• Stripping/ working with wiring (used as an insulator)
• Working on pipes/plumbing (used as pipe lagging)
• Woodworking (used as a floor covering, behind fire doors, paneling)

Employees of businesses that have mined asbestos minerals, or employees that have made asbestos products have a far greater risk of asbestos inhalation than the average person.

Asbestos covering wires

Asbestos Pipe Lagging

Asbestos In Door Cavity

What is asbestos?

Asbestos is a naturally occurring rock made of six different fibrous minerals: chrysotile, crocidolite, amosite, tremolite, anthophyllite, and actinolite. The asbestos minerals came from numerous mines throughout the world. The fibres were mixed with cement or woven into fabrics, mats, boards etc.

Asbestos Rock Mineral

How can asbestos fibres cause cancer?

The long thin shape of an asbestos fibre may enhance its entry deep into the lung. Following inhalation, fibres of several micrometres in length can enter the respiratory airways, whereas other particles larger than 5 micrometres could not penetrate. Once in the lung – the long fibres may not be cleared by the bodies natural defence mechanism such as ‘macrophage clearance’ macrophages generally mop up foreign bodies, but scientists have discovered that certain stubborn asbestos fibres (such as needle-like shapes of blue asbestos) cannot be cleared by macrophages. These fibres may more easily migrate along tissue planes, lymphatic channels and make their way into the pleural space.

Uncleared fibres can have an inflammatory effect and disrupt normal cell growth –hence leading to cancer, such as ‘mesothelioma’ Mesothelioma is predominantly associated with asbestos exposure. Malignant cells develop within the ‘mesothelium’, a protective lining that covers most of the human body’s internal organs. Mesothelioma can be detected more commonly in the ‘pleura’, the outer lining of the lungs and internal chest wall. Mesothelioma has a long latency period – which means that development of the disease may not manifest itself until 20-50 years later.

When is asbestos harmful?

Asbestos is generally more harmful when it is damaged or deteriorating with age. This is when it is referred to as being ‘friable’ – friable means that it has become brittle and starts flaking. In this deteriorating condition – the asbestos material can release more fibres into the air, increasing the risk of fibre inhalation. Asbestos that is hidden away, i.e. behind a wall cavity and it is 100% intact and not friable will not pose any threat to health. To be completely safe though – any asbestos should be assessed and monitored by an asbestos abatement professional.

Damaged Asbestos Lagging

What is the likelihood of what will happen if I have been exposed to asbestos?

Being exposed to asbestos does not necessarily mean that you will definitely develop an asbestos-related disease such as mesothelioma or asbestosis. As this depends on how long you have been exposed to asbestos, how many fibres you have inhaled, and what type of asbestos fibres they were.

What are the symptoms of an asbestos related disease?

The symptoms of mesothelioma can be vague and mistaken for other illnesses such as asthma and COPD. Symptoms that have been reported include shortness of breath, due to ‘pleural effusion’ (fluid between the lung and the chest wall), chest pain or discomfort, fatigue, and weight loss.

UK Patients suffering from a form of cancer caused by asbestos exposure called ‘mesothelioma’ are in great need of a specialised treatment that is only available in Germany.

Debbie Brewer was diagnosed with mesothelioma in 2006. After conventional chemotherapy, in 2008, she was told that not only her tumour had grown, but it was growing around her heart. Debbie then heard about a Professor in Germany ‘Professor Thomas. J. Vogl’ that was trialing a new treatment called chemoembolisation, and felt that the treatment may be her last hope. After 6 treatments her tumour shrunk by 83%, giving her partial remission.

I first knew of Debbie’s story when I came across her on Facebook. She had not only embarked on a mission to set up a petition for a chemoembolisation trial to treat mesothelioma in the UK in 2009, but was also promoting Dr. Vogl’s treatment; bringing hope to many other mesothelioma sufferers, like herself, who had been left with very little or no hope. Debbie’s story is an incredible testimony to what chemoembolisation treatment has done for her and her family, and her gratitude is poignantly evident on the facebook page that she has set up and dedicated to Dr. Vogl. She states:

“Please join me in thanking this amazing man, without people like him in the world who are prepared to go out on a limb, a lot of people would have no hope. The Professor has given me back my life, the greatest gift any human being could give another. There is not enough thanks in the world that would compare to what he has done for me and many others”.

Debbie continues to be a wonderful support to fellow mesothelioma sufferers and is an inspiration to all that have the privilege of knowing her.

