A Family's Guide to Dealing with Mesothelioma


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Dealing with mesothelioma can be very difficult for families. The ebook is a helpful guide on the facts about mesothelioma, the treatment, possible causes and frequently asked questions.



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A Family's Guide to Dealing with Mesothelioma

  1. 1. A Familys Guide toDealing with MesotheliomaIntroductionA diagnosis of mesothelioma can turn your world upside down. You may wonderwhether youll ever have a normal life again. Your familys future can be a concern. Fearmay be at the forefront of your emotions. This is all natural. Theres no right or wrongway to feel after a cancer diagnosis, and like all cancers, mesothelioma brings with it aunique set of challenges that you and your loved ones will face together.How you cope will depend on so many factors, from your personality to the severity ofyour disease to your willingness to arm yourself with information. Some aspects of thefight against mesothelioma will be outside the realm of your control. Education,however, is one way you can take ownership of your circumstances and be an activeplayer in your care. This book is designed to put knowledge at your fingertips so youcan be your own strongest healthcare advocate and help your family understand whatit is youre going through.
  2. 2. Table of Contents1. The Facts on Mesothelioma a. Cause of Mesothelioma b. Symptoms of Mesothelioma c. Diagnosis of Mesothelioma d. Types of Mesothelioma e. Stages of Mesothelioma f. Mesothelioma Risk Factors g. Mesothelioma Life Expectancy2. Mesothelioma Treatment a. Surgery b. Chemotherapy c. Radiation d. Mesothelioma Gene Therapy e. Mesothelioma Photodynamic Therapy3. Asbestos Exposure a. Occupational Exposure b. Non-Occupational Exposure4. Veterans a. Navy Veterans and Mesothelioma b. Army Veterans and Mesothelioma c. Marines Veterans and Mesothelioma d. Air Force Veterans and Mesothelioma e. V.A. Benefits for Mesothelioma5. Nutrition and Mesothelioma a. Mesothelioma Treatment and Eating Problems b. Preparing to Eat Well during Treatment c. How to Manage Eating Problems during Cancer Treatment d. Sensory Changes Caused by Therapy Can Affect Your Eating Habits6. Mesothelioma Lawsuits7. Frequently Asked Questions about Mesothelioma8. A Glossary of Terms
  3. 3. Chapter 1: The Facts about MesotheliomaMesothelioma is a rare cancer that is caused mainly by exposure to asbestos. It is therarest but also the most dangerous disease related to asbestos exposure, and up to3,000 Americans face a mesothelioma diagnosis every year.The Cause of MesotheliomaExposure to asbestos is the main cause of mesothelioma. Asbestos is a mineralcommonly used as an insulator and binding agent in industrial, commercial, andresidential products and equipment. Though the dangers of asbestos exposure and theresulting asbestos-related diseases like asbestosis have been documented for morethan a century, products containing asbestos were in common usage until the early1980s and can be found in many homes and structures today.More than 80 percent of mesothelioma and asbestosis patients were exposed toasbestos on the job.  This occupational exposure to asbestos, when industry clearlyknew of the dangers associated with the material, has been the basis for thousands oflawsuits.Symptoms of MesotheliomaThe most common form of mesothelioma cancer is pleural mesothelioma, whichaffects the lining of the lungs.  Symptoms of pleural mesothelioma are often comparedto symptoms of the flu or a common cold.  These include: • Shortness of breath • Chest pain or lower back pain • Persistent, dry cough • Difficulty swallowing • Fever • FatigueOther forms of mesothelioma affect the abdominal area (peritoneal mesothelioma) andthe heart (pericardial mesothelioma). 
  4. 4. Diagnosis of MesotheliomaMesothelioma has an unusually long latency period, which means that patients maynot be diagnosed with the disease for as long as 5 decades after they were lastexposed to asbestos.  After careful evaluation, a variety of tests are necessary tocorrectly diagnose mesothelioma.  Some of these clinical and radiological tests includea complete physical examination, including the patient’s medical history and history ofasbestos exposure, x-rays, lung function tests, CT scan, MRI, and sometimes a tissueor fluid biopsy.The Types of MesotheliomaMesothelioma can affect different parts of the body. There are four types ofmesothelioma: • Pleural mesothelioma, which affects the lungs, is the most common form of the disease.  Roughly 75 percent of mesothelioma patients have pleural mesothelioma. • Peritoneal mesothelioma, which affects about 20 to 30 percent of mesothelioma cancer patients, is concentrated in the abdominal area. • Pericardial mesothelioma attacks the cells of the lining of the heart, known as the pericardium.  Only about 5 percent of mesothelioma patients have pericardial mesothelioma. • Testicular mesothelioma (a form of peritoneal mesothelioma) is by far the rarest form of the disease, affecting fewer than 100 patients in the last 20 years.The Stages of MesotheliomaIn terms of cancer, staging is a prognostic tool used to determine how far a particularcancer has spread, which can aid doctors in determining life expectancy and treatmentplans.  Mesothelioma cancer doctors have established a number of different stagingsystems for pleural mesothelioma, which is the most common form of this rare disease. There is currently no formal staging system for the other forms of mesothelioma.
  5. 5. Mesothelioma Staging SystemsThere are currently three main staging systems used by doctors to determine how far apatient’s mesothelioma has progressed.  Each system uses 4 stages to describe theprogression of a particular case, but the definitions of the stages vary slightly accordingto the method used.Butchart Staging SystemThe Butchart System is the most widely recognized and most commonly usedmesothelioma staging system.  This system is based on tumor size, dividing malignantmesothelioma into four stages.Stage 1: The mesothelioma has affected the right or left side of the pleural lining andmay be seen in the diaphragm.Stage 2: Both sides of the lungs show the presence of malignant mesothelioma, as dothe lymph nodes.  In Stage 2, the disease may also have spread to the heart, stomach,or esophagus.Stage 3: In Stage 3, the mesothelioma has reached the peritoneum (abdominal cavity),as well as lymph nodes past the chest.Stage 4: This is the most severe stage of malignant mesothelioma cancer.  Here, thecancer has entered the blood stream and spread to additional organs.TNM Staging SystemThe TNM System was developed by the American Joint Committee on Cancer, and isvery similar to staging systems used to measure other types of cancer.  This systemweighs not only the condition of tumors, but also the effect of mesothelioma on thelymph nodes and whether the cancer has spread (metastasized) to other parts of thebody.
