Mesothelioma Histology

 

Mesothelioma Histology

Cancer specialists can uncover important microscopic features of your disease with the science of histology. These features play an important role in diagnosis, treatment and your life expectancy.

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Histology is a branch of biology and medicine that involves the study of the cells and tissues of animals and plants. Samples of tissue are stained on a slide and observed under a microscope to study the structure and composition of each cell. Because mesothelioma histology involves the study of cancerous mesothelial cells, it is considered a branch of histopathology, which is the study of diseased cells. Trained medical doctors, usually board-certified pathologists, examine the tumor tissue under a microscope and classify cells by type.

Histopathology is within the larger field of pathology, which studies the nature, cause and effect of diseases. Pathologists are highly trained medical professionals who examine tissue samples to get an accurate diagnosis, and they’re assisted by histotechnicians and histopathologists, who help with tissue staining to identify diseased cells.

There are several types of mesothelioma cancer cells. Each cellular type responds to different treatments and affects the individual patient's prognosis, so an accurate diagnosis of cancer cell type is essential to develop an effective treatment plan. After treatment is administered, studying tissue samples can also provide insight on the effectiveness of chemotherapy drugs and other treatments.

Histology also helps prevent mesothelioma misdiagnosis. For example, peritoneal cancer in women and ovarian cancer can be difficult to differentiate without analyzing the cell type through histopathology. If patients are pursuing legal action against an asbestos-producing company that may have caused their cancer, a misdiagnosis can also negatively affect their chances of obtaining compensation.

Cell Types

When specifically examining a tumor sample for the presence of mesothelioma, a histopathologist will carefully inspect the sample for three types of cells:

Epithelial cells appear most often in these tumors, and this subtype accounts for 50 to 70 percent of all cases. These cells, which are uniform and sharply defined, feature prominent nuclei and often form complex branching patterns.

These spindle-shaped sarcomatoid cells typically lack strong characteristics and occur in approximately 10 to 20 percent of reported cases. While they are the most aggressive cell type, they are also the least common.

Malignant mesothelioma is considered biphasic when both epithelial and sarcomatoid cells are present and each type accounts for at least 10 percent of the tumor's mass. Biphasic (mixed) cells are present in 20 to 35 percent of all mesothelioma cases.

Dr. Fontaine explains how does mesothelioma cell types affect a patients treatment options.

Doctors use these histological classifications to develop a prognosis and treatment plan for patients. Although the life span associated with mesothelioma can be short, your cell type can account for differences in life expectancy ranging up to 200 days.

Cell Types

Of all subtypes, tumors involving epithelial cells are typically most responsive to treatment, which often leads to a better prognosis. Because sarcomatoid cells are the most resistant to treatment, some surgeons do not consider sarcomatoid tumors eligible for surgery. The biphasic cell type is also considered less responsive to treatment than epithelial.

Diagnosing a patient's specific type of cancer can be challenging for doctors. One common obstacle is differentiating mesothelioma from adenocarcinoma, the most common form of lung cancer among non- smokers.

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Characteristics of Malignant Mesothelioma Cells

Each specific cell type has different visible characteristics. For example, sarcomatoid cells have elongated nuclei, while epithelial cells are most commonly distinguished by the identification of microvilli (microscopic protrusions of a cell) or cell organelle.
The characteristics noted in the different cell types are very subtle. Unfortunately, this can make the diagnosis process quite challenging. Specifically, distinguishing mesothelioma cells from adenocarcinoma cells, a cancer that affects glandular tissue, can be a serious challenge because the cells can appear similar.

Fast Fact: Frozen section fixation is a histology process where a surgically removed tumor is quickly frozen. A slice of the frozen tissue is stained and placed on a slide to determine if a tumor is malignant, usually while the patient is still in surgery.

Rare Variances in Histological Mesothelioma Types

• Deciduoid
• Desmoplastic
• Lymphohistiocytoid
• Small Cell

• Deciduoid Mesothelioma

  A rare variant of epithelial mesothelioma, this cell type has been diagnosed in approximately 45 cases. Roughly half of these cases originate in either the pleura or the peritoneum.
  

• Desmoplastic Mesothelioma

  A form of sarcomatoid mesothelioma, the framework of these cells is more than 50 percent collagenized, or made up of fibrous tissue that produces collagen.
  

• Lymphohistiocytoid Mesothelioma

  This cell type is a rare and often misdiagnosed variant of sarcomatoid mesothelioma that contains histiocyte-like dense lymphocytic infiltrates.
  

• Small Cell Mesothelioma

  A rare variant, this cell type occurs when at least 50 percent of desmoplastic cells are formed by small cells.
  

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Additional histological variances include adenoid cystic, tubulopapillary, glandular, histiocytoid, microcystic, macrocystic, signet ring, single file; diffuse, not otherwise specified (NOS), glomeruloid, poorly differentiated (large cell) or pleomorphic, mucin positive, gaucher cell-like, in situ and well-differentiated papillary.

The Histology Process

Before a diagnosis of cell type is made, tissue samples are obtained and prepared for study. Teams made up of surgeons, histotechnicians, histopathologists and other professionals work together to provide a patient's doctor with information.

When testing for mesothelioma, a medical test involving the removal and examination of cells, tissue or fluids from the body, known as a biopsy, is often performed. After the biopsy, the tissue is prepared by specialists called histotechnicians. These scientists process the tissue by preserving it and staining it with a number of special chemicals that will reveal the minute structures of the cells. They also observe the size, shape and anatomical structure of cells, which helps identify the cell type.

How Histotechnicians Prepare a Tissue Sample for Staining

Fixing

Makes the tissue more rigid and allows for easier slicing. The tissue is placed in a chemical like formaldehyde.

Sectioning

Takes place in a machine called a microtome. The microtome can slice extremely thin pieces of the sample.

Embedding

The tissue is embedded in a block of paraffin or plastic resin to make the material easy to cut.

Mounting

After the slices of embedded tissue are smoothed out in a water bath, they are placed on slides and baked to set the paraffin.

After the cancerous tissue is mounted and stained on a slide, the specimen is now ready for study. Then, histopathologists take the slide and view it under a microscope. They can determine what type of cancer may be present by viewing the structure of cells in the tissue.

In addition to staining, histotechnicians may choose to use different techniques for highlighting the details in cells that may be of interest, such as in situ hybridization and immunohistochemistry. In situ hybridization uses the application of fluorescent or radioactive probes to bind DNA and RNA and analyze the genes of a cell. Using this method, scientists can detect genetic abnormalities present in the cells.

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Immunohistochemistry

Immunohistochemistry is based on the principle that antibodies bind to specific antigens and proteins called oncoproteins in human tissue. Different antibodies are applied to tissues on a microscope slide. The tissue samples are then analyzed for specific visual patterns created by the interaction of antibodies and proteins.

