Adjuvant – Something that aids or assists. An adjuvant therapy helps make a primary therapy more effective. If the primary treatment is chemotherapy, radiation may be added as an adjuvant therapy.

Alveoli – Tiny air sacs in the lungs where the blood releases carbon dioxide and absorbs oxygen through extremely thin membranes.

Asbestosis – A lung disease caused by asbestos fibers. The fibers damage the lung tissues, causing progressive scarring and a reduction in breathing function.

Aspiration – Removing fluid and or cells from an area within the body using a needle. Also refers to accidentally inhaling something into the lungs.

Benign - A tumor that does not spread to other parts of the body (non-cancerous). Opposite of “malignant.”

Benign Cystic Mesothelioma - A non-cancerous tumor of the peritoneum that is easily cured by surgical removal, though the tumor may recur years later in a small percentage of cases.

Benign Fibrous Mesothelioma - A non-cancerous tumor of the pleura that is easily cured by surgical removal, though the tumor may recur years later in a small percentage of cases.

Biopsy – A tissue sample or sample of cells taken from the body that is examined under a microscope to identify the types of cells present.

Biphasic -  A type of cancer that exhibits both epithelial and sarcomatous cancer cells.

Brachytherapy – A form of radiation therapy in which radioactive material is placed in the body inside or near the target (usually a tumor).

Brigham System - A method developed specifically for pleural mesothelioma to describe how far the cancer has spread.

Bronchoscope – A flexible, lighted tube a doctor inserts through the mouth into the bronchial tubes to examine air passages.

Bronchoscopy – (bron-KOS-koh-pee) A medical procedure in which a doctor looks inside the breathing passages using a lighted tube (a bronchoscope).

Butchart System - A method developed specifically for pleural mesothelioma to describe how far the cancer has spread.

Cancer – A type of disease characterized by the uncontrolled growth of abnormal cells that often spreads to other parts of the body.

Catheter – A flexible tube inserted into the body to introduce or withdraw fluids.

Chemotherapy – A method of treating a disease using drugs or other chemical compounds.

Clinical Trial – A research study for determining the safety and effectiveness of a medical treatment by testing it on large groups of people.

Complementary Medicine – A healing art that is not embraced by mainstream Western medicine which is intended to complement standard medical treatment. Aromatherapy is an example.

CT or CAT Scan – Abbreviation for Computerized Tomography or Computerized Axial Tomography scan. A CT scan is a diagnostic test using multiple x-ray images in which a computer combines the images to create a three–dimensional view of internal organs and tissues.

Decortication - Removal of an organ’s outer layer or membrane. Decortication is used to treat some types of lung disease.

Diaphragm – A muscle separating the chest cavity and the abdominal cavity. The diaphragm’s rhythmic contracting and relaxing causes breathing.

Effusion – Fluid that has escaped from its normal structures in the body and collects in an undesirable location. (See Pleural Effusion.)

Epithelial - Describes a type of cancer cell that is slower to grow and spread than sarcomatous cells.

Extrapleural Pneumonectomy – (ex-truh-PLOO-rul noo-moh-NEK-tuh-mee) A surgical treatment for malignant pleural mesothelioma in which the surgeon removes the diseased lung, part of the membrane surrounding the lungs, part of the membrane surrounding the heart, and part of the diaphragm.

Gene Therapy – A treatment for disease involving replacing the DNA in cells in the body with normal or genetically altered DNA.

Hyperthermic Intraoperative Chemotherapy - A form of cancer treatment in which the surgeon applies heated cancer-fighting drugs directly to internal tissues during tumor-removal surgery.

IMRT - Abbreviation for Intensely Modulated Radiation Therapy. This form of radiation treatment simultaneously directs multiple low-intensity beams at a cancer tumor from different directions, concentrating the radiation energy on the tumor and reducing damage to adjacent tissues.

Infusion Pump - A battery-powered pump that can be implanted under the skin of the abdomen to deliver pain-relieving drugs through a tube connected to the base of the spine.

Laparoscope – (LAP-uh-ruh-scope) A lighted tube a doctor uses to see inside the abdomen.

Laparoscopy – (lap-uh-ROSS-koh-pee) A medical procedure in which a doctor looks inside the abdomen using a lighted tube (laparoscope) inserted through an incision.

Malignant – A type of tumor that invades adjacent tissue and can spread to other parts of the body (cancerous). Opposite of “benign.”

Mediastinoscopy – (mee-dee-as-tin-AHS-koh-pee) A medical procedure in which a doctor inserts a lighted tube through an incision in the chest to view the organs and lymph nodes in the area between the lungs.

Mediastinum – (mee-dee-AS-tin-um) The area between the lungs where the heart, esophagus, trachea, bronchial tubes and lymph nodes are located.

Mesothelium – (mess-oh-THEE-lee-um) A membrane which forms a sac to enclose bodily organs. (See Pleura, Peritoneum, Pericardium, and Tunica Vaginalis.)

Mesothelioma – (mess-oh-thee-lee-OH-muh) A cancerous or non-cancerous (malignant or benign) tumor originating in the membrane that surrounds the lungs, heart, or abdominal organs.

Metastasis - (muh-TAS-tuh-sis) The process by which cancer cells spread from the original tumor site to other places in the body. When cancer spreads by this process, it metastasizes. A malignant tumor is considered metastatic because it has the tendency to spread.

MRI – Abbreviation for Magnetic Resonance Imaging. MRI is a diagnostic procedure using a large circular magnet and radio waves to map signals generated by atoms in the body. The signals are combined by a computer to create detailed images of internal organs and tissues.

Multimodal Treatment - A cancer treatment strategy that combines surgery, chemotherapy and radiation.

Oncologist – (on-KALL-uh-jist) A doctor specializing in treating cancer.

Oncology – The study of cancer.

Palliative Treatment – (PAL-ee-uh-tiv) Treatment that relieves pain or other disease symptoms but is not intended to cure the disease.

Paracentesis – A medical procedure in which a doctor uses a needle to remove fluid from a body cavity.