  6. 6. Stage 1: In Stage 1 of the TNM System, the malignant mesothelioma is in either theright or the left pleura.  It may have also spread to one lung, the heart, or thediaphragm on the same side.Stage 2: In Stage 2, the mesothelioma has reached a lymph node on the same side ofthe lungs affected by the cancer.  It has also spread to the lung on the same side as thetumor, or to the heart or diaphragm.Stage 3: Here, the mesothelioma has entered the abdominal cavity and lymph nodesbeyond the chest.Stage 4: In this stage, the mesothelioma has spread throughout the pleural area as wellas to the lymph nodes on both sides of the body.  The cancer may also have reachedadditional organs or the abdomen at this stage.Brigham Staging SystemThe Brigham System is the most modern mesothelioma staging system.  Unlike theButchart and the TNM Systems the Brigham system also assesses the proposedeffectiveness of surgical intervention at each stage.Stage 1: The mesothelioma tumor is still removable and lymph nodes are unaffectedby the cancer.Stage 2: In this stage, the lymph nodes are now affected but it is still possible toremove the cancer surgically.Stage 3: In Stage 3, the tumor is not removable and the mesothelioma has reached theheart, chest cavity, abdominal cavity, or the diaphragm.Stage 4: Here, the malignant mesothelioma is no longer removable through surgery, asit has spread (metastasized) throughout the body.
  7. 7. The Treatment of Mesothelioma by StageUnfortunately, a person can end his or her asbestos exposure and develop the diseaseyears before mesothelioma symptoms appear, so diagnosis commonly occurs in thelatest stages of mesothelioma. If you or someone you love has been repeatedly exposed to asbestos, you shouldmake this known to your doctor immediately so that he or she can closely monitor thehealth of your lungs.  This may aid in early detection of mesothelioma, which candramatically improve the prognosis.Asbestos Exposure and the Development of MesotheliomaThe biggest mesothelioma risk factor is exposure, particularly in the workplace, to thesilicate mineral asbestos either by inhaling or ingesting airborne particles. Mostexposure is direct exposure, i.e., the individual exposed worked around or handledasbestos regularly. Some exposure, however, is indirect (known as secondaryexposure), as in cases of family members of people who worked with asbestos andcarried it home on their hair, skin, and clothing.Other Mesothelioma Risk FactorsAccording to the Mayo Clinic, the following factors may also increase your risk formesothelioma: • Living with someone who works with asbestos. People who are exposed to asbestos may carry the fibers home on their skin and clothing. These stray fibers can put others in the home at risk of mesothelioma. People who work with asbestos should shower and change clothes before leaving work. • Radiation. Some research links mesothelioma to the radioactive substance thorium dioxide, which was used along with X-rays to diagnose various health conditions from the 1920s to the 1950s. Mesothelioma has also been linked to radiation therapy treatments to the chest, such as those used to treat breast cancer or lymphoma. • Family history. A family history of mesothelioma may increase your risk of mesothelioma, but more research is needed to understand this theory.
  8. 8. What is the Life Expectancy for Mesothelioma Patients?Although no one can calculate how long an individual’s life expectancy is, there aresome general observations based on percentages of patients. Currently, the averagelife expectancy for mesothelioma patients after diagnosis is between six to eighteenmonths. The currently available therapies do impact life expectancy in some patientsdepending on the stage of the cancer at diagnosis. Some patients who undergoaggressive therapy that includes surgery, chemotherapy and radiation experience alonger than average life expectancy.However, the majority of patients die from respiratory failure caused by the tumorextending beyond the pleura, small bowel obstruction caused by a tumor in theabdominal cavity extending below the diaphragm, and heart failure or irregular heartbeat caused by a tumor in the sac surrounding the heart extending into the heartmuscle.But keep in mind that new techniques are being developed that can diagnose thedisease at an early stage and treat it more aggressively than current therapeuticagents. This will ultimately increase life expectancy.New Ways to Predict Life Expectancy are Being FoundResearch published in the January 2009 edition of the International Archives ofOccupational and Environmental Health suggests that the decrease in lung functionthat occurs as a result of asbestos-related disease is a better indicator of lifeexpectancy than exposure history. Consequently, individuals with known asbestosexposure should be given primary screenings with a spirometer, which measures theamount of air that is inhaled and exhaled.Chapter 2: Mesothelioma Treatment OptionsMany patients opt to undergo one or more mesothelioma treatments to combat thedisease and to ease the physical symptoms of mesothelioma cancer. Not all treatmentslisted in this chapter are appropriate for every mesothelioma patient. The best way todetermine the course of your own treatment is to consult with your own doctors.Understanding their recommendations can help you and your family make the best
  9. 9. possible choices, however, so researching your options may be beneficial in the longterm.Mesothelioma SurgeryThere are a number of surgical procedures that may offer hope or have a palliativeeffect for mesothelioma patients.Thoracentesis is a minimally invasive procedure during which a needle is inserted intothe chest cavity to drain excess fluid and provide relief to the patient suffering frompleural mesothelioma.  In some cases, antibiotics or talcum powder may also beinjected into the chest at this time.  In patients with peritoneal mesothelioma, a similarprocedure may be performed to drain the abdomen.  Similarly, a needle may beinserted into the area around the heart to drain fluid that is a result of pericardialmesothelioma.In rare cases, when the patient’s mesothelioma is at an early stage, curative surgeryknown as pleurectomy may be performed to remove pleura (the lining of the lungs),thus removing the cancerous tumor, as well.  Unfortunately, in many cases microscopiccancer cells have already spread, so this procedure is not an effective cure tomesothelioma.In cases of localized (early stage) mesothelioma of the pleura, extrapleuralpneumonectomy is a very extensive surgery that may be offered.  This operation isonly performed by a select few doctors, as it involves the removal of portions of thelung, pericardium, and diaphragm on the affected side of the body in order to remove atumor without dissecting it. A surgical option for patients with peritoneal mesothelioma is known as aperitonectomy.  This procedure can only be performed at very early stages of thecancer, and involves the removal of a portion or all of the peritoneum to rid the body ofcancerous tissues. As with most cancer surgeries, patients who undergo mesothelioma surgery may alsobe treated with chemotherapy and radiation.