Immunohistochemical staining is widely used in the diagnosis of mesothelioma cells and other abnormal cells. However, many medical experts say that immunohistochemistry should be used in context with other diagnostic data. In other words, the results of an immunohistochemistry analysis should not be considered the primary indicator for a mesothelioma diagnosis.

However, other studies have found that immunohistochemical stains improve the accuracy of diagnosis. In one Japanese study, it was estimated that 10 to 15 percent of patients received an inadequate diagnosis. Since many patients require this diagnosis for legal action, the study recommended improving current diagnostic techniques by improving the quality of immunohistochemistry stains.

Two antibodies often used to aid in diagnosis are BerEP4 and vimentin. BerEP4 is helpful in the diagnosis of epithelial mesotheliomas. However, immunohistochemists are still researching the efficacy of BerEP4 as a diagnostic indicator, because this antibody has appeared both in mesotheliomas and other similar tumors.

Like the antibody BerEP4, vimentin helps diagnose mesothelioma, but the protein also appears in other tumors. Because vimentin appears in other malignant tumors, it is not considered a discriminatory marker for mesothelioma, but rather a piece of the diagnostic puzzle.

 

Testicular Mesothelioma

Testicular mesothelioma is a cancer of the membrane lining that covers the testicles. This rare disease, also known as mesothelioma of the tunica vaginalis testis, accounts for less than 1 percent of all mesothelioma cases.

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This diagnosis puzzles researchers because most people with mesothelioma can trace their disease to the inhalation or ingestion of asbestos dust or fibers.

Most testicular mesothelioma patients have no history of asbestos exposure. There is limited research on testicular mesothelioma because of the rarity of this diagnosis.

Despite the limited number of known cases, men with this type of cancer have a significantly better prognosis than most people with other forms of mesothelioma. Most studies report median survivals of about 20 to 23 months, and one patient lived 15 years after diagnosis.

Symptoms and Diagnosis

There is no set of symptoms unique to testicular mesothelioma. Many people with this cancer initially receive the wrong diagnosis because doctors may mistake it for a more common condition such as a hernia.
The most common symptom is a hydrocele, a buildup of fluid in the scrotum. Men may also notice an abnormal lump inside the scrotum or pain and swelling of the testicles. Typically, testicular mesothelioma is only properly diagnosed during surgery.
The diagnostic process usually starts when someone visits the doctor to discuss a problem with his testicles. The doctor will ask about the patient’s medical history and perform a physical examination.
Next, the doctor will order an ultrasound, a type of imaging scan that is 90 percent accurate for detecting testicular tumors. If a potential tumor is spotted, a CT scan will be performed to determine the stage of the tumor and whether the cancer has spread.
To confirm the tumor is testicular mesothelioma, doctors can collect a blood sample and perform a blood test. They look for mesothelioma tumor markers, or substances released by mesothelioma tumors that help confirm a diagnosis. Tumor markers for testicular mesothelioma include calretinin, cytokeratin 5/6 and Wilms’ tumor gene 1, also known as WT1.
A much more accurate way of confirming a mesothelioma diagnosis is performing a biopsy. This involves removing a tissue sample from the tumor and sending it to the lab for testing. Evaluating the sample with a technique called immunohistochemical staining helps doctors determine if the patient has testicular mesothelioma or another condition.

Treatment

Testicular mesothelioma treatment typically involves removing a portion of one testicle, or an entire testicle if necessary, depending on the extent of the cancer.
One 2015 study explains the most effective surgery for localized testicular mesotheliomas that have not spread is a radical inguinal orchiectomy. This procedure removes the affected testicle and the entire spermatic chord. If the cancer has spread to nearby lymph nodes, doctors will remove them as well with a surgery called lymphadenectomy.
Surgery may be followed by chemotherapy with cisplatin and pemetrexed. Radiation therapy may be offered next to kill any remaining cancer cells and prevent the cancer from returning. If the cancer is diagnosed at an early stage, chemotherapy and radiation therapy may not be needed after surgery.
In some cases, testicular mesothelioma is a secondary tumor, with the primary tumor located within the peritoneum, the membrane that lines the abdominal cavity. For situations like this, doctors will have to treat the patient for peritoneal mesothelioma as well.
Doctors treat peritoneal mesothelioma with similar techniques to those described above — a combination of surgery and chemotherapy. Radiation therapy is often avoided because of the damage it can cause to vital organs near the tumor. A special technique called HIPEC may also be used. This involves delivering high doses of heated chemotherapy immediately after surgery.

It should be noted that peritoneal and testicular mesothelioma are classified as being clinically aggressive types of cancer. This means they can spread rapidly. In addition, the testicular type tends to recur within a few years, even in cases where tumors are surgically removed.

Asbestos and Testicular Mesothelioma

Because this type of cancer is extremely rare, little is known about how it develops. Most researchers theorize there are two possible points of origin for testicular mesothelioma. The tunica vaginalis, the membrane where the cancer develops, is composed of mesothelial cells, which are present in most of the body's membranous linings. The tunica vaginalis is made up of two layers, known as the parietal (outer) and visceral (inner) layers.
Firm white-yellow nodules can be found on the serosal surface of the tunica vaginalis. The nodules can eventually encase the contents of the scrotum and cause the tunica vaginalis to thicken.
While there is currently no theory to explain how asbestos exposure might cause a primary tumor to develop in the testicles, it is understood that once the asbestos fibers enter the body, they can become lodged in organs and cause inflammation or infection. Eventually, this can result in the development of mesothelioma. The fibers cause cancerous cells to divide abnormally, causing buildup of fluid and the formation of tumors.
Once cells have become cancerous, they are no longer able to regulate their own cycles of growth and division. A primary tumor that develops in the testicle is formed from cancerous cells that divide without restraint, which causes the thickening of the tunica vaginalis and can eventually lead to the formation of tumors.

Legal Claims

As with other asbestos-related injuries, legal compensation may be available for men who develop testicular mesothelioma.

In September 2013, a South Carolina jury awarded $38 million to a former millwright who developed testicular mesothelioma. Given the extreme rarity of the cancer, the case may be one of relatively few lawsuits involving the disease, compared with widespread lawsuits for other asbestos-related illnesses.

The plaintiff, Lloyd Strom Garvin, alleged he was exposed to asbestos-laced gaskets and valve packing stemming from the negligence of 13 defendants. He and his wife filed their lawsuit in the South Carolina Court of Common Pleas for Richland County. The jury took only four hours to deliver its verdict following a 12-day trial.

The case is significant, not only for the plaintiff's substantial award, but also because the plaintiff successfully proved his illness was caused by asbestos exposure. Although mesothelioma is caused almost exclusively by asbestos exposure, a small number of cases have been reported with no known exposure to asbestos. Therefore, it's a good idea for all mesothelioma claimants, including those who are diagnosed with testicular mesothelioma, to get a mesothelioma attorney's help when tracing their exposure history.

