How research mesothelioma in laboratory?
Introduction: Mesothelioma is a malignant conditioncaused by exposure to asbestos that has typically a long latency period. The disease is usually found in the later stages when the prognosis is poor despite treatments. Objective: To report a mesothelioma found in a laboratory. Method: We reported here a case of a 60 year- old-man who was exposed to asbestos fibresfirst when he studied in a laboratory at high school and then he had exposure over the following years until graduating with a master’s degree, but he did not have exposure after it. He was a smoker as a teenager and he gave up after 23 years. His first symptom was coughing at night which lasted for several months until the pleural fluid was discovered on the right side of thorax. This triggered investigations led to a diagnosis of mesothelioma. According to a systematic literature search, mesothelioma has not been reported previously in relation to asbestos exposure in laboratory work. An operation was carried out, but the patient refused to take chemotherapy due to the limited benefits that could be expected from it. Instead, he opted for a Budwig protocol. The case has had a good qual- ity of life since the surgery, and did not have any medications. He has regular check-ups at the hospital. Conclusion: Our study has shown that mesothelioma is not only a risk to people di- rectly exposed to asbestos, but also indirectly from, for example, laboratory work. People should avoid exposure to asbestos in daily life.
1. INTRODUCTION
Mesothelioma is a malignant disease caused by exposure to asbestos fibres. It originates from the mesothelial lining of the pleura. The symptoms of the disease generally manifest 14 - 40 years after exposure to asbestos which often leads to a late diagnosis as the cause is often not immediately apparent and early detection is rare. The disease is usually found in the later stages when the prognosis is poor despite the treatments.
Because mesothelioma
is an aggressive cancer affecting the membrane lining of the lungs and abdomen. Malignant
mesothelioma is the most serious of all asbestos-related
diseases. Exposure to asbestos is the primary cause and risk factor for
mesothelioma.
Making a
correct mesothelioma
diagnosis is particularly difficult for doctors because the
disease often presents with symptoms that mimic other common ailments. There is
currently no known cure for mesothelioma, but treatments such as surgery and
chemotherapy can help to improve the typical mesothelioma
prognosis.
Pleural
mesothelioma (affecting the lung’s protective lining in the
chest cavity) represents about three-quarters of all mesothelioma incidence. Peritoneal
mesothelioma, which affects the abdominal cavity, and pericardial
mesothelioma, which affects the cardiac cavity, comprise the
remainder.
There are
three recognized mesothelioma cell types. Between 50% and 70% of all
mesotheliomas are of the epithelial variety. While prognosis is generally poor,
it is considered less aggressive than sarcomatoid mesothelioma and biphasic
mesothelioma, which comprise the remainder of cell-type diagnoses.
The
cavities within the body encompassing the chest, abdomen, and heart are
surrounded by a membrane of cells known as the mesothelium. Mesothelial cells
assist in general organ functions. The mesothelium is particularly important to
organs that are commonly in motion, such as expansion or contraction of the
lungs, stomach, or heart. Lubrication from the mesothelial cells allows free
range of motion within the body. The mesothelium of the chest, abdomen, and
cardiac cavity are called the pleura, the peritoneum, and the pericardium,
respectively. Each of these groupings of mesothelial cells is extremely
critical to the functions of the body structures which they encompass.
Malignancies
(cancerous tumors) occurring within the mesothelial membranes are known as
malignant mesothelioma, or simply mesothelioma. Benign tumors of the
mesothelium are known to occur, but are much more rare than malignant
mesothelial tumors.
While tumors of the
mesothelium were first recognized in the late 18th century, it was not until
the middle of the 20th century that this particular cancer was studied and
examined with more detail. It was at this time when suspicions of the cancer’s
causal relationship with asbestos exposure became
more substantiated. A joint research venture
through the Department of Thoracic Surgery at the University of the Witswater
and Johannesburg General Hospital in South Africa provided the most compelling
evidence of the nexus between asbestos exposure and the development of pleural
mesothelioma.
Incidence
of mesothelioma is still quite rare, with only 2,500-3,000 diagnoses in the
United States each year. There was a spike in reported diagnoses between 1970
and 1984, which has been attributed to the latency period between diagnosis and
the height of industrial exposures, which occurred roughly 40-60 years prior to
this time. While exposure was common in nearly all industries, it was
particularly prevalent in the WWII-era military industrial cycle, including navy
shipyards.
Although
this cancer is much more common in men over the age of 60, mesothelioma in
women and children has been documented as well. Mesothelioma causes for
diagnosis in women and children are mainly attributed to secondary exposure to
asbestos, as it was not uncommon for men to bring asbestos back into the home
on their bodies or clothing.
