Pulmonary mesothelioma is a primary malignant tumor of mesothelial surfaces, generally affecting the pleura and in fewer cases, the tissue that surrounds the abdominal cavity (peritoneum).

Prohibition of asbestos

In 1991 the World Bank stipulated as a policy, a preference not to fund the manufacture or use of products containing asbestos.

Asbestos (in its five amphiboles: ammonite, anthophyllite, actinolite, crocidolite and template) is prohibited under the Rotterdam Convention, signed by more than one hundred countries. Not without some controversy still exporting countries asbestos.

Asbestos has been banned in the following countries: Germany, France, Italy, Britain, Chile, Luxembourg, Argentina, Saudi Arabia, Slovenia, Austria, Iceland, Finland, Norway, UAE, New Zealand, Belgium, Denmark, Netherlands, Poland , Czech Republic, Sweden, Switzerland, Spain, Portugal and Greece and has been severely restricted in Brazil and Australia.

Obligations of companies that use asbestos

Despite the ban on asbestos, there is a profuse legislation governing safety requirements to be met by employers and employees. For companies who are working at risk of exposure to asbestos, are required to enroll in a special register and submit a detailed work plan before undertaking any work involving the handling of this material and of course the binding of rest of the regulation of workers at risk for Asbestos

* It prohibits overtime and incentive systems and requires that the number of workers handling asbestos are kept to a minimum.

* When you can not replace asbestos or avoid exposure to technical measures, personal protection will be provided to workers, basically mask and full protective clothing.

* The exposed workers should have two lockers to avoid contact with work clothes and street clothes should change and shower before eating and at the end of the day. The cleaning work clothes shall be borne by the company.

* Workplaces where there is exposure to asbestos must be clearly demarcated and signposted. The floor and walls must be smooth to facilitate cleaning and this will be done every time you notice a visible accumulation of dust and with means to prevent the dispersion of fibers.

* Asbestos is transported and stored in suitable sealed containers. Stacks of bags shall be protected in plastic sleeves or similar and deposited on dry surfaces.

* Workers at risk of exposure to asbestos is subject to specific medical examinations prior to employment, annual surveys, and even post-depositional alteration surveys.

* The company is obliged to provide workers and their representatives any information regarding the risks, preventive and protective measures required as well as train workers in safe work methods.

Asbestos mainly affects the lungs and lining of the lungs, the pleura. Asbestos causes two main types of diseases: cancer and asbestosis.

Asbestosis

Breathing high levels of asbestos fibers have long or short exposure to high levels of asbestos can cause scarring lesions that appear in the lung and pleura. This disease is called asbestosis, lung was the first disease that was associated with asbestos and can cause disability and death.

It is defined as diffuse interstitial fibrosis of the lungs resulting from exposure to asbestos dust and, therefore, commonly occurs in workers exposed to asbestos. People with asbestosis because of the scars in the lungs, difficulty breathing, often a cough, and in severe cases suffer enlarged heart.

Breathing low levels of asbestos can cause alterations in the pleura, generating so-called “plaques”. Pleural plaques can occur in workers and occasionally in people who live in areas with high environmental levels of asbestos. The effects of pleural plaques on respiration are not usually serious, but exposure to higher levels can cause a thickening of the pleura which may restrict breathing.

Cancer

The Department of Health and Human Services (DHHS), the World Health Organization (WHO / WHO) and the EPA (Environmental Protection Agency – EPA) EE. UU. have determined that asbestos is carcinogenic to humans.

It is known that breathing asbestos can increase the risk of cancer in humans. There are two types of cancer caused by exposure to asbestos: lung cancer and mesothelioma.
The first reports linking lung cancer and asbestos date back to 1935. The cancer caused by asbestos is not immediately apparent but emerges after several years (pleural mesothelioma usually has a latency period of 20 to 40 years). Studies of workers also suggest that breathing asbestos can increase the chances of getting cancer in other body parts (stomach, larynx, intestines, esophagus, pancreas and kidneys). The early identification and treatment of all cancer can increase the quality of life and survival of the individual.

Common symptoms are loss of appetite and weight, fatigue, chest pain, hemoptysis, or coughing up blood and shortness of breath.

It was suggested that the combination of exposure to asbestos and cigarette smoke significantly increases the chances of contracting lung cancer. Although this combination is considered to asbestos as the main cause of death, up from smoking. Generally production companies are hiding, even today, consider the potential impact of smoking on cancer development, since most of the manufacturing population were smokers at times of peak use of asbestos. Several court decisions have ruled out, depending on levels of exposure that the incidence of smoking is higher than that of asbestos for the development of occupational cancer.

