My father was working at a processing industry of asbestos. When he was retired, his retirement took place ten years ago, he was a man of sinew who liked to take long walks into the woods nearby our village. One day, after his daily walk, he complained to us for chest pains. We were all scared. After a brief family meeting, we programmed a visit to the cardiologist. In our minds was the thought of an infarct and we were prepared for a by-pass surgery to his heart. No one could imagine what the doctor was about to tell us. My father had been through several tests and some days later the doctor told me, as I was attending medical school, his diagnosis: “Your father suffers from pericardial mesothelioma”. I was as silent as the grave. The words couldn’t get out of my mouth. I gathered myself and I told the news to my mother and my sister. I let the doctor to inform my father for his condition, as I couldn’t stop crying. I did some research and I found out that pericardial mesothelioma – a disease that affects the lining of the heart – is caused by the prior exposure to asbestos. That means that my father’s profession was responsible for this disease. So, what were we supposed to about his treatment and the company he was working for? I discussed with the doctor the options. We discussed all the necessary measures to relief my father’s symptoms, which were not only chest pain, but also heart palpitations and some more. The doctor did not want to perform surgery as the cancer was too large, so he started radiation, as it was easier for my father to handle. Even though the radiation treatment was in progress, many times my father had to admit to the hospital for removing the mesothelial fluid in order to be relieved from pain and pressure. Time was passing by but the tumor wasn’t shrinking with radiation. So, the doctor decided to proceed with chemotherapy. Unfortunately my father suffered from hair loss and extreme nausea. I couldn’t bear this situation any more. If only pericardial mesothelioma was diagnosed earlier, he could have a chance to be operated and live more happy years. Since he was diagnosed with that awful disease, he spent most of his life into the hospital, suffering from pain. I understand that I couldn’t just magically disappear off the cancer. No one could. We all tried to be there for him. But the most amazing thing was that my father wasn’t thinking of himself, but of his family. He prepared us for his “departure” by saying: “I want to thank you all for your support and for everything you did for me. I know that if there was something more that could be done, you would do it. Take care of each other and love one another. I love you.” After one day he passed away.

A mesothelioma patient frequently forgets his or her contact with asbestos. To track down the source of asbestos exposure, obtain a detailed work history, beginning with the first job the patient held; ask about materials the patient and his fellow workers used.

Positive identification of asbestos exposure significantly helps to clarify clinical and radiologic suspicion, as well as pathologic diagnosis of mesothelioma, gastrointestinal cancer, or lung cancer. Also file a report of work injury. An individual should be compensated for medical expenses and disability due to a hazardous work environment that has subjected him to high risk or to diseases such as mesothelioma.

Although a cure for pleural mesothelioma–stage I, or carcinoma in situ–is associated with a five-year survival o’70-100 percent. Thus, identifying workers at high risk from asbestos, through periodic chest X-ray study and sputum cytology, is merited.

It also is important to screen a potentially hazardous work environment for epidemiologic information. Hazardous materials then can be identified and inhalational exposure controlled by suitable respiratory exhaust ventilation, and substitution of other materials for asbestos. Waiting for signs and/or symptoms of cancer to appear is waiting far too long.

“Treatment for malignant mesothelioma remains investigational. . .. Radical surgery, such as pleuropneumonectomy for patients who have pleural mesothelioma, in the majority of patients is not curative.”

Early diagnosis of malignant mesothelioma is difficult. A patient often presents with an isolated pleural effusion of unknown etiology; pleural thickening or scalloping may be absent. Pleural cytology and needle biopsy rarely are diagnostic.

A recent review of our experience at Mount Sinai Hospital indicates that the diagnosis of malignant mesothelioma was delayed for more than six months in 25 percent of patients. Many patients were observed during several months or received treatment for suspected tuberculosis, rheumatoid arthritis, or lupus.

