The Incidence of Nonrespiratory Cancers And Exposure to Asbestos

Summary

Research has shown a clear link between exposure to asbestos and respiratory cancers (cancer of the lungs and mesothelioma) in humans. However, the link between exposure to asbestos and other types of cancers is less clear.

Some epidemiologic studies suggest an association between gastrointestinal and colorectal cancers and asbestos exposure. However, very few studies suggest an elevated risk for cancers of the kidney, brain, larynx, and bladder and asbestos exposure.

Epidemiologic studies do not clearly support a consistent relationship between nonrespiratory cancers and asbestos exposure.

Introduction

Medical research has shown that people who are exposed to asbestos (through breathing in the asbestos fibers) have an increased risk of developing respiratory cancers such as lung cancer and mesothelioma (a rare form of lung cancer).

Some research suggests that exposure to asbestos also increases the risk of nonrespiratory cancers. However, despite a few studies reporting these associations, most studies do not show a consistent relationship between asbestos exposure and nonrespiratory cancers.

Following is an overview of studies on asbestos exposure and nonrespiratory cancers.

Gastrointestinal and Colorectal Cancers

Studies of asbestos workers suggest that asbestos exposure might be associated with gastrointestinal (esophagus and stomach) and colorectal (colon and rectum) cancers. However, the evidence is unclear.

These studies showed small increases in the number of deaths from gastrointestinal and colorectal cancers. For example, among 17,800 insulation workers, 99 people died from these cancers, even though the rate in the general population is expected to be 59.4 deaths. Among 2,500 asbestos textile workers, 26 people died from these cancers, but 17.1 deaths were expected. Several other studies have shown similar patterns.

However, other mortality studies of asbestos workers found no significantly increased risk for gastrointestinal or colorectal cancers. Other reviewers found no causal relationship between workers' exposure to asbestos and gastrointestinal cancer.

Some evidence shows that short-term (acute) oral exposure to asbestos might bring on precursor lesions of colon cancer, and that long-term (chronic) oral exposure might increase the incidence of gastrointestinal tumors.

Most epidemiologic studies to see if cancer incidence is higher than expected in places with high levels of asbestos in drinking water detected increases in cancer deaths or incidence rates at one or more tissue sites (mostly in the gastrointestinal tract).

Some of these increases were statistically significant. However, the magnitudes of increases in cancer incidence tended to be rather small and might be related to other risk factors such as smoking. Also, these studies were conducted on worker populations, with generally higher exposures; still, only small and inconsistent elevations have been reported.

There is relatively little consistency in the observed increases across studies.

Kidney, Brain, Bladder, Laryngeal, and Other Cancers

Results of studies of cancers at other sites are also inconclusive. One reason is that relatively few studies have tried to evaluate the relation between asbestos exposure and nonrespiratory cancers.

Some studies have noted excess deaths from, or reported cases, of certain cancers such as the kidneys (two studies), brain (one study), and bladder (one study). Several epidemiologic studies have reported an increased risk of laryngeal cancer in workers exposed to asbestos.

In contrast, other epidemiologic studies have not found a strong link between increased risk of cancers and asbestos exposure (except for cancers of the lungs and surrounding areas). For example, one analysis concluded that misdiagnosis or chance may be the best explanation for asbestos-related cancer at any other site than the lungs or surrounding areas.

Another combined analysis of 55 studies did not find a significant association between occupational exposure to asbestos and laryngeal cancer and concluded that the evidence of a causal relationship was weak.

Another combined study of asbestos-exposed workers suggested a possible association between asbestos and laryngeal cancer. This same study found no clear association of asbestos exposure and urinary, reproductive, lymphatic, or hematopoietic cancers.

Conclusions

Studies show a strong link between respiratory cancers (cancers of the lung and mesothelioma) and exposure to asbestos in humans.

However, epidemiologic studies do not clearly or consistently show a strong link between cancers at other sites and exposure to asbestos in humans.

• Some epidemiologic studies suggest an association between gastrointestinal and colorectal cancers and asbestos exposure.
• Very few studies suggest elevated rates of cancers of the kidney, brain, larynx, and bladder and asbestos exposure.
• Although some evidence suggests that exposure to asbestos also increases the risk of nonrespiratory cancers, the evidence remains weak, compared to that of lung cancer and mesothelioma.

A final combined analysis of studies of asbestos workers providing data on laryngeal disease concluded that there was no evidence of a positive association between asbestos exposure and laryngeal cancer.

Living with Asbestos-Related Illness [HTML Version]

Topics covered in the guide include characteristics of asbestos, asbestos-related illness, the respiratory system, treatment methods, preventive care, traveling tips, pulmonary rehabilitation, and relaxation and breathing techniques.

Conditions Associated with Asbestos

Asbestosis

Asbestosis is a serious, progressive, long-term disease of the lungs. Asbestosis is not a cancer. Inhaling asbestos fibers that irritate and inflame lung tissues, causing the lung tissues to scar, causes asbestosis. The scarring makes it hard to breathe and difficult for oxygen and carbon dioxide pass through the lungs. Asbestosis generally progresses slowly. The latency period for the onset of asbestosis is typically 10-20 years after the initial exposure. The disease can vary from asymptomatic (no symptoms) to disabling and potentially fatal.

Microscopic view of lung tissue with asbestosis.

Signs and Symptoms of asbestosis can include:

• Shortness of breath is the primary symptom
• A persistent and productive cough (a cough that expels mucus)
• Chest tightness
• Chest pain
• Loss of appetite
• A dry, crackling sound in the lungs while inhaling.

Pleural Abnormalities

Persons with significant exposure to asbestos are at risk for developing various types of pleural (lining of the chest cavity, outside the lungs) abnormalities. These abnormalities include pleural plaques, pleural thickening, pleural calcification, and pleural mesothelioma.
Mesothelioma

Mesothelioma is a rare cancer, which may affect the lining of the chest cavity, outside the lung (pleura) or the abdominal contents (peritoneum). Most mesotheliomas are caused by exposure to asbestos.
Lung Cancer

Lung cancer is a malignant tumor that invades and obstructs the lung's air passages. Cigarette smoking greatly increases the likelihood of a person developing lung cancer as the result of asbestos exposure. The most common symptoms of lung cancer are cough, wheezing, unexplained weight loss, coughing up blood, and labored breathing. Other symptoms of lung cancer include shortness of breath, persistent chest pain, hoarseness, and anemia. People who develop these symptoms do not necessarily have lung cancer, but they should consult a physician for advice.


















Scanning Electron Micrograph of Lung Cancer Cells.

Living with Asbestos: Introduction

Asbestos is a naturally occurring mineral. It is made up of fibers that are so small that you cannot see them. If asbestos fibers are in the air you breathe, you will get asbestos fibers in your lungs. This is the main way that people are exposed to asbestos. Asbestos fibers may remain in the lungs for a lifetime. In some cases, the fibers might damage the lungs or the pleura covering the lungs, leading to illness and even death.

Some people who worked with asbestos years ago are now getting sick. They may have brought asbestos fibers home on their clothes, shoes, and bodies. People who lived in those same households could have been exposed to asbestos, too. Some household members may now be sick because of this exposure.

Asbestos fibers may also be released into the air when asbestos-containing material is disturbed during product use, demolition work, and building or home maintenance, repair, or remodeling.

About this Guide

This guide will help you understand the illnesses asbestos may cause and how to take care of yourself if you have any of those conditions. Caregivers may also find the guide useful.

First Steps

If you think you might have been exposed to asbestos:

• Tell your doctor. Your doctor may take an exposure history and recommend a thorough physical exam, including a chest x-ray and lung function tests. Your doctor may need a specialist who is experienced in reading x-rays for asbestos-related illness to help interpret the results. Other tests may be necessary.

• Quit smoking. If you are a smoker, quit smoking. Smoking combined with asbestos exposure greatly increases the risk of getting lung cancer.

• Get regular influenza (flu) and pneumonia shots. Regular inoculations help reduce the chance of lung infections.

Being exposed to asbestos does not mean that you will develop health problems! Many things need to be considered when evaluating whether you are at risk for health problems from asbestos exposure. A doctor can help you find out if you have health problems from asbestos exposure.

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Asbestos Related Illnesses

Asbestos has been widely used in the United States; nearly everyone has been exposed to asbestos at some time in his or her life. However, most people who become sick from asbestos are exposed to high concentrations of asbestos, are exposed for longer periods of time, and are exposed more often.

Most asbestos fibers that are inhaled are breathed out, but some can become lodged in the lungs and remain there throughout life. Because asbestos fibers attach to the membranes that line the chest cavity and cover the lungs, they cannot be coughed out or washed out. Fibers can gather and cause scarring and inflammation. As the lung tissue scars and thickens, breathing becomes more difficult.

Most people do not show any signs or symptoms of asbestos-related disease for 10 to 20 years or more after exposure. The most common asbestos-related illnesses are lung cancer, mesothelioma, and asbestosis:

• Lung cancer is a malignant tumor that invades and obstructs the lung’s air passages. Cigarette smoking greatly increases the likelihood of a person developing lung cancer as the result of asbestos exposure.

