What Is Mesothelioma?

Mesothelioma, an extremely rare form of cancer, derives its name from mesothelium, which is the tissue infected by this cancer. Mesothelium is a membrane covering most of the body viscera. Factually speaking, mesothelium consists of two layers: one of the two forms an immediate cover of the organ; the other one leaves a space around the first layer and then forms a covering. A fluid released by mesothelium fills this sac-like space. Function of this fluid is lubrication, in other words, it allows convenient and frictionless motion of the internal body organs.
Mesothelial tissue, if surrounds the lungs and chest cavity, is called pleura, it is called peritoneum if it surrounds the abdominal organs and pericardium if it surrounds heart. Mesothelial lining surrounding the male reproductive system is called tunica vaginalis testis, and the one surrounding internal female reproductive organs is called tunica serosa uteri.

Mesothelioma is a disorder, in which uncontrollable division of cells of mesothelium leads to formation of a tumor in this tissue, which, in most of the cases is malignant. That is why, mesothelioma is also known as cancer of mesothelium. The cancerous cells of mesothelioma can metastasize to other body parts and can also damage nearby tissues. Most of the cases of mesothelioma begin in pleural cavity. Peritoneal and pericardial origin is less common. Rarely, mesothelioma may originate in groin and give a hernia-like appearance.

What Is Mesothelioma?

Mesothelioma, an extremely rare form of cancer, derives its name from mesothelium, which is the tissue infected by this cancer. Mesothelium is a membrane covering most of the body viscera. Factually speaking, mesothelium consists of two layers: one of the two forms an immediate cover of the organ; the other one leaves a space around the first layer and then forms a covering. A fluid released by mesothelium fills this sac-like space. Function of this fluid is lubrication, in other words, it allows convenient and frictionless motion of the internal body organs.
Mesothelial tissue, if surrounds the lungs and chest cavity, is called pleura, it is called peritoneum if it surrounds the abdominal organs and pericardium if it surrounds heart. Mesothelial lining surrounding the male reproductive system is called tunica vaginalis testis, and the one surrounding internal female reproductive organs is called tunica serosa uteri.

Mesothelioma is a disorder, in which uncontrollable division of cells of mesothelium leads to formation of a tumor in this tissue, which, in most of the cases is malignant. That is why, mesothelioma is also known as cancer of mesothelium. The cancerous cells of mesothelioma can metastasize to other body parts and can also damage nearby tissues. Most of the cases of mesothelioma begin in pleural cavity. Peritoneal and pericardial origin is less common. Rarely, mesothelioma may originate in groin and give a hernia-like appearance.

Types of Mesothelioma?

Malignant Mesothelioma
A cancerous form of tumour, which is virtually always caused by sustained exposure to asbestos. The time period between first exposure to asbestos and appearance of first symptoms can be anywhere between 20-50 years. In some cases, it may stretch even beyond that. Besides the treatment methods mentioned forth, supportive treatment such as pain-relief and oxygen may also help in relieving the symptoms a bit. Even though. Prognosis depends upon the stage of cancer, and availability of effective treatment options, different studies indicate median period to be between 4 and 18 months.

Benign-fibrous Mesothelioma

A non-cancerous tumour of the pleura. This is a localized type of tumour, which, as studies suggest, affects men more frequently then women. The usual symptoms to appear are chronic cough and shortness of breath. The reason for appearance of these symptoms is, the tumour grows to a large size at times and compresses the lung, causing shortness of breath. During physical examination, the health care professional may observe a clubbed appearance of fingers. Pleural effusion is a complication of this disorder

Types of Mesothelioma?

Malignant Mesothelioma
A cancerous form of tumour, which is virtually always caused by sustained exposure to asbestos. The time period between first exposure to asbestos and appearance of first symptoms can be anywhere between 20-50 years. In some cases, it may stretch even beyond that. Besides the treatment methods mentioned forth, supportive treatment such as pain-relief and oxygen may also help in relieving the symptoms a bit. Even though. Prognosis depends upon the stage of cancer, and availability of effective treatment options, different studies indicate median period to be between 4 and 18 months.

Benign-fibrous Mesothelioma

A non-cancerous tumour of the pleura. This is a localized type of tumour, which, as studies suggest, affects men more frequently then women. The usual symptoms to appear are chronic cough and shortness of breath. The reason for appearance of these symptoms is, the tumour grows to a large size at times and compresses the lung, causing shortness of breath. During physical examination, the health care professional may observe a clubbed appearance of fingers. Pleural effusion is a complication of this disorder

What Causes Malignant Mesothelioma?

Up to 9 out of 10 cases of mesothelioma are caused by exposure to asbestos. Asbestos is a natural mineral, mined from rock found in many countries. It is made up of tiny fibres that are as strong as steel but can be woven like cotton and are highly resistant to heat and chemicals. Before the 1980s, asbestos was imported to the UK in large quantities for use in construction, ship-building and the manufacture of household appliances. When asbestos is disturbed or damaged, it releases tiny fibres that can be breathed into the lungs and cause inflammation, a build-up of scar tissue (fibrosis) and sometimes cancer.

During the 1960s the first definite link between mesothelioma and asbestos was made. Asbestos is now known to be the most common cause of the disease.

Asbestos was very widely used in insulation materials, such as amosite insulation board, and building materials, including asbestos cement. Asbestos fibres are very fine and if they are breathed in they can penetrate to the smallest airways of the lung, so they cannot be breathed or coughed out. Once the fibres are in the lungs the body’s defence mechanism tries to break them down and remove them, which leads to inflammation in the lung tissue. The asbestos fibres can also penetrate through the lung tissue to settle in the pleura (the membrane around the lung).

The asbestos fibres can also be swallowed, and some of the fibres can stick in the digestive tract. They can then move into the membrane that lines the abdomen (the peritoneum), where they cause inflammation.

The people most likely to have been exposed to asbestos include construction workers, plumbers, electricians, boilermakers, shipbuilders and demolition workers. People who lived near to asbestos factories, or worked in buildings where asbestos was present have developed mesothelioma. Family members of people who worked with asbestos and brought the dust home on their clothes have also sometimes been affected.
There are three types of asbestos: blue, brown and white. Blue and brown asbestos, are most commonly linked with mesothelioma. They are now very rarely used and cannot be imported into the UK. Originally, white asbestos was not thought to be dangerous but recent studies have now shown that it is also harmful.

Mesothelioma does not usually develop until 10-60 years after exposure to asbestos and for this reason it is often difficult to discover the exact cause.

In the 1980s, imports of blue and brown asbestos into the UK were stopped and in 1999 the importation and use of all asbestos was banned. However, as mesothelioma develops so slowly it is estimated that by 2020 approximately 3,000 people will be diagnosed with mesothelioma each year. The number of people who develop mesothelioma will then start to reduce each year.

Rarely, mesothelioma develops in people who have never been exposed to asbestos. The other causes of the disease are not fully understood, but exposure to radiation has also in rare cases been linked to mesothelioma. Currently a research study is taking place to try to find out more about the causes of mesothelioma. It is called the National Study of Occupation and Lung Diseases. Your doctor may invite you to take part in the study, and if you agree you will be asked to fill in a short questionnaire and have a telephone discussion for about an hour with a researcher.

Research has not found any evidence that smoking increases a person’s risk of developing mesothelioma. It is also thought that exposure to other building materials such as fibreglass does not increase the risk.

Mesothelioma is not contagious and cannot be passed on to other people. It is not caused by inherited faulty genes and so children of people with mesothelioma do not have an increased risk of developing it, unless they have been in contact with asbestos.

What Causes Malignant Mesothelioma?

Up to 9 out of 10 cases of mesothelioma are caused by exposure to asbestos. Asbestos is a natural mineral, mined from rock found in many countries. It is made up of tiny fibres that are as strong as steel but can be woven like cotton and are highly resistant to heat and chemicals. Before the 1980s, asbestos was imported to the UK in large quantities for use in construction, ship-building and the manufacture of household appliances. When asbestos is disturbed or damaged, it releases tiny fibres that can be breathed into the lungs and cause inflammation, a build-up of scar tissue (fibrosis) and sometimes cancer.

During the 1960s the first definite link between mesothelioma and asbestos was made. Asbestos is now known to be the most common cause of the disease.