The treatment called ‘Transpulmonary chemoembolisation’ is more effective than conventional chemotherapy as the drugs are injected directly into a tumour. Many UK patients who have travelled to Professor Vogl’s Clinic in Germany for the treatment say that not only their quality of life has been improved, but also prolonged.

For example – one patient – Ron Bonfield, age 70, from Devon, spent £22,000 of his own savings on the treatment. Chemoembolisation has transformed his health and now he is in remission. ‘Devon Primary Care Trust’ funded one of his five courses of treatment, but the funding is limited and has now ceased. Ron was recently on ‘The Politics show South West’ (31st January 2010) and he expressed his frustration regarding lack of UK NHS funding and treatment . . .

“I’m quite upset, knowing that there is a treatment out there that can prolong my life, not just by months, but by years and also give me a quality of life, but the NHS seem to bury their head in the sand and don’t want to know about it”.

Ron’s case has been backed by his local MP Geoffrey Cox, and he has written to the Health Secretary in support of mesothelioma patients.

Another mesothelioma sufferer ‘Gary Meager’ who sent a letter to the Politics show in support of chemoembolisation treatment wrote:

“Just like Ron Bonfield, I have been to Germany (at a cost of £24,000.00 all inclusive of travel and subsistence) to be treated by the same specialist (Prof. Dr. Th. J. Vogl at the department of Diagnostic and Interventional Radiology). I have also received the same outcome to the treatment and the same response from my PCT. (referring to Devon Primary Trust). Patients with other cancers are being treated in the UK by the same procedure. Patients with other cancers e.g. Kidney cancer are receiving treatment at costs that far exceed the Mesothelioma treatment in Germany. It’s about time the UK Government recognised the treatment. How much more evidence of benefit to patients is do the PCT’s need to enable them to understand the benefits are apparent”.

Dawn Veal – a nurse and who helps run a support group in Devon for patients with mesothelioma, rightly points out on the Politics Show that the drugs used in chemoembolisation are recognised by the ‘National Institute for Clinical Excellence’, who audit medications in the UK. She stated

 “so we have the drugs, we have the technique, what we need now is a trial to allow people to actually explore this technique for extension of life”.

Jenny Hill also wrote to the Politics show on behalf of her husband:

My husband (Ricky Hill) was diagnosed with mesothelioma in March 09. In May 09 he started chemotherapy of Cisplatin & Alitma. It made him very sick and ill and he spent most of the time in bed. Prior to each chemo treatment he had to have 2 units of blood because the treatment had made his blood count low. He had a scan after the 4th treatment and saw the oncologist. He said the treatment had not done anything to reduce the mesothelioma and he didn’t think he should continue with the remaining two treatments as they were making him so ill. He could not offer him an alternative treatment and was very much doom and gloom.

My daughter researched the internet and found Prof Vogl in Frankfurt hospital Germany offering chemoembolisation treatment trial for mesothelioma. She sent him my husband’s medical records and within a week my husband was in Germany having his first treatment of chemoembolisation (01/09/09) he had 3 further treatments at monthly intervals. He had a scan after each procedure and the results were good and promising. At the 4th treatment on the 18th Dec 09 he had a scan of the results from the 3rd treatment. He was told that the mesothelioma was totally dormant and no new activity elsewhere. He would not require any further treatment at this time. He now has an appointment for a scan on the 19th February. The side effects of the chemoembolisation were less severe to the normal chemotherapy he had previously. He felt sick for about a week after each of the treatments but he was able to carry on as normal. He now feels very well and is able to carry on a normal day to day life.

We had to pay over £20,000 for this treatment. His oncologist did not refer him for this treatment and would therefore not sign the forms for funding of this treatment by the Health Commission Wales. There is very little or no research for alternative treatment being carried out in the UK for mesothelioma.

The chemoembolisation treatment is working for my husband and others with this terrible illness and we believe that funding should be made available for this treatment. This treatment should be made available to all who need it not just to those that can afford to pay for it. Without this treatment my husband would not be here today. There is no cure at the moment for this illness and without the funding for research there is never going to be a cure. It is bad enough that my husband has to fight off this disease he should not have to fight for the right to have payment for the treatment he needs. Many others who have been to Germany for the chemembolisation treatment have had good results and seen an improvement in their condition.

What Does The Devon Primary Care Trust Have To Say?

In a statement Devon Primary Care Trust states:

“Local experts in the treatment of lung cancer do not wish to use the procedure…until more evidence of benefit to patients has become apparent. That said in this case there appears to be early indications that the treatment may be leading to some improvement. Although there is no application for funding pending…should future applications be received we would take into account the latest clinical and personal information before coming to a decision.”

