 mg/kg curcumin on days 7, 9, 11 and 14 after tumor challenge dramatically reduced the mean total tumor mass at day 16.” Dr. Pouliquen went on to say that, ““These data open up interesting new prospects for the therapy of sarcomatoid mesothelioma with curcumin and its derivatives.”

The study found that the median survival time of 18.3 months. Of the cases studied the survival rates were as follows:

• After 1 Year: 68% of patients were still living
• After 2 Years: 37% of patients were still living
• After 5 Years: 7% of patients were still living

Understanding the TNH system

The staging system is designed for predict outcomes and select treatment protocols based on three factors:

• T – Original tumor size
• N- level of lymph node involvement
• M- Metastases or spread of the cancer

Surgery Versus The Staging System

The results of the study points to the idea that the stage alone may have negligible impact on survival rates. The author of the study reported that “A significant difference in survival was observed in patients undergoing surgery versus no surgery…and treatment with chemotherapy alone versus chemotherapy with surgery.” One of the other significant factors for survival times was whether the patient was a smoker. Smoker tended to have worse treatment outcomes.

The study concludes that not all P/D methods are created equal. Of the three P/D methods, the researchers concluded that only two had positive impacts on survival rates.

The three P/D surgical protocols examined were Extended P/D, P/D, and Partial P/D.

• Extended (radical) P/D: (162 patient cases) Includes removal of the membrane around the lungs, heart, diaphragm, as well as other tissues
• P/D: (115 patient cases) The standard mesothelioma surgical procedure which just leaving more tissue untouched than the extended P/D.
• Partial P/D: (37 patient cases) Only attempts to remove the pleura but does not seek to remove all of the tumor tissue.

Marulli, the author of the study concluded that, “Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumour behind, has no impact on survival.”

The app even allows healthcare providers to who use the application to provide patient specific treatment plans and advice.

The information that the patient inputs into the device provides healthcare providers with an efficient way to get vital patient information. While the app is designed to help patients with all types of cancers, it is likely that it will be an invaluable resource for mesothelioma patients.

Currently CancerAid is the leading cancer app in the apple store for the United States, Australia, and the United Kingdom. There have been over 30,000 downloads and the numbers continue to rise. To learn more about the application click here.

The Italian study observed 5,344 pleural mesothelioma cases in Italy ranging from year 2000 to 2014. Of the sample there were four individuals who where subkected to 100% of all of their exposure from the dental field. These individual included three males and one female who helped her husband make dental implants for over 30 years. Total exposure between the technicians ranged from 4 to 34 years.

Asbestos was previously used as a binder in periodontal dressings as well as the heat resistant tape in implants. The dental field was one of those industries that many thought wouldn’t be effected by asbestos exposure however according to the author of the journal article, Caroline Mensi, “We confirm the association of malignant mesothelioma with dental technician work.”

The lead author of the study Cyril Habougit, stated that, "Our work shows that mitotic count <3/10 HPF, the lack of necrosis, mild nuclear atypia, the lack of atypical mitoses, a nucleoli size <3 um and a nucleoli absent or visible at 200x or higher magnification are significantly associated with a better median overall survival in epithelioid mesothelioma."

Currently, the less precise subtype is the only generally accepted way to predict survival rates using pathology. If these cellular factors could enable doctors to better target therapies leading to better treatment outcomes.

Dr. Bertino, the head of the research team, is optimistic at the progress they’ve already seen in the animal trials. Bertino’s approach is novel in the sense that it doesn’t seek to treat the malignant mesothelial cells but rather prevent them from ever forming in the first place.

The vaccine works by targeting specific proteins requisite for mesothelioma tumor growth. Early results show the vaccine successfully eradicated mesothelioma tumor cells in mice which ultimately lead to a tumor free life in 40% of the animal subjects. If successful, the vaccine could be administered to people who have bio-markers for a predisposition to mesothelioma as well as those who have a particularly risky occupational exposure history.

Pietro Bertino has a long history in the mesothelioma research and well regarded as an expert in his field. He grew up in Italy right next to a large asbestos plant and saw firsthand the devastating health effects of the dangerous mineral. Bertino stated, “This is a different kind of intervention, my final goal is to make a preventative vaccine and help perfect it. And if it works for mesothelioma, it could be effective in preventing other kinds of cancers, too.”