Mesothelioma
is diagnosed through a comprehensive combination of biopsy and imaging scans.
Mesothelioma
can be a difficult malignancy to diagnose because the symptoms of the disease
closely resemble other respiratory conditions, and because the pathology can be
very difficult to distinguish from adenocarcinoma of the lung. For these
reasons, misdiagnosis is not uncommon in mesothelioma patients. Symptoms of
mesothelioma include chest pain, chronic cough, effusions of
the chest and abdomen, and the presence of blood in lung fluid.
Diagnostic
surgeries, including a biopsy, will typically be required to determine the type
of malignant cells that are present in the body. Typically a body imaging scan,
including a magnetic resonance image (MRI), computer topography (CT scan),
and/or positron emission tomography (PET), will be required to determine the
extent and location of the disease.
While
mesothelioma is typically advanced at diagnosis, treatment options are
available.
Mesothelioma,
while certainly an aggressive disease,
is a manageable malignancy. While there is no cure for the cancer, mesothelioma treatment options
may potentially include surgery, chemotherapy, and radiation therapy. A
combination of Alimta® and cisplatin is currently the only FDA-approved chemotherapy
regimen, though several clinical trials are currently in progress utilizing
other drugs including gemcitabine and Onconase®, that may lead to new treatment
options that provide a benefit for patients.
Mesothelioma has previously been reported in connection with exposure to asbestos in asbestos mining, different types if insulation works, construction, and maintenance work, but in our systematic literature search, we did not find any previous reports linking mesothelioma to laboratory work.
Radiotherapy, chemotherapy and surgery are most frequently used treatments for mesothelioma, but these are all considered experimental as there is no standard treatment for it. Radiotherapy is a treatment option for mesothelioma, but has not proved to be unequivocally effective, and may adversely affect the surrounding organs leading to side effects.
Chemotherapy is another treatment method, but it of-ten has limited success in treating mesothelioma. Like radiation therapy, it may be used after surgery to eliminate any cancerous growth that could not be removed during the operation.
Budwig protocol is an alternative cancer treatment for patients who refuse the traditional cancer treatment methods mentioned. The idea behind this protocol is that a cancer cell has been proposed to have deficiencies of phosphatides and lipoproteins and these deficiencies result in a reduced level of oxygen in the cells. The Budwig protocol is suggested to create a method to reoxygenate the cells. It includes flaxseed oil with cottage cheese and high intake of fruits, vegetables and fiber. Flaxseed oil provides linoleic and linolenic fatty acids, which are supposed to transfer oxygen into the cells, allowing for oxidation and detoxification of cellular waste. They also facilitate restoration of the lipid membrane of cells.
Radiation
therapy is also utilized, but typically in conjunction with other treatment
methods like surgery and chemotherapy. Surgical resection of mesothelioma is
possible in early-stage-diagnosed patients. Diagnostic and palliative procedures
such as thoracentesis and pleurodesis are also commonly performed in patients
with malignant mesothelioma in order to minimize cancer-related symptoms.
Alternative therapies have also been used effectively by many mesothelioma
patients to assist in managing symptoms of the disease and conventional
treatments.
In this paper we report a case who was exposed to asbestos during his education in laboratory setting, while he had no exposure to any industrial setting. He did not encounter any asbestos later in his working career. We also present his experience with the alternative Budwig cancer treatment for which he opted instead of any traditional treatment.
In this paper we report a case who was exposed to asbestos during his education in laboratory setting, while he had no exposure to any industrial setting. He did not encounter any asbestos later in his working career. We also present his experience with the alternative Budwig cancer treatment for which he opted instead of any traditional treatment.
Mesothelioma
is caused by exposure to asbestos.
Mesothelioma
is primarily caused by exposure to asbestos, though cases have been documented
in children or other individuals with no asbestos history. Asbestos is a
microscopic and naturally-occurring mineral that lodges in the pleural lining
of the lungs and the peritoneal lining of the abdominal cavity. In most cases,
several years will pass (up to 60) before mesothelioma develops in those who
have been exposed to asbestos.
In many
cases, those individuals diagnosed with mesothelioma that have been known to be
exposed to asbestos may be eligible for financial compensation from asbestos
manufacturers for their illness. Those who have been diagnosed with mesothelioma
and were exposed to asbestos should fill out the brief form on this page to
receive a free information kit detailing new mesothelioma treatments, clinical
trials, top doctors and financial resources.