Asbestos was very widely used in insulation materials, such as amosite insulation board, and building materials, including asbestos cement. Asbestos fibres are very fine and if they are breathed in they can penetrate to the smallest airways of the lung, so they cannot be breathed or coughed out. Once the fibres are in the lungs the body’s defence mechanism tries to break them down and remove them, which leads to inflammation in the lung tissue. The asbestos fibres can also penetrate through the lung tissue to settle in the pleura (the membrane around the lung).

The asbestos fibres can also be swallowed, and some of the fibres can stick in the digestive tract. They can then move into the membrane that lines the abdomen (the peritoneum), where they cause inflammation.

The people most likely to have been exposed to asbestos include construction workers, plumbers, electricians, boilermakers, shipbuilders and demolition workers. People who lived near to asbestos factories, or worked in buildings where asbestos was present have developed mesothelioma. Family members of people who worked with asbestos and brought the dust home on their clothes have also sometimes been affected.
There are three types of asbestos: blue, brown and white. Blue and brown asbestos, are most commonly linked with mesothelioma. They are now very rarely used and cannot be imported into the UK. Originally, white asbestos was not thought to be dangerous but recent studies have now shown that it is also harmful.

Mesothelioma does not usually develop until 10-60 years after exposure to asbestos and for this reason it is often difficult to discover the exact cause.

In the 1980s, imports of blue and brown asbestos into the UK were stopped and in 1999 the importation and use of all asbestos was banned. However, as mesothelioma develops so slowly it is estimated that by 2020 approximately 3,000 people will be diagnosed with mesothelioma each year. The number of people who develop mesothelioma will then start to reduce each year.

Rarely, mesothelioma develops in people who have never been exposed to asbestos. The other causes of the disease are not fully understood, but exposure to radiation has also in rare cases been linked to mesothelioma. Currently a research study is taking place to try to find out more about the causes of mesothelioma. It is called the National Study of Occupation and Lung Diseases. Your doctor may invite you to take part in the study, and if you agree you will be asked to fill in a short questionnaire and have a telephone discussion for about an hour with a researcher.

Research has not found any evidence that smoking increases a person’s risk of developing mesothelioma. It is also thought that exposure to other building materials such as fibreglass does not increase the risk.

Mesothelioma is not contagious and cannot be passed on to other people. It is not caused by inherited faulty genes and so children of people with mesothelioma do not have an increased risk of developing it, unless they have been in contact with asbestos.

Asbestos Mesothelioma?

The major risk factor for mesothelioma is exposure to asbestos. Only about 20% of the cases reported occur due to other reasons. These reasons are not vivid as yet. Asbestos is a the name of a category of minerals, and finds extensive use in several industrial products, including cement, brake linings, flooring products, roof shingles, textiles, and insulation. During the process of manufacturing, several small fibres float in air, which are inhaled and swallowed. Over a period of time, these asbestos fibres reach a threshold concentration in lungs and pleura, and lead to several complicated disorders. Besides mesothelioma, exposure to asbestos multiplies the risk of other health ailments like lung cancer, asbestosis, and other cancers such as the ones of lungs and kidney.

Asbestos Mesothelioma Facts

In the groups of workers with cumulative exposures to asbestos ranging from about 5 to 1200 fibre-year/ mL, diseases like lung cancer, mesothelioma, asbestosis etc. are found extensively. Such exposures result from 40 years of occupational exposure to air concentrations of 0.125 to 30 fiber/ Ml.

Tremolite asbestos exposure has been associated with an increased incidence of disease in vermiculite miners and millers from Libby, Montana.

Long and thin fibres reach the lower airways and alveoli of lungs, where they are retained for longer. These fibres are more toxic than short and wide fibres or particles. Wide particles deposit in the upper respiratory tract and do not reach the lung and pleura, which are the sites of asbestos-induced toxicity. Short, thin fibres play in role in asbestos pathogenesis.

Fibers of amphibole asbestos, for instance, tremolite asbestos, actinolite asbestos, and crocidolite asbestos are retained longer in the lower respiratory tract than chrysotile fibres of similar dimensions.

70-80% of the reported cases of mesothelioma occur due to chronic exposure to asbestos fibres.

Malignant pleural mesothelioma is an extremely painful cancer.

Smoking does not appear to increase the risk of mesothelioma, however, the combination of smoking and asbestos exposure steeply raises the slope of a person’s risk of developing cancer of the air passageways in the lung.

Stages of Malignant Mesothelioma:

Staging is the process of finding out how far the cancer has spread. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. The treatment and outlook for patients with mesothelioma largely depends on the stage (extent of spread) of their cancer. Since pleural mesothelioma occurs most frequently and has been studied the most, it is the only mesothelioma for which a staging classification exists.

The major staging system has recently been developed by the International Mesothelioma Interest Group and adopted by the American Joint Committee on Cancer (AJCC). This is a TNM system, similar to staging systems used for most other cancers. T stands for tumor (its size and how far it has spread to nearby organs), N stands for spread to lymph nodes, and M is for metastasis (spread to distant organs). In TNM staging, information about the tumor, lymph nodes, and metastasis is combined in a process called stage grouping to assign a stage described by Roman numerals from I to IV.

T Stages

T1: Mesothelioma involves either the right or left pleura lining the chest. It has only spread to the pleura covering the lung, with the exception of possibly a few other small spots.

T2: Mesothelioma involves either the right or left pleura lining the chest and has spread from the lining of the chest into 1) the outer lining of the lung, 2) the diaphragm, or 3) into the lung itself.

T3: Mesothelioma involves either the right or left pleura lining the chest and has spread into 1) the first layer of the chest wall, 2) the fatty part of the mediastinum, 3) a single place in the chest wall, or 4) the outer covering layer of the heart.

T4: Mesothelioma involves either the right or left pleura lining the chest and has spread 1) into the chest wall, either muscle or ribs, 2) through the diaphragm, 3) into any organ contained in the mediastinum (esophagus, trachea, thymus, blood vessels), 4) into the spine, 5) across to the pleura on the other side of the chest, 6) through the heart lining or into the heart itself, or 7) into the brachial plexus (nerves leading to the arm).

N Stages

N0: No spread to lymph nodes.

N1: Spread to lymph nodes on the same side of the chest as the mesothelioma.

N2: Spread to lymph nodes around the point where the windpipe branches into the left and right bronchi or to lymph nodes in the space behind the chest bone and in front of the heart (mediastinum). Affected lymph nodes are on the same side of the cancerous lung.

N3: Spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung.

M Stages

M0: No spread to distant organs or areas.

M1: The cancer has spread distantly.

Stage Grouping for Pleural Mesothelioma

Once the T, N, and M categories have been assigned, this information is combined (stage grouping) to assign an overall stage of I, II, III, or IV. Patients with lower stage numbers have a better prognosis.

Stage I (T1, N0, M0): Mesothelioma involves either the right or left pleura lining the chest. It has only spread to the outer lining of the lung in, at most, a few small spots. It has not spread to the lymph nodes or distant sites.

Stage II (T2, N0, M0): Mesothelioma involves either the right or left pleura lining the chest and has spread from the lining of the chest into 1) the outer lining of the lung, 2) the diaphragm, or 3) into the lung itself. It has not spread to the lymph nodes or distant sites.

Stage III (T1 or 2, N1 or 2, M0; OR T3, N0-2, M0): Mesothelioma involves either the right or left pleura lining the chest and may or may not have spread from the lining of the chest into 1) the outer lining of the lung, 2) the diaphragm, 3) into the lung itself and has spread to lymph nodes anywhere in the chest on the same side as the tumor, but has not spread to distant sites; OR Mesothelioma involves either the right or left pleura lining the chest and has spread into 1) the first layer of the chest wall, or 2) the fatty part of the mediastinum, or 3) a single place in the chest wall or 4) the outer covering layer of the heart and may or may not have spread to lymph nodes but not as far as to lymph nodes near the collarbone or on the opposite side of the chest. It has not spread to distant sites.

Stage IV (T4, any N, M0; OR any T, N3, M0; OR any T, any N, M1): Mesothelioma involves either the right or left pleura lining the chest and has spread 1) into the chest wall, either muscle or ribs, 2) through the diaphragm, 3) into any organ contained in the mediastinum (esophagus, trachea, thymus, blood vessels), 4) into the spine, 5) across to the pleura on the other side of the chest, 6) through the heart lining or into the heart itself, or 7) into the brachial plexus (nerves leading to the arm), and may or may not have spread to lymph nodes anywhere, but has not spread to distant sites; OR the tumor is of any size, but has spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung but not to distant sites; OR the mesothelioma has spread to distant sites.

