Mesothelioma FAQ

Anything that can cause cancer in humans or animals, or helps it to grow is known as a carcinogen. Carcinogens can be naturally occurring or synthetic. They can be physical, from chemical compounds to fibrous materials; they can be solid, liquid or gas. They can be biological, like the virus that causes cervical cancer. Many chemical carcinogens are molecular substances found in liquids or solids like pesticides, or in the air, like cigarette smoke and components of smog.

Carcinogens usually act directly on a cell’s DNA to cause a mutation. The mutation will cause the cell to grow in an uncontrolled way. Some carcinogens act indirectly by causing normal cells to grow more rapidly, leading to a higher chance of a cancer-causing mutation.

Carcinogens are discovered in a number of ways. Lab studies may show that a particular substance causes cancer in animals. It is often suspected that chemicals with similarities to known carcinogens might also cause cancer, and this may be tested in animals. It is assumed that what causes cancer in animals may cause it in humans.

Population studies can correlate clusters of cancer, and use available data to try and get an idea of what might be causing the particular cancers.

Scientists usually use information from epidemiologic studies as well as laboratory studies to determine if something is carcinogenic. Sometimes the evidence is strong and sometimes it is not.

There are a number of agencies that list carcinogens. The International Agency for Research on Cancer which is part of the World Health Organization is one such agency. They place possible cancer-causing agents into one of 5 groups, from carcinogenic to probably not carcinogenic.

The U.S. National Toxicology Program which was formed by parts of the NIH, the CDC and the FDA release reports about every two years. They make two classifications, “known to be human carcinogens” or “reasonably anticipated to be human carcinogens.”

The Environmental Protection Agency has its own 5 categories, from carcinogenic to not likely to be carcinogenic.

The lists of these groups are not identical. The IARC lists about 100 known human carcinogens, the NTP lists about 50.

Both include groups of chemicals, medications, radiation, certain dusts and fibers and viruses.

Asbestos is on all the lists of known carcinogens.

Dr. Kaplan

Chemotherapy may affect the cells lining the intestines and this may cause diarrhea (frequent, loose or watery bowel movements). If the diarrhea persists for more than 24 hours or causes pain, bleeding, or weakness, the patient must consult his or her physician. Patients should not use over-the-counter medicines without consulting their doctor. The doctor may prescribe a medication to control the diarrhea. If the diarrhea still continues, the patient may need intravenous (IV) fluids to compensate for the loss of fluid and nutrients. Usually the condition does not require hospitalization.

Here are a number of ways to manage diarrhea:

• Use anti-diarrheal medications prescribed by your physician.
• Drink as much fluid as possible. This will help compensate for what you have lost. Water, vegetable broth, and sports drinks like Gatorade can be useful. Ask your doctor what liquids he advises you to drink when you are having diarrhea. Avoid alcohol, and tea or coffee with caffeine.
• Large meals can make diarrhea worse. Small amounts of food all through the day instead of three large meals are easier for your body to digest.
• If your diarrhea cannot be controlled by medication and oral fluids, you may need intravenous fluid so you do not get dehydrated.
• You may need to work with a dietitian if certain foods seem to worsen your diarrhea. It is important to get necessary nutrients and calories. A dietitian can help you find ways to do that.
• Your doctor may suggest that chemotherapy be withheld during this time.

Dr. Kaplan

Tissue removed by biopsy is usually placed into a container with formalin or other preservative. The container is tagged with the name and other necessary details of the patient. When the pathologist receives it, he first observes it with the naked eye and makes a gross description by noting its size, weight and color. He decides which parts of the biopsy should be examined first. The tissue has to be compared with normal cells and identified. For this, the tissue is prepared for examination under a microscope.

Frozen section techniques are used when the surgeon needs a diagnosis while the patient is still in surgery under anesthesia. To do this, the removed tissue is frozen at once and cut into thin layers. It is then placed on a slide and stained with dyes to get a very clear view of the nucleus, cytoplasm and other contents of the cell. This is usually not necessary or helpful for diagnosing mesothelioma.

