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| Glossary |
Asbestos-related medical conditions include:
This is the least serious form of asbestos-related disease
The “pleural cavity” is a closed space within the chest walls that houses the lungs. The “pleura” is a thin, transparent membrane that covers the lungs and lines the inside of the chest walls. There are two layers of this membrane. The inner (visceral) layer of the pleura is attached to the lungs and the outer (parietal) layer is attached to the chest wall. A small amount of fluid usually fills the gap between the parietal and visceral layers of pleura. This fluid is produced by cells in the pleura called “mesothelial cells”. The pleural membranes prevent the lung from making direct contact with the chest wall and the diaphragm.
Pleural plaques are areas of thickening or scarring which occur on the parietal pleura, most commonly on the lower chest walls and diaphragm. They take the form of small, hard, plate-like raised surfaces of calcified tissue, similar to arteriosclerosis in coronary arteries. These changes are visible on x-ray and can cause impairment of the lung. However in most cases will not produce any symptoms, so you may be unaware that you have them.
Plaques are simply a marker of asbestos exposure and usually do not develop until 20 years or more after first exposure to asbestos. Pleural plaques alone are not prejudicial to health. However, because they are evidence of asbestos exposure, they can indicate that the sufferer is at a small risk of developing a more serious asbestos-related condition such as pleural thickening, asbestosis, mesothelioma or asbestos-related lung cancer.
Pleural Plaques - State Benefits/Compensation
The Department for Work and Pensions (“DWP”) will not pay any benefits for this condition.
However civil compensation can be claimed through the courts. A civil claim is based on the fact that pleural plaques are seen as a marker of exposure to asbestos. Most doctors will therefore accept that they cannot exclude the possibility that someone who has pleural plaques will develop a more serious asbestos-related condition in the future.
A claim for civil compensation may include a claim for “provisional damages”. Normally compensation claims result in a once and for all award. An award of “provisional damages” gives compensation for the condition and the anxiety caused on the basis that there will be no deterioration but enables the victim to return and seek additional compensation should any more serious asbestos related condition develop. This provides for some compensation in the short term but allows the claimant to return for more compensation in the future should he develop a more serious asbestos-related condition. Provisional damages awards can be in the region of £4,500 to £6,000. Alternatively a claimant can elect to have his claim dealt with on a full and final basis. A full and final award may be more attractive for the older claimant.
The time limit for bringing a personal injury claim is three years from the date of knowledge of the injury. The diagnosis of pleural plaques would count as knowledge of an injury and therefore a claim should be brought rather than waiting to see if any further condition develops.
For further details see “Bringing a Civil Claim for Compensation”.
Fluid that accumulates in the pleural space because of disease is called a “pleural effusion”. You may also hear this described as a “benign pleural effusion” if the accumulations of fluid are non malignant. It may precede or predispose to diffuse bilateral pleural thickening.
When microscopic asbestos fibres are breathed in they become lodged in the lungs. The bodies reaction to the lodged fibres can cause “mesothelial cells” to become abnormal and produce large amounts of fluid. It is this overproduction of fluid by the mesothelial cells that causes the pleural effusion.
Pleural Effusion - Symptoms
Some effusions cause chest pains, but many do not cause any symptoms.
Pleural Effusion – Diagnosis/Treatment
Pleural effusion can be diagnosed using chest x-rays and CT scans. It can be treated and you may make a complete recovery. Excess fluid can be removed from the pleural space and an operation known as a “pleurodesis” can be carried out to prevent fluid building up again.
The pleural effusion can be caused by a variety of factors including infections, persistent inflammation or by cancers. However it can be evidence of exposure to asbestos and it may lead to the development of a more serious asbestos related illness such as pleural thickening, asbestosis, mesothelioma or asbestos-related lung cancer.
Pleural Effusion - State Benefits/Compensation
Department for Work and Pensions (“DWP”) will not pay benefits but civil compensation can be claimed as in the case of pleural plaques.
For further details see “Bringing a Civil Claim for Compensation”.