Signs and symptoms of lung cancer include

• coughing,
• hoarseness,
• wheezing,
• labored breathing,
• shortness of breath,
• persistent chest pain, and
• anemia.

Other symptoms can include weight loss, fever, chills, and night sweats. People who develop these symptoms do not necessarily have lung cancer, but they should consult a physician for advice. Most cases of lung cancer in workers occurred 15 years or more after the person was first exposed to asbestos.

• Mesothelioma is a very rare cancer of the lining of the chest or abdomen. Most mesothelioma cases are caused by exposure to asbestos and are diagnosed 30 years or more after the first exposure. By the time a person is diagnosed with mesothelioma, it is almost always fatal.

Signs and symptoms of mesothelioma include

• shortness of breath or trouble breathing;
• unexplained weight loss;
• pain under the ribs; and
• pain, swelling, or lumps in the abdomen.

• Asbestosis is a serious, progressive, long-term disease that causes scarring of the lungs. This scarring makes it hard for lungs to get oxygen into the blood. It restricts breathing and leads to smaller lung volume. Asbestosis is not a cancer.

Signs and symptoms of asbestosis include

• shortness of breath (the primary symptom),
• a persistent and productive cough (a cough that expels mucus),
• chest tightness,
• chest pain,
• loss of appetite, and
• a dry, crackling sound in the lungs while inhaling.

Asbestosis generally progresses slowly, but the rate can vary greatly from one patient to another. Breathing can become more difficult as the symptoms progress over time. Lung tissues and the lining of the chest wall can change from the thinness and stretchiness of a balloon to the thickness and hardness of an orange peel.

As the disease progresses, shortness of breath becomes worse. After awhile, a person may require supplemental oxygen to carry out daily activities. The end result of the disease is lung and heart failure.

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Treating Asbestos Related Illness

A doctor can help manage asbestos-related symptoms, but no cure is available. Treatment involves preventing further complications of the disease and treating its symptoms.

For information about treating asbestos-related cancer illnesses, contact the National Cancer Institute’s Cancer Information Service. Their toll free number is 1-800-4-CANCER (1-800-422-6237).

Taking Care of Yourself

If you have an asbestos-related disease, the following self-care tips and techniques will help you take care of yourself and live more comfortably:

Food, Rest, and Exercise

Taking care of your body will help you breath easier

• Eat healthy foods, including lots of fruits and vegetables. Good eating habits help maintain muscle mass and body functions.
• Limit your salt intake.
• Drink lots of fluids—at least six glasses of water daily, unless your doctor tells you differently.
• Sleep 7 to 8 hours every night.
• Take several short rests during the day. Conserve your energy and avoid getting too tired.
• Exercise to increase the strength and endurance of your heart and lungs.

Cleanliness

• Wash your hands often to lower your risk of colds and flu.
• Wash your hands before taking your medication or handling your oxygen equipment.
• Avoid situations, like large crowds, that might expose you to respiratory infections.
• Get flu and pneumonia shots every year (offered between September and December). To protect your health, caregivers and all household members also should get shots.
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Keep a diary

Keep a diary of when you have trouble breathing. Note how often you have trouble, how bad it is, and what you were doing that may have triggered the trouble. The diary will help you recognize and avoid events that trigger breathing trouble.

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Avoid Bad Air

• When air pollution and pollen counts are high, stay inside. An air-filtering machine can improve the indoor air quality.

• Avoid breathing pollutants that can trigger shortness of breath. This includes traffic fumes, smog, aerosol sprays, and chemical vapors (from products such as paint, kerosene, and cleaning agents).

• In cold weather, breathe through your nose. Cover your mouth and nose with a scarf.
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Cough Productively

People with chronic lung diseases are more at risk for respiratory infections because their lungs are already damaged. One of the most important preventive measures is a “productive” cough. This is a cough that is moist and brings up mucus from the lungs and air passageways. This helps clear the air passages.

An unproductive cough reduces airflow and causes respiratory muscle fatigue. If mucus and other foreign bodies remain in the respiratory tract, they can pool in the airways. This makes it difficult to expel bacteria and increases the risk of infection.

Very dry air increases shortness of breath and thickens the mucus in your lungs. Your doctor may recommend a humidifier, breathing therapies, and chest percussion (pounding or clapping the chest to loosen secretions). These steps loosen and thin out bronchial secretions, allowing them to be expelled by the cough.

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Avoid Smoke

• Stay away from smoke and smokers.
• If you smoke, now is a good time to quit. Smoking can increase the rate at which a disease gets worse. It can also increase the risk of lung cancer. Even if you have been smoking for years—or you already have lung disease—quitting smoking now will greatly improve your health. Your blood vessels will relax, allowing the blood to flow normally; your heart will not have to work as hard. Your lung tissue will become healthier and you will breathe easier.
• If you smoke, a structured stop smoking program may help you kick the habit. The use of nicotine patches and antidepressants along with counseling may also be helpful.
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Participate in Respiratory Therapies

• Participate in respiratory therapies (such as bronchial drainage) as recommended by your doctor. Your doctor might recommend using an ultrasonic mist humidifier to help clear secretions from your lungs.
• You might also learn postural drainage; the positioning of a person to drain and remove secretions from particular areas of the lungs.
• Clean and maintain respiratory therapy devices to limit their risk of causing infection. Though you may need proper training to do that, the following are general recommendations:
• Clean all reusable respiratory therapy equipment twice a week. That includes ventilator circuitry, nebulizers, aerosol tubing, and peak flow meters. Consult your provider about cleansing routines for respiratory equipment.
• Completely air dry all cleaned devices before putting them back together. Moisture trapped in the devices can allow bacteria, viruses, and fungi to grow.
• All ventilator filters should be cleaned and changed as often as the manufacturer recommends.
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Practice Breathing Techniques

Breathing techniques can help you control your respiratory rate and breathing pattern. That will help you breathe easier and more efficiently, and make you feel like enough air is getting into your lungs. Breathing techniques and correct posture also can improve the function of respiratory muscles and effectiveness of coughs.

You can also do exercises to help you breathe more easily. Practice the exercises daily so that when shortness of breath occurs, you will do them naturally and not panic. Some of the exercises are the following:

• Pursed-lip breathing: Pursed-lip breathing will slow down your breathing so that it is more efficient (breathing fast only worsens shortness of breath). You can do this kind of breathing anywhere.
  • Breathe in slowly through your nose. Hold your breath for 3 seconds.
  • Purse your lips as if you are going to whistle.
  • Breathe out slowly through your pursed lips for 6 seconds.
• Abdominal/diaphragm breathing: Abdominal breathing also slows down your breathing and helps relax your entire body.
  • Lie on your back in a comfortable position with a pillow under your head and knees.
  • Rest one hand on your abdomen just below your rib cage. Rest the other hand your chest.
  • Slowly breathe in and out through your nose using your abdominal muscles. The hand resting on your abdomen will rise when you breathe in and fall when you breathe out. The hand on your chest should be almost still. Repeat three or four times before resting.
• Active Cycle of Breathing Technique (ACBT): ACBT is a series of breathing techniques that help clear secretions and improve air delivery to your lungs. ACBT can be done sitting up. This technique combines breathing exercises with the “huff” cough and has three components in a set cycle. The huff cough involves holding a deep breath for a few seconds and then exhaling forcefully. The cycle is repeated until the huff becomes dry or nonproductive, or when 20 minutes have passed. Ask your doctor for guidance and instructions on this therapy.
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Participate in Pulmonary Rehabilitation

Talk to your doctor about taking part in a pulmonary rehabilitation program. Pulmonary rehabilitation uses different therapies for persons with pulmonary disease. The goal of pulmonary rehabilitation is to help patients reach and maintain their maximum level of independence and ability to function in the community.

Pulmonary rehabilitation is becoming a crucial part of therapy for many patients. It offers the best treatment option for patients with chronic respiratory illnesses. It helps people increase their exercise capacity and endurance and improves their health-related quality of life. The treatment also helps people breathe easier and results in fewer hospital admissions, even among patients with the most severe degree of lung disease.

Patients with advanced lung disease may have emotional disorders, mainly depression and anxiety. In addition to appropriate medical therapy for these disorders, exercise as part of a pulmonary rehabilitation program can help lessen these feelings.

The goals of a pulmonary rehabilitation program are to:

• make breathing easier,
• improve pulmonary function,
• ease shortness of breath,
• increase efficiency of energy use,
• correct nutrition deficiencies,
• improve exercise performance and daily activities,
• restore a positive outlook,
• improve emotional state,
• decrease health-related costs, and
• improve survival.

If you are interested in pulmonary rehabilitation, ask your doctor to help you design a program that will work for you.