Pericardial Mesothelioma

 

Pericardial Mesothelioma

It's one of the rarest types of asbestos-related cancers. Treatment options are few because the heart lining, which is where tumors develop, is too close to the delicate organ; however, there are some cases where surgery can help remove small tumors.

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Pericardial mesothelioma develops in the thin membrane surrounding the heart, known as the pericardium. The membrane has two layers: An outer layer called the parietal layer, heart sac or theca cordis; and an inner layer known as the visceral layer or epicardium.

There are four common forms of mesothelioma, and pericardial and testicular are the rarest. To date, approximately 200 cases of pericardial mesothelioma are described in medical literature — that's 1 percent of all known diagnosed mesotheliomas.

Almost all mesotheliomas can be traced to asbestos exposure, but medical researchers continue to study the link between asbestos and cancer of the pericardium. Studies are clear on how inhaled microscopic fibers reach the lungs, but less clear on how the fibers reach the heart.

This form of cancer strikes twice as many men as women, and is most often diagnosed in people between the ages of 50 and 70. Like the other types of mesothelioma, the disease develops over a long period of time — one to five decades — and is typically discovered at a later stage. Symptoms include chest pain, fatigue and shortness of breath. Diagnosis is difficult because symptoms mimic those of other disorders.

Pericardial treatment options: Surgery (if a patient is deemed healthy enough), chemotherapy, radiation therapy or a combination of all three modalities. About half of the people who contract the pericardial type survive longer than six months.

What Are the Symptoms of Pericardial Mesothelioma?

Most pericardial mesothelioma patients experience no symptoms when the cancer initially develops, a fact that contributes to a late-stage diagnosis. The symptoms also resemble those of other heart conditions, making the cancer difficult to accurately diagnose. Most symptoms are caused by fluid buildup around the heart and thickening of the pericardial layers.
Most symptoms are caused by the buildup of fluid and the thickening of pericardial layers. The presence of any of these symptoms should be followed by a visit to the doctor with recommended screenings such as an X-ray or CT scan.

The following symptoms may indicate pericardial mesothelioma:

Heart palpitations or irregular heartbeat (arrhythmia)
Difficulty breathing, even when at rest (dyspnea)
Murmurs
Cough
Shortness of breath when lying flat
Chest pain
Fatigue
Fever
Night sweats

If you are experiencing any of these symptoms, especially heart-related symptoms, schedule an appointment with your doctor immediately. Screening tests like X-rays, CT scans and echocardiograms can usually reveal the underlying cause of these health problems.

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How Does Asbestos Cause Pericardial Mesothelioma?

The causal relationship between asbestos exposure and this type of mesothelioma is not fully understood. Researchers confirm the pleural and peritoneal types of the cancers are primarily caused by exposure to asbestos, yet the causes of the pericardial type are less definitive. Some patients with this rare type of mesothelioma have a history of exposure, but the limited number of reported cases prohibits researchers from effectively analyzing the relationship between the two. A 1982 study found a history of asbestos exposure in three of 15 cases, and a 1994 study reported asbestos exposure in four of 15 cases.

Pericardial mesothelioma is thought to occur when asbestos lodges itself around the heart.

Asbestos fibers can become lodged in the membranes that surround the heart. When this occurs, just as it does in the linings of the lungs and abdomen, the body experiences extreme difficulty in eliminating the fibers. They can remain stuck in the membranes, and over a long period of time — sometimes up to 50 years — the asbestos fibers cause the cells to undergo changes that may result in cancer.
Once cells become cancerous, they begin to divide more rapidly, without the restraint that regulates the growth cycles of healthy cells. As the mesothelioma cells continue to grow, they cause the lining of the heart to thicken, and eventually tumors develop. These changes in the membrane lead to the buildup of fluid between the pericardial layers, which combined with the thickening of the layers, puts pressure on the heart.

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How Is Pericardial Mesothelioma Diagnosed?

To diagnose pericardial mesothelioma, doctors make a cumulative assessment of your symptoms, medical history and current medical condition. Next, you will receive a physical examination, imaging tests and biopsy to determine the location of tumors and confirm whether or not they are cancerous.
When you see a doctor to discuss heart-related symptoms, one of the first diagnostic tests you will receive is an echocardiogram, which is essentially an ultrasound for your heart. This noninvasive test uses sound waves to help doctors see the size and shape of your heart and determine how well it's working overall.
Although an echocardiogram can reveal fluid buildup around the heart and help guide pericardiocentesis, the procedure doctors perform to drain the fluid, other imaging scans are needed to determine if potential tumors are present. If doctors spot abnormal growths, they need to take a fluid or tissue sample and perform a biopsy, which can confirm a mesothelioma diagnosis.

Physical Examination

A small percentage of all heart-related mesothelioma diagnoses, between 10 and 20 percent, are made before a patient dies. Some of the challenges with early and accurate diagnosing of the pericardial type include the minuscule number of people with the disease and the delayed presentation of symptoms.

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Imaging Tests

Radionuclide imaging is an advanced detection method involving the injection of radiogallium, a radioactive material, to identify cancerous cells. It was reportedly used to detect at least one case of this type of cancer. Patterns of radioactivity show possible tumor sites in the human body.

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Biopsy

A biopsy is a crucial diagnostic procedure that can be more suitable in determining the cancer's point of origin. A surgeon will remove tissue or fluid from the pericardium, examine its cells under a microscope to positively confirm the presence of pericardial mesothelioma.

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Computed tomography (CT) scans are effective for detecting pericardial tumors, making them a preferred diagnostic tool. Magnetic resonance imaging (MRI) can also yield extremely successful results in identifying and assessing the cancer. These tumors generally are not localized, and they tend to cover most of the heart. Furthermore, this cancer type accounts for approximately half of all pericardial tumors.

Seek a Second Opinion to Avoid Misdiagnosis

Because pericardial mesothelioma symptoms like chest pain, cough and difficulty breathing are shared with various other diseases, it's crucial to meet with a specialist to confirm your diagnosis. To ensure an accurate diagnosis and prompt treatment, you need to speak with an expert who knows the intricacies of this rare cancer.
Pericardial mesothelioma is often mistaken for more common heart illnesses, including:

• Heart failure
• Coronary heart disease
• Tuberculosis pericarditis
• Constrictive pericarditis
• Cardiac tamponade
• Intra-atrial myxoma
• Cardiomyopathy

If you have been diagnosed with any of these conditions, always seek a specialist to confirm. An accurate and early diagnosis not only gives you access to a wider range of treatment options, but it may also lead to improved survival.

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What Treatments Are Available?