  10. 10. Mesothelioma ChemotherapyChemotherapy usually involves the intravenous administration of drugs designed tointerfere with the processes that occur during cell division, thereby killing rapidly-dividing cancer cells.  Depending on the stage of a patient’s mesothelioma,chemotherapy may be given as the primary treatment or in conjunction with othertreatments such as surgery or radiation therapy.While chemotherapy drugs kill cancer cells, they also kill or damage some normal cells. Thus, careful attention must be paid to maximize the effectiveness of the treatmentwhile minimizing the side effects.Mesothelioma RadiationRadiation therapy is a form of mesothelioma treatment that is usually given inconjunction with other treatments such as chemotherapy and surgery. Radiation worksby using beams of intense energy like X-rays to kill cancer cells.  There are 2 types ofradiation therapies that have proven effective in mesothelioma cancer patients:external beam radiation and brachytherapy. External beam radiation works by bombarding cancer tumors with X-rays to kill cancercells. Brachytherapy is a newer radiation treatment that involves the implantation ofradioactive material directly into tumors to provide a stronger dose of radiation whiledoing very little damage to surrounding healthy tissue.In some cases, radiation therapy is the main form of mesothelioma treatment.  This ismore common in patients whose overall health has declined to a state where they aretoo weak to endure chemotherapy or invasive surgery.  In other cases, such as afollow-up to mesothelioma surgery, radiation therapy is used as a complementarytreatment.  Radiation is also used as a palliative therapy to relieve mesotheliomasymptoms such as pain, difficulty swallowing, shortness of breath, and bleeding.As with chemotherapy, radiation therapy damages healthy, normal cells as well ascancerous cells. 
  11. 11. Mesothelioma Gene TherapyMesothelioma gene therapy is a newer treatment used in conjunction withchemotherapy. The type of gene therapy used for mesothelioma patients is oftenreferred to as “suicide gene therapy” because it forces cancer cells to cause their owndeath.  In essence, genes are introduced into the body that render cancer genes’defense mechanisms useless and thus make them more susceptible to cancermedications issued through chemotherapy.Mesothelioma Photodynamic TherapyPhotodynamic therapy is commonly used to treat skin cancers, some types of lungcancers, and pleural mesothelioma. This therapy involves the use of light energy toeliminate cancer cells. The patient is given an I.V. solution of medication designed tomake cancer cells highly sensitive to a specific kind of light. A few days afteradministration of this medicine, the patient is exposed to this specific kind of light,killing the medicated cancer cells.Photodynamic therapy is only effective in localized mesothelioma, and is unsuitable forpatients with other types of mesothelioma.In addition to surgical and oncological treatment options, many mesothelioma patientschoose to investigate less common or alternative forms of treatment, such asimmunotherapy, physical therapy, or natural remedies. Additionally, a percentage ofmesothelioma patients will participate in clinical trials that give them access to thenewest possible treatments. Learn more at http://www.yourmesotheliomalawfirm.com.
  12. 12. Chapter 3: Asbestos ExposureThere are two main types of asbestos exposure, occupational and non-occupational.The former is much more commonly associated with mesothelioma than the latter, butthere have been cases of family members of workers exposed to asbestos developingthe disease.OccupationalAsbestos was widely used commercially from the late 1870s to the mid-1960s. Themedical community first determined that asbestos had a harmful effect on humanhealth in the 1930s when an association between occupational exposure to asbestosand the development of asbestosis was established. Later on in the 1950s, scientistsfound that asbestos was a risk factor for lung-related cancers, including mesothelioma.Many American Workers Have Been Exposed to AsbestosWorker exposure to asbestos started to significantly increase in the early 1940s, andresearchers estimate that millions of Americans came in contact with asbestos duringthe course of their employment. There are some industries whose workers have ahistory of long-term exposure to high levels of asbestos, such as miners and millers ofasbestos, workers involved in the production of textiles containing asbestos, or otherasbestos products, and construction workers who installed insulation made fromasbestos, or who were involved in the demolition of buildings containing asbestosmaterials like drywall. Even auto mechanics may have been exposed while repairingbrakes with linings made from asbestos. The following professions are those mostoften affected: • Electricians • Power Plants • Oil Refineries • Shipyard Workers • Boilermakers • HVAC Workers • Machinists • Pipefitters • Contractors • Navy Engine Room Workers
  13. 13. Many members of the military were also occupationally exposed to asbestos,especially those serving in the Navy. Asbestos-containing insulation was commonlyused in Navy ships until the early 1980s, which meant that civilian workers in shipyardswere also exposed.Governmental Agencies Intervene to Regulate Asbestos ExposureThe Environmental Protection Agency (EPA) issued a ban in 1989 on all new uses ofasbestos; however, uses that were already in existence were permitted to continue.The Occupational Safety and Health Administration (OSHA) established regulationscontrolling the level of asbestos exposure for construction, shipyards, and generalindustry.  The agency’s current acceptable asbestos exposure limit for the workplace is0.1 fibers per milliliter. In addition, OSHA created standards regarding the use ofprotective equipment like respirators and specific workplace practices and safetyprocedures.Non-Occupational ExposureAlthough mesothelioma results primarily from occupational exposure, there areinstances of patients developing the disease even though they weren’t employed injobs that exposed them to asbestos.Levels of asbestos fibers are always present in the ambient air that is the air that is allaround us that we normally breathe. Some studies have shown that on average, thelevel of asbestos fibers can be as high as 0.005 fibers per cubic centimeter in urbanareas. Fiber levels tend to be lower in the suburbs, generally between 0.003 to 0.004fibers per cubic centimeter.Studying Non-Occupational Exposure and ResearchIt is just as important to study non-occupational exposure to asbestos as it is to studyworker exposure because mesothelioma cases that result from non-occupationalexposure actually give researchers a clearer picture of what amount of fibers producesa response, meaning development of the disease.  That’s because work exposure-induced mesothelioma develops when the patient is an adult and has been around anespecially high concentration of fibers. Also, the majority of these workers are male. In
  14. 14. order for researchers to understand how the disease affects both sexes and at whatexposure level, they have to study non-work related cases of mesothelioma.Scientists are very interested in observing what happens when individuals are exposedto natural sources of asbestos because the exposure can start during childhood andcontinue throughout the person’s lifetime, and it can occur 24 hours a day, seven daysa week. The evidence that results from these observations provides data about the wayin which early exposure affects cancer risk, how both sexes are affected by exposure,and whether or not different types of asbestos fibers have different effects onindividuals.How are Individuals Non-Occupationally Exposed to Asbestos?There are a number of ways an individual can be exposed to air that contains asbestosfibers: • Mining – Mine workers aren’t the only ones exposed to asbestos fibers. People who live near mining or manufacturing locations that are associated with material that contains tremolite asbestos may be exposed to high levels of asbestos in the air they breathe. • Building Materials – There are a number of different types of building materials, such as insulation, ceiling or floor tiles, and cement pipes that contain amphibole asbestos. Many buildings constructed before 1981 are assumed to have been built using these asbestos containing materials. • Homeowners that do maintenance, repair, or remodeling work on houses containing these products have the possibility of being exposed to high amphibole levels. The exposure occurs when the asbestos-containing materials are moved, causing them to release fibers into the air. If the materials remain untouched, the exposure level is minimal. • Gardening Supplies – The majority of the vermiculite supply came from Libby, Montana, which had a natural deposit of asbestos. This meant that the vermiculite was contaminated with asbestos. The contaminated vermiculite that was sold in gardening supply stores was used to improve the quality of soil or as a fertilizer carrier. It was also a component in potting soil mixtures. The Libby
  15. 15. mine closed in 1990, so the current vermiculite supply is assumed not to becontaminated.