Surely Personal Testimonies Are Evident Enough That Chemoembolisation Treatment Is Beneficial To Mesothelioma Patients?

For instance – One only has to go on Facebook (all links provided at the end of this article) to see how many mesothelioma sufferers are benefiting from chemoembolisation treatment. But I have corresponded with many of them – and I am deeply saddened by the unnecessary anxiety they have had to endure, (and some still have to) – such as having to travel to an unfamiliar country when they are ill, flight booking, (some during threats of delays) hotel searching, (that charge extortionate high season rates) making care arrangements for their children, and on top of all this – having to finance their own treatment!

Could you imagine how less stressful it would be for mesothelioma sufferers if chemoembolisation was available nearer to home, and they received relevant funding? Chemoembolisation therapy is commonly used in the treatment of liver cancer in the UK, so why not mesothelioma? It is time we had a clinical trial in the UK, and the 4 following facts tell us why:

1. Personal testimonies prove that chemoembolisation treatment is beneficial and prolongs life
2. There has been no reports of devastating side-effects from the treatment and evidence suggests that it is well-tolerated
3. UK consultants support chemoembolisation, acknowledging tumour reduction
4. Chemoembolisation costs about the same as conventional chemotherapy in the UK.

Note: If you feel that you could have any input in any way that would bring a clinical trial for chemoembolisation treatment for mesothelioma a step closer in the UK, relevant contacts are at the end of this page.

More inspiring and poignant testimonies in support of chemoembolisation treatment:

My Mesothelioma story – Veronica White

My name is Veronica White and I am age 62. I was diagnosed with Mesothelioma in April 2008 after breathing difficulties. My Doctor treated me for Asthma until I said I wanted to be referred to a hospital consultant. I had to wait nearly three months for an appointment.

I was given a scan, which showed my right lung had lots of fluid in it. A sample of the fluid was sent for analysis and it took 22 days for the result to come through that I had cancer. I had a pleurectomy on the 19th May and was in hospital for 11 days, my drains came out another 11 days after discharge from hospital. This was a particularly painful and difficult time as I had to have a nurse come to the house to dress the drain site which was very sore.

July – I started Radiotherapy on the operation wound and drains sites. After three sessions I realised that the radiotherapy had missed the drain site and contacted the hospital. I went back for a check-up and my suspicions were confirmed. I then had another radiotherapy session on the drain site. Chemotherapy started also in July and I had six sessions of ‘Pemetrexed’ (Alimta) and ‘Cisplatin’ until November. This was very difficult as the hospital had a lot of trouble getting the cannula in to administer the chemo, which mostly took about 12 – 13 hours each time. The nurses were very understanding though. During this treatment I was very sick and felt very ill, also my hair started thinning quit a bit. Fortunately I had a lot of hair so it didn’t look too bad.

On a follow-up by my Oncologist in January he said I was currently stable. He also told me about a Medical chemotherapy drug trial starting at Guys hospital. He did say it would come to Maidstone in about 6-8 weeks and I opted to wait for that. In the end it didn’t come to Maidstone though so I went to Guys on 31st March 2009.

I started the trial and found the drug very toxic to me. My hair started falling out in greater amounts than before and I got myself a wig. I had a rash all over my face, neck, and ears and got nasty blisters on the bottom of my feet as the trial went on. Each monthly visit I was told that I was still stable. However, during my August appointment my Oncologist at Guys said the drug wasn’t working, and that my tumours had been growing for three months. Understandably I was very upset at this news. Firstly, because the drug ‘Sorafenib’ wasn’t working, and secondly, because my cancer was growing. I had already found out about Prof. Dr. Thomas Vogl, via the Internet and Debbie Brewer -  who had received the treatment from him was now well.

My Oncologist told me there wasn’t really much they could do for patients who insisted on more treatment, and  he prescribed me with ‘Vinorelbine’. But the message I got was that was it for me now. I mentioned the Prof. to him and he got quite heated about patients wasting money and going off all over the world chasing treatment. He also said that chemoembolisation couldn’t possibly work on this type of cancer, and that the Prof. couldn’t get all of the cancer anyway. We were both shocked and upset at his reaction and how callous he seemed. He was running very late that day and obviously overworked but he could have shown us a little humility after the news he had just given us. Even the Doctor who had asked him to assess me (because she felt out of her depth at our questions) looked shocked too.