Lots of deaths from cancer, previously diagnosed as being due only to lung cancers are currently considered caused by asbestos, but only if done correctly autopsy of the deceased, so that relevant statistics are not entirely reliable.

There is controversy about whether chrysotile is carcinogenic potency higher or lower than other varieties of asbestos.

Asbestos, also known as asbestos is a group of fibrous metamorphic minerals. They are composed of double chain silicates.

Asbestos minerals have long, strong fibers that can be separated and are flexible enough to be intertwined and also resist high temperatures.

Because of these special characteristics, asbestos has been used for a wide variety of manufactured products, mainly in construction materials (tiles for roofing, tiles, paper products and asbestos cement products), friction products (automobile clutch, brake, transmission components), heat-resistant textile materials, containers, packaging and coatings, protective equipment, paints, vermiculite or talc …. is also present in some foods.

It has been determined by international medical bodies that asbestos-related products / asbestos cause cancer with high mortality and therefore, for decades, has prohibited its use in all developed countries, although it is still used in some countries developing.

The main carcinogenic asbestos

Asbestos effects on health have been known for a long time, because in the first century, Pliny the Elder, in Rome, described the disease in the lungs of slaves who wove asbestos clothing.

The ancient alchemists believed that the extraordinary asbestos fibers were made by “the hair of mythical and salamanders toxic fire resistant” and named it “salamander’s wool. The deadly substance that poisoned the salamander segregated fruit trees and the waters of rivers and wells. It is said that 2000 men and 4000 horses of Alexander the Great died in India after drinking poisoned by a stream salamander.

Charlemagne had a tablecloth asbestos fibers, with which acts of fire impressed with their guests and diners, who cleaned and bleached by simply inserting it into the fire.

During the second half of the thirteenth century explorer Marco Polo visited China asbestos mines in describing the process of ore extraction and finally discarding the myths and eliminating the old “theory of the salamander.

It was in 1906 in London (England) when he described the first known case of “pulmonary fibrosis Asbestos” a worker of 33 years, the area of carding in a textile factory.

Since 1935, the first known scientific work related asbestos exposure and lung cancer in 1947 and describes the mesothelioma of pleura and peritoneum, and is now known that asbestos is the best known of industrial chemicals linked to cancer lung.

Today it is absolutely certain of two types of cancer caused by asbestos exposure: asbestosis, lung cancer and mesothelioma. Not recognized a minimal amount of the agent below which an exposure is safe. Lung cancer in workers exposed becomes up to 7 times more frequent than in the general population.

Patients with mesothelioma have concentrations of mesothelin in pleural fluid from 7 to 12 times greater than patients with metastatic cancers or benign pleural effusions. Moreover, compared with cytology, pleural fluid mesothelin had better sensitivity, similar specificity and a greater negative predictive value.

Mesothelioma is a malignant attributed to asbestos exposure. The serum mesothelin is expressed by mesothelioma cells and released into the pleural fluid, making it more useful measurement pleuritic its measure serum.

These findings show that pleural fluid mesothelin is an invaluable aid to cytology in patients with undiagnosed pleural effusions. It is reproducible and not influenced by inflammatory joint effusions.

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According to experts, the research published in American Journal of Respiratory and Critical Care Medicine (American Journal of Respiratory Medicine and Intensive Care) – will help doctors more accurately diagnose the cause of abnormalities in the lungs.

Construction malignant

Mesothelioma is a very difficult cancer to treat due to its location as the tumor does not seem to respond well to chemotherapy.

The disease can strike people who have no history of exposure to absesto, but overall, it is known that the main risk factor is the inhalation of mineral dust free.

Decades ago I used to use asbestos in construction materials and other products, so those most affected are usually the construction workers such as bricklayers, plumbers and electricistas.En developed countries have established regulations banning asbestos exposure and production with mineral materials. But in many other nations have no such restrictions. And because the development of mesothelioma can take many decades, experts believe the number of cases could increase in coming years.

Diagnosis difficult

“The accumulation of fluid in the pleural cavity can be extremely difficult to diagnose because there are a variety of benign and malignant causes,” says Dr. Helen David, Center for Respiratory Medicine, University of Oxford, who led the research.

“But one of these causes malignant pleural mesothelioma, and although a relatively rare cancer incidence is rapidly increasing globally,” he adds.