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Follow Your Doctor’s Instructions

• Follow your doctor’s instructions on taking your medicines, oxygen therapy, and chest physiotherapy.
• Make an effort to prevent infection. People with asbestosis may require aggressive medical care, including frequent use of antibiotics when warranted, for any respiratory infection.
• Do not try to treat yourself. Over-the-counter cold remedies might worsen the problem. Do not use them unless your doctor tells you it is okay.
• Get regular chest x-rays to help screen for cancers associated with asbestos exposure.
• Call your doctor if any of the following signs occur:
• Fever;
• Increased wheezing, persistent coughing, or difficulty breathing;
• Changes in mucus (mucus is thicker; either more or less mucus is present than usual; mucus has a foul odor; or mucus is green, yellow, brown, pink, or red);
• Stuffy nose, sneezing, or sore throat;
• Increased fatigue or weakness;
• Weight gain or loss of more than 6 pounds within a week; or
• Swollen ankles or feet
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Oxygen/Traveling With Oxygen

Oxygen

If your doctor has prescribed oxygen, you will have a liquid oxygen unit, an oxygen tank, or an oxygen concentrator. You will breathe the oxygen through either a mask or nasal cannulae (two short prongs that fit just inside your nostrils). The system will also have a humidifier to warm and moisten the oxygen.

As a precaution, also keep a small portable oxygen tank available in case of power failure.

Only your doctor can decide how much oxygen you need. You should never change the flow rate without instructions from your doctor. The medical supply company will show you how to set the flow rate and how to care for the equipment. Keep the supplier’s telephone number handy in case the system does not work properly.

Sometimes it is hard to tell whether oxygen is flowing through the tubes. If you have doubts, check to be sure that the system is turned on and the tubing does not have any kinks. If you still are not sure, place the nasal cannulae in a glass of water with the prongs up and watch for bubbles. If no bubbles appear, oxygen is not flowing through the tubes and you need to call your supplier.

Oxygen is very flammable. Keep your oxygen unit away from open flames and high heat, including lit cigarettes, burning candles, log fires, gas stoves, space heaters, or kerosene heaters.

Traveling With Oxygen

When traveling around town, be sure to plan for an adequate supply of oxygen and know how much time you can safely travel between refills. Always allow for a 20%–25% safety margin to cover any unexpected delays. When traveling, keep the oxygen container upright and secure at all times.

Planning a longer trip

• Discuss your travel plans with your doctor to be sure it is all right for you to travel and to find out how long your trip can safely be away.
• Contact your oxygen supply company about your travel plans. The company will recommend the equipment you need and help determine the time you can safely travel between refills. Get the oxygen equipment with which you will travel ahead of time so you can become familiar with how to operate it. Your supplier can also arrange to have oxygen supplied to you at your destination.
• Check with your insurance company. You may have to pay in advance for equipment and submit the insurance claims after you return home. Be sure to keep your receipts.
• Always keep your prescription with you throughout the trip.

Traveling by Bus

Bus lines do permit travel with oxygen equipment. However, to prevent any unexpected problems, check in advance. Most bus companies permit you to take one E (M-24; 680 L) cylinder onto the bus. Empty tanks can be checked as baggage. You must be able to put your tank on and take it off by yourself.

Traveling by Train

In the United States, Amtrak requires at least 12 hours notice in advance of your train’s boarding time of your need to bring oxygen aboard. Portable oxygen containers must meet the following requirements:

• Power source: Oxygen equipment cannot rely solely on train-provided electrical power.
• UL or FM listed: Oxygen equipment must be Underwriter's Laboratory (UL) or Factory Mutual (FM) listed.
• Weight limits: Each tank and its associated equipment may weigh no more than 50 lbs (22.7 kgs) per unit.
• Configuration: Amtrak permits only one of the following:
• a two-tank system (maximum of 50 lbs [22.7 kgs] per tank), or
• a six-tank system (maximum of 20 lbs [9 kgs] per tank), but only if the tanks can be separated and handled individually.

Traveling by Ship

Cruise line regulations differ and are subject to change, so you must contact the cruise line regarding current rules. Some cruise lines permit you to travel only with oxygen cylinders and limit the number you may bring on board.

• Be prepared to supply the following information from your doctor:
• a prescription stating the quantity of oxygen and the flow rate,
• a letter describing your diagnosis, and a statement that you are approved for travel.

Traveling by Plane

Regulations vary from one airline to another and are subject to change.

• Always call ahead of time to inquire about current rules. Some airlines will not permit passengers to use oxygen. Other airlines are willing to provide oxygen if you make advance arrangements, but you must use their oxygen supply. Airlines do not allow passengers to bring oxygen on board the plane.
• Always bring your own nasal prongs: some airlines use only simple oxygen masks, which allow carbon dioxide buildup. Also bring a universal nipple adapter that fits various sizes of tubing.
• You must make reservations 2 to 5 days in advance, depending on the individual airline’s rules. Be sure to ask what documents you will need to supply. Airline documentation requirements are similar to those of cruise lines. Some airlines also have special forms that must be filled out by your doctor. You might have to sign a liability statement. In a few cases, you are required to bring a companion with you on the flight. Additional charges vary, but expect to pay about $50 extra.
• Allow at least 1 hour between connecting flights. Remember that you must arrange for oxygen for the time between flights. Local oxygen suppliers will provide this service for layovers between flights. Whenever possible, use small airports because they usually have fewer delays and their boarding gates are closer together.

Lodging

Hotels and motels are usually very accommodating about special needs. Someone is usually available to transport your oxygen tank.

• Contact your local supply company about arranging for a supply company at your destination to set up the equipment in the room before you arrive.

Asbestos

Health Effects

General Information

Significant exposure to any type of asbestos will increase the risk of lung cancer, mesothelioma and nonmalignant lung and pleural disorders, including asbestosis, pleural plaques, pleural thickening, and pleural effusions. This conclusion is based on observations of these diseases in groups of workers with cumulative exposures ranging from about 5 to 1,200 fiber-year/mL. Such exposures would result from 40 years of occupational exposure to air concentrations of 0.125 to 30 fiber/mL. See Detecting Asbestos, for typical levels of concentration. The conclusion is supported by results from animal and mechanistic studies.




















Asbestos fibers lodged in the lungs. Asbestos-related conditions affect the lungs and surrounding tissues

Diseases from asbestos exposure take a long time to develop. Most cases of lung cancer or asbestosis in asbestos workers occur 15 or more years after initial exposure to asbestos. Tobacco smokers who have been exposed to asbestos have a "far greater-than-additive" risk for lung cancer than do nonsmokers who have been exposed, meaning the risk is greater than the individual risks from asbestos and smoking added together. The time between diagnosis of mesothelioma and the time of initial occupational exposure to asbestos commonly has been 30 years or more. Cases of mesotheliomas have been reported after household exposure of family members of asbestos workers and in individuals without occupational exposure who live close to asbestos mines.

Asbestos Facts

* When asbestos fibers are inhaled, most fibers are expelled, but some can become lodged in the lungs and remain there throughout life. Fibers can accumulate and cause scarring and inflammation. Enough scarring and inflammation can affect breathing, leading to disease.
* The term “naturally occurring asbestos” refers to the mineral as a natural component of soils or rocks as opposed to asbestos in commercial products, mining or processing operations. Naturally occurring asbestos can be released from rocks or soils by routine human activities, such as construction, or natural weathering processes. If naturally occurring asbestos is not disturbed and fibers are not released into the air, then it is not a health risk.
* People are more likely to experience asbestos-related disorders when they are exposed to high concentrations of asbestos, are exposed for longer periods of time, and/or are exposed more often.
* Inhaling longer, more durable asbestos fibers (such as tremolite and other amphiboles) contributes to the severity of asbestos-related disorders.
* Exposure to asbestos can increase the likelihood of lung cancer, mesothelioma, and non-malignant lung conditions such as asbestosis (restricted use of the lungs due to retained asbestos fibers) and changes in the pleura (lining of the chest cavity, outside the lung).
* Changes in pleura such as thickening, plaques, calcification, and fluid around the lungs (pleural effusion) may be early signs of asbestos exposure. These changes can affect breathing more than previously thought. Pleural effusion can be an early warning sign for mesothelioma (cancer of the lining of the lungs).
* Most cases of asbestosis or lung cancer in workers occurred 15 years or more after the person was first exposed to asbestos.
* Most cases of mesothelioma are diagnosed 30 years or more after the first exposure to asbestos.
* Asbestos-related disease has been diagnosed in asbestos workers, family members, and residents who live close to asbestos mines or processing plants.
* Health effects from asbestos exposure may continue to progress even after exposure is stopped.
* Smoking or cigarette smoke, together with exposure to asbestos, greatly increases the likelihood of lung cancer. See Cigarette Smoking, Asbestos Exposure, and your Health.