I had been in contact with the Prof. who asked me to send my scan result and a CD, and he would see if he could help. He telephoned me upon receipt of the scan details and said he could help and that I should come Germany. We delayed going for 6 weeks though as we were trying to get PCT funding as the treatment is all approved by NICE, but not available for Mesothelioma. But six months later and they still had not made a decision. I went for my first treatment in October. My second treatment was in November and I was told there was about 5% improvement and that the pressure of the tumour was reduced. This was very good news for us. I had an appointment with my surgeon, who likes to keep in touch with her patients, after the second visit, she gave me an X-ray and was delighted with the results. She wrote to both of my Oncologists saying how pleased she was.

I had my third treatment on January the 2nd and the Prof. was delighted with the results, saying I may only need one more treatment after this. He said the tumour had even less pressure in it meaning that it was dying. We were ecstatic with this news.

I have my fourth treatment on the 3rd February when I will find out if it is the last treatment of Chemoembolisation or not. He will also talk to me about ablation treatment. I wish I had known about this chemoembolization treatment before the operation, as this took about 10 months to recover from, and the pain from the drains 15 months to ease off.

It seems to me that it would be cheaper for the NHS to pay for this treatment than operations and chemotherapy, which must cost several times more overall? I found out about Debbie Brewer because she mentioned that she had Mesothelioma when she sponsored my daughter, who was racing with me in the ‘Cancer Research Race for Life’, in May 2009. Because of the chemoembolisation treatment, I am racing again this year. When I was diagnosed I knew that I only had 8-12 months left. This was devastating for my family and me. We were all in shock, firstly about the initial diagnosis but then again at the prognosis. I was worried I wouldn’t make it to Christmas or see my young grandson grow up. Now I feel more optimistic at  least of having an extended life, and are more philosophical about my illness. While I am feeling quite well – I will have hope.

The cost of the treatment in Germany is very high, about £4,500.00 per visit. This is the treatment, the Hotels, who charge astronomical rates when there is an exhibition on, and this is often, plus the flights and the parking.

We were very anxious over the Christmas period as we normally book our flights straight away and usually with BA, but there was talk of an impending strike and it was very upsetting. In the end it didn’t happen, but we have booked Lufthansa this time, just to be on the safe side.  There is a tremendous support network on Facebook, and we all get comfort in helping others who are just starting this journey, and gain strength from those that are further on.

My Mesothelioma story – Keith Turnbull

My name is Keith Turnbull and I am 65 years old in May I was diagnosed with Mesothelioma in October 2008 following a VATS procedure and a biopsy in Harefield Hospital Middx. My Oncologist at Watford General Hospital where I had originally been an inpatient gave me no hope and offered me no treatment other than palliative chemotherapy which would only prolong my life by 3 months and would probably leave me totally deaf as I already have no hearing in one ear and less than perfect hearing in the other. I was very despondent about the outcome and returned home having been told to just make the most of what life I had left. My daughter Lise noticing how despondent I was searched the internet for help and found out about Professor Vogl’s work via Facebook and Debbie Brewer’s Blog. Lise contacted Debbie for further information and talked to Professor Vogl regarding my situation. After examining my scans sent to him from my son-in-law he decided I was a suitable candidate for his Research Programme and offered for me to go to Germany and talk to him regarding Chemoembolisation. Debbie had also mentioned Mistletoe therapy at Park Attwood Clinic near Kidderminster as being part of the whole package as it would kick – start my immune system. I talked to Dr Orange the Consultant Oncologist and Director at Park Attwood and he convinced me to go to Kidderminster and undergo the Mistletoe therapy prior to undergoing Chemoembolisation as both he and Professor Vogl were in agreement that the two treatments worked better in tandem. I decided to consult with the Consultant and Surgeon at Harefield to see if there was anything that could be done on the NHS as by this stage I was no longer able to work, however, he could offer me no other hope than an E.P.P. and this only as a matter of last resort. At this stage I was emotionally upset and in a depressed state as was my wife Judith so it took a few months to get my head round the idea of trying something new, not available on the NHS and moreover not in the UK.

Eventually with some cajoling from my daughter, my wife and the rest of our family I was persuaded to try out the Mistletoe therapy on a private basis at a cost of several hundred pounds a visit and with great trepidation my wife, my son-in-law, and I, flew to Germany to see Professor Vogl for a consultation in August 2009 as at this stage I felt I had nothing to lose. Within the hour he suggested that I should have a MRI Scan to be swiftly followed up by the Chemoembolisation treatment. Consequently I didn’t have time to have any doubts about what I was about to do, especially as my wife and son-in-law had travelled with me and my son-in-law had taken time off work and I felt I couldn’t let them down. We paid the money over and I went off for the treatment. Although not painful it was definitely uncomfortable and I was glad when it was over and I was taken to a ward to recover. This took approximately 5 hours and then I had a CT Scan before I could leave the clinic .Professor Vogl told us that he wouldn’t be able to tell us how the treatment had gone until my next scheduled visit the following month.