This may also be described as “pleural fibrosis”. Either term may be combined with the word “diffuse” (e.g. “diffuse pleural fibrosis”). This simply means that the area affected is widespread.
When microscopic asbestos fibres become lodged in the lungs they can cause inflammation of the “pleura” (i.e. the thin, transparent membrane that covers the lungs and lines the inside of the chest walls). Even with long-standing or severe inflammation, often only a slight amount of scar tissue remains after complete healing. However the lung occasionally becomes encased in a thick fibrous layer that limits chest wall motion and impairs the function of the lungs.
Pleural Thickening - Symptoms
You can become breathless and suffer pain as a result of this condition that might also deteriorate. It can affect one lung or both lungs, and can result in significant disability if it is extensive. It will generally take 10 years after first exposure to asbestos to develop. Alternatively it may not prove disabling or produce significant physical symptoms but is the cause of great anxiety.
Pleural Thickening - Diagnosis/Treatment
Pleural thickening can be detected by chest x-rays, ultrasound and a special scan called a CAT or CT scan.
The presence of pleural thickening can indicate that you are at risk of developing a more serious asbestos related disease such as asbestosis, mesothelioma or asbestos-related lung cancer.
Pleural Thickening - State Benefits/Compensation
Provided your job involved working with asbestos or being exposed to asbestos after 4 July 1948 then Department for Work and Pensions (“DWP”) Industrial Injuries Disablement Benefit can be claimed.
It may also be possible to obtain civil compensation by suing your previous employer/s. Awards vary, depending on the degree of disability.
If you are unable to sue your former employer because, for example, they have ceased to trade(and you are unable to trace their insurers), then you still may be able to claim under the Pneumoconiosis etc. (Workers' Compensation) Act 1979 which provides a scheme under which qualifying employees are entitled to a one-off lump sum payment ranging from £2,068 - £58,718 depending on circumstances.
For further details see “Bringing a Civil Claim for Compensation”.
This is a progressive crippling respiratory disease that was first found in naval shipyard workers. It is caused by inhalation of asbestos fibres and usually strikes workers in the textile, cement and insulating industries.
Serious asbestosis is usually caused by heavy exposure to large quantities of asbestos fibres. Either a sustained exposure over a period of years (e.g. a long time worker at an asbestos textile plant) and/or intense exposure for a shorter period (e.g. a worker in the boiler or engine rooms of ships under construction.) The specific type of asbestos fibre to which the worker was exposed does not seem to be significant in the development of asbestosis.
When airborne asbestos fibres are breathed in they become trapped in your lungs. The body tries to dissolve the asbestos fibres by producing acid. The acid does little to damage the asbestos fibres since they are very durable and chemically inert. Unfortunately the acid does cause irritation and inflammation of the cells in the lungs and may scar and thicken the surrounding tissue. Eventually a “fibrosis” or scar tissue develops in the spaces around the small airways and the tiny sacks at the end of your bronchial tubes called “alveoli”. The alveoli are where the oxygen from the air enters your blood, and the carbon dioxide from your body goes into the air. Alveoli are very tiny, but you have a lot of them in your lungs. The thickening and scarring caused by the asbestos fibres prevents oxygen and carbon dioxide from travelling between the alveoli and the blood cells, so breathing becomes much less efficient.
Over a period of many years this damage may become so severe that the lungs cannot function. The “latency period”, that is to say the time it takes for the disease to develop, is very long (25 to 40 years).
Asbestosis – Symptoms
The symptoms of asbestosis typically include shortness of breath, coughing, a dry crackling sound while inhaling and chest pain.
However not all of these symptoms might be apparent straight away. Asbestosis is a slow progressing disease that may show no symptoms for 10 to 30 years. Once the process of inflammation and scaring of the lungs has been started by the asbestos fibres the disease can continue to progress even after the exposure to asbestos has ceased. As the disease progresses, the symptoms can worsen. Shortness of breath may initially only be experienced only during heavy exertion. However, over time it may be produced by lower levels of exertion and then start to interfere with the ability to carry out everyday activities. Eventually the individual may require oxygen. In unusual cases the condition can even prove fatal.