  16. 16. Chapter 4: VeteransThe U.S. Department of Veterans Affairs states that there are more than 25 million livingveterans of the U.S. Armed Forces. Unfortunately, military veterans comprise one ofthe highest risk groups for asbestos exposure and mesothelioma in the United States.It is estimated that many thousands of living American veterans were exposed toasbestos during their tours of duty.Asbestos is a naturally-occurring mineral that is valued for its insulation and heatresistance properties. As such, it was widely used by every military branch, mostly forinsulation purposes in ships, planes, vehicles, buildings, and military housing.Navy Veterans and MesotheliomaU.S. Navy Veterans and shipyard workers are among the highest risk group fordeveloping mesothelioma and other asbestos-related diseases like asbestosis. Thereason for this is that, between the 1930s and the 1970s, every ship and shipyardconstructed by the U.S. Navy was built with the use of a number of asbestos-containing materials. In fact, the use of asbestos was so effective for the Navy that itwas actually mandated to be used before it was gradually phased out.The most common use of asbestos in U.S. Navy ships was in the boiler rooms, enginerooms, and other areas below deck where insulation and fireproofing were needed. Forthis reason, veterans who worked below deck on a Navy ship suffered repeated andprolonged asbestos exposure. Below-decks staff werent the only sailors exposed toasbestos, however: asbestos was also used in mess halls, sleeping quarters, andnavigation rooms of all ships, as well as in the flooring, pipe coverings, brakes,cements, adhesives, gaskets, and valves on every Navy ship. This means that therewas a high probability of every sailor on a ship inhaling or ingesting asbestos at sometime.Army Veterans and MesotheliomaAsbestos is relatively cheap and very plentiful, so it was used in the construction ofbuildings on Army bases all over the United States and overseas. Unfortunately, asthese buildings aged, the asbestos used in their construction weakened and oftenbecame airborne, leading to the inhalation and swallowing of asbestos fibers bymillions of Army veterans and their dependents.
  17. 17. Marines Veterans and MesotheliomaThe Navy and the Marines of the United States have historically worked together,especially in times of war. Many U.S. Marines serve or have served on Navy ships,thus facing the same threats of asbestos exposure as Navy veterans. Marines havealso been exposed to asbestos that was used in the construction of older basebuildings or camps.Air Force Veterans and MesotheliomaFrom the 1930s to the 1970s, many U.S. Air Force planes were constructed with partscontaining asbestos, such as engine, brakes, and other parts that needed to beinsulated from the extreme heat of a jet engine. Pilots, mechanics, and other personnelwho worked on or with these planes have all been exposed to asbestos through theinhalation of asbestos dust. Asbestos was also used in the base buildings and militaryhousing used by Air Force service members and their families.VA Benefits for MesotheliomaThe U.S. Department of Veteran Affairs now recognizes mesothelioma and otherasbestos-related diseases as service-related medical conditions. This means thatveterans with mesothelioma are able to apply for Veteran Affairs (VA) benefits to pay fortheir treatment.The application process for VA benefits is arduous, and some veterans who havemesothelioma or another asbestos-related disease find that their claims are denied. Ifyou are a U.S. Armed Forces veteran who has been diagnosed with mesothelioma, aveterans mesothelioma lawyer from Shrader & Associates, LLP can help you with theVA benefits claims process and can guide you through the process of recoveringcompensation for your military occupational exposure to asbestos.
  18. 18. Chapter 5: Nutrition and MesotheliomaA healthy, nutritious diet is important for everybody, but people who are fighting cancersuch as mesothelioma often have special dietary needs. When people have cancer, itis important to eat foods that will help them keep up their strength and fight infectionduring treatment. This can become a challenge when certain cancer treatments lead tothe development of eating problems in some patients.Mesothelioma Treatment and Eating ProblemsA person never knows how cancer treatment will affect his or her eating habits until heor she begins that treatment. Many patients have no trouble with eating healthy duringmesothelioma treatment, while others may experience some of the following treatmentside effects that may make eating a struggle: • Dry mouth and mouth sores • Nausea and vomiting • Constipation or diarrhea • Inability to properly digest foods and absorb all nutrients • Loss of appetitePreparing to Eat Well during TreatmentFighting mesothelioma is just that: a fight. When a person is undergoing cancertreatment, it is crucial that he fortifies his body with the right foods in order to staystrong and fend off infection. Unfortunately, many cancer treatments make eatingdifficult for patients, and malnutrition is very common amongst mesothelioma cancerpatients. Before beginning cancer treatment, it’s a good idea to prepare for eating wellby taking the following steps: • Stock up. Fill your home with healthy foods that you can eat even when you aren’t feeling your best. Also purchase foods that are easy to prepare, such as frozen meals, for when you may not feel well enough to cook. Many patients also prepare meals ahead then freeze them for later use. • Talk to your doctor about your current nutritional habits to learn whether there are some changes you need to make before beginning treatment. Your doctor may be able to refer you to a dietician, and you may be able to get a list of foods that other cancer patients have found helpful or appealing during treatment.