I have now had 4 monthly sessions of Chemoembolisation preceded by the Mistletoe therapy at a cost of 4,000 euros a time for the German treatment, this is not including the flights for myself, my wife or my daughter who has accompanied me on the last 3 visits or the hotels in which we have stay. In order to come with me and to support my wife my daughter has now given up work as it was proving more difficult to find childcare for our two grand-daughters. Consequently we are all undergoing financial hardship at present and my wife has resorted to fundraising to pay for my treatment as the original government payment of £17,000 that I received due to contracting Mesothelioma almost certainly via my father whilst he worked for the local Cape Universal Asbestos Company has disappeared through funding all those Chemoembolisation treatments. This leaves a bitter taste in my mouth as that money was supposed to help to provide for me for the rest of my life however long or short it may be and pay for any aids I might require due to the nature of my illness. I am now reduced to paying for any further treatments by way of my savings and friends and family have been generous with their donations but that can’t last for ever Professor Vogl ’s research and treatment has improved my quality of life to such an extent that each time I go to Germany my breathing has improved and the cancer cells have reduced significantly and the last time I went in November 2009 Professor Vogl told me that the “cancer had been rendered inactive” which was a wonderful feeling, especially as he told me that I didn’t have to go again until this month (3 months later) and that unless deemed necessary I will only be having a MRI and CT scan.

It is so hard to believe that I’m still alive as I was told by the Consultant in Harefield last year that he would only expect me to live 6 months so it’s due to Professor Vogl and his brilliant research programme that I am alive today. If only this treatment was available in the UK and on the NHS, as the procedure is actually carried out here for Liver Cancer patients so it can’t be rocket science, many more innocent victims of this terrible cancer could have some hope for the future. As it is we just have to keep hoping that our savings will last as long as we need treatment to stay alive.

Many thanks to you to all who have shared your story and participated in this article:

Debbie Brewer, Ron Bonfield, Gary Meager, Dawn Veal, Jenny & Ricky Hill, Veronica White, Keith & Judith Turnbull.

Written by Ann-Marie Waters.

Contacts:

Debbie Brewer website:  http://www.mesothelioma-and-me.com/

Debbie Brewers dedicated page -Professor Thomas Vogl, Mesothelioma angel:  http://www.facebook.com/group.php?gid=263532046239&ref=ts#!

Veronica White Website:  http://ronnywhite.blogspot.com/

PROFESSOR THOMAS VOGL

Johann Wolfgang Goethe

University Clinic (23c)

Theodor Stern Kai 7

760590

Frankfurt am Main

Tel : 00496963017277

Email : T.Vogl@em.uni-frankfurt.de

The Devon Primary Care Trust – NHS Devon, Commissioning Headquarters, County Hall, Topsham Road, Exeter, Devon, EX2 4QL Telephone: 01392 205205 or 0845 140 5005.

Email corporateservices.devonpct@nhs.net

BBC iPlayer – The Politics Show South West: 07/02/2010 www.bbc.co.uk

Mesothelioma – petition response August 2009:  http://www.number10.gov.uk/Page20326

Mesothelioma is known for its diverse growth patterns. In addition to the more common subtypes – several rare variants of the disease are known.

Small cell mesothelioma

The small cell variant of mesothelioma is rare and can be misdiagnosed as a small cell carcinoma. Desmoplastic mesothelioma should present at least a fifty percent ‘small cell’ morphology to qualify as a rare variant of mesothelioma. Small cell mesothelioma does not display the haematoxphilic nucleoprotein precipitates – commonly seen in small cell carcinoma.

Lymphohistiocytoid mesothelioma

This is an extremely rare variant of mesothelioma and only counts for one percent of cases, and was first reported in 1988. Lymphohistiocytoid mesotheliomas are predominantly ‘sarcomatoid’ or poorly differentiated ‘epitheloid’ tumours. These rare mesotheliomas can also be characterised by histiocytoid neoplastic cells – obscured by intense lymphocytic infiltration.

Deciduoid mesothelioma

Only 3 cases have been reported – 2 patients were described by ‘ Nascimento et al’.  These epithelioid mesotheliomas were found in the peritoneum in young women. The tumour cells were large with abundant glassy eosinophilic cytoplasm, reminiscent of decidual cells and followed an aggressive course. The 3^rd reported case described by ‘Orosz et al’ was deciduoid mesothelioma of the peritoneum found in a 15 year old girl, she died 11 months later.