Asbestos Mesothelioma?

The major risk factor for mesothelioma is exposure to asbestos. Only about 20% of the cases reported occur due to other reasons. These reasons are not vivid as yet. Asbestos is a the name of a category of minerals, and finds extensive use in several industrial products, including cement, brake linings, flooring products, roof shingles, textiles, and insulation. During the process of manufacturing, several small fibres float in air, which are inhaled and swallowed. Over a period of time, these asbestos fibres reach a threshold concentration in lungs and pleura, and lead to several complicated disorders. Besides mesothelioma, exposure to asbestos multiplies the risk of other health ailments like lung cancer, asbestosis, and other cancers such as the ones of lungs and kidney.

Asbestos Mesothelioma Facts

In the groups of workers with cumulative exposures to asbestos ranging from about 5 to 1200 fibre-year/ mL, diseases like lung cancer, mesothelioma, asbestosis etc. are found extensively. Such exposures result from 40 years of occupational exposure to air concentrations of 0.125 to 30 fiber/ Ml.

Tremolite asbestos exposure has been associated with an increased incidence of disease in vermiculite miners and millers from Libby, Montana.

Long and thin fibres reach the lower airways and alveoli of lungs, where they are retained for longer. These fibres are more toxic than short and wide fibres or particles. Wide particles deposit in the upper respiratory tract and do not reach the lung and pleura, which are the sites of asbestos-induced toxicity. Short, thin fibres play in role in asbestos pathogenesis.

Fibers of amphibole asbestos, for instance, tremolite asbestos, actinolite asbestos, and crocidolite asbestos are retained longer in the lower respiratory tract than chrysotile fibres of similar dimensions.

70-80% of the reported cases of mesothelioma occur due to chronic exposure to asbestos fibres.

Malignant pleural mesothelioma is an extremely painful cancer.

Smoking does not appear to increase the risk of mesothelioma, however, the combination of smoking and asbestos exposure steeply raises the slope of a person’s risk of developing cancer of the air passageways in the lung.

Stages of Malignant Mesothelioma:

Staging is the process of finding out how far the cancer has spread. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. The treatment and outlook for patients with mesothelioma largely depends on the stage (extent of spread) of their cancer. Since pleural mesothelioma occurs most frequently and has been studied the most, it is the only mesothelioma for which a staging classification exists.

The major staging system has recently been developed by the International Mesothelioma Interest Group and adopted by the American Joint Committee on Cancer (AJCC). This is a TNM system, similar to staging systems used for most other cancers. T stands for tumor (its size and how far it has spread to nearby organs), N stands for spread to lymph nodes, and M is for metastasis (spread to distant organs). In TNM staging, information about the tumor, lymph nodes, and metastasis is combined in a process called stage grouping to assign a stage described by Roman numerals from I to IV.

T Stages

T1: Mesothelioma involves either the right or left pleura lining the chest. It has only spread to the pleura covering the lung, with the exception of possibly a few other small spots.

T2: Mesothelioma involves either the right or left pleura lining the chest and has spread from the lining of the chest into 1) the outer lining of the lung, 2) the diaphragm, or 3) into the lung itself.

T3: Mesothelioma involves either the right or left pleura lining the chest and has spread into 1) the first layer of the chest wall, 2) the fatty part of the mediastinum, 3) a single place in the chest wall, or 4) the outer covering layer of the heart.

T4: Mesothelioma involves either the right or left pleura lining the chest and has spread 1) into the chest wall, either muscle or ribs, 2) through the diaphragm, 3) into any organ contained in the mediastinum (esophagus, trachea, thymus, blood vessels), 4) into the spine, 5) across to the pleura on the other side of the chest, 6) through the heart lining or into the heart itself, or 7) into the brachial plexus (nerves leading to the arm).

N Stages

N0: No spread to lymph nodes.

N1: Spread to lymph nodes on the same side of the chest as the mesothelioma.

N2: Spread to lymph nodes around the point where the windpipe branches into the left and right bronchi or to lymph nodes in the space behind the chest bone and in front of the heart (mediastinum). Affected lymph nodes are on the same side of the cancerous lung.

N3: Spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung.

M Stages

M0: No spread to distant organs or areas.

M1: The cancer has spread distantly.

Stage Grouping for Pleural Mesothelioma

Once the T, N, and M categories have been assigned, this information is combined (stage grouping) to assign an overall stage of I, II, III, or IV. Patients with lower stage numbers have a better prognosis.

Stage I (T1, N0, M0): Mesothelioma involves either the right or left pleura lining the chest. It has only spread to the outer lining of the lung in, at most, a few small spots. It has not spread to the lymph nodes or distant sites.

Stage II (T2, N0, M0): Mesothelioma involves either the right or left pleura lining the chest and has spread from the lining of the chest into 1) the outer lining of the lung, 2) the diaphragm, or 3) into the lung itself. It has not spread to the lymph nodes or distant sites.

Stage III (T1 or 2, N1 or 2, M0; OR T3, N0-2, M0): Mesothelioma involves either the right or left pleura lining the chest and may or may not have spread from the lining of the chest into 1) the outer lining of the lung, 2) the diaphragm, 3) into the lung itself and has spread to lymph nodes anywhere in the chest on the same side as the tumor, but has not spread to distant sites; OR Mesothelioma involves either the right or left pleura lining the chest and has spread into 1) the first layer of the chest wall, or 2) the fatty part of the mediastinum, or 3) a single place in the chest wall or 4) the outer covering layer of the heart and may or may not have spread to lymph nodes but not as far as to lymph nodes near the collarbone or on the opposite side of the chest. It has not spread to distant sites.

Stage IV (T4, any N, M0; OR any T, N3, M0; OR any T, any N, M1): Mesothelioma involves either the right or left pleura lining the chest and has spread 1) into the chest wall, either muscle or ribs, 2) through the diaphragm, 3) into any organ contained in the mediastinum (esophagus, trachea, thymus, blood vessels), 4) into the spine, 5) across to the pleura on the other side of the chest, 6) through the heart lining or into the heart itself, or 7) into the brachial plexus (nerves leading to the arm), and may or may not have spread to lymph nodes anywhere, but has not spread to distant sites; OR the tumor is of any size, but has spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung but not to distant sites; OR the mesothelioma has spread to distant sites.

Early Detection : Malignant Mesothelioma

Certain findings on chest x-rays that suggest asbestos exposure could prompt the need for further tests or close follow-up. However, the chest x-ray is not an effective test for early detection of mesothelioma in the general population.

Medical History and Physical Exam

A complete medical history (interview) is taken to check for risk factors and symptoms. This will include questions to determine if you have been exposed to asbestos.

A physical exam will provide information about signs of mesothelioma and other health problems. Patients with pleural mesotheliomas (mesotheliomas of the chest) often have fluid in their chest cavity (pleural effusion) caused by the cancer. Some will have fluid in the abdominal cavity (ascites) in cases of peritoneal mesothelioma, or fluid in the pericardium (pericardial effusion) in cases of pericardial mesothelioma. All these might be detected during a physical exam. Otherwise they will be found by imaging studies.

Rarely, mesothelioma can appear in the groin and look like a hernia

Early Detection : Malignant Mesothelioma

Certain findings on chest x-rays that suggest asbestos exposure could prompt the need for further tests or close follow-up. However, the chest x-ray is not an effective test for early detection of mesothelioma in the general population.

Medical History and Physical Exam

A complete medical history (interview) is taken to check for risk factors and symptoms. This will include questions to determine if you have been exposed to asbestos.

A physical exam will provide information about signs of mesothelioma and other health problems. Patients with pleural mesotheliomas (mesotheliomas of the chest) often have fluid in their chest cavity (pleural effusion) caused by the cancer. Some will have fluid in the abdominal cavity (ascites) in cases of peritoneal mesothelioma, or fluid in the pericardium (pericardial effusion) in cases of pericardial mesothelioma. All these might be detected during a physical exam. Otherwise they will be found by imaging studies.

Rarely, mesothelioma can appear in the groin and look like a hernia

Diagnosis of Malignant Mesothelioma:

 If there is a reason to suspect you may have mesothelioma, your doctor will use one or more methods to find out if the disease is present. The first step in diagnosing mesothelioma is recognizing your symptoms.

Signs and Symptoms of Mesothelioma

Early symptoms of mesotheliomas are not specific to the disease. People often ignore them or mistake them for common, minor ailments. Most people with mesothelioma have symptoms for only 2 to 3 months before they are diagnosed. About one-fourth of people have symptoms for at least 6 months before they are diagnosed.