2. CASE PRESENTATION
2.1. Personal Characteristics and Work History
The case is a 60-year-old man born in Poland who now works in a professional job at an academic institute in the UK. He was a smoker when he was 17 years old and he gave up on his birthday at 40 years old, having smoked about 20 cigarettes per day on average, giving cumulative exposure of 23-pack years.
The patient reported his first exposure to asbestos when he studied at high school from the age of 14 to 19 years old in the Technical College of Chemistry where he worked in laboratory classes which involved heating substances in glassware using gas burners. This required putting the glassware on meshes with asbestos to carry out tasks over a 4-year period. The meshes were kept in cupboards and, while handling them, there were clouds of asbestos due to dispersion during and after the heating process. After graduation from the college, he did a mas- ter degree in Chemical Engineering and Technology where he was further exposed to asbestos in laboratory. He might also have some asbestos exposure while he lived in the students’ halls of accommodation, because there was asbestos in the roof and the roof was in poor condition.
2.2. Medical History
The case was diagnosed with mesothelioma when he was 58 years old. The first symptom was the onset of coughing at night, which woke him up while he was on holidays in August 2010. He went to see a GP and was prescribed an antibiotic for a suspected infection but the symptoms did not improve. A few months later, the coughing symptoms at night worsened and another type of antibiotic was prescribed for suspected infection.
Six months later in 2011, the patient still had bad coughing episodes at night. After visiting a GP, the pa- tient received another antibiotic. From auscultation of the lungs, the GP suspected the patient might have a build- up of fluid on the lung but did not refer the patient for any other test at the time. The coughing symptom did not improve after the patient completed the course of antibiotics over a 5 day period, so a chest x-ray was then taken. The results of the X-ray showed pleural fluid on the right side while the left lung was clear. Sprimetry showed- normal values. The case was referred to a respiratory unit. He was suspected to have tuberculosis, respiratory infec- tion or cancer. The patient had a computed tomography (CT) scan to investigate further. The X-rays showed thickening of the pleura and at least 2 litres of pleural fluidon the right side, but no findings in other parts of the body. 60 millilitres of fluid was taken from the pleura for analysis. A biopsy was also taken and cancer cells were discovered but the histological type remained unknown. A video-assisted thoracoscopy (VAT) was performed, which confirmed the diagnosis of mesothelioma with 1) a biopsy and 2) pleural fluid samples.
The patient chose not to have chemotherapy because he felt he was in good health and did not want to subject himself to the side-effects of such treatment, as chemo- therapy has been shown to produce only minor improve- ment of lifespan for this kind of cancer.
The first operation was carried out on the case’s right pleura by Keyhole surgery in September 2010. The operation team removed as much mesothelioma as possible. Following the operation, the patient had a short course of radiotherapy to try to prevent cancer cells from spreading to other parts of the body. Later control investigations showed that cancer had not spread.
The case had another consultation on chemotherapy treatment following completion of the radiotherapy. How- ever, due to the limited benefits of this treatment against the side effects the case declined chemotherapy again. Instead he chose to take part in a clinical trial called ADAM which employsa treatment with pegylated arginine dei- minase. However, the case was randomized in the control group.
The case was given PET (Positron Emission Tomo- graphy) and another CT scan (Computed Tomography). Before the PET/CT scan, the patient received an intra- venous injection of radioactive glucose to help to assess the stage of cancer. At this stage, the mesothelioma was reported not to have spread and the patient was symp- tom-free. He reports to his GP monthly and is planned to have a CT every 2 months and a PET scan yearly. After the operation, the case has used the Budwig protocol diet. He has linseed oil and cottage cheese for his breakfast daily. Linseed oil contains a significant amount of omega-3 and omega-6 fatty acids. Linseed oil and cottage cheese have been suggested to produce traces of arsenic which is believed to kill cancer cells but not healthy cells. He also eats fruit and vegetables during the day. To date, the case reported he is healthy.
3. DISCUSSION
Asbestos has been widely used in insulation and construction and to some extent also in vehicle brakes. It is known to be hazardous for people who are exposed to its fibres. The symptoms of diseases linked to asbestos ex- posure generally manifest 14 - 40 years after exposure to asbestos which often leads to a late diagnosis as the cause is often not immediately apparent.
The case presented here did not work in any occupations where workers traditionally come into contact with asbestos. However, he was directly exposed to material containing asbestos while he was a student in a labora- tory setting. In our systematic Medline search we did not find any previous reports on asbestos exposure leading to significant health hazard in such conditions. Some studi- es have suggested that exposure to asbestos at younger ages may result in a shorter latency period for the dis- ease [14] but traditionally, exposure to asbestos mani- fested as mesothelioma will take a long latency period.