Treatment options are limited because the heart lining rests so closely to the heart itself that most therapies can easily damage this delicate organ. Most patients with pericardial mesothelioma are not ideal candidates for surgery, which is often the most effective treatment for this cancer. However, there are rare cases where the cancer is diagnosed early and surgery can be carried out to remove small, localized tumors. Still, any surgery near this area is extremely dangerous because of the close proximity to the heart.
The four primary treatment options for pericardial mesothelioma are pericardiectomy, chemotherapy, palliative treatment and fine needle aspiration.

• Pericardiectomy
• Chemotherapy
• Palliative Treatment
• Fine Needle Aspiration

• Pericardiectomy

  Patients who doctors decide are good candidates for surgery are treated with a pericardiectomy, the surgical process of removing part or all of the pericardium. A pericardiectomy can relieve pressure and minimize fluid buildup, allowing the heart to continue functioning properly. A pericardiocentesis removes excess fluid from the pericardium to relieve pressure around the heart.
  

• Chemotherapy

  Chemotherapy is an option that is normally considered for asbestos-related cancers, but the clinical benefits seen in pericardial patients who received this treatment were minimal. Similarly, radiation therapy, which is considered one of the primary therapies for most peritoneal and pleural cases, is considered minimally effective for this rare cancer.
  

• Palliative Treatment

  Palliative treatment options are the most viable and common treatments, which aim to minimize pain and reduce the symptoms caused by the buildup of fluid in the pericardium. Essentially, palliative care can improve quality of life and make patients more comfortable. Palliative treatments can include therapies that relieve pain and pressure around the heart, such as a pericardiocentesis or pain medication.
  

• Fine Needle Aspiration

  Another treatment that removes excess fluid is known as a fine needle aspiration. This palliative procedure is more commonly used as a diagnostic method for pleural mesothelioma patients, but can provide comfort for certain patients.
  

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What Is the Average Prognosis?

The common prognosis for the pericardial type is poor, compared to that of peritoneal or pleural mesothelioma. Nearly 50 to 60 percent of pericardial patients pass away within six months of receiving a diagnosis. However, this is not the case for everyone.
Hope exists for some patients because researchers have cited positive results after surgery to remove local tumors. In one study, surgery to remove part of the heart's lining combined with radiation therapy improved survival in two patients.
One patient lived a year after treatment, and another was alive five years after treatment. Smaller, less impactful benefits were demonstrated from chemotherapy.

Early diagnosis can yield a more optimistic prognosis, often resulting in more treatment options.

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Author

Karen Selby

Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining Asbestos.com in 2009.

Peritoneal Mesothelioma

 

Peritoneal Mesothelioma

Peritoneal mesothelioma is one of the four primary types of malignant mesothelioma. The name stems from the area where the cancer develops, along the peritoneum, also known as the lining of the abdomen. Roughly 250 to 500 new cases of peritoneal mesothelioma are diagnosed in the U.S. each year, making it the second-most common mesothelioma type.

All mesotheliomas, including peritoneal, stem from extended exposure to asbestos, usually at work. People diagnosed with the disease often can pinpoint a time in their lives when they were around asbestos dust, fibers or products for a sustained period. This exposure leads to ingestion or inhalation of microscopic asbestos particles, which can produce cancerous cells and then tumors.

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Mesothelioma in the Peritoneum

The peritoneum is a protective membrane that surrounds the abdomen, or belly. It has two layers, and mesothelioma can develop on both. The parietal layer covers the abdominal cavity, while the visceral layer surrounds the stomach, liver and other organs of the abdomen. Together, the layers support the abdominal cavity as a whole and the organs within it.

What Causes Peritoneal Mesothelioma?

Although no definitive answer is available, cancer experts most commonly associate the cause of peritoneal mesothelioma with the following theories:

• Swallowed asbestos fibers travel from the digestive system to the peritoneum.
• Inhaled asbestos fibers reach the peritoneum through the lymphatic system, which produces and stores cells that fight disease.

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Peritoneal Mesothelioma Symptoms

Early symptoms of peritoneal mesothelioma can include abdominal pain or swelling, and diarrhea or constipation. Unfortunately, some patients don't experience any symptoms until tumors have spread. This scenario makes treating the disease hard and surviving it even harder.

Common peritoneal mesothelioma symptoms include:

Abdominal pain or swelling
Diarrhea or constipation
Changes in bowel habits (including diarrhea or constipation)
A feeling of fullness
Night sweats or fever
Unexplained weight loss
Nausea or vomiting
Fatigue
Anemia

You may not experience cancer symptoms for 20 to 50 years after your first exposure to asbestos. Once asbestos fibers reach the peritoneum and irritate the cells, the peritoneal lining starts to thicken. As the cancer develops, the buildup of excess fluid in the abdomen, known as ascites, may occur next. Over time, tumors form and place pressure on the organs.

Diagnosis

The latest advances in medical technology allow doctors to diagnose this disease earlier than ever before, yet even experienced cancer doctors can struggle to diagnose it accurately. In fact, the process can take months.

Peritoneal mesothelioma accounts for 10-20 percent of all diagnosed cases.

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The Diagnostic Process for Peritoneal Mesothelioma

The process of diagnosing peritoneal mesothelioma is similar to that of other types. It starts with a thorough examination of your medical history, occupational history, and overall physical condition, followed by a series of tests including imaging scans and biopsies.
Be sure to mention any history of asbestos exposure, even if your doctors forget to ask. It's important to share every detail you can remember, including the dates the incidents occurred and the length and duration of the exposures. This information will alert your doctors about the possibility of an asbestos-related disease and help them determine the appropriate next steps.
Because this cancer is so rare, doctors who lack experience with the disease often misdiagnose mesothelioma patients with more common illnesses who have similar symptoms — a serious mistake that delays proper treatment. Peritoneal mesothelioma symptoms like abdominal swelling, weight loss and hernia also arise in other abdominal cancers and many less serious conditions, increasing the likelihood of a misdiagnosis.
If you have a history of asbestos exposure, the best way to ensure an accurate diagnosis is to schedule an appointment with a specialist. Doctors who specialize in mesothelioma and other asbestos-related conditions have the knowledge and tools needed to make a prompt diagnosis and explain all the treatment options available to you.

Imaging Scanning

When a patient is experiencing symptoms like pain or swelling in the abdomen, doctors likely will ask for a chest X-ray, CT scan or another type of imaging scan. These tests will help detect potential tumors and show any cancer spread. They also help doctors choose the best biopsy locations.

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Biopsies

Biopsies come next. Radiologic biopsies are minor procedures that pull fluid and tissue samples that can be inspected under a microscope and can be used for other tests. This is an essential step in the diagnostic process because only a biopsy can confirm a peritoneal mesothelioma diagnosis.