Asbestosis – Diagnosis/Treatment
The scarring and thickening of the tissues of the lungs cause by asbestos fibres can be seen on x-rays and CT scans which will show a typical fibrotic pattern. There are added chest sounds also called rales, crackles or crepitations that can be heard with a stethoscope. A breathing, or respiratory function, test (sometimes called a “pulmonary function test” or “PFT”) may also be carried out to check whether the functioning of the lungs has been reduced. It can be conclusively identified by taking samples of lung tissue (called a “biopsy”).
Asbestosis affects both lungs (it is “bilateral”) and, although it is mainly in the lower fields of the lungs, it is usually widespread (“diffuse”.)
At the moment there is no cure or effective treatment for asbestosis. However some measures can be taken to slow the progression of the disease and prolong life.
Asbestosis itself is not a cancerous lung disease. However, people with asbestosis should stop smoking immediately because people with asbestosis are much more susceptible to lung cancer. There is also a high risk of developing another serious asbestos related condition called mesothelioma.
Asbestosis - State Benefits/Compensation
You may be entitled to Department For Work And Pensions (“DWP”) benefits. Industrial Injuries Disablement Benefit is payable to those who suffer a disability caused by a disease accepted by the DWP as being due to occupation. Asbestosis is Prescribed Disease D1.
If you are unable to sue your former employer because, for example, they have ceased to trade, then you still may be able to claim under the Pneumoconiosis etc. (Workers' Compensation) Act 1979 which provides a scheme under which qualifying employees are entitled to a one-off lump sum payment ranging from £2,068 - £58,718 depending on circumstances.
Although provisional damages are available it is more usual for the courts to deal with asbestosis claims on a full and final basis. For the disease itself, awards vary between £25,000 and £45,000. In addition, the claimant may also be able to claim for loss of past and future earnings, the cost of specialist care, care provided by the claimant's family, special needs, such as the cost of a stair lift, or special shower or bed.
For further details see “Bringing a Civil Claim for Compensation”.
Mesothelioma is a particular form of tumour almost always associated with exposure to asbestos. It has been recognised by the medical profession since the 1960s.
Even relatively low exposure to asbestos can cause mesothelioma. You do not have to first contract asbestosis in order to get mesothelioma. It also has no connection with cigarette smoking.
The condition is slow to develop. The “latency period” between first exposure to asbestos and the development of clinically obvious mesothelioma is usually 20-35 years but can be as long as 50 years and as short as 10 years. Mesotheliomas have usually been growing for 10-12 years before becoming clinically obvious.
It is caused when fine asbestos fibres become lodged in the tissues of the body after they have been inhaled (or ingested). They then cause inflammation as the body tries to break down the almost indestructible fibres. The body’s defence mechanisms try to break down the fibres but sometimes the “mesothelial cells” in the body become abnormal and develop into tumours.
Tumours can occur on the lining of the lung which is known as the “pleura” (a thin, transparent membrane that covers the lungs and lines the inside of the chest walls).
Alternatively tumours sometimes appear on a similar lining between your bowel and the abdominal and pelvic cavities that is known as the “peritoneum”.
The more common form of mesothelioma attacks the pleura (“pleural mesothelioma”).
Pleural mesothelioma
Pleural mesothelioma can be either:
(1) diffuse and malignant (cancerous), or (2) localized and benign (non-cancerous.)Benign mesotheliomas can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure.
Malignant mesotheliomas, however, are very serious and almost always result from exposure to airborne asbestos fibres. The details below apply to malignant mesothelioma.
Pleural Mesothelioma – Symptoms
Symptoms may include shortness of breath, chest pains, lower back pains, persistent coughing, weakness, weight loss, loss of appetite or difficulty in swallowing. At first a person with mesothelioma may be breathless only during heavy exertion, but as lung function drops, sufferers can become short of breath even while resting. The mesothelima may also be accompanied by pleural thickening and/or pleural effusions.