Pathologist – A doctor who studies cells and tissues under a microscope to identify diseases.

Pathology – The study of changes in body tissues and organs caused by disease.

Pericardial Mesothelioma – (pair-uh-CAR-dee-ul) A cancer that originates in the membrane surrounding the heart (the pericardium.)

Pericardiocentesis – (pair-uh-card-dee-oh-sin-TEE-sis) A medical procedure in which a doctor uses a needle to remove fluid from the sac surrounding the heart (the pericardium).

Pericardium – (pair-uh-CAR-dee-um) The membrane that forms a sac surrounding the heart.

Peritoneal Mesothelioma – (pair-uh-to-NEE-ul) A cancer that originates in the membrane surrounding the abdominal organs (the peritoneum.)

Peritoneocentesis - (pair-uh-tuh-nee-oh-sin-TEE-sis) A medical procedure in which a doctor uses a needle to remove fluid from the sac surrounding the abdominal organs (the peritoneum).

Peritoneoscope – (pair-uh-tuh-NEE-uh-scope) A lighted tube a doctor uses to see inside the abdomen.

Peritoneoscopy – (pair-uh-tuh-nee-OSS-koh-pee) A medical procedure in which a doctor looks inside the abdomen using a lighted tube (peritoneoscope) inserted through an incision.

Peritoneum – (pair-uh-tuh-NEE-um) The membrane that forms a sac surrounding the abdominal organs.

PET Scan – Abbreviation for Positron Emission Topography scan. A PET scan is a diagnostic procedure using short-lived radioactive compounds injected or ingested into the body to make bodily functions or processes visible.

Pleura – (PLOO-ruh) The membrane that forms a sac surrounding the lungs.

Pleural Effusion – An abnormal collection of fluid in the space between the two layers of the pleura.

Pleural Mesothelioma - A cancer that originates in the membrane surrounding the lungs (the pleura).

Pleurectomy – (ploo-REK-tuh-mee) A surgical procedure to remove the pleura.

Pleurodesis – (ploo-roh-DEE-sis) A medical procedure that causes the two layers of the pleura to adhere to one another, eliminating the space where fluid can collect. This eliminates the possibility for pleural effusion to recur.

Pneumonectomy – (noo-moh-NEK-tuh-mee) Surgical procedure in which a lung is removed.

Sarcomatous - Describes a type of cancer cell that tends to grow and spread rapidly.

Testicular Mesothelioma - A cancer that originates in the membrane surrounding the testicles (the tunica vaginalis).

Thoracentesis – (thore-uh-sin-TEE-sis) A medical procedure in which a doctor uses a needle to remove fluid from the sac surrounding the lungs (the pleura).

Thoracoscope – (thore-ACK-uh-scope) A lighted tube a doctor uses to see inside the chest

Thoracoscopy – (thore-uh-COSS-coh-pee) A medical procedure in which a doctor looks inside the chest using a lighted tube (thoracoscope) inserted through an incision.

TNM System – A method developed specifically for pleural mesothelioma to describe how far the cancer has spread.

Tunica Vaginalis - The internal membrane that forms a sac surrounding the testicles. It is an extension of the peritoneum.

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Mesothelioma is a form of cancer that originates in one of the membranes surrounding internal organs. It can occur in the membrane surrounding the lungs, the heart, or the abdominal organs.

Is it serious?

It is very serious. It is incurable and ultimately fatal.

Mesothelioma is frequently not detected in time to be treated surgically. In those cases, radiation and chemotherapy can help slow the cancer’s growth, but survival after diagnosis is often just one or two years.  When it is detected early enough to be treated with surgery as well as chemotherapy and radiation, survival rates can improve to five years or more.

What causes mesothelioma?

The only known cause of mesothelioma is repeated and/or heavy exposure to asbestos dust.

What is asbestos?

Asbestos is a mineral that can be separated into fibers and woven into a cloth-like material.  It can also be mixed with other materials into a slurry, and applied as a coating or formed and dried into shapes.  Asbestos is used in over 3,000 products because it is very durable, fire-proof and an effective insulator for heat, sound, and electricity.

How would someone be exposed to asbestos?

Asbestos itself is not what is hazardous.  It is the fine, fiber-like particles present in asbestos dust that can get into the lungs and ultimately cause mesothelioma.  Millions of people have been exposed to asbestos dust at work where asbestos-containing products are manufactured or where asbestos-containing products are used. Some people have been exposed at home when a family member unknowingly brings asbestos dust home on clothing, or when asbestos products in the home are disturbed or begin to deteriorate.

How much asbestos exposure does it take to get mesothelioma?

First of all, we should note that only a few percent of people who are exposed to asbestos dust acquire mesothelioma. Of those who do acquire the disease, they have typically been exposed to some level of asbestos dust in the air for years.  There is one reported case, however, of a man whose exposure consisted of several days of sawing up asbestos panels.

Are asbestosis and mesothelioma the same disease?

No. Although both are caused by inhaling asbestos dust, asbestosis is not a cancer. It is a condition caused by damage to the lungs from asbestos fibers. 

How long does it take to get mesothelioma?

Mesothelioma is typically not diagnosed until 15 to 40 years following initial exposure.

What are the symptoms of mesothelioma?

Symptoms that can occur with each of the different types of mesothelioma are:

• Chest or abdominal pain
• Breathing problems
• Sleeplessness, loss of appetite and weight loss

Additional symptoms depend on which internal membrane is affected, but may include gastrointestinal problems or heart problems.

Why are lawyers so interested in people with mesothelioma?

People being diagnosed with mesothelioma now were exposed to asbestos dust years ago when manufacturers had little incentive to protect people from asbestos, even though it was known then to be harmful. Therefore, in almost every case of mesothelioma, some company or another can be shown to be negligent in allowing the exposure hazard to exist.  Because of that negligence, lawyers can sue on the victim’s behalf and obtain compensation for them. 