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Sometimes doctors need to perform a laparoscopic surgical biopsy, which is more invasive. In both cases, pathologists look to see if lab results show cancerous cells in your peritoneal fluid or tissue. This delay, combined with the speedy progression of tumors, usually results in a late-stage diagnosis for most patients.

Prognosis

Doctors who treat peritoneal mesothelioma generally deliver a projected life expectancy of less than one year. However, one promising and innovative treatment called HIPEC, which combines surgery and heated chemotherapy, can extend survival by several years.
Peritoneal cancer survival rates are better among those with an early diagnosis (stage I and stage II) than a late stage (stage III and stage IV) which makes early detection a key in improving a patient's prognosis. Stage I or stage II diagnoses typically give oncologists more options for treatment and gives patients more time for those treatments to work.
Although the stage of the cancer is the most important factor for determining the peritoneal cancer survival rate early, other things about the cancer can be meaningful. The location of tumors, their cell type, a patient's age and overall health all come into play. Someone who can withstand aggressive treatments like surgery often have an improved long-term prognosis.

25 percent of peritoneal mesothelioma patients survive three years after diagnosis.

There are many stories of patients surviving several years after diagnosis. The best way for you to improve your prognosis is by seeking the best available treatment options.

Treatment Options

Although an increasing number of cancer specialists have emerged as treatment leaders for peritoneal diseases in recent years, the total number of specialists remains small. If there are no peritoneal specialists nearby, you may want to look for one in a neighboring state.
Treatment options for peritoneal mesothelioma include surgery, chemotherapy, radiation therapy and combination therapy. Doctors believe combining traditional treatments often works better than any single treatment. A combination of one or more treatments is called multimodal therapy. Research shows that a multimodal treatment approach usually offers the best improvement in terms of survival.
The most promising therapy for peritoneal mesothelioma may be heated intraperitoneal chemotherapy (HIPEC), a multimodal treatment that combines surgery and heated chemotherapy. While doctors only give HIPEC on a case-by-case basis, it has shown excellent results for select patients in terms of extended survival and improved quality of life. In studies on small groups of patients treated with HIPEC, some people lived five years or longer.
To qualify for HIPEC, a patient's cancer must be limited enough for doctors to completely remove with surgery, and must not have spread beyond the abdomen. In addition, qualifying patients must spend more than half of their waking hours up and about and be capable of self-care, which includes basic health maintenance, personal hygiene and the ability to follow doctor recommendations. In studies on small groups of patients treated with HIPEC, some people lived five years or longer.

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• Surgery
• Chemotherapy
• Radiation
• Alternative Treatments

• Surgery

  Surgery is the most promising traditional treatment option for peritoneal mesothelioma, but it is only effective for early-stage cancer. Because doctors most commonly diagnose asbestos-related diseases after the cancer has spread, most surgeries only attempt to remove sections of the tumor.
  Surgery can be curative or palliative. Curative surgery aims to remove as much of the tumor as possible in hopes of curing the cancer. Otherwise, doctors may perform palliative surgery, which aims to remove parts of the tumor to relieve symptoms and improve quality of life. Palliative therapies do not stop the cancer.
  Tumor spread is usually too vast at stage IV for surgery to completely remove the cancer. Surgery with a curative intent is not recommended at stage IV. However, a surgery to remove the majority of tumors may be performed to alleviate pain and improve breathing.
  

  Learn more about mesothelioma surgeries

  

  Typical surgeries include peritonectomy, cytoreductive surgery, bowel resection and removal of some organs.

• Chemotherapy

  Doctors can provide chemotherapy drugs that shrink tumors and slow the growth and spread of cancer. It can be given before, during or after surgery. In some cases, doctors offer chemotherapy as the only treatment option. Chemotherapy drugs considered effective in peritoneal treatment include pemetrexed, cisplatin, carboplatin and gemcitabine.
  

  

  Doctors are now seeing extraordinary results with HIPEC. Once an experimental treatment, HIPEC starts with surgery to remove all visible tumors from the patient’s peritoneum. Next, doctors introduce a heated salt-water solution that contains chemotherapy drugs.
  A machine pumps the medicine throughout the patient’s abdomen, which helps destroy any cancer cells left behind after surgery. Some peritoneal mesothelioma patients who receive HIPEC can live several years after diagnosis.
  

  Learn more about chemotherapy for mesothelioma

• Radiation Therapy

  Although some studies show radiation therapy can improve survival slightly when combined with surgery and chemotherapy, doctors tend not to recommend radiation for peritoneal patients. Even though targeted radiation can shrink tumors and slow cancer growth, the procedure is risky because of the location of these tumors. The peritoneum wraps around the stomach, liver and intestines. Aiming radiation at nearby tumors could harm these organs and cause damage.
  

  Learn more about radiation therapy for mesothelioma

  

• Alternative Treatments

  Alternative treatments and emerging therapies are available, but these treatments have less predictable outcomes. One emerging therapy called immunotherapy works by boosting the body’s immune system to help fight off cancer. However, research on this approach mainly focuses on the treatment of pleural mesothelioma, which develops in the lining of the lungs.
  Many patients find hope in clinical trials, medical studies that test new and experimental treatments. Research from clinical trials helps improve treatment outcomes and may bring us the standard treatments of tomorrow.
  

  Learn more about alternative mesothelioma treatments

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Omental Mesothelioma

Omental mesothelioma is a rare form of cancer that grows in the omentum, a sheet of fatty tissue in the abdomen that hangs in front of the intestines like an apron. The omentum protects our organs, stores nutrients and prevents the spread of infection. The peritoneum covers the omentum, and both contain mesothelial cells that can turn cancerous and form tumors.
Peritoneal mesothelioma usually causes omental mesothelioma because the cancer spreads from the peritoneum to the omentum. It's also possible for cancer to develop in the omentum and spread to the peritoneum, but fewer than five cases like this have been reported in medical literature.
Symptoms of both cancers are similar, although someone with omental cancer may experience lower back pain and no other symptoms. Because this kind of cancer is so rare, it is difficult to diagnose and treat. In some cases, surgery and chemotherapy have proved successful.
It's unclear if the prognosis for patients with omental mesothelioma is better, worse or the same as for patients with peritoneal cancer. While there is not much data available on patient outcomes, some evidence suggests a reason for optimism.
In 2009, a patient diagnosed with omental mesothelioma was treated successfully with chemotherapy. When the study was published 14 months after diagnosis, the patient was still alive. In another case reported in 2004, surgeons removed a malignant tumor from the omentum and watched the patient recover and remain in good health for nearly three years.

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Author

Dr. W. Charles Conway

Dr. Conway is a surgical oncologist who joined the Ochsner Medical Center in New Orleans in 2009, taking a special interest in peritoneal mesothelioma, along with pancreatic, esophageal and

Pleural Mesothelioma

 

Pleural Mesothelioma

Pleural mesothelioma is a malignant cancer that develops on the lining of the lungs called the pleura. It is the most common type of mesothelioma. Although the prognosis is typically poor, finding a pleural cancer specialist can diversify your treatment options and help improve your prognosis.