Over half of patients with pleural mesothelioma have pain in the lower back or at the side of the chest. Many report shortness of breath. A smaller percentage have trouble swallowing, cough, fever, sweating, fatigue, and weight loss. Other symptoms include hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, and sensory loss.

Symptoms of peritoneal mesothelioma include abdominal (belly) pain, weight loss, nausea, and vomiting. There may also be fluid or a mass in the abdomen.

If you have any of these symptoms and have been exposed to asbestos you should see a doctor right away

Imaging Tests

Chest x-ray: This may show irregular thickening of the pleura, calcium deposits on the pleura, or fluid in the pleural space. These findings suggest asbestos exposure leading to the development of a mesothelioma.

Imaging studies such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans will help determine the location, size, and extent of the cancer.

Computed tomography (CT): The CT scan is an X-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.

CT scans are often used to make the initial diagnosis of malignant mesothelioma, and are helpful in staging the cancer (determining the extent of its spread).

Often after the first set of pictures is taken you will receive an intravenous injection of a "dye" or radiocontrast agent that helps better outline structures in your body. A second set of pictures is then taken.

CT scans are more tiring than regular x-rays because they take longer and you need to lie still on a table while they are being done. But just like other computerized devices, they are getting faster and your stay might be pleasantly short. Also, you might feel a bit confined by the ring you lie within when the pictures are being taken.

You will have an IV (intravenous) line through which the contrast "dye" is injected. The injection can also cause some flushing (redness and warm feeling). Some people are allergic and get hives or rarely more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may be asked to drink 1 to 2 pints of a solution of contrast material. This helps outline the intestine so that it is not mistaken for tumors.

Positron Emission Tomography (PET Scan): In this test, radioactive glucose (sugar) is injected into your vein. Because cancers use sugar much faster than normal tissues, the cancerous tissue takes up the radioactive material. A scanner can spot the radioactive deposits. This test, which is still being studied, is useful for telling whether a thickening of the tissues is cancer or merely scar tissue. It can also spot spread of the cancer.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. A contrast material might be injected just as with CT scans, but is used less often. Sometimes MRI scans are useful in looking at the diaphragm (the thin muscle at the bottom of the lung cage that is responsible for breathing) where the mesothelioma may spread.

MRI scans are particularly helpful in examining the brain and spinal cord. MRI scans are a little more uncomfortable than CT scans. First, they take longer — often up to 1 hour. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia (fear of enclosed places). The machine also makes a thumping noise that you may find disturbing. Some places will provide headphones with music to block this out.

Blood Tests

There are no blood tests that are useful in diagnosing malignant mesothelioma

Tests of fluid and tissue samples

If you have a pleural effusion (a build up of fluid) a sample of this fluid can be removed by inserting a needle into the chest cavity. A similar technique can be used to obtain abdominal fluid and pericardial fluid. The fluid is then tested to see its chemical make up and viewed under a microscope by an expert in diagnosing cancer (pathologist) to determine whether cancer cells are present.

A tissue sample of a pleural or pericardial tumor can be obtained using a relatively new technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. Your doctor can see the tumor through the thoracoscope, and can use special forceps to take a tissue biopsy. Similarly, laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In this procedure, a flexible tube attached to a video camera is inserted into the abdominal cavity through small incisions on the front of the abdomen. Fluid can also be collected during thoracoscopy or laparoscopy. The biopsy specimen will be sent to the pathology laboratory where the pathologist will examine it to determine if it is cancer.

Surgery, either a thoracotomy (which opens the chest cavity) or a laparotomy (which opens the abdominal cavity), allows the surgeon to remove a larger sample of tumor or, sometimes, to remove the entire tumor.

If you might have pleural mesothelioma, the doctor may also do a bronchoscopy. In this procedure a flexible lighted tube is inserted through your mouth, down the trachea, and into the bronchi to see if there are other masses in the airway. Small samples of abnormal-appearing tissue can be removed for testing.

You may also have a mediastinoscopy. A lighted tube is inserted under the sternum (chest bone) at the level of the neck and moved down into the chest. Mediastinoscopy allows the surgeon to view the lymph nodes in this area and remove samples to check for cancer. Lymph nodes are bean-sized collections of immune system cells that help the body fight infections and cancers. Cancers in the lung often spread to lymph nodes, but mesotheliomas do this less often. Tests on lymph nodes can give the doctor information on whether a cancer is still localized or if it has started to spread, and can help distinguish lung cancer from mesothelioma.

It is often hard to diagnose mesothelioma by looking at the cells from the fluid around the lungs, abdomen, or heart. It is even hard to diagnose mesothelioma with tissue from small needle biopsies. Under the microscope, mesothelioma can look like several other types of cancer. For example, pleural mesothelioma may resemble some types of lung cancer and peritoneal mesothelioma may resemble some cancers of the ovaries. For this reason, special laboratory tests are often done to help distinguish mesothelioma from some other cancers.

These tests often use special techniques to recognize certain markers (types of chemicals) contained in mesotheliomas. One test called immunohistochemistry looks for different proteins on the surface of the cells. It can be used to tell if the cancer is a mesothelioma or a lung cancer, which can appear to start in the lining of the chest cavity. A newer test is called DNA Microarray analysis. This test actually looks at genes in the cancers. Mesotheliomas have different gene patterns than other cancers.

The electron microscope can sometimes help diagnose mesothelioma. This microscope can magnify samples more than 100 times greater than the light microscope that is generally used in cancer diagnosis. This more powerful microscope makes it possible to see the small parts of the cancer cells that distinguish mesothelioma from other types of cancer.

Diagnosis of Malignant Mesothelioma:

 If there is a reason to suspect you may have mesothelioma, your doctor will use one or more methods to find out if the disease is present. The first step in diagnosing mesothelioma is recognizing your symptoms.

Signs and Symptoms of Mesothelioma

Early symptoms of mesotheliomas are not specific to the disease. People often ignore them or mistake them for common, minor ailments. Most people with mesothelioma have symptoms for only 2 to 3 months before they are diagnosed. About one-fourth of people have symptoms for at least 6 months before they are diagnosed.

Over half of patients with pleural mesothelioma have pain in the lower back or at the side of the chest. Many report shortness of breath. A smaller percentage have trouble swallowing, cough, fever, sweating, fatigue, and weight loss. Other symptoms include hoarseness, coughing up blood, swelling of the face and arms, muscle weakness, and sensory loss.

Symptoms of peritoneal mesothelioma include abdominal (belly) pain, weight loss, nausea, and vomiting. There may also be fluid or a mass in the abdomen.

If you have any of these symptoms and have been exposed to asbestos you should see a doctor right away

Imaging Tests

Chest x-ray: This may show irregular thickening of the pleura, calcium deposits on the pleura, or fluid in the pleural space. These findings suggest asbestos exposure leading to the development of a mesothelioma.

Imaging studies such as x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans will help determine the location, size, and extent of the cancer.

Computed tomography (CT): The CT scan is an X-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.

CT scans are often used to make the initial diagnosis of malignant mesothelioma, and are helpful in staging the cancer (determining the extent of its spread).

Often after the first set of pictures is taken you will receive an intravenous injection of a "dye" or radiocontrast agent that helps better outline structures in your body. A second set of pictures is then taken.

CT scans are more tiring than regular x-rays because they take longer and you need to lie still on a table while they are being done. But just like other computerized devices, they are getting faster and your stay might be pleasantly short. Also, you might feel a bit confined by the ring you lie within when the pictures are being taken.

You will have an IV (intravenous) line through which the contrast "dye" is injected. The injection can also cause some flushing (redness and warm feeling). Some people are allergic and get hives or rarely more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may be asked to drink 1 to 2 pints of a solution of contrast material. This helps outline the intestine so that it is not mistaken for tumors.

Positron Emission Tomography (PET Scan): In this test, radioactive glucose (sugar) is injected into your vein. Because cancers use sugar much faster than normal tissues, the cancerous tissue takes up the radioactive material. A scanner can spot the radioactive deposits. This test, which is still being studied, is useful for telling whether a thickening of the tissues is cancer or merely scar tissue. It can also spot spread of the cancer.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. A contrast material might be injected just as with CT scans, but is used less often. Sometimes MRI scans are useful in looking at the diaphragm (the thin muscle at the bottom of the lung cage that is responsible for breathing) where the mesothelioma may spread.

