Mesothelioma cancer is a rare disease of the lining of the lungs. It is considered an extremely aggressive cancer that is unfortunately accompanied by low survival rates. The only known cause of this disease is exposure to the toxic yet naturally occurring mineral asbestos.
Asbestos fibers get lodged in the organs of the body, causing gradual scarring. Over the period of 20 to 50 years, this scarring develops into the respiratory cancer of mesothelioma.
Because asbestos is the only cause of mesothelioma, the cancer is more commonly found in select individuals who are at higher risks of exposure. Approximately 3,000 Americans are diagnosed each year with this disease.
Who is At Risk?
While we are all exposed to some levels of asbestos on a daily basis, the amounts are so minimal that it has limited effects on our health. However, some occupations involve heavy interaction with asbestos-containing materials, putting these workers at significantly higher risks of occupational exposure to asbestos.
One example of increased risk of occupational exposure involves industrial fields like construction work. People who constantly work in an industrial or construction environment, where asbestos fibers are being disturbed and likely are in the air, may inhale these toxic fibers. The same could be said for people who work in factories or manufacturing-related occupations.
Another significant group of people who are statistically at higher risk of developing mesothelioma is Navy veterans. The United States Navy widely used asbestos throughout many of its ships and products during the 1900s. Unknowingly, many of the servicemen and women inhaled asbestos fibers over the course of their careers. In fact, it is estimated that 30 percent of all mesothelioma patients are Navy veterans.
Treatment Options
Regardless of whether the patient is a construction worker, Navy veteran or something else, the outcome is often similar. Negative prognoses are commonly followed by a mesothelioma diagnosis. This can be attributed to the unique manner in which the disease develops. This cancer is usually detected in later stages which results in doctors having limited treatment options to offer.
Surgery, chemotherapy and radiation therapy are the primary treatment forms that are utilized for mesothelioma patients. Depending on how far the cancer has progressed, each treatment option has its benefits and drawbacks. Commonly, more than one of these procedures may be used together to better combat the cancer.
Experimental treatments are offered through clinical trials. These research trials are for unproven, yet potentially breakthrough procedures that may work for some and not for others. The U.S. National Institutes of Health compiled a list of clinical trials that are actively recruiting. This list can be found at www.ClinicalTrials.gov.
Bio: Mark Hall is a writer for the Mesothelioma Center. Between his interests in environmental health and his writing experiences, Mark has committed to communicating relevant news and information regarding the dangers of asbestos exposure and breakthroughs in mesothelioma treatments.
Introduction
The medical profession generally has very special connotations to act on similar individuals in which the professional action has tremendous descent.While there are huge variables in these events in relation to the various medical specialties, always, the values of medical care are a very delicate to handle.
When we focus on patients with serious conditions that can lead to fatal problem becomes much more complicated. Within these processes Cancer brings together a highly variable number of diseases whose evolution can lead to the death of the patient but sometimes the only possible evolution is a fear of the patient and their environment to achieve the patient, through the intervention of effective treatments to overcome his illness partially or permanently.
That is why I consider of paramount importance to analyze these different possible evolutions in order to accurately establish the true role of the physician before a deadly cancer evolution.
Most important when performing this analysis is to try to set a number of current concepts regarding tumor diseases, not to call cancer, and from them come to truly define the status of a patient with impending death process and actually see that role played by the doctor at that time.
We must first clarify the meaning of the very word “cancer” as the development of knowledge of the same process until the enormous therapeutic gains achieved today, lead to the need to sift the word in what I call ” Conceptual Changes on Cancer “, which is always introduced in most of our seminars and training activities.
When we talk about cancer in our environment we have in mind a situation in general very poor and often very distant from reality.
In general the word CANCER, has many connotations, often different from reality. It is used as a synonym of something terrible, close to the worst that can happen to someone and that is why people are afraid to suffer.Even the word has connotations dramatic in its associations. Journalistically make reference to “cancer” when you mean something tragic or terrible …. ETA is “Cancer society …., and Ben Laden is the” cancer “of humanity. Even when you want to refer the disease and try not to use terminology that obscure used but their meaning such as “carrier of an incurable disease or “ died of a long and painful illness ”….
It is sad that this happens because it keeps the “taboo” about a group of diseases that while it is true that in many cases are very serious and consistent with these concepts, there are other times, usually much more frequent, that it is not.
Cancer comprises a set of processes of all kinds, according to many factors, as with all diseases. Since starting positions perfectly solvable with simple treatments, usually erradicativos to situations extremely serious.
The current concept of cancer is very different from the classic regionalist surgeons before. Malignancies (cancers) are diseases that are often spread at the time of diagnosis. Sometimes the disease can be eradicated, when diagnosed at localized situation, achieving durable remissions by locoregional treatment with surgery and radiotherapy.