Permanent section usually takes a few days. The processed tissue is embedded in a paraffin block. After the block hardens, very thin slices of the tissue are cut and mounted on a slide. The tissue on each slide can be stained with different dyes for examination.

The pathologist looks at the slides under a microscope and looks for a number of things that demonstrate that the tissue is cancerous. These include structures inside each cell as well as the way the cells have grown together.

Mesothelioma is very difficult to diagnose. The pathologist will use special procedures, such as   immunohistochemical stains, and DNA microarray analysis to help aid in the diagnosis. He or she will also look at the cells under an electron microscope which reveals much more of the tiny details in the cell.

There are a number of other specialized tests used to make the diagnosis of mesothelioma. If the pathologist cannot be sure, he can send the slides to an expert pathologist who has diagnosed many cases of mesothelioma.

Mesothelioma will also be classified by type, either epithelioid, sarcomatoid, or mixed.

After all the required information is obtained, the pathologist will write a report.

Dr. Kaplan

Closed biopsy uses a much smaller surgical incision than an open biopsy. A camera-like instrument is inserted through the incision and used to locate the appropriate area for biopsy.

Dr. Kaplan

An open biopsy is a surgical procedure. The patient is under general anesthesia while the surgeon visualizes the tumor directly and takes biopsies from what he sees.

Dr. Kaplan

A percutaneous biopsy removes tissue using a needle. Needle biopsies are usually performed using x-rays (typically CT scan), which aids the surgeon in locating the correct area.

Dr. Kaplan

Complementary medicine and alternative medicine are terms that may be familiar to mesothelioma patients. Integrative medicine is comparatively a new term. It combines the best conventional therapies like surgery, radiation, and chemotherapy with appropriate complementary therapies that have been established as safe and effective. Another term for this is integrated medicine Due to the comparative shortage of thorough medical studies to support its use, some physicians do not encourage integrative medicine. However, some cancer centers have accepted some of the methods when treating mesothelioma patients, and some patients do find elements of it helpful.  Some aspects of integrative and complementary medicine can be helpful to alleviate stress, and to overcome the adverse effects of treatment such as fatigue, pain and nausea.

The National Center for Complementary and Alternative Medicine (a component of the National Institutes of Health) has classified complementary medicine into five categories:

Whole Medical Systems:

Whole medical systems are complete ways of looking at health and disease that have evolved separate from traditional Western medical practice. Examples would be homeopathic and naturopathic medicines found in Western countries, and Ayurveda and Chinese traditional medicine found in Asia.

Biologically Based Therapies focus on natural materials like food, herbs, vitamins, and other natural products. While they may be natural they have not been proven safe or effective scientifically.

Energy Therapies are based on various beliefs about energy systems that envelop and pervade the body, and that fields of this energy can be used to reach a state of recuperation. Reiki and Therapeutic Touch are some popular examples. There are also ideas about electromagnetic-based treatments using magnets and other pulsed devices to manipulate the field.

Body-Based and manipulative therapies involve the controlling or moving certain parts of the body, as in massage therapy, osteopathic or chiropractic manipulation.

Mind-Body Therapies are based on the thought that the mind affects the functions of the body, and thus can cause improvement in symptoms.  A few examples are yoga, meditation, hypnosis, biofeedback, and guided imagery, all of which are becoming fairly-well accepted.  Other techniques are still unproven, such as the use of dance, music and art for healing.

Dr. Kaplan

Substance abuse is the use of illicit drugs or the overuse of prescription drugs, or alcohol. The definition can include using drugs for other reasons than why they were prescribed, or in larger amounts than prescribed.

Patients with cancer need control of their pain. Mesothelioma especially causes severe pain for most patients. Patients with mesothelioma who have narcotics prescribed for them should not be afraid to take them. It is true that your body can become more tolerant to the narcotic, and you many need to take higher doses or switch to a different narcotic as time goes on. That is to be expected when treating cancer and your doctor will make sure you are getting safe and effective amounts.

If you already have a substance abuse problem when you are diagnosed with mesothelioma, you need to tell your doctor the complete truth about what you have been taking. That is the only way for you to get the medication that will control your pain. If you are already taking narcotics, you will need higher doses. If you have a problem with something else, such as alcohol or tranquilizers, the doctor needs to know this.