To read the full article from the University of Hawaii click here

Unfortunately, diagnoses typically come far too late for those treatments to be very effective. The stress of the diagnoses as well as the physical and mental toll treatment takes requires the mesothelioma patients to seek both physical and mental reinforcement. Mental wellbeing is critical to maximizing and increasing the quality of the precious time that the patient has remaining. Meditation and massage are both classified as Complimentary Alternative Medicine (CAM). According to the National Cancer Institute approximately 4 out of 10 adults take advantage of CAM therapies with the most common being deep breathing exercises.

In a study published in The American Journal of Hospice & Palliative Care the researchers concluded that “massage, as well as other coveted CAM therapies, available as regularly offered options to enrollees in hospice and palliative care programs may offer significant benefit, particularly if provided over an extended period.”

Research continually shows positive and meaningful improvements in the quality of life of those even with terminal cancers. Because scheduling a massage is a little more intuitive than practicing meditation, we’ve provided some techniques below which were compiled by Cancer Forward.

Sitting Meditation Tips:

• Sit in a comfortable and dignified position. If you are using a chair, sit in one with a straight back with your feet flat on the floor or a bolster if your feet don’t reach the floor. If you sit on the floor, you may want to sit cross-legged style with a thick cushion to raise your buttocks. Either way, the point is to embody the wakefulness that you are cultivating through mindfulness practice and in a position that you can maintain for a while. Allow your hands to rest comfortably on your lap.
• If it is comfortable, close your eyes. If not, keep your eyes open, positioning your head straight ahead and then lower your gaze to a spot on the floor.
• Make a gentle intention to be alert and aware of your experience.
• When you are ready, draw your attention to your breathing. Notice your breath wherever you notice it the most. Allow the breath to be as it is. Don’t try to change your breathing, just bring gentle awareness to it.
• During meditation, the mind will leave the breath. This is not considered a distraction, but part of the practice. You do not have to try to suppress thoughts. Each time you notice that your mind has left your breath, take no responsibility for its wondering. The mind simple wanders. With patience and gentleness, bring your attention back to the breath. If you notice that you are judging yourself during this process, you can let go of that judgment.
• You may start with a few minutes or as long as you want. People with an established practice typically meditate for 20 to 45 minutes.
• When your practice of focusing on the breath feels stable, you can expand your attention to include focusing on your body as a whole, your thoughts and feelings or perhaps the sounds around you. Note the nature of thoughts and feelings and that individual thoughts do not last long. Avoid being drawn into thinking about the thoughts, simply observe and note them. Come back to your breath if you get lost in this process.
• If you have the urge to react to physical sensations, such an itch, simply notice the urge and stay with the focus of your meditation. After experimenting allowing the sensation to be present without changing, if you feel you need to move, then do so with awareness.

Countries with the greatest number of mesothelioma deaths per 100,000 include

• United Kingdom: 3.3-3.6
• Australia: 3.2
• The Netherlands: 2.85
• New Zealand: 2.5
• Belgium: 2.0
• Republic of Malta: 1.2

Countries with the fewest numbers of Mesothelioma diagnoses per 100,000 include

• Ireland: .8
• Lebanon: .3-.6
• Poland: .3
• Estonia: .3
• Spain: .2
• India: .05

To view the full journal article click here.

At the conference, scientists and researchers from around the world reported their most recent breakthroughs and innovations for various forms of cancer.

One of the stand out presentations for the week included Bristol-Myers Squib drug in first phase clinical trials called Opdivo (MDX-1106). The drug increased the five year survival for some patients with non-small cell lung cancer to 16% from the National Cancer’s Institute’s rate of 4.9%. To read the whole study click here.

Opvido operates by blocking the PD-L1 protein and leading the immune system to fight the cancerous cells. This type of treatment protocol also is a signature of fighting pleural mesothelioma. The results are very promising for other types of cancers including asbestos related ones.

Dr. Brahmer stated that, “We are performing further studies to learn why these patients did so well for so long and better understand which patients can stop treatment at two years and which of them need to continue treatment beyond two years.”

The researchers are investigating the use of an immune system modulator called FTY720which comes from a fungus called Iscaria Sinclairi. The results were published in The Journey of Translational Medicine.

Scientists believe that FTY720 has potential therapeutic applications for other cancers as well but the University of Hawaii’s tests represent the first time that the treatment has been used for pleural mesothelioma. Currently the test has just been performed on mice but the results are promising.

Agata Szymiczek, author of the published study, stated that, “FTY720 administration in vivo [in a live subject] effectively reduced tumor burden in mice without apparent toxicity.” While there is still much work to be done, we remain hopeful that there may be positive results in the near future.