Health Risks of Asbestos Exposure

Chronic exposure to asbestos may increase the risk of lung cancer, mesothelioma, and nonmalignant lung and pleural disorders. Evidence in humans comes from epidemiologic studies as well as numerous studies of workers exposed to asbestos in a variety of occupational settings. Tremolite asbestos exposure has been associated with an increased incidence of disease in vermiculite miners and millers from Libby, Montana. This evidence is supported by reports of increased incidences of nonmalignant respiratory diseases, lung cancer, and mesothelioma in villages in various regions of the world that have traditionally used tremolite-asbestos whitewashes in homes or have high surface deposits of tremolite asbestos and by results from animal studies.
Risk Factors

Various factors determine how exposure to asbestos affects an individual:

* Exposure concentration - what was the concentration of asbestos fibers?
* Exposure duration - how long did the exposure time period last?
* Exposure frequency - how often during that time period was the person exposed?
* Size, shape and chemical makeup of asbestos fibers:

Long and thin fibers are expected to reach the lower airways and alveolar regions of the lung, to be retained in the lung longer, and to be more toxic than short and wide fibers or particles. Wide particles are expected to be deposited in the upper respiratory tract and not to reach the lung and pleura, the sites of asbestos-induced toxicity. Short, thin fibers, however, may also play a role in asbestos pathogenesis. Fibers of amphibole asbestos such as tremolite asbestos, actinolite asbestos, and crocidolite asbestos are retained longer in the lower respiratory tract than chrysotile fibers of similar dimension.

* Individual risk factors, such as a person's history of tobacco use (smoking) and other pre-existing lung disease, etc.

Note, cigarette smoke and asbestos together significantly increase your chances of getting lung cancer. Therefore, if you have been exposed to asbestos you should stop smoking. This may be the most important action that you can take to improve your health and decrease your risk of cancer.

What Is Mesothelioma?

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the sac lining the chest or abdomen. Exposure to airborne asbestos particles increases the risk of developing malignant mesothelioma.

The word Mesothelioma (like other cancer names) is derived from mesothelium, a membrane that covers and protects most internal organs of the body. Mesothelium is composed of two layers of cells, one layer surrounds the organ and the second layer forms a sac around it. Lubricating fluid is produced by the Mesothelium and is released between the layers which help moving organs to flow easily against adjacent structures. Organs such as the heart, lungs and stomach that expand and contract rely on this fluid.

Mesothelium is named differently depending on where it is located in the body. The mesothelial tissue covering the lungs and the chest cavity is the pleura. The tissue covering the organs in the abdominal cavity is the peritoneum. The tunica vaginalis testis covers the male internal reproductive organs and the tunica vaginalis testis surrounds the female reproductive organs. Most cases of Mesothelioma begin in the pleura or the peritoneum. When mesothelioma develops in the pleura (known as pleural mesothelioma), the delicate lining thickens and fluid may collect between the two layers of the pleura. The abdomen peritoneal mesothelioma causes thickening of the lining and a collection of fluid in the abdomen, called ascites. Symptoms are associated with the organs that may be affected by mesothelioma.

Mesothelioma has a long latency period and it's important to determine who needs to be examined. This long silent period makes diagnosis difficult and symptoms may sometimes be mistaken for something else. Treatment options are often determined by the stage of mesothelioma of the patient.

Mesothelioma is serious and life-threatening. By the time cancer is diagnosed the patients survival time is usually short. Mesothelioma usually spreads throughout the peritonal or pleural cavity before diagnosis, and complete surgical removal is unlikely. Because of this, the average survival time is only 1 year. If the cancer is found early, approximately 50% of the patients survive 2 years and approximately 20% survive 5 years. Additionally, unlike with other tumors, chemotherapy and radiation therapy are not very effective.

Abestos: Did you mean asbestos?

Asbestos (commonly misspelled or mistyped "abestos") is a naturally occurring mineral substance. There are different uses and types of asbestos; most often it is used to strengthen substances. When airborne, it can cause serious harm to people who ingest of breath it in, resulting in asbestosis, or a scaring of the lung tissue, or mesothelioma, a cancer of the lining of the lungs or abdomen.

Other common misspellings of asbestos besides abestos are asbetos, azbestos, asbostose, asbestose, asbeztos, and azbetos.

* Types of Asbestos
* Asbestos Exposure
* Common Asbestos-Containing Products
* Who is at Risk for Asbestos Exposure and Disease
* How to Deal with Asbestos
* Asbestos' Effects on Health
* Abestos: Did you mean asbestos?

Your Legal Rights

If you or someone you know has an asbestos-related disease, you owe it to yourself to make sure that your rights are protected. Asbestos cancer lawsuits (sometimes mistyped as "abestos cancer lawsuits") are best taken on by lawyers experienced in such areas. Many are taken on on a contigency basis, and as such require no out of pocket costs from you.

Your rights vary depending on many factors such as your residence, where you were exposed to asbestos, and the location of the responsible asbestos companies. Each state has its own laws and governs the law differently. Each state also has its own deadlines for allowing victims of asbestos disease to file lawsuits, called statutes of limitation and statutes of repose. Because of these limitations, it is important that you promptly contact an attorney in regards to your asbestos cancer lawsuit.

To find out more about your legal options, please contact us for more information. We are a lawfirm experienced in asbestos claims and have many experienced mesothelioma lawyers . Learn more about us.

Mesothelioma Treatment

While there is currently no cure available for malignant mesothelioma, there are treatments available. The types of treatments may include:

Surgery: A common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed. Depending on how far the cancer has spread, a lung also may be removed. This operation is called pneumonectomy.

Radiation therapy: Using high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).

Chemotherapy: Using drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).

Intraoperative photodynamic therapy: A new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.
The Stages of Treatment

How mesothelioma is treated depends on where the cancer is, how far it has spread, and the patient's age and general health. Some typical treatments are as follows:

Localized Malignant Mesothelioma (Stage I) If the cancer is only in one place in the chest or abdomen, treatment will probably be surgery to remove part of the pleura and some of the tissue around it. If the cancer is found in a larger part of the pleura, treatment may entail one of the following:

* Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
* Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
* External beam radiation therapy to relieve symptoms.
* A clinical trial of surgery followed by chemotherapy given inside the chest.
* A clinical trial of surgery, radiation therapy, and/or chemotherapy.

Advanced Malignant Mesothelioma (Stages II, III, and IV) For advanced malignant mesothelioma, treatment may be one of the following:

* Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.
* Surgery to relieve symptoms.
* Radiation therapy to relieve symptoms.
* Chemotherapy.
* A clinical trial of surgery, radiation therapy, and chemotherapy.
* Chemotherapy given in the chest or abdomen.

Recurrent Malignant Mesothelioma Treatment depends on many factors, including where the cancer came back and what treatment the patient received before. Clinical trials are testing new treatments.

Diagnosis and Symptoms

Symptoms of Mesothelioma
Common symptoms of Mesothelioma are shortness of breath, pleural effusion, pain in the chest, or pain or swelling in the abdomen. If you are experiencing any of these symptoms, and have been exposed to asbestos, you should see a doctor immediately.

Diagnosis of Mesothelioma
As a first step in diagnosing the disease, the doctor may order an x-ray of the chest or abdomen. The doctor may look inside the chest cavity with a special instrument called a thoracoscope. A cut will be made through the chest wall and the thoracoscope will be put into the chest between two ribs. This test, called thoracoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time). Some pressure may be felt, but usually there is no pain.

The doctor may also look inside the abdomen (peritoneoscopy) with a special tool called a peritoneoscope. The peritoneoscope is put into an opening made in the abdomen. This test is also usually done in the hospital. Before the test is done, a local anesthetic will be given.

If tissue that is not normal is found, the doctor will need to cut out a small piece and have it reviewed under a microscope to see if there are any cancer cells. This is called a biopsy. Biopsies are usually done during the thoracoscopy or peritoneoscopy.

The chance of recovery (prognosis) depends on the size of the cancer, where the cancer is, how far the cancer has spread, how the cancer cells look under the microscope, how the cancer responds to treatment, and the patient's age.

Find out about treatment options.

Asbestos' Effect on Health

Asbestos fibers can have a serious effect on your health if inhaled. There is no known safe exposure to asbestos and the more you are exposed to asbestos, the greater chance you have of developing an asbestos-related disease, such as lung cancer, mesothelioma (a rare cancer of the lining of the chest and abdomen lining), cancer of the stomach, intestines, and rectum.

A non-cancer-related disease associated with asbestos inhalation is asbestosis, a scarring of the lungs that leads to breathing problems and heart failure. Individuals who have helped manufacture asbestos or asbestos-containing products run a significantly higher risk of being affected by asbestosis.

The first signs of an asbestos-related disease may develop as late as 30 years after the exposure to asbestos.

* Types of Asbestos
* Asbestos Exposure
* Common Asbestos-Containing Products
* Who is at Risk for Asbestos Exposure and Disease
* How to Deal with Asbestos
* Asbestos' Effects on Health
* Abestos: Did you mean asbestos?