  19. 19. • Build your community of care. Speak with friends and family members about your treatment and how the side effects may affect your nutrition. Perhaps a friend can do your shopping or bring meals a few times a week.How to Manage Eating Problems during Cancer TreatmentDuring cancer treatment, many patients have “good food days” and bad days. Bypreparing yourself and your pantry for this possibility, you may make it easier to findfoods that you can tolerate during those more difficult days. Here are some other tipsto help you keep your body fueled during cancer treatment: • Some days, you may not be able to eat at all. This is normal. If you can’t eat for more than 2 days, however, you need to let your doctor know. When you can’t eat, try to focus on other ways you can make yourself feel better. • Eating lots of protein and calories will should strengthen your body and help to rebuild tissues damaged by cancer treatment • It is very important to keep drinking lots of liquids, especially on those days when you are unable to eat. Many patients find it easier to stay hydrated when they keep a water bottle near them at all times. • On those more difficult days, eat whatever you can. Liquid meal replacements are often an easier way for patients to get some food into their bodies. Even if you just eat a small snack, it is important to eat whenever you are able to.Sensory Changes Caused by Therapy Can Affect Your Eating HabitsMaintaining good nutrition for mesothelioma patients undergoing radiation orchemotherapy is a complex issue that needs to be addressed from several differentperspectives. While it is common knowledge that good nutrition is important to helppatients withstand the rigors of treatment, it is difficult for many to do so because ofthe effect these treatments have the sense of taste and smell.In a study titled Taste and Odor Abnormalities in Cancer Patients published in theMarch/April 2009 edition of the Journal of Supportive Oncology, researchers revieweda variety of existing studies that examined changes to taste and smell in patientsreceiving cancer treatments. They observed that problems with taste and smell aredaily concerns for these patients that can affect their quality of life and possibly lead tomalnutrition, or the onset of other medical conditions.
  20. 20. The most common problem patients experience is changes to taste acuity, meaningthe ability to differentiate between the four general tastes of sweetness, bitterness,sourness and saltiness. In some cases, sensitivity of taste is decreased, but manypatients report an increased sensitivity, especially those receiving chemotherapy andradiation.Bitterness seems to be the taste most significantly affected by treatment. It isespecially common in patients who have experienced weight loss. The findings fromsome studies reviewed by these researchers suggest that an increased sensitivity tobitterness can lead to a loss of appetite, which could possibly lead to malnutrition.Another change in sense perception is taste quality. This usually manifests as a metallicaftertaste, most closely associated with eating red meat. The reason for this is believedto be the high amount of iron compounds in red meat, such as hemoglobin. Theresearchers noted that studies indicated that 77 percent of patients undergoingchemotherapy with cisplatin alone, the standard of treatment for mesotheliomapatients, or cisplatin combined with other chemotherapeutic drugs reportedexperiencing this metallic aftertaste.Changes in the way food smells is another side effect of both radiation andchemotherapy. Aromas of foods the patient once enjoyed can now be unpleasant oroffensive, causing them to avoid them.Avoiding foods can also be the result of an association with nausea or vomiting whileundergoing treatment. The researchers reported that this type of food aversionhappens to 30 to 55 percent of patients who receive chemotherapy and radiation. Itcan lead to poor nutrition because the patient does not vary the foods consumed andin the extreme cases, malnutrition.So what can be done to help eliminate some of the problems associated with taste andsmell disorders?Researchers suggested that when preparing foods for a mesothelioma patient, youshould avoid foods that have been shown to be poorly tolerated, such as red meat,vegetables, caffeinated drinks, chocolate, and foods high in fat content. Instead, usefoods like chicken, fish, eggs, and cheese. These foods are high in protein but havemild flavors that are well tolerated.
  21. 21. Here are some other recommendations they made to help encourage the patient to eat: • Avoid using metallic silverware to decrease the risk of a metallic aftertaste • Add seasonings and spice to enhance flavors, especially in patients with a decreased sensitivity to taste or smell • Serve foods at cold temperatures to reduce unpleasant flavors or aromas • Be sure the patient practices good oral hygiene by frequently brushing their teeth and rinsing with mouthwash to remove any carryover unpleasant tastes • Encourage the patient to chew sugar-free gum or suck on sour-tasting hard candy, which stimulate saliva secretion, increasing taste perception
  22. 22. Chapter 6: Mesothelioma LawsuitsDo I need a lawyer?It has long been known across industries that asbestos was dangerous and the rootcause of various illnesses. A claim cannot undo the damage that negligent companiesdid when they exposed unprotected workers to the dangers of asbestos, but pursuingand winning a lawsuit can give you and your family peace of mind. They will be takencare of, no matter how mesothelioma impacts your life from this point forward.Why do I need a mesothelioma lawyer?A mesothelioma lawyer is one who has understands this disease and its occupationalorigins. Its an area of law that requires a vast amount of knowledge about the uses ofasbestos across industries, the types of products that contained asbestos, the sciencebehind exposure, and the science behind the development of mesothelioma cancer.Most non-specialized lawyers are not going to be familiar with the past 40 to 50 yearsof asbestos litigation in this country. A mesothelioma lawyer is going to understand thespecifics and be able to put you in the best possible position to successfully argueyour case.When do I need to file a mesothelioma lawsuit?Theres a statute of limitations in every state that dictates when a claim needs to befiled to be valid. Some states have a one year statute of limitations, some states twoyears, and some states can go up to four, five, and six years. It also depends on whereyou lived when you were diagnosed and where you were exposed to asbestos. Alawyer can help you understand the statute of limitations in your case. If the victim isstill living, it runs from the date that asbestos exposure is associated with themesothelioma cancer. Most state statutes state that if the victim passed away the limiton lawsuits is one or two years from the date of death. Most of the time, the statute oflimitations is two years from the date of diagnosis and most often, its one to two yearsfrom the date of death.What if I cant afford an attorney?In these types of lawsuits, most attorneys work on what is called a contingency feebasis, meaning that you never actually have to pay your attorney until a settlement or a
