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Mesothelioma

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.

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 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.

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.

If you are successful with a claim for mesothelioma then, in addition to an award for pain, suffering and loss of amenity, 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.

Call Philip Thompson, Mark Thompson, Jacqueline Rafferty or Helen Roberts free on 0800 7313982

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