How to Deal with Asbestos

Exposure to asbestos is a serious health risk, so if you believe you may have asbestos in products within your home or work environment, especially if it is crumbling or disintegrating, do not handle them yourselves. Airborne asbestos fibers are dangerous if inhaled, but generally, asbestos products in solid condition pose no serious risks. Professionals can analyze asbestos containting products in your home and remove or correct their presence in a number of ways, depending on the condition of the product. Read on to find out the safest steps to deal with potential asbestos hazards.
Inspection

If you believe you have asbestos in your house, it is important to have it inspected. State health agencies or independent testing companies can do this for you. They can take a sample of suspicious materials and have them analyzed to determine whether they are asbestos-related and what level of risk there may be.
Asbestos Encapsulation (Sealing)

Asbestos encapsulation, or sealing, is a method to make existing asbestos more safe. Encapsulation involves sealing off an undamaged asbestos-containing substance by coating the materials. This prevents fibers from loosening and becoming airborne. Encapsulation will not work if materials are damaged, soft, or crumbling. If repair or encapsulation is not appropriate, it is recommended that the asbestos be covered or removed.
Crumbling Asbestos

Crumbly, soft or damaged asbestos-containing products increase the risk that asbestos fibers will be able to enter the air. Do no sweep or vacum the asbestos dust as that will cause the fibres to become airborne; they should be wet-mopped or vaccumed with a HEPA Crumbly asbestos should be covered or removed by asbestos-handling professionals only. Consult a reliable professional if you have crumbling asbestos.
Damaged Asbestos

Like crumbly or soft asbestos-containing products, there is a greater risk that asbestos fibers will be airborne. Crumbly asbestos should be covered or removed by asbestos-handling professionals only. Consult a reliable professional to determine the appropriate way to deal with damaged asbestos.

Who is at Risk for Asbestos Exposure and Disease

The following is only a partial list of those who are at risk for asbestos-related disease. As stated by one prominent asbestos expert, "Asbestos does not respect job classification." Regardless of your job title, if you worked in any of the following occupations or industries, you may have been exposed to asbestos.

* Aircraft mechanics and repairmen
* Asbestos plant workers
* Asbestos workers
* Atomic workers
* Automobile mechanics
* Automotive workers
* Blacksmiths
* Boilermakers
* Brick masons and stone masons
* Buffers
* Bulldozer operators
* Cabinetmakers
* Carpenters
* Car shop workers
* Chemical technicians
* Clothing ironers and pressers
* Construction workers
* Cosmetologists
* Crane, derrick and hoist men
* Draftsmen
* Drill press operators
* Drywall tapers
* Electric power linemen and cable men
* Electricians
* Elevator constructors
* Engineers
* Family members of exposed workers
* Filers
* Firefighters
* Food and commercial workers
* Foremen
* Forge workers
* Foundry workers
* Freight and material handlers
* Furnace men
* Garage workers
* Gas station attendants
* Grinding machine operators
* Hairdressers
* Heavy equipment mechanics
* Household appliances installers and mechanics
* Industrial plant workers
* Insulators
* Iron workers
* Job and die setters
* Laborers
* Locomotive engineers
* Longshoremen and stevedores
* Machinists
* Maintenance workers
* Masons
* Metal lathers
* Millwrights
* Mine workers
* Mixing operatives
* Molders
* Oil refinery workers
* Operating engineers
* Painters
* Pipe fitters
* Plasterers
* Plumbers
* Polishers
* Power plant workers
* Railroad workers
* Refinery workers
* Road machine operators
* Rollers and finishers
* Roofers and slaters
* Sailors and deckhands
* Sanders
* Sculptors
* Sheetmetal workers
* Shipbuilders
* Shipyard workers
* Smelter-men
* Stationary engineers
* Steamfitters
* Steel pourers
* Steelworkers
* Teachers
* Telephone workers
* Textile workers
* Tile setters
* Tool and die makers
* U.S. Navy veterans
* Weavers
* Welders

Common Asbestos-Containing Products

What is Asbestos?

Asbestos is a naturally occurring mineral which has been used all over the world in a huge range of applications since its first discovery. Its chief physical properties are its durability and resistance to heat and combustion. It is an extremely fibrous mineral and mining, milling, processing, and use of asbestos and its products create many small fibers. These fibers, which can be either inhaled or ingested, can cause very serious health problems. In many countries asbestos is still mined, processed, and used. In a growing number of others, it is either banned or its use is severely restricted.
Where is Asbestos Used?

Asbestos has been used in industry since about the 1880's. As early as 1918, American and Canadian insurance companies were no longer insuring asbestos workers because of the assumed health hazards of the asbestos industry. In 1935, researchers in both the United States and England reported a suspected association between asbestos exposure and lung cancer. By 1955 this association had been confirmed, and the link to several other types of cancer had been made as well.

However, the asbestos industry spent—and continues to spend—large sums of money trying to play down the hazards of exposure to asbestos fibers and to fight off stricter legislation.

The following are some of the more common asbestos-containing products. This list is not exclusive. Between 1900 and the mid 1980s, asbestos was used in over 3,000 different products. During the 20th century, more than 30 million tons of asbestos were used in industrial facilities, homes, schools, shipyards, steel mills, power plants and commercial buildings in the United States.

If you have any questions about these products, please contact us.

* Acoustical panels
* Acoustical plaster
* Acoustical tile
* Adhesive
* Aircell insulation
* Aprons
* Asbestos board
* Asbestos canvas
* Asbestos cloth
* Asbestos cord
* Asbestos corrugated sheets
* Asbestos curtains
* Asbestos felt
* Asbestos fiber
* Asbestos fiber felt
* Asbestos finishing cement
* Asbestos flatboard
* Asbestos forms
* Asbestos furnace tape
* Asbestos gaskets
* Asbestos gloves
* Asbestos insulating blankets
* Asbestos insulating cement
* Asbestos insulation
* Asbestos lap
* Asbestos micarta
* Asbestos millboard
* Asbestos mineral wool
* Asbestos mittens
* Asbestos packing
* Asbestos pads
* Asbestos panels
* Asbestos paper
* Asbestos rollboard
* Asbestos rope
* Asbestos seals
* Asbestos sheets
* Asbestos sponge block
* Asbestos sponge cover
* Asbestos spray
* Asbestos tank jacket
* Asbestos tape
* Asbestos textile
* Asbestos tiles
* Asbestos wick
* Asbestos yarn
* Asbestos-faced mineral wool
* Asphalt
* Attic insulation
* Automobile hood liners
* Blaze shield
* Block
* Board
* Boiler wall coat
* Boilers
* Bonding cement
* Cables
* Calcium silicate insulation
* Carded asbestos cloth
* Castables
* Ceiling tiles
* Cement
* Ceramic tile
* Cigarette filters
* Clapboards
* Clay
* Cloth
* Clutches
* Cork board
* Cork covering
* Cork-filled mastic
* Cork mastic
* Corrugated asbestos sheets
* Corrugated paper
* Dry mix joint compound
* Duct adhesive
* Eighty-five percent magnesia insulation
* Emulsion adhesive
* Emulsions
* Expansion
* Expansion joint
* Fake snow
* Fibrous adhesive
* Finishing cement
* Fire resistant insulation shield
* Firebrick
* Fireclad asbestos paper
* Firefoil board
* Firefoil panel
* Fireguard asbestos paper
* Fireproofing cement
* Flex board
* flexible duct connectors
* Furnace cement
* Fyrbestos sheets
* Gasket material
* Gaskets
* Generators
* Goldbestos
* Gunning mix
* Hair dryers
* Heat shield
* Heatguard
* High pressure packing
* Industrial A-C board
* Insulation coating
* Insulation duct
* Insulation jacketing
* Insulating mix
* Insulation seal
* Insulmastic
* Ironing board covers
* Joint compounds
* Kent cigarettes
* Lagging
* Lagging adhesive
* Lagging cloth
* Lagging tape
* Leggings
* Limpet
* Marine panels
* Mastic
* Masonry fill
* Mastic
* Mastic adhesives
* Metal mesh blanket
* Millboard
* Mineral wool block
* Mineral wool insulating cement
* Mineral wool mineral wool blankets
* Mittens
* Mitts
* Navy sealer
* Nuclear reactors
* One-shot cement
* Packing
* Packing material
* Paint
* Paper
* Paper tape
* Panels
* Patching fiber
* Patching plaster
* Permaboard
* Pipe covering
* Plaster
* Powershield
* Pumps
* Putty
* Quick-setting joint compound
* Railroad electrical arc chutes
* Raw asbestos fiber
* Refractory cements
* Roofing felt
* Roofing paper
* Rollboard
* Rope
* Rope packing
* Sealer
* Sheet packing
* Sheet rope
* Sheetrock
* Sheets
* Shingles
* Sound shield
* Sleeves
* Spackle
* Spackle paster
* Sponge felt
* Spray
* Spray fireproofing
* Stone corrugated sheets
* Stone sheathing
* Talc powder
* Tape
* Tar paper
* Transite
* Troweled coating
* Turbines
* Valve rings
* Valve stem packing
* Valves
* Vermiculite compounds
* Vinyl asbestos floor tile
* Vinyl wallpaper
* Waterproofing
* Welding rods
* Wick
* Wires
* Wood fiber plaster
* Yarn

Asbestos Exposure

Although prolonged asbestos exposure significantly increases your chances of developing an asbestos related disease, like asbestosis or mesothelioma, even minor exposure can put you at risk. Wives being exposed by shaking out their husbands' asbestos-dusted clothes are not uncommon. Unfortunately neither are stories of second-hand asbestos exposure to the children of those who worked with asbestos. (This is known as paraoccupational exposure.)