  23. 23. verdict is reached or money has been recovered in your case. Lawyers are expensive.A defense lawyer, for example costs $300 to $600 an hour and most plaintiffs cantpossibly afford that number up front. When an attorney is working on a contingency feebasis, their fee comes out of whatever money is recovered in the case.I filed and received compensation for an asbestos lawsuit – now that I havemesothelioma can I file suit again?Generally speaking, the answer is yes. Most states have what they call a two diseaserule, meaning that you can file once for a non-malignant form of asbestos disease suchas pleural plaques or asbestosis. Then you can sue again if you develop lung cancer ormesothelioma. It should be noted, however, that if you did file a case years ago forasbestosis and then later developed mesothelioma, the defendants in themesothelioma case will have a credit if they already have already paid out money. Theinitial settlement or damages will be discounted from whatever the defendant isordered to pay in the second case.What role do I need to fill in a mesothelioma lawsuit?If the plaintiff is the person with mesothelioma, they are the most critical witness intheir case. Only the person suffering from the disease – the person who actuallyworked with asbestos – will know the minute details of how, when, and whereexposure occurred. If this is you, then your job is to be your own advocate. You need toshare everything you can remember with your attorney so he or she can mount athorough case. In cases where the plaintiff is a loved one of a mesothelioma patient, heor she must fulfill this role.Will I have to go to trial?Most mesothelioma cases do not go to trial. They reach a settlement or a plea bargain.If a reasonable settlement offer is made, it is up to the plaintiff to decide whether or notto proceed with a trial. Even in cases where the defendant implies they will not pay, asettlement is usually the outcome.What if I pass away before my claim is settled?If you have mesothelioma and pass away before a settlement is reached, the claim istreated as if it was a piece of property, similar to a house or a car. If you have a will,
  24. 24. that will dictate who receives the claim. If you do not have a will, your states "intestatesuccession laws" will determine who owns the claim. Additionally, most states have awrongful death statute that allows the surviving spouse and the surviving children tocontinue the case in their own names. So if you were to pass away before your claim issettled or before it goes to trial, your successors step into your shoes and continue thecase.If the company responsible for my asbestos exposure has filed for bankruptcy, doesthat mean I cant recover compensation in a mesothelioma lawsuit?Most companies that have gone bankrupt through asbestos litigation have establishedbankruptcy trust funds against which asbestos victims can file claims. There are twotypes of defendants in these kinds of cases: those which are solvent (which can still besued in a court system) and those which are bankrupt (and cannot be sued). Bankruptcompanies have a claims process and your attorney will file your claim with that trust.The only difference in the two scenarios is the bankrupt defendants have a set amountthat they can actually pay on a claim, which was determined previously by abankruptcy court judge.What kind of compensation can victims recover in mesothelioma or asbestos lawsuits?That number varies significantly based on various factors. In an asbestos case, themore companies you can identify that exposed you to asbestos, the greater the valuethe potential claim holds. Factors also include the victim’s age, employment status,spouse, and number of children. These factors are evaluated by a jury.How much will I be involved and about how long will the legal process take?An asbestos lawsuit client can be as involved in their as they want to be, but thepreliminary element of every case involves recalling past experiences to uncoverasbestos exposure. The initial work from the client is much higher at the beginning thanit is at the end. At the start of a case, the victim or their family shares history, gathersold files and pictures, and contacts former coworkers. After it is determined who thelawsuit will be filled against, there is not a lot the client must do. A lawyer will handlefiling the pleadings, arguing discovery, taking depositions, and reviewing documents.If I was exposed to asbestos while serving in the Navy, will I need to sue the Navy forcompensation?
  25. 25. Its actually impossible to sue the Navy except in very special circumstances. Thefederal government, like most state governments, has sovereign immunity, meaningthat they dont allow you to file suit against them. In a situation where somebody wasexposed to asbestos in the Navy, lawsuits are typically filed against the companies thatmanufactured the various asbestos-containing ship parts. The preliminary phase of alawsuit involves figuring out which products were used on the ship or Naval base.If I have mesothelioma can I receive workers compensation or disability benefits?Yes, you can. Workers Compensation and disability benefits are separate claims thatdont involve the court system and are dictated by state or federal law. WorkersCompensation, which is designed to compensate workers who cannot work, involvesseeking compensation from the insurance company employed by your company.Retired workers are not usually involved in these types of cases because theyre notactively trying to work. Likewise, when it comes to filing for disability, most people whoare diagnosed with mesothelioma are of retirement age and therefore utilizing SocialSecurity benefits or Medicare. Some people diagnosed with mesothelioma are ofworking age, however, and these individuals can file for the appropriate benefits.Is there anything specific I should be looking for in a law firm?You need to ask the right questions when interviewing potential lawyers. First, youneed to know whether a law firm is going to litigate your case individually or if they planto file a class action suit. Look for smaller law firms that will treat you like an individual.Can you get ahold of a lawyer – not a paralegal – when you need one? Is the firmattentive to your needs and willing to travel to your location? Does it feel like the firmwill be a part of your advocacy team?
  26. 26. Chapter 7: Frequently Asked QuestionsWhat is mesothelioma?Mesothelioma is a very rare cancer that can affect the linings of the stomach, lungs,and heart. Every organ has a thin membrane around it, which protects it from the otherorgans, and mesothelioma is a cancer that develops in that lining. It is caused byexposure to asbestos.Is mesothelioma the same thing as lung cancer?No, actually its not. Mesothelioma develops on the outside lining of the lung, whereaslung cancer generally develops inside the lung. There are different cell lines. Theycreate different forms of cancer. People discuss mesothelioma as lung cancer mainlybecause of the close proximity to the lung. But its two different forms of cancer, andthe treatments available for lung cancer vs. mesothelioma are different.Does everyone exposed to asbestos develop mesothelioma?Absolutely not. Its a very rare cancer. It happens roughly 2,000 times a year in ourcountry. Theres no rhyme nor reason as to who gets it, but people who were exposedto more asbestos have a higher risk of developing the disease than people who wereexposed to less. You can be exposed to asbestos, but its extremely rare to developmesothelioma.Is mesothelioma preventable?Mesothelioma is preventable in the sense that asbestos companies never should haveused asbestos, thereby exposing millions of people to the deadly fiber. Mesotheliomais not preventable in the sense that it takes so long to develop. Mesothelioma hasabout a 40-year latency period. It was preventable from the company’s end by notputting it into our environment, but its not preventable on the worker’s end for thosealready exposed to asbestos. Going forward, you dont want to be exposed toasbestos, but theres nothing you can do about past exposure.Is asbestos still used today?