MRI scans are particularly helpful in examining the brain and spinal cord. MRI scans are a little more uncomfortable than CT scans. First, they take longer — often up to 1 hour. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia (fear of enclosed places). The machine also makes a thumping noise that you may find disturbing. Some places will provide headphones with music to block this out.

Blood Tests

There are no blood tests that are useful in diagnosing malignant mesothelioma

Tests of fluid and tissue samples

If you have a pleural effusion (a build up of fluid) a sample of this fluid can be removed by inserting a needle into the chest cavity. A similar technique can be used to obtain abdominal fluid and pericardial fluid. The fluid is then tested to see its chemical make up and viewed under a microscope by an expert in diagnosing cancer (pathologist) to determine whether cancer cells are present.

A tissue sample of a pleural or pericardial tumor can be obtained using a relatively new technique called thoracoscopy. A thoracoscope (telescope-like instrument connected to a video camera) is inserted through a small incision into the chest. Your doctor can see the tumor through the thoracoscope, and can use special forceps to take a tissue biopsy. Similarly, laparoscopy can be used to see and obtain a biopsy of a peritoneal tumor. In this procedure, a flexible tube attached to a video camera is inserted into the abdominal cavity through small incisions on the front of the abdomen. Fluid can also be collected during thoracoscopy or laparoscopy. The biopsy specimen will be sent to the pathology laboratory where the pathologist will examine it to determine if it is cancer.

Surgery, either a thoracotomy (which opens the chest cavity) or a laparotomy (which opens the abdominal cavity), allows the surgeon to remove a larger sample of tumor or, sometimes, to remove the entire tumor.

If you might have pleural mesothelioma, the doctor may also do a bronchoscopy. In this procedure a flexible lighted tube is inserted through your mouth, down the trachea, and into the bronchi to see if there are other masses in the airway. Small samples of abnormal-appearing tissue can be removed for testing.

You may also have a mediastinoscopy. A lighted tube is inserted under the sternum (chest bone) at the level of the neck and moved down into the chest. Mediastinoscopy allows the surgeon to view the lymph nodes in this area and remove samples to check for cancer. Lymph nodes are bean-sized collections of immune system cells that help the body fight infections and cancers. Cancers in the lung often spread to lymph nodes, but mesotheliomas do this less often. Tests on lymph nodes can give the doctor information on whether a cancer is still localized or if it has started to spread, and can help distinguish lung cancer from mesothelioma.

It is often hard to diagnose mesothelioma by looking at the cells from the fluid around the lungs, abdomen, or heart. It is even hard to diagnose mesothelioma with tissue from small needle biopsies. Under the microscope, mesothelioma can look like several other types of cancer. For example, pleural mesothelioma may resemble some types of lung cancer and peritoneal mesothelioma may resemble some cancers of the ovaries. For this reason, special laboratory tests are often done to help distinguish mesothelioma from some other cancers.

These tests often use special techniques to recognize certain markers (types of chemicals) contained in mesotheliomas. One test called immunohistochemistry looks for different proteins on the surface of the cells. It can be used to tell if the cancer is a mesothelioma or a lung cancer, which can appear to start in the lining of the chest cavity. A newer test is called DNA Microarray analysis. This test actually looks at genes in the cancers. Mesotheliomas have different gene patterns than other cancers.

The electron microscope can sometimes help diagnose mesothelioma. This microscope can magnify samples more than 100 times greater than the light microscope that is generally used in cancer diagnosis. This more powerful microscope makes it possible to see the small parts of the cancer cells that distinguish mesothelioma from other types of cancer.

Can Malignant Mesothelioma Be Prevented?

The best way to prevent mesotheliomas is to prevent or limit your exposure to asbestos in homes, in public buildings, and at work. People who may be exposed to asbestos at work include miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with insulation. If there is a possibility of on-the-job exposure, such as renovating old buildings, then you should use all protective equipment, work practices, and safety procedures designed for working around asbestos.

If you live in an older home, there may be asbestos-containing insulation or other materials. A knowledgeable expert can check your home to determine if there is any asbestos and if it poses any risk of exposure. This may involve testing the air for asbestos levels. It is often more dangerous to remove the materials containing asbestos than to leave them alone. You may then decide to have the asbestos removed from your home. You should hire a qualified contractor to perform this job, to avoid contaminating your home further or causing any exposure to the workers. You should not attempt to remove asbestos-containing material yourself.

Can Malignant Mesothelioma Be Prevented?

The best way to prevent mesotheliomas is to prevent or limit your exposure to asbestos in homes, in public buildings, and at work. People who may be exposed to asbestos at work include miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with insulation. If there is a possibility of on-the-job exposure, such as renovating old buildings, then you should use all protective equipment, work practices, and safety procedures designed for working around asbestos.

If you live in an older home, there may be asbestos-containing insulation or other materials. A knowledgeable expert can check your home to determine if there is any asbestos and if it poses any risk of exposure. This may involve testing the air for asbestos levels. It is often more dangerous to remove the materials containing asbestos than to leave them alone. You may then decide to have the asbestos removed from your home. You should hire a qualified contractor to perform this job, to avoid contaminating your home further or causing any exposure to the workers. You should not attempt to remove asbestos-containing material yourself.

Types of Treatment for Malignant Mesothelioma?

There are different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma . Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.


Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma:

Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.
Pleurectomy and decoration: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
Extraplural pnemonia: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other types of treatment that are being tested in clinical trials include the following:

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.  

Types of Treatment for Malignant Mesothelioma?

There are different types of treatment for patients with malignant mesothelioma.

Different types of treatments are available for patients with malignant mesothelioma . Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.


Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:

Surgery

The following surgical treatments may be used for malignant mesothelioma:

Wide local excision: Surgery to remove the cancer and some of the healthy tissue around it.
Pleurectomy and decoration: Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
Extraplural pnemonia: Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
Pleurodesis: A surgical procedure that uses chemicals or drugs to make a scar in the space between the layers of the pleura. Fluid is first drained from the space using a catheter or chest tube and the chemical or drug is put into the space. The scarring stops the build-up of fluid in the pleural cavity.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other types of treatment that are being tested in clinical trials include the following:

Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.  

Mesothelioma : Risk Factors

Risk factors are those activities that increase the chance of getting a particular condition or disease. Malignant mesothelioma is a very rare cancer, and the vast majority of cases are associated with exposure to asbestos (either its production or use in various industries). In fact, because asbestos is used so widely in the building and other industries, even in those cases where a history of asbestos exposure is not evident, it is likely that the victim was exposed without his/her knowledge. Other risk factors that are associated with malignant mesothelioma less often include:

Radiation. Cases of malignant mesothelioma have been reported after exposure to radiation, but the association is not very strong. The use of Thorotrast (thorium dioxide), a radioactive substance used for 'contrast' x-ray studies in millions of people between 1930 and 1955, has also been associated with malignant mesothelioma (particularly peritoneal mesothelioma).
Polio vaccine. Between 1955 and 1963, some batches of polio vaccine were contaminated with the Simian Virus 40, which has been detected in certain rare cancers, including malignant mesothelioma.

Erionite. This is a type of zeolite silica stone containing fibrous/wool-like strands that is widely used for house construction in the Cappadocian region of Turkey, where ~1% of the population dies from malignant mesothelioma each year.
Chronic pleural disease. In one study of 35 patients with malignant mesothelioma, 3 had evidence of long-term pleural tuberculosis, but not of asbestos exposure.
Note that smoking tobacco does not appear to increase the risk of developing malignant mesothelioma in those exposed to asbestos. However, smoking does greatly increase the risk of developing bronchogenic lung cancer (i.e. arising in the breathing tubes/airways)

Mesothelioma : Risk Factors

Risk factors are those activities that increase the chance of getting a particular condition or disease. Malignant mesothelioma is a very rare cancer, and the vast majority of cases are associated with exposure to asbestos (either its production or use in various industries). In fact, because asbestos is used so widely in the building and other industries, even in those cases where a history of asbestos exposure is not evident, it is likely that the victim was exposed without his/her knowledge. Other risk factors that are associated with malignant mesothelioma less often include:

Radiation. Cases of malignant mesothelioma have been reported after exposure to radiation, but the association is not very strong. The use of Thorotrast (thorium dioxide), a radioactive substance used for 'contrast' x-ray studies in millions of people between 1930 and 1955, has also been associated with malignant mesothelioma (particularly peritoneal mesothelioma).
Polio vaccine. Between 1955 and 1963, some batches of polio vaccine were contaminated with the Simian Virus 40, which has been detected in certain rare cancers, including malignant mesothelioma.