Until now the standard test to detect mesothelioma in patients with pleural effusion is pleural fluid cytological examination, but this is not very accurate.

Dr. Davies and his team, looking for ways to distinguish mesothelioma as a cause of pleural effusion, focused on the mesothelin, a protein found in high levels in the pleural fluid of most patients with the disease.

The researchers analyzed samples of pleural fluid of more than 200 patients who had been referred to a specialist clinic in respiratorias.Descubrieron diseases that levels of the protein were almost six times higher in patients with mesothelioma in patients with secondary lung cancer and 10 times higher than in those whose behind wrong causes were benign.

According to Dr. Davies, “this study shows a way to identify more quickly and since the beginning of mesothelioma cases.

“Because mesothelioma has a median survival time of 12 months to minimize the number of invasive procedures and tests that patients need is vital to reduce death and how long to spend in hospital.

The researcher adds that “early diagnosis also allows for more rapid relief of symptoms and start other treatments such as chemotherapy or radiotherapy.

“And you can also encourage the patient to seek compensation for their condition once the diagnosis is confirmed,” says Helen Davies.

According to the World Health Organization, about 90,000 people die each year from diseases related to asbestos exposure. And 43,000 of these deaths are caused by malignant mesothelioma.

The tiny carbon nanotubes are being evaluated for use in numerous products and services, from sports equipment to medical applications, but many things still unknown about the health effects that have these nanotubes.
Now a study from the State University of North Carolina, Hamner Institutes for Health Sciences and National Institute of Environmental Health Sciences (one of the National Institutes of Health in the U.S.) indicates that these nanotubes can affect breathing the outer lining of the lung, although the effects of long-term exposure are not clear yet.

In a study with mice, James Bonner, a professor of environmental and molecular toxicology at the State University of North Carolina, and his team investigated what happens when inhaling carbon nanotubes multiple wall. Specifically, they wanted to determine whether nanotubes could reach the pleura mesothelioma, the tissue covering the walls of the chest cavity and surface of the lungs.

This tissue is affected by exposure to certain types of asbestos fibers that cause the deadly cancer called mesothelioma. The researchers observed the result of inhalation exposure and found that inhaled nanotubes they are capable of reaching the pleura mesothelioma and cause adverse health effects.

The short-term experiments conducted in this investigation we can draw conclusions about the effects of inhalation of nanotubes in the long term, such as cancer. However, inhaled nanotubes clearly reach above the tissue and produce a pathological reaction at the surface of the pleura, causing fibrosis.

Chemotherapy involves using anticancer drugs that act by preventing cancer cells from multiplying. In most cases, combinations of drugs are used to increase efficiency. Chemotherapy can be used aggressively to reduce the tumor or palliative to relieve symptoms such as breathlessness or pain. Chemotherapy can be administered by injection into a vein or muscle, ingestion, or can sometimes be administered directly into the pleural or peritoneal cavity.

The drugs most commonly used are:

* Pemetrexed (Alimta)
* Cisplatin (Platinol)
* Carboplatin (Paraplatin)
* Gemcitabine (Gemzar)
* Doxorubicin (Adriamycin)
Mitomycin *
* Raltitrexed (Tomudex)
* Vinorelbine (Navelbine)

New drugs are constantly being studied by pharmaceutical companies, so feel free to check with your doctor about the drugs most recent and most promising. One such drug, Alimta (pemetrexed) has been approved in Europe in September 2005.

Radiotherapy

Radiotherapy involves using high X-ray energy to kill cancer cells and reduce tumors. It can be used in conjunction with surgery to help remove microscopic aggressively seeding can cause recurrence of disease or for palliative treatment of pain caused by tumors that compress the nerve endings or other organ. Radiation therapy has also proved effective in preventing tumor seeding from biopsy sites or tube drainage of the chest.

Clinical Trials

The purpose of clinical trials is to involve patients in discovering new and better treatments for their disease. Various clinical trials have different objectives which may include testing of new drugs, by comparing various ways of treating a disease or test several ways to prevent cancer. Clinical trials are divided into three phases. Short summaries of what each phase of the test seeks to achieve are outlined below.

The Phase I are those of the earlier phase in the system of clinical trials. At this point, drugs were only tested in the laboratory, but have had a destructive effect on cancer cells. These tests n’enrôlent a limited number of participants, and are only available in few institutions cancer. The objective of Phase I trials are to determine the maximum tolerated dose of the drug without causing serious side effects what side effects are more common, and the drug continues to have anticancer activity when administered to humans . If the drug showed an effect on cancer at a safe dosage, the drug is then tested in Phase II trials.