Many people who have been exposed to asbestos will not become ill, but for those that do, it may take 10 to 40 years for symptoms to show up.

Asbestos exposure is a serious matter for you and your family. If you believe that you may have been exposed to asbestos, click here.

Types of Asbestos

There are two families of asbestos, the Amphibole family and the Serpentine family, which differ based on the structure of their mineral crystals.

Amphibole Asbestos

The mineral fibers in Amphibole asbestos are chain-like, while Serpentine mineral fibers are in layered sheets. This can be seen under the microscope. There are five different types of Amphiboles: Amosite ("brown asbestos"), Crocidolite ("blue asbestos"), Anthophyllite, Tremolite, and Actinolite.

Amosite

A type of Amphibole asbestos that is made up of mineral fibers formed by crystals that look chain-like. Amosite is also called "brown asbestos" takes its name from the asbestos mines of South Africa.

Crocidolite

Crocidolite is one of the five types of Amphibole asbestos. This means the fibers in Crocidolite are made up of mineral crystals that look like chains. Crocidolite is often called "blue asbestos," and occurs naturally in Austrial, South Africa, the former Soviet Union, and Canada.

Actinolite

One of the more rare forms of asbestos. It is a mineral with fibers that form in manner of the Amphibole family — which means the fibers are made of crystals that are chain-like in appearance. Like two other rare forms of asbestos, Tremolite and Anthophyllite, Actinolite is found mainly as a contaminant in other minerals. Actinolite was not used commercially as were chrysotile, amosite, and, to a lesser extent, crocidolite.

Anthophyllite

One of the more rare forms of asbestos. It is a mineral with fibers that form in the Amphibole family — which means the fibers are made of crystals that are chain-like in appearance. Like two other rare forms of asbestos, Tremolite and Actinolite, Anthophyllite is found mainly as a contaminant in other minerals. Anthophyllite was not use commercially as were chrysotile, amosite, and, to a lesser extent, crocidolite.
Serpentine Asbestos

Chrysotile

The most common type of asbestos, it is also known as "white asbestos," and Chrysotile comprises approximately 90%-95% of all asbestos in the United States. It is made up of minerals which crystallize in the "serpentine" pattern, which means its crystals are formed in sheets. Chrysotile has been linked with all asbestos-related diseases, including asbestosis, lunc cnacer, cand mesothelioma.

Asbestos fibers are extremely durable and are heat and fire resistant. Asbestos also serves as a strong binder for other materials. Because of these properties, asbestos was used in over 3000 different products in a variety of industrial, commercial, and consumer products. Because of their size and shape, asbestos fibers can easily become airborne and can remain in the air for long periods of time. Once asbestos settles, it can be redistributed into the air easily through a process called reentrainment. Unfortunately, once asbestos fibers are inhaled or swallowed, they tend to remain in the body for many years.

What is Malignant Mesothelioma?

Malignant mesothelioma is the most serious of all asbestos-related diseases. It is a rare form of cancer in which malignant cells are found in the sac lining of the chest (pleura) or abdomen (peritoneum). Virtually all cases of malignant mesothelioma are attributable to asbestos exposure. Learn more about mesothelioma.

If you're not sure whether you've been exposed to asbestos, the links below may help you determine whether you're at risk.

* Types of Asbestos
* Asbestos Exposure
* Common Asbestos-Containing Products
* Who is at Risk for Asbestos Exposure and Disease
* How to Deal with Asbestos
* Asbestos' Effects on Health

Asbestos and Mesothelioma

Asbestos is a natural mineral made up of crystals that form long fibers. Asbestos can take two forms — Serpentine and Amphibole — which are different based on the structure of their crystals. Before the late 70s to early 80s, asbestos was often combined with other bonding agents to make products that were strong, fire-resistant and insulated from heat. These products included everything from building materials to common household appliances such as toasters.

Later, it was discovered that the mineral fibers could cause serious health problems. If airborne and inhaled, asbestos fibers' small size and thin shape allows them to defeat the body's regular protections against inhaled debris and become lodged deep into the lung. Once there, asbestos fibers cause damage to the lungs; many exposed to asbestos develop life-threatening diseases, such as asbestosis, mesothelioma, or lung cancer.

Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

What are the risk factors for mesothelioma?

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.

What is Mesothelioma?

Malignant Mesothelioma is the most serious of all asbestos-related diseases. It is a rare form of cancer in which malignant cells are found in the sac lining of the chest (pleura) or abdomen (peritoneum). Virtually all cases of malignant mesothelioma are attributable to asbestos exposure.

An x-ray is often the first method used in the diagnosis of mesothelioma. Although mesothelioma typically cannot be seen on an x-ray, the tumor often causes a pleural effusion, or fluid collection between the lung and chest wall. This abnormal finding is associated with shortness of breath and warrants clinical followup. For confirmation of the disease a pathology specimen from a biopsy or operation is usually required. Like most cancers, malignant mesothelioma is best treated when it is diagnosed early. Mesothelioma progresses through stages. In the early stages, the cancer is found in the lining of the chest cavity, the lining of the lung or the lining of the abdominal cavity. In the advanced stages of mesothelioma, the cancer spreads beyond the lining of the chest or abdomen to lymph nodes, into the chest wall, center of the chest, heart, through the diaphragm, or abdominal lining. Eventually the mesothelioma may spread to distant organs or tissues.

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the sac lining the chest or abdomen. Exposure to airborne asbestos particles increases the risk of developing malignant mesothelioma.

The word Mesothelioma (like other cancer names) is derived from mesothelium, a membrane that covers and protects most internal organs of the body. Mesothelium is composed of two layers of cells, one layer surrounds the organ and the second layer forms a sac around it. Lubricating fluid is produced by the Mesothelium and is released between the layers which help moving organs to flow easily against adjacent structures. Organs such as the heart, lungs and stomach that expand and contract rely on this fluid.

Mesothelium is named differently depending on where it is located in the body. The mesothelial tissue covering the lungs and the chest cavity is the pleura. The tissue covering the organs in the abdominal cavity is the peritoneum. The tunica vaginalis testis covers the male internal reproductive organs and the tunica vaginalis testis surrounds the female reproductive organs. Most cases of Mesothelioma begin in the pleura or the peritoneum. When mesothelioma develops in the pleura (known as pleural mesothelioma), the delicate lining thickens and fluid may collect between the two layers of the pleura. The abdomen peritoneal mesothelioma causes thickening of the lining and a collection of fluid in the abdomen, called ascites. Symptoms are associated with the organs that may be affected by mesothelioma.

Mesothelioma has a long latency period and it's important to determine who needs to be examined. This long silent period makes diagnosis difficult and symptoms may sometimes be mistaken for something else. Treatment options are often determined by the stage of mesothelioma of the patient.

Mesothelioma is serious and life-threatening. By the time cancer is diagnosed the patients survival time is usually short. Mesothelioma usually spreads throughout the peritonal or pleural cavity before diagnosis, and complete surgical removal is unlikely. Because of this, the average survival time is only 1 year. If the cancer is found early, approximately 50% of the patients survive 2 years and approximately 20% survive 5 years. Additionally, unlike with other tumors, chemotherapy and radiation therapy are not very effective.

If you're not sure whether you've been exposed to asbestos, this site may help you determine whether you're at risk.

Support Groups and Counseling

Living with cancer presents many new challenges for people with cancer and for their family and friends.

* People with cancer will probably have many worries about how the cancer will affect them and their ability to live a normal life, that is, to care for their family and home, to hold a job, and to continue the friendships and activities they enjoy.

* Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.

For most people with cancer, talking about their feelings and concerns helps.

* Friends and family members can be very supportive. They may be hesitant to offer support until they see how the person with cancer is coping. People with cancer should not wait for friends or family to bring it up; if they want to talk about their concerns, they should let friends and family know.

* Some people do not want to burden their loved ones or just prefer talking about their concerns with a more neutral professional. Discussing feelings and concerns about having cancer with a social worker, counselor, or member of the clergy can be helpful. A surgeon or oncologist should be able to recommend someone.

* Many people with cancer are profoundly helped by talking to other people who have cancer. Sharing concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with cancer may be available through the medical center where treatment is being received. The American Cancer Society also has information about support groups all over the United States.

Outlook

Overall (including all types and stages of lung cancer), 16% of people with lung cancer survive for at least five years. Survival rates tend to be low when compared to the 65% five-year survival rate for colon cancer, 89% for breast cancer, and over 99% for prostate cancer.