  27. 27. Asbestos is still used if you look at the world market. Its still used in developingcountries, and its still being mined in certain places such as Canada. It is still used inspecialty applications such as the aerospace industry when protection from extremeheat is a consideration. But in consumer applications in the US, its not being usedanymore.How do I know if there is asbestos in my home or workplace?The best way to determine if there is asbestos in your home or workplace is throughresearch. Things that were built in the fifties, sixties, and even the seventies andeighties may contain certain amounts of asbestos. Asbestos can be found in dry wall,ceiling tiles, floor tiles, different types of cements, siding, or roofing shingles of homesor other structures. Newer products on the market today do not use asbestos, but ifitems were installed 30 or 40 years ago, there is a chance they may contain asbestos.It’s best to assume that an old house might contain asbestos and to protect yourselffrom dust while doing home improvements or repairs. You shouldn’t conduct anyconstruction, even minor, unless youve tested to see if theres asbestos present.What are the symptoms of mesothelioma?Mesothelioma has a wide range of symptoms. Some of the first symptoms ofmesothelioma are a dull pain in the back or the chest or difficulty breathing. Sometimesthe body, when the cancer just starts to develop, will start to fill with fluids. Fluid putspressure against the lungs and makes it very difficult to breathe. Some asbestossymptoms are similar to lung cancer symptoms, such as shortness of breath witheither exertion or at rest, cold-like symptoms, and a deep cough. Anything along thoselines can be a symptom of mesothelioma, which makes it very difficult to detectbecause it can be easily dismissed as simply a cold.If I have shortness of breath or trouble breathing, should I be concerned that I havemesothelioma?No. If you are suffering from shortness of breath, there are many things that might bekeeping you from breathing correctly. One of the symptoms of mesothelioma isshortness of breath, but that’s also a symptom of colds, pneumonia, and lung cancer.There are a number of afflictions that can cause shortness of breath. If you areexperiencing this, you should consult your personal physician just as you would withanything else. When you speak with your physician and explain your symptoms, theyre
  28. 28. going to know what to look for. If you were ever exposed to asbestos, you want tomake sure that your doctors are aware of it so they can assess your risk of potentiallydeveloping mesothelioma.Can I have mesothelioma but show no symptoms?Yes. Mesothelioma is what we call a long latency period disease, meaning that it cantake 20 to 40 years to develop. The exact molecular process controlling how and whena regular cell turns into a cancer cell is not completely known. The hypothesis is that anasbestos fiber makes contact with a cell, changes the DNA of that cell, and then thatcell becomes active 20 to 40 years later. Its very difficult to detect mesothelioma untilit has expanded and grown into Stage Four cancer.What is asbestosis, and can it progress into mesothelioma?Asbestosis is a non-malignant form of asbestos-related diseases. Its essentially adifficulty breathing related to asbestos in the lung tissue. When asbestos gets into thelung, it is not expelled and damages lung tissue, causing scarring and making it difficultto breathe. Lung capacity is reduced because scar tissue cannot expand and contractas readily as healthy lung tissue. Asbestosis itself does not progress intomesothelioma. These are two distinct forms of disease. But the fact that you haveasbestosis proves that you were exposed to asbestos, and asbestos fibers are the rootcause of mesothelioma.Is there a cure for mesothelioma?It depends on who you ask, but generally speaking, there is no cure for mesothelioma.The goal with mesothelioma is to treat the patient to slow the progression of thedisease and improve quality of life. Doctors will attempt to stop the spread of thetumor, isolate it chemically or through oncology practices, and/or remove as much of itas possible and maintain a relatively small size of that tumor for the rest of the personslife. Remission, in the case of mesothelioma, means a tumor that is not growing orspreading.How is mesothelioma diagnosed?The first step in diagnosing mesothelioma is to talk to your personal physician. Theyare the ones who know your health and your body best. Generally speaking, if theres a
  29. 29. pain in your chest, your doctor will order a chest x-ray or a CT scan to identify anyabnormalities inside the chest. If the doctor sees an area that theyre concerned about,a pathologist will come in and do a biopsy to remove a small amount of tissue foranalysis. Then the pathologist will look at those cells underneath the microscope. Thepathologist is trained to look at the cells and determine what they are. A confirmeddiagnosis of mesothelioma can only be made in this way.Can mesothelioma be misdiagnosed?Yes. The most common forms of misdiagnosis of mesothelioma involve flu-like or cold-like symptoms that are misdiagnosed as a cold, pneumonia, or a bacterial infection.Also, there are times when a biopsy is performed and the pathologist doesnt get thetumor (because the cancer has not spread to the biopsy site) and misdiagnoses theproblem as something else. Mesothelioma is sometimes misdiagnosed as a differenttype of cancer. Mesothelioma is very rare and sometimes doctors are not familiar withit. There are only a handful of clinics in the country that specialize in the diagnosis andtreatment of mesothelioma. Often, if youre in a small health care market, thepathologist will send your tissue to the Mayo Clinic, Sloan Kettering, or an MDAnderson type of facility to have experts make a more practiced analysis. Sometimesmesothelioma can go undiagnosed or misdiagnosed until a medical professionalfamiliar with mesothelioma actually sees the tissue taken at a biopsy.When do I need to seek treatment?You want to seek the care of a physician because there are going to be treatmentoptions available based on your age or your general overall health. There are ways toextend your life and to continue to lead a productive life. It’s in your best interest tospeak with a physician to discuss all the possible treatment options and therapiesavailable to you. There are new mesothelioma treatments becoming available all thetime, including new drugs, new therapies, and new procedures. You want to be part ofthat process because you will help further treatment research that will not only benefityou, but future mesothelioma sufferers as well.Do I need to see a specialized doctor for mesothelioma treatment?When youre diagnosed with mesothelioma, you will be referred to an oncologist.Oncologists are doctors who practice oncology, the branch of medicine that deals withcancer. Among the oncologists of the world there are some that specialize specifically
  30. 30. in mesothelioma. You will find those particular types of doctors and physicians at majorhospitals in major metropolitan areas such as New York, Philadelphia, Houston, andLos Angeles.How do I find a mesothelioma doctor?If youre concerned about having access to a doctor that is a specialist inmesothelioma, you need to talk to your oncologist and other treating physicians to seeif they can help you find someone. If youve been diagnosed with mesothelioma, mostoften, you’ve already seen a primary care physician, a pulmonologist, a pathologist,and an oncologist. There are medical facilities in the country that specialize inmesothelioma treatments, and these are traditionally within the top three cancerhospitals in the country. You can contact those hospitals directly, but it’s recommendedthat you start discussing these types of concerns with your personal physicians first.What is metastasis?Metastasis or metastatic disease is the spread of disease from one organ to another.Typically, a cancer will start off in a specific area and then spread, or metastasize, toanother organ. For example, if you had colon cancer and it’s diagnosed early, it’s oftencontained within the colon and is easier to treat. Colon cancer that is caught later mayhave spread to other organs, such as the liver, and at that point is much more difficultto treat.Can mesothelioma be removed through surgery?There are some doctors that have had success removing the cancer, but whetheryoure a candidate for surgery is something only your physicians are going to be ableto determine. Surgery to remove mesothelioma is very invasive and very painful.Doctors go in and remove as much of the tumor and the surrounding tissue as possibleand then follow up with traditional oncology measures. The goal is to remove the entiretumor and then keep any remnants of the tumor from growing.Is chemotherapy an option for mesothelioma treatment?Chemotherapy is an option for mesothelioma. There are different types ofchemotherapy drugs that target cancerous cells. The idea is to keep those cells fromgrowing. A cancer thats not growing is one that could be going into remission, which