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Pleural mesothelioma accounts for about 75 percent of all mesothelioma cases. Like other types of mesothelioma, this particular form of the disease gets its name because of where it is formed — in the pleura, a soft tissue that surrounds the lungs. In almost all cases, pleural mesothelioma is caused by asbestos exposure.

The first symptoms of pleural mesothelioma typically include chest pain and shortness of breath. You may experience no symptoms at all in the first few stages of the cancer’s progression.

The life expectancy of someone with pleural mesothelioma is less than 18 months, but some patients live much longer. It often takes decades (20 to 50 years) for mesothelioma to develop after someone is first exposed to asbestos. This lag time — called a latency period — explains why the disease usually affects older people.

How Asbestos Leads to Mesothelioma

Once inhaled into the lungs, asbestos travels to the pleura. The body then struggles to get rid of the needle-like fibers. Over a long period of time, trapped fibers irritate the pleural membrane, causing chronic inflammation and scarring.

Odds of Development

In 2 to 10 percent of people heavily exposed to asbestos, the trapped fibers cause pleural mesothelioma by triggering genetic changes in cells that make up the pleura. These cancerous cells grow fast and uncontrollably, forming tumors that wrap around the lungs.

Who Is Affected?

About 80 percent of people diagnosed with pleural mesothelioma are older men, mainly because most asbestos exposure occurred at industrial jobs traditionally worked by men.

What Are Pleural Mesothelioma Symptoms?

Symptoms of pleural mesothelioma include persistent dry or raspy cough, coughing up blood (hemoptysis), shortness of breath (dyspnea), and difficulty swallowing (dysphagia). There are four stages of mesothelioma that doctors use to describe how far the cancer has progressed. For many people, unfortunately, symptoms are not noticeable until the cancer is in a later stage — stage III or IV.

Asbestos fibers can cause excess fluid to build up between the two layers of the pleura, a condition called pleural effusion. While a little fluid in your pleural space is important, too much can make breathing difficult. The extra fluid puts pressure on the lungs, causing chest pain that gets worse when you cough or take deep breaths.

Tumor Complications Are Largely Responsible for Symptoms, Which May Include:

Persistent dry or raspy cough
Coughing up blood (hemoptysis)
Shortness of breath (dyspnea)
Pain in the lower back or rib area
Painful breathing
Lumps under the skin on the chest
Difficulty with swallowing (dysphagia)
Night sweats or fever
Unexplained weight loss
Fatigue

In their first meeting with a doctor, a majority of pleural mesothelioma patients report chest pain and shortness of breath. Patients rarely mention weight loss and fatigue during their initial doctor visit, but these symptoms may be present if the cancer is in a later stage.

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Diagnosis

Two layers of tissue make up the pleura. These tissues protect and support the lungs and other important structures of the chest. They also produce lubricating fluid between to help the lungs move smoothly as we breathe. The outer layer, the parietal pleura, lines the entire inside of the chest cavity. The inner layer, or visceral pleura, covers the lungs.
Mesothelioma commonly affects both layers of the pleura. The cancer generally forms in one layer of the pleura and rapidly invades the other pleural layer, diaphragm, chest wall or lung. If the cancer reaches nearby glands called lymph nodes, it can metastasize, or spread, to other parts of the body.
Non-cancerous conditions like pleural plaques and atelactasis can develop on the surface of the pleura as a result of asbestos exposure and these conditions are not associated with pleural mesothelioma. They don’t develop into cancer and they don’t increase the risk of developing lung cancer or pleural mesothelioma.

Pleural mesothelioma can be difficult to diagnose, since symptoms usually do not arise until long after the first exposure to asbestos. Since many diseases of the lungs and respiratory system have the same symptoms as pleural mesothelioma, doctors may mistake it for the flu or pneumonia.

Difficult to Confirm a Diagnosis

It is challenging for doctors to tell the difference between pleural mesothelioma and lung cancer. While doctors may suspect mesothelioma based on a patient's symptoms, history of asbestos exposure and irregular imaging scan results, these signs are not enough to confirm a diagnosis.

Reliable Ways to Diagnose

More reliable ways to diagnose the disease include thoracoscopy, which allows doctors to view the patient's chest through a small camera and collect a tissue biopsy, which doctors use to test tissue and fluid samples for cancerous cells.

Diagnostic Imaging

To achieve the best treatment options and survival outlook, an early diagnosis is crucial. After a review of medical and occupational history and a physical examination, patients typically undergo imaging tests that can reveal potentially cancerous tumors. There are three primary imaging tests used to diagnose pleural mesothelioma: Chest X-rays, CT Scans, and PET Scans.

Chest X-rays

X-rays can reveal pleural effusions and pleural-based masses in some cases.

CT Scans

CT scans provide more advanced images that often show evidence of asbestos exposure.

PET Scans

PET scans can also detect signs of cancerous spread to the lymph nodes.

With the introduction of the PET scan in the early 1960s, doctors could better distinguish between cancerous and non-cancerous growths on the pleura. While imaging plays an important role in staging mesothelioma and guiding treatment, it cannot be used to diagnose the cancer on its own.

Cytology and Biopsy

Other tests are needed to diagnose mesothelioma with a high level of confidence. One test is thoracentesis, in which doctors insert a hollow needle into the lungs to collect pleural fluid.
Doctors look at the cell samples from the fluid under a microscope. They look for substances called biomarkers that indicate the presence of cancer. Specialists can use this analysis to make an accurate diagnosis in 80 percent of malignant mesothelioma cases.

Cytologies and biopsies help to accurately diagnose mesothelioma.

Sometimes, however, a thoracentesis isn't enough, or there may be no pleural fluid to study. In these cases, doctors perform biopsies to collect pleural tissue samples. During a biopsy, doctors remove a tissue sample and look for cancerous cells. A thoracoscopic biopsy produces an accurate diagnosis in 98 percent of mesothelioma patients.
If a series of tests or biopsies confirm the presence of mesothelioma, doctors develop a treatment plan based on the results.
Similar diagnostic tests will be performed on different parts of the body for other forms of mesothelioma. For example, even though similar imaging scans and biopsies are used to diagnose all types of mesothelioma, the part of the body that undergoes imaging or biopsy will differ for each type of mesothelioma.
Because mesothelioma locally invades the body cavity in which it develops before spreading, doctors rarely have a hard time differentiating one form of mesothelioma from another. Only in late stage IV cases may there be enough spreading to or from the lung to the abdomen to question whether the cancer originated in the lining of the lungs or abdomen.