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In a personal injury claim, the injured person receives financial compensation from the liable party for their injury and any related damages or expenses. Hundreds of thousands of mesothelioma cases have been filed since the first U.S. case in 1966, and many of those resulted in victims receiving compensation reaching into six and seven figures.

Proving liability for asbestos exposure and responsibility for a particular victim’s injury, however, can be extremely complicated.  Because mesothelioma doesn’t manifest itself until 15 to 40 years after exposure, gathering evidence decades after the fact can be an almost insurmountable challenge.

That’s why many personal injury law firms have specialized in handling mesothelioma cases exclusively. If you or a loved one have been diagnosed with mesothelioma, be sure to speak only to an attorney with extensive experience assisting mesothelioma victims.  The attorney specializing in mesothelioma has the experience to:

• Evaluate your case and determine your likelihood of prevailing
• Investigate the source of your exposure and determine the companies responsible
• Obtain evidence and establish proof of liability
• File a claim in court or with trust funds established for mesothelioma victims
• Determine fair compensation and negotiate a settlement
• Successfully prosecute a case in court if necessary

Moreover, because the experienced mesothelioma attorney can appreciate the strength of your case, he or she will take the case on a contingency fee basis. That means you pay the attorney nothing unless and until you win your case. When the attorney is successful in obtaining compensation for you, you will typically pay a fee of 30% to 40% of the amount you receive. The exact fee will be specified in the agreement you sign with the attorney before the case begins.

Evaluating your Case

When the attorney has extensive experience in mesothelioma cases, he (or she) can quickly analyze the facts of your situation to determine the likelihood of your obtaining compensation. He will probably also have an idea of how much compensation would be fair in your case, though most attorneys are reluctant to specify any particular amount for obvious reasons.  But because the attorney will be taking your case on a contingency basis – meaning he is paid nothing if he doesn’t win something for you – the fact that he accepts your case at all is a fairly strong indicator that he believes he can obtain a substantial payment for you.

Investigating Who’s Responsible and Obtaining Evidence

This can be one of the most challenging aspects of a mesothelioma claim because the exposure to asbestos happened so long ago.  It is the crucial reason for needing someone with extensive experience.  The law firm that has already handled hundreds of cases has compiled vast amounts of evidence from these prior cases and has agreements with other law firms specializing in mesothelioma to share their information.  Extensive databases have been compiled of companies involved in manufacturing, maintaining, and installing asbestos-containing products, and documentation of their involvement is already on file. Attempting to gather all this detailed evidence from scratch would be prohibitively expensive for any personal injury attorney not having access to such a wealth of existing information.

Filing a Claim

When filing a claim in court is the appropriate course of action, the experienced attorney knows the subtleties of crafting the claim that insure a winning case. 

Sometimes, however, the responsible company has gone through bankruptcy because of the volume of asbestos claims against them. As a result of the bankruptcy settlement, many of these companies formed trust funds to pay the asbestos claims of their victims, and can no longer be sued. The qualified attorney knows all of these trust funds and the ins and outs of filing claims to obtain the maximum permissible compensation.

Negotiating a Settlement

Compared to a lawyer with little experience in mesothelioma cases, the attorney with a track record in negotiating settlements for mesothelioma victims has an advantage in settlement discussions. The opposing attorneys have been defending their clients from mesothelioma claims for many years and can take advantage of an attorney without experience in these cases, possibly resulting in a smaller settlement.

The experienced attorney, on the other hand, has negotiated with asbestos companies before and recognizes the other side’s tactics in trying to minimize your claim.  Your attorney knows the strength of the evidence in your case, and having been successful in previous trials he can convince most opposing attorneys to offer a fair settlement instead of trying the case in court.

Succeeding at Trial

If it becomes necessary to proceed to trial, that’s when you absolutely need an attorney experienced in mesothelioma claims.  In court, your attorney will be facing the asbestos company’s lawyers who have defended their clients in many similar cases.  Against less experienced attorneys, they may have even been able to successfully cloud the claims enough to greatly reduce the compensation in the case.

Your experienced attorney, on the other hand, is seasoned in presenting the evidence in a way that makes the defendant’s liability inescapable, and portrays the amount of compensation requested as eminently fair.

A Valuable (Though Informal) Side Benefit

One final benefit, albeit an informal one, is that the attorney who has worked with hundreds of mesothelioma patients over the years has seen firsthand how their medical treatment affected their comfort and survival.  Though certainly not a doctor, the experienced mesothelioma attorney has no doubt worked with more mesothelioma sufferers than most oncologists, and probably has an awareness of the track record of many specialists and treatment centers. And while no one would suggest taking a lawyer’s opinion over a health professional’s regarding a medical matter, the veteran mesothelioma attorney can at least steer you to the right people and help you ask the right questions.

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Time is important also because victims are frequently not diagnosed until they are in the late stages of the disease, and many will not survive more than a year or two. Though it’s possible to collect compensation for the benefit of the family after the victim succumbs, the amount of compensation can be greater if the lawsuit is settled or won while the victim is able to assist in the case.

Recognizing that they’re up against the clock, many victims’ attorneys will request the court grant an expedited schedule that can lead to concluding the case within one year instead of the more typical two years. Knowing the victim’s poor prognosis, judges will often grant such a request.

The bottom line is that unless an experienced mesothelioma attorney is retained within a few weeks of diagnosis, the mesothelioma victim may not live to see how the case turns out.

The Investigation

In most lawsuits, employers are not named as a responsible party or defendant because they are shielded from employee lawsuits by workers compensation laws. Therefore it’s necessary to determine the companies responsible for manufacturing, installing or maintaining the asbestos-containing products to which the victim was exposed. (There are exceptions in some states, however, for employers who acted with callous disregard for employee health and safety. Your attorney can advise you if your employer is in this category.)

In some cases, the source of exposure may be clear. For example, the Navy veteran whose military service involved maintaining asbestos-insulated boilers and steam pipes aboard ship knows clearly where he was exposed. Experienced mesothelioma attorneys have access to existing data bases cataloging each asbestos company associated with each and every ship in the U.S. Navy. Determining whom to sue in this case is not that difficult.