The essays Phase II continue to test the safety of medications or procedures, but also begin to examine more carefully their particular effectiveness for certain types of cancer. These tests include larger numbers of participants, and can be dispersed over several institutions. These tests may be “randomized”, ie different groups of participants are chosen by computer, rather than by a physician.

The Phase III trials compare new drugs or procedures promising to current standard treatment. Large numbers of participants from widely scattered regions involved in these tests, and receive either the new treatment is the standard treatment. One of the primary objectives of Phase III trials is to determine if the cancer is reduced or slowed by drugs, how long patients remain stable without progression of the disease and how drug treatment affects quality of life of patients.

If you are interested to participate in a clinical trial for mesothelioma, your doctor would be able to provide information on eligibility and availability in your area.

The pleurectomy / decortication is considered the least radical of the two approaches since it only involves the removal of the pleura (lining of the lung) without removing the lung beneath. In some cases, the pericardium and diaphragm must be removed, depending on the size of the tumor. The advantages of this procedure is a recovery time usually faster, and utility for patients who may not be able to tolerate more radical PPEP. The disadvantages include an increased risk of disease recurrence due to the inability to remove the whole tumor and the inability to use high doses of adjuvant radiation because of potential damage to the underlying lung.

The extrapleural pleuropneumonectomy is a more radical procedure that involves removing the lung, pleura (lining of the lung), the pericardium surrounding the heart and part of the diaphragm. During surgery, the pericardium and diaphragm were reconstructed with a material similar to Gortex. To be eligible for this surgery, patients must meet certain criteria and demonstrate stage pulmonary and cardiac functions appropriate to be able to withstand the procedure.

The occurrence of this disease, sometimes referred to asbestos cancer, this fiber is the main risk factor known for this type of cancer is not indicative of a minimum threshold of exposure and medical treatment has an impact limited to the life expectancy of patients, usually 12 to 18 months.

The first signs found on clinical examination are chest pain, often associated with breathlessness and recurrent pleural effusion, usually bleeding. The latency between first exposure and the development of mesothelioma is seldom less than 20 years, often around 30 to 40 years or more. It does not seem to exist a threshold value of exposure in relation to risk of onset.

He described cases of pleural mesothelioma occurring in the family environment close to the workers exposed to asbestos, subjects were exposed due to contamination of residential premises or during maintenance of dusty clothes.

Tobacco plays a synergistic role of cofactor in the risk of developing mesothelioma.

One of the largest studies undertaken on the treatment of mesothelioma, this study three-arm, open, multicenter trial for (WCLC Abstract No. C5-01) consisted of patients treated with ALIMTA alone, arm, and combination with either cisplatin or carboplatin in the other two arms. The three arms showed survival rates at one year clinically similar (58.6% for ALIMTA alone, 63.1% for ALIMTA + cisplatin, and 64.0% for ALIMTA + carboplatin). The arms of ALIMTA plus platinum combination therapy achieved response rates higher ALIMTA alone (10.5% for ALIMTA; 26.3% for ALIMTA + cisplatin and 21.7% for ALIMTA + carboplatin). All 2023 patients treated in first intention had a histological or cytological diagnosis (the patient’s cells were examined under a microscope) of MPM that was not compatible with curative surgery.

An open multicenter study (abstract WCLC N C5-03) assessed the results of 988 patients who were treated in second line against the MPM with ALIMTA as a single agent, ALIMTA + cisplatin or ALIMTA + carboplatin, having previously undergone chemotherapy. The three arms showed survival rates at one year significant (54.7% for ALIMTA alone, 67.9% for ALIMTA + cisplatin, and 65.5% for ALIMTA + carboplatin). Patients treated with ALIMTA in combination with chemotherapy based on platinum obtained higher response rates (12.1% for ALIMTA; 23.8% for ALIMTA + cisplatin and 16.8% for ALIMTA + carboplatin). The toxicities of grade 3 / 4 most frequent for both studies were leukemia, neutropenia, thrombocytopenia and anemia.

Said Richard Gaynor, MD, vice president, responsible for research on cancer and oncology platform for global Lilly.

ALIMTA was approved by both the European Agency for the Evaluation of Medicinal Products (EMEA) and the Food and Drug Administration (FDA) of the United States in 2004, in combination with cisplatin for the treatment of MPM. To date, ALIMTA has been allowed in over 85 countries in combination with cisplatin for the treatment of MPM.

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