Learn more about mesothelioma diagnosis

Treatment Options

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Historically, doctors have treated pleural mesothelioma with traditional cancer treatments like surgery, chemotherapy and radiation therapy. Most treatment plans used a combination of the three which is called multimodal therapy.
Depending on how far your mesothelioma has progressed, these therapies can be either either cytoreductive (meaning reduction of tumor cells) or palliative (meaning control of symptoms).
Cytoreductive treatments aim to control the cancer, while palliative treatments only address the symptoms and try to improve the quality of life for patients.

The most common treatments for pleural mesothelioma are the following:

• Surgery
• Chemotherapy
• Radiation
• Mulitmodal

• Surgery

  Surgery may be a treatment option for pleural mesothelioma patients. One common procedure is pleurectomy/decortication (P/D), in which doctors remove the tumor and affected pleura. A more aggressive surgical option, extrapleural pneumonectomy (EPP), aims to remove the pleura, the entire cancerous lung, the diaphragm and the pericardium, a protective membrane that covers the heart.
  

  

• Chemotherapy

  One of the most common mesothelioma treatments is chemotherapy, which uses one or more drugs to kill cancer cells and decrease the size of tumors. While recent advancements have improved how well patients respond to chemotherapy, success rates have been low overall.
  However, clinical trials that combine several chemotherapy drugs in one treatment have shown great potential. While researchers have not yet found a combination of chemotherapy drugs that can cure pleural mesothelioma, this is a primary goal of countless clinical trials.
  

  

• Radiation Therapy

  During radiation therapy, doctors administer targeted radiation that destroys cancer cells and decreases tumor size. Pleural mesothelioma often resists radiation therapy, but it can be effective for managing symptoms like chest pain.
  One of the most successful radiotherapy techniques is called intensity-modulated radiotherapy. Usually given in intervals after a radical surgery like EPP, this technique prevents cancer recurrence in many cases.
  

  

• Multimodal Therapies

  While there is no single course of treatment for pleural mesothelioma that all doctors agree on, the majority of experts believe that survival is best when several treatments are used. This approach is known as multimodal therapy. Researchers are constantly experimenting with surgery, chemotherapy and radiation therapy to uncover the most effective combination and timing for these treatments.
  In one example of a multimodal pleural mesothelioma treatment, doctors first perform extrapleural pneumonectomy surgery. Radiation therapy is then administered to reduce the risk of local cancer recurrence, and distant spread is prevented with chemotherapy.
  

  

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Complementary Therapies

Some people with pleural mesothelioma take an integrative approach to treatment by combining complementary therapies with traditional cancer treatment. While complementary therapies cannot cure pleural mesothelioma, they can ease cancer symptoms and reduce side effects of cancer treatment.
For example, certain herbs like slippery elm bark may help relieve a cough and pulmonary discomfort. Some yoga breathing techniques may feel soothing to the lungs and most offer a sense of relaxation to ease stress. Mental health counseling is the most effective therapy for psychological stress.
Acupuncture and acupressure are clinically proven to help control nausea and vomiting caused by chemotherapy. Other complementary therapies used in cancer care include:

• Nutrition
• Meditation
• Tai chi and qigong
• Osteopathic medicine

Prognosis

After the diagnostic process, doctors analyze the expected course and outcome for the disease — your prognosis. While some cancers carry promising prognoses, malignant mesotheliomas do not. Providing an accurate prognosis challenges doctors because the disease is so complex and aggressive.

Factors That Affect Your Prognosis

• Stage of disease at diagnosis
• Age of patient
• Gender of patient
• Patient's smoking history
• Painful breathing

The most important factor in a pleural mesothelioma prognosis is the stage of the disease at diagnosis. Staging is how doctors describe cancer's progression. An early stage cancer offers a better change of long-term survival than a late-stage cancer. Patients in otherwise good health who can still perform normal daily tasks tend to respond better to treatment, which is also a significant factor for survival.

Other important prognostic factors include your age, sex and smoking history. Generally speaking, survival rates are higher for female patients, non-smokers and patients younger than 55. A cancerous tumor's cellular makeup — called histology — also can have a major influence on prognosis.

Subtypes

Among the subtypes of this disease, epithelial mesothelioma makes up the most cases (50 to 70 percent) and also offers the most long-term hope.

Pleural Mesothelioma Survival Rate by Year

• 40% Survive one year after diagnosis.
• 20% Survive two or more years after diagnosis.
• 10% Survive three years after diagnosis.

Patients with epithelial mesothelioma respond best to treatment and typically live at least one year. Other subtypes like sarcomatoid and biphasic mesothelioma have poorer survival rates, usually around six or eight months.
Sarcomatoid cells are the most aggressive mesothelioma cells in terms of rapid growth and resistance to treatments like chemotherapy. Because biphasic mesothelioma is a mix of both epithelial and sarcomatoid cells, how a patient responds to treatment and how long they live will depend upon the percentages of epithelial and sarcomatoid cells. A higher ratio of epithelial cells translates into longer survival.

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Author

Karen Selby

Karen Selby is a registered nurse and a Patient Advocate at The Mesothelioma Center. She worked in several subspecialties within nursing before joining Asbestos.com in 2009.

Mesothelioma and Asbestos Lawyers

 

Mesothelioma and Asbestos Lawyers

Mesothelioma attorneys understand asbestos legal issues and the unique challenges asbestos victims face. We offer information on what to expect when working with a mesothelioma lawyer, as well as help finding a qualified mesothelioma attorney for your case.

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Successful asbestos ligation requires an attorney who understands the many facets of the case, from how people get exposed to asbestos to the state-by-state regulations about filing lawsuits, to the fragile nature of many clients. Often, people who inquire about an asbestos-related claim are people who are also coping with mesothelioma cancer and all the health issues that go along with treatment.

Choosing a lawyer to represent you in depositions and in legal filings can be as important to your family's future as selecting the right doctor. If were you exposed to asbestos and you got sick as a result, you have a right to stake a claim for compensation.

The dangers and toxicity of asbestos were well-known in the 1930s, yet corporations continued using it extensively through much of the 20th century. They willingly put profits ahead of the health and well-being of employees and the public. An experienced asbestos lawyer will know how to hold those corporations responsible.

Tips When Looking For an Asbestos Litigation Specialist

You should consider several things when you start to evaluate the hiring of an attorney. You want to find someone with whom you feel comfortable talking because you will be discussing intimate details about your health and about where you used to work. Although your lawyer likely will know all the right questions to ask you, good communication is essential.

You should not restrict yourself to your community. Your case may not get filed in the state where you live.

Qualified attorneys in this area of the law have practices in many states and understand your cancer prognosis.

Lawyers should be aware of the importance of collecting information early on in the process.

Before You Hire an Attorney, You Need to Determine if He or She:

Has a proven track record with asbestos lawsuits (large settlements and winning verdicts).