Erionite. This is a type of zeolite silica stone containing fibrous/wool-like strands that is widely used for house construction in the Cappadocian region of Turkey, where ~1% of the population dies from malignant mesothelioma each year.
Chronic pleural disease. In one study of 35 patients with malignant mesothelioma, 3 had evidence of long-term pleural tuberculosis, but not of asbestos exposure.
Note that smoking tobacco does not appear to increase the risk of developing malignant mesothelioma in those exposed to asbestos. However, smoking does greatly increase the risk of developing bronchogenic lung cancer (i.e. arising in the breathing tubes/airways)

Mesothelioma: Clinical Trials

The purpose of clinical trials: Studies of promising new or experimental treatments in patients are known as clinical trials. A clinical trial is only done when there is some reason to believe that the treatment being studied may be valuable to the patient. Treatments used in clinical trials are often found to have real benefits. Researchers conduct studies of new treatments to answer the following questions:

Is the treatment helpful?
How does this new type of treatment work?
Does it work better than other treatments already available?
What side effects does the treatment cause?
Are the side effects greater or less than the standard treatment?
Do the benefits outweigh the side effects?
In which patients is the treatment most likely to be helpful?
Types of clinical trials: There are 3 phases of clinical trials in which a treatment is studied before it is eligible for approval by the FDA (Food and Drug Administration).

Phase I clinical trials: The purpose of a phase I study is to find the best way to give a new treatment and how much of it can be given safely. The cancer care team watches patients carefully for any harmful side effects. The treatment has been well tested in lab and animal studies, but the side effects in patients are not completely known. Doctors conducting the clinical trial start by giving very low doses of the drug to the first patients and increasing the dose for later groups of patients until side effects appear. Although doctors are hoping to help patients, the main purpose of a phase I study is to test the safety of the drug.

Phase II clinical trials: These studies are designed to see if the drug works. Patients are given the highest dose that doesn’t cause severe side effects (determined from the phase I study) and closely observed for an effect on the cancer. The cancer care team also looks for side effects.

Phase III clinical trials: Phase III studies involve large numbers of patient – often several hundred. One group (the control group) receives the standard (most accepted) treatment. The other group receives the new treatment. All patients in phase III studies are closely watched. The study will be stopped if the side effects of the new treatment are too severe or if one group has had much better results than the others.

If you are in a clinical trial, you will have a team of experts taking care of you and monitoring your progress very carefully. The study is especially designed to pay close attention to you.

However, there are some risks. No one involved in the study knows in advance whether the treatment will work or exactly what side effects will occur. That is what the study is designed to find out. While most side effects disappear in time, some can be permanent or even life threatening. Keep in mind, though, that even standard treatments have side effects. Depending on many factors, you may decide to enroll in a clinical trial.

Deciding to enter a clinical trial: Enrollment in any clinical trial is completely up to you. Your doctors and nurses will explain the study to you in detail and will give you a form to read and sign indicating your desire to take part. This process is known as giving your informed consent. Even after signing the form and after the clinical trial begins, you are free to leave the study at any time, for any reason. Taking part in the study does not prevent you from getting other medical care you may need.

To find out more about clinical trials, ask your cancer care team. Among the questions you should ask are:

Is there a clinical trial for which I would be eligible?
What is the purpose of the study?
What kinds of tests and treatments does the study involve?
What does this treatment do? Has it been used before?
Will I know which treatment I receive?
What is likely to happen in my case with, or without, this new treatment?
What are my other choices and their advantages and disadvantages?
How could the study affect my daily life?
What side effects can I expect from the study? Can the side effects be controlled?
Will I have to be hospitalized? If so, how often and for how long?
Will the study cost me anything? Will any of the treatment be free?
If I am harmed as a result of the research, what treatment would I be entitled to?
What type of long-term follow-up care is part of the study?
Has the treatment been used to treat other types of cancers?
The American Cancer Society offers a clinical trials matching service for patients, their family, and friends. Based on the information you provide about your cancer type, stage, and previous treatments, this service can compile a list of clinical trials that match your medical needs. In finding a center most convenient for you, the service can also take into account where you live and whether you are willing to travel. 

Malignant Mesothelioma: Treatment

If you have mesothelioma, your cancer care team will recommend one or more treatment options for you to consider. This is an important decision and you should take time to think about all of your choices.

In addition to the stage of the cancer, your health and your personal preferences are factors in deciding on a treatment plan. Because mesothelioma is such a rare cancer, it has been difficult for doctors to compare the value of different treatments. Only a few large clinical trials have been reported to date. In addition, most doctors have little or no experience treating this disease. They usually refer patients with this cancer to specialists who treat a large number of mesothelioma patients in large medical centers.

Another problem with treating mesothelioma is that it does not grow as a single tumor mass. It tends to spread along nearby surfaces, nerves, and blood vessels. Because of this it is almost impossible, except in rare situations, to completely get rid of it with surgery, radiation or both.

Because treatment has resulted in modest benefit, you may question the treatment options suggested. It is often a good idea to seek a second opinion. A second opinion can provide more information and help you feel more confident about the treatment plan that you choose. Also, some insurance companies require a second opinion before they will agree to pay for certain treatments

Mesothelioma: Clinical Trials

The purpose of clinical trials: Studies of promising new or experimental treatments in patients are known as clinical trials. A clinical trial is only done when there is some reason to believe that the treatment being studied may be valuable to the patient. Treatments used in clinical trials are often found to have real benefits. Researchers conduct studies of new treatments to answer the following questions:

Is the treatment helpful?
How does this new type of treatment work?
Does it work better than other treatments already available?
What side effects does the treatment cause?
Are the side effects greater or less than the standard treatment?
Do the benefits outweigh the side effects?
In which patients is the treatment most likely to be helpful?
Types of clinical trials: There are 3 phases of clinical trials in which a treatment is studied before it is eligible for approval by the FDA (Food and Drug Administration).

Phase I clinical trials: The purpose of a phase I study is to find the best way to give a new treatment and how much of it can be given safely. The cancer care team watches patients carefully for any harmful side effects. The treatment has been well tested in lab and animal studies, but the side effects in patients are not completely known. Doctors conducting the clinical trial start by giving very low doses of the drug to the first patients and increasing the dose for later groups of patients until side effects appear. Although doctors are hoping to help patients, the main purpose of a phase I study is to test the safety of the drug.

Phase II clinical trials: These studies are designed to see if the drug works. Patients are given the highest dose that doesn’t cause severe side effects (determined from the phase I study) and closely observed for an effect on the cancer. The cancer care team also looks for side effects.

Phase III clinical trials: Phase III studies involve large numbers of patient – often several hundred. One group (the control group) receives the standard (most accepted) treatment. The other group receives the new treatment. All patients in phase III studies are closely watched. The study will be stopped if the side effects of the new treatment are too severe or if one group has had much better results than the others.

If you are in a clinical trial, you will have a team of experts taking care of you and monitoring your progress very carefully. The study is especially designed to pay close attention to you.

However, there are some risks. No one involved in the study knows in advance whether the treatment will work or exactly what side effects will occur. That is what the study is designed to find out. While most side effects disappear in time, some can be permanent or even life threatening. Keep in mind, though, that even standard treatments have side effects. Depending on many factors, you may decide to enroll in a clinical trial.

Deciding to enter a clinical trial: Enrollment in any clinical trial is completely up to you. Your doctors and nurses will explain the study to you in detail and will give you a form to read and sign indicating your desire to take part. This process is known as giving your informed consent. Even after signing the form and after the clinical trial begins, you are free to leave the study at any time, for any reason. Taking part in the study does not prevent you from getting other medical care you may need.

To find out more about clinical trials, ask your cancer care team. Among the questions you should ask are:

Is there a clinical trial for which I would be eligible?
What is the purpose of the study?
What kinds of tests and treatments does the study involve?
What does this treatment do? Has it been used before?
Will I know which treatment I receive?
What is likely to happen in my case with, or without, this new treatment?
What are my other choices and their advantages and disadvantages?
How could the study affect my daily life?
What side effects can I expect from the study? Can the side effects be controlled?
Will I have to be hospitalized? If so, how often and for how long?
Will the study cost me anything? Will any of the treatment be free?
If I am harmed as a result of the research, what treatment would I be entitled to?
What type of long-term follow-up care is part of the study?
Has the treatment been used to treat other types of cancers?
The American Cancer Society offers a clinical trials matching service for patients, their family, and friends. Based on the information you provide about your cancer type, stage, and previous treatments, this service can compile a list of clinical trials that match your medical needs. In finding a center most convenient for you, the service can also take into account where you live and whether you are willing to travel. 