Three diagnostic steps are important. First, suspect the diagnosis. The most helpful hint is a history of past asbestos exposure. Be sure to list the dates and durations of the patient’s jobs when taking a careful occupational history. Temporary employment such as summer jobs while in high school or college and activities during World War II are impotant. It took six months for one of my patients to remember that she had been exposed to asbestos; only when she discussed the matter with an old friend did they both recall having worked in a factory 40 years previously insulating electric wires with asbestos.

When a history of occupational exposure is absent, explore the possibility of environmental or familial exposure to asbestos, such as residential proximity to shipyards or asbestos factories. I have seen several patients below age 40 with mesothelioma who were exposed to asbestos as children through the work clothes of a family member, usually the father. Cigarette smoking does not appear to increase the risk of malignant mesothelioma, although it seems to act synergistically with asbestos to induce lung cancer .

Second, obtain an adequate biopsy specimen for diagnosis. Usually this requires an open surgical approach, such as thoracotomy or laparotomy, although thoracoscopy or laparoscopy may be substituted at an early stage when serosal thickening still is minimal. When the pathologic features are characteristic–as in mixed (biphasic) mesothelioma, where both epithelial and fibrosarcomatous elements are present–the diagnosis is established. The majority of cases of mesothelioma, however, are epithelial (tubulopapillary) and quite often are confused with a metastatic adenocarcinoma in the lung, breast, pancreas, or in the ovaries.

Third, confirm the diagnosis by ruling out another primary tumor and obtaining special stains. The absence of mucin (as indicated by muciearmine stain or the periodic acid-Schiff stain) and the presence of hyaluronic acid (as indicated by colloidal iron or Alcian blue stains), followed by hyaluronidase digestion, are characteristic of epithelial mesothelioma. If doubt persists, a repeat biopsy or electron microscopy may become necessary.

Treatment for malignant mesothelioma remains investigational. A staging system based on the tumor, nodes, metastasis (TNM) classification has been proposed.

Radical surgery, such as pleuropneumonectomy for patients with pleural mesothelioma, usually is not curative. But palliative surgery such as pleural decortication may be beneficial, particularly in patients with recurrent pleural effusion. radiotherapy often is disappointing, partly because the extent of disease would requires very large radiation fields. And clinical experience with chemotheraly–doxorubicin HCl Adriamycin has been the most commonly employed agent–is limited.

Mesothelioma arises most commonly from pleural or peritoneal surfaces. Patients with pleural mesothelioma first complain of chest pain and shortness of breath, while individuals with peritoneal mesothelioma usually present with abdominal pain, ascites, or an abdominal mass.

Pleural mesothelioma is the more common of the two, although very heavily exposed asbestos workers generally develop peritoneal primary lesions.

Because of the proximity of the pleura to the pericardium, pericardial involvement–manifested as atrial arrhythmia or as fibrinous pericarditis–often accompanies pleural mesothelioma. Reccurent unilateral pleural effusions also are common in pleural mesothelioma.

A benign asbestos-related pleural effusion must be differentiated from one resulting from malignancy. In the first 10 years after asbestos exposure, benign pleural effusions may develop in some patients and then resolve. A few of these patients will develop a malignancy years later.

For the mesothelioma patient there may be clotting abnormalities, frequently disseminated intravascular coagulation DIC or microangiopathic hemolytic anemia. Reports of tumor-related DIC, however, are most often associated with mucin-producing tumors, which mesotheliomas are not. The mechanism of induction of the clotting abnormality in these patients is not known.

Histologic confirmation of malignant mesothelioma is frequently delayed after the onset of symptoms by as much as six months, because only pleural fluid is evident early in the course of the disease, and because pleural cytologic evaluation often is equivocal. X-ray evidence is usually just supportive: Only about 20 percent of patients with pleural primary lesions have asbestosis evident on X-ray. Calcified plaques may look lide buttons on the diaphragm. “Eggshell” calcifications of the pericardium also are characteristic.