In the past, based on the only existing therapeutic weapon against malignant tumors was surgery, malignant diseases were classified according to their anatomical extension at the time of diagnosis in operable , when they were in a position located or inoperable, when they were extended to distance. The operability of the process was synonymous with curability , and conversely when the tumor was inoperable because of its size or once operated the patient fell was considered incurable . These concepts, which unfortunately prevail at present, especially at the level of patients and their families, and they were right for a long time, we must distort them for many reasons.
Firstly because we know much more and better the development of various tumors and the other side it has many more local and general treatments which generate important changes in all stages of different diseases. Therefore at present there is a significant change in the “Therapeutic Target” to be achieved and that is great interest the clarification.
Unfortunately many times the disease, despite initial eradication, it grows back. This fact is partly explained by current knowledge about the biological basis of cancer, identifying genetic alterations present not only in tumor cells eradicated but in other cells of the host organism that although they have normal histological aspect with standard techniques , may progress to malignancy and cause a relapse or a new primary tumor.
A fact known for a long time is that malignant cells originating from the primary tumor, migrate away early on and can not usually be detected by standard diagnostic techniques. This means that despite being a tumor limited to your region or area of origin as determined by the classical methodology of extension study, sometimes the disease can be found now spread elsewhere in the body. These cells called sleeper cells, are responsible (or not) relapses in a process apparently localized. This increasingly supports the combination of local treatments remote general treatments such as chemotherapy administered before surgery or immediately thereafter.
Approach to the disease
When diagnosing a malignant tumor arising situations the patient and the physician must know to know broadcast. The disease can be eradicated definitively, that is curable or not, that is incurable. The latter situation does not indicate that it can not be treatable, implying that therapeutic procedures are available to improve their situation, reducing the symptoms that occurs and increasing patient survival. That’s where the information that the physician must provide the patient and family is essential, as they often do not get to fully understand this situation. The possibility of effective treatment is a reality in many incurable diseases that people usually have, such as with diabetes, hypertension, heart disease, etc.. but not being a cancer people assume without much fear. These diseases, like many others, are so incurable as cancer cure but still no effective treatment, as are chronic diseases, current target for new cancer treatments. In Table 1 describes these changes on traditional and current concepts of cancer, and in Table 2 one can see a list of chronic incurable but is an effective treatment, including the cancer relapsed.
In Figure 1 , shown schematically the evolution of a tumor and the various possible therapeutic intent. In general, the tumor is diagnosed when the patient has symptoms that appear when you reach a certain volume and affects sensitive structures. There is previously pre-symptomatic period, which in some solid tumors, and based on extrapolation of data on cell doubling times, can be of years (6-8 years in breast cancer), during which the patient found in normal and without symptoms, but with his tumor. If the disease has not spread, a fact we do not know for sure, the application of surgical treatment can eliminate it definitively but, as already said, the disease after a while you fall and then the therapeutic approach must be different.
Another different situation is one in which at the time of diagnosis the disease is in advanced standing and not subject to eradication and the patient did not have symptoms until then. It is then that we must consider therapeutic alternatives are limited only to reverse the situation symptomatic of the previous tumor, a fact readily achievable with current treatments. That is a current line of work, with an empirical but very realistic and is being studied with new agents with mechanisms of action on cell growth inhibition above mentioned situations that could extend partial response or stable for long periods of time . In the new studies under way is being given increasing importance to parameters such as time to progression, overall survival, as well as the duration of responses and clinical benefit.
Therapeutic Advances
With current treatments, it says we can cure about half of the processes which must be added 35% of cases in which although the tumor can not be deleted if you can apply effective treatments to alleviate symptoms and prolong life of patients. In other words, at the present time more than 80% of cancer patients can benefit from effective treatment, a fact not the case in many diseases that are generally not as afraid as you have cancer, usually ignorance of these data.
That this is so is due to the evolution of all the different therapeutic tools currently available, along with the incorporation of new treatments, have managed to increase the cure rate and especially the survival time of patients, especially in certain types of tumors.
Radiotherapy, second weapon healing after surgery, currently administered with linear accelerators that manage to destroy residual tumor cells after surgery or tumors in areas not accessible by it. With the new techniques of shaped fields and intensity modulated radiation doses achieved so effective that they have managed to replace the surgery itself, as with breast cancer, larynx, bladder, prostate, etc..
We also have more active new drugs administered in combination cause significant responses with significant increase in patients’ lives. This chemotherapy can be administered in patients with recurrent or advanced or as a complement to surgery and radiation therapy when the patient is at risk for relapse. Also given as first treatment ( primary chemotherapy or neoadjuvant ) in tumors difficult to resect because of their size. Among them we mention the taxanes (paclitaxel and docetaxel), the new platinum (oxaliplatin) , new intercalating agents known(irinotecan, topotecan, liposomal anthracyclines) , and new hormonal agents like aromatase inhibitors (letrozole, anastrozole, examestano ) and new antiestrogens ( fulvestran ).