Malignant Mesothelioma: Treatment

If you have mesothelioma, your cancer care team will recommend one or more treatment options for you to consider. This is an important decision and you should take time to think about all of your choices.

In addition to the stage of the cancer, your health and your personal preferences are factors in deciding on a treatment plan. Because mesothelioma is such a rare cancer, it has been difficult for doctors to compare the value of different treatments. Only a few large clinical trials have been reported to date. In addition, most doctors have little or no experience treating this disease. They usually refer patients with this cancer to specialists who treat a large number of mesothelioma patients in large medical centers.

Another problem with treating mesothelioma is that it does not grow as a single tumor mass. It tends to spread along nearby surfaces, nerves, and blood vessels. Because of this it is almost impossible, except in rare situations, to completely get rid of it with surgery, radiation or both.

Because treatment has resulted in modest benefit, you may question the treatment options suggested. It is often a good idea to seek a second opinion. A second opinion can provide more information and help you feel more confident about the treatment plan that you choose. Also, some insurance companies require a second opinion before they will agree to pay for certain treatments

Treatment of Mesothelioma by Stage

Stage I: Many patients with stage I pleural mesothelioma have their cancer removed by pleurectomy/decortication or extrapleural pneumonectomy, as described in the section "Types of Treatment for Mesothelioma." The value of adjuvant chemotherapy or radiation therapy (treatments given after surgery) for stage I mesothelioma is unproven. Radiation therapy may be used if your general health is too poor to tolerate a major operation.

Stages II, III: Treatment options include palliative and supportive care providing relief of symptoms, such as thoracentesis (to remove fluid accumulation in the chest cavity), operations to remove as much of the tumor as possible in some cases, and radiation therapy or chemotherapy aimed at easing symptoms. Cure is usually not possible for patients in these stages. Enrollment in clinical trials evaluating the newest treatment possibilities in large medical centers should be considered.

Other approaches include putting chemotherapy or radioactive drugs directly into the pleural space. This can be done simply with the doctor placing a needle into the pleural space after numbing the skin with local anesthetic. Although this only kills some of the cancer cells, it often helps slow down fluid collection.

Stage IV: Because stage IV mesothelioma cancer has spread to distant organs, a cure is not possible. If any aggressive therapy is used, such as chemotherapy and radiation therapy, the goals should be clear to you and your family. Enrollment in clinical trials evaluating the newest treatment possibilities in large medical centers should be considered.

Supportive care may be the best choice, perhaps in the setting of a good hospice program. Pain management is an important aspect of your care. It is important for you to know that medications are available to effectively treat pain due to mesothelioma. You should not hesitate to request pain medications or discuss pain control problems with your cancer care team.  

Treatment of Mesothelioma by Stage

Stage I: Many patients with stage I pleural mesothelioma have their cancer removed by pleurectomy/decortication or extrapleural pneumonectomy, as described in the section "Types of Treatment for Mesothelioma." The value of adjuvant chemotherapy or radiation therapy (treatments given after surgery) for stage I mesothelioma is unproven. Radiation therapy may be used if your general health is too poor to tolerate a major operation.

Stages II, III: Treatment options include palliative and supportive care providing relief of symptoms, such as thoracentesis (to remove fluid accumulation in the chest cavity), operations to remove as much of the tumor as possible in some cases, and radiation therapy or chemotherapy aimed at easing symptoms. Cure is usually not possible for patients in these stages. Enrollment in clinical trials evaluating the newest treatment possibilities in large medical centers should be considered.

Other approaches include putting chemotherapy or radioactive drugs directly into the pleural space. This can be done simply with the doctor placing a needle into the pleural space after numbing the skin with local anesthetic. Although this only kills some of the cancer cells, it often helps slow down fluid collection.

Stage IV: Because stage IV mesothelioma cancer has spread to distant organs, a cure is not possible. If any aggressive therapy is used, such as chemotherapy and radiation therapy, the goals should be clear to you and your family. Enrollment in clinical trials evaluating the newest treatment possibilities in large medical centers should be considered.

Supportive care may be the best choice, perhaps in the setting of a good hospice program. Pain management is an important aspect of your care. It is important for you to know that medications are available to effectively treat pain due to mesothelioma. You should not hesitate to request pain medications or discuss pain control problems with your cancer care team.  

Mesothelioma: Surgery

Surgery

Surgery for pleural mesothelioma may be done for 1 of 2 reasons: to believe pain and discomfort caused by the tumor (called palliation), or to cure.

Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to completely remove, or if you are too ill to tolerate a more extensive operation.

Curative surgery is offered if you are in otherwise good health and the tumor is thought to be localized and can be completely removed. Unfortunately, the cancer cells tend to spread into the chest wall, around the heart, over nerves, and the diaphragm. It is often difficult to detect this spread. Because of this, doctors are not clear on the exact role of surgery. It is not likely to cure you, but may extend your lives.

Depending on the stage of a mesothelioma, surgery may be used to remove the cancer and some of the surrounding tissue. Often, however, an operation is not appropriate and you may have only smaller procedures to relieve symptoms.

A thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity, may be done to make a patient more comfortable. Sometimes talc or drugs that cause scarring may be injected into the chest cavity to try to prevent the fluid from returning. These techniques are successful in controlling the fluid, at least temporarily, in as many as 90% of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help you breathe more easily, however, they do not cure the cancer.

In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, a needle inserted into the pericardium (sac around the heart) can drain pericardial fluid and help relieve circulatory problems. Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area. This concern should not prevent fluid removal, though.

Two surgical procedures may be offered if you have pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy.

Pleurectomy/decortication: Pleurectomy/decortication is usually a palliative (relieves symptoms without curing the cancer) procedure in cases where the entire tumor cannot be removed. It involves removing the pleura, where the majority of the tumor is located. It effectively controls fluid accumulation and may decrease pain caused by the cancer.

Extrapleural pneumonectomy: Extrapleural pneumonectomy is a far more extensive operation and is most often used in cases of localized mesothelioma, when the surgeon thinks a cure is possible..It is a difficult operation to do and is done only by surgeons in large specialized medical centers. It involves removing the pleura, diaphragm, pericardium, and the whole lung on the side of the tumor. You must be in overall good health with no other serious illnesses in order to tolerate the large operation. This operation attempts to remove all or most of the cancer and some surrounding tissues as well.

Surgical treatment of peritoneal mesothelioma is often done either to help relieve symptoms or to attempt to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be done to remove a mesothelioma from the pericardium (the sac around the heart).

Surgery for mesothelioma of the tunica vaginalis testis, which occurs in the groin, is also not usually curative. Most of the time surgery is done because the tumor resembles a hernia. The surgeon attempts to treat a suspected hernia and only realizes the diagnosis after the surgery is begun. This kind of mesothelioma can’t be entirely removed.

Palliative or curative surgery is not at all possible if you have peritoneal mesothelioma. Palliative surgery may be necessary if the intestine or ureter tube (that carries urine from the kidney to the bladder) is blocked.

Mesothelioma: Surgery

Surgery

Surgery for pleural mesothelioma may be done for 1 of 2 reasons: to believe pain and discomfort caused by the tumor (called palliation), or to cure.

Palliative surgery is typically done in cases where the tumor has already spread beyond the mesothelium and is difficult to completely remove, or if you are too ill to tolerate a more extensive operation.

Curative surgery is offered if you are in otherwise good health and the tumor is thought to be localized and can be completely removed. Unfortunately, the cancer cells tend to spread into the chest wall, around the heart, over nerves, and the diaphragm. It is often difficult to detect this spread. Because of this, doctors are not clear on the exact role of surgery. It is not likely to cure you, but may extend your lives.

Depending on the stage of a mesothelioma, surgery may be used to remove the cancer and some of the surrounding tissue. Often, however, an operation is not appropriate and you may have only smaller procedures to relieve symptoms.

A thoracentesis, where fluid in the chest is removed by placing a needle into the chest cavity, may be done to make a patient more comfortable. Sometimes talc or drugs that cause scarring may be injected into the chest cavity to try to prevent the fluid from returning. These techniques are successful in controlling the fluid, at least temporarily, in as many as 90% of patients. Because pleural fluid can compress the lung and cause shortness of breath, these procedures can help you breathe more easily, however, they do not cure the cancer.