If you find yourself having trouble with medication like narcotics, if for example you want to take more than you actually need for your pain, and you have had a substance abuse problem in the past, you need to be completely frank with your doctor.

But when narcotics are used to treat cancer, their abuse is rarely a problem. It would be worse for people who need a narcotic to not take it because of fears of substance abuse, than it would be for the occasional person to develop a substance abuse problem.

There is one thing anyone taking narcotics should know – prescription drugs are very commonly abused by other people. Make sure you know where your medicines are, and don’t leave them where someone can steal them.

Dr. Kaplan

Peripheral neuropathy is a disorder of the nerves that carry information from the brain and spinal cord to the body.  It can be caused by a number of chemotherapy agents, in which case it is called CIPN – chemotherapy induced peripheral neuropathy. It usually affects the nerves going to the arms and legs.

Symptoms of CIPN related to nerves that cause sensation include a feeling of pins and needles or tingling, numbness, pain, burning, increased pain with exposure to different temperatures (especially cold) or increased sensitivity to pressure. If sensation is lost in the feet, balance can be a problem, and you may find yourself tripping.

CIPN affecting the nerves that control the muscles include weakness and loss of muscle mass. If CIPN is affecting the arms and legs, it usually starts at the point farthest away from the spinal cord – the hands and feet – and it is often the same on both sides. This can be called a stocking/glove distribution.

When CIPN is more advanced and affecting nerves closer to the center of the body, you can have trouble swallowing, difficulty urinating, constipation, and even changes in your blood pressure.

There are some chemotherapy medicines that are more likely to cause CIPN than others. They include the platin drugs often used to treat mesothelioma, including cisplatin, carboplatin, and oxaplatin. Vinorelbine and vinblastine are part of a another group causing this problem.

If you have any of the symptoms described, you must tell your doctor immediately. Your chemotherapy may need to be stopped, or the dosage lowered. Much of the time, CIPN lasts only a short time and goes away after treatment is stopped. However, it can go on longer. Severe CIPN is more likely to last, which is why your doctor needs to know about your symptoms early on.

Doctors are trying to help lower the chances of patients getting CIPN by giving chemotherapy agents more slowly, or over more days. They are also looking for substances that may reduce the risk, for example, vitamin E, calcium and magnesium. There are also ways to treat it, with pain medicine, local patches of numbing medicine, steroids, and other classes of medication.

There are other medical problems that cause peripheral neuropathy, such as diabetes. It is important for you to make sure all your other medical conditions are being treated.

Dr. Kaplan

Loss of weight with mesothelioma and treatment can be severe, and can make it much harder to fight the cancer. You may have already lost weight by the time you are diagnosed. You need to try and gain as much weight back as you can before treatment.

The following are some tips regarding good nutrition for mesothelioma patients. For additional information see Proper Nutrition During Mesothelioma Cancer Recovery

• You need enough calories, protein, fats, carbohydrates, vitamins and minerals to try and prevent or reverse weight loss, and to have enough strength to fight the cancer. You especially need high calorie and high protein foods.
• Your diet may have to change from what you were eating previously, especially if you were watching your cholesterol, limiting red meat, and limiting calories.
• Drink as much water as possible. Chemotherapy may cause diarrhea or vomiting and the fluid intake can compensate the water loss.
• Avoid the use of tobacco products entirely.
• If your doctor allows it, one small glass of beer or wine with a meal can actually make your appetite stronger.
• Include a lot of fruits and vegetables. They contain almost all vitamins and minerals that are essential for your body. Consult with a dietician if you are not able to eat a balanced diet to see if you need supplements. It is more important for you to get enough protein and calories.
• Cook meats and fish thoroughly, as they may contain bacteria that can cause food-borne illnesses.
• Eat things that appeal to you. Add sugar, butter, milk and cheese to foods you are eating. There are many ways to increase the calories in the foods you are eating.
• You will need to continue to eat a high-calorie high-protein diet through your treatment. After you are done with treatment and you have regained lost weight, you would then want to go back to the balanced healthy diet recommended for adults.

Dr. Kaplan