Desmoplastic small round cell tumour

Desmoplastic small round cell tumours (DSRCTS) have distinctive pathological features that differ from mesothelioma. Although DSRCTS is not generally considered to be a variant of mesothelioma – it may represent a primitive form of mesothelioma or ‘mesothelioblastoma’.

Well – differentiated papillary mesothelioma

Well-differentiated papillary mesothelioma is a rare variant of ‘epithelial mesothelioma’ and is thought to present low malignant potential. Most reported cases of papillary mesothelioma developed in the peritoneum of young women where a history of asbestos exposure was not always apparent. The tumours present as ‘peritoneal nodules’ and rarely occur in the pleura.

Benign multicystic mesothelioma

Benign multicystic mesothelioma  – also referred to as (peritoneal inclusion cyst) is a rare lesion found on the abdominal peritoneal surface, and is predominantly found in pre-menopausal women. It may form a large multicystic mass; and although benign, its existence can cause infertility.

Chemoembolization is a medical procedure used predominantly in the treatment of liver cancer.

The treatment is more effective as it allows a far higher concentration of ant-cancer drugs (20 times higher than conventional chemotherapy drugs) in direct contact with the tumour for a longer duration. It works best in patients where the tumour is more localised.

In 2006 a UK resident ‘Debbie Brewer’ age 47 (below) was diagnosed with mesothelioma – a rare type of cancer that is predominantly caused by exposure to asbestos. Her prognosis was bleak as she was told that she had between 6 and 9 months to live. Debbie looked in to alternative treatments and went to visit Harley Street cancer specialist ‘Dr. Etienne Callebout’. Dr. Callebout is one of the finest ‘alternative cancer treatment’ specialists – and cancer patients often turn to him when conventional treatment has proved little hope.

Dr. Callebout offered Debbie valuable advice regarding nutrition and also informed her about Professor Thomas Vogl. Professor Vogl is head of the ‘Department of Diagnostic and Interventional Radiology, J.W. Goethe University Hospital, Frankfurt, Germany. He pioneered a clinical trial to test whether chemoembolization would treat mesothelioma tumours and the results were promising.

Debbie made an appointment to see Professor Vogl in Germany and he agreed that she was a good candidate for chemoembolization treatment. After several treatments – Debbie’s tumour shrunk by 80%, not only prolonging her life but she is hopeful that she is now in full remission. Despite her personal battle with mesothelioma – Debbie has shown much gratitude and enthusiasm regarding Professor Vogl’s treatment by highlighting his pioneering treatment and bringing new hope to others.

In 2009 Debbie launched a petition asking the UK government that chemoembolization clinical trials would be available to mesothelioma patients in the UK, and has also highlighted the treatment on her blog mesotheliomaandme.blogspot.com and facebook account. Professor Vogl treats approximately 20 mesothelioma patients per year. The NHS does not fund chemoembolization treatment – hence Debbie had to pay around £20.000 for hers, and currently there are no plans of chemoembolization trials for mesothelioma patients in the UK. But hopefully – more public awareness of this type of treatment and further campaigning may render it available in the UK.

•  Cancer Research UK
  P.O. Box 123
  London
  WC2A 3PX

Telephone: 020 7242 0200
http://www.cancerresearchuk.org

Not only is ‘Cancer Research UK’  the most prominant cancer research organisation in the world, but a leader in the latest anti-cancer drugs, as well as funders of  research into the disease , treatment, prevention, and causes. They also offer both education and psychological support for patients.

Mesothelioma organisations and sites:

• Macmillan Cancer Support
  Head Office
  89 Albert Embankment
  London
  SE1 7UQ

Email: cancerline@macmillan.org.uk
Website: www.macmillan.org.uk

Macmillan Cancer-Line: 0808 808 0000
Textphone: 0808 808 0121

Macmillan Cancer Support provides excellent care and support for people with cancer at every stage of their illness as well as financial help and support for patients and families in need. Emotional support is also offered which is very valuable.

• National Cancer Institute
  This site provides patient information on malignant mesothelioma. It is written indepth on an academical level – hence – very detailed and comprehensive.
  http://www.cancer.gov/cancerinfo/types/malignantmesothelioma

Biological toxicity relates to the shape of asbestos fibres. The mesothelial cell appears to be a predominant target of the asbestos fibre – consequently leading to the disease ‘mesothelioma’. Understanding how the shape, chemical composition, and surface structure interact to result in a harmful biological agent is paramount to the study of prospective harmful fibrous materials in the future.