Some cases, on the other hand, may not be so clear. In the case of the welder who had worked at numerous power plants throughout his career, it may require some sleuthing to determine what asbestos products were in these plants and who the manufacturers and installers were. The process may require obtaining all the victim’s work records, and thoroughly researching asbestos cases from around the country to find links between specific asbestos companies and the victim’s work sites.

Claims Against Bankruptcy Trust Funds

Another issue that may be discovered during the investigation is that one, some, or all of the responsible asbestos companies in the victim’s particular case may have filed for bankruptcy and established trust funds to handle all asbestos-related claims.

Based on a court-approved bankruptcy settlement, such companies can no longer be sued for damages. Any claims for asbestos-related injuries must be submitted to the trust fund and are settled according to pre-established rules. The experienced mesothelioma attorney knows these trust funds and the rules for settling claims efficiently for the maximum permissible amount.

If there are no other responsible companies, then the case ends with the filing and receiving of a settlement from the relevant trust funds.

Filing the Complaint

When the responsible companies have been determined (and they still exist and haven’t created bankruptcy trust funds), the attorneys prepare a complaint naming those companies as defendants and file it in state court. The defendants typically have 30 days to respond. A hearing is then held to discuss motions and establish a schedule. The victim’s attorneys will usually request the expedited schedule at this point. When the schedule is set, the discovery phase begins.

Discovery

During the discovery phase, each side is given the opportunity to question the other, and to gather the evidence from whatever sources it can find. Each side is required to share with the other all the information it intends to bring to trial.

The victim and any witnesses may be asked to give statements regarding their knowledge of the facts of the case. These statements given under oath are called depositions. Depositions are not conducted in a court, but can be taken in any location convenient to all the parties. If the victim is very ill, the deposition can even be taken in the hospital or at the victim’s home.

Settlement Negotiations

In almost every case, the parties will enter negotiations to see if a mutually agreeable financial settlement can be reached without the need for a trial.  By virtue of experience, the victim’s attorney knows in advance what a reasonable settlement should be. If a fair settlement is offered, the victim is advised to accept it. Though every situation is unique, settlements are often in the six and seven figures.

In the event the attorney feels the settlement being offered is not fair, the attorney will discuss with the victim the pros and cons of proceeding to trial. It is then up to the victim to make the decision.  If the victim decides against a trial, then the case is settled for the amount of compensation offered by the defendants.

Upon settlement, the victim irrevocably agrees that the compensation received is satisfactory payment in full for all liability of the defendants and no further claims can be brought.

Trial

If the case is not settled before trial, it then goes before a jury. The victim’s attorney attempts to convince the jury that the victim’s disease was caused by the irresponsible actions of the defendants, and that they owe the victim compensation for the resulting injury.  The defendants’ attorney may attempt to argue that it was not their products that caused the disease or that the defendants acted responsibly and the disease was the result of the victim’s irresponsible actions.

If the victim’s case is legitimate, and the attorney’s investigation was thorough and accurate, the jury will usually decide in the victim’s favor.  That is why most cases are settled before trial.  When the case is not settled, it means the defendants’ believe the victim’s case is flawed or the amount being requested for a settlement is more than a jury would award. 

Before going ahead with the trial, the victim and victim’s attorney should be certain of the strength of the case and the reasonableness of the damages being sought.

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• Affects the patient’s ability to sleep and eat, leading to fatigue and worsening health
• Interferes with being able to schedule treatments
• Contributes to a negative mental outlook
• Makes it more difficult for the family to help the patient cope

Avoiding these negative effects by successfully managing pain is essential to improving treatment outcomes and lengthening survival.

Initially, the pain and discomfort of the disease is mild and controllable with over-the-counter medications. In the end stages, the pain progresses to severe and chronic but is treatable with strong narcotics. Throughout the course of the disease, the patient also has other options for keeping pain under control.

Pain Causes

Initially, discomfort and pain is normally caused by the build-up of fluid between the two layers of the mesothelium. In pleural (lung) and pericardial (heart) mesothelioma, fluid build-up in the chest area results in pain in the chest or back. In peritoneal mesothelioma, the pain occurs in the abdomen.

As the tumor grows, it begins pressing against nerves and other organs causing an increase in pain sharpness and longer-lasting episodes. It can also cause a burning or tingling feeling. Surgical treatment, radiation, and chemotherapy can also contribute to short-term pain issues.

In the later stages of the disease, as the cancer spreads farther into adjacent tissue, it begins to have a greater effect on nerves and organs. This greater involvement leads to increasingly severe and chronic pain symptoms.

Medications

Pain Relievers

In the early stages of the disease, pain is controllable with over-the-counter medications such as acetaminophen or ibuprofen. When pain advances to the point that these are no longer effective, the doctor will prescribe a narcotic medication such as:

• Codeine
• Hydrocodone
• Oxycodone
• Hydromorphone
• Fentanyl
• Morphine

The choice of medication is usually determined after considering the patient’s condition and the drug’s potential side affects or interactions with other medications. These drugs – whether delivered orally or using a patch – are usually slow-release to help maintain a constant amount of pain-reliever in the bloodstream. Note that narcotics do not stop pain. In the right dose, they simply reduce the perception of pain to a tolerable level.

Occasionally, however, the patient on narcotic pain relievers experiences breakthrough pain, which is an intense episode lasting a short while. If breakthrough pain becomes a problem, the doctor can prescribe a fast-acting narcotic such as oral immediate-release morphine to be taken when breakthrough pain occurs.

Other Medications

Anti-depressants can actually be effective for some types of pain, and anti-convulsants can control burning and tingling pain. When pain results from swelling, steroids can reduce the swelling and thus the pain.

Because there is such an array of choices, it’s important to discuss with your doctor exactly what type of pain you’re experiencing, when and where it occurs, how intense it is and how long it lasts. When one medication is not working, he or she will be able to adjust the dosage or choice of medication to be more effective.