* People who have stage I NSCLC and undergo lung surgery have a 60%-70% chance of surviving five years.

* People with stage II NSCLC have a 30%-40% chance of cure, and those with stage IIIa have a 20%-30% chance of cure.

* People with extensive nonoperable lung cancer have an average survival duration of nine months or less.

* Those with limited SCLC who receive chemotherapy have a two-year survival rate of 20%-30% and a five-year survival rate of 10%-15%.

* Less than 5% of people with extensive-stage SCLC (small cell cancers) are alive after two years, with a median survival range of eight to 13 months.

Prevention

Lung cancer remains a highly preventable disease because 90% of lung cancers occur in smokers or former smokers. The best way to prevent lung cancer is to not smoke.

* Cigarette smoking is highly addictive, and quitting often proves to be difficult. However, smoking rates have recently decreased in North America and in other parts of the world.

* Health-care workers play an important role in identifying smokers and helping them quit.

* Many products such as nicotine gum, nicotine sprays, nicotine inhalers, and other types of medications have been successfully used to help people trying to quit smoking.

* Minimizing exposure to passive smoking is also an effective preventive measure.

* Using a home radon test kit can identify and allow correction of increased radon levels in the home, which can also cause lung cancers.

* Smokers who use a combination of supplemental nicotine, group therapy, and behavioral training show a significant drop in smoking rates.

Screening for lung cancer consists of the following:

* Currently, the American Cancer Society does not recommend routine chest x-ray screening for lung cancer. What this means is that many health-insurance plans do not cover screening chest x-rays or CT scans.

* Periodic chest x-rays may be appropriate for current or former smokers. Discuss the pros and cons of this approach with a health-care provider.

* Low-dose CT scans have shown great potential in detecting early stage lung cancer and therefore surgical cure. This procedure requires a special type of CT scanner (spiral CT) and has been shown to be an effective tool for the identification of small lung cancers in smokers and former smokers. However, it has not yet been proven whether the use of this technique actually saves lives or lowers the risk of death from lung cancer. Trials are underway to further determine the utility of spiral CT scans in screening for lung cancer.

Next Steps

Follow-up

Following surgery for any operable lung cancer, there is an increased risk of developing a second primary lung cancer is present as well as risk that the original tumor will come back.

* Many lung cancers come back within the first two years after treatment.

* Regular testing should be performed so that any recurrence can be identified as early as possible.

* A person who has undergone surgery should receive follow-up care and examinations according to recommendations from the treatment team.

Palliative and terminal care

Palliative care or hospice care refers to medical or nursing care to reduce symptoms and suffering without attempting to cure the underlying disease. Because only a small number of people with lung cancer are cured, relief from suffering becomes the primary goal for many.

* The patient, his or her family, and the doctor will probably recognize when the patient has reached this point.

* Whenever possible, the transition to palliative care should be planned in advance.

* Planning should begin with a three-way conversation between the patient, someone representing the patient (if he or she is too ill to participate), and the health-care provider.

* During these meetings, likely outcomes, medical issues, and any fears or uncertainties can be discussed.

Palliative care may be given at home, in a hospital if home care is not possible, or in a hospice facility. Palliative care consists mainly of treatments to relieve shortness of breath and pain.

* Breathlessness will be treated with oxygen and medications such as opioids, which are narcotic drugs such as opium, morphine, codeine, methadone, and heroin.

* Pain management includes anti-inflammatory medications and opioids. The patient is encouraged to participate in determining doses of the pain medication, because how much is needed to block pain will vary from day to day.

* Other symptoms, such as anxiety, lack of sleep, and depression, are treated with appropriate medications and, in some cases, complementary therapies.

Surgery

Surgery is the preferred treatment for patients with early stage NSCLC. Unfortunately, 60%-80% of all patients who have advanced or metastatic disease are not suitable for surgery.

* People who have NSCLC that has not spread can tolerate surgery provided they have adequate lung function.

* A portion of a lobe, a full lobe, or an entire lung may be removed. The extent of removal depends on the size of the tumor, its location, and how far it has spread.

* A technique called cryosurgery is sometimes used for NSCLC. In cryosurgery, the tumor is killed by freezing it. This treatment is mainly for relief of symptoms.

* Cure rates for small peripheral cancers are around 80%.

* Despite complete surgical removal, a large proportion of patients with early stage cancer have recurrence of cancer and die from it.

Surgery is not widely used in SCLC. Because SCLC spreads widely and rapidly through the body, removing it all by surgery usually is impossible.

An operation for lung cancer is major surgery. Many people experience pain, weakness, fatigue, and shortness of breath after surgery. Most have problems moving around, coughing, and breathing deeply. The recovery period can be several weeks or even months.

Medical Treatment

Chemotherapy and radiation therapy

* Chemotherapy and radiation may lead to a cure in a small number of patients. These therapies result in shrinking of the tumor and are known to prolong life for extended periods in most patients.

* Chemotherapy and radiation are very effective at relieving symptoms.

* Inoperable NSCLCs are treated with chemotherapy or a combination of chemotherapy and radiation.

* If SCLC is in an early stage (confined to the thorax), the standard of care is chemotherapy and radiation therapy given at the same time.

* In later stages (spread outside of the thorax), SCLC is treated with chemotherapy and palliative radiation therapy to areas where metastases may be present.

* The brain is sometimes treated with radiation even if no tumor is present there. Called prophylactic cranial irradiation (PCI), this therapy may prevent a tumor from forming. PCI is not suitable for all patients, however, and side effects may occur.

* Limited SCLC (has not spread outside the chest cavity) has an 80%-90% rate of response to combination chemotherapy and radiation therapy. Remission (no cancer detected by physical examination or x-ray studies) occurs in 50%-60% of cases.

* Of all cases of advanced-stage lung cancer (spread outside the chest cavity), approximately 50%-60% of SCLC and 15%-40% of NSCLC will go in to remission with chemotherapy.

* If relapse occurs, a different type of chemotherapy regimen may offer symptom relief and modest survival benefit.

* Even with an initially favorable response to treatment, SCLC tends to relapse within one to two years in most patients, particularly in those with extensive disease.

* Recent research has shown benefits of adjuvant chemotherapy in early stage NSCLC in preventing or delaying recurrence of the tumor, even after surgery that is felt to be successful at removing cancer.

* Chemotherapy uses chemicals that travel through the bloodstream. It affects both cancerous and healthy cells. This accounts for the many well-known side effects of chemotherapy, including nausea and vomiting, hair loss, skin problems, mouth sores, and fatigue.

* Radiation therapy does not affect cells throughout the body the way chemotherapy does. However, it does affect healthy tissues overlying or directly adjacent to the tumor. To a certain extent, the side effects of radiation depend on which part of the body is targeted with radiation.

* Based on recent clinical trial data, chemotherapy has been found to be beneficial for all stages of non-small cell lung cancer, including stage I or II. People with lung cancer should be referred to an oncologist for discussion of options.

Lung Cancer Treatment

Treatment decisions in lung cancer depend on whether SCLC or NSCLC is present. Treatment also depends on tumor stage, particularly in NSCLC. A person's general physical condition (the ability to withstand treatment procedures) is also taken into account.

The most widely used therapies for lung cancer are surgery, chemotherapy, and radiation therapy.


Medical Treatment

Chemotherapy and radiation therapy

* Chemotherapy and radiation may lead to a cure in a small number of patients. These therapies result in shrinking of the tumor and are known to prolong life for extended periods in most patients.

* Chemotherapy and radiation are very effective at relieving symptoms.

* Inoperable NSCLCs are treated with chemotherapy or a combination of chemotherapy and radiation.

* If SCLC is in an early stage (confined to the thorax), the standard of care is chemotherapy and radiation therapy given at the same time.

* In later stages (spread outside of the thorax), SCLC is treated with chemotherapy and palliative radiation therapy to areas where metastases may be present.

* The brain is sometimes treated with radiation even if no tumor is present there. Called prophylactic cranial irradiation (PCI), this therapy may prevent a tumor from forming. PCI is not suitable for all patients, however, and side effects may occur.

* Limited SCLC (has not spread outside the chest cavity) has an 80%-90% rate of response to combination chemotherapy and radiation therapy. Remission (no cancer detected by physical examination or x-ray studies) occurs in 50%-60% of cases.

* Of all cases of advanced-stage lung cancer (spread outside the chest cavity), approximately 50%-60% of SCLC and 15%-40% of NSCLC will go in to remission with chemotherapy.

* If relapse occurs, a different type of chemotherapy regimen may offer symptom relief and modest survival benefit.

* Even with an initially favorable response to treatment, SCLC tends to relapse within one to two years in most patients, particularly in those with extensive disease.

* Recent research has shown benefits of adjuvant chemotherapy in early stage NSCLC in preventing or delaying recurrence of the tumor, even after surgery that is felt to be successful at removing cancer.