As the disease progresses the tumour spreads by direct invasion of surrounding tissue. Inward growth of the tumour can compress the lungs. As the tumour spreads outward it can invade the chest wall and ribs, and this can be extremely painful.
Pleural Mesothelioma – Diagnosis/Treatment
Detection is usually by chest x-ray or CT scan followed by a “bronchoscopy” when a viewing scope is used to look inside the lungs. Diagnosis of the condition is then confirmed by taking a small sample of tissue by a surgical procedure called a “biopsy”. The biopsy can either be a “needle biopsy”, an “open biopsy”, or a “thoracoscopy”, or chest scope, whereby a tube with a camera is inserted into the lungs. In a thoracosopy a tissue sample can be taken from any abnormality seen through the camera using the same tube. This is a simple hospital procedure that does require anaesthesia, but is not usually painful. The sample tissue is then tested sent for pathological testing. This is important because there are also benign tumours that have a similar appearance to mesothelioma.
As yet there is no known cure for malignant mesothelioma. However clinical trials are being undertaken for various new treatments and combinations of treatments (including gene therapy, immunotherapy, and angiogenesis inhibitors).
The prognosis depends on the size, stage and extent of the tumour, the cell type, whether or not the tumour responds to treatment and various other factors. Many people live for five to ten years after diagnosis, most of them in good health for a majority of those years. Some mesothelioma victims succumb within a few months. The average survival time is about a year to fifteen months. It is estimated that the number of people who will die from mesothelioma in the UK the will shortly rise to about 2,700 each year, and will not begin to fall for another 20 years.
Treatments are available to reduce pain and improve lung function. Many people are treated with a combination of therapies (sometimes known as multimodal therapy). These include chemotherapy and other drug-based therapies, radiation therapy, surgery (including debulking to remove a substantial part of the tumour and reduce the pleural thickening), and intra-operative photodynamic therapy.
Peritoneal mesothelioma
Many of the organs in the abdomen are enveloped by a thin membrane of mesothelial cells, known as the peritoneum. When a tumour develops in this membrane it is known as “Peritoneal mesothelioma”. Peritoneal mesotheliomas account for about one-fifth of all mesotheliomas.
The only known cause of peritoneal mesothelioma is previous exposure to asbestos. It is not certain how the asbestos fibres become lodged it the peritoneum. One explanation is that fibres caught by the mucus of the trachea and bronchi end up being swallowed. Some of them lodge in the intestinal tract and from there they can move through the intestinal wall into the peritoneum. The second explanation is that fibres that lodge in the lungs can move into the lymphatic system and be transported to the peritoneum. Once lodged in the peritoneum the asbestos fibres can act as a carcinogen like asbestos causing the cells to become cancerous.
Like pleural mesothelioma, peritoneal mesothelioma can be either benign or malignant. This details below apply to malignant peritoneal mesothelioma only.
Peritoneal mesothelioma - Symptoms
It can be many years after exposure to asbestos before the disease appears. This disease may not initially show any symptoms seen and is sometimes only discovered following a routine abdominal x-ray for a check-up or before surgery.
When the symptoms of peritoneal mesothelioma appear, they can include abdominal pains, abdominal swelling, weakness, weight loss, loss of appetite, and nausea. Fluid often accumulates in the peritoneal space, (a condition known as “ascites”).
Over time the wasting symptoms can become more severe. As the tumour grows it can exert increasing pressure on the organs in the abdomen, leading to bowel obstruction and other problems. Breathing capacity can be impaired if the tumour presses upward. If the tumour pushes against areas with many nerve fibres, and the bowel distends, the amount of pain can increase.
Peritoneal mesothelioma – Diagnosis/Treatment
X-rays and CT scans are usually the first step towards detecting peritoneal mesothelioma. Certain diagnosis involves analysis of a piece of the affected tissue. A medical procedure known as a “peritoneoscopy” is undertaken under anaesthetic to see whether there is any abnormality. If an abnormality is seen a tissue sample is taken by a “biopsy”. The tissue sample is then sent for examination by a pathologist who makes a diagnosis using microscopic analysis.