Medical Treatments

Paracentesis

When pain is being caused by fluid build-up on the lungs (pleural effusion) or in the abdomen (peritoneal effusion), the doctor can relieve the pain by draining the fluid in a procedure generally called paracentesis, or more specifically:

• Thoracentesis when fluid is removed from the membrane lining the lungs (pleura)
• Peritoneocentesis when fluid is removed from the membrane lining the abdomen (peritoneum)
• Pericardiocentesis when fluid is removed from the membrane lining the heart (pericardium)

To accomplish this, the doctor applies a local anesthetic and uses a fine needle to locate and withdraw the fluid from the chest or abdomen.

Pleurodesis

If fluid build-up in the mesothelium is a recurring problem, the doctor can perform pleurodesis. In this procedure, an irritant such as Bleomycin, Tetracycline, or talc powder is injected into the space between the layers of the mesothelium. This causes the membranes to stick together and eliminates the space where fluid would otherwise collect. Preventing further fluid build-up effectively eliminates this as a source of pain.

Surgery

Although surgery involves inevitable short-term pain, removing the tumor that is invading adjacent organs, tissues, and nerves can remove some of the source of a patient’s more chronic pain. After recovering from surgery, the resulting pain relief should last for some time until the cancer begins to recur.

Radiation

Radiation has the effect of killing cancer cells and can reduce the size of a tumor. Studies have shown that this can reduce pain symptoms for up to several months following treatment. Sometimes no more than a single treatment is necessary to have an effect on pain. A long course of radiation therapy may itself become a source of pain, however, if extensive treatments begin to damage healthy tissues.

Spinal Catheter with Infusion Pump Implant

When pain is no longer controlled satisfactorily with standard medications and delivery methods, the doctor may change the pain management strategy to a spinal catheter with an infusion pump implant.

This approach places a catheter below the skin and directly into the fluid at the base of the spine and attaches it via tubing to an infusion pump. The programmable pump delivers precise doses of narcotic into the spinal fluid where pain signals are then blocked. This direct drug delivery method requires much smaller doses and therefore reduces side effects.

Even better for the patient, the pump – about the size of a hockey puck – can be implanted just under the skin of the abdomen providing the patient with a highly effective and portable pain relief system. Batteries last up to five years and the doctor can refill the pump’s drug reservoir with a simple injection.

Other Pain Relief Strategies

Some patients may be interested in alternative pain relief techniques that don’t involve drugs and narcotics. Though many of these approaches will not completely alleviate pain – especially severe pain – many people find that they can reduce their reliance on pain medications by using one or more of these techniques. If any of these techniques appear interesting, you may want to do further research to learn more.

• Relaxation
• Biofeedback
• Imagery
• Distraction
• Hypnosis
• Transcutaneous Electric Nerve Stimulation
• Acupuncture
• Massage
• Acupressure
• Vibration
• Cold or Heat
• Menthol
• Skin Stimulation

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• Surgery
• Chemotherapy
• Radiation

Because none of these treatments is very effective alone, multimodal treatment is often undertaken. Multimodal treatment employs surgery plus radiation and/or chemotherapy together when the disease is not too far advanced and the patient is healthy enough to tolerate it.

Other treatments intended to alleviate symptoms and pain include paracentesis and pleurodesis. These are discussed in the article on Pain Management in Mesothelioma.

Multimodal Treatment

Pleural mesothelioma is often diagnosed in its later stages when it has spread beyond the original tumor site. For patients receiving trimodal treatment with Stage 2 disease (lymph nodes involved), survival rates vary depending on the type of cancer cells. In one study, patients with the epithelial type had a 65% survival rate at 2 years versus 27% for those with sarcomatous or biphasic type. The 5-year survival rates were 27% compared to 0%.

Even when diagnosed in its earliest stages with the pleural tumor still localized (Stage 1), recurrence of the cancer following surgery is almost inevitable. Still, surgery combined with radiation and chemotherapy was successful in extending survival rates in early-stage patients. The median survival for patients with no lymph node involvement was 74% at 2 years and 39% at 5 years.

Another study of patients with localized peritoneal mesothelioma yielded a 79-month median survival rate following surgery and intraperitoneal chemotherapy. For patients with advanced disease, abdominal surgery is typically not considered adequate in removing the cancer cells. If performed, surgery is typically to help reduce symptoms and make the patient more comfortable, but does not significantly slow the progress of the disease.

Because pericardial mesothelioma is in the lining surrounding the heart, surgery is almost never a successful choice. If chemotherapy and/or radiation are chosen, it is often for palliative reasons (to reduce symptoms and make the patient more comfortable).

Types of Surgery

The objective of surgery is to remove the cancerous tumor and as much of the adjacent tissue as possible to which cancer cells are likely to have spread. In advanced stages of cancer, surgery is not an effective option because the cancer cells have become involved in too much tissue to be effectively removed or have spread to other parts of the body making local surgery pointless.

The two types of surgery for pleural mesothelioma are extrapleural pneumonectomy and pleurectomy

Extrapleural pneumonectomy is a radical procedure to remove part of the lung and its lining (pleura), the heart lining (pericaridium), and the diaphragm. This surgery is only effective when the disease is confined to the chest cavity.  When combined with chemotherapy and radiation, it is not a cure but it has the potential to increase survival by two to three years.  Because it is such an aggressive surgery, patients with weak heart or lung function are not candidates.

In very early stage disease when the tumor is still largely confined to the pleura, the surgeon may opt to perform a pleurectomy.  Because this procedure involves removing a limited amount of tissue from the lung surface, recurrence of the cancer is high. However, this may be the only option for patients too weak to undergo more extensive surgery. When combined with chemotherapy and radiation, this treatment can reduce the patient’s pain and provide modest improvement in survival.

Because a pertinoneal mesothelioma tumor can be in any part of the abdominal lining, the procedure for removing the cancerous tissue is simply called debulking (or cytoreductive) surgery. The outcome of this procedure is better when the surgeon is able to remove the majority of the tumor. For larger tumors, surgery may be ineffective and not recommended. 