In the case of peritoneal mesothelioma, a needle may be inserted into the abdomen to drain the fluid. Similarly, a needle inserted into the pericardium (sac around the heart) can drain pericardial fluid and help relieve circulatory problems. Sometimes the cancer cells spread along the needle path, and a tumor nodule may form under the skin of that area. This concern should not prevent fluid removal, though.

Two surgical procedures may be offered if you have pleural mesothelioma: pleurectomy/decortication and extrapleural pneumonectomy.

Pleurectomy/decortication: Pleurectomy/decortication is usually a palliative (relieves symptoms without curing the cancer) procedure in cases where the entire tumor cannot be removed. It involves removing the pleura, where the majority of the tumor is located. It effectively controls fluid accumulation and may decrease pain caused by the cancer.

Extrapleural pneumonectomy: Extrapleural pneumonectomy is a far more extensive operation and is most often used in cases of localized mesothelioma, when the surgeon thinks a cure is possible..It is a difficult operation to do and is done only by surgeons in large specialized medical centers. It involves removing the pleura, diaphragm, pericardium, and the whole lung on the side of the tumor. You must be in overall good health with no other serious illnesses in order to tolerate the large operation. This operation attempts to remove all or most of the cancer and some surrounding tissues as well.

Surgical treatment of peritoneal mesothelioma is often done either to help relieve symptoms or to attempt to remove the tumor from the wall of the abdomen and other digestive organs. As with pleural mesothelioma, these tumors are often too extensive to remove completely. Similar operations can be done to remove a mesothelioma from the pericardium (the sac around the heart).

Surgery for mesothelioma of the tunica vaginalis testis, which occurs in the groin, is also not usually curative. Most of the time surgery is done because the tumor resembles a hernia. The surgeon attempts to treat a suspected hernia and only realizes the diagnosis after the surgery is begun. This kind of mesothelioma can’t be entirely removed.

Palliative or curative surgery is not at all possible if you have peritoneal mesothelioma. Palliative surgery may be necessary if the intestine or ureter tube (that carries urine from the kidney to the bladder) is blocked.

Mesothelioma - Management or Prevention of Side Effects

Introduction
The treatment of cancer may include the use of chemotherapy, radiation therapy, biologic response modifiers, surgery, or some combination of all of these or other therapeutic options. All of these treatment options are directed at killing or eradicating the cancer that exists in the patient’s body. Unfortunately, the delivery of cancer therapy often affects the body’s normal organs not involved by cancer. The undesired consequence of affecting an organ not involved with cancer is referred to as a complication of treatment or a side effect.

Why do side effects occur?
Side effects, or complications, of treatment cause inconvenience, discomfort, and occasionally even fatality to patients. Additionally and perhaps more importantly, side effects may also prevent doctors from delivering the prescribed dose of therapy at the specific time and schedule of the treatment plan. This is extremely important to understand since the expected outcome from therapy is based on delivering treatment at the dose and schedule of the treatment plan. In other words, side effects not only cause discomfort and unpleasantness, but may also limit a patient’s ability to achieve the best outcome from treatment by preventing the delivery of therapy at its optimal dose and time.

While cancer treatment may be associated with a wide variety of side effects, some are more common than others. Additionally, certain treatments may lead to long-term side effects, also called “late complications”, which are conditions that do not resolve once treatment is completed.

What can be done about side effects?
Fortunately, in the last 15 years there has been a great deal of progress in the development of treatments to help prevent and control the side effects of cancer treatment. These compounds have led to vast improvements in the management of symptoms associated with cancer treatment, allowed for greater accuracy and consistency concerning the administration of cancer treatment, and have made many cancer treatments more widely available to patients.

Mesothelioma - Management or Prevention of Side Effects

Introduction
The treatment of cancer may include the use of chemotherapy, radiation therapy, biologic response modifiers, surgery, or some combination of all of these or other therapeutic options. All of these treatment options are directed at killing or eradicating the cancer that exists in the patient’s body. Unfortunately, the delivery of cancer therapy often affects the body’s normal organs not involved by cancer. The undesired consequence of affecting an organ not involved with cancer is referred to as a complication of treatment or a side effect.

Why do side effects occur?
Side effects, or complications, of treatment cause inconvenience, discomfort, and occasionally even fatality to patients. Additionally and perhaps more importantly, side effects may also prevent doctors from delivering the prescribed dose of therapy at the specific time and schedule of the treatment plan. This is extremely important to understand since the expected outcome from therapy is based on delivering treatment at the dose and schedule of the treatment plan. In other words, side effects not only cause discomfort and unpleasantness, but may also limit a patient’s ability to achieve the best outcome from treatment by preventing the delivery of therapy at its optimal dose and time.

While cancer treatment may be associated with a wide variety of side effects, some are more common than others. Additionally, certain treatments may lead to long-term side effects, also called “late complications”, which are conditions that do not resolve once treatment is completed.

What can be done about side effects?
Fortunately, in the last 15 years there has been a great deal of progress in the development of treatments to help prevent and control the side effects of cancer treatment. These compounds have led to vast improvements in the management of symptoms associated with cancer treatment, allowed for greater accuracy and consistency concerning the administration of cancer treatment, and have made many cancer treatments more widely available to patients.

Questions to be asked to your Doctor about Malignant Mesothelioma?

As you cope with your cancer and the process of treatment, you need to have honest, open discussions with your cancer care team. You should feel free to ask any question that's on your mind, no matter how trivial it might seem. Among the questions you might want to ask are:

What kind of mesothelioma do I have?
Has my cancer spread beyond the primary site?
What is the stage of my cancer and what does that mean to me?
What treatment options do I have?
What do you recommend and why?
Based on what you've learned about my cancer, what is my prognosis?
What risks or side effects are there to the treatments you suggest?
What are the chances my cancer will come back with these treatment plans?
What should I do to be ready for treatment?

Questions to be asked to your Doctor about Malignant Mesothelioma?

As you cope with your cancer and the process of treatment, you need to have honest, open discussions with your cancer care team. You should feel free to ask any question that's on your mind, no matter how trivial it might seem. Among the questions you might want to ask are:

What kind of mesothelioma do I have?
Has my cancer spread beyond the primary site?
What is the stage of my cancer and what does that mean to me?
What treatment options do I have?
What do you recommend and why?
Based on what you've learned about my cancer, what is my prognosis?
What risks or side effects are there to the treatments you suggest?
What are the chances my cancer will come back with these treatment plans?
What should I do to be ready for treatment?

Free health alerts from a city doctor

COIMBATORE: He cares for the health and well-being of those around him. He believes that a healthy nation needs healthy people. So, Amith Kumar, a physiotherapist and fitness consultant based at Kovaipudur here, has launched a initiative, offering health tips as mobile alerts on a daily basis. And he does it absolutely free of cost.

Amith Kumar's treatment centre named 23 Physia Clinic is now embarking on a unique mission of mobile alerts on heath tips to Coimbatoreans on a daily basis, free of cost. Once you subscribe, you can get health alerts on a daily basis. The alerts mainly pertain to major diseases like diabetics, cancer, AIDS, hypertension etc.

"Prevention is better than cure. So I am encouraging people to lead a healthy life to reduce the time and money spent on medical treatment. The health sector is largely money oriented and even minor consultations are very expensive," says Amith Kumar, who was born in Mannargudi and has worked in Singapore and Mumbai.

"It is not a business. I set aside about Rs 5,000 from my earnings every month to provide health education to residents through this mobile alert service. I feel it is my responsibility," says Amith, who has decided to settle down in Coimbatore permanently.

Getting enrolled in Amrit's mobile SMS list is easy. All you have to do is send the following message, 'HEALTHYLIVING NAME' to the mobile number 9488545655. "This is free of cost," says Amith, who has availed the free services of half a dozen medical practitioners in his efforts to supply health tips.

Dr M Aarthy, Dr V Lakshmy, Dr Rashmi Desai, Dr M Sarmila and Dr P Sruthi and Dr M V Parthipan are now helping Amith to prepare his tips.

Amith started the project on an experimental basis this January, sending out his tips to his list of patients. Initially, he had 256 members. "Now we have about 1,320 subscribers, only through word of mouth. We have a few from other cities too," says Amith.

"As a physiotherapist, I am dealing with pain on a daily basis. Through this project, I am hoping for a painless world," he says.