At yet there is no known cure for peritoneal mesothelioma. However clinical trials of new drugs and various experimental treatments like gene therapy and immunotherapy, and antiangiogenesis drugs are being undertaken.
The prognosis depends on various factors, including the size and stage of the tumour, its extent, the cell type, and whether or not the tumour responds to treatment.
Treatment are available for pain relief and to reduce symptoms. Many people receive a combination of therapies such as chemotherapy and other drug-based therapies, radiation therapy, and surgery.
Other Mesotheliomas
The majority of mesotheliomas occur in the pleura. The second most common incidence is in the peritoneum. However, malignant mesotheliomas sometimes occur in other parts of the body, including the heart (a variety of pleural mesothelioma) and the testicles (a variety of peritoneal mesothelioma). These are also caused by exposure to asbestos fibres.
Benign mesotheliomas occur less frequently than malignant mesotheliomas. They are generally thought to be unrelated to asbestos exposure.
Mesothelioma – State Benefits/Compensation
You may be entitled to Department for Work and Pensions (“DWP”) benefits. Industrial Injuries Disablement Benefit is payable to those who suffer a disability caused by a disease accepted by the DWP as being due to occupation. Mesothelioma is a prescribed disease (D3).
If you are unable to sue your former employer because, for example, they have ceased to trade, then you still may be able to claim under the Pneumoconiosis etc. (Workers' Compensation) Act 1979 which provides a scheme under which qualifying employees are entitled to a one-off lump sum payment ranging from £2,068 - £58,718 depending on circumstances.
Typical civil awards made by the courts against former employers for mesothelioma itself are now £45,000 - £50,000. Extra amounts are awarded for loss of past and future earnings, cost of specialist care, specialist equipment (e.g. a stair lift, or special shower or bed), medical expenses, and for care provided by the claimant’s family. Compensation claims for mesothelioma are frequently worth £100,000 or more.
For further details see “Bringing a Civil Claim for Compensation”.
Lung cancer refers to any type of malignant tumour that originates in the lung itself (unlike mesothelioma, where the tumours usually occur in the pleural lining around the lung.) This is the same sort of cancer as that caused by smoking. People who have asbestosis (or diffuse pleural thickening) and who also smoke cigarettes are much more likely to get lung cancer than people who have asbestosis and are not smokers.
It usually takes 20 years or more from being exposed to asbestos before lung cancer develops. All asbestos exposure up to the time of development of clinically obvious asbestosis is relevant both in terms of future risks and current disability.
Between 1 in 20 and 1 in 50 individuals with lung cancer are still alive 5 years after the diagnosis is made.
Asbestos Related Lung Cancer - State Benefits/Compensation
The Department for Work and Pensions (“DWP”) and courts are very reluctant to accept the connection between lung cancer and asbestos in the absence of any other evidence. The DWP will only accept benefit claims if their special medical board also diagnose asbestosis or a certain amount of diffuse pleural thickening.
If a claim is accepted by the DWP then civil compensation can be claimed. If you are unable to sue your former employer because, for example, they have ceased to trade, then you still may be able to claim under the Pneumoconiosis etc. (Workers' Compensation) Act 1979 which provides a scheme under which qualifying employees are entitled to a one-off lump sum payment ranging from £2,068 - £58,718 depending on circumstances.
In a court action, it is difficult to prove that lung cancer is caused by asbestos dust if you do not already have asbestosis. So it is difficult, but not impossible, to get compensation for lung cancer without asbestosis. But if tests on your lungs show you have inhaled a large number of asbestos fibres, many doctors believe this can cause lung cancer, without first causing asbestosis.
A Court will usually award between £30,000 and £50,000 for the asbestos related lung cancer itself. In addition, you will get compensation for loss of earnings, and the value of care your family and friends give you, the cost of professional nursing care and any special aids/adaptations you need to buy.
For further details see “Bringing a Civil Claim for Compensation”.
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