* Chemotherapy uses chemicals that travel through the bloodstream. It affects both cancerous and healthy cells. This accounts for the many well-known side effects of chemotherapy, including nausea and vomiting, hair loss, skin problems, mouth sores, and fatigue.

* Radiation therapy does not affect cells throughout the body the way chemotherapy does. However, it does affect healthy tissues overlying or directly adjacent to the tumor. To a certain extent, the side effects of radiation depend on which part of the body is targeted with radiation.

* Based on recent clinical trial data, chemotherapy has been found to be beneficial for all stages of non-small cell lung cancer, including stage I or II. People with lung cancer should be referred to an oncologist for discussion of options.

Exams and Tests

Upon hearing about the symptoms, a health-care provider will formulate a list of possible diagnoses. He or she will ask questions about the symptoms, medical and surgical history, smoking and work history, and other questions about lifestyle, overall health, and medications.

Unless severe hemoptysis is occurring, a chest x-ray will most likely be performed first to look for a cause of the respiratory symptoms.

* The x-ray film may or may not show an abnormality.

* Types of abnormalities seen in lung cancer include a small nodule or nodules or a large mass.

* Not all abnormalities observed on a chest x-ray are cancers. For example, some people develop scarring and calcium deposits in their lungs that may look like tumors on a chest x-ray film.

In most cases, a CT scan or MRI of the chest will further define the problem.

* If symptoms are severe, the x-ray may be skipped and a CT scan or MRI may be performed right away.

* The advantages of CT scan and MRI are that they show much greater detail than x-rays and are able to show the lungs in three dimensions.

* These tests help determine the stage of the cancer by showing the size of the tumor or tumors.

* They can also help identify spread of the cancer into nearby lymph nodes or certain other organs.

If a person's chest x-ray film or scan suggests that a tumor is present, he or she will undergo a procedure for diagnosis.

* This procedure involves collection of sputum, removal of a small piece of the tumor tissue (biopsy) or a small volume of fluid from the sac around the lung.

* The retrieved cells are reviewed under a microscope by a doctor who specializes in diagnosing diseases by looking at cell and tissue types (a pathologist).

* Several different ways exist to obtain these cells.

Sputum testing: This is a simple test that is sometimes performed to detect cancer in the lungs.

* Sputum is thick mucus that may be produced during a cough.

* Cells in the sputum can be examined to see if they are cancerous. This is called cytologic review.

* This is not a completely reliable test. If negative, the findings usually need to be confirmed by further testing.

Bronchoscopy: This is an endoscopic test, meaning that a thin, flexible, lighted tube with a tiny camera on the end is used to view organs inside the body.

* Bronchoscopy is endoscopy of the lungs. The bronchoscope is inserted through the mouth or nose and down the windpipe. From there, the tube can be inserted into the airways (bronchi) of the lungs.

* A tiny camera transmits images back to a video monitor.

* The physician operating the bronchoscope can look for tumors and collect samples of any suspected tumors.

* Bronchoscopy can usually be used to determine the extent of the tumor.

* The procedure is uncomfortable. A local anesthetic is administered to the mouth and throat as well as sedation to make bronchoscopy tolerable.

* Bronchoscopy has some risks and requires a specialist proficient in performing the procedure.

Needle biopsy: If a tumor is on the periphery of the lung, it usually cannot be seen with bronchoscopy. Instead, a biopsy is taken through a needle inserted through the chest wall and into the tumor.

* Typically, a chest x-ray or CT scanning is used to guide the needle.

* This procedure is safe and effective in obtaining sufficient tissue for diagnosis. After the chest surface is cleaned and prepared, the skin and the chest wall are numbed.

* The most serious risk with this procedure is that the needle puncture may cause an air leak from the lung (pneumothorax). This air leak occurs in as many as 3%-5% of cases. Although this condition can be dangerous, it is almost always recognized and treated without serious consequences.

Thoracentesis: Lung cancers, both primary and metastatic, can cause fluid to collect in the sac surrounding the lung. This fluid is called a pleural effusion.

* The fluid usually contains cells from the cancer.

* Sampling this fluid can confirm the presence of cancer in the lungs.

* The fluid sample is removed by a needle in a procedure similar to needle biopsy.

* Thoracentesis can be important for both staging and diagnosis of the condition.

Thoracotomy: Sometimes a lung cancer tumor cannot be reached by bronchoscopy or needle procedures.

* In these cases, the only way to obtain a biopsy is by performing an operation.

* The chest is opened (thoracotomy), and as much of the tumor as possible is removed surgically. The removed tumor is then examined microscopically.

* Unfortunately, this operation may not be successful in removing all tumor cells if the tumor is large or has spread to the lymph nodes outside of the lungs.

* Thoracotomy is a major operation that is performed in a hospital.

Mediastinoscopy: This is another endoscopic procedure. It is performed to determine the extent that the cancer has spread into the area of the chest between the lungs (the mediastinum).

* A small incision is made into the lower part of the neck, above the breastbone (sternum). A variation is to make the incision in the chest.

* A mediastinoscope is inserted behind the breastbone.

* Samples of the lymph nodes are taken to evaluate for cancer cells.

* Mediastinoscopy is a very important step to determine whether the tumor can be surgically removed or not.

Other tests: Other tests are performed to stage the tumor and to assess a person's ability to withstand surgery and other treatment.

* Pulmonary function tests assess breathing capacity.

* Blood tests are performed to identify any chemical imbalances, blood disorders, or other problems that might complicate treatment.

* CT scans or MRIs may be performed on the most common areas of spread to check for metastatic disease. These tests are generally performed only if symptoms occur that suggest metastatic disease. Certain treatment protocols require that these tests be performed.

* A bone scan can determine whether the cancer has spread to the bones.

Staging: Staging is a method of classifying the tumor for purposes of treatment planning.

* Staging is based on size of the tumor, location of the tumor, and degree of metastasis of the tumor (if any).

* The treatment will be individually tailored to the tumor stage.

* Tumor stage is related to the outlook for cure and survival (prognosis). The higher the tumor stage, the less likely the disease will be cured.

When to Seek Medical Care

See a health-care provider as soon as possible if any of the following develop:

* any symptom of lung cancer,

* new cough or change in an existing cough,

* hemoptysis (flecks of blood in the sputum when coughing),

* unexplained weight loss,

* unexplained persistent fatigue, or

* unexplained deep aches or pains.

Go immediately to the nearest hospital emergency department if any of the following occur:

* coughing up a large amount of blood,

* sudden shortness of breath,

* sudden weakness,

* sudden vision problems, or

* persistent chest pain.

Lung Cancer Symptoms

Up to one-fourth of all people with lung cancer may have no symptoms when the cancer is diagnosed. These cancers usually are identified incidentally when a chest x-ray is performed for another reason. The majority of people, however, develop symptoms. The symptoms are due to direct effects of the primary tumor, to effects of metastatic tumors in other parts of the body, or to disturbances of hormones, blood, or other systems caused by the cancer.

Symptoms of primary lung cancers include cough, coughing up blood, chest pain, and shortness of breath.

* A new cough in a smoker or a former smoker should raise concern for lung cancer.

* A cough that does not go away or gets worse over time should be evaluated by a health-care provider.

* Coughing up blood (hemoptysis) occurs in a significant number of people who have lung cancer. Any amount of coughed-up blood is cause for concern.

* Chest pain is a symptom in about one-fourth of people with lung cancer. The pain is dull, aching, and persistent and may involve other structures surrounding the lung.

* Shortness of breath usually results from a blockage to the flow of air in part of the lung, collection of fluid around the lung (pleural effusion), or the spread of tumor throughout the lungs.

* Wheezing or hoarseness may signal blockage or inflammation in the lungs that may go along with cancer.

* Repeated respiratory infections, such as bronchitis or pneumonia, can be a sign of lung cancer.

Symptoms of metastatic lung tumors depend on the location and size. About 30%-40% of people with lung cancer have some symptoms or signs of metastatic disease.

* Lung cancer most often spreads to the liver, the adrenal glands, the bones, and the brain.

* Metastatic lung cancer in the liver usually does not cause symptoms, at least by the time of diagnosis.

* Metastatic lung cancer in the adrenal glands also typically causes no symptoms by the time of diagnosis.

* Metastasis to the bones is most common with small cell cancers but also occurs with other lung cancer types. Lung cancer that has metastasized to the bone causes bone pain, usually in the backbone (vertebrae), the thighbones, and the ribs.

* Lung cancer that spreads to the brain can cause difficulties with vision, weakness on one side of the body, and/or seizures.

Paraneoplastic syndromes are the remote, indirect effects of cancer not related to direct invasion of an organ by tumor cells. Often they are caused by chemicals released from the cancers. Symptoms include the following:

* clubbing of fingers-the depositing of extra tissue under the fingernails

* new bone formation-along the lower legs or arms

* anemia-low numbers of red blood cells and high calcium level or low sodium level in the blood

* other effects-muscle weakness, skin rashes, and degeneration of the brain

* weight loss

* fatigue

* low sodium levels