Has experience filing claims with asbestos trust funds.

Has the ability to travel to you to gather information.

Has the ability to evaluate your potential compensation based on the facts of your case.

A trustworthy attorney will never guarantee you an outcome, a settlement or a successful jury verdict.

Find a Mesothelioma Attorney

Affording an Attorney

In the area of asbestos lawsuits, attorneys work on a contingency fee basis. You pay nothing until you receive compensation, and nothing at all if your case is not successful. There is very little risk to you. Contingency fees protect you because they usually are based on a percentage of any compensation you receive. Be sure to discuss this percentage during your first meeting with an attorney.

Contingency fee basis means you pay nothing unless you receive compensation.

How Attorneys Help in Asbestos Cases

Mesothelioma claims are different from other workplace injuries in a couple of ways. They fall into a special area of the law because the injuries that are in question do not typically occur because of an accident or sudden event. Instead exposure to asbestos takes place over time, with an illness developing 20 to 50 years later. This is why a qualified mesothelioma attorney makes sense for someone considering litigation or a trust claim.

Questions to Ask When Choosing Your Attorney

• Do you have an asbestos claim?

Mesothelioma attorneys are familiar with important legal decisions and stay up to date on asbestos-related cases all over the country. They use this knowledge to offer an opinion about your case and also to present the strongest possible case, should you decide to file a claim.


• When were you exposed to asbestos?

Identifying when and where you were exposed to asbestos is very important to your lawsuit. Without this information, it may be difficult to make a claim. Mesothelioma attorneys can help gather evidence related to your asbestos exposure. They routinely work with medical experts to trace when and where asbestos exposure occurred. They already have research and medical evidence at their disposal, which may be helpful to your case. They may also have helpful contacts with other organizations that fight for workers' rights concerning asbestos-related diseases.


• Who is responsible for your asbestos exposure?

It can be difficult to know which companies to sue in an asbestos lawsuit. During the decades that usually pass between asbestos exposure and diagnosis, the companies at fault may go out of business, move, change their names or even be sold to other companies. Mesothelioma attorneys have experience identifying and locating the companies responsible for their clients' suffering.


• What is your case worth?

Part of presenting a strong case is adequately estimating how much compensation you should receive. Mesothelioma attorneys are familiar with the medical and other day-to-day costs of living with asbestos-related illnesses. They also have experience estimating the value of future expenses, as well as the value of damages that are harder to put a number on, such as emotional anguish.

Experienced law firms have detailed records of asbestos claims, asbestos workplaces and asbestos products dating back more than 50 years. They can help you pinpoint potential exposure sites from anywhere in the country.

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Filing a Claim

Tim Povtak talks about why choosing a mesothelioma attorney is important.

The financial aspects of mesothelioma care can be overwhelming. They can include income loss, expensive treatments that may not be covered by your health insurance, plus pain and suffering suffered by you and for your family.

Asbestos Exposure and Negligence

Because the disease is preventable - asbestos exposure usually is caused by someone else's negligence - legal options may be available to help recover these costs. Learn more about asbestos exposure:

Occupations at Risk of Asbestos Exposure

Products Containing Asbestos

Asbestos lawyers focus their practice on knowledgeably and effectively bringing to justice companies that exposed employees and the public to asbestos products. An attorney can help you consider your options and file a claim against the company responsible for your asbestos-related illness. More than one company may be responsible, too. A mesothelioma attorney can identify all companies at fault.

Obtaining Compensation

Mesothelioma lawsuits have helped thousands of victims receive financial assistance. The ultimate goal is to put money in the hands of someone who deserves it - someone who needs help reducing financial hardships during an illness and providing a more stable future for loved ones.
Every claim is different, and an experienced attorney will treat each client individually. This is not class-action law. A good attorney can explain what types of compensation are available specific to your individual case. It is important to save all your medical and financial records so that your lawyer can have up-to-date information about your expenses.

Common expenses related to illness caused by asbestos exposure:

• Lost wages
• Medical bills
• Expenses not covered by insurance
• Travel expenses for medical treatments
• Pain and suffering
• Caregiver costs
• Funeral expenses

You will be asked to show medical records and to answer questions about how you may have been exposed to asbestos. A good attorney can walk you step-by-step through the process, making sure you are kept up to date on every development. Much of the time, the attorney handles almost everything for you, making the whole process easier.

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Mesothelioma Lawsuits: Different Types

There are two types of asbestos injury cases. A lawsuit filed by an individual suffering with an asbestos-related illness is a personal injury claim. A lawsuit filed by the family of someone who has passed away from an asbestos-related disease is a wrongful death suit. Specific rights in these lawsuits depend on the county and state where the case is filed. A lawyer can explain your options and take care of filing a lawsuit.

Personal Injury Claim

A lawsuit filed by an individual suffering with an asbestos-related illness.

Wrongful Death Suit

A lawsuit filed by the family of someone who has passed away from an asbestos-related disease.

Most mesothelioma lawsuits are between people who had direct exposure (also known as primary asbestos exposure) and the manufacturers of asbestos products. There also are cases of secondary exposure. A person can be exposed by a family member who unknowingly brings home the asbestos fibers on his clothes from a workplace. A mesothelioma lawyer can help understand if you, too, should file a claim.

Overall, asbestos litigation is regarded as the longest, most costly mass tort in U.S. history. Legal analysts calculate that there have been more than 600,000 plaintiffs, more than 6,000 defendants, and a total outlay for the lawsuits reaching $200 billion.

Although many asbestos companies have gone out of business, there remains an estimated $32 billion in trust funds designed to compensate victims of asbestos exposure.

Furthering Asbestos Claims Transparency (FACT) Act

The U.S. House of Representatives in 2013 passed the Furthering Asbestos Compensation Transparency (FACT) Act, much to the dismay of the asbestos victims and mesothelioma advocate groups. The legislation, if it clears the Senate and the White House, would impose unnecessary, burdensome reporting requirements on asbestos bankruptcy trusts and threaten victims' privacy. It also would bring more attention to meritless accusations of widespread fraud among asbestos victims who seek compensation for their injuries.
Hopefully, recent political developments won't dissuade asbestos victims from exercising their rights to seek legal compensation for their injuries. A recent verdict from an Ohio jury demonstrated that defendants should be held accountable for injuring innocent victims, including victims of secondary asbestos exposure. The jury awarded $27.5 million to a 40-year-old mesothelioma patient who was exposed to asbestos fibers as a child from his father's work clothes. The verdict was reported to be the largest of its kind in Ohio.

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Author

Tim Povtak

Tim Povtak is an award-winning writer with more than 30 years of reporting national and international news. His most recent experience is in researching and writing about asbestos litigation issues and asbestos-related conditions like mesothelioma. If you have a story idea for Tim, please email him at tpovtak@asbestos.com