However, the most important of therapeutic advances has been the development and incorporation of new antitumor agents that act by different mechanisms of hormones and chemotherapy, called agents acting on novel targets (Targeted Agents). These include a series of design small molecules or large molecules such as monoclonal antibodies, which involve inhibiting or blocking the signals of tumor cell growth. The great advantage of these new agents, in addition to its high effectiveness as single agents or enhancers of chemotherapy, is its low toxicity allowing prolonged administration easy. Among small molecules include the imatinib -resistant leukemias and for chemosensitive tumors such as GIST, the Tarceva for lung cancer, the Sorafenib and Sunatinibfor kidney cancer, etc.. Among the available monoclonal antibodies Herceptin for breast cancer, the Erbitux for colon cancer and head and neck tumors, and Bevacizumab for colorectal cancer, breast cancer and lung cancer.
In Figure 2 , as a mere example of many similar situations, we can see the evolution of the survival of patients with Colorectal Cancer advanced over the years with the addition of various new treatments. Within 10 years we have multiplied almost fourfold the survival of these patients.
Physician’s attitude to the terminally ill
Despite the good data expressed in the previous section, often the patient becomes refractory to all therapeutic measures active against the disease and its course following his death is certainly a relatively short time. It is therefore extremely important to the effective management of this situation, called “terminal” in order to give the patient the best quality of life through the implementation of symptomatic treatments to be as effective as treatments against the disease.
As has happened in the time of diagnosis, it is important to give adequate information to patients and their family when a terminally ill “confirmed” according to the name agreed by the experts on these topics.
In Figure 3 details the different situations around a patient of this type, which as shown is extremely complex and therefore requires special attention. The key is proper identification of this terminal situation and then the correct, in each case, the best treatment. To complement these concepts believe very important to establish, according to experts on these subjects three very important concepts:
Sedation: deliberate administration of sedative drugs at the doses and combinations required to reduce the consciousness of a patient with advanced disease and terminal, whose death is near, both as needed to adequately relieve one or more refractory symptoms and with their explicit consent, implicit or delegate ( J. Porta et al ).
Refractory symptoms: Symptom that can not be adequately controlled despite intensive efforts to find a tolerable treatment within a reasonable time without compromising the patient’s consciousness ( Cherny and Portenoy ).
Euthanasia: conduct (act or omission) intentionally directed at ending the life of a sick person with a serious and irreversible, for humane reasons, in a medical context and with the consent of the patient ( SECPAL, 2002 ).
Finally, in Table 3 one can clearly see the difference between active euthanasia and sedation, concepts are often confused even by the doctors themselves.
Consider it essential that clinicians are faced with situations they know and be able to differentiate these concepts, although their application should be in charge of specialized equipment to prevent inappropriate situations as happened recently in our environment.
Conclusions
Medical assistance to the patient in the final period of his life faced today more and more problems are not only related to the medical side but also to the legal world and the complex world of ethical values.
The physician has an obligation not only knowing how to cure (Science), but know-how (Art), and all use it at any time during the course of the disease.
Faced with the imminent death of the patient, both qualities must be developed and applied to the maximum extent possible according to the preparation of medical and ethical values.
It is estimated that this year will be diagnosed with invasive breast cancer in 230,480 U.S. women and is diagnosed with breast cancer in situ to 57,650 women. In the United States, approximately 2,140 men will be diagnosed with breast cancer. It is estimated that this year will produce about 39,970 deaths (39,520 women and 450 men) because of this disease.
If the cancer is confined to the breast, the survival rate five years (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) is 98%. If the cancer has spread to regional lymph nodes, the survival rate five years is 84%. If the cancer has spread to a distant site, the rate of five-year survival is 23%. Approximately, 5% of people with cancer at a distant site at the time of diagnosis of the original breast cancer. Although cancer is in a more advanced stage, new treatments allow many people with breast cancer to experience the same quality of life they had before diagnosis.
Importantly, these statistics are averages and that the risk of each person depends on many factors, including tumor size and number of positive lymph nodes (those with cancer, this is called ‘cancer with lymph node “) as well as other tumor characteristics.
Breast cancer is the second most common cause of cancer death in women after cancer pulmón. But since 1990, the number of women dying from breast cancer has declined steadily. In women younger than 50 years, there has been an annual decline of around 3%. In women 50 and older, the decline has been 2% per year. Currently, there are more than two and a half million American women who are diagnosed and treated for breast cancer.
Survival statistics for cancer should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the real risk of a specific individual may vary. It is possible to tell a person how long he will live with breast cancer. Because the survival statistics are measured in intervals of five years, may not represent the progress that has been made in the treatment or diagnosis of this cancer.