Chemotherapy

Typical cancer chemotherapy involves taking powerful oral or intravenous medications that travel through the bloodstream to attack cancer cells. These systemic drugs often have nasty side effects such as nausea, fatigue, diarrhea and hair loss.

The standard chemotherapy drugs for mesothelioma and a few in late-stage clinical trials include:

• Pemetrexed (ALIMTA®)
• Ralitrexed (Tomudex®)
• Ranpirnase (Onconase®)
• Bevacizumab (Avastin®)
• Vinorelbine, gemcitabine
• Doxorubicin
• Cisplatin, carboplatin and oxaliplatin (platinum compounds)

These drugs have different side effects and their effectiveness can vary under different circumstances.  They are often used in various combinations and treatment schedules can differ significantly based on the treatment plan. Your doctor has to take these factors and your individual circumstances into consideration when determining the chemotherapy regimen that’s best for you.

A new type of chemotherapy used in mesothelioma treatment involves applying heated cancer-fighting drugs directly to internal tissues during surgery – referred to as hyperthermic intraoperative chemotherapy. This type of treatment only occurs when tumor removal surgery is performed.  Its purpose is to apply high-dose chemotherapy directly to the tissues that may harbor microscopic remnants of cancer cells following surgery. The technique is effective and results in fewer drug-related side-effects to the patient. Nonetheless, standard chemotherapy treatment often follows.

Radiation

After surgery to remove a mesothelioma tumor, subsequent radiation therapy can significantly reduce the rate of local recurrence. Radiation inhibits a cell’s ability to divide and grow.  Healthy cells are able to rebound from the effects of a limited amount of radiation that is sufficient to kill cancer cells. Radiation therapy is intended to extend survival by slowing the recurrence of cancer, but it has also been found to have some short-term benefit in reducing pain.

Ordinary radiation therapy uses an external machine to direct a beam of radiation at the location were malignant cancer cells are likely to remain.  Treatment may be prescribed five days a week for five to six weeks. The short break in treatment each week gives the healthy tissue a chance to recover. Side effects can include sunburn-like reddening of the skin, inflammation of internal organs, and fatigue.

To reduce side effects, some treatment centers use 3-dimensional conformational radiation therapy (3D-CRT). This technique requires taking a full-set of CT scans of the area of the cancer. The resulting image data is fed into specialized computers that control the radiation delivery equipment.

Doctors and radiologists identify the precise areas in the scans to be targeted, and the 3D-CRT machine is able to deliver a very narrow beam to the designated areas with great accuracy.  During a treatment session, the beam is aimed at the body first from one direction, then another. Periodically changing the path by which the beam enters the body minimizes the radiation’s effect on healthy tissue while consistently penetrating the target area each time. This reduces collateral tissue damage and side effects, and improves the treatment effectiveness.

An even newer therapeutic technique is called intensity modulated radiation therapy (IMRT). This technique also uses CT scans fed into computer systems to control multiple simultaneous radiation beams aimed at the cancer area from different angles. Alone, each low-intensity beam doesn’t cause significant damage to the tissue it passes through.  At the location where the beams converge, however, the combined effect is much stronger.

Related Articles

• Pain Management in Mesothelioma
• Mesothelioma Symptoms
• Diagnosing Mesothelioma
• Cancer Staging for Mesothelioma
• How to Find Clinical Trials for Mesothelioma

References

Tan, Winston W., MD (2008), “Mesothelioma – Treatment and Medication.”  Retrieved Dec 27, 2008 from the Medscape.com web site: http://emedicine.medscape.com/article/280367-treatment.

University of Florida Shands Cancer Center (2008). “Radiation Therapy for Malignant Pleural Mesothelioma.” Retrieved Dec 27, 2008 from the University of Florida Shands Cancer Center web site: http://www.ufscc.ufl.edu/Patient/content.aspx?section=ufscc&id=30346.

Because of the long time that passes between exposure and diagnosis, many people who were exposed in the 1970s and 1980s are only now learning of their illness. From 2,000 to 3,000 new cases are diagnosed each year and this trend is expected to continue for the next decade or two.

Who is Liable?

In the 1960s, the hazards of asbestos were becoming apparent. In the 1970s, asbestos began to be regulated by the Environmental Protection Agency (EPA), the Occupational Health and Safety Administration (OSHA) and the Consumer Product Safety Commission (CPSC).

Even though the dangers of asbestos exposure were understood by the 1960s, many companies manufacturing or using asbestos products did not take appropriate steps to limit exposure to the hazardous substance until well into the 1980s or 1990s. Hundreds of thousands of successful lawsuits filed by mesothelioma victims since the 1960s have found many of these companies financially liable for their disease by failing to properly control asbestos exposure.

But determining the specific company liable for your exposure may not always be straightforward. If you worked your entire career for the same company where the presence of asbestos has already been established, it’s not much of a mystery who’s responsible for your condition. An example is the pipefitter who worked 35 years in the same power plant and was diagnosed with mesothelioma a few years following retirement.

On the other hand, if you worked for several employers with no clear connection to asbestos or if your exposure was to products in your home, it may take some investigation to determine the source of your exposure and who is liable. An example is the former television reporter who developed mesothelioma in her 60s. She had no known occupational exposure to asbestos. Investigation revealed, however, that the basement laundry room of the building she had lived in for over 30 years contained deteriorating asbestos insulation.

What Compensation Am I Owed?

Mesothelioma victims obviously should have 100% of their medical expenses paid for them. Also, if the illness prevents the victim from working, compensation for lost income is necessary. Compensation for pain and suffering is also appropriate, not only for the victim, but also for the family. If premature death is expected, the victim should receive enough to provide for family support in the victim’s absence. In some cases, the victim may also receive an award of punitive damages to punish the company for its negligent conduct.

While the specifics of every case are unique, the compensation received by most mesothelioma victims reaches into the six or seven figures. 

Because of the disability associated with this illness, mesothelioma sufferers may also qualify for various forms of private or government disability payments. Veterans may qualify for VA disability. When the illness severely impacts the family’s finances, they may also qualify for other forms of financial aid.