Even though the health risks related to asbestos expo- sures are well known, asbestos is still widely used around the world, especially in Asian countries. Epidemics of occupational diseases relating to asbestos have been reported in developing countries including Thailand re- cently. Banning or limiting use of asbestos fibres worldwide will be an important issue to prevent further death and disability from such exposure. Our case indicates that even rather minor exposure may lead to a seri- ous malignant disease, which mesothelioma inarguably is.
Mesothelioma is a malignant disease with poor prog- nosis with a rather short average survival time of 10.5 months and an average 5-year survival rate of less than 9%. In patients treated with systemic chemo- therapy, the median survival time (MST) is in the range of 6 to 12 months and the 2 -year survival is <20%. When the case described in this report was first diagnosed with mesothelioma, he was given a life expectancy of less than 6 months. However; two years have now passed and he is still free of recurrence of this disease.
There is unsatisfactory evidence of chemotherapy pro- viding real benefits in mesothelioma treatment. Because of this our case chose an alternative cancer treat- ment, revolving around special dietary methods called Budwig protocol. This seems to have worked well for our case, but randomized controlled trials are needed to evaluate if they can provide any longterm benefit for the patients with mesothelioma.
4. CONCLUSION
This case was diagnosed with mesothelioma at the age of 58 years. The only asbestos exposure he had experi- enced was in a laboratory setting while he studied in high school and it continued through to graduation with a master degree in Chemical Engineering. Two years after the diagnosis the case still has been free of disease, after his tumor was removed with surgery in September 2010. He did receive a short radiotherapy and has since then followed the Budwig protocol involving diet with flax- seed oil and high intake of fruit, vegetables and fiber. Diet may be an important consideration as complementary therapy for mesothelioma patients, but randomized clinical trials are needed before any firm conclusions can be made.
2. CASE PRESENTATION
2.1. Personal Characteristics and Work History
The case is a 60-year-old man born in Poland who now works in a professional job at an academic institute in the UK. He was a smoker when he was 17 years old and he gave up on his birthday at 40 years old, having smoked about 20 cigarettes per day on average, giving cumulative exposure of 23-pack years.
The patient reported his first exposure to asbestos when he studied at high school from the age of 14 to 19 years old in the Technical College of Chemistry where he worked in laboratory classes which involved heating substances in glassware using gas burners. This required putting the glassware on meshes with asbestos to carry out tasks over a 4-year period. The meshes were kept in cupboards and, while handling them, there were clouds of asbestos due to dispersion during and after the heating process. After graduation from the college, he did a mas- ter degree in Chemical Engineering and Technology where he was further exposed to asbestos in laboratory. He might also have some asbestos exposure while he lived in the students’ halls of accommodation, because there was asbestos in the roof and the roof was in poor condition.
2.2. Medical History
The case was diagnosed with mesothelioma when he was 58 years old. The first symptom was the onset of coughing at night, which woke him up while he was on holidays in August 2010. He went to see a GP and was prescribed an antibiotic for a suspected infection but the symptoms did not improve. A few months later, the coughing symptoms at night worsened and another type of antibiotic was prescribed for suspected infection.
Six months later in 2011, the patient still had bad coughing episodes at night. After visiting a GP, the pa- tient received another antibiotic. From auscultation of the lungs, the GP suspected the patient might have a build- up of fluid on the lung but did not refer the patient for any other test at the time. The coughing symptom did not improve after the patient completed the course of antibiotics over a 5 day period, so a chest x-ray was then taken. The results of the X-ray showed pleural fluid on the right side while the left lung was clear. Sprimetry showed- normal values. The case was referred to a respiratory unit. He was suspected to have tuberculosis, respiratory infec- tion or cancer. The patient had a computed tomography (CT) scan to investigate further. The X-rays showed thickening of the pleura and at least 2 litres of pleural fluidon the right side, but no findings in other parts of the body. 60 millilitres of fluid was taken from the pleura for analysis. A biopsy was also taken and cancer cells were discovered but the histological type remained unknown. A video-assisted thoracoscopy (VAT) was performed, which confirmed the diagnosis of mesothelioma with 1) a biopsy and 2) pleural fluid samples.
The patient chose not to have chemotherapy because he felt he was in good health and did not want to subject himself to the side-effects of such treatment, as chemo- therapy has been shown to produce only minor improve- ment of lifespan for this kind of cancer.
