Information currently under review
What are the symptoms of asbestos-related disease?
Treatment for peritoneal mesothelioma
When asbestos is disturbed, it forms a dust made up of tiny fibres. This can easily be breathed in and cause serious health problems, notably:
The health hazards of asbestos have become clear in recent decades and its use is now restricted in Australia.
Almost everyone has been exposed to some asbestos fibres, but for most the exposure and the risk are very small.
People who have been exposed to asbestos fibres in their jobs are at greater risk. Such jobs include:
It may take up to 30 or 40 years after exposure for any disease caused by asbestos to become evident. Most workers exposed to asbestos will not develop an asbestos-related disease.
If you have been exposed to asbestos you should tell your doctor. He or she will examine you and may refer you for tests, for example, a chest x-ray or lung function test. If you smoke, you should stop, since smoking can greatly increase your chance of developing asbestos-related lung cancer.
You should see your doctor if you experience any of the following symptoms:
Pleural plaque is not cancer, and it does not cause cancer. It takes at least seven years to develop after asbestos exposure. It is quite common, generally causes no symptoms and generally requires no treatment. It may cause a dull pain or, in rare cases, make you short of breath.
A plaque is a thickened patch, known as ‘fibrosis', on the pleura. The pleura is the two layers of membrane that line the chest wall and cover the lungs.
While pleural plaque shows that you may have been exposed to asbestos, pleural thickening can also be caused by a lung infection.
If you have pleural plaque, it is important that you stop smoking. You need to see your doctor for regular check-ups and have a chest x-ray every three to five years. You may also need to have a lung function test.
Asbestosis is not cancer but is a serious disease. It takes 10 years or more after asbestos exposure to develop. It causes scarring of the lungs and may lead to disability or even death.
Asbestosis is not cancer but is a serious disease. It takes 10 years or more after asbestos exposure to develop. It causes scarring of the lungs and may lead to disability or even death.
When asbestos fibres stay deep in the lungs, scar tissue forms around them, and this may grow over years. The scar tissue can be seen on a chest x-ray. It stops oxygen moving into the bloodstream, so the person with asbestosis feels out of breath. The doctor will also hear ‘crackles' in your chest-a bit like the sound made by rubbing hair between your fingers. These are signs of scar tissue in the lungs.
Asbestosis slowly progresses over time. Some treatments can help to improve quality of life. Extra oxygen can help some people-you should discuss this with your doctor.
Asbestosis usually develops in asbestos workers who have had a lot of exposure, so new cases in Australia are becoming uncommon. People with asbestosis may also develop lung cancer.
Lung cancer may not develop until decades or more after exposure, and is much more likely to develop in smokers and people with asbestosis.
If you have been exposed to asbestos and you smoke, your risk of getting lung cancer is very high-perhaps as much as 90 times that of non-smokers who have not been exposed to asbestos. If you have been exposed to asbestos, you can probably reduce your risk if you stop smoking. The risk continues to fall the longer you don't smoke.
This is a cancer that is very strongly linked to asbestos exposure, occurring more frequently in Australia than anywhere else in the world. Mesotheliomas can take 30 or 40 years after exposure to asbestos fibres to develop. The most common type starts in the pleura (the two layers of membrane that line the chest wall and cover the lungs).
Mesothelioma may occur in one or more places over the pleura. It forms growths shaped like small pieces of cauliflower. They grow and spread gradually to surrounding areas.
If asbestos fibres are ‘breathed into' the stomach, they may also work their way through the stomach wall and cause mesothelioma in the lining of the abdomen (peritoneum). Occasionally, mesothelioma arises in the membrane around the heart or the reproductive organs.
The cancer causes cells in the pleura to produce fluid, called a pleural effusion. The fluid builds up between the two layers of pleura and presses on the lungs. This causes shortness of breath and a dry cough, and can also be painful. As the cancer progresses, it can grow into the lung, lymph nodes, chest wall and ribs.
Mesothelioma in the peritoneum ('peritoneal mesothelioma') causes pain and a swollen abdomen, sometimes with nausea , vomiting, fever or bowel or urinary problems.
In both types, other symptoms may appear later, including severe weight loss, spitting up sputum or blood, difficulty swallowing and a hoarse voice.
There is no proven cure for mesothelioma, but new research findings have recently resulted in better symptom relief and longer survival. The main aim of treatment is to keep quality of life as good as possible for as long as possible.