Amphibole needle-like fibres

The long thin shape of an asbestos fibre may enhance its entry deep into the lung. Following inhalation, fibres of several micrometres in length can enter the respiratory airways, whereas other particles larger than 5 micrometres could not penetrate. Once in the lung – the long fibres may not be cleared by the bodies natural defence mechanism such as ‘macrophage clearance’ macrophages generally mop up foreign bodies, but scientists have discovered that certain stubborn asbestos fibres (such as needle-like shape) cannot be cleared by macrophages. These fibres may more easily migrate along tissue planes, lymphatic channels and make their way into the pleural space.

Animal studies show certain asbestos shapes induce mesothelioma

Asbestos shape has been considered to be a primary characteristic determining asbestos toxicity, i.e. ‘Stanton et al’ 1977, recognised size and shape as a major factor in inducing mesothelioma in animal studies. For instance – other materials with the same shape but different chemical composition share the ability to produce mesothelioma. Also – studies of asbestos fibres with a long thin shape were shown to be able to induce chromosomal abnormalities.

Studies of human epidemiological trials and lung mineral toxicity conclude that ‘amphibole’ asbestos fibres (crocidolite and amosite) are more predominantly associated with mesothelioma than chrysotile fibres. Amphibole fibres contain more iron; possess a higher aspect ratio, and their needle-like shape is more brittle.

 Conclusion

Asbestos shapes have chemical differences. Physical properties are important in determining the toxicity of the fibre, predominantly – the fibres shape, surface reactivity and chemical composition.

If your symptoms include unexplained fluid accumulation in your chest area or abdomen, or /and you have a small to moderate amount of thickening of the pleura – then a biposy will be performed. The biopsy will be semi-invasive which will only require a local anesthetic and that does not involve cutting into the ches or abdomen. For example – the biopsy may involve a ‘thoracentesis’ (drainage of fluid from the chest), a ‘paracentesis‘ (drainage of fluid from the abdomen) or a ‘pleural biopsy’. These procedures are carried out by either a pulmonologist (lung physician), a radiologist, or a surgeon. A pleural biopsy may offer conclusive results as mesothelioma tends to be widely scattered in the chest, so a random sample of tissue may produce mesothelioma cells.

Pleural Biopsy

The fluid and the tissue collected from the pleural biopsy will be sent to either a pathologist or cytologist. The cells will be examined under a microscope to determine whether mesothelioma is present. The fuid will be stained with a special fluid which will distinguish cancer cells from non-cancerous ones. This process is called ‘immunostaining’. After your biopsy – a chest xray is normally performed, this is to ensure that you have suffered no complications from the biopsy – such as accumulation of air in the chest (pneumothorax). This will also be able to predict whether enough fluid has been drawn from the chest – allowing for normal lung expansion.

Thoracoscopy

 If the semi-invasive test is inadequate or a CT scan reveals that fluid is not flowing freely but hidden in pockets that are difficult to reach – then A thoracoscopy (lighted scope) with or without connected camera, will be inserted into the chest cavity. If the physician sees any tissue that looks abnormal – a small piece of tissue will be cut out for inspection under a microscope.

Peritoneoscopy

A peritoneoscopy is similar to a thoracoscopy but involves close examination of the abdemen. If the radiolic tests indicate that there is more solid tumour than fluid – an open biopsy will be performed by a thoracic surgeon. He may remove a small piece of rib to allow a better view ogf the thickened pleura. A good size piece of the thickened pleura will be cut away (approx 1-1.5 diameter) to ensure an adequate diagnosis can be made. This procedure is carried out under general anesthetic and you may need some pain relief if you are experiencing any after pain or discomfort associated with the procedure.

Moreover – Sometimes physicians may want to give a dose of radiation to the sites where boipsies have been performed. This is because mesothelioma has a tendency to grow tumours at biopsy sites and the radiation will inhibit cell growth.

Lovastatin – manufactured by Merck, Sharp & Dohme is a fungal metabolite and is predominantly used as a cholesterol reducing drug i.e. in the treatment of ‘hypercholesterolemia’. According to a study conducted by the ‘Department of Medicine, University of Minnesota, and Minneapolis’ in 1998, it has shown some promising results in the laboratory clinical trials.

Tests showed that Lovastatin inhibited mesothelioma cell viability (cell growth) – see labatory slides below, i.e. reference figure (A) compared to untreated mesothelial cells – reference figure (B).