How Do I Get Compensation?

Obtaining compensation for mesothelioma requires the services of an attorney, preferably one who specializes in asbestos-related lawsuits.  The qualified attorney knows how to determine the proper responsible party or parties, and if it requires investigation, the attorney will be experienced in locating and examining the necessary records.

Once the responsible company is identified, the attorney files a claim. If the company offers to settle the claim out of court, the experienced attorney knows if the settlement offered is fair under the circumstances. If not, the attorney can negotiate more aggressively or ultimately recommend taking the matter to trial. 

One of the potential difficulties that can arise is if the company responsible for your asbestos exposure has gone bankrupt. Many major corporations faced with thousands of asbestos lawsuits declared bankruptcy, such as Owens Corning and Federal Mogul. These companies are still in business but through bankruptcy they were able to transfer asbestos liability claims to trust funds they established for victims. The experienced attorney knows these cases, and also knows how to prepare a claim for maximum permissible compensation from the fund.

If you need assistance finding an attorney, please contact us using the form at the right.

Related Articles

• Benefits of an Experienced Mesothelioma Attorney
• What’s Involved in a Mesothelioma Lawsuit?
• What is a Class Action Lawsuit?
• Financial Resources for Mesothelioma Patients
• Assistance for Veterans with Mesothelioma

The high incidence of mesothelioma cases in past years has led to many lawsuits against employers and manufacturers for exposing workers to asbestos in the workplace even after the health dangers had become known. Payments made to victims have helped to offset medical expenses, lost income and support to the victim’s family, and pain and suffering.

But while civilian mesothelioma victims can in some cases sue their former employers over the harmful working conditions that led to their asbestos exposure, U.S. servicemen are prevented by law from suing the military services. What recourse does the veteran have, then?

First of all, veterans can sue the manufacturers of the asbestos products they were exposed to. But identifying those products and proving exposure may be very difficult. Some law firms specializing in asbestos-related lawsuits have done extensive research, however, to identify exactly what companies supplied what asbestos-containing products found in most of the Navy’s ships. Therefore if you’re a Navy veteran whose asbestos exposure was aboard ship, responsibility for your disease can be traced back to a particular manufacturer or manufacturers.

Second, past lawsuits have resulted in multi-million dollar funds created to pay the claims of mesothelioma victims. For those who qualify, no lawsuit is required to obtain just compensation for asbestos exposure. Any attorney who specializes in mesothelioma cases can guide you through the claim process.

Third, veterans with mesothelioma whose asbestos exposure occurred during military service qualify for VA disability compensation. It’s not a fantastic sum, but it is a monthly income part of which the spouse can continue to receive after the veteran’s death.  Because qualifying for VA disability can be a red-tape nightmare, several non-profit organizations offer professional assistance. Visit the Disabled American Veterans web site or see the VA’s list of recognized organizations for representing veterans’ claims.

If you need assistance finding an attorney, please contact us using the form at the right.

Related Articles

• Mesothelioma Compensation
• Financial Resources for Mesothelioma Patients
• Mesothelioma Support Groups
• What’s Involved in a Mesothelioma Lawsuit?
• Benefits of an Experienced Mesothelioma Attorney

Support groups can be face-to-face groups or online communities.  The face-to-face groups often provide the deeper emotional support that comes from actual human contact. To find a local group, ask your oncologist. Because mesothelioma is a relatively uncommon form of cancer, a mesothelioma-specific group may not exist in your area. In that case, you might consider joining a local lung cancer or general cancer support group.

An online support group is another alternative. Though you’ll rarely meet face-to-face with other members from across the country or the world, you’ll have no trouble finding one to join, and no lack of people to talk to who are in your shoes. Members are often very active in discussing the latest treatment information and how they deal with the myriad everyday problems they face, as well as sharing their deepest feelings and helping one another cope.

Online Support Groups

Association of Cancer Online Resources (ACOR) – In addition to useful information and resources for cancer patients, ACOR manages a mesothelioma mailing list. Subscribers to the list are linked into a community where each member’s email to the group is received by all other members, An independent study revealed that the shared experiences in these types of communities help members feel less isolated by their disease.

CancerCare - Offering support for all cancer patients, Cancer Care has online groups specifically for men and for women, and for patients and for caregivers.

Cancer Hope Network - Although they can’t always match you with someone having the same cancer, they attempt to match you one-on-one with a Cancer Hope Network Support Volunteer.  They are actively recruiting support volunteers with mesothelioma in case you’ve thought of reaching out to help another sufferer.

Cancer Survivors Network - Sponsored by the American Cancer Society, the Cancer Survivors Network has a variety of discussion boards and chat rooms for cancer sufferers and cargeivers. Although there is not a mesothelioma-specific forum, you can find discussions of mesothelioma by going to the lung cancer forum and entering mesothelioma in the search window.

LUNGevity – The LUNGevity Foundation offers extensive support resources for lung cancer patients, and a mesothelioma-specific discussion forum on its Message Board.

Mesothelioma Applied Research Foundation – Joining the Meso Foundation community gives you access to discussion boards offering information and support, as well as the most up-to-date treatment information.

OncoChat – OncoChat offers a live chat room for anyone whose life has been touched by cancer.

The Wellness Community – The Wellness Community provides a discussion forum and online support groups for cancer sufferers and caregivers. They don’t yet have a mesothelioma-specific forum, but many of the current forum topics apply to most any cancer patient. Their unique support group format enrolls a maximum of 10 people in each group and is led by a trained counselor in a 90-minute once-a-week live chat.

Related Articles

• Financial Resources for Mesothelioma Patients
• Assistance for Veterans with Mesothelioma
• Mesothelioma Compensation
• Pain Management in Mesothelioma

Worrying about money while fighting a potentially fatal illness is difficult at best, so we’ve assembled a list of resources that may help you obtain financial assistance for:

• Medical Payments
• Living Expenses

You should also know that lawsuits in past mesothelioma cases have created settlement funds that are available to current victims. See our discussion on how to file a claim in the Mesothelioma Compensation article in the Legal Issues section of this web site.