Some people's outlook is better than others, and occasionally doctors from the larger cancer centres can recommend more effective therapies that have tolerable side effects.
Your decision about treatment will depend on how far your cancer has progressed, what you prefer and what your doctor suggests. PET/CT scans and specific blood tests may help to choose which treatment option is suitable for individual patients.
All treatments have good and bad points and risks, and you should talk these over with your doctor. Opinions may vary between different specialists, and some people will find it helpful to get a second opinion from experts who treat larger numbers of mesothelioma patients as part of a dedicated team at specialised cancer centres.
You may be advised to have an operation known as ‘pleurectomy'. This is a major operation. The operation itself carries a risk of complications and death and cannot help everyone. For a few people, however, it may be worthwhile. If the cancer is found when it is still small, and you are otherwise fit, pleurectomy may help to gain a few more months or, sometimes, some years of good quality life.
Some surgeons also use phototherapy with surgery. This means that before the operation, a special substance is injected in a vein. This gets taken up by cancer cells and shows up under laser light. After removing the pleura, the surgeon uses a laser light to find extra cancer cells around the outside of the lungs, and destroys them with the laser. The downside of this treatment is that you must stay away from sunlight for the next six weeks.
The surgeon may also suggest removing part or all of a lung, if the cancer has spread into it. Sometimes lymph nodes inside the chest are removed together with part of the diaphragm and any tumour deposits growing through the ribs but involving only one side of the chest, in an operation called an extrapleural pneumonectomy.
If a major operation is planned, the addition of chemotherapy and radiotherapy should be considered to reduce the chances of the cancer growing back.
Your doctor may recommend chemotherapy (treatment with drugs that kill cancer cells). This will usually be recommended if other treatments are not suitable or the cancer has regrown following other treatment. In many cases it may reduce the size of the cancer, reduce its symptoms and improve quality of life. In addition, chemotherapy has been shown to gain a few more months of life. The more effective drugs that are now available to mesothelioma patients include combinations of pemetrexed (Alimta), cisplatin or carboplatin and gemcitabine.
Often the first concern with mesothelioma is to prevent or control pleural effusion-the build up of fluid around the lungs. The surgeon can put an irritant like surgical talcum powder into the pleural sac. The pleura becomes inflamed and the two layers stick together. This leaves no space for fluid, so the cells stop producing it. This is called pleurodesis. It is often done during thoracoscopy, when the doctor is looking inside the chest with a flexible instrument like a small telescope.
Pleurodesis does not work for everyone. Removing the pleura will also control fluid build-up, but as discussed above, it is a major operation.
Radiotherapy (treatment with radiation, using x-rays) to small areas of the chest can often help control pain and lumps that grow up from the surgical scars. It has generally not been used to treat the whole pleura because it would do too much damage to the lungs, heart and liver. This damage can be reduced by delivering the radiotherapy after most of the mesothelioma has been removed by major surgery. Recently, new advanced methods of high dose radiotherapy using very complex beam arrangements with state of the art radiotherapy equipment ( known as IMRT - intensity-modulated radiotherapy) have been adopted successfully in a few specialised centres.
If mesothelioma is in the lining of the abdomen - the peritoneum - surgery can often help. It is not often possible to remove all the cancer, but surgery may prolong life and can relieve symptoms such as bowel obstruction and pain. Radiotherapy and chemotherapy may also be used.
In radiotherapy, the x-rays are carefully targeted to do as little damage as possible to normal body tissues. It may cause some side effects, but most go away after treatment stops. They can include tiredness, reddened and peeling skin in the treated area, nausea, vomiting and difficulty swallowing for a few days or weeks. It can also cause permanent changes (‘fibrosis') in the lung tissue. This is not usually a problem unless high doses of radiotherapy are used to a large area.
The side effects of chemotherapy depend on the drugs used and can vary from person to person. The side effects usually go away after treatment stops. Your doctor will talk to you about the side effects you might expect, and how to manage them. With surgery there may be a chest pain; this usually goes away or greatly improves over weeks to months.
If you developed lung disease after exposure to asbestos, you may be entitled to seek compensation. Contact the Asbestos Disease Society of Victoria or your solicitor for information.
Gippsland Asbestos Related Diseases Support Group Inc. (Gards)