Both chemotherapy and radiation treatment for mesothelioma have been shown to produce toxic side effects for mesothelioma patients and is not considered as a cure for mesothelioma, whereas Lovastatin is a widely used and well tolerated pharmaceutical drug that can substantially inhibit mesothelioma growth and   promote tumour-cell apoptosis (cell death).

Dr. Dan Sterman’ one of the worlds leading researchers on gene therapy from the University of Pennsylvania points out that it would be a little premature to get too excited at this stage as Lovastatin has only been tested on mesothelial cells in vitro (test tube), Also, like with many rarer diseases  - companies tend to target the more prevalent diseases, thus making it more difficult to fund the resources that are necessary to finance the very much needed clinical trials.

 Hopefully – It won’t be too long before Lovastatin can offer fresh hope to mesothelioma sufferers.

The recurrence of cancer is one of the most dreaded fears during treatment .

Where is mesothelioma likely to recur?

Mesothelioma tends to recur in the area that it originated in. It also has a tendency to grow in old wound sites – known as malignant seeding and is a common complication in mesothelioma patients. When you go for regular check ups – your doctor will monitor treatment sites such as biopsy tracts, thoracentesis tracts, chest sites, and surgical incisions. If the mesothelioma has spread to metastatic sites (which usually only happens later in the course of the disease) such as the abdomen – you are most likely to experience a feeling of fullness in that area, bloating, and a loss of appetite. The symptoms are normally a result of a build up of fluid in the abdomen.

• Pemetrexed (Alimta)
• Cisplatin
• Carboplatin (paraplatin)

 Pleural Mesothelioma

Pleural mesothelioma is predominantly caused by exposure to asbestos and is a rare cancer that develops in the ‘mesothelial cells’ The mesothelium cells make up the mesothelium, which is a thin membrane acts as a protective layer and lines many of the body’s organs. Malignant pleural mesothelioma, develops in the lining of the lungs, called the pleura or pleural membrane.

Commonly used drugs to treat pleural mesothelioma

Pemetrexed (Alimta) is in powder form and administered by injection. Alimta is given in combination with cisplatin as it appears to be a more effective treatment for patients suffering from ‘malignant pleural mesothelioma’ and whose disease is not suitable for curative surgery. Alimta is considered to be a toxic drug and therefore – to reduce toxicity, patients taking Alimta are prescribed a low daily dose of oral ‘folic acid’ or multivitamins containing folic acid.

Cisplatin is a chemotherapy drug that is more widely used than Alimta as it is used to treat various types of cancer such as testicular, lung, and bladder cancer. Cisplatin is used with Alimta as the drug forms DNA cross-links via the platinum which damage cancer cells, hence destroying them and discouraging cell division.

Carboplatin is chemically different from cisplatin as it is a larger molecule. This slows down the metabolic breakdown of the agent (which enables it to be in the body longer) thus reducing the rate of formation of toxic by-products. Carboplatin is an Alkylating agent and Alkylating agents are usually considered of greatest value in treating slow-growing cancers

Peritoneal mesothelioma

Peritoneal mesothelioma – (cancer of the lining of the abdominal cavity) is less common than pleural mesothelioma, comprising approximately 1/5th – 1/3rd of the total number of cases of pleural mesothelioma diagnosed.

Intravenously used drugs to treat peritoneal mesothelioma via the abdomen.

• Cisplatin & Doxorubicin  
• Heated Cisplatin & Mitomycin  
• Mitomycin
• Fluorouracil & Paclitaxel

Doxorubicin works effectively by binding itself to the cancer cells DNA, inhibiting a significant enzyme (topo-isomerase II).  Thus disrupting the DNA, and preventing new cancer cell growth and division.

Mitomycin is classified as an anti-tumour antibiotic and is predominantly used as treatment for bladder cancer. Mitomycin works by adhering itself within the strands of genetic material (DNA) and binding them together. This prevents the cell from producing genetic material (DNA), thus preventing the cell from dividing.

Flourouracil is also commonly known as ‘FU’ or ‘5FU’ and is one of the most commonly used drugs in the treatment of cancer. Fluorouracil is an anti-metabolite drug.  Anti-metabolites are similarly structured to normal body molecules but possess a slightly different make-up.  It is these differences that enable anti-metabolites to prevent cells from functioning properly. Hence – preventing cell growth and division.

Paclitaxel – also known by the brand names of ‘Taxo’l and ‘Abraxane’ is a chemotherapy drug and derives from the bark of a yew tree.  It works by preventing cancer cells dividing into 2 new cells, hence- blocking the growth of the cancer.