Medical Payments

Health Insurance

Private Health Insurance – Having your own health insurance or insurance through your employer will significantly ease your financial burden. However, insurance won’t pay for everything and insurers have been known to make mistakes that leave you owing for services they should have covered. Before you know it, you can be deeply in debt for just your share of medical expenses. Your best advice is:

• Know your insurance policy’s terms and limits.
• Keep your records organized.
• Question anything the insurer says is not covered. Sometimes it can be as simple as a mistake in a billing code. Some insurers offer Case Managers who can work on your behalf to cut through red tape and fix mistakes.

Staying on top of the paperwork can be a challenge when you’re ill and trying to manage critical care and treatment at the same time. If you need to, don’t be afraid to ask a loved one or friend to help you.

To understand the ins and outs of the typical health insurance policy, refer to the following well-written article on Traumatic Brain Injury – The Medical Insurance Maze.

Medicare – In some respects, this federally sponsored health insurance for people 65 and older is similar to private health insurance. You need to know what’s covered, what’s not, and coverage limits, and you also need to keep your records organized. Medicare, however, offers trained counselors to help you with a wide variety of issues related to:

• Medicare, Medicaid, and Medigap insurance
• Claims and billing problems
• Other health plan and long-term care options
• Referral to other medical and financial assistance programs

These Medicare counselors are sponsored by the federally-funded State Health Insurance Assistance Program (SHIP). You can reach your local SHIP counselor by calling 1-800-MEDICARE and asking for health insurance counseling.

Assistance with Medical Expenses

Medicaid – This is a state and federal program to provide financial assistance to people who need help paying medical expenses.  Qualification is based on income and assets. For more information, contact your local state health department, social services agency or welfare department.

Hospital Funds – Many hospitals have access to state or federal funds that are available to offset the medical bills of people who are unable to pay. If you’re struggling with hospital bills, ask someone in your hospital’s billing department what help may be available.

Medical Office – It’s also possible to negotiate with your physician or clinic for reduced charges on services, especially if you’re paying a significant portion of the bills out of your own pocket.  It doesn’t hurt to ask.  Explain your situation and ask if there is any discount they can apply to their services.

Non-Profit Organizations – Many charitable organizations provide financial and other forms of assistance to cancer patients in need.  In addition to those listed below, you can also check with your local United Way, Salvation Army, Lutheran Social Services, Jewish Social Services, and Catholic Charities to see what other assistance may be available in your area.

• CancerCare
• Patient Advocate Foundation, Co-Pay Relief
• National Patient Travel Center (air transportation)
• American Cancer Society (out-of-town lodging)
• American Cancer Society (travel)

Drug Assistance Programs – A variety of resources are available to help with the costs of prescription drugs.  To find out what assistance programs you qualify for, visit:

• Partnership for Prescription Assistance 
• CancerCare Copay 
• NeedyMeds

HRSA and Hill-Burton – These government programs that provide free healthcare and assistance with medical payments are often cited as potential resources for mesothelioma patients. In reality, the health clinics and hospitals involved in these programs will rarely be capable of treating mesothelioma. If you would like to check them out anyway, here are the web sites.

• Health Resources and Services Administration (HRSA)
• Hill-Burton

Living Expenses

Disability Insurance

Private Disability Insurance – If you have a disability insurance policy, now is the time to discuss your coverage with your insurer.  Even though you may still be physically able to work, being diagnosed with a fatal illness is sometimes de facto evidence of disability. 

Be sure to check with your employer, too. Disability insurance might be an employment benefit that you didn’t know you had. Disability insurance payments can be used for any purpose.

Also, check your credit cards.  You may have disability insurance on one or more. It won’t provide actual cash for you to use, but it will suspend the need for you to make payments, freeing up your available cash for other needs.  You’ll want to be cautious, though, because activating such insurance may put a temporary freeze on your ability to make additional charges.

Social Security Disability Insurance – Contact your local Social Security Administration office to inquire if you qualify for Social Security Disability payments. Qualification will depend on your age, work history, and prognosis.

Veterans Disability – Qualified veterans can receive VA disability payments when their mesothelioma is caused by asbestos exposure in the military. For more information, see the article on Assistance for Veterans with Mesothelioma in the Legal Issues section of this web site.

Life Insurance

Cash or Loan Value – The cash or loan value of a life insurance policy can be a source of funds for living expenses.

Viatical or Life Settlement – Another way of obtaining cash from a life insurance policy is by selling the policy to an individual or corporate investor. After the sale – referred to as a viatical or life settlement – the investor becomes the beneficiary and is responsible for making the premium payments.  The selling price is typically much higher than the policy’s cash or loan value, but you lose the policy.

Notice: Do not attempt to obtain money from a life insurance policy without first consulting a knowledgeable financial advisor.

Reverse Mortgage

If you have significant equity in your home, you may want to investigate taking out a reverse mortgage. With a reverse mortgage, the lender sends you a check each month and adds that amount to your mortgage balance. 

Supplemental Income

Supplemental Security Income (SSI) – When contacting your local Social Security Administration office concerning Social Security Disability, also inquire about Supplemental Security Income.  This program provides monthly payments to qualifying seniors and the disabled who have limited or no income.

Temporary Aid to Needy Families – This program replaced many of the former state and federal welfare programs in 1997. The program is now administered by the states with block grants from the federal government, so qualifications vary by state. Contact your state social services agency for more information.

Other Assistance

GovBenefits.Gov – This Web site provides access to an extensive list of Federal aid programs from nutrition assistance to help with utility bills. To use the site’s search tool requires answering a 133-item questionnaire, but the resulting list of programs is quite comprehensive. Even though it may list many programs you qualify for but aren’t interested in, it’s very likely you can find helpful resources included.

RELATED ARTICLES

• Assistance for Veterans With Mesothelioma
• Mesothelioma Compensaation
• American Cancer Society Financial Assistance Brochures
• Mesothelioma Support Groups