The first operation was carried out on the case’s right pleura by Keyhole surgery in September 2010. The operation team removed as much mesothelioma as possible. Following the operation, the patient had a short course of radiotherapy to try to prevent cancer cells from spreading to other parts of the body. Later control investigations showed that cancer had not spread.
The case had another consultation on chemotherapy treatment following completion of the radiotherapy. How- ever, due to the limited benefits of this treatment against the side effects the case declined chemotherapy again. Instead he chose to take part in a clinical trial called ADAM which employsa treatment with pegylated arginine dei- minase. However, the case was randomized in the control group.
The case was given PET (Positron Emission Tomo- graphy) and another CT scan (Computed Tomography). Before the PET/CT scan, the patient received an intra- venous injection of radioactive glucose to help to assess the stage of cancer. At this stage, the mesothelioma was reported not to have spread and the patient was symp- tom-free. He reports to his GP monthly and is planned to have a CT every 2 months and a PET scan yearly. After the operation, the case has used the Budwig protocol diet. He has linseed oil and cottage cheese for his breakfast daily. Linseed oil contains a significant amount of omega-3 and omega-6 fatty acids. Linseed oil and cottage cheese have been suggested to produce traces of arsenic which is believed to kill cancer cells but not healthy cells. He also eats fruit and vegetables during the day. To date, the case reported he is healthy.
3. DISCUSSION
Asbestos has been widely used in insulation and construction and to some extent also in vehicle brakes. It is known to be hazardous for people who are exposed to its fibres. The symptoms of diseases linked to asbestos ex- posure generally manifest 14 - 40 years after exposure to asbestos which often leads to a late diagnosis as the cause is often not immediately apparent.
The case presented here did not work in any occupations where workers traditionally come into contact with asbestos. However, he was directly exposed to material containing asbestos while he was a student in a labora- tory setting. In our systematic Medline search we did not find any previous reports on asbestos exposure leading to significant health hazard in such conditions. Some studi- es have suggested that exposure to asbestos at younger ages may result in a shorter latency period for the dis- ease [14] but traditionally, exposure to asbestos mani- fested as mesothelioma will take a long latency period.
Even though the health risks related to asbestos expo- sures are well known, asbestos is still widely used around the world, especially in Asian countries. Epidemics of occupational diseases relating to asbestos have been reported in developing countries including Thailand re- cently. Banning or limiting use of asbestos fibres worldwide will be an important issue to prevent further death and disability from such exposure. Our case indicates that even rather minor exposure may lead to a seri- ous malignant disease, which mesothelioma inarguably is.
Mesothelioma is a malignant disease with poor prog- nosis with a rather short average survival time of 10.5 months and an average 5-year survival rate of less than 9%. In patients treated with systemic chemo- therapy, the median survival time (MST) is in the range of 6 to 12 months and the 2 -year survival is <20%. When the case described in this report was first diagnosed with mesothelioma, he was given a life expectancy of less than 6 months. However; two years have now passed and he is still free of recurrence of this disease.
There is unsatisfactory evidence of chemotherapy pro- viding real benefits in mesothelioma treatment. Because of this our case chose an alternative cancer treat- ment, revolving around special dietary methods called Budwig protocol. This seems to have worked well for our case, but randomized controlled trials are needed to evaluate if they can provide any longterm benefit for the patients with mesothelioma.
4. CONCLUSION
This case was diagnosed with mesothelioma at the age of 58 years. The only asbestos exposure he had experi- enced was in a laboratory setting while he studied in high school and it continued through to graduation with a master degree in Chemical Engineering. Two years after the diagnosis the case still has been free of disease, after his tumor was removed with surgery in September 2010. He did receive a short radiotherapy and has since then followed the Budwig protocol involving diet with flax- seed oil and high intake of fruit, vegetables and fiber. Diet may be an important consideration as complementary therapy for mesothelioma patients, but randomized clinical trials are needed before any firm conclusions can be made.
Thank you for reading. I hopefully this article useful for you :)
REFERENCES:
1. www.mesothelioma.com
2. Faculty of Public Health, Thammasat University, Bangkok, Thailand; #Corresponding Author: sripaiboonkijpor@Hotmail.com
REFERENCES:
1. www.mesothelioma.com
2. Faculty of Public Health, Thammasat University, Bangkok, Thailand; #Corresponding Author: sripaiboonkijpor@Hotmail.com
3.Respiratory Medicine Unit, Oulu University Hospital, Oulu, Finland; maritta.jaakkola@oulu.fi
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