  31. 31. will ultimately extend the patients life. Chemotherapy has been a successful option inmesothelioma treatment for a number of years.Is radiation an option for mesothelioma treatment?In most cases, radiation is not the preferred method of combating mesotheliomacancer. That being said, a physician is the only one who can really determine that. It isalso important to note that there are new treatment options becoming available all thetime.If Im diagnosed with mesothelioma, should I volunteer for research or experimentaltreatments?Thats a personal decision. Anyone whos diagnosed with mesothelioma needs toconsult the support resources they have available, including their family, religiousgroup, physicians, and lawyers. Whether somebody wants to fight the cancer to theend through experimental measures is an important, and often delicate, decision. If youcant beat the cancer, but youve participated in experimental treatments thateventually led to the cure, youre making something positive out of a very difficultsituation.How can I be sure Ive explored all of my mesothelioma treatment options?You want to start off by discussing this with your physicians. In addition to consultingyour physicians, there are online options available that you can use to researchtreatments. The major cancer treatment hospitals in the country will be better equippedto discuss treatment options available to you. You want to be sure youve explored allof them, and you may want to seek the opinion of more than one physician. Secondopinions are valuable, but if all of the physicians you consult are in agreement, youhave probably found your answer.How can my family and I cope?You need to focus on three parts of your life. Medically, you need to be your own healthadvocate, talk to your doctors, follow their advice, and inquire about treatment options.Your spiritual and emotional health is important, too. You need to gather your familyand loved ones around you for mutual support. Cancer not only affects an individual,but it also affects their spouse, children, and friends. Legal concerns, should you
  32. 32. choose to file a claim, also need to be a part of your life and your lawyer should be apart of your team.Who should I tell about my diagnosis?A diagnosis of mesothelioma can be extremely personal and extremely painful. Makesure your loved ones are aware of your disease and how your physical and emotionalneeds are changing right now. Other than that, you can choose who you will and wonttell about this health challenge. No one whos not a close part of your life truly needs toknow.How will mesothelioma affect my daily life?Mesothelioma is a very aggressive form of cancer. Depending on the treatment optionsthat are available to you, its likely going to reduce your energy. Fighting cancer is oftena painful process and there are going to be certain types of narcotics prescribed to youto combat the pain. These can cause drowsiness. If breathing is an issue, you may findyou cant do as much – even simple chores may become difficult. On the other hand,you may find yourself growing closer to your family and friends as you celebrate thetime you have right now.Should I exercise during mesothelioma treatment?Maintaining an active lifestyle is important, but only your doctor can tell you how muchactivity is appropriate. How much youre able to do will likely change during differentphases of your treatment, but in general, exercise can be your ally in the fight againstcancer.How can I help a family member or friend who has been diagnosed with mesothelioma?Be supportive. Make specific offers of help instead of asking what you can do. Simplylistening can be the best thing you can do, and always show the kind of love and carethat you would want if you were in the same scenario. Maintain a positive outlook andtry to help your loved one do the same because optimistic people fight cancer betterthan those who are negative. Focus on the good times and be the biggest cheerleaderfor your relative or friend because thats how they will cope with cancer.
  33. 33. Are there support systems in place to help me and my family get through mesotheliomatreatment?Most major hospitals are going to have support groups for cancer victims. You may notfind a specific group for mesothelioma sufferers because its a very rare form of cancer.But many of the issues relevant to those diagnosed with mesothelioma are alsoimportant to those battling other cancers. Sharing support with others in your situationcan help both your physical and emotional health.Chapter 8: A Glossary of Terms • Adjuvant therapy – the therapy that is given after the primary therapy. • Angiogenesis – the process through which new blood vessels are formed from ones that already exist. Tumors develop a network of blood vessels that supply them with oxygen and nutrients so they can continue to grow. These blood vessels also remove waste materials created during cell cycles. • Ascites – fluid buildup in the abdominal cavity. This is a common symptom of peritoneal mesothelioma. • Bilateral lung disease – this is disease that is present in both lungs. • Brachytherapy – this is a procedure in which radiation is placed in or adjacent to the area requiring treatment. It allows higher doses of radiation to be delivered directly to the treatment area while minimizing the damage to surrounding organs. • Cachexia – the physical wasting away of a patient caused by disease and/or treatment. • Contralateral tumor - a tumor that is on the opposite side of the body from the original tumor. • Dyspnea – shortness of breath • Epidemiology – the medical study of the cause, spread, and control of disease in the population. • Epithelial cells – the cells that line the insides of organs. • Fibrosis – the formation of scar tissue that results in hardening of tissues, which makes it difficult for fluid to flow through them. • Gene therapy – an experimental form of treatment that works either by altering diseased genes or replacing them. • Ipsilateral tumor – disease that is located on the same side of the body as the original tumor.
  34. 34. • Latency period – the time that elapses between exposure to asbestos, or another cancer-causing substance, and the development of a disease like mesothelioma.• Marker – this is usually a protein present in the blood whose level indicates the presence/severity of disease.• Mediastinum – the area between the lungs. It contains all of the other organs and tissues of the chest.• Mesothelium – the epithelial cells that form the surface of the membrane that covers the lungs, the lining of the abdominal cavity and the sac surrounding the heart.• Metastasis – the spread of cancer cells from the location where it originated to other parts of the body.• Multi-modality therapy – the use of two or more therapies to treat a disease.• Neoadjuvant therapy – this is a treatment such as radiation or chemotherapy that is administered before surgery.• Oncology – the branch of medicine that studies cancer.• Palliation - treatment to alleviate symptoms of a disease.• Parenchyma – the elements of an organ that are necessary for it to function.• Parietal pleura – the part of the pleura that lines the chest wall.• Pericardium – this is the sac surrounding the heart.• Peritoneum – this is the membrane that lines the abdominal cavity.• Photodynamic therapy – a form of therapy that uses a sensitizing drug to make cancer cells more easily destroyed by laser.• Pleural effusion – fluid buildup in the space between the lung and the chest wall.• Recurrence – this is the return of the disease either to the site where it originated or to another location.• Resectable tumor – a tumor that can be surgically removed.• Tri-modality therapy – the combination of surgery, chemotherapy and radiation to treat mesothelioma.• Visceral pleura – the part of the pleura that covers the lungs.