Due to the frequent equivocacy of the pleural cytologic evaluation, an open biopsy is generally required. A biopsy of normal lung tissue also may be performed since asbestos fibers can usually be identified in the lung tissue but not generally in the tumor.

There are three histologic types of mesotheliomas: sarcomatous, epithelial, and mixed. The pathologist has no trouble diagnosing either the sarcomatous or mixed variants. The epithelial type, which is the most common, can easily be mistaken for adenocarcinoma, particularly if the asbestos exposure is long forgotten. If the condition is misdiagnosed as adenocarcinoma, a search for a primary lesion may take a significant proportion of the patient’s remaining life.

To confirm a diagnosis of mesothelioma, th pathologist generally uses the periodic acid-Schiff PAS stain with diastase digestion. A PAS stain is positive in many mesotheliomas and adenocarcinomas, but after diastase digestion, the PAS disappears in mesotheliomas but remains present in adenocarcinomas.

In the most extreme cases, conservative pathologists refuse to confirm a diagnosis of mesothrlioma until after a carefully performed autopsy eliminates all other possible primary malignancies.

When the diagnosis is “adenocarcinoma” in a patient with a history of asbestos exposure, it’s wise to obtain an adequate biopsy for special studies. Close-needle pleural biopsy is seldom adequate; a samll thoracotomy is frequently necessary to provide the pathologist with a sufficiently large piece of tissue.

Many patients are involved in litigation or require substantial documentation of asbestos exposure for workmen’s compensation. A fiber count of more than 500 per gram of wet tissue weight has been established as documenting a “substantial asbestos exposure.” A count of 200 per gram of tissue may be seen in urban dwellers in the general population and apparently is not associated with added risk of asbestos-related malignancies.

When my husband was diagnosed with mesothelioma, we were advised to contact a lawyer that specializes in that field to protect our rights. Mesothelioma is a cancer in the sac lining the chest or abdomen. It is caused by breathing in asbestos dust and particles. This usually occured at the work place (mostly construction sites). The mesothelioma patient may be entitled to compensations from the business or businesses responsible for the asbestos. Because the victim’s rights vary according to where they live, where the exposure to asbestos occurred, and what companies are responsible, it is important to contact an attorney that has experience in this field. The attorney will be able to inform you about what recourses are available and if the patient is entitled to any financial compensation. We had no idea how to go about choosing an attorney. I checked first on the web site of the Texas Bar. There was very good and easy to understand information on how to choose a lawyer and how to prepare for your first visit. The most important thing is to contact an attorney that specializes in mesothelioma. The web site http://texasmesotheliomahelpcenter.com/Mesothelioma_Lawyer.php was especially helpful. There is a huge amount of information about the disease and the legal aspects that come with it. They, also have a free referral service to connect you with a mesothelioma attorney in whichever state you reside. There is a form on the site to fill out or you can call them toll free. You can usually expect a response back within 1-2 business days. I would suggest you become informed about this terrible disease and your legal rights. Make sure you receive the information from reliable sources. The best way is to work closely with your physician and a mesothelioma attorney.

Mesothelioma is a fairly rare, but nearly fatal, form of cancer. It is caused by exposure to asbestos, which gets into the lungs and the bloodstream.

The symptoms of mesothelioma often do not appear until 30 to 50 years after the exposure. Many more cases are being diagnosed every day, although it has been about thirty years since asbestos was banned. There are people who worked in factories where asbestos was present, as well as those whose jobs it is to mitigate the asbestos in buildings. These people are all at risk.

Fine asbestos particles make their way into the body and begin to line the internal organs. Breathing can become labored and difficult, when it gets into the lungs. Asbestos in the stomach causes abdominal pain, weight loss or swelling in the abdomen, and obstruction of the bowels. Within the blood vessels, these particles can cause abnormalities like anemia or blood clotting.

Some things to look for are mentioned above, but you also want to be aware of general pain, fever, and fatigue. Although these are symptoms common to many maladies, if you know you were exposed to asbestos a long time ago